HomeMy WebLinkAbout1654 (20) ( 'f'� CITY O� DIAMOND BAR
' PRESS
; ��: � �-'" � DEPARTMENT OF BUILDING AHiD SAFETY
��^ BUILDING PERMIT FIRM�.Y
JOBSITE � APPLICATION PERMIT - USE
ADDRESS �'���� ,� � DATE NUMBER CODE
ISBUE �} TYPE C.
� APN LOT TRACT DATE ��A�"' /� CONST. GROUP
o CROSS STREET SETBACKS ���
°� OWNER Z���N� FRONT RW ❑
o ADDRESS � ? REAR Q
W CITY D�.�r..w.� �iA2 ZIP �'�TEL � �� SIDE/SID�STREET RW �
a APPLICANT �1�jy�L'� �rg TE�� B ll SIDE �
Q CONTRACTOR ��-�` �`� SEWAGE
o ADDRESS -� . � PUBUC PMT#
DISPOSAL Q pRIVATE SQ.FT./100 GAL
W CITY Z� �.�Qj�'� ZIP G•�i TEL. s'�
= STATE --
,y LIC.NUMBER g I��r�r�-O GRADING C� CU.YDS.EXC CU YDS FILL
y ARCH/ENG/ � TYP� St?�? fAC�'t3F!Pfi ' �tL�L°:AR�fklt/i�CUATI�N
u' DESIGNER � 1
o RDDRESS �: 2
= CITY ZIP TEL. �; 3
o PROPOSED USE �� �C.% z` 4
� �� � :d: 6ARAGE
o NO.CWEL. N0. NO.
y UNITS STORIES BEDROOMS �� PORCH
� LOT DIMENSIONS � VALUATION ADJ.AREA
o NO.OF BLDGS HOW �UaWrrrY :t3ESGI�IP'�`if��[` F'��. •':
;
= ON LOT USED �
� . _ _ . __ �
W ❑. . . . ___ .
S- (�:
~ UCENSED COMflACTOHS OECLApATI0N�.1 he eby affirm Ihat I am 1 censed under prov nons ol Chapur 9�wmmencmp ��
'¢- witA Section 70001 of Drvuion 3 M the Business anA Pmfess�ons Cotle,anA my license is m tull force and etfect .�.; -
3 � 1T
"u- OV✓NER�BNLOEP�ECLAflATWN:I here6p aiflrm tha[1 am exempt fmm tlie Cmrtractoi"s Gcense taw fo�Me idlawing - .
�_z; reason(Sec 70315.Business and Pmfessians Code�Any city or canty whi[h�requires a pe�mit to ronstruct �}•
:o�- al�er,impmve,demdish,o�repair am s�mcture,prio�lo its issuance,also requires the applicant for such permii ..,..zi
�_¢ tn file a si9nen statement�hat he is licensed rynsuam ro�he pmrisions ot the Connactor's license Law(Chapter ;�-_
�Q 9(commencing with Section 7000�af Divisian 3 of�he Business and Profeuions Code)m that he iz exempt therefmm ;__.��
;a and 7he 6a<is fnr!ho aile9ed exemption pny violation of Sectioa 7017 5 6y any appiicant for a p?rmit su6pxts :�' -
K� _the applicant ro a civil penalty ot not more�han five hu�red dollais(55001.b -1'
w �_
�0�..OI.as ow sr of the praperry,a�my employees with wages as their sole wmpemaunn,will do the vrork,and
�.- tAe s�mcture�s noc inrendea or offereA foi sale�Sec 7044.Business anA Proieuions Cade:The�Lantracta s Uc¢nse -
.r,~�-_ Law doxs r.ot appiy te an a.vner of p�operty who hwlds a�imprpves thereon,and who dces sucM1 work himself, �i: �
•.•- or through hisown employees.prorided that such improvements are nm inteMed or affemd far sak,iF,however �
m-.the 6uiidinq ar improvement ft sold within one year of tanpletion.Ihe owner�bufider will have the hurden af proving ��'. - . .
y:-[hat he tlid nonhuiH or impmve for the purpose af sale.) �T.. .
tn-�❑I.as awner oi ihe qnperty.am ealusively comractiny with licensed mniratlors to construct the projeet�Sec _�> t
- -co'�7(144,8usir�ess ane Pmfessions�Catle:-The Comrecmr's Lamse Law dotr�mt applyio an ownerM prppeny who r�� � - � - --- -
�- huilds a�impaves ihtreon.and whn cmuratls for sur.h projec�s witM1 a comrxror�s)licmte+l pusuani m[he Coniracta's
o:
L1e"��a^� CONS'TRUCTION �'
__�-_ ❑I xm e.empi unAer Sec. - ,8.fi P.C.(Actach Genificate� = PLAN REViEW .
'�" °"` P"'nef __: ELECTRIC
;�- WORKERS'COMPENSATION OECLARATION,I herehy ilfirm ihat I h�ve a certiiieate af cansem ta selt-insure,or ,
a certiticate of Workers'comce�saiion��surance,or a eero�iee coov�hereat�sec.3sao,�ab.�.l. �=PLUMBING
o=
- '_' ❑Cerlilied c y Is here6y furnished .�'�
Q w � MECHANICAL
.o ❑Certilied copy is ided wrth ihe Bufiding Inspecoon Depatment a oepartment �t'�-GRADING
W_ �"�`_
�� CENTIF�ATE OF EXEMP710N FROM WDPKEFS'COMPFNSATION INSUfiANCE This section need not 6e campleted :ISSUANCE
�y-: if the permn is for one�undred IS100)or�ess,I certify iha�iA�e�'LiiorN'Mitt-ak,the wmk tar whkh�this �%
: permii is issued.1 shall rot empbY arry p¢rson in any manner so as M heEom¢subject to;':jhe Nb`kers'Compensatim . S`M�P
,� laws of calrfarnia. ' ' _�" �PARK FEE
so
�p.. Oate Apdipnt .:
.� NDTICE TO APPLICANT:If,aftar making this Certifrcate�6zemption,you should become su6iea m the Nbrker's �:�SCHOOL FEES
Compensanon provisbns nf Ihe tahor Code,you must f hhvrth;tomp�y Wjlh suQ�_�(7iir�3inns or this pe�mit shap
-LL: hedeemedavoked. • .. ��;:;�
�
-.� qV1510N OF INDUSfBIAL$AfETY PEFMIT CERTIFICAiHMI:
�LL�. ... ._ . .
j0` ❑)h8f80y[Bfiif�[h8t 110 BMC8V8I10�INE�5�UI�ilpfe feC[ill dCplh In�O':Wh�Ch 9�15011 i5-iCl�Uitid 10 d[E[¢Ild --
C
'�s" will he made in connectian wiM vrork authoraed 4y ih}s permrt,a�d that�w fii�il�ng zlructWe,�sEaffalding,lalsr.vork -
'�� o�demoliian or dismantlirg theieof.win 6e mare"�tlua.tl�ury:sir;,t36hiee�;nu,�h.IChap.�.?.G�p,.2.An 2.Sa
;w: 30i.TiBe 8.C.A.C.1. - -. '". .
'-_
�3` �As ownu-hwldei,I wdl not emphy anya�u ta do work which would require a permit Ram the Oivision of
u
-:_�_ Industrial Sa(ety,as iroted above.uniess such person has a permit ro Ao sucM1 vrork from the dNisnn.
�` '
-W� ❑pvision a1 Iridusirial Safery Permii No. �OI w L ^^^�
�� CONSTflUCfqN LENOING AGENCY:I here6y aHirm tl�at there is a wmtruction knding agenry for tlie per(mmairce �j rtt
2 ot thx work far whuh�his permit is fssued(Stt.3097.Civ.C.1.
'� Lender'S Name COMMENTS �-✓f�' `
;m Lender's Address
�4 CEIiTIFICATE OF COMPLIANCE AND AUtFqRIZATIdJ OF ENTHV�I certrfy I luve read tlws applieriion»d staa
.V.f- that d�e infamatian�ven is conect.I agee lo wmply with ali sbte laws a�d�iry ordimncea rdaag to 6uiNinp =
'-y. consvutiion.aM wMorae a representative ol Ilie Oepximen�of BuiNiig a�d Salety Oo[nM ipn ihe prupe�ry - _
__, Iw whuh I hav pp d fw this pe�mu for the pr se ot making i . -
~ / �,J� i
r. nat e ot dk t or t n ��� _ RECPT NO. ��PAID BY��VALIDATION
WHITE—DepaRment Copy. ELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,(3REEN—Applicants Copy
BS106-11/89
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