HomeMy WebLinkAbout1351 (17) _ -� '"� CITY OF DIAMOND BAR PRESS � - DEPARTMEN'Y OF BUIIDtNG AND SAFETY p�RMLY '� BUtLDING PERMIT JOBSITE APPUCAl10N -"?�, ��01� NU BER ��CO E ` I ADDRESS ���`�� �� ��"'�� ����� DATE � �. ISSUE TYPE OCC. Q APN _ LOT TRACT DAl'E ��� CONST. GROUP o` CROSS S ET �-�-��� SETBACKS ��"rs °�°i OWNER � � t ZONiNG FRONT RW CI o ADDRESS L` o�✓� � REAR C.� W CITY � P .0 EL. �+��~��� SIDE/SIqE STREET RW � p APP4ICANT �"' TEL. SIDE O z , � CONTRAGTOR � SEWAGE � PUBLIC PMT� W; CDDRESS—�� zIP TEL. DISPOSAL (❑ PRIVAtE SQ.FT./1Q0 GAL z STATE �++ GRADING CJ CU.YDS EXC. CU YDS FfLL y; LIC.NUMBER ;_ s.�=ia_ARCH/ENG/ �l �3,TYI�� .�S`� F�' �AG`;�II�:F i A�,#� 'R��KlV'`�.1,� Tl '_P+� � `" DESIGNER �� ����r`"'" �- 1 � ';�, ADDRESS �; 2 " . '= CiTY ZIP TEL. (�,. 3 :� PROPOSED USE %°�'� �'� �� 4 � �; GARAGE. �< a NO.t�WEL. NO. . —�""" � PORCN y UNITS�...,�_STORIES_L�BEDROOMS m; � LOT DIMENS{ONS '� VALUATION ADJ.AREA o' NO.OF BLDGS HOW f�i1AN7t7�'.;DESCF�IPT`IL��";. .. ':�E . ." _ -� ON LpT USED �; ' t . W � � � Q � � �7 � _ LILENSEO CONTflACTORS OECLAflATION:i he�e6y alfirm that I am licensed mdar D�o�isions nf Chapter 9(commeircing ��� ith Section 70U0�of Uivisian 3 of�he Business and Professions Code,and my luense is in wll fu¢e and eHect �,_ _ _ - 3 t;f° ��: (hVNER-BUIlOER DECLAflATION�I heie6y atfi�m tAat I am eKemDt Irom�he ConlracWrb Li�ense Law.br�he fdlowing - ... x - r¢xon!Sec.7031.5,Business and Protessions Cade�Any city or cnumy which reqaires a permit to cnnstruct sf7� - � � � ^�4 ��'� :'O� elter,impmve,demolish,or repaii any�mcNre;prior to ifs is5uance,also requrt¢s lhe applicam for such permit �; .. . r1--�, to file a signed statement tha7 he is licensed Oursuant ro the pmvisions of ihe ConUador'S License Law(Chapte� a�J: :�; 9(canmenting with Section 7011U1 of�iv�sion 3 ai the 8nsiness and Pmfessinns Code)ar thai he is e�empt�hereLan '�:; �-n.-- and the basis for ihe aileged exempGon Any violatron ot Sxtion 7D31.5 6y any appticant for a permR suhjecn ,'�'�, � ,`W�- ihe applicant to a civil penal�y ol nat mote than five hum0ed dollers(S5D0�.1: ;�- �-` ❑I as uw�rer of the praperry.or mY emo�m'ees with wages as Mefr sole comoenution,will dn the work,and �: ihe stmcrore is not intenAetl or o�fered for sale�Sea 7044,&isiness and Pmfesswns Code�.The Contracm�'s Grente �-.. taw Aoes not apply m�an ovmer ot properly who 6uiMs or improves thereon,and who tloes such wo�k himself �y. � W= or through his own employees,Dro�ided�hat suc6 imprwements are not intended ar oftered for sale.If,however �i, �m�. �he 6uiltling or imprnvement is soM within one year ol canpletion.!he mvnerhuilde�will have ihe bwden of pwvin9 eQ; y� that he did not hmitl or improve far ihe purpose of sale.i .. 3�� �/i. ❑I,as owner nt the pmpeny am exdu�iuelY�ontrecting with licensed temractws to tonstruct�k p�aj¢ct�Sec �{y}? :0, 7D44,Business antl Professions Code:Tl�e ConlraCiars Lic w doet not apply ta an owner af properry wh 6mlds or imD�o�es thereon,and who controtts for;uc ect �t a contracrorls)Iice ed pmsuant to the Coniractoi s �' L1Ce���aw� „�CONSTRUCTION __, a - �, ❑1 am exempt uMer Sec.� .B.6 P.C.IAttach-Certifioate) �P�N AEV�Ew 0 oe,e � ELECTRI ,..� �..,�Q �',WORKEPS'COMPENSATION OEClAf1AT10N�.I hme effirm that I heve a ureticate of wns¢nt to s¢It-insure,a - a certificate of N4rked Campensation Insuranae,w a ceriified capy ihereof(Sec.3800,La6.C-1. 'PLUMBING _Q ❑ce<<�rra�anv�s ne�eav i���:n�a. ..�.�;MECHANICAL p,� �Cefti(ied Copy is filed Wit�the BUikling InSpecli0n OeDartment m Oepar�ment �-:•GRADING a' ��CERTIFlCATE OF EXEMPTpN FROM WORRERS'COMPENSA7IINJ INSUflANCE Thie seclion need not be completed �"�uA(V^L'`E �� r� �', if ihe permit is for one hunUred(5100)ar less 1 certify that In tM1e pe�immance of!he work tar whzti this �s.:,.. p peimft is iswed,I shall npt emD�W a�V Gerson in any manner ta a5 to betame suGjtct W Ihe Nb�kHs'Cm',qensation . S'M - O' Laws of Cali�omie. �PARK �E� p: Date A%��L3'"'� lE�-,,SCHOOL F�ES W�r f.OTiCE TO APPIICANT:�If,after making Nis CertiLcate of EnmOtion,you sMuld hecame subjec�to ihe Worker s ���.Compensat�on pmvisions af the La6or Code,you must�orthwith comply with such qmisuns a itiis pe�mil shall �? '�-- he deemed rewkttl. ��'�'y � � � � �- OIVISION Of IN�USfNIAI SAfETY PEPMIi CERTIFICATi[Md. �y� �k.�� j;i�i , ua a` ❑1 heiebY cenBy that na eKcavatwn five(5)or more teet�de�f mt6—wAu`fi a persan is required co descer�a s- will he made in cv�ection with work authw¢ed 6y Ihu p¢�mu,and Mat�w Wildi�g svucture,steftdding,tdseWorF - � or demolition ar dismanOiM ihereot,wiN Ge more Man thirry�siM 1361 feet M1ph.IChaD.3.2,Gry 2,Art 2,Sec .-.�'�� � Z' 341.Title B.CA.G.I. . x ��,� °��� ���� 3� ❑As uwner�euilde�,I will nm-empby anYoce to da, Which'` repu�e�a�permit�ham Ax GV6ql1 OI . p..�� Industrial Safety,as noted above.unkss such person has a permit ro do such work lrem me Aivisinn. . � .. _.. .� .;. - .W-❑Ovision of Indushi�l Safety Permil No. .- �� � ��- - T�TAL FEES .�(�''y � CONSTflUCfION LEND�I�pGENCY:1 harehy aflir�.tl�aj{hera�is a unstuCuo0.leMdip.agertcV�dor tlM perk�mznee �v = al the work fw whuh�his permit is issued(Sec.30,97,Ctr..G{;��-���-�^' ' ' �� � tender's Name COMMENTS m Lender's Address � � '� CERTIFICATE OF COMPLIANCE ANU AUTHOflIZATIpI OF ENTRY:I cntify 1 Mve rcad this applknian�nd state � , v� that the��rfamation given is torceq.I agree m mmpfy with all stal¢lewa arid�M ordinances rebtsp to 6uiMing . � construpion,and autAorize yp�eu �re of the Dryar�ment at Buikiny ad Sateiy to Ier�qon prope�ry , � = for wArth I Aa�e ap � or Mis per t �Me qxpou M making inspections. �� r , - ��I � � � � 'L, X �l REGPT NO. � t �a_�___ ✓ ��, ��� �4 PAID BY VALIDATION WHITE—D rtment Copy,YEILOW—Finance Copy,PINK—Asaessi�r Copy,GOIDENROD—File Copy.GREEN—Applicants Copy _, --- BStOG•11l89 � . . - ; _ ._._.. r - �.. . f �- --��- .. , ._.e... ._ .... �_._... . ,._ , , 3 r. f �I . , � i ` , __.. s ___� , =. . 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