HomeMy WebLinkAbout1682 (42) , �
' x � CITY OF DIAMOND BAR
� DEPARTMENT O F B U I L D I N G A N D S A F E 7 Y PRESS
"" BUILDING PERMIT FIRMLY
JOBSITE ` APPl1CATION PERMIT �USE
ADDRESS '�� � U IL.(,�� DATE NUMBER CODE
�? APN L07 TRACT DA EE IC,�" ���� TYPE OCC.
CONST. GROUP
o� CROSS STR�EQT+ ZONING SETBACKS ..w+aer,�nrs
`-° OWNER—t/�� (MI'2S .
o adDRESS�3 ,..Sc.�; w� Q 7 EART � �
W_ CI7Y � ZIP—�–TEL. SIDE/SIDE STREET �/ ❑
o APPLICANT-- or.�SC�LC� TEL9�� SIDE ❑
z
a CONTRACTOR �Z-��
o. ADD SS � t� ,�p� SEWAGE ❑ PUBIlC PMT#
W CI7Y�. � ZIP TEL.� DISPOSAL ❑ pRfVATE SQ.FT./t00 GAL
= STATE �!,.,�
y: L{C.NUMBER �`N��7 GRADING ❑CU.YDS.EXC. CU YDS FILL
� ARCHIENG/ � N�� SQ FT' fiACTOR p5. AbJ. AREAN LUATIOIV
y DESIGNER �+� • 'W i
o ADDRE�S 1 : � u'�. � 2
= CITY � ZIP �1'��7EL.� 3
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o PROP05ED USE 1 � � 4
" n GARAGE f
o NO.DWEL. + N0. NO.
y UNITS STORIES BEDROOMS � PORCH �
� L07 DIMENSIONS VALUATION g" � p'° ADJ.AREA
o NO.OF BLDGS HOW auaNrrrr DESCRtPTiON ���
W ONLOT USED �
s U
~ LIL SEI]CONiHACTOpS DECLAAATION.I herehy aftum Ihat I am licensed under Drovisions ol Chapter 9(comm¢ncing ��hr
Y wnh Secuwi 7000)of�rvision 9 ni ihe Business and Pwfesswns Code.and mv Ikense is in tull lorce end elfect W
2
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�+- OWAIER�BU1IDEfl UECLAAAT111N�I qme8y affi�m�ha�1 am exernpt Irom ihe Conhacmr's L¢ense iaw Ia the fdlowmg
= reasnn ISec 7031 5.Busir.bss and Proles>�ons Code AnY���Y o�cwmy whrch�equues a permn ro canstiucl, (;}
o altei,nnpmve,Jemul!sh,nr repair any stmclme,prior to its issuance,also m0uires Ihe appliwM Im sucL pnmil .2�
� lu IAc a signed slaremem�hat he is litmsed pursuanl io the pr�vismns o1 ihe Cont�aclor'S li[ense Law�Cha01¢r .m
s 9lcommencmg with SecUon)UOD�nf Orvrsmn 3 ot�he Business anA Pmfesaons Cadel er ihal he is eaempt Iheietrom ��
XanJ the 6asis fnr ihe;7legeJ?�eniption Arry vioGnon ol S¢tnon 7031 5 hy airy�pphcanl!oi a permit suEK[ts
w the apph[am In n ciml penally a(na1 mare than fr�e honEred dollais�55001 I� �.J
a
� ❑1 as nwner cf ihe OrapertV.nr my¢mpinyees wnh wages as their sale campensatqn.wAI do the work.�nd
r ihe structure a nM imeWetl ar uHered loi sale�Sec 1044.Bnameas and Professrons Cade�The CwNacOor's L¢ense �',Q
V Ww Aues nul dpplY lo an own¢r ai Oraperty who 6�dds or improves IAemm.and whn dcea suah wark himstlf. ��U' _..
' a tLrnngh lus awn enployees,prov�deJ ihal euah nnprovemenls are nm mtended a offered far sak Ii.hawever.
= ihe Luddmg or imprnvemem is snld wilhin one yea�ol compleum,the ownerLuilder wdl have the burden ol provinp ,�Q t
y Ihal he diA nm huild oi impwve kr Ihe purpose ot sale,� � i
� ❑I za nwnei of�he yrpeny.am eidwnely conuacbng with hrensed coniraclors m conslmcf tM p�oJect�Sec ��j ` —
� 7[IAd,Busicess and Pmtessions Cude.The Cantractnr's Lkense taw does not apply to an ownei ol piopeny who S4
� butlEs nr unpioves lhereun,and wha contrans foi such pm�ecls weh a wntixtor�sl��ctnsed Dmsuam Io the Comntloi 5
l�censelawl CONSTRUCTIpN _ '
4 ❑C r-r.-�--�� _ —
1 am exempt uMer Sec ,H 6 P.0 14naeh Certifi[arel (��,n�y rtC y�E�l ' � --
o Uale — �^e� � ELE,('iTRIC
yWOflNENS'f.OMPENSATION�ECLAflAT10N I hereM+ffirm Ihai I heve e urOFic�1e ol tarisenl Io sel4nsure,or '�
a iendreaie of Nhrkers'f.ompensatnn Insura�e,m a cntified coPY tAeieof ISec 3800.laM1.C 1 � PLUMBING '
o —
� ❑f.rrtdi¢d cnpy is Lere6y lurnished J MECHANICAL
`o Ceni6ed tnpy is Iiled wilii Ihe Bmiding Inspecuon pepartmenl er DeOartmem Q GR ---
� CERIIFICATF UF EXEMPTION FBOM YWAKERS'GOMPENSAl10N INSU . his secuon need nol he compk�al ISS�ANCE . • [�"X"
y A the permil is br nne 6unUred�5100)ar leox I�erufy thal�n pedor �e ol IAe waN t kh tAis �y
permit is�5suetl,I shall�pl empby any persun m any manm�so as o 6ecome s dn pensapon ��—�0� A--7r'^
= Laws of Calibrnia � — /�
O �
T—
p Date �.�� � npp�icam . EE
� NUTICE TO APPLICANT�II,after mabny ihis GrniKale of Exem an,yw thould pecnme euhjen to ihe Waker'a �-.SCHOOL FEES
� Cumpensahon povisions ol the La6or Code,you must fatAw�lh comply with su[h provisnne or�Ais permi�shall �
LL hr.Ae¢meA ievokM
Y �.- ' •.� •� _—_
� pVlSION OF INDUSTRIAL SAFETY PEPMIPCERTIFIfAT10N.� ,
u� �: �: , . ,- 6.
p ❑I heie6y cerirfy ihal no e�cavmon Irve I51 or more leel m depth mto whKh a peison is repuired ta desr.enq � � �'`
� wdl Le made m tonnettwn with work alha%ued by Mis permtt,a�M m�t no Oml�mg atm�lwe,solfobinp,fakewp�k,
a 7emohunn u�dismant4ng�Mreof,wdt be mae ihan thj�np�s�K�36�feet hqh.(Chap.32.Gry 2.An 2,Sec
W 34l.LileB.CAL.1- .,�u;{ ,• � 7�:,?;�s — "
x a:.., i s . �`-r �.. Q� ��G,-
3 nAs owner-budder,I wdl no�empby anYone to do worNew�ab wouW requ��!a perrtril hom tlrc Ovrsm al
`-. Industnal Sakty,as not�d a6ove,unk�s such person fus a pe�mil�o do euch v�erR fram 1Ae dNeion .
� . .� , . ... . . �:'.. - .
y�j ❑Oirisiuno�Indusirial$p(e{y;�,m,�Ha. �� � ' � � TOTAL FEES
� 1� s�
� CRJSTRUCTqN LENDING AGENCY�I herehy aflirm Ihet there7s`a"wnstiueGon kndmg apency for tice p�rformmce
� of ihe wark Poi wh¢h this�permn is issued($ec.3097,Cn C�. —
= lende�'s N�me COMMEN 1 �L+ �
aq Lendei s AAdress �
Q CERTIFICAiE OF P�IAAIC ANO AUTFqIdZAT![H OF EA�AY�1 artity!ham red Niu appcation arA�ite " C
N'
y Ihal ihe int n 9iuen is ecl I agree ta co wrth a�l slate It.vs md�iry ordNncea rd9�inp Io 6ui17i`q
U
N cnnsnuc and author¢e re �ue of� tmenl ai BViNinq ad$a�ety 1�m�er�qM U1D p[yprry
z tar wh"h �re appl�ed s n lor 1 0l makiny i�pecuon:
r � ��w�
H +
Sqnetue of npqkam or nqent p�� RECPT NO. `� PAID BY � VALIDATIO�
WHITE—Depanment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
8S106-11l89
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