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
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� 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
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,� PROPOSED USE /�'�r,•�'„���= 'Z 4
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" �.`'�.°�'��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, �-/�
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��'�' 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.
H � � i.
�� "�f � � `�C� PAID BY VAUDATION �
si o eaw r ngent pm RECPT NO.
WHITE—Department Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
85106-11/89
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