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HomeMy WebLinkAbout1577 (22) �'` CITY OF DIAMOND BAR ppESS �� �� DEPARTMENT OF BUILDING AN�SAFETY F�RMLY -� BUILDING PERMIT J09SITE ,� ' APPUCATION �`"` F'ERMIT USE ADDRESS � ��el''c�'/�f��`� ��`�'� SSUE -„�,t") T�ER �'�COOE �' CROSS STREET /�f - �OT T CT DATE �'"� �� ` �1 d CONST. GROUP 6 OWNER ��. ' , �4� ZONWG FRONTCKS _ ..;_, ,...._ ,4:.,: � :,. ��rrrs �� �� ADDRESS S��� REAR ❑ LL; CITY ZIP TEL. 51DE/SIDE STREET RW � _�I APPLICANT TEL. SIDE C❑ GI Z: a'; CONTRACTOR 7' � �" �� SEWAGE � PUgIIC PMT# �y ADDRESS '� � `''"�"�''�� ��'��� � DISPOSAL u� CITY��'���'�'`�°�-Y ZIP i ��°-�TEL.�°��`�'�� ❑ PRNATE SQ.FT./100 GAL � STATE �.�..T��,-�� GRADIfVG C� GU.YDS.E%C. CU YDS FII.L N LIC.NUMBER TYPE 5C� Fl` FAGTC�R F�� : ,�C�«l. 1��E1kl1lALUATION , � ARCH/ENG/ � � � DESIGNER � ADDRESS � W 2 �� CITY ZIP TEL. j,►�; 3 �� . . . , � 4 �� PROPOSED USE �, ` �� �,•'���,�, d; GARAGE �:; N� DWEL. NO. NO. � pORCN �'� UNiTS STORIES BEDROOMS ��_ LOT DIMENSIONS VALUATlON ADJ.AREA �� NO.OF BLDGS HOW c�UAtuTr`far; (��S�Rif�1�1t!t ?- �E� . . c�; ON LOT USED u ;� `�. F'—' UCENSEI)f.�NiHACTOHS OECL0.flATI0N:I AerebV affirm that 1 am ti[ensed under Orovisions of Ghapter 9(commencinp _�.�.. �� wah Section 7000)of pvision 3 ot the Business and Rdessions Code,and my license is in tull fo¢e and eNect �� �i� ❑ . . �:-,�. �b OVJNfN�BUILOEfl DECLAflATiON:I hereby atlirm that I am e�empt imm the Contractor's Ucense L�w lor the idiowing ieason(Sec. 7031.5,8usiness and Prolessians Code:Any oty or courrty which requires a permu Io cor.slrucl (!jj: �i alter,imprwe,demolish,or repair any structure,prior b i�s issuance,alsa requires the applicmt For such permit ;�`�� � �•—'to lile a siqnzd statement t�at he is li�ensed Oursuam ro the Oravisions ot the Contractor's Liceme law(Chapter ����p^�:� � GC 9 I�ommencing with Senion 100D)ol Division 3 ai ihe Business and Praiessions Codel or that he is exempl therefram ,;R�� , - . i;�. and the 6asis lar Ihe alleged eiempaart Any vialation of SeCtinn 7U315 Ay any applicant for a perM�subjects ���';��� ` - � �� ihe aCPlicant ro a civil penalry ol na�mofe ihan five hundred do�lars(5500�.j: .-a_ �� ❑I as owner ol the property,or mY employees with wages as Iheir sole oompensatian,will do the wmk,and " �� the slructure is not imended or oftered tor sale(Sec.7044,Business and Pwfessions Code�.The Contrxtor's GfenS= -��Q,; �;,� Law does nm apply m an nwner of pmperty who builds er improves thereon,and who Cces such wark Aimsell. ��`U? y�+ ur thmugh his own employees,pmvided Ihat such impmvemenis are not interded ar ot{ered for sale.It.however, :�Z�1. i� the 6uilding or impmvement Is sold within one year of completim,ihe owner-6uildar will have tM1e 6urden ol pmving -,�'. �;n thal he ditl not build or impmve for Ihe Ourpose at sale.� ,��. ;ti ❑I,as owne�af the pmpeny,am eMclusively comractiny with licensed contracto�s ro canstruct�he pmjec��Sec .�:, 7044,Business and Piofessions Code:The Cantracror's License law does nm apply to an owner ol pop¢rry wM �z builds or improves thereon,and who contracis tor such prolecis with a contwctor�sj licensed pursuant la the Conuacmr's - "¢ License I.aw.l � ��CONSTRUCTION 0 W ❑I am exempt�nder sec. .B.&P.0 IAnxe Certiticatel ,; PLAN REVIEW H �= Date Owner ELCd+Tp� .�...,.,-�-, :¢ WORKERS COMPENSATION OECLARA710N�,I here6y aflirm Nat I have a aenilicafe of oonaent lo sefl-insure,oi '� -^� a cerlificate of Workers'Compensation Inwrance,or a certified copy theieof(Sec.3800.La6.C.L `���PLU��v� /� � � � ❑Cenified copY�S ne�enV�W��gnea. :;;��,MECHAN ICAL �p f.erlified copy is 61ed with the Building Inspection Department oi o�aa�,m•��. �.-�GRADING �y �Z CEflTIPICATE OF EXEMPTION FPOM WORKERS"COMPENSATION INSURANCE�.This seCtiOn ne¢d rwl he compktetl SUA��? .,1� �'� if Ihe permit is for ane hundred�5100�oI kss.I ceiYfy that in thR,Q,Wi�a�mance o�the work�fot whicH ihu . �— �n ermit Is issued,i shall nnt em I an erson in an er as�tiMo�subeet lo Ihe Mbrkers'Com v nw v u v m�F �4 � i o����� SMIP � �aws ot ca�rfomia. 1 : �' '�W''F'`� PARK FEE p Oate l�plcant .R�»�SCHOOL FEES "�'� NOTICE TO APPLICANT�If,afler making this Cernikare M Exemptwn,you siwuW 6ecome subject�o the Wakar s . �� Compensauon provisions of�he Labor Code,you mast fathwith comply.wU¢-�qpr�,h prmisbns a this permit shall � be deemed reuaked. �� '4w�11� -- J + ' y� DIVISIIXJ OP W�USTHIAL SAFETY PERMIT CERTIFI�ATIOFI W � I herehy cerlity ihat nn excavation frve�5)or more teet in depth n)a which a plrsaf�is�epuired to descend � il 6e made m�onneceion wifi xrork autlwr¢ed,by lhayermrt�;BnE ilwt nv Lwldinpstruciu�t swNaWinp,falsework, a or demolition or dismantli�q thereof wAl!fip'mor2;M2n�thirry�sii�36�feet h�qh��Chay.,3.Z,'Gry 2,Art 2,Sec W- 341.Title 6.C.A.C.1. -' "," � s :_:�'_. '. " . . 3 ❑As owirer-huilder,I will not emplay an}rone ta do wark which wauld requirc�permit kam Ilro Division of � �-- intlustrial Safery.as nmed above.unless suoh persan�as a permit ro do such vrork from the division. . .. g W ❑a�5�o��������a�sa�N��m,�Ne. TOTAL FEES `� p � � COM1ISTRUCf10N LENOING AGENCY:1 herehy aNi�m that there is a constructbn Imding agency for Me peAmmanu z of�he work for wnich this permii is issued(Stt.3097,Civ.C.�. . Q �ender's Name COMMENTS�---" /~ �'" �T1 �' % p�p LenJer's Address " � "' . , � Q CERTIFICATE OF COMPUANCE ANO 710N OF ENTpY:I urtily 1 M1ave read tl:s applicetian ad swr d . „, _ �, va �ha��Ae information given is carect.1 t comqy wnh all stau laws and city ordinwices rdatinp to buildinp A� � construcuan.and autAoritt a repre tive the OaparUoent of BuiWitq and Sefety to enM tlie praperry ��-' . . . .. - = ro� �iea ro�mis n me o�m mat�ro i�eceo�. . . � � �{ q„•�, � i Sianatwe o�1wu��o Agen� � �a � RECPT NO. � � � PAID BY � w"''``'��� VAI..IDATIO y,� WHITE—Departmerrt Copy,YELLOW—Finance Copy,PINK—Pssessor Copy,OOLDENFiOD—File Copy.GREEN—App6cants Copy BS106-11l89 :,.. �:�: , _ � ,., ., ,:, y x , . , : ,_. ,�. < �,:.: ,.. ,�,..,, , ,eN' � S+ tX � �e €� � nx ���^ �s �u'��* r ,�p .s�;�� :,��+�' �`€ �� �£.��?� a �:� ,��;��:����,��s�,.s�� '�,�#�S?��� � i� ( 11�'3 n �' �' 3.,::�� ¢ �"�.y.���'L �1 S<.«§,� '.s.:�� ����' '�",_."'�:;r� "°`,�i���'�, saa'��`��� �§�'a ' ¥��-� �'�u��'�,:���1��4��y3k:�t;�.a�a`�§t���ai.��'�_�'���,.1"�"����.�as�'�' €�.�T.€V'-�. ���-��+�y€�zs.�_�.�rs��IG�«���s�'�.�� � � �.m• �n� e��, ��� � ai h_;.;* �, x � Y��.� & ,?m �. � €� ���� ��5� .�x't,�` ���,��#��a��a4e:`_�.���� �''td,'�$@ �j`�.� #��"� �A'°�is ,�, �a i ;�1�#. s�....:��r��:` ���' � R � �d:;{� i��'���'::7i,�r���Ef,_�t� 3�'��,'.�-..� ,,z H g,.��p 1;. �`� �'�' i�� ��.:h ��€��,; ������ ���€���� �at� q���� <�.€i��` ���i q��a� E�€ m°�� � �' �� ;�i����€ �- �����, ,�� � �¢ ti��������c��� �s�s.�,�� d�u.r���.....,k,��a(,.�.r���..,.��,�i��..,,�nz���....���_���.���,��. ..,��.,<,��r�P..,,,,:����i .,z���€:€.�.��.t��€_.,,.��a .,,�r .�.Y,�� �.€��€�e��,��.r���i�..�,w,���..,>.����,.��a...:.�.�.����w����.��€«�.,..,�a���m 5 ;.� � �.. . _... _..�._ .. . .... ...__.. _....... __....,. _....... � ...� _......._ . ..._.... ... � , § . i�.¢�.�. i tt ;`a ' y � � K= _.. . ............... �......_..... ... �.3.. ................. . ,.._........... . .......,.._... _ ......_...... _..... ... , �. ._............._._......__. ...... 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