HomeMy WebLinkAbout1146 ''� CITY OF DtAMOND BAR pRESS
'�'" �' DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT �bRMLY
J08SITE APPUCATION PERMIT USE
ADDRESS b ���� �, DATE NUMBER CODE
ISSUE TYPE OCC.
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` APN LOT TRACT DATE CONST. GROUP
`� CROSS STREET �.O�l.v`- SETBACKS
� ZONING ���
�° OWNER =�C9'Y�-M �-nrt,��2.�_/`i,vL, FRONT RW CI
o ADDRESS D `J� . REAR ❑
W CITY_(��A.�ma�� Z�p G 17 � ! �-Si� SIDE/SIDE STREET RW �
� APPLICANT �i✓�.���?�n� . �+°����� SIDE ❑
� CONTRAGTOR ..��� SEWAGE
a ADDRESS ' � PUBUC PMT#
DISPOSAL � pRNATE SQ.FT./100 GAL
„� CITY - ZIP ��
z STATE GRADING 0 CU.YDS.EXC. CU YDS FILL
a LIC.NUMBER
y ARCH/ENG/ �+� C� TYPE SQ �I' FAGT(3R P,�.` ' • /�L7,1.A Al:.UAFI�N :
¢ DESIGNER �(�-'rinv � C�l P.��LlZ .W: 1 � .�C? -C'.�Gc�--P
� ADDRESS il_ 2
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� CITY ZIP TEL. -(�; 3
� -�, v�cL..� � a
� PROPOSED USE
� O GARAGE
o NO.DWEL. NO. N0. �' PORCH
y UNITS STORIES BEOROOMS
e LOT DIMENSIONS m. VALUATION • ADJ.AREA
� NO.OF BLDGS HOW auar�rirx .DE$CR�P�1�3I►I FEE `
W ON LOT USED Q>
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'�`- ~` UCENSED CdMNACT�RS OECLARATION:I herehy atfirm Iha[I am licensed unde:pmrisions al Chapier 9 Icummuxinq �..
�' •,vir�Senron 7000)of Oivision 3 ol!he Business antl Professians Code,and my luense is fn tull fo¢e and effec� �- -
O: . ,�}' ... . . .
3 W=
LL-. YNER-Bt�LOER DECtAPAT10N.-I he�e6y affirm that I am exertpl(mm the Contranor"s License law fo�the fdlmvmg
- - reasor.ISec.70315 Business and Pmlewions Code�.Any city or counfy which reQuires a pennit�o cwstruci, ��_.
o- aher improve.demolish.or iepau.arry struiwre.prior ta i�s issuance.also�equues�he applicant(o�sish permn Z--
f-- to fde a sgn�stareRent t0at he is licensed pursuant m�he pmvis7ons of Ihe tnn[ractor's License taw(Chapter ,'Q(:
- . ��- 9 Icammancing w th Section 7000)c�Litision 3 of tAe 9usine55 and Pmfeuioet tale)ar that he is exempt therefmm _g_'. _
p: ar.d the basrs fm Ihe allegeA exemptian.Rny violatian ot Sec6an 7�375 Ay a�ry•applican�:m a pe�mn su�jects .':�i
�. the applicant to a crvil penalty ot not more ihar.tive huM�ed do��a�s(S500j.1. ;�"
�..
�-�- �I,as ou.ner et th¢prop�ry.�or my employees with wa9es-as.their sole rompensauan,wiil an ihe work,and --.
i--- ~�� Cce saucturx a not imended or aHereE fcr sale iSec.7{144,9usiness ane PrMes;ions f.ode�The Cmtracta's Lirense ,..Q.:
� Law Aoes n��apply to�an owner of pmpeny who builds or imOmves tnereon,ard wtro dces such work h sell (1'
w o threugh hfs awn emplayees pmvided ihat such-Imprv+zments are not in�ended or oft¢rz0 far sak.If,however z?
m-: .�he buildir.?or.mprovement rs sald wrthm one year ol cmnpletion Ihe owner-6ufidx wJl Aave ihe burden of p avmg ¢-�.
� �hat he diA nm-hudd or impwve for Ihe purpose ot sale.) ��-
H;
�a; ❑I.as.o�vne�uf the pmpenv.-am esclusrveM commcting with lice�aed conlracrore to canstmct the O�aject ISec �;
� 7046.8usir.ess anA Pmiessians Code:Tlu Com aalar's Lirense law does nat aW�Y to an owner ot D�aPeny who :�.-�-
�� huiltls o�inprores fierem.antl who contracrs loi such pro�ecis witli n�anlractor(s)licrosed➢wsuam to the Canintlar's
< e�sz ta,v, STRU �A ��-��J
0
�> ❑�am eumpt uneer Sec. e.6 PC.(Anach CercAuaref ';PLAN-REVIEW �
p` Date Owner
:ELECTRIC
¢� 410BKERS'C�MPENSATION�ECIAflAT10N:1 UereM alfrm Ihat I have a certificate of consmt to self-insure w � -
�_ a cendicare of Workers'Compensation Insu�a�e.o�a certdied copy thereaf ISec.3800.lab.C,1. ' � PLUMBING .
Q
�'. ❑Certified copy is herehy furnfshed. �,_M�C.HA���i��.
4
o ❑Cerlifie�capy is hlee with Ihe Bwlding Inspection OeDanmen�or OePa�me t �Q=`�GRADING .
W �:
Z- CEPTIFICATE OF EXEMPTION fflOM WOAKERS'COMPFNSATION INSUNANCE:TAfs section nred not 6e compMtei
�- if the Dennit is for one hundred�51001 a less.I cerlify Ihat in the performance of tAe wwk lor which th¢ .- . ,� �� -
y. . _ . . . . ��'�� .
� -� Vermil i5 isw¢�.1 Shall not¢mpby any Per50n In any mann¢f So a9 Io 6xome subjcci ro Ih¢N6rkers'Compensauan M�p -Jr- Q
_: LaWs at California. F� �i ���.3 -
- o= ���,,f; � PAAK FEE
� n�te �°�"a� �-=: SCHOOL FEES
�- NOTICF TO APPLICpM�.If,atter making�h�s CerniKa of Exempton,ya shouW berome su6�ut m[he Nbrkers
-�'?Compensalion provisions ol Ihe La6ar Cade,you must 1mMwith camply wiM such provisnns a Mit permn shall
"; hz deemed revoked. - ---
�"- qYIS10N pF INOUSTAIAL SP.FETY PEHMIT CENT� � £�•� - --
d. ❑1 heroUY nrhfy ihat no exaavation five(5�r mo�e�hel in depth fnro whicA a pe�son is�eQuired to des�end
. �,. will Le made in cannecuon with wwk auMa¢ed by this perm L anA ihat no 6udd ng st(uciqre;ywildd�ng,felsework
- o�demolition or e smantling�he eof.w�fll,6g,,,mm�ihan-tA fry s r 13fij teet hqh IU`iaP''J2E Gry 2.Art 2 Sa �
�_ 341.TitleS.CAC1. �„ . : -�
x �.. ---' -, �,.. . . . .�
3- []As ow er-6uilder.I will nal emDbYtanYone ro�arc Wor�whch would requre a permn hom m¢U�iswn of
f-. Industrial Salery,as noted a6ove,unless such persan has a permit to do such work Irom the division. - �
S� _
W ❑a�'='����n�'a�sa+��Y��m't�. TOTAL FEES Cj
�
�_ CONSTRtICT10N LENOING AGENCY-1 hereby alfirm that there is a canstruclian k�i�q apencV��de perfoimanu �
2- af ihe wark fa which this permit is issued�Stt.3091,Civ.G�- ! �` ^
� LendersName COMMENTS ��-'� C�—L/ � L
�� m Lentler's Add�ess
Q: CENTIfICATE OF COMPLIANCE ANO AUTNOHIZA7qN�.ENTflY:�certify 1 haw read Nks ap�ication xM stah
y,- that the mfwmetion g�ven is carect.I agree to campN wnh all stau la.vs aM city orGnaxes rWtinp ro 6uilEiry
y, construcuon,and authorii a repreuntative ot tlie tmenl o�Buildinq and Safety N e�la upon iM qaperty
. = for which I have apPlie Mi: rt far t meking ins{�ections. - J
~ � i 7 / /�
� � " � �G RECPT NO.==��_PAID BY � ( �
Signature of Applsant r nqen par VAIIDATION .
WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy.GREEN—Applicants Copy
BSt06-11/89
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