HomeMy WebLinkAbout1485 (20) � t� �
, '"� CITY QF DIAMOND BAR
��.., �"" ' DEPARTMEN7 OF BUILDING AND SAFE7Y PRESS
'^� B ILDING PERMIT FIRMLY
JOBSITE APPLICATION � 7�PERMIT `j� USE --
ADDRESS DATE UMBER � CODE
tSSUE YPE OCC.
� APN LOT . TRACT DATE .r f � ONST. GROUP
� CROSS ST SETBACKS ��y�
°O OWNER ZONING FRONT RW ❑
� ADD SS . I REAR ❑
W CITY IP TE SIDE/SIDE STREET RW ❑
o APPLICANT TEL. SIDE ❑
a
4
a CONTRACTOR SEWAGE
o ADD 5S �" • DISPOSAI � PUBLIC PMT�
W CITY � ZIP � TEL. ❑ PRIVATE SQ.FT./100 GAL
z STATE GRADING �CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER
� ARCN/ENG/ � �'� �Q F1" FACTOFt PS ADJ. AREANALUATfON
`=' DESIGNER � � �
o ADDRESS � 2 �
= CITY ZIP TEL. �. 3
�'PROPOSED US - Z 4 �
� 'n„a" . GARAGE
o: NO.DWEL. . � � PORCH �
y UNITS_ STORIES BEDROOMS
� LOT DIMENSIONS_ m VALUATION ADJ.AHEA �
o NO.OF BLDGS HOW QCyAN7tTY DESCRiPT10N FEE �
w ON LOT USED q
� U. �
W �
= Q
~ IICENSEO CONTRkf.TlIRS f1ECLARATNN�1�ereby aflinn Ihat I am Ucensed unAer provfsians of CM1apter 9(commencmg k'•
� witli Serunn/000)�1 flrvrcmn 3 of ihe Piismess a�d Professmns Code,anA my IMense�s in lull forte anE elhci �
3 � �
W Q�YNFH 8t11LUEfl OECI AHRT!ON.I he�eFy alfrtm thet I am erempt fram IAe C,ontrecrot's License law lar iht fdlowmg
- = reason ISer. 7031.5 Bus�r.ess and Pmie�sinns f,ode Any ciry nr county which reqwres a peimit to cunstruct, (f- �
o 'ahe.r impiave,dr:mclish,or�epau any struclnre,pnnr m its issuence elsa�¢quiiec the appqca�t lo�s�eh permit �
�!rto��k a siqred si�:ement that he�s licensed pursuanl m the p�wisions af ihe Contrecror's lirenae Law(CheOf¢r 'm p
���9 lemnmener.g wnh Seruon 70'�01 of Oivismn 3 ot ihe Business aM Pmfessio�Code�or thal he is eaempt thereham .S�, �
d ,and the Lasis fnr the alleged exemphon Any vidatwn of Seciion 70315 6y any applioant to�a permrt suh�ecis � �
x -1he apphcanl to a r.rvd penal�y ol not more lhan 4ve hundieC dollars IS500�)� 'a q5
W ]
� ❑I,as ownei nt tAe propeitY.m iny employees wnA wages as iheu sole aompensauon.will do the xrork,and 1�:
F tlie mm�ure�s�ut nnenM�ar ottere�l in sale(�ec 7064.Rusiness and Prutessmns Cade The Lamractor's license ,� � Y"^� � S r #
� taw dues rm aCV�Y tu�n owner of p�upeny x�ho hwlds m imprmes thereon.and who does such wmk himself. � � -�
' or tiirou,h Lis ewr[nU�uyeec.pmv�0e�that s¢h imo�ocements are not imerAeA or aflered hi sak If.howr.ver. :� �� � / 4
= ihr.huddmg n im�nnvcment is sol�wnM1m one yeer ol[omplelion,ihe owne�-builde�wdl have Ihe hurden nf O�aving �d� �'�� �� f
y tliei he�itl nm Ludd o�impmve im tlie Durpose of sale 1 �� , �
v� []I,as r.woer uf�he O�openy,am exclusrvety conliacm�y wrth hcensed comranors tn canstmct thz project ISec �y,� �
IONi.BU511'RES an0 Pro�essinns Cude.The Contrxmr'y L¢ense Ww tlaes noi applY a an owner of p�apenY wha '� � �
ahniMs or imWaves thereon.and who r.ontra[ts im snch pmlecls wilh a mniraqarlsl ficensed Dursuam�o Hie Conuacla's
Q �'°'"sE��'"' CONS N k
� ❑�am ex�m�����ne�sP� a�P.e w��=�cP���e�a��i AN REVIEW � 1"1�1t Vtf�i"V1LA,vY1 ��% '�
0 oa,� M.nei ELECTR'��•�IC�
� WUBKER5 COMAENSGTIO�J�ECIAqATIW I heielry a�frtm Ihal I have a cetlihCate of ton5em m S¢It�insiae,m i�
a rerof¢ate of Nbikeis Compensatmn Inswance,m a rerufied copp�her¢M ISec 3804 lah C�. P •��
n _"7�p(///'��`-``��+J�(r_ �`
2 ❑Cerldirtl copy is hen6y�urnishnd MECHANIGAL '
6 —�-�`, i
o endied mpy is ideA wnh Te Bm!tlmg Inspecuou Ueo�tment oi Oepartmem Q ('j y� }'
� LERTIPN:ATE OF EREMPTqN FNOM VWNKfHS'COMPENSAIIUN�NSUNANCE T�is sectbn nee0 nm he[anpletcA � SSUANCE � �.�J'�L/�" 9
y A t�e perma¢iar ane hund�e0 IS1001 a�ess I�enily thst m the pedoimance a1 Ihe wmk far which t�is �
permn rs asued.I shall nm employ arry person in any manrer so as io hecome su6�ec�m�ta Nhrlre�s Compensation S
o Laws m ma _ `��y�. PARK FEE �
�
�
p Date �� Y M .Lt�.. SCHOOL FEES �
� Nf1�ICE IO PPIICANT�If,aNer making t��s li E � o' ?c �Su } lhe Worker's I
� Cumpensauon pmuismns N ihc La6or CoEe,yptl must mthw ic s q ie perme shNl
� he Jeen�ed�evnYeA ' �
i
. � qVI51UN OF IN�USfflIAt SAFETY PEflMIi CEPTIFICA {Y� I� �yy��
� ��� llal�6u' II�SMlIR
❑I heie�y cendY that no eMcavation trve 151 ar mo t Jep im 6i is requi�ed ro descmd.
� witl he madx m connenrn wnA wort amhaued hV m�s permrt, d t ddi e�scaltdding,falaework,
nr demohuun m i6smantlinq thneof.wtll be mae Man IMrh-six 13BI fee�hi9M1.IChap.32.Gry!.Art 2.See
x' 341.Title B.C.A.CI
= GI1`Y C7F�1�`�?'���y/�n
� ❑As nwner-hmlde�,i wtll no1 einpby anyo]d�tq�o•y,pyk y���� �� nW➢.M�hlme Oivnqn ot
F InJuslna!Safety,as noted ahore,unless such(Rrsbfh3G�r� tl k
� . ���.
� ❑ansmr o}Intlusinel Salery Pormit No TOTAL FEES =
v CONSfRUCT10N IFN�ING AGENCY I M1ereby afLrm that�h�e is a consnuctwn lendnp apencY b��R<<aimence
7C of the waik irv wh¢6 tlns pwmit rs�ssUed(Se[3[I97,Crv,C.)
� lenAer"s Name COMMEN S � , 1��'�-G� �'
� Lender'All�rr,ss C^ '�/�,
v1 �
"`� CERiI �E=OF COMPLIAN(:E AND AUTIpNIZA71a!OF ENTRY�I ce�tAy I Aave iead iha applicalion and smte �
v� ihal il int�lnaiion�rven i;�wrzq I agree to wmply wrth all stele laws aM[iry o dinances reta�inp to hmNi�q
ycansiiu ion. nA aut �te a r irve of t Deparurem of BuiWinq and Salet tn enta Ihe poqerry
= tor whi I L e ap➢��d Im �s t fa Ihe D se at maMing? tians, A
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X � Sgnauxe " or �e RECPT NO. � � PAID BY�3����� � VALIDATION
WHITE—Depart ent Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Capy,GREEN—Applicants Copy
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