HomeMy WebLinkAboutNo Permit Number (32)CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION PRESS
BUILDING PERMIT APPLICATION FIRMLY
JOBSITE
ADDRESS
APPLICATION PERMIT P/C
DATE NUMBER #
ISSUE TYPE OCC
DATE _ CONST GROUP
APN LOT TRACT
CROSS STREET
OWNER . 1 s ' ` i�` .0 L
ADDRESS C" S ° � 0 L (
ZONING SETBACKS tar�kowehENTs
FRONT Ryy ❑
REAR ❑
CITY D I ., f-Jb ZIP e " ''TEL. L0 0
APPLICANT a ' 4-om, TEL O
SIDE/SIDE STREET RW ❑
1:1SIDE ❑
CONTRACTOR ,,�tr
ADDRESS
CITY ZIP TEL.
SEWAGE ❑ PUBLIC PMT #
DISPOSAL ❑ PRIVATE SO. FT./ 100 GAL
STATE
LIC. NUMBER
GRADING ❑ CU. YDS. EXC. CU YDS FIL
DESCRIPTION
SO. FT.
FACTOR PSF
ADJ. AREA/VALUATION
DESIGNER i
W
SFR/ADD/REM
ADDRESS
LWL
Garage/Carport
CITY ZIP TEL.
(►)
Patio/Deck
PROPOSED USE C`k - >"
®
Pool/Spa
Re -Roof
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DIMENSIONS
_J
:)
Commercial
CoLOT
VALUATION ADJ.
AREA
NO. OF BLDGS HOW
ON LOT USED
OUANTm
DES RlPTION
FEE
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❑
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am kensod under provisions of Chaper 9 (commenting
with Section 70001 of Division 3 of the Busmess and Professions Code, and my Trento is in full force and effect
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❑
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OWNER -BUILDER DECLARATION: I hereby affirm that I m exempt from the Catiecer's License Law for to Wowing
reason (Sec 7031.5, Business and Piolassions Code: Any city or county which requires a permit to construct.
after improve, demolish, r repair any rructurs, prior to its issuance, also requires the applicant for such pamn
to file a signed statement that he is kcensd punsuanl to the provisions of the Catractor's L'cente Law (Chapter
9 icommencmg with Section 7000) of Divisor 3 of the Business and Profession Coll of that he is sumpt therefrom
and the basis for the alleged exemption. Arty violation of Section 7031.5 by any applicant for a PIMA suEpcts
the applicant to a civil penalty of not more than On hundred dollars (11500).1
01, as owner of the property, or my employees with wages as tent solo canponsation, will do the work, and
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the structure is not intended or offered for sale (Sec. 7044. Business and Professions Coda: The Contracto's License
Law does not apply to an owner of proporty who builds or impale" thereon, and who dos such Work himself
or through his own employees, pmndd that such rmpfmtmmts are not intended a offered for sae. If, howrwr,
IN building or improvement is sold within one year of tmplatim, the owner -bum will him fM burden of proven_
that he did not build or improve for the purpose of sae.l
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01, as owner of the property, m eeckmwiy contradng with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The ContfKta's Hansa Law dos net apply to an owner of property who
builds of impmes thereon, and who contracts for such preNctt with a conlre 3crU) kcased pursuit to the Contractor's
License Laws
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,
CONSTRUCTION
❑ l am e.empt under Sac. B. b P.C. (Attach Ceft flee).
PLAN REVIEW
Date Owner
U3
Q
F
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ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE �1D�
SMIP 2
ENERGYP/C
WORKERS' COMPENSATION DECLARATION. I hereby affirm that I hm a cereicar of tenant to srf•nsure, or
a certificate of WMkers' Compensation Insurance, or a cabbed copy thued ISec. 3800, Led. C.l.
❑ CNtdkd copy is hereby fumished.
❑ Certified copy is filed with the Building Inspection Dprtmenl at lAprtrront
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section rod net be competed
d the permit its for one hundred ISIOO) or )us. i certify that in the prformrca of the weak for which this
permit is issued, I shall notai employ ry person in any manna so as to bacom subiw to the WIodws C arpnsr tion
Law: of California.
Data Appkcanl
LL
ENERGYPERMIT
NOTICE TO APPLCANT. N, after making this Certificate of bhp, you shouldhecrm stbpel to the Wicker's
Compensatim provisions of the Labor Code, you must forthwith comply with such provisions or this Perim shed
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
01 hereby certdy that no sscswbon few 151 or more feet in depth into which a pia is reqierd to duerd,
will be made in connection with work aut hrud by this permed. red that no building rructtn. sceffdMnp, IWwroork,
of demolition or dismantling throol, w11 be more than Hovey-tu (38) Mt hips. (Chap. 3.2. Grp 2. Aar 2, Sec
341, Title B, C AC I-
❑As owrw-builder, I will not einploy anyone to do work which would ropira a prod Firm do Divisor of
Indhrfei Sally. as road stew, unless such parson has a patnt to do such wit from the
❑Dmsor of industrial safety Parrot No.
TOTAL FEES
CONSTRUCTION LEMON AGENCY: I hraby oNirm Ow Mere is a eomtneaa y for tho prtamrw
of the wok for which this parrot it issued (Sac. 3087, Ca. C.).
Lerdr's Name
COMMENTS
Lender's Address
CERTIFICATE OF COMPLIANCE AND AU NOINZATIO! OF ENTRY: I crtify I Imw rod 66 opjirMion and star
that de information Vwn is conw. I qo to MIN# With in VWA law ad City reetiaq to biahvif
constructor, and authorize a r of tlr she s West b ason parry
fat which 1 applied fat hip prWA ON of
sgnalm Appkat or Apem Oor
RECPT NO. PAID BY VALIDATION —
WHITE —Department Copy, YELLOW —Finance Copy, PINK— slur Copy, GOLDENROD —Fib Copy, GREEN— Appkan s Copy
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