HomeMy WebLinkAbout1836 (28) � �/� �� ��� � � .
�'"` CITY OF DIAMOIVD BAR PRESS
"�. "�•�' ; DEPARTMENT'OF L3UILDING AND SAFETY
�^: � FIRMLY
;� BUILDING PERMIT
JOBSITE APPLJCATION �L4_n r�- PEFiMIT � �� � USE
ADL�RESS . 1800 Derringer Lane DATE NUMBER ' CODE
ISSUE n TYPE
4 APN — LOT_�TRACT 24046 DATE �l ����"�'1�' CONST. GROUP
o CROSS STREET ��dg 1;n SETBACKS MAPfOAr�'"E"'s
�' OWNEFi Mx' ^n�1 M�c �1, I�,inde� _ ZONING FRONT RW ❑
o ADDRESS �Rnn �,=,=.r� o,- T�ra REAR ❑
W CITY������� $�g ZIP Q��T TEL. _ SIDEl51DE STREET RW C�
o APPLICANT � +- T-.� TEL. SIDE ❑
—�f e�'-�ilLl-�'i�i�-al4zrr.z�
� CONTRACTOR Piermarini Ent., Inc. SEWAGE
o ADDRESS 2100_S. Reservoir St. DISPOSAL �-� PUBLIC PMT�
w CITY Pomona Z�p 91766 TE�, 590-480 �❑ PRIVATE SQ.F7/100GAL
= STATE $-1 283724
y LfC.NUMBER GRADING ❑ CU.YDS.EXC. CU YDS FILL
y ARChi/ENG/ �. n`F'E SQ F7" �Tt3R P3 Af�J. AflEANALUATlO
y DESIGNER I'rank Piermarini W 1 1348 (;. l '° ' Q�• ) �
� ADDRESS 2100 Reservoir St. � 2 � � '[[�;.;.� ( " 1 ��,7, .�
� CITY Pomona _ZIP�STEL. 590-48 3
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� PROPOSED USE U ``�• 4 _
� "[L-4c'' �µ R• � � GARAGE
o NO.DWEL. NO. NO. � pORCH
� UNITS STORIES BEDROOMS ,
s LOT DIMENSIONS _ m VALUATION C.%� L � ADJ.AREA • s-
o NO.OF BLDGS HOW QUANTITY p�SCrRI (O �E�
Z OV �L _USED
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Q �
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~ IICENStU Cf1NIRpLTOBS OECI.ANpT10N�1 he�ehy aflirw�lixl I am I¢ensed untler pmvisions ot Chapter 9 Icammen�inp
Y wnh 8eclmu/UUO�o�Divrsion 3 uf Ihe Business and Professions Code.and my Ireense is�n full lorce and e�fect ��
a
3 � �
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� OWNER�BUIlOER OCCLARATION I hercEy afhrm th�t I am e.empi hum the Conirazlar's t¢ense Law fo�Me Idlowmg — F
Z ¢ason�Sec )031 5 H;¢mess antl Piofessmns Code Any[dy oi wuntY wh¢h requues e pennn m wnslrucl, -(y �
O ahei.impinve,demulish.m�epzii anY�i�vlure,prmr fi i1s issuance,al5o:eqwres ihe ayV�iwnt foi such permit ,Z
� w L!e a signnl statemem fhai he is hcensed pmsunm to the pmvisians o(the Contractor's LMense Law(Chap�e� 'p�
Q A ICOmmCnCm�WitM1$afbDO 7000)uf avis�en 3 ul ihe 6usiness and Pmfessions f.odel ot Iha1 he rs ecem0�Iherefrom .�2,.
a ana nre 6asis lor the alleged^_xempnan Any�ialanon oi Secuon 7031 5 hy any apph�ant Por a permn sub�ects �
� thc a,phcam m a uvd penaNy nf not mnre�har live hunlred dollars�5500)I � "
� UI.as rr.vie�nl ihe prnfe��Y.ci:�ry employees wnh wages as their sole compensauon,will do the wo�k,and — F
iLz sim�wre is nul i�rtended or oNcred ioi sale�Sr,c 7044,&�smess anJ Pmfessions Cade.The Contracmi 5 Laenie ,Q,
� Law does nnt apply in an ownei ul pruperty who builds ar impmves thereon.and who dces such wmk him5elL •(� — —
••• nr ifncunli tns uwn r.r.q�loyees.yroviJeJ ihai such im0�ovemen�s are not intended nr olfe�ed lo�sale If,haweuer, �
= the boiXlm9 ur impmvement is 5old within one year af compleuon,Ihe owner�huddei wdl have Ihe buden al pmvmg —
y Ihat hC did nM hni41 Or improve for the puipose o�sals� U
� ❑I,az nwnar nt ihe yrupeny.am exclusrveN ro����ucuny wnh h�ensed cnmracmrs m consimct�he pro�ect ISec .W� —�� .
0 7pq4.Business anU Professions Code The Cnmracmr's llcense Law does no�apply to en owne�ol piapeny wha g �y
¢ Uwlds nr�mpmw:s ihereon,and who cnNrecis tor such prole��s with u canuactorls)lice'�eed pursuam to the ComncNi s �. -�..
���r�,>r�aw� CONST�I}.�TIQP�J� � � ��"�
��++ .B 6 P.0 IAttach Cenifrcate '�'PL. �� p� 1C �� . M.�-+�,� `��C- r ( ��" � ; r
� ❑I am erempl under Sec � . L..,,,,A��q..J.,].c_�JG�..----_ q � ��� ��
p Ila�e __ Pnner � '� I �, !
� WDRREAS'CAMPENSATION�FCIARATION�I here6y atfirm t�at I have a ce�ldi[ate ul cansenl lo sell msure,m .^';' � { �
L., ':
a:.ere6wle of Wmkeis'Cornpensalian Insmance,or a ceni�ied cupY theieof�Seo 38�0,la6 C I ..__.:_,�_�_�` —T--
0 F �y
_ ❑CernUetl cnpy rs herehy fixnished 1.J Ci�A ��i�` —
¢ -� ^r..:.,._.�`,..�..,..�-... '
o �Ce�idred�opy is filee with the 6miding InSDeniOn Ikpanmen�o� Oepanmem si GRADING __ ; y�
LFNTIFICAIE OF EXEMPTqN FRUM WORKERS'COMPENSAT�ON INSUFIANCE.This sectinn need not 6e eompMlM ISSUANC�_..-r � {` '�'/�( !C.��
y d tiie permrt is for ane hundred(5100)m less;1 GcrtAy thM,n ihe pedarmante ol the wak far whKh Ihfs �;"'"' • ••
permit is issuPd,I shall npt e�nploy anV Pcrsan in airy ma�er so as�o hecome suh�ecl to the VWrNers'Canp¢nu�ion gM�P ,... 1
� Laws nl CaLfomia. � �
o ARK FEE ;
o Dare Avv°n"� .... . . i.L SCHOOL FEES ��, ��`�" -.�r- �
W N[)TICE I�APPLICANT IC after making�hiS;CeiufKate oi Eremptian,yq0 should hecame sub�ect to Ihe Waher's
� Compensahun pmvismns af ihe La6o!LoAC you mUst�a�hwnh complY wnh sucM1 pmixwns a thrs peimtl shall
� Im tle¢metl iCvokeA --
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pp OIVISION Of INlIDSfflIAL SAfETY VEflMIT CER7IFICATIQV� , .
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'd ❑I heir.hy ixndy ihal na emarauon bve�51�or more leei�n depth mvo,whkh a cersM is requned�o descend, _� �
¢ wdl be made m connectwn wrth work,aulhw¢ed by�thix pertmt,and Nat no hutldinp strutlure,sratlolding,�alsework. �
� or demoleian or dismamling iMreaf,will he mae ihan thirry�siM 1361���hgh ¢hap 32.Gry 2.An 2.Sec
W :141.iitlr.B.C,AC1
2 r� ,
3 IJAs nwn�-bmWei,I wi4 not emplaY arryore to da work whah wouM reqmre a permil hOm Ihe Oivnqn d
H Indusinal Sakty,as noted a6ove,unless su[h persnn has a permit to do such xrork from Me di+ision.
� — ,
� ❑Dnisiu�of�nMrstnal Salery Permrt No TOTAL F=EES
� '�. ' ':,���, �
� CONSfHI1CfI0N LENDING AGENCY 1 herehy aflirm iha�there is a constructun kndmg apencY�a�D�����^�
z o1 thz work Inr whah Nis pe�mi�is issued�Sec.3091,Civ.C�. ,���p
� lendei s Name COMMENT µ� �� �'� � S1 ��
m Lendei s Add�ess C� � '�� '"
Q GENTIFK'AiE OF COMPUANCE AND AUTHOflIZATqN OF ENTflY.I mtily I have reaL Mis appliutbn artd state '"- _ � �j�
�i ihat the rtAamation 'en is careat I agree to campiy with all s te laws aM ury orMtunees reqMq to 6uitliiq _
= ronstrucLon, aNhon a r -e of Ihe�f�fpl Imenl iHinq ind SaIeIY C�t6f WM ihe Wuperry
= fnr whrzh ave�au I�tl or s' n for rw��V�maki tions. __'
~ x �' . f� ✓� �� ��k`�"t t'- ( ,,� j r
twe a�Mp�cent or nt h RECPT NO.�_PAID BY__--%�`�—VAL.IDATION/
tTE--Department Copy,Y LIOW—Finance Copy,PINK—Assessor Copy,GOLDENROO—File Copy,GREEN—Applicants Copy
BS106-17/89 '
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