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HomeMy WebLinkAbout1143A '"� CITY OF DIAMOND BAR pRESS ��...,.,� ' DEPARTMENT OF BUILDING AND SAFETY < BUILDING PERMIT FIRMLY JOBSIT� APPLfCATION i — �! G, PLRMIT � �, � � �p�.USE ADDREf�S ��s� ,� ,��% -�v/ �,-, DATE �'� "" 1� NUM�ER_L.L'T:--� r ►CODE ISSUE �7 � TYPE OCC. � APN _ LOT TRACT _ DATE �'"`�� CONST. GROUP o CROSS STREET_ SETBACKS .�a►+ove►�►rrs °.° OWNER ��'� ���rM �. f��r.--.�-,.r,.E� ZONING FRONT RW � o AODRESS //S 3 iS/ O�l S1/ �� REAI4 � W CITY �.��.•� -���+ ZIP �'�- TEL. -�yz SIDE/SIDE STREET RW � � o APPLICANT �=�',«.�-f �; i`/Fs�...�.-�EL. ���-�v SIDE _ � � 6 CONTRACTOR s"Q'�f'' -- gEWAGE � ADDRESS C) PUBUC PMT� o DISPpSAL CO RRIVATE SQ.FT./100 GAL W CITY ZIP TEL. _____ z STATE GRADING �CU.YDS.EXC. CU YDS FILI a LIC.NUMBER y � y ARCH/ENG/ � 'TYPE SQ FI':FAC"t�.F� F�S._::: AD,: AR�AL�A71i�1�-� ::.::'. � "—'. DESIGNER �ic c.r/r� C��C...�yiF� �W� 1 � p' HDDRESS s..--,P IJ:;; 2 {� CITY ZIP TEL. --- � 3 W� ^ ,� PROPOSED USE /�'�r,•�'„���= 'Z 4 ,o - :�:� --- . " �.`'�.°�'��G2� ;,:,J. GARAGE o NO.DWEL. NO. NO. i�, pORCH y UNITS � STORIES L BEDROOMS� '�:: � LOT DIMENSIONS /r',�/// VALUATION ADJ.AREA � o NO.OF BLDGS HOW `t�UANTtTY . / i7ESCR#P't't�N _ . : ��� : � .� ON LOT � USED /�-E'rirf..s-y7, �-/� Oe � U' • , W 2 ,�. ��'�' LICENSEI7 CONTRACTORS DECLARATION:i herehy af�irm�hat I am liunsed under prmisians at ChapUr 9 Iwmmencinp }� � with Stttmn 70U0)al Divition 3 ot the Business and P�ofessions Code,and my license ix in full to¢e and eNect. �<W�, - � "'.�` _ fh N�BUILOEH UECLARATqN:I herehy allirm tlia�I am etempt}rom ihe Caniractor's License Law for Me fdlowing . z reason(Sea 7031.5.Business and Pm(essions Cadc Any city ar counry which requires a permi�ro construcl, .:'.(�}.j o alter improvr.,demolish nr repair any structure_prior ta its issuance,also requires�he appliaant lor such pe�mil •-<2;�. <Q to ide a signed sialemem thal he is licensed pursuanl to the prwisians of the Contractai s Licrose taw(Chapta .!C({j� � .� 9 IcummencinB wilh Section 7000)of avision 3 nf Ihe 6usiness and Pmfessiant Codel or ihat he is erempt tM1erefmm ;`��:. �a and ihe Sesis fnr O�e allegnd eiempLon Any�aioleiion o�Section 7031.5 6y any applicant for a permit sub�ecis . � '_r�' ;� W !he ap;9icanl lo a ci�nl F=��ylly al not mnre than five hundred dollars�5500�J� .•�...1�, , Q. � ,� �❑t,es uwner of Ihe pmperlY.ar my emplayees with wages as their sok compensaiion,will tlo Ihe wOrN,and �."; — ,,� fM shnr.lwe is nni imended ai oHered lor tale�Sec.7044.Business and Professbns Code:TAe Canlraclor's license ',:Q7. � ;W law Jaes nut epply to an owner ot pmpenV who builds or impioves thereon,and wha tices sueh worK himselt. ��<(�; ar tMough his own employees.provided that sueh impmvemenfs are not mtended m ollered loi sele.II,however, � � -.'�m the.M1uikimg or impwvemem is sald witliin one year af complelion.1he owneo-builder will have�he burden oi pmving ���Q-_ . .{.N�j;.lhat he,Jid nut Iwild m impmve for the purpose of sale.) i•�.�� �� I,as uwner af the piopeity,am exclusively contracting with licensed cantracPors to canstru;.t the pmj¢q ISe� %•:1j�. .f 0 10 , siness antl Professians CoAe:The�Contncror's License taw Ao65 nol apply Ia an Ownei af p�operly wM .'.'�,S" ..,6 tudAs m impwves the�e.on,and wAo camracts for such pmjecis wilh a[onLe[tor�s)licrosed pursuant to Ihe Comrector's u�e�se taw.� �'CO RUCTION � ----- ;6 ❑I am exemo�under Sec. � .e.�b P.G(nttxh Cero�icate�. " PLAN R��/�� ..._-- � 0 oe�r o�,y�., ir:::': ELECTRIC ���¢ 5YT1RKEflS'COMPENSA710N OECLARATION�I herehy aifirm Ihai 1 have a eertiAcate ol wnsem to self�insure,w ' — � �� a ceriifica�e of Workers'Compensaaon Inwrarce,or a certified copv thereof�Sea 3800,�ah.C.�. ' �`�'����•- PLUMBING � 1'e — _ ❑Ceriilied cnpy�5 ne�enY i�.��snee. '� MECHANICAL c �p ❑Certdr¢d copy is filed with ihe Nuiidinq Inspecuon Depa�tmem or oroe«e��. `<.E�GRADING W .,� f,F.qTIFICATE OF EREMPTIUN FflOM WIXiRERS'CQIPPENSlP�'�N IWSUHATkf:This section neetl not be canDkteO ISSUANCE �,y if the permn is lar ane hundred�SI00�or less.I;.reY�rf�,Hh�l iry;,tFe pe!�ormance of IAe wak lor whicN this permii is issueq I shall ini empby any person in anwmampi so�3s�w�G¢catne subjen to the N6rMns'Compensation ��� SMIP = Lews of CalAarnia. — o �: PARK FEE o u�ie ^�o���'�� SCHOOL FEES .'W {!�'..:').. ,,7Y"�'. NOTICE TO APPLICANT:If,after makinA ihis�v fale o ,EMe tion,r�(pweaaWd 6ecame subject to the NMker"s ��"". .� r,.,,R�.. f•. yp � Compenseuon provis�ons of�he Labor Code,;yNkfius�fathwitlr''eompYq'Wi��M�sueh prwisuns a this permit shall � �� he deemed ievoYeJ. � ��� qVISION OF INWSfflIAL SAFETY PEflMIT CEflTIFICATl�7:,..,. , __ _ '.W : �.' : . �� � �: ' : ; ��'�. ;o ❑I herehy oe�lify Ihat na eMcavatron INe�5)or mae leel depth mta.wAich.a persm is requue�to destend ��� wdl Ge made n cannetian wiM work lii�Y�rcUed 6y:tl�u pRrmrt,and ihat n 6udding 6kuclwt,scel�dAinp,hisewwM w demolnion o�dismamling thereol,wdl 6e mae tAan thirty-si��36)feet high.(Chap 31.Gry 2,An 2,Sec� �� :.W� 341.Title 8.C.A.C.1. 6 '3 — As owner�6wlAer,I wdl not empWy anyone to Ao xro�k whkh xrouU repuire a permit Irom tAe pvuqn d � .F� n i I Safeiy,as noted a6oue,unless such person has a permit to do such work Irom Ihe diviaion. � �: CC ; .� ❑Ovision oi Indusuial Salety Permi�No. TOTAL FEES � �.� CONSfRUCfION LENOING AGENCY�I herehy aHirm tl�at thne is a conctruction Imdi�apency fa Ihe pnfarman�e :Z at tls wark Fa whkh this permii is issued�Sec.3097,Civ.C.�. � ! � Lender's Name COMMENTS � mLender's Address Q CERTIFCATE Of COMPUANCE AND AUTFpflIZATIp�OF ENIflY-.I cenily I have read�his appGaiqn and stah 'j� �� Ihal�he infnmation given is�ortec�.I ayee ta comply weh all s�ate laws aid ciry mdinancec rchdq to huildinp w �y canstructwn.aid author¢e a represmutrve of the Deryr�ment of Buildinp nd S�kry m enta�qon ihe paqerry �. ,= for whrch I have applied tor this permd Ia ihe pu ose �e1Tnp inspectians. 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