HomeMy WebLinkAbout1416 (14)�b CITY OF DIAMOND BAR
_ DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT
JOBSITE
ADDRESS
APN
CROSS
CITY�.�
APPLICANT
PRESS
FIRMLY
APPLICATION PERMIT USE
ISSUE `/� ��,, TYPE NUMBER CODE
LOT TRACT DATE I `-1 - - I l J CONST. GROUP
ZONING SETBACKS m'°"° EWNM
FRONT RW ❑
REAR ❑
ZIP TEb- _ _ SIDE/SIDE STREET RW ❑
TEL SIDE ❑
CITid e S� ZIP `FEL.72!l.T
STATE
LIC. NUMBER 1�7 JSL�
ARCH/ENG/
DESIGNER
ADDRESS
CITY IP TEL.
PROPOSED USE
NO. DWEL. -No- NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
NO. OF BLDGS HOW
ON LOT USED
LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed Lanolin provisions of Chapter 9 tconenerw:irg
with Section 70001 of Onion. 3 of the Business and Piofessions Code. and my France Is in fall forte ad effect
OWNER BUILDER DECLARATIONS I hereby affirm that I am exempt from the Contractor's Lx"se Law for the following
reason (Sec. 10315 Business and Professions Code Any city or county which requires a prmit to conouti,
7 alterimprove. demolish, N repair am/ aracture, prior to its isswnce, also request the applicant rot each perms
= to file a signed statemert that he is licensed pursuant to the pravisens of the Conaactw's License Law (Chapter
C 9lca rionam ill wch Section 70001 01 Drvismn 3 of the Business and Professions Cade) or that he is exempt therefrom
endthe basis for the alleged exemption Any violation of Section 70315 by airy applicam for a permit subrcts
the applmam to a eml penalty of not more than five hundred dollars (5500)1.
V
❑I as owner of the property, or my employees with wages as their tale compensation, will do the work, and
the structure is not intended a thereof far sale (Sec. 7044, Business and Pmfessinns Code The Contractor's Locant,
Law does not apply to an owner of property who budds or improves 1weon. and who does such wark himseH,
w a through his own employees, prawded that such improvements are nm mteMrd or offered for sal. If, however.
she budding m improvement is sold within one year of canplelion, the owrier.balder will have the burden of paving
n that he did not hu!Id w improve for the purpose of sal.)
A 0 as owner of the property, am eirclusryely camrachng with htensed contractors to construct the project IS.
7044, Business and Processions Code The Cordractor's License Law does not apply to an owner of property who
C builds a� improves thereon, and who contracts fa such projects with a clool sclor(s) licensed purswnt to the Cont-ta's
License Law)
'U ❑ I am exemp under Set . B. B PC IAtuch C"ufcal
Q WORKERS' COMPENSATION DECLARATION. I hereby affirm that I have a certRcate of consent to sell -inset, a
z renihrate of Wad"sCompensation Insurance, or a cerrfied copy thereof (Sec. 3800. Lab C.).
L� ❑ CerLhed copy is hereby famished
ki—IRrTified copy , hied with the Building Inspection Department d Cepartment.
a CERTIFICATE OF EXENPTIUII FROM WORKERS' COMPENSATION.NISU" Tarts section need at be completed
n d the permit is for one hundred (51001 or less. I urkty that in Etreperlatanknce of the work fa which this
permit is issued, I shall not employ any person in any manner so as to become inflict to the wbrkarz' C ropensatim
Laws of Cahf anew
DateAppi(�'t T!r
NOTICE TO APPLICANT- H aft" makg dr
inn Cal __ Il ai#wn�zion;'Eyou slppuW�6. subject ro the
Nkker's
Compensation provisions of the Labor Code, you most fathwmr comply with such provisions or this pemrol shag
'i be deemed revdrd
DIVISION OF INDUSTRIAL SAFETY PERMIT CF,9TH4CATHOW 7
i ❑I hereby story that no egavaten live JS). a +ronin feet to depth into which a persue xi regard to deaend,
a=C will be made on ewaection with work authorised M this permit; end that no bonding stnetive, snfldding, talsnellrk,
i a demoktmn a dismantling thereat, wdl be more then thirty -iia (381 Net high. (Clwp- 32. Grp 2. An 2. Sin
y 341. Tide 8, C A 1
3 ❑As mvrrer Wild., I will not empty air. to do work which would rendre a print ban do Claimant of
Industrial Safety, as noted above, unlss such person has a permit an do such work from the dKin al.
E
w
00vision of Industrial Safety Permit No.
Z CONSTRUCTION LENDING, AGENCY: I hereby allium that time is a construction fending ago" toe the paMmaece
i of the work IN which this painnn is issued ISee. 3097. Cir. Q.
tender's Name
p:p Lender's Address
IC
CERTIFICATE OF COMPLIA AUTHORIZATION OF ENTRY. 1 candy 1 have red ddb *AMM and sum
en that the information given - . I agree to can* wdh all state laws and city Ndkw " rWtwg to bnitiag
yconstruction, ad authat a over of erre Detainment of BpAdirg ad Safety m aft upon the pop"
y to which I here mat 1 r de purpose d maki g inspection.
X
Signature d Armlcont 011e
BS1D&11189
❑ PUBUC PMT
❑ PRIVATE SO. FT./ 100 GAL
❑ CU. YDS. EXC. CU YDS FILL
Cl)
W
/ e r L WN9 e e r —1W. t r- Vin I /la ai. . t 1v a7
1
W
I.1_
2
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3
Z
4
0
GARAGE
PORCH
m
VALUATION ADJ. AREA
0
Z
CL
CONSTRUCTION
SMTP
W PARK FEE
W I SCHOOL FEES
TOTAL FEES
e. . -Lar.mm —IIIIIIII&MW
RECPT NO. 5!�PAIO 8Y fi�VAUOATKNY V
YELLOW—Finance Copy, PINK --Assessor Co", GOLDENROD—File Copy, GREEN— Applicants Copy