HomeMy WebLinkAbout047 ��
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CITY OF DIAMOND BAR �`!�1:�,�.. -
� � PRESS ` �
,, DEPARTMENT OF BUIL�ING AND SAFEYY
JOBSITE � BUILDING PERMIT FIRMLY � �
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ADDRESS � � r' • '-Zi f�,��(,}''� '/� DATE CATION ,n � PERMIT USE --
� AF'N ��` ISSUE `� .f /� +� � e' TYPE ER - CODE
�, LOT��TRACT � �!�" DATE f <<� �corvsr. Y °C�� �'-
�, CROSS STREE _� GROUP �
= OWNER � . -� � ZONING SETBACKS ���
� ADDRE S � � � `' , .�,y FRONT � �
W CITY n-�' ��P� ZIP `' `� • . . REAR
� Z APPLICANT ;� • TEL. '" � � SIDE/SIDE STREET �
� � `` TEL.._,_ SIDE � �--
� � CpNTRACTOR - ��. ,- .�;"L ❑
� o ADDRESS ` �� � '!��,� ,�ti SEWqGE
1'Yc =�. ❑ PUBLIC PMT#
w CITY � ��,�4: !�, � DISPOSAL
� = STATE � ZIP_.��__TEL. �' �j ' ❑ PRIVATE SQ.FT./100 GAL
� y LIC.NUMBER I ��j���j?�I�j GRADlNG ❑ CU. YDS.EXC.
y ARCH/ENG/ T1'PE SQ �T.FqC7pR pS ADJ, qa�A URT10N .
� DESIGNER �l� I�- � 1
o ADDRESS � ` �J
i CITY Zlp � 2
LL, -____,TEL.
� PROPOSED �, v ��.tc,yy�, ., ,_ � 3 .
� 1 . : G.ttL� Z 4
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� NO.DWEL. Np . N� '�� ' ' � GARAGE
�, UNITS___�STORIES � BEDROOMS � PORCH
� LOT DIMENSIONS VALUATION
a NO.OF BLDGS �
= HOW • ` ADJ.AREA
W ON LOT f USED "��=,� Q�ANTITY [)��CR1P1`IC�N ���.
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w IICENSEU CONTHACTORS�ECLARATI(1N.I herehy alfirm that I am I�cznsed ur,de�prowsions of Chapter'J Icammennng • ,/
Y with Stttmn 7000�of�ivismn 3 nf the Nusiness and Pr�tessions Code,and my liCense is in full force and effect �
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� OWNEq�BI11LIlER f1ECLpRATION.I here.Ly afhrm ihat I am exempt(rnm the Cuntraaor's Gcense Law Io�the(ollow9�y �
g. reasun(Sec 7031 5.Burness and Pmfessions Code Any city ui r.ounty w6ich�eqnues.�r '
6 o alter,nnpmve,Jemolish.ur repau any struaure, rjor to its issuance,also re�•• qactoi s License Law IChapter ��yp�
to fi!e a sipneJ staieinent that he is GcenseA pur uant ta the pmvisions af'thc�`� ..�.,_�<exempt tt�e�ef�am ',S`r
¢ �(commencinp with Sr.c6m!mg,�i,�(�j��v.�<ien,?nL.mn w,�;�>�<„e o.,�,v.�r ShV apphcant for a Oarmit su6�er.rs a
� M anA the 6asis inr tho-�'-�° . 1
' W �he upplicam m a crvd penalty nf na1 nw�e lhan Lve hundreJ Juliars(55001 F .,a
r �- ❑I,as ownr.r of tl�n p��ve�W.�r my emploVees with wages as ihert sule compensah�n,wiA do ihe wnrk,and
i ihe sUuemre rs nuc�nte.iuled o�aflerttl to�sale(Sea 7043,6uunes:and Pmfesxiau Code The Canttactw's license <L
v law does nnt apply to an owner nf property whn hwlds nr im�rnaas therean,and who does such wark himself, U
W or 7hmnp6 bis uwn employecs,pinvided thai such iinpiovements aie not mtended or olteied far Sala If,howevet .,� �
m tlie Dwldii+y ar fmprm�ement is SnIA wdhin one year at tompletinn,the owner-hwlder will 6ave ihe 6urden of pioving .Q.
� that hr.did nui hwld ar iinpmvc inr the purpnse of sale� ���
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h �il,as ownr.r of thr,pmperty.am ezclusrvelV cunlia�ting wnh hcensed contraclms to cansNuct the proiect�Sec {1}
v l044.Business and Prolessions Code The Cnntracro�'s License Law dues no�apply to an owner 0(Oiopefly Wh0 � '�.
Z 6mlJs ur impmues therean,autl whu cuniracts Im su�h pro�ects with a r.ontrActor�s)litensed pursuam fi the Contiaalar's
"° ��=���5�:<<�w� CONSTRUCTION � , _
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W ❑i a���.Pm,,���a��sec e.b Pc�a�r�n ce«�s�aie�. PLAN REVI�W
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Datc_ owner ELECTRIC -�f."/�
� Wf]RKERS'f.OMPFNS0.T10N OFCLARATION I herelry affirm that I have a cenilica�e of consent to sel4msure,ur ' � ��'T—'—
a r.ertrticatr,of Wuikers"ComVensation Insurance.or a certdied coUV�hereot ISec.3800.La6 C� PLUMBING _
� 6 ❑Ceru4ad capy is he�ehy lmnished � MECHANICAt _ _
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o �erafied c�py u(tleJ with the 6uildmg Inspectmn�epaiimem or Deparime.nt � GRADiNG ___
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� CERTIFICATE OF f.XEMYTIUN FRUM�1+OflKEflS C.OMPENSATION INSUHANCE.This se.c6on need nol he completed ISSUANCE
� if�he pennit is for one hundred 15100�or less I ceruly tlial in the peiformance o�Ihe work toi which tM1is —
� permn is issued,I shail imt emU�N'any person m anp mann¢r s0 as tu 6etome suhject to the Nfirke�s'Compensation �"�' ,SMIP _�
jL�vs ol Califamia
o � PARK FEE
p flafe nVVLtanl
'�'� NOTIf,F f0 APPLIC�Ni.II,atter makinp this Cerhhcate oS Eyemptiun,yoo should hecome su6�ett�o Ihe NbrMer 5 .U" SC+HQO�- FEE.S
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� Cumpensatinn provisions af the La6or Code,yau musl for�hwrth comply wnh such prmisbns or ihis permd shall
�+^ he Aeented�evaked
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p� IHVISIUN OF INOIISTAIAL SAFE7Y PEAMIT CEHTIFICATION. ��}qqq,,,���
W ' ¢�e �
�- I he2Ay r.anAy that no excava�ian five�5�ar more k¢t in deplh in�a wliich a person i5�eqwre�l to descend, ��� �� ��
s" will be made m connetuon wit�work authorizetl by thrs permit,and ihat no huilding stmcwre,scallolding,lalsework,
�' ur demolrtmn m dismantling tlrereu(,will 6c more than ihrtty-si��36�fcet high.�Chap 32.Grp 2,Ari 2,Sec
,� :sa�.r��s.c,a,c.�. cl�--qaAFV9�Nr� ���
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3 ❑As ownenhwldei,I will not employ anyone In do work which would requi¢a permrt irom ihe�ivisun af
�— Yndustrial Safety,as noied abave,unless such persan has a permit m do such wark fmm ihe drvision. (��.iic��{��3 �1��--cJl���T�
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W ❑ILusionofindusirial$afetyPermrtNo TOTAL FEES �
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CONSTHUCTION LENf]ING AGENCY.I herehy afhr ihat there is a construction lendmg apency�or�he pedo'manra
' 2 nf Ihe work for wlmh thu permn�s issced(Sec�09 v.C.�.
� Lender's Nanie �� COMMENTS
/ lenAer's AJJiess —
/
TIFIf.ATE OF COMPLIANCE AND AUTHONIZATION OF ENiRY.I catify I have read Mis applkation and sWh
•informalian grven is carrec� I a9ree ro compN W��h all slate laws and ciry ordinanre reWtmg ro 6wWing
�.and au��e a�epresemative of tfie Depanmem of Bui�ding and Sa1Ny to en upon property
�ve ap ietl nr this peimn for purpose ol makfng m tians
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� ` RECPT NO. ' D BY
�amre of ApplicaN or Agen te �� � VALIDATIO
�eparlmenl Copy, EL�OW—Finance Copy,PVNK—Assesso�Copy,GOIDENROD—File Copy,GREEN—Applicants Copy
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