HomeMy WebLinkAbout1288 (13) ,
'('� � CITY OF DIAMOND BAR PRESS
' DEPAR'TMENT OF BUILDING AND SAFETY
�' BUILDING PERMIT FIRMLY
JOBSITE ( APPLJCATION
ADDRESS �� � ��1 �`� � DATE 7"- ��� ���NUMB R j z Y� CODE
ISSUE
` APN LOT TRACT DATE '� �~ r �� "�C, CONST. GOUP
� CROSS STREET ZONING SETBACKS ����+*S
^ OWNER Z-- FRONT pW (�
o ADDRESS ��� � � REAR �
W CITY ZIP TEL.� SIDE/SIDE STREET RW �
o APPLICANT EL. SIDE. �
z _
� CONTRACTQ�` " �� � o�'•
o ADDRESS � v!� SEWAGE � PUBUC PMT#
- DISPOSAL O PRIVATE SQ.F1'./100 GAL
W CITY�� ZIP �� � TEL�. �� ��
= STATE �j C�CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER `��[ � � GRADING
'#'X�'E: . Q ;:F ::�� . :;, _At);�: R�f.'LUAa"� N :. ,
y ARCH/ENG/ CJ;1:
`=' DESIGNER `-Etl 1 Sr.'�c� �C� J>�,e�•
p /,DDRESS �
;Ctr: 2
= CITY IP TEL. • ;�; 3
� PROPOSED USE 1'��'���" C�`"" ` �-' �= 4
� ,� C.,��r ;�, O "� �°
;;;� 6ARAGE
o NO.DWEL. NO, NO. ',-�^�,,►;. PORCH �
y UNITS�_STORIES BEDROOMS ° °'`
� LOT DIMENSIONS '�- VALUATION_ '7��U �-"' ADJ.AREA
o NO.OF BLDGS HOW OtrA1Ma'�fY Q��`CrR1RT�C}I�J ;' FEE ;:
,,
,.
W ON LOT USED
_
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� LICE E[I CONiRACTORS OECLAAATION:1 Aerehy a(firm tha�I am Gcensed und¢r provuions of CM1apter 9�eomimncinp —
Y wnh Section]000�of Oivision 3 nf the Busmass and Proieuions Code,and my licrose is in full force aM ekeet. "��'��
a ci,tit
3 � ='�y.
LL OWNFR-NWlOEN�ECLARATION:I M1ereEy alFiim tAat I am eumpl hom the ConlracWr's Lkenx taw for Me Idbwing `�-
x reason(Sec 7031.5.Business and Pmlessions Code:AnV city or caunty whicM1 iequires a permit w constmct,
o alter,imprme,demolish,ar repair airy slriKtua,prior ta ila issuance,alsp repuiies Ihe app�icant for such permit ��;:��,�
¢ to hle a signed s�atemeni ihat he i3 IfeenSed Dursuant to Ihe prwisions o1 the Contractar's lieense law�Chaptp ;��.:
p� 9 Icammencing wi�h SecUan 7000�a(Uvisron 3 0l the Busineu and Profeuioiu Codel a tha�he is eMempt Iherelmm ;.�',
u
Xand t�r.hasfs lor the alleqeA sKemption.0.�vplaunn at Seclan 703L5 hy any applicant fw a permit aubjects l.:�;
� the applicant to a ci��l penalry ol nol mo�e Ihan(ive hundrtd.�hrs��OOYF'�i`�"`,!`. ���:�:
�':;.:i .j�.;, i:. :: •:i �:Q.
� ❑I,as owner of the property,w my employees with v�es ih�p saje±tyU'►�nmtpn.will do Ilw wnrk,a�d ��
~� the siniciwe rs net inlendN ar affered ip sale(Sec.7044��usineAs anBPmhssians Code:The Contnctai s License � q. �' �
� Law dnes nm apply Io an owner ol propertp who buiWs or improves�ereon,ar�d who das such woh himcel[ ���'L�:.� �
W or ihrough his own employees,pmvided ihat such improvemenis are npt mtend¢d a ollered for sek.If,Aowever, � �
m the hwlding or improvement is solA wilhm one Y��of etim..�he�yner•ppldertyWl have the hurden of provinp �' _ '
y tha�he A�id not huiN or improve lor the purpose of sei���� v`i t,i"'t"�€� -� � �
s ba=w��f
vJ ❑t,as mvner M Ure o�ocerlv.am ezcWsrveN contia�tiny wiN hcerxed conUactws m eanslrutt ihe praject(Sea_
�0 70b4,6usiness and Prolessions Code:The Coniraetor's Licente Lew Eces�rol apply to an owner of prape�ty wlro `:;;��
Z Iwi;tls m impwves Ihe�eon,au0 wlw eontratls la�prpjeUs WiM,a,canlracto�ls)ticensed puf{uapt tp the Cmtr�etai s :
Q LicenseLaw.) 1.�:: ? i:':• :-.,..•. `� • ,;:;:CONSTRUCTION `7)G� :`
,,. ,-,.�
�� ❑�am e.empt under Sec. ''� � " ,8.6 PC.IAttah Ce�oticate�. .`; P�N REVIEW
p Date �Mr =�'���=` ELECTRIC
� W(IFKEflS'COMPENSATIOAI OECIAflATION�.I herehy allirm Iha�1 have a cenilicate ol consmt m seN-insme,a .i —
a cerldicale ol Nbders'Compensatian Insmance,or a calrfied capy�hereof(�t.3800.Lah.C.1. "In�Y,'•PLUMBING
Z ❑� �r ;;J, MECHANICAL
Certilied is heie IurnisheA. vr:
4
�o nhed capV is Ii1M vnth the Builtlinq Insp¢tnOn Depariment or Ueparmrent. �;'Q�::.'GRADING
W
�,� CEBTIfICATE OF EXEMPTI�N FpOM WOqNERS'COMPENSATION INSIIR4NCE:This sectian��e��n��o�,��a � ISSUANCE �I :3 L`% r
y if ihe perma is for one�undre0 IS100)n kss.I certify�Aa�m me per mente ol ihe wak for whkK this .
permit is issueA.I shall mi emplay airy parson in a�ry manner so as ta a w6jxt to the Nbrtds'c����� ,�, SMIP
� laws al Cal'rfornia. �
� �CT� � PARK FEE -
�j Oate �v�� Appiicant �;� "
� NOTICE TO APPLICANT.If,after maki�this Cntilicate ol Exem �. �nana n�„�n�,„a,e,ob,k�; ���.SCHOOL FEES
_+ ComOensation Drovisions of the LaOor CoAe,you must fathwith co wim such prmrisons a this permu shaN ' ^
� 6e deemed ievo4ed.
J (" i.. '
s dVI51W�F INqiSfRiAt SAFETY PEHMIT CEIiTIFICAlION: �� � � � �'�
��� ❑I here6y urtily that na ercavatbn five(5)or mae leet in depth inm whkh a persm is requird�o dacmd. � " ���� ` �e--
OC wiE he made in cmnettion with wnri auMorued hy Mu pe�mit,and Ilut no WiNuq suutlue,stafklAinp,falfe�vork, �� �
d a demotuion or dismaniFng the�eaf,wdl be more ihan thirry�six�36�he�hiqh.(Chap.3.2.Grp 1,An 2,Sec ' �Z� — � S��
�W� 341.Title 8.C.A.C.1.
3 ❑As awner�6uiider,I wiA rot empby anyone la do work whkh wauN rpwre�parmit iran the 6vision d : �; �
�t— Indusrtial Safety,as m�ed ahoro,unksa wch person Ms a permit to do such waN from the division. �. �
� ;.�t.:`• a- :
W ❑pvisim of Industrial Safery Pormd Na � ?x
d
� CONSfptlCfpN LENDING AGENCY:I herehy�ifirm thai thne ia a construction kid'np apenq fa�he perfamame TOTAL FEES C� �� �� �r'
Z af ihe wark for whkh Mis permii is isaued�See.3097,Civ.C.�. �.,
O ��$Na� COMMENTS ��� �
p�p 4nder'a Addrcss
4 CERTIFICATE OF COMPlIA1�LE A!D AUTN�Po2 OF EHIHY:1 cetily I have read tliis applintion md st�te �s�
y that Me inlametbn gven is wrect.I apree to mply wiMi all sta4 law:md ciry adewaa reptip to bW6np .
y construc�ion.md auNoiize�rcortsen - ot Uepenmem of BuiNinp rd S�Mv m eneer iqm the prapnry ��.
= for which I have applied far ths permil d makirq inspxtiant. � �:
1 1 ryrsE ...+-� �q >'
1-- v �.1/�.y'�.Ly � ��j , j
Z � ( / y
� Signature a Appl n o Agen� �au . RECPT NO. `�'3��`- PAID BY� -`'�`� K VALJDATION — .
WHITE—Department Copy,YEILOW—Finante Copy,PINK—ASsessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy �
BS706-11l89
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