HomeMy WebLinkAbout1062 (15)CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT
PRESS
FIRMLY
JOBSITE -
ADDRESS 1C l
CATION PERMIT 10� : SE
NUMBISSUE I 1 (�� TYPE ER CODE
DATE _ "I - ��c) CONST GROUP
APN LOT TRACT
,
CROSS STREET s
OWNER � ^
ADDRESS 677kl!) ir" S >/ •
SETBACKS .ew4ovE emn
ZONING FRONT RW ❑
REAR ❑
CITY - ZIP 2 'O TEL �-/`'t'
SIDE/SIDE STREET RW ❑
APPLICANT � tc{{i1-7_-�i .ri�,.s TEL Nom'
SIDE ❑
CONTRACTOR —fir
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ADDRESS 4/mss" �'c.%-1s..(1� 1411-- -0
CITY M- C-- C h . , (�,L'l ZIP ? D TELj � 7
SEWAGE
DISPOSAL
❑ PUBLIC PMT T
❑PRIVATE SO. FT./100 GAL
GRADING
❑ CU. YDS. EXC. CU YDS FILL
STATE
LIC. NUMBER .N� S! LI % U
Cl)
W
LL
TYPE SO FT FACTOR PS ADJ. AREAWALUATION
ARCH/ENG/
DESIGNER
ADDRESS
1 , LIO C, " !' I (c.
2 Cl1n [. n; ri -
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CITY - ----- ZIP- TEL.- - -
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PROPOSED USE //
GARAGE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
07
PORCH -
VALUATION ADJ. AREA
QUANTITY DESCRIPTION FEE'
NO. OF BLDGS HOW
ON L T USED
Q
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LICENSED CONTRACTORS DECLARATION I hereby aft— that I am licensed under p•ovisions of 1h,,1 91[on "Mir,,
with Section 7000) of Omison 3 of the Boniest and Prafessions Cade, and my license is in full lone and effect
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❑
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PLANER BUILDER DECLARATION I hereby sffem that I am enmpi Isom the Contractoe's License Law lar the Mowing
reason (Sec. 70315, Business and Professions Cade Any city a county which requires a p.—it to construct
.le,. improve, demolish, a repair any stramre, preop r as issuance, also requires the applicant for such permit
m file a spned statement [hat he is licensed pursuant to Me prwispns of Me Dar"actal s License law (Chapter
9'commencing with Secnon 7000) of Division 3 of the Business and Professions Codel a that he is anion therefrom
and she basis lot the alleged onstpnon. AM Wolohan d Section 70315 by any applicant M a permit subpcta
IN applicant to a ml penalty of rot more than live hundred dollars (1500)1.
❑I, as "mi of the property a my employees with wages as their sole carspensation, w41 do Me work- and
the strunurt is not intended or offered fa sale (Sec. 7084, Business and Pwfessri Cade The Contractor's License
law does rot apply an an comet of property who builds a improves thereon. and who does such work himself.
err "rough his own afoppoyees. provided that such enpravrrrnts are nm mtende9 a offered for sok B, however,
the balding a imgovent"I is said within one Yew of completion. Me owner-hudcer will hon IN leaden el paving
that he did era build a improv for the pnpow of sale I
❑,. as owner of the popery, am esclnwely controctmy with licensed contractors to construct Ife pgect (Sec
7088, Business and Professions Code The Contractor's License Law does not apply to in purer al popery who
builds or improves thereon, and who contracts M such pmle[ts with a contracforlsl hCensed pasuaml to Mt Coniticloi a
License Law I
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CONSTRUCTION
❑ I am exempt under Sea , a b PC.lAtuch Certificate).
PLAN REVIEW
D.fe quina
ELECTRIC
ROReERS " COMPENSATION DECLARATION I lareby offam that I have a arnhcale of consent to serbnsore. a
a eerhhcafe of hlsvke i Compensation Insaance..or � sanded copy thereof (Sea 3800, lab CL.
❑ Car hived copy raherebyfamshed
PLUMBING
MECHANICAL
' ❑ Cettif ed copy a hied with the Building Nspecnon Department a Department
i
GRADING
CERTIFICATE O EKEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need era be completed
p
ISSUANCE •� . • C�
d the perm) is Ion one hundred (1100) or kss. I carbly thea in the performance of dw work la wtuA this
permit n Issued. I shah mit oy any person m any manner so as to wtllrI to it. Nhrk - Canpnsation
laws of Caldornu
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SMIP
.�� �.` �y /t�K
oat Applico
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L1.
PARK FEE
SCHOOL FEES
NOTICE TO APPLICANT. , offer anebrg this Certificate N rrmption, aid slnuif became sublect to of. Water's
! Conpensatron provnsrons of the Labor Code. you must for y with such provisions a Ens permit shag
• be deemed revoked
le
r DN751O1 OF INDUSTRIAL SAFETY PERMIT O TI • �9'�� ��'j�
r try Y ( f.'s� aMn nob which a person is reouirad 1. descend.
i ❑1 here said that no a.cavnpn live a attic telt Fiir
wib be made m comfort with work authorized by the pond, and that m WWII structae, staffosdmp. lakework,
• a derrolnwm or dismantling therrol, will be more than tArny.sa 1381 feet high. (Chap 3.2. Grp 2, Art 2, Sec
K 1. Title B. C A C) P,l) I�rTY 4 1(y� yyy'''kk)
❑As owns builder. I will not empHy Yr'rdck to 0 svotk whM1u ngare a point have Me Division of
Industrial Safely. as noted ahoy, onlens such person hat a permit to do each work horn ted druisien.
❑Dvisicn of Industrial Soletylar Oa
TOTAL
FEES a/
'/ 55
CO[STRUCIDN (ENDING AGEIe�Y!I lrrefX.ofhrn thet alwa O l ron! Wmiortm apaney lar M Porlorrorica
of In. wok fa which Ws pamnraissardl5ec.�909�, riv'C7 •� .. r - L 1 s
Landev t N'r"e
COMMENTS
j Lender's Address
= CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY. 1 candy I he" tied this application and star
k that the nfarmahon given is correct. I agree m Comply with so state Laws and ted ordinances rskrq to bussing
conmucton. and authorire a representafrvt of the Degrtment of Buildup and Safety to wrw yon dr pAerlY
c M which I �v applied la Mrs pent`la/ted purpose of snalirg ntpa[tfonL
Y �' `"�� --���
ewnatua d Apycant a /pons ti
RECPT
NO. PAID BY VAUDATIO
.
�00 q
(
` dopy YELLOW—Finance Copy, PINK—Assessor Copy. GOLDENROD—File Copy, GREEN— Applicants Copy
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INI ME-C` IO RECORD
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H PRE-GRADING
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