HomeMy WebLinkAbout120CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY
__W� n BUILDING PERMIT
JOBSTE ADDRIESS I / / 6 !3 C1 r
APN LOT T— TRACT
CROSS STFJEET e c
°= OWNER! i n
o ADDRESS -11 LZ Q d k4.
oro CITY Q,!:A, 1 M-1 - ZIP TEL
APPLICANT - 2 TEL",4_1%- %'-,L
t CONTRACTOR Z r a
ADDRESS 27/7 Alfe w testi 3
W CITY 41P TELSSIV ' __
i STATE
ti LIC. NUMBER.u5y-J?--I
R ARCH/ENG/
DESIGNER
o ADDRESS
z
CITY ZIP TEL.
PROPOSED USE Q
C 1
o NO. DWEL. NO. NO.
y UNITS STORIES BEDROOMS
s LOT DIMENSIONS
o NO. OF BLDGS HOW
W ON LOT USED
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t— tEENSEO CONTRACTORS DECLARATION. I hereby affirm that 1 am licenud under priva"s of Chaprr 9 frmmwiicino
2 AN Secoon 70001 of DiviNon 3 of the Business and Prolessims Code, and my kasrse a in top Mce and ellen
El
LL OkNNER BUILDER DECLARATION: I hereby affirm that I am earnest from the Contractor a Litems Law for the fallowing
= reason ISec. 7031.5. Business and Professions Code: Any city a county wMch requites a permit to crosnuct,
o alter rmprrtve, demolish, or repair, any su-ts". PA. to its issuance, " requites me alpkant for such permit
N to "Ie a sgnad statement that he is keened pursuant to the prwisimss of the Contractor's Lio— law IChaptp
S9 Icomnus.mg with Section 70MI of Nvicion 3 d the Business and Prafessu- Cudel a that M is evampt dwehom
X: and the hasis for the alleged eaemption. Any violation of Section 7071.5 by any applicant for a permit sttWts
a"A the applicant to a civil penally, of not more than ti» hundred dollars ($500)T.
W
CF 01, as owner of the property.. my employees with wape.s as their safe compnsation, will do Ore wont. and
de st—titre is not intended or others! to sak IS. 7044. Business and Prohssians Code. The Contractor's Laense
Iaw does not app" so an owns of property whe builds a unpro es dtereon. and who does such were hanse0,
Ar throoph his own employees, provided that such inso—revints are not me d ul is, effrmd for sok. N, hiessewer,
the huddrng or imp—ment is sold within Are year of compledoo. ale owmes-buil0r will have the burden o1 proving
H that be dad awl bulla m improve for the purpose of $ak.l
N ❑1, as owner of the progeny, sen evckawely —tirastivar with hcensd contrxters As construct it. protest ISm
0
7(144, Rosiness and Professions Code. The Contnctar's License Law does now apply in An owner of property who
2 holds or mpraves thereon, and who contrecu for such pmpets with a cpntracmrls) licensed pusuam M the Lmenta s
Liven. Low I
ca
IW- ❑ I am esempt oder Sec . 8.8 P.C. IAmxh Cmkliearl.
oDare Uwner
i WORKERSCOMPENSATION DECLARATION. I hereat' affvm that I have a albficak of COAWl to Fail iosue, As
? a certi irate of INI'll , Compensation mstrance, or a certified ropy thereof ISrr. 3800, Lah. C1
❑ Certified copy is hereby furnished.
G ❑ Cesulsd Copy is filed with the Building Inqui tion Dewba"I or Doporwlnt.
W
,a, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE : This section mad m1 M cmrpard
r:9 8 the perimt is for one hundred (StOOI or less t cenity that m It. prfamaarce of art —k for Nrh this
permit is issued, I shM net employ arty person in any MAW Mas n becirme LINKt to the IAbrkars' Camp 31010A
Laws of Cahlornia.
0
e,, Data Applkant
W NITTICE TO APPLICANT: N, after making sok CntilirMe of fasmption. you sfauld hesso a sudnet In Ort Worker
J_ Cmpensatirm prmnsiers of the Labor Code, you must torwwOh comps wits sues prweim or Otis pared deep
W he deemed twilled
T
C
DIVISION OF INOUSTRIAI SAFETY PERMIT CEINIFGATIW
W
�^ ❑I hemhy certify that ar exuvatkn five 151 or rope feet in ON10i nN wdpgt a Anson q raWind W daserd,
eQC will be owls in cmmctim with work wmaitad by Oil perch, all tlkt ell hdkip atN.tim. sralklditg, faimmeark.
d or demolition . dismantling threat, we be more than minty -sir (36) loss high. (CMA. SZ. Dry 7. Ad Z, Sec
341. Title S. CAC)
S
3 DAs ower-buiNer. 1 will not employ myitis to d wok wMch would rostra a prion farm tM Oiwlolon d
I— Industrial Safety. as sited aapva. mru out Parson has a prmit r do mein wart front that diwiaois
❑ Dwisan of h0wtrial Safety Permit No.
CONSTRUCTION LENphG AGENCY: I Imply affrrn Mal Awe a a canssneYw Wrap sppwy for the pvt4 mwoa
2
At the work for which Ras prmrt is "W ISee 3097, Civ. C.I.
aLedm's Name
q=p Laeft s Address
t CERTIFICATE OF COMPLIA9LE AND AUENOIIZATIM O ENTRY-. I welly 1 Mar OW 0. oppkaim and ,lata
N�
that the Westminster FAA is career. I arae N comply .0 all swe Wer ON City ordnaesat mrlap 10 biaNiw
yn sonnructW ad eutMrve a normarinbve of Me Departmest d Buldap and Sankt' to am pipes pr property
for wMch I nw avow tet Ota p IN Ole Paposl of making inryaComs.
PRESS
FIRMLY
DATE NUMBER CODE
ISSUE�J TYPE OCC.
DATE _ 1 CONST GROUP_
ZONING
SEWAGE
DISPOSAL
00 1 1 rya.
1
2
(pj 3
4
_p GARAGE
=01PORCH
VALUAI
A
0.
REAR
SIDE/SIDE STREET RW
SIDE
PUBLIC PMT #
❑ PRIVATE SO. FT./ 100 GAL
❑ CU. YDS. EXC. - CU YDS FILL
CONSTRUCTION
PLAN REVIEW
ELECTRIC
ISSUANCE
SMIP
PARK FEE Q
SCHOOL FEES
_ ADJ. AREA
,rF—FF-�
W)
11 TOTAL FEES Z"9' Z /
COMMENTS
,___0` II RECPT NO.
)j n e d Apoacry on Allam Oar
RAID BY t q6 0-
- — r ^ -Ci-a eras Com. PINK -Assessor Copy, GOLDENROD -File Copy, GREEN- Appkaft Capt'
SOLAII SERVICt SPECIAL181-
e /1,/.
?.;1011 Moulton Pkwy., C-13 rAllo.ta < < nArton SrACRIO noorlrre
LAGUNA 11ILLS, CAW011NIA 921353
Phone 1199.151) 1 TANK elltq
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