HomeMy WebLinkAbout1467 (20)CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY
Rull_alNr PERMIT FI13MLY
JOBSITE
ADDRESS CL CnA aeA=
APPLICATION PERMIT USE
DATE Q ..� G� NUMBER _ CODE
DATE —O ' 1V !� CONTYPEST.— GROUP
APN LOT TRACT
CROSS STREET
OWNER M -e- P_D
ADDRjE�SS Xir)0� a'�\ coCT w�-�
SETBACKS �Wmn
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ElCITY
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APPLICANT
APPLICANT TEL
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CONTRACTOR -T
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ADDRESS S k 9g-n''`j S"C'�
CITY ZIPgOI— TELVI1 -'7:2;
SEWAGE
DISPOSAL ❑ PUBLICPUBLIC PMT �
❑ PRIVATE SO. FT/100 GAL
GRADING ElCU. YDS. EXC. CU YDS FILL
STAT E
LIC. NUMBER-9M70�—
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TYPE SO FT FACTOR PSF ADJ. AREAIVALUATION
ARCH/ENG/
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DESIGNER
ADDRESS
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ZIP TEL
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PROPOSED US
GARAGE
NO. DWEL N NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
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PORCH
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VALUATION ADJ. AREA
QUANTITY DESCRIPTION FEE
NO. OF BLDGS HOW
ON LOT USED
❑
ICE LASED CONTRACTORS DECLARATION I hereby affirm that 1 am tcmud trader Dmvisions of Lhapts, 9lt011mencirq
with Section 17001 of Division 3 of the Business and Professions Cade, and my kense is in hl fact and effect
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OWNER BORDER DECLARATION I hereby affirm that I am morpt Ian the Ctmtracta's bents Law for tie folb 'rq
reason ISec. 70715. Busirms and Professions Code: Any city a county which requires a pnmit to construct
sue, else requires the applicant fa permit
after, iinptewe, demolish, or 'Taff any struclue, prior to its sucr such
to file a signed statement that he is kensed paswnt to the pwisions of the Contractor's License Law (Chapter
9 (commemm�g with Session 7000) of Division 3 of the Rustiness and Prolessoa Cork) or that M is e.empt IAerefrom
and the basis for the apeged eamgtion. Any violation of Section 7D715 by arty applicant Int a permit wbiects
to spptcam to a civil penalty d not mere Ran five hundred dollars (25001)
❑l. is ow. of the Property, or my emp"S win wanes as their sop compensation. win do the work. and
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the structure s not imended affer
oed fa sale (Sec. ]Dolt. Businesses and lomfessias Cods The Corame s License
Law floes rot apply to an owner of Property who builds of tnpoves thereon. and who does such wart himself,
or through his own empkyees-provided shat such improvements an act intended a offered for up H, hawed,
the bu dmg or Improvement in sob within one yes, of so pktm, the pwner-budder wit haw the burden of proving
That he did nm Wall a mpreve for tk expose of sale 1
❑I, as owrier of the Property. em enl sorely contractny with learned camacim to construcl the pgKt ISee.
7044. Business and Professias Code: The Contractor's Liana Bow does not apply to an owner of rowty who
builds or impnvn thereon, and who contracts he such p caws with a cwtractafsl lensed pursuant r the C."....s
Lumiru law)
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CONSTRUCTION
❑lamtaempwmdaSec 66PC.(AnachCertificarl
PLAN REVIEW
Date Owms
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KM"ERS' COMPENSATION DECLARATION 1 hreny affirm that I have a certrkam of consent to W nsat, at
a certificate of %,kiss' Compenssaw Insurance, as a eertrf ed spy tiered (Sec. 3800, tab. C 1
❑ CerM spy is hereby eby furmthed.
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17,
MECHANICAL
febfed copy is fled with to Budding Inspection Depatmenta Depattnem
CERTIFICATE OF EI(EMPTION FROM WORMERS' COMPENSATION t1St1RANCE: This section need nuc be tohpleted
d the pemirt is for one hundred IS IOM a Ins. 1 certify that in the performance of to way fa which thin
pertmt a ploy issued. I Shap tat emany person in any manner so is to become Subject to the IVbrteri Cmpematlm
Laws of California. '� {
Date — Z?r c_ Appk,m E .-Trey
NOTICE TO APPLICANT. p, fifer .gyp this Certdtcata-oE.Et�ksr' ;Yon sirhAd lemons S&fact to lr tVhr;l
Comtirnsanm pwnwms of the taha Code, you mat"tgr�svian ivnipty�w A such provisions or this perms sur
he deemed reworked.
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I UANCE���
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SMI P
PARK FEE
SCHOOL FEES
DIVISION OF MISTRIAL SAFETY PERNpT CERTIFICATION
01 hereby certify that ro emavetion live (5) or dgth nu Persiana rpuinll to thousand.
wdl be made in Connection withwed aulhaQlO n d 1Aat ro 4tttcytn. sWfos&nD, fapawart.
smirg tkreol, wed h min ihirysa 3B1 het hipA. (Cup. 72. Grp 2. Art 2, See
a demolition a ds,�t
341, TO S. CAC).
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❑N owner 6M., 1 will oat empby saro s. la, wvrl M''hili"� vAldd Iaputm'a paten tone IEP Division of
Industrial Safety. as rord above. utiles truth pdsat W{i Pemvt to do such, wet (rat ON 6i7sion
tj,�tJ:�L':
❑D"tAnolldustriaiSafety PermtNo.
TOTAL ES
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CONSTRUCTEN LENDAGENCY: I hereby th
ING eby affms ere a a eonstructian %,*I op C M ftpala+nanct
a ted wok roe which this; permit is issued (Sec. 7097. Cit. Q.
tender's Name
COMMENTS
tende's Address
CIRTIFICATE OF COLIPLIAECE AND AVTHRZATION Of ENTRY: I tertty 1 have red his alpkcatian and state
that the nformatian given a card. I sign to comply web all star Laws and city adnree rd.* to hiding
conmuctAn, and attiat:e a rtprtuotaove at the Department d IMidrq and Sally to Sara wen fat papery
for whch�i—I hien apph4 la�t.s pruned for t qupv to making inspcodta
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&Wtufe of art A art Lute �._ t I
RECPT NO. � Q PAID BY � VAUDA
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WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Appficants Copy
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