HomeMy WebLinkAboutEP91-132CITY OF DIAMOND BAR
PRESS
DEPARTMENT OF BU4LDING AND SAFETY
BUILDING PERMIT FIRMLY
JOBSITE
ADDRESS
APPO7C N PERMIT USE
DATE NUMBER _���CODE
ISSUE TYPE OCC.
APN LOT TRACT
DATE CONST. — GROUP
CROSSSTREET
OWNER
ZONING SETBACKS &Vqowwum
FRONT— RW❑
—
REAR ❑
F_
ADDRESS
CITY ZIP TEL. Ll,1
SIDE/SIDE STREET RW❑
APPLICANT TEL. 1L. L, 2
—
SIDE ❑
CONTRACTOR V
ADDRESS
SEWAGE
DISPOSAL
El PUBLIC PMT
n PRIVATE SO. FT./ 100 GAL
CITY ZIP 1,1 TEL.
STATE
LIC. NUMBER
GRADING
❑ CU. YDS. EXC.. cu YDS FILL
V)
TYPE FACTOR PS F --ADJ. AREA/VALUATION
ARCH/ENG/
DESIGNER
W
LL W
Q)
ADDRESS
-
2
CITY ZIP— TELL- —L"'Ll'
3
PROPOSED USE
z
4
GARAGE1
----F-'
NO. DWEL.' NO. NO.`r
UNITS STORIES— BEDROOMS—
LOT DIMENSIONS
-3
W
PORCH
—_
VALUATION _L, �' 2 , - , ADJ.
AREA
NO, OF BLDGS HOW
ON LOT USED
6_u—AP4Tw—yT
DESCRIPTION
FEE
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed unit& provisions of Chapter 9 Icam"Mind
with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect_
F]
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Ull
OWNER -BUILDER DECLARATION: I hereby affirm that I am eampt train the Contractar's License Law fat the following
reason (Sec. 7031 5. Business and Professions Code: Any city of county which requires a patina to construct,
alter, "prove, demolish, of repair any structure, prior, to as issuance, also requires the applicant I., such permit
to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
9 (C am . ..... g with Section 7000) of Oiyisrorr 3 at the Bustriess and Prolesuore; Code) or that he is exempt therefrom
and he basis for the alleged eumption. Any violation of Section 70315 by any applicant for a Permit subjects
IN applicant to a civil penalty or not more than five hundred dollars (S500II:
111, as owner of the property, or my employees with wages as their sofa compensation, wal do the work, W
the structure is not intended or offered far sale ISerc. 7044, Business and Professions Code: The Can uItor ' License
'
La, does rat apply 10 an owner of property who builds of improves thereon. and who does such walk himself,
IM
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or through his own employees, provided that such improvements are not intended or offered for sale. 11. however, the building at improvement is sold within one you of completion, the ovmu-builder wiff have the burden of plaving
,he, he did nor build or improve for the purpose of sale.)
0I as owner of the property, 8M eXCI0lcontractingcontracting With licensed curituactous to construct the project (Sea.704!aWcontracting, Business and Professions Cade: The Contractor's License Law does not apply to an owmar of property who
builds or improves Itifferin, and who contracts lot such famrsons with a comFulovisl licensed pursuant to the Corallactos"s
License Law
CONSTRUCTION
El I am exempt under Stai 8. 6 P.C. (Attach Certificate),
PLAN REVIEW
Bate Owner
ELECTRIC
WORKERS' COMPENSATION DECLARATION:I hereby affirm that I him a certificate of ccausuit to sell-insure,as
a certificate of Milkers' Compensation Insurance, or a cesudied copy thoseal IS#c. 3800, Lab, C.).
El Certified copy is hereby famished.
U)
PLUMBING
MECHANICAL
❑ Certified copy is filed with The Building Inspection Dopubnowl as Deparhmnt.
_j
GRADING
CERTIFICATE OF EXEMPTION FROM WORKERSCOMPENSATION INSURANCE: This section need act be completed
it the permit is for one hundred 111100) or less. I certify that in the profismoonce at that work far which this
pe mit Is issued, I shall not employ any person in any marmar so I as to teac sublact tip the ftliess' Compensation
'Ws of California. I'' , 7 La
Date ran
NOTICE TO APPLICANT. Lf, after making this Certificate of Eroamption You ShOW bacteria Sldbidi to the Was If
W
W
U-
ISSUANCE
SMIP
PARK FEE
SCHOOL FEES
Compensation provisions of the La., Code, you must forthwith chrroy with such prwiswit or this permit ships
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Of hereby culdy that no excavation five (5) or, we feet in depth into which a pum is fessfirited to doused,
willbe made in connection with work autticaced by this permit, adthat no lidildiriff stmutre, tuallDibling, 1i 0114ARr
or dear"Idiont of dismantling 1u hnf, will be more than Ihirty-six 136) feet high, (Chap. 3.2. Grp 2, An 2, See
341, Tide 8, C,A.Cf.
[]As owns -builder, I will not employ entrust to do Work which world requite a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such warts from the divission.
Cl Owism of Industrial Safety Permit mo.
TOTAL
FEE S
CONSTRUCTION LENDING AGENCY: I hereby affirm that thanthanis a comiruction liselitiff agi for be par
of the ware for Which this permit it issued tS&t, 3097. Civ. Cl.
lender's Nam
COMMENTS
Lender's Address
CERTIFICATE OF COMIPLIANCE AND AUTHORIZATION OF ENTRY: I cw* I him mad Ides apisficadran and stores
that the Information given is correct. I age" to comply with aft stato Laws wed city or refuting to builditiq
contraction, and audiorbus a representative of that Boaptertmoom of Builthrig and Satiety to am aM ft We"
far which I IIM applied fier this parnmit fm the purpose of Virg'
RECPT
NO. L PAID BY VAUDATION
Signature of Apphuavt or Agent DM
WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN— Applicants Copy
BS106-11/89