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HomeMy WebLinkAbout160 (22) / '!'� CITY OF DIAMOND BAR PRESS �' `� � `""' '' DEPARTMEN7 OF BUILDING AND SAFt�TY ~' BUILDING PERMIT FIRMLY ; JOBSITE APPLICATION � �PERMIT � ��'''� USE i ADDRESS �� � DATE NUMBER.��l�CODE ISSUE TYPE OCC. i � APN _ LOT . 7RACT DATE _ �C(�NST. GROUP i � CR05S 5T ET. SETBACKS '�0'��'"5 ' °.-' OWNER��v�'!,�1 e�-ayi ZONING FRONT � RW � � � ADDRESS `f�Cc'ds�+-� REAR _ � ' . W CiTY S`C��r' ZIP TEL. SIDE T RW � i . o APPL�CANT TEL. ❑ z ; Q CONTRACTOR !� � c SEWAGE o ADDRESS� � --_� piSPOSAL � �UBLIC PMT#� ; W CITY�T!Lv� ZIP 7� TEL.C���;�.� ❑ PRNATE SQ.FT./100 GAL x STATE �-� ; y LIC.NUMBER �l�"`,��I (iRAUING C�CU.YDS.EXC. CU YDS FILL _ I y ARCH/ENG/ (J}, TYP.E. S�.'FT::�'AIG�QR.PS -.: :.ADJ;:`AREA�VALUATION :.:.::. I = DESIGNER Cll'. 1 � 9 p ADDRESS � 2 ( x CITY _ZIP TEL. � 3 �� �. W �Z.. 4 � �' PRUPOSED USE 'i " � � � '�,�,� GARAGE — � w ! � NO.DWEL. NO. NO. �: pORCN ; y UNITS_ STORIES BEDROOMS I s LOT DIMENSIONS m VALUATION �ADJ.AREA � o NO.OF BLDGS HOW OURN?iTx:_[�ESC; 1PTIOAI i fiEE" " ' � W ONLOT USED ,Q. ` i - - { y¢j �:'o:�: . 2. � . ~�. LICENSfD CUMPpCTOFlS OECLAflATION:I herehy allum that I am licensed unde�p�ovisions of Chayter 9(commmcing y�� Y with Se�iiun 7Q00��f Division 3 af the Business ana Prohssions Code,and mY license is fn full imre and effe�t. "'�� � x o ;"w: '�� ❑ :rr�:� . � ,�- INJNEN�BUILOER OCCLARA710N:I herehy aNirm that I,m eMempt imm�he Contrac�or's license Law far me Idlowing � � � z� reasmi ISec 7031.5.Business and PrMessinns Code�Any ciry o�coumy which requires a permil ta ronstruct, ����O:' �O alter,improve,demnlis6,n,reDaii nny stmcture,prior to ils issuance,also requires ihe app�ir.am lor suth peimit -�;`d"�j ' � .¢� m fdr.a s9neU sta�er.iem Ihat he is liaensed oursuam ta tM prnvisions of the Connactor's Lice�ae taw(Chapter (;•m.� pp� 3(curun�amir.y with Sedion 7000�oi Oivisia��3 al thz Business and Piolessions Cude�ar thal he is ecempt therr.lmm d and ihe Uasis tor[he a!loyetl exr.mp!!on.P.ny vinl2lien ol Section 7031.5 hy anY a�licanf lor z pxrmit subjeGs �,:��, � �W' thn appl¢an;w a civil pdnalty al nut mure ihan five hundred dallais�55001.1: � �_�;��' i � 'i.4= :F: UI.as o�.vne�ul ihe�nopeity,oi iny emp!uyees with wages as their snle cnmpensaoan,wi�l Au�he wod,and tl�e suuctu�r.is nut intended ur ol(ered lor sxle�Sec 1044,Hus�ness nnd Professiens Code�The Com�ectar's License ����: � e,�� ,law Jues rm aDnly ic an owner of pmDenV who builds m imprwes Ihereon.and who dces su�h work h�msell, �x�(�', . � W'. ar thmuph h�s nwn e.mploYr,es,providr.d that such imp;wements aie not intended or oHercd fo:sale If,however, i �.a'O f�tR hudNny ni unC��vemen�is solA wiUiin one Veai of camD�e�ion,the owner�huilAer will have the 6mden ol proving �;`;�• _ .y thai Le CiJ nm build ar impwve for the Ouryose nf saieJ �?.x�� i..V; �h���❑I,as uwner ot the pmpe�ty,am excliurvely comractmy wuh hcensed canirZclOrs lo[ansirutt ihe Orolttt iSe[. i•.u;(� � , �0�, 7044,Business and Nroiessions Cade:The Comiacfor's licanse law does no1 apply to an owner ot pmperty who •�."y� - � . 4 Inulds m impiovr.i tl�eieun,and who cam ects foi su[h pmjecls with a comrac�or�s)IicenseA pursuant to IAe Gonlraclor's ��� � L1e"'��""'� •.:'' CONSTRUCTION _ �� -"--"--�- � � n I am nxemyi under Sec. ,H.6 P.C.IAltech Certificale). ,j PLAN REVIEW � eata— °xne [: ELECTRIC � ;'::: �� � :� WOR�COMPiNSATMJN DECLARFTION.I herehy athrm that 1 have a certificate of cansenl Io sell�inswe.w -��.y`.� �- . � a certi ate ul Workers'Compensatmn Insurance,nr a ceriilied copy iheroal ISec.3800.lab.C.I. � "� pLUMBING o — r�; r,���a��a�onv�:ne�PnY r�x���:nea. � MECHANICAL 'o� C�Cernfied ropy rs filed with Ihe Bwldinq Inxpecunn Ilepartment ar Oepartment. ��'Q;�GRADING W' "'_' ���� f,ERTIFItl+iE OF ExEMPT10N FNOM l'VOFKERS'WMPENSATION INSUflANCE:ihis secaan naeA nm he compkted ';��� ISSUANCE �� � �; rt Ihe yeunn is lor one hundred�5100)ur less.1 certify that in the performance of Me wmk lor which Ihis — . . : permit is issued,I s�all not employ any peisan in any manner sa as�o�ecome suhjecl lo fhe Nbrkers'Comcensation r�;� SMIP :Q: Laws r.l Cahfnmia ;W; �� ` ---- PARK FEE � p�.. Oate Applicanl � � �... ...._ NOTICE TO APPLICANT:If,aher makin thrs Certificate of ExemD��on,you sAaulA 6ecome subxt to Ihe Worker's �""""•� � 9 ; SCHQOLFEES ���: CompensaM1on provlsions of the LaMr Code,you musl IonhwiM comply with su[h pmvisunz w Mis permil shall ' �� he deenxd revoked. � .. �,j .� fNV151UY OF INUUSTpIAL SAFETY PEflMIT CEfliIFICATION�. 1 I' ! W i' �o�, ❑I heieby rertifY ihat n�e�cavaiian Irve 15)or more feet iu deD�h mlo whi[h a person is requir�il to drscend. � ' �� '�� -•-''�J�i ',�' will lie made in�onneclion wilh work authw¢ed hy Mis permit,and that na Wildi�rimcture,scalloldinq,lalsework. ; i � oi demalition ar dismamling thereof,will he more than tAiny�src 13GI teet nqh�CAaD 31.GiD Z.Art 2.Sec �s : ..x' 341.Title A.C.A.C.�. ' _ � ��3 ❑As ownerhmlder,t will not empby anyone lo do work whir.h wuuld requiie a permit fmm the Gvisun ot - � ��� • � .� . ! F-. Indrslria:Salety,as noied aMve,unless such pefton has a permit to do su�h work frum Me divition. �.�. . ::::';i .W ❑Ilrision of Ind�rsVial Safely Peimit No. �TOTAL FE�S `� a.. ��� CONSiRUCTqN LENOING ASEI�Y:I heiehy aHirm Nat ihere is a wnstruetion lendi�g agency for the perPormmte �' �Z ol the woik Inr wMch Mis permn is issued�Sec.3157,Ciu.G�. j -�� Lendei s Name C�M N�u• ,� �m� Lendei's Address t � � : �Q� CER"fIFA.ATE OF f.OMPI IANCE AN�AUTFIORIZATpM OF fNTHY:1�ertity I have read Mis 3ppliatian and:taro �� that ihe iniwmaiion yiven is carect.I agra N oamply wuh aA state laws aM ciry ordiiunces releliiq l0 6uildinp ( . y constmcnan,and aulhorize a re0resentatiue af fhe Uepamrent of Buildinq and$afely W enter i.pan Ihe paperry � ��_� for whicA I hare applied Inr Mis permit Mr ihe pupose o�meking inspections. � � � ��'���i RECPT NO. t ��PAID BY—J%-G�—VALIDATION � 55gnatme o ApdKant ar Agent Oata WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,OREEN—Applicanis Copy _ __ _ . 3� � ��. ��� .��� W,��.�� ; i � _. 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