HomeMy WebLinkAbout137 '"� CITY OF DIAMOND BAR
�� � '�•" ' DEPARTMEN7 OF BUILDING AND SAFI�TY PRESS
-� BUILDING PERMIT FIRMLY
JOBSITE APPLICATION PERMIT 'r�.-� USE -
ADDRESS � �•� �� �` OATE NUMBER.L�L�CODE
ISSUE I 1 TYPE � OCC.
� APN LOT _ TRACT DATE � CONST.�GROUP�.
O CROSS S7REET .a�n�r+er�ns
� ��� ZONING FRONTCKS —�
— OWNER �
� ADDRESS— 7 �v — REAR � ❑
W CiTY ` ZIP " "+ T . �—�-��-{ SIDE/SIDE RW ❑
, o APPLICANT_. �' ���L�1 �SllaC � ❑
a
4 CONTRACTOR SEWAGE �
o ADDRESS.�� ' ��• - _J ' �� � DISPOSAL � PUBLIC PMT�
,� CITY �- ��.T—ZI TEL�cf� _ � ��VATE SQ.FT./100 GAL
� STATE .1 �p
a LIC.NUMBER ��'�(� �F. �/ GRADING ❑ CU.YDS.EXG. CU YDS FILL
y ARCH/ENG! /� — � N�E SQ � FAGTUR PS AD,1. AREANALUATION
y DESIGNER / 9� W 1
� ..
o ADDRESS � 2
z CITY __ ZIP TEL. (� 3 (
� PROPOSED USE � 4 (
� � GARAGE �
� NO.DWEL. NO. NQ � pORCH
; y UNITS STORIES BEDROOMS �p �
� � LOT DIMENSIOiVS VALUATION � ADJ.AREA !
o NO.OF BLDGS HOW QUANTt7Y DES R1 iON F�E I
W ON LOT ' USED�L�,� ,� I
� — p �
� � i
ICEN, f]CUNiNACTORS�EC4AAATION.I here6y alhrm ihat I am hwnsed under p�onsions of Chaptx 9(commennnp k'r �
� � wnh Secuan 7000��f U�vision 3 nt ihe Ausiness and Prohssions Cade.and my IKense is m tull fo�ce and elfec[ ,w
3 ❑ ll1
LL (JvVNFR HIIII DEN OCGLAflATION.I herebv efh�m thai I am eumpt Irom ihe Conliacroi s Li�enu Law lor�he Idlowing (
� reason ISec 7031 5,6usmess and Pro�essons Cade.Any uty m counly which requires a permit to canstrutt, O a x
elter impmve_Ar.mo6sM1.nr ieVAu airy slrucNre,C��or ro i1s issuance.also repwres the apyhcanl ta suh permn �: �
Q to fde a srireJ s�aien�em ihut he is I¢ansed pur5uant fo the pronsians ot the Ca�tnc�ar's lieense law(Chapter {p
s 9�cnmmenc���n wqh Sxct�an 7000)of Orvision 3 of the Busmess and Protessions Code�or Ihal he�s exempt ihereLom :�
d and ihe hnvs for�he alleged exempuan Any violaUon of Secnnn 7031 5 hy any apphoM Por a permit suh]ects ,�
W �6e auul¢an�tn a nml pennity ol im�more�han irve huMieC dollars 1350061. �Q
o ❑I,as awner nf 7h2 piopeny.o�:ny emD�oyees wnh wages as then sole campensanon,w�ll tlo 7he wvrk,and
~ ihe anunme i>nut inlended oi alferM lar sale(Sec 7044.Busmess and Pwfesamns Code The Contractar's l¢ense K(
V Law Anes nut apyly to an nwner nf yiapeny who budds or im0�a�es ihereon.and who dces suoh woik himse��. �`U�, .��
�++ o�tl:mugh h¢nwn employees,piovided ihat such impmvemenls a�e na1 inRnded or otfereG M�sal¢II.howeveC :,�
= t6e bmldmg nr mq:io�ei�ent is sald within ane ye�r nf ao���Dlenon.ihe ownerbuilder will have the hurden ni piarirg d
y �ha+hr.AiJ nut hwlJ u�impmvc lor the yuryose al sale.� , � r
rn ❑I,ar ux��er ul the pmpeny.am eKclusively cantreahng with lir.ensetl mmraclms m ronsl�u�t tM pro�e[t(Sac ..(yJ
0 7044.8usiness and Rnfessmns CoJe The CantractoYs hcense Law does not ayply ro an owner of praperty who �
Z� huilds m imnroues ihrrem.and who cantracts for such pro�ec�s wnh a camrecb�is)Lcensed pursuant tn the Comrecta'a
���P^s^�aw� CCINSTRUCTION _
W ❑i aii�e:einpi mmer sec e B PG lAnacn Cenitaate6 PLAN FIEVIEW �� ��i � �
0 oe�� aw�ef �. ELECTRIC � l ,,��
� 1M7NKER$'COMPENSATION OECLAHf+TION I hereby aflinn�ha�I have a ce�llhcate nf mnsenl ro self�insure,w : � �y �►^�
a rerOhcate ol VVoikers'Com�ensauon�nsurance.or a rertihed com ihereot ISec 3800.�a6 CI ' PLUMBING �' G • Ll V
G
x C�,f,wufed r.npy rs hereby turmshed � MECHANICAL '�.��Le�____
4 ` �
o Certilied copy is ttletl with ihe Butldinp Inspectmn OeOartmr.m d�'+������'� Danmem E„d_ GRADING __
W O �_
� CERTIFICAik UF EXEMPTION FROM WOHKERS'COMPENSATI(1N INSUFlANCE This sectian nreA not he compkud ISSUANCE ,jyl.�
� d thr.permn rs lor une huntlre��51001 ar less I cerlify that In the perfwmance of�he wwk lor whrcA this
N I rs issued.I shall rot em lo an e son in any manrer so as In hetome 5uhe[I In tAe Wo�kas'Compensauon f`"� SMIP
�e��,�� p v v r� i
oLaws af Calrtmma � PARK FEE
,o u,�N appr�a�i � �'�
W NOTICE TU APPLICANL IF,af�er making t�is CerU(icate of Exnnptian,you sMub hecome suQect to the WaAer's SCHOOL FEES
..a -
d CumpensaGon pmwsians nf�he Labar Code,you must hrthwrth complY with such prmisbns a d�is perme shall
� be deemed rerokeA — `p`
' � p4 IQV OF IN�I1SfflIAI SAFF7Y PEflM1T CERTIfICAl10N. �`j� � � ���'
w
� I herehy cerufy tAai no e.cavalinn�rve�5�o�more feet m depth mto wh¢A a person is nqmred lo descend,
¢ wi he matlo in cnnnecUun wah work au�horved hy ihs permn,anA that na huAdnp simtlure,scatlddinp.�alsework,
d or Anunlmun nr dismantling thereol,will he more than thiny�sia(361 feet high (Chap.32,Gry 2.An 2.Sec
W 341.Tnle 8,C A.C.�. '
S
� ❑As uwne��builder,I will no�empby anyoue�a do work whicA wwid require a permn�mm ihe 6vism aF
�... IndusVia!Safety,as noteU a6ove,unless such person has a permrt m do such vro�k from the drvision.
�
W ❑Unsim�of Industnal Safery Permii No TOTAL FEES
a
�y CONSTflUCTNJN LENOING ASENCY 1 heieby aHirm tM1at there is a conatrucwn kndinp eqeMy for Me performmce
x af the wnrk to�whKh this peimit is issued 1�3097.Crv.C I
� i��ae�•s Name COMMENTS , �--� �
� Lender's AAd�ess
m
� CEHfIFICATE OF COMPLIANCE ANU AUTFqqIZATIDN Of ENTqY.I tnMy I have reaA Hue appGta�ian aiM statt c. lr�..n �
vJ thai Ihe inf atian grven is rorrect I aryee m compty wilh all state lawa aiN ary ordmances relatinp to huikliiq Q�� �4�(� �:?Ve'9A����—.
. y consimctm, hd autha�rse a repreunta( of the De{uriment of BuiMing and Safety m mar y+ui 16e paperry
= la whm ve applied lor Ihls permn lo the p 56 0�rt�iY�ilJ i0b�liEip116.
� t�r
�'�, � �� � �j RECPT NO. L � � PAID BY�!�.Se�-VALIDATION �
\ Synatwe ApDIM �ai 'nt Date �
�� WHITE—Department Copy,YELIOW—Finance Copy,PINK—�sessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy �/�
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