HomeMy WebLinkAbout154CITY OF DIAMOND BAR
PRESS
DEPARTMENT OF BUILDING AND SAFETY
-^ BUILDING PERMIT FIRMLY
JOBSITE p1� ' !
ADDRESS O N DfiV,,._D O�� ��V�
APPLICATION PERMIT USE
DATE ISSUE TYPE T -5 _CODE
DATE `L 9 CONST. GROUP
APN LOT TRACT
CROSS !�REET
OWNER AYvL�A Q N I
ADDRESS 20 ° IAQ RT 0 VD O
ZONING SETBACKS Nis
REAR El
[:]FRONTRW
SIDE/SIDE STREET Rli ❑
CITY Z_vi N� ZIP IS T L.
APPLICANT �"0 1� q5 TEL
SIDE ❑
CONTRACTOR
ADDRESS IWAa ;
CITY M).Mln1 � ZI � TEL'�3
STATE
LIC. NUMBER bk]
SEWAGE ❑ PUBLIC PMl
DISPOSAL ❑ PRIVATE SQ.FT./100GAL
GRADING ❑ CU. YDS. EXC. CU YDS FILL
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TYPE
1
SID FT
--3d •,
FACTOR P
AN. AREANALUATION
- ARCH/ENG/
DESIGNER
ADDRESS
2
CITY ZIP TEL.
3
PROPOSED USE t
Z
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4
GARAGE
NO. DWEL. NO, NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
Co
PORCH
VALUATION l ADJ.
AREA
OUANTrTY
DESCRIPTION
FEE
NO. OF EILDGS HOW
ON LOT USED
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LICENSED CUNIRACTORS DECLARATION I hereby storm that I am licensed under provisions of Chapter 9 (commencing
wnh Secoon 70001 of Division 3 of the Busmess and Professmns Code. and my license rs in full force and effect
GIVNER BUII nER DECLARATION I hereby al firm that I am exempt from the Contractor License Law for the fmlkrwing
reason. Sao. 70315. Busmess and Professions Cade Any city or county which requires a permit to construct.
alter, improve, demolish or repair any slmcture, prior it its issuance. also requires the applicant for such permit
to file a .grerl statement that be is Imenaod pursuant to the provisions of the Contractor's License Law (Chapter
9 lcomn ing will. Secrmn 7000) of Division 3 of the Busmess and Pmfessioas Code) ar that he a exempt therefrom
and the oasis for the alleged exemption Any violation of Seniron 7031.5 by any apphtant for a Permit subjects
the appbcam In a civil penalty of not more than five hundred dollars IE5D01 J:
❑I as nwner it the properly of my employees with wages as their sole timpeassition. will do the work, and
the structure is not intended or ollead far sale (Sec 1044, Business and Professions Code The Contractor's License
Law does not apply to an owner of,properly who hwlds nr improves thereon. and who does such work himself.
I; w through his awn employeas. provided that such improvements are not intended ob-afleted for sale. (h, howuver.
the budding if ;mprnvemer t is sold within one year of completmn: the owner builder will have the its of praying
r that he dud nor build or Improve Im the purynse at sale.)
i
❑I, as owner of the properly. am Lxcluanyely contracting with licensed contractors to construct the pici ci (Sec
i 7044. Busmess and Professions Code The Contractor's License Law does not apply to an owner of properly who
builds Of impnoves thereon, and who contracts for such projects with a mnnactor(s) licensed pursuant to the Contraco('s
License Law)
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CONSTRUCTION r_ c
i
r LJ I am exempt nMer Sec , B 8 PC Attach Certificalel.
-
PLAN REVIEW � .1 I
Date Owner,
ELECTRIC 1 ��
PLUMBING
MECHANICAL
' WORKERSCUMPFNSATION DECLARATION I hereby aUnm that I have a mrtdettes of consent m sell mine, or
' a .at heart of \Vmkers' Compensation Insurance, or a certified copy tnerenf (See 3800, Lab C I
L❑�// Ceruhed copy is hemhy [—,,had.
p CJ Certified copy us filed with the Building Inspe ten Department Or Department.
GRADING
C.EfaTIFICATF OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need mat he completed
®
—._.
ISSUANCE
A the permit is for nne hundred (51001 or less I certify that in the performance of the wink far which this
- permit a issued. I shah rill employ any person m any ma s uhled W the WbrNers' Compensation
I awa mf calif rim
! c �'s 4 APphcaot
p NOTICE
NOTICE TO A LICANT a after making this Certihcaf ou should hemme subject to the Hiker's
Cnmpensaton provisions of the labor Cade, you must ferthwilh comply wnh surM1 provisgns or this permit shall
^ be deeuned revoked
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sM,P
PARK FEE
SCHOOL FEES
ENVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
� ❑I hereby rertdY that no excavation five 15) or more tees in depth into with a person is required to tlescentl,
e wall he tirade nr connection with work euthaued by this permit, and that no building suuctae, scaffolding. falsework,
^ or demnlltimn or drsmamlurg thereof. will be mine than thirty-six (36) fret high (Chap 32. Grp 2. Art 2, Sec
341, Title 8, LAC
(".lTY n F tr•••sy�A M t r EAR
DI ��
BUII OIrJ(; AK1_
C EIAa owterbmtder, I will nor employ anyone to dui work which would require a permit from the Diation of
^ Industrial Safety, as noted above, unless such person has a permit to do such work from the division
❑Ownum of Industrial Safety Permit No.
TOTAL
/ t
FEES
y CONSTRUCTION IFNOING AGENCY I hereby affirm dial (here is a construction lending agency for the performance
C of the work fro wheh this permit is issued ISec 3B97, Civ. C.).
.ja Lender s Name
COMMENTS
oLender's Address
= flT lIA E AND AUTHORIZATIN OF ENTRY- I certify I have read this application and stale
teat the mine aturn iver nett. I agree to comply with all state laws and oily, ordinances relating to building
consuucuun, rid a on reaentatrve of the Bepartmem of Building and Solely to enter, goon the Properly
ITwhich 1 n the pormir for the propose of making unsixel its.
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•` f '� rf ✓ d1 f, � �j�i�,�n
NO...-_V 'I -•L PAID BY .,�ti,. r r-' VALIDATION
1 1( �//,{y
i 1 � � aJ �
RECPT
_wona tire o plcant or Agent Date
WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN— Applicants Copy
PIF
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