HomeMy WebLinkAbout1068 (5) �'"� CITY OF DIAMOND BAR PRESS
• DEPARTMENT OF BUILDING AND SAFETY FIRML
-� BUILDING PERMIT
JOBSI7E p� ' APPL1CATiON PERM i USE
� ADDRESS ' o� ���� ISSUE �, G� TYPE ER ! �CODE�_
�: APN LOT TRACT DATE � ^ � ��� /(a � CONST. GROUP
o CROSS STREET SETBACKS '"'�"�"B -�
�° OWNER �,�L �_ ZONING �ONT RW O
� ADDRESS REAR O
"`Ws CITY ZIP TEL SIDElSIOE STREET RW �
g APPLICANT TEL. SIDE --_ _ O
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e CONTRAC�� � �b � �-- �
SEWAGE � PUBUC PMT#
o ADDRESS � � DISPOSAL �
W: CITY ���tip ZIP 911 t O TEL.. -�� � PRIVATE SQ.FT./100 GAL
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y LIC.NUMBER ��/����C.� GRADING �CU.YDS.EXC CU YDS Flll ,
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y DESIGNER ;�' � L B�� _ �4
o ADDRESS CI;;; 2 �`{
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�'PROP�SED.USE E ��': 4
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o. NO.DWEL. NO. NO. =""
y UNiTS STORIES BEDROOMS <`�'' PORCH
� LOT DIMENSIONS �` VALUATION � � ADJ AREA �
o NO.OF BLDGS HUW ;QUANi►T�r ��°E3�F!TI�I!+� ` ' ' F�� ;'' "``
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� LICENSED CONiRACiORS OECLAHATION:I I�rety affi�m Ihat I am liwnmd unde�D�ouieions of CM1apM 9�tummencitq �;:��,
Y with Secnnn 7000)ul Oiv�sion 3 of the Business and Vmfessions Code,and my laense is in iull foiee and effmt. ,�::�;
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� 04VNEfl-BUiLOEN UECLARATqN�.I Aerehy alli�m that I am evempt Uom tl�e Conl�azroi s L"xense law for Me IWbwing •-�-- `�. -�7 �
- reasnn(Eec T031.5,Business and Professnns Code:Any dry or county Which rryuires a pertne to constrU[�„ � � L � ��
o alter,impmve,Jemolish,a repair any sirm;hie,priw ta i�s issuaMe,also roquires I�e appluanl Inr wch permil �-
�— ta lile a eigred s�aiement ihat M1e is licensed pursuant m the prwisians ol�he Cantractar's tRe�e Law IChapta� `��:�r ,
� 9 I�ommencing with Secoon 70001 ul Udsion 3 0l�he Busineu and ProFeavions Cade)rc that he is aKempt therefrom ::'�^';
d anJ Ihe basis for Ihe alleged exemD4on Any vidation af Seclion 7031.5 hy arq epplirant M�a pe�mtl wbjec6 j:."°.-�" �
W t�e eppli�am ta a civd penahy af nol mme ihan�ire hundred dollars(5500LF ;.,�
Q LJI,as owner ot the properry,o�iny employees wi�h wages as�thei�sde compenss6on,will do ihe work,2nd ����;; -
� iM slmcmre rs imt intended ar alfered for sale�&c.7(144,Busineas end P�ofessions Code:�The tontmctp's LiCense '
V Law does no1 apply lo an owner ol prapertY who huilds oi impmves themon,and who dcea sueA wnrk himself, .���f,��y.��
'� or thmuyh his own emplayees.pmvided�hat such YnpiwemeNs are nat intended a ollettd for sak.IL howe�eC -<;��
_- Ihe WilCing or improvement is suld within one yeer af completion,ihe owner6uilder will have Ihe hmden of provinB '.:;Q;�
y I�at he diA nm huild m improve lo�Ihe purpose ol sale.) �:����
�a ❑I,as owner ol ihe propeily,am exclusrvety camraciiny w�m iicenssC aonuaciars to cansuuct the prqvt�(Sec� ;,;'u;.
7044,Business ar�d Rolessions Code�The Comrxtor's luense Law dces not apply ro an wmer of poperty wM 't"�^
� builds or imD�oves thereon,a�who mnirects Poi wth Oi%eeis with a aonhacmr(s)iiunseC qnsuanl�o IhB Cantncta i •
�1Ce�Se iaw� '>: CONS7RUCTI � _
� ❑I am exempt uMer Sec - — .B.fi P.C.IAttach Ceriificalel. �� %�;P�N (�EV�Ew
q Daie ��� �� ELECTRI � ��C.�
�r'�� WOHKEflS'COMPENSATION DEGLANATION:I heieby aflum thal I have a urtl�icate of�oasem ro zell-insure,a .'W;`.y¢ i�`�
� a anikate of Worke�s'Cmnpensa�ion Insuance,m a cenilied copy thereol ISec 3800,lab.rC.l. � UMBIN � � U
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� a ❑w��a�ee<�Y�s ne�env�����h�a. '� ECHANICA d,:�c� • _
emfied�opy is hled with Ne BuiWing Insptttiun Deparirrent ar s�• a�w«m. :'�: ING `,
� � f,ERTIFICATE OF EXEMPTION fROM WORKfPS'COMPENSATION WSUMNCE This uttion need no�he campkted ISS 7� � � � �
�� ;y i(the permit is fnr ane hundred�5100�a�ess.I certify Ihat in Ihe perfamanee M IAe wdk la whicM ihis � � �
f' permit is issued,I shall mt employ arry permn in anV manner sa as m hxame w� t la�he V.hrkers'c�o���� ���c�'" SMIP � �
� = Laws nl Cdilnmie �- �
0 1_�lq� �PARKFEE
� oa1e �P0'"'^' SCHOOL FEES
W NOTICE 10 APPIIGANi�il,aflei makinp ihis Cedfia�e„,o�.��xqnption,you s uld hecoms sub to tlK Workei s ��'
�
. Compensatinn provisions o�Ihe LaEar Gpdx;�yo, t4 rtli';cm�ply w' such praisions tluE pemid shall �
� he deemed revoked. �� �f�'
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. � pVISION OF INW5fRIAL SAFETY PEflMIrCER FICAl10N:`
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❑I heie6y certify that no excavatian five(5�or mve feet in eaptn inta wh¢h a pe�sm is repuireD m 4eseeiW. �
� will M made in comrecicn with»%�ed yy tNs�perm7��l�t rro Wildxq aVutlure.tcaHotdlnp,felnavak. � .
el
a demal'ition m dismantlirg Iher m�r�tl�8n tlti��idy'jsW(y�)����I�V�3.2,Gry 2,l4t P.Ste ;
W' 341.Title 8.C.A.f,l.
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3 ❑As owner�huilder,I will not empby anyone lo da�yoj.k,whieh wwYl.(eq�&a permil Uan tlie Diruian al :
�— Industriai Safely,as nared ab�q..yul�sa�uC6�;R��1�';{ptreuf to�Ao�iuck'�Lorli(rom the diwmn. . �
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W ❑ansion of InAustiul SaleSp k n�•;� �� ���-� — TOTAL FE�S �
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� � CONSfflULfqN LENDING A6E I hereby aHum Mat iMre x o wqrtuttion kMinp apenry far the perldieente
2 ot Ihe work la whi[h Ihis permit is issued(Sec.3W7,CN.C.�. '�
� Leneer's Name —— — COMMENTS �-� �� "`
mLender's Address
Q CEflfIFICATF OF CaNPLNNCE ANO AUiHdtlIAT�I OF ENTflY:I rerfily 1 Mre tead tho appliralion and shft �
�a tl�at the intamaaon g�ven is caien.I apree w mmply wnh atl stah laws md eiry w3�a�r�rdehp to hiiYtinp � .
y consv and ihorite a rpreaematrve ol the De�arvrent ot BuiWinp eM SsMV m e�r�qon ihe praprry
= In wh' I have a lied for ' permil hr Ihe p�pse of inekrtg inspectiona.
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sgnai e o� icam ar m p�r RECPT NO. � - PAID BY VALJDATION
WHIT —Department Gopy�YELLOW—Finance Copy,PINK—Assessor Copy,GOLDEWROD—File Copy,GREEN—ApplicaMs Copy
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