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HomeMy WebLinkAbout1259CITY OF DIAMOND BAR PRESS DEPARTMENT OF BUILDING AND SAFETY R1111 nlMry PERMIT FIRMLY JOBSITE w APPLICATION �1C PERMIT f" I USE ADDRESS DATE ; :" NUMBER -=' -� CODE ISSUE -^ _ TYPE � ME. DATE _ 1 `_ -- CONST. GROUP '- APN LOT ` -� TRACT ' _ , -�' CROSS STREET "`' a 24 Q2,E,`'t.r ZONING SETBACKS PAFFIOVEWtsTB OWNER _ -CYA 4 :�n1A id ? sir , SA u ,T FRONT RW ❑ ADDRESS REAR ❑ a„ CITY ? SIDE/SIDE STREET Rw ❑ APPLICANT f -I r TELg1-a•- }L y� SIDE ❑ err GONTRACTO SEWAGE ❑ PUBLIC PMT A ADDRESS'- DISPOSAL ❑ PRIVATE SO. FT./ 100 GAL u CITYZIP TEL. GRADING ❑ CU, YDS. EXC. CU YDS FILL STAE GT UNUMBER '� TYPE SQ FT FACTOR PS A01 A EANALUATION ARCH/ENG/f f DESIGNER i I W 1 ADDRESS 1L i i - c_ CITY ZIP`'��7 {/ 7E L.� 1 "� C7 3 ., PROPOSED USE c✓� ��_ I ' Z 4 ©_ GARAGE NO. DWEL. NO. r NO. PORCH UNITS STORIES-1- BEDROOMS m LOT DIMENSIONScf „/ -ter- VALUATION ADJ. AREA QUANTn Y DESCRIPTION': FEE v NO. OF BLDGS HOW w ON LOT � '} k USED U t= s ❑ F— LICENSED CONTRACTORS OECLARATION:1 hereby a€)ism that I am licenud under provisions of Chapter B {wmmerrcinp '= wah Section )0001 at Division 3 of the Business and Professions Cade, and my license is in full force and effect CJ EL . O J WNER BUILDER DECLARATION: I hereby al€irm that t am exempt from the Conliaclor's License Law for the following 0 y reason {Sec. 103t.5. Business and Professions Code: Any city or county which fequlnes a pe€inn to consutict, e altee improve, domahsh- or repair any structure, prior to its tnwrict. also requires The applicant for such permit Z Cin isle a signed slalement Ihal he is licensed pursuant to the prwiliuns el the Contractgi s License Law (Chaples C13 as 9 (cemmencing wnh Section I00DI of Civismn 3 of the Business and Professions Code) or that he is exempt therefrom 1E and the basis jar the alleged exemption. Any violation at Section 1D315 by any applicant eat a permit subjects YC the opplcant to a civil penalty of not mo+e than live hundred dollars {5500).1 sit -� EL. O Of. as ownet of the property, or my employees wish wages as thou sole compensation, will do the work, and Q U f•— the structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractors License 'C's Law does not apply to an owner of property who builds or imprmees thereon, and who does such wash hrmsejl. Z 6W or through his owe employees. loomed that such Improvements are not InlendM or ollered for sale. If, hmevti. m the huddmg or improvement is sold within one Year of complaunn- the owner -builder will have the burden of proymil Q that he did not build or improve for The purpose of sale.) ILI c/a ❑1. as owner of the property, am exclusively carstrachny with licensed cantiactors to construct the plojoct {Sec- 1044 Business and Prolessams Code: The ConVactru a License Law does not apply to an awnet of property who g 0 s hudtls or improves thereon, and who conl£acls for such projects with a Conlcaccorlsl licensed purauant to the Contractor's License Law.) GONSTRUCTIOiV I �, I / 0 i am exempt� n-iter Sec,,' �� 6 P.C. IAltxh Certdiralel- PLAN REVIEW Date /f - a —Linter n r `�" ELECTRIC PLUMBING y14DRKERT COMPENSATION DECLARATION, I hereby affirm Thai"€'have a certificate of consertt to lelt•msare, o. a cerld€care of Militia' Compeasatiao Insurance, or a ceehfiad copy Ikereol €Ste. 3000, Lab. C1 o El MECHANICAL c:c Certified copy is hereby Ittraished. a o ❑ Cenihed copy is filed wdh the Building Inspection Oepatime a an Department GRADING = CER1[FICATE OF EXEMPTION FROM MlUFFIS' COMPENSATION INSURANCE: This seeltan need not be completedISSUANCE-,' � tf the permit is for one hundred IS1001 no less, I certify that in t-0m per€aimance of the work for which :hit become to the Militia' Compensation ~f' 1 - c fZ- forma_ is issued. I shag not employ any person m any manner so as to subject Laws of Coliloirim� o W SMIP PARR FEE d Data lWpSicam NOTICE TO APPLICANT It. alter malting this Cendicate of Exemption, you should become mbyect to the YAhxker's L SCHOOL FEES rJ.a Campen .. provisions of the Labor We. you must lerihornh comply with such provisions or ibis permit shelf �• he deemed revoked. J x DIVISION OF INDUSTRIAL SAFETY P C IF ❑I hereby cenify Thal ' w - r is depth irsso whtch a person rs required to descend. t. n '.ell :fl, be_made in connector w€fh-warfil aul gM 'e)t and.ThaLnn.huilding silnucltee, toallolding-Aetsavrark, rZ or damnitam or disma"flag lbereaf. wit) be more than thinly -six 1361 teal high. (Chap. 3.2, Grp 2, An 2. Sec 34 t, ride D, C.A.C.). ©As owner-hudder, l will IaY fro to hich would requite a permit from dfe Pviaion of qq� �!�"]� >— Inrinalrsal Salary, as nottd a s s n I Fe dq such ww4 €coin N,e division. b�s udt phSO tt�r W 011vison of Industrial Safety Permit No. TOTAL FEES C CONSTRUCTION LEN N6 a10 FT�ineb(elhldi'aThll+tl+eiF+s 3aitTion lending agency for Eire pafosmertu e� of the work €nr whit itiq totm!€etisa tit{Smp 30>tF, Cin Ui �= .'it': rkiv are'"} Lender's Name COMMENTS co Address 4 CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this applicstian and stall ca that The mlormaban given is correct. I agretAir wmpfy wAh ad state laws and city ardmences relating to Wilding ycunslrecttae, and aullm6m a represenlatrva of ft Department of Building and Solely to mice sport the property = for which I hard appl,elf for this perm�rl4gt* purpose of making inspections. ~2 RECPT NO. 1 PAID BY VALJDATION '--- Sig atsae of Appiicaat or Agent Data WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN— Applicants Copy BS146-11l09