HomeMy WebLinkAbout91-064CITY OF DIAMOND BAR �
' DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT
PRESS j�,qj_
/�,FIRMLY �O I
JOBSITE
ADDRESS I& ¢�: Apia N u'# V o V i- _
APPLICAnON PERMIT USE
DATE- TYPE R CODE —
DATE CONST. GROUP
APN LOT �7 TRACT �? 7 ,
CROSS STAREET
OWNER W lei L <
ADD ES Rol-
ZONING SETBACKS '�1.*NM
FRONT RW ❑
REAR ❑
CIT1 1-1 A ZIP TEL.
SIDE/SIDE STREET RW ❑
APPLICANT 121VI21 TEL.522-7110
SIDE ❑
CONTRACTOR
ADDRESS
CITY ZIP TEL.
SEWAGE ❑ PUBLIC PRAT A
DISPOSAL [] PRIVATE so. Fat 100 GAL
GRADING ❑ CU. YDS. EXC. CU YDS FILL
STATE
LIC. NUMBER
U)
TYPE
Sid FT
P PS
AD& AFIEANALUATiON
ARCH/ENG/r,-� h \ 1
DESIGNER JGiyid - .�]t3�'ilgsyt'1
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ADDRESS 1.0 S J_=UCj0 .. -.- - _
CITY kih ikti1 a ZIP 11773 TEL. 9Z—
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IL
2
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PROPOSED USE _ /M , il-eS,
NO, DWEL. NO.
UNITS STORIES-2,_BE BEDROOMS
LOT DIMENSIONS
4
JL
GARAGE
v
tj
ADO
m
VALUATION
a ADJ.
AREA
tauANrtrY
DESCRIPTION . -
FEE
NO. OF BLDGS HOW
ON LOT USED
❑ .
LICENSEO CONTRACTORS O(CLARATM, I hemby affirm that I am licensed under pravisiont of Chapter 9 {cammaociny
wah Secton 1000) of Division 3 of the &ainea and Pmlessmi Code, and my license is in full lot" and eflact
t
❑
LLI
W
MNER-BUILDER DECLARATION: I hereby affirm that I am eampt from she Contrsatot's tic" Law for de laibxinq
mason (Sec. 1031 S. Business and Professions Code: Any city or ceunly which requires a pamd to conshtrt.
alley. improve, demolish. or repair any stfutruro. prior to its istrtenee. also roquves de applcsnt for such permit
to file a signed statement that he is licensed pursuant tothe Provisions of the CwbroctWs License Law (Chapter
Icanmencing with Section 70001 of Division 1 at the Business and Professions "I or that Ie it exempt therefrom
and the bases for Me alleeged extrnption. Airy violation of Section 7031.5 by any appliant for a pounce a4yecu
the appl cant to a 4Nd ptnatty of not mote man Ebn hundred dollar [S5DOI.):
1111. as owner of she propttly. or my employees with wages as chair sole compensation, wig do the work, and
the structum is not intended or offered for sale ISec. 7044, Outmost and Pfolessmi Code: The Conlsectdr-s La4w
Law does not apply to an owner of property who Wilds or improves thereon, and who does such work Aimseff,
a through his own employees, provided that such impovements aft not intended or oHaed lot sale- If, however,
the budding w improvement is sold within one Veer of compMtio, the owner-bulde wig have the burden of proving
that he did noS Wdd a impruw lot the purpoto of U44
❑l, as owner of the peopehy, am eeciasrwly canlracl;ry with licensed tonitaelora to rAn ins the protats (See.
1044. Business and Pm4ssions Lade: 1. Conirecmi s Wnte Law does not apply to an owntr of property wbo
badds or improves thereon, and who contracts for such projects with a eoAtea.torlsl krantsd pursuant to tle Contractor's
License Law.l
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El am esempt uuds Sec. . B. h P.C. lAt xh Centifidlel.
LAN REVIEW
Date Dwner
ELECTRIC
5h17BMERS' COMPENSATION DECLAFtATIQ4: I he eby affirm that I haw a crubhcsn of consent to sefl•nsure, or
a certificate of %Wkeri Compensation Insurance, or a cxhtied copy gwrol (Soc. 3800, Lab. C.1.
❑ Can&d ropy is hereby Iwnsded.
PLUMBING
MECHANICAL
❑ Certified copy is filed with IN Building lospection Depersment a Owuttmant.
CERTIFICATE OF EXEMPTION FRDAL IMORIFRS' COMPENSATION INSURANCE: This section used not be completed
g the permil is far one hundred 131001 Of WL I artily that in the Paformenp of she work for which this
permit is issued. I shelf rot employ ary persan in arty morers a as to become subIxt to ffe fAbrkeyi Cwnpansaskws
Laws of Caldmfee.
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-
LU
GRADING
ISSUANCE
SMIP
Dose A
LL
PARK FEE
SCHOOL FEES
se of of Emnption, ym sMuid becomesetpd to the yAeku's
NOTICE TO APPLCANF: g- afar making ibis Contrail
Compensation provisions of the labor Coda, ysso mutt forthwith won* with vAh provisions sae This permit shag
be deemed revoked.
ONLSIDN OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑l hereby candy that no eaawauon five (5) or we fed in depth into which a Person is r"rad to desard,
will be spade in wnneciwn with work audnnved by M permit. and gees no Larding cow". scal4kknq, labew"k.
or demoklmn or dismantling thereof. wdl be mote than thirty -sat i361 halt �* ICMp. 3.2. Grp 2, Att 2, Sat
- 341. T11le 8. CAC.).
.
❑As owns -builder, I will not ampby anyone to do work which would require a wind five fM Givisim of
Indusural Salary. as noted show. atoms such person has a pwm to do such work Isam the divisiaet
❑dawn of in4wtal Seim ftmo Noe.
TOTAL. FEES
CONSMUC ION LEfiM AOEWY: I ImAy affirm that there 4 trswo a conson krdirg gonty hoe the Whrinarrs
of the wok for which this permit 4 issued LSae. 3097, Ire. Gl,
Lenders Nane
COMMENTS
Lender's Address
CERTIFCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I artily I have esad eth boks6m and stet
sin she ntonutiatf gvtrr is ownw. I agree to conor wish am steel Lorna and to oroinae7a rd * to batil4riq
wnstnchm, and authaiee a nopresem-'m of tll� Dpnsmtn of Buou" at 9aidy lu aria; WM that popnty
NIX which I bow applied for that per for tit pub Off o) m - Mtlpee40lK
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RECPT NO. ?AiD BY VAILIDATION
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Sgnalura of Apo& t or Aon, Deal
WHITE--DaparimWCopy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN— ApplWants Copy
851 G6.11189