HomeMy WebLinkAbout1316 (14)CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY
- BUILDING PERMIT
PRESS
FIRMLY
JOBSITE
ADDRESS
APPLICATION , PERMITSE
DATE NUMBER CODE
ISSUE TYPE OCC.
APNLOT RAC-
CROSS STREET ' M' .b (�
OWNER ; ( F. V l z
ADDRESS I
DATE CONST GROUP
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REAR ❑
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SIDE/SIDE STREET RW ❑
APPLICANT TEL 11
SIDE ❑
CONTRACTOR (I
SEWAGE ❑ PUBLIC PMT #
ADDRESS h
CITY L � ZIP E � TEL �
DISPOSAL ❑ PRIVATE SQ.FTJ100GAL
STATE
LIC. NUMBER
GRADING ❑ CU. YDS. EXC. CU YDS FILL
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TYPE SO FT FACTOR PSF ADJ. AREANALUATION
ARCH/ENG/
DESIGNER
ADDRESS
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CITY ZIP TEL
PROPOSED USE
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GARAGE
NO. DWEL. NO. N •
UNITS STORIES BEDROOMS
LOT DIMENSIONS
PORCH
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VALUATION ADJ. AREA
OUANTITYJ DESCRIPTION FEE
NO. OF BLDGS HOW
ON LOT USED
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1-1
LICE EO COh'1RACTORS DECLARATION I hereby affirm that I am Licensed under proviuons of Chappa 9 [commencingr
with Section 70001 of Dvisron 3 of the Buswess and Professions Code. erd m, kense is n tull force and affect
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OWNER BUILDER DECLARATDN I hereby affirm that I am asmpi From IM Contactors License Lar 1" the fallowing
reason (Sec. 70715. Business and Professions Code Any city Or Canty which requires a puma to construct,
alter mpioae, demoksh, on repair any Structure. prior to its uswnct, also mquees the applicant for such punt
to file a signed stattment that he is kensed pursuant to the prwrsrons of the ConaaCbl'a Entitle Law CChapler
9 (comrnencrrgf with Section 70001 of Dvaron 3 of the Busress and Professions Code) or that he is exempt therefrom
and the basis lot the alleged taernption Any violation of Section 70315 by any applicant for a perms subjects
IN applicant to a crud penalty of net mon then Five hundred dollars ($5001)
❑I, as owner of the property, in m1' emplgees with wages as Mev sok eompensatnn, will do the work, and
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the ttucture is not intended at offered for sale ISK. 7066. Business and Professions Code The ContrKta's tacrine
law does not apply to an owner of proper" who builds or arprows thereon, and who does such work lvmulf.
or dvough his own employees, prwded that such improvements are not intended a offered for ask If, however,
Me building a improvement is sold within one yea of completion. IM wmer-bmlder will have the burden of previrp
that he did not Mild a improve for IN purpose of sale 1
[31. as owner of the property, am eeckarvely contracting with Itemed conuacbrs to construct the protect ISK
7066. Business and Professions Code The ContrKbr s License Law does not apply to an armor of property who
Milds a improves thereon, said who ContrKts for such prefects with a contractor(s) lensed pursuam to the Contia"ai's
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License law)
CONSTRUCTION
❑ I am eaempt under Sec B b P.C.lAttKh Cntificatel.
PLAN REVIEW
D/1eowner
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ECTRIC
PLUMBING
MECHANICAL
YA]IIKERS' COMPENSATION DECLARATION I hereby affirm IMt I haw a cerbfcart of Consent to edf nave, or
a terikate of ytbrkui Compensation Insurance. or a certified can thereof (Sec 3800. Lab C7
❑ certifud Copy it hereby furnished
i ❑ Certified fro" is filed with Me Building Inspection Department a Depatmem
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GRADING
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i CERTIFICATE OF EXEMPTION FROM "KERS' COMPENSATION INSURANCE: This section need not be completed
i d Me punt is lot ere hundred ISIOCI a less 1 certify Cut in IN perfamarce of Me war far which lids
permit IS issued, I Shat not employ any penton in ant manner 20 at to become subject to ON gsbrkerl Compensation
' Law, of pldaas
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ANC
PARK FEE
' Date Apple"ext
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SCHOOL FEES
'
r NOTICE TO APPLICANT. M, alto mtkr^9,�his CeiWcalr af-fwwptan, you flaald become sr6gact b Mt yyartrr't
I Compensation prmmns of rhe Lab" fiae w� nwst;loMOwrpf comply with each Panama a this Ruud shite
• be deemed revoked E• .1. �<_
DMSION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
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i ❑I hereby curdy that on eagwten Bw 151 or nae het n[p'ppM nb which a Paan is requited 0o dacwd.
wd be made n tonnKtm wvdtr 0a/yy�y ¢* pa!tL Q jut m laaNaq Structure, KafWift lalwak.
- a demolition a dsman6rq I1erjfVrrM gppri ilYn tMp�iig36I fast 1.0. (Chap 32. Grp i. Art 2. Sec
3e 1, Tide 8. C A C).
❑As mvner-budder, 1 we not npfaf prrynne to do-woiiiiNch'. ;aW lgrro a Paml hem the Division of
Indusnul Sale", as noted afaova, uAns isu ch'pery n has a pamvl b a(a AOUa wait hem the division.
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a CONSTRUCTION LEMM AUKY. I herby MM Cut than is a eonshuctm Wring ago" to IM prlamaca
of Ili work fa which Mrs permit is issued CSee. 3097, Civ G
TOTAL FEES e
i Lmdee'sName
COMMENTS
Lomder's Address
c ¢RRFCATE OF COhiL AND A171MN2ATIN of ENTITY. 1 trtdy 1 Naw mad via application and aur
a out the nlamatron a mrrKt. I Pse ro rah all auto laws and tiff efdiwcas 1*" In laitkp
constrtictnat, and a rue a aeprtsntKrw d IM ptrtnwrrl of ad6q new sally b apw er property
for wtreh I haw a ea hr Mtl perms M l e of taakwg nsPKtiom.
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Srputue ml epApm . pfay
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RECPT NO. PAID BY 1 VALIDATION
\,WHITE16
partment Copy. YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy
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