HomeMy WebLinkAbout1484 (20) '�'� CITY OF DIAMOND BAR pRESS
<« .� ''��-" " DEPARTMENT aF BUILDING AND SAFETY
BUILDING PERMIT FIRMLY
JOBSITE APPUCATION �, �y_�� PERMIT � USE
ADDRESS ���� DF.�:��-i �t� SSUE TYPE ER � �CODE
� APPI LOT TRACT DATE �'���l� CONST. GROUP
� � CROSS S�REET L���N ZONING- SETBAGKS > . ����
� OWNER N .FRONT. - RW �
o ADDRESS��C.��J [�f'�'c��t-f t� REAR 0
,� CITY__��1�1� �� ZIP ��TEL.g�+�� SIDE/SfDE STREET RW (�
O APPLICANT cl�i t� ArrU��E�i'��f'� TEL. SIDE — �
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Q CONTRAC70R�F� �iJli1.D SEWAGE
o ADDRESS ✓'�� DISPOSAL ,; � � PUBUC PMT#
W CITY ZIP TEL.
C� PRIVATE SQ.FT./100 GAL
= STATE �;
� LIC.NUMBER GRADING ' '`C�CU_YDS:�XC_ CU YDS FILI
y ARCH/ENG/ � TYPE S� . Fl�, F�f�F�_:;:. A �:Afi�tVA�.k1 �'IC?N
�' DESIGNER �ii� `V�2�S"��11t)C�� ti!'. 1 � ,
Q_ ADDRESS �: � � � t . � � �
�t.: 2
z CITY�-L�.iJ��� ZIP TEL. �; 3
o PROPOSED USE � �I� _P��i3 .� �'i � 4
� .STG��Y �, 6ARAGE
o NO.t�WEL. NO. �1�- � PORCH
� y UNITS�STORIES�BEDROOMS �: �
� � LOT DIMEN IONS - VALUATION � DJ AREA
o, NO OF BLDGS HOW � � ��JANTITY:D�S�.:RI�T`I� - �-' " =;'FEE-".:' i '
� ON�OT � USED �'�`,�������`
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�'' LICENSE�COt�AACTOPS�ECLAqAT10N.I he e6y aifi that I a licensed under pmvisans ot Chepur�J(wmmenci�g .
x� with Sec- 70001 at Drvisian 3 of the Business and Rofessfons Cade,and my luense is m full Mrce anA ettect ��- �- �� - ��j� `�� t��
o: �. �s M
3
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:.C LL: OSYNER-BUILOEfl DECLAflATION:1 herehy affirm ihat I am exemp�from�he Cnntranor s license Law Por the fdlowing �• -- . - . .
• reason(Sec.70315.Busineas and Pmfessions Cada-Any cily or county which requires a permR to construct �,' - -
-o: alte�.Improve,demolish,w repair any slmtture,prior m iu inuance,also requires the applicam fot such p¢rmn ,-��- �
_!-_'- m flle a signed:[atemem that he ie licensed pursuant to the piovisions o�the Conttacmr's license law(Chapter ;pj_.
.;��: 9(wmmencing with Sectiun 7000)of Division 3 oi the Business and Pmfessqns Cade)or that he-is eMempt therefmm ;,a:�;;
- �-y. and ihe hass for!he alleged=zemptian.Any vfolation ot Section-7�37.5 by any applicant Por a permit wbiects ..�'_ .
W: ihe applicam ro a civil penalry of not mare than frve hundred dollars(3500�-1. - =��-
LL.:.
�--_ �� ❑I,as ow�r of the property,or my employees with wages as'their-sde compensapon,wdl da Me wo�k,a� ;
~- ihe stmaure is not intended ar otfereC fm ule ISec.7(144.Business atM Piofesswns Cade�.The Cuntracta"s ilcense �'`� /%J� fj
�- -_ V' law does not apply to an owner of properry who builds or imprwes Me�eon,and who dces such work himseif j��. � �J "'" • f v - .
�++` or thmugh his awn employees,pmvideG ihat such im0�ovements are not fntended w oflered far sak.if,havever �-�:
m� :the building or improvemer.t is soW within one year of completion;the mner6uilder will.hav¢the hurden of prov� �i�----
Iy' -tha[he diA rv�t Ouild or improve for ihe W�OOSe af Sale.I. .- S:� -
�Vs'-❑I;as owner oi ihe properry,am exclusively comraCliny wilh licensed coniractors to cansiruct tpe pmject{Sec �{j�-' -
----.- '- '�-7044.Busiress a�M Pmfessions Code�.The-CanVaclor's License taw daes not appty to an ownet�of prpp¢rry-who '•�--. - - - - - -,- - -
�' buiids or-improves thereon,and who coninms tor tuch projeets�wfM a comrxror�sUicensed purtwni to ihe Contractw a �.
Q; License WW.I . . .. .
o� �ON i0 � -,.�
��❑I am exempt u�er Sec. - .B.5 P.C.(Attach Cernficatel � P� W ��
0 oa�e �^ef CECTRI ' ��� 5'I�'�
- ���: N1)RRERS'COMPFNSATION OECIAFATION_I h¢retry affirm that I have a certi}icate of consem to sell-insurc,w �
a certrficate of lM14rke�s'Compensation Insurance,or a cenified copy ihereol iSec.3800,Wh.C.). `:P UMB�NC.7 _
o:
� ❑Cenified�opy is herehy tumished. - p,
����� •
�; ❑C.ertified copy is filed with the Bmd�ny�sp�yon Oepol��t or 0¢p�rtmeM �,GRAD-- G
_�` CERTIFICATE OF EXEMPTWN FflOM WA[II�A�S;CQMP,F,N,�ATif�l INSURANCE:Tnis sec�ion need rrol 6e mmpkled S ANCE -- �Q -
. y� if ihe permit is far one hundred(E1�)a�55�Y.cEp�7�n-,ifibt in the performaiue of the wark for whzh'th�s _ � . �
. �. permit�s issued.1 shall not employ any persnn in any manrer so-as to hecome su6ject m tice Ybrkxs"Canpenution � - � -.
�} Laws of Ca�do��ia. MIP ��'��
_ o� � P `RK FEE
o� t��e , . � �� b>�
"' � { ` ti rya you ahouid hecome sub t to tl�e Workn s �--SCHOOL FEES
�: NOTICE TO APPUCA It,afte+h rig.,`�ihis_enR te�_' on, �ec
_ '�'; Cmmpensanan provision.c of the Lahor Code,you must tmthwilh co�ly wiM aceh pmisians ar this permit shall . . -
`�- be deemed revoked. - �
�a-:
�- qVISION OF INDUSfNiAI`S,A�fT�PE6�11�;CE�IFICATNIIJ ... �.:=� - -
W:: - ..: �- _
o- ❑I ne�e6y cerMy that Yw°e�tBvatWn}�.`{'�I oi mpe�eet tn:"Aepth into'wheh a persm is requfred m d�scaid -
��� will be mede in�onMctwH"wiih'iVoh Suth�r�ed 6y fhu pe�m`R�,a�thal ro hiriWinp struct�re.scatfolding.f�lsework
`�'' or demolition or disman4ing.th¢reo1,w�l he more Man ihirty-Six�761 fett hi9n.�Chap.3.2.Grp T.An 2.Sx
- ;W` 341.TiBe 8.C.A.C.1.
>2".
'3:� ❑As owrrer-6uilder.I will nat employ anyoire la da wark wh¢h wauld require a permit from tlu Oivisian ot � . .
;;H- Industrial Safety,as noted a6ove,unless such person has a pe�mif W do such uwrt irom the division. �
,� °:: £
,y�j: ❑Dirisionoflndu5trial5aferyRermitNo. TOTAL FEES �
�
;�; CONSTHI1CTqN LENIUNG AGENCY:I Aere6y aNirm Nat thre is a canstructron k�np apmcy for the perPoimmee J J
."2� ot thx wo�k fa which this permit is issued�Stt.3097,Civ.C.�. - 'J ,q
� Le�weisName COMMENTS ����� C�C+'�r�(�4! /�?� �i7���
. `=m� lendei s Address � -
���Q CEHTIFICATF Of;OMPLIANCE ANU AUTFpRIZATla1 OF ENTNY�I cntiiy 1 have reeC ONs epplieation aid suh �' -
€
=-ti. mat�he intamandn g�ven is carett 1 agree ro co�ly witA all siate mws aid eiry wdiwnces rtl�tinp to huildinp - - �
- canstruc�inn,and�wlhorue a r mative ol Department oi BuiWinp md Sahty1�eDar upon the p�ppe�ly ��/�y,/' -
_ � fa wnich i nare' ' lo��t ot mak� inspec9onx C7 j/rj /� s .�� U'r�.J�E+—V� �
�- ;�"G.[��' �td � �
Signatuie j or nBent � �pate RECPT NO.--���PAID BY Y/��'j�•I ��`3VAUDATION
en
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y WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy `
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