HomeMy WebLinkAbout1442 (19) '�'� CITY OF DIAMOND BAR pRESS
' " ' DEPARTMENT OF BUILDING AND SAFETY
��" FIRMLY
��^ BUILDING PERMIT
JOBSITE ,, 1 APPLJCATION PERMIT U3E
ADDRESS� ��7�� �� �� -� � DATE �/� ly�� NUMBER ����`7 CQDE
ISSUE � TYPE OCC.
� APN LOT TRACT DA7E �"%��"' �� CONSL GROUP
� CROSS STRE T �,,,err,s
� ZONING SETBACKS ,
°� OWNER ��1 �� ' � FRONT RW ❑ �;
o ADDRESS � � � ' � � REAR ❑ �
,� CITY j ZIP TEL. - SIDE/SIDE STREET RW ❑ �
���
o APPLICANT TEL. SIDE �
:
a CONTRACTOR � � � SEWAGE
� ADDRESS ���� �f ❑ PUBLIC PMT#
„� CITY � �' : l�� ZIP'��TEL� `� ISPOSAL O PRIVATE SQ.FT./100 GAL �
= STATE + �d�/ �
� LIC.NUMBER�� 7 b ���' GRADING C-� CU.YDS.EXC. CU YDS FILL
y� ARCH/ENG/ � TY�'E 5Q F1' FACTUa P� A[�i. AREANALUATION I
�_ DESIGNER /U��'" W 1 I
o ADDRESS }t. 2 �
= CITY _ ZIP TEL. �r 3 �
� Z. a �
� PROPOSED USE _
� e � GARAGE �
o NO.GWEL. N . NO. F
y UNITS STORIES BEDROOMS � �'ORCH �
� LOT DIMENSIONS �� m VALUATION _ADJ.AREA `
o NO.OF BLDGS HOW µ� QUANTtTY DESCRIPTION F�� a
W OU LOT_ USED ¢ G/ T W �•r �
� — — U
� 'a _z_v ��.�.�.,,='� c� � ' �
LICFNSEO C,OM Rl�CTOHS[1fCLAHATION I herehy a�h�m that I am Izmsed under pronsions ot Chapin 9 I�minencup � �
� with Sectmn 1000)ul Orvision 3 of tl�e Busmess anJ Professions Code.and my IKense�s in lull foae and elfec� W e.
3 �] W y
u— OWNFN bI�ILOER LECLAAATVJN I here6y aH�rm lhat 1 am exer.p!liom ihe Cunlractar's Litente Law fm the lullowmg _ �
_ ;eeeon�Sec 10���1.NL'S�I:B53 and Prn!essicns Cade Any cit;er coumy wh¢h reGwies a permn to conslruct, ('y �.
o alter impio�e,Jemuhsh,or repan auy rimcWre,p�ior to ds rssuance,alsa�eQnl�es Ihe applicant for s�ch permu Z �ta
�- Io file a signed statemem that he rs hcensed pursuant ta the prwismne oi the ConVaclar's LicenSe Law(Chapter �,[p $
� 9(cummencmG wdh Sec6en 7000)u�[llvision 3 0l Ihe�isiness and Professinns Code1 ar Ihat he is exempt therefrom .y ��
� anA the M1asis inr ihr.alleged_aemp[ion AnY�idation of 5¢tion 7031.5 6y any applicant!o�a permit sub�etls tr
W !li=apyh�nnl b e civd penahy nl no�more ihan 1rve hnndred dallart IS5U011 a IT
� ❑Ias awmr cf Ihe ru•�I or in em I ec,wi h era es iheii;ole com nsauon,wdl do ihe wo�k,and �;
� V Le 4 v 0%�� j 9 61. 3 Ve
� the seucmrr�s not intendaA or nHered la sale($ec•7D44:,BGsiries5'and B�alessions Code The Contracror's L¢ense q. � �` � '� �6���� .� ��a �'
� Law Jues nui apply m en ownw ol wope�tY Who hmldi nr�xnp�ove5-18ereon,and who dces such work himself. U
!7 v � �
W or ihmugh h¢mvn crployees,pmviJeJ lhat such impwvemems are not imended o�olfered for sale If,however. �
m �6e�nilJin9 nr impimeinem is sold within one year al mmpletion,the ownerbuilda w�ll have ihe hmden uf pioving '.Q� �
� Ihat he Jid nul 6uild oi�mpruva Im tl�e pwpose pt,�ale� „ x �7
y t; .' ' F.�jP}
y ❑I,as awner vl Ihe pmperty,am ecc.hhNeJ�Enj�treruny i'vjrn uc5�i5ea�Fb�vanars m co�svuct me p�o�ect ISec '{jj — �
70M,Buvi�ess anA Prnfession3 CoAe�The Contraclar s Lirense Law`doei nol ayply to an awnei ol pioperlY who S�
ZLudds oi imp�oves Iheieon.and who coniracis lor such pra�ecls wnh a conuactaqs)I¢ensed pwsuant to tAe Comraztor's
a ���.z„�e�.w., _. _ CUNSTRUCTION • __ �
W ❑I ame.empi under Sec t„ � � t �� I�� �,8 fi PC IAnachCerldicalel PLAN REVIEW
F— ,:. ':-r.'.' , .. .- ___—
0 0�,�� ._-..,...., .ay�e�,. . .. : : ELECTRIC s�� , t� C� �
� KUfiHEAS�GOMPENSl+710N DEGLAflAiION�I here6y altirm thal I have a rerohca�e at cansem m sNl�insure,or �� , PLUMBING �
a ce hcate nf Nbrkr.ri Campensanon Inwrnnce,or a tatdied cayy ingeo�ISec 3800.lah C I � -- _
0
x Ceiuhed caDY is here6y hKnishe4 � ECHANICAL J �, < fJ`
q "_ p
p ❑Caruhed copy is ided wuh ihe Nwidmg InspecUon Depaziment or D¢panment ;d GRADING 4
W �
Z CEflTIFICAT[OF EXEMPTION FROM WORKEBS'CUMPENSATION IAISUNANCE:This secuon need not be campkted � �1 �
� il �he penmt ic fnr nne h�mdred(5100�or less I ceruly Ihat in Ihe pedmmance ol Ihe wqk lor whKh Ihis },U,,, �SSUANCE L� . � C� ____
y
� ueimlt rs issued.I shall nol empiny anV permn m am manner so as to hetome suh�ect Io Ihe Nbrkas'Compensaiian SMIP _
= Laws nt Caldnrma
o W PARK FEE �
0 o�,r Appl¢ant lt- SCHOOL FEES �
W NfiTICF f0 APPLIf.dNT II,afler makmg ihis Cendicate ol ExemO��on.ya shoultl 6ecome suAl��to Me Waker's
� Conipensalian piovisions ol ihe labar Code,you must fathwilh comply wiih such qwisions a Ihis permit shell
LL 6e dcemed revaked. —
J
� qVIS!ON OF INWSfRIAI SAFETY PEHMIt CEH7IFMATION� _
w
�- UI herehy cendy that no excavaton I�ve(5�or rtxwe f¢et m depth mro wh¢h a persm is reqwred m descmd.
¢ wtll M maAr.in emnecnon wnh wnrM authwued hy thu permi�,and ihat no 6utldmg stmcture,swllddmg,takework,
� or demolition o�dismantling ihe�eof,will 6e mare Ihan thirry�sir�36)feel hiqh.�Chap 32.Gry 2.Ait 2.Sec
W- :A1.Tinr.A.C A.0 I
S t
� ❑a5 nwnerM1mlder.I wtll not empby anynrk to do wark wNcM1 wauld repuue a permit irom Ihe Gv�iion al
p— Industrial Snfety,es no�ed ehove.unless such person has a permit to do such work Uom the division
�
� W ❑prisian of Induslrial Sal¢IV��mit Na TOTAL FEES
d �
� f.(1NSTRU[.TkIN LENUING AGFNCY:I hereby aflirm that there is a mnstruc�wn kndi�g apdx.y lar the perfo(mante �s t �
Z ui Ok work fo�whKh ihis permrt rs issued�Se�.9097,Civ.C.�.
� LeMer's Name COMMENTS
m Lender's Address
Q CFNTIFK'ATE�f COMPIIANCE ANO AUfFIOHIZATIQ7 OF ENTIIY I certilY I hare iead IM1is applk��ion sid stah
rn tl�al Ihe mlamatwn grven�s carect I agree 1g com wilh ali M laws and ciry adi�w¢ea releMg la 6uilAi�
ycnnsirunwn,and au�harrze a reunta4ve � nt Bu and Safety to enkr upon tlk property
= for w Ikd far pe�mit for of ' i ions.
r ��
Siynatue a�app�ic n �u^ ,� RECPT NO. !���� PAID B VALIDATIONJ�,"�
WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
� BS106-71/89 �
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