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HomeMy WebLinkAbout1224 (11) , - • '`�' GITY OF DIAMOND BAR PRESS ��'' ' DEPAR'TMENT OF BUILDING AND SAFETY BUILDING PERMIT FIRM Y JOBSITE yj,/_ 1, q APPLlCATiON PERMIT USE ADDRESS a� `� w C3��f7-.�}'1 i') � �S�T�E � _ NTYU�ER� �CODE � APN LOT Z RACT DATE v CONST. GROUP o CROSS ST ET SETBACKS ��� � m OWNER ZONING �ON7. �W ❑ � ADDRESS Z REAR ❑ W CITY ��{�zdf7'F]rLvh ZIP t� TEL. S1DE/SIDE STREET RW ❑ o APPLICANT TEL.� SIDE ❑ a a CONTRACTOR t "��ID SO• r SEWAGE C) PUBLIC PMT# o ADDRES$ DISPOSAL ❑ PRIVATE SO.FT./100 GAL W CITY w ZIP 9 TEL. z STATE 1 � GRADING ❑ CU.YDS.EXC. CU YDS FILL y LIC.NUMBER a$��a''t'' � ARCH/ENG/ �Q � TYPE SQ Fi PS . A .AREANA�.IlATIOhI � y DESIGNER 1 � �G� � 1 b(Xj -rj, - (��,� a kDDR�S�S "�� o� � 2 I � � � �t� �t� '] z CITY �'U ZIP TEL. (� 3 �RZ 21��[� t- � PROPOSED USE �'�. Z 4 � � GARAGE o NO.DWEL. NO. NO. y UNITS J. STORIES�BEDROOMS � PORCH e� LOT DIMEN510NS m VALUATION � ADJ.AREA o NO.OF BLDGS HOW ouA1�(1'erY DESCRIPT[ON FEE . . W ON LOT USE q . i: �� ��/. �� � W ❑ � F I �O UCENSEO CONTHACTOHS OECIAFlATION:I herehy atlum Ihat I am Ircensed under prov�ums ol Chepm 9 kammmcmp � � wnh Secnan 1�001 of Oivision 3 ot�he&ui�uss aiM ProFessions Gatle,and my Iceme is m IUN force and effect � 3 � � �J � j . � QrVNER-BUIIOER OECLARATqN I hereby aflirm that I am exempl Irom the Comracmr's lKenu law br Me fdbwing reason fSec.7031.5.Business and P:ofesswns Cade Any city ur county whid�requirec a permil m eonsiruet. �t!} �(,L� � Q"i oalter,imp�we,demdish,a repau airy slructure,prior to its�swaMe,alsa re�unes the�pplicam(w�ucA petmt ? � � � 6 m file a s�gned staroment tha�he is�icensed pursisn[to the prwisions of Me Canbxlo�'s licrose lsw(Chaple � � 9 Irommencing witA Secnon T000)of Divrsion 3 of tM1e Busineu and Pmfeuwru Codtl a that he is ezempt tAerefrom ,'L ��) d and Me 6asis lar the alleged eampuon Gny vidatwn of Sectian 7031 5 by a�ry applicant Iw�pemN sub�ecO . � � W� rD w� -�.� �� x the app6cant to a cml penalty of rot more than live hundred dollars(35001�6 � `., (--.A�j YZI��'J � ❑I,as anr�er of the property,or my employees wit�waqes as their sde canpenaaAon,will Co tlk woh,eM tM1e sfrucmre is not intended or olFerra fw sale tSec 7064.Busmess and P�ofessians Lade:The Camruta's Liunu e� `���� � V Law does'm1 apOW to an owner of Oroperty wM hmi6s o�inprwes 5;efeM.aid who dws s,rcE x_rk himuiF, �i'j n th�ou5h his awn employees prondM Ihat wch imprmemenb are not�ntenCed a of�ered 10�saN.II,howersr. �f �,r�, m the�unCing ar imprwement a wid within ane year af cpnpletion,th mrmer�6uilEer�wY have II/e hurden ol proviiry .¢. � �`'� `�-'��� � that he did nat Wild m imprave Por the purpose of sak.l 2 � J j ��� y (j V y ❑I,as awrer of ihe properry.am eMclusrvely com�actiny wrth lieemed cmvxtms Ia mnsuuct IM project IStt. �t}� e.v� � � OT 0 7044,Bus�ness and Pralessions Code TM Coniraemr's license Law doa ml apply m an ovmar of prapetty wha � .r�i O V Z hu�lds ar improVes thttem,and wlp canUacts Im such proRcts wrth a conrtactm(s)Ircmsed pusuam m the Cmira[tar's � License law.l � N ' .^� 1 � � ❑1 am erempc uMer Se[. ,8 6 P.C.�Anxh Certifrtatel. N( � pC,� � °ae a""" LECTR � � 4AHKEflS'COMPENSATION DECIAMTIpJ�I hereby alfirm that I have a mufintt of consmt to sd1-mwre,a � Q a cern�icaie o�workers'�anpensatim Inswanoe,or a ce��iued copy tkrmt(Sec.3800,l�h.t.l. U MB IN O ` ❑Cernfied capy�s hrehy lixnished � ECHANICAL o ❑firvl�ed capy is filed wrth the BmWmg Inspecuan Depxtmmt a o.cy���. Q GR - W � CERTIFICATE OF EXEMPTION FROM V�UqKERS'COMPENSATION INSURANCF:This utvon need ro�6e tompkud , Q y d the permn�s Por me�undrcd(51�0)a kss 1 cerofy uh�t m the perfamace o�the wak for whcA this �,,, permn is issuetl.I s�all mt empby airy pe�stlC'i¢�m�lenn��q a3��2p Ce[ome aEKct b Ih 4Wrkds'Cmqentatmn 3 i � - � Laws ol Calilarnu. r�.-.' �:° 'a a W _ � t�""�:!u•y' W PARK FEE 0 o�re a°°rtim LL SCH�OL FEES � NOT�E TO APPLICANT N.after makmB t�is CernFcare af Exemp�ron.you sMdd hsrarc suqect to the Warker's --� Canpensauan pmvrsions ol the Whor Cade.you must farthwit� with suth prwnpnz a thia permit shall � 6e deemed revokd �� � pC pViSpN OF INWSTflIAL SAFETY PE IT IFICA . W a ❑I here6y certdy that no earavatnn Irve(S)a mae teet in.depth ipw which�,person is rpw�d m de+emd. 0 � wa�te made m co�nen�on wim.worEsytlrorcd:fir;eie oum�:,ne Mn,.po aNMine�io-unu..sralfd6na�yuw«k. a demald'wn m dismantGnp��xdoP,will be inpe'TASn ifiiity`eu(3f�ktl-hipk�d�ep.3.2.Gry 2.Art 2.See W361.Titk 6.C.A.L.1 � _.......,., , -�:.1 v, .. .�i i _ '1.�:% � :�.-. . .. . 3 ❑As owner�buiWer I wiU notLLempby anyane ro do work whch wouN rmpnre�pmnt fram IM Oirvnian a1 - H �ndumial Safery,as nped eEove,unless sudi person Ms a permt W Ao such work fram 1M divisian. � � W ❑Qnswn ot IMumnl Safery Permn No TOTAL FEES (j f. a � CONSfAIICfION IENDING AGENCl.I Mre6y alfum tlwt tAere is a tamvutirm knding�y fa IM porlmmsics e = ol tne work fa whkh this permn it issued ISee.3�97.Civ.CI. \� � —�� � leidn's Name COMMENTS m LmAer'S Address ! � CEIffIFICATE�L ANCE 1W0 A ZA7O1 OF EN1HY:I ceMy 1 lu�e ns0 Mis appinlian 7M sY! 7 t/J Mui Me inlofmaf � n iS CanM. ee lo rnmply wltll atl stah bws and ciry ordinance nYunp to huil6nq � 1 ' y CMSifll[I101. h � i i6V!0�11M�qilMllM Of Blll�l�y ila$i�llY b Mld!W011�0���1' = fw whKh I Mis mM1 la lle pupo�d m�kinp intpixnq¢ �.- X -^ '" r [ � d Applkant a Aqm� p�y RECPT NO. 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