HomeMy WebLinkAbout1337 (14) _ __ __ -
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'('� CITY F �IC' � `'�
O DIAMOND BAR pRESS
� �`" DEPARTMENT OF BUILDING AND SAFETY
•^� BUILDING PERAAIT FIRMLY
JOBSITE ,../ APPUCATION PERMIT / �� USE
ADDRESS �j �� L � DATE ��-��UMBER �i �� CODE
— ISSUE
! APN LOT TRACT DATE ���" �� CONST: G OUP "
o cRoss sr ET SETBACKS ���
°O pWNER ZONING FRONT Ryy [�
o ADDRE S REAR CI
W CITY ` � ZiPp- TEL. SIDE/SIDE STREET RW C�
o APPLICAN7 TEL.�� SIDE �
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4 CONTRACTOR__.t���L "� S�WAGE ,
o ADDRE�s DISPOSAL IO PUBUC PMT#�
„� CI�Y L��.��, ZlP Z-�-- T L. ❑ PRIVATE SQ.FT.1100 GAL
a STATE �/
� LIC.NUMBER '7''�I CS � GRADING C�CU.YDS.EXC. CU YDS FIIL
y ��T�"7��,:._��,� ; �'�"�!7 ta .���.ra`. Fl� ,�..��V/1��1JT�1
y ARCH/ENG/ " �_
". DESIGNER �` � `�C} � �
Q. FiDD S � �'
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�, CITY ZIP TEL �; 3
, � PFiOP�S�D USE � 4
o' • C�= �ARAGE
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o' NO.DWEL. : NO. ' NO. �; pORCH
y UNITS STORIES BEDROOMS ' `
� LOT DIMENSIONS � VALUATION - ADJ.AREA
c: NO.OF BLDGS HOW �, Qtipt�tTliY =C����F�1F!�I�I - =:F�+� :` ;' ., -
W ON LOT USED � g� �
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: LICENSEO WNTflACTORS OECtARAT10N�1 hereby atfirm that I am Gcensed uMer provisians of Chapta 9�commencing �''` . , �
�j wdh Section 7000�of Oivision 3 of the Business and Prufessions Cade,and my ficense is in full�wce and etlect r.�; � . � - . .� ,
3, � `y�
LL;' P.VNER�BUILDER OECLARATION:I herehy affirm�Aa�I am ezempt kom Me Con�racWr's License Law far the�dlawing
_,; rrasun(Sec 7031.5.Business anA Professons Code:Any nry or eounly which requir¢t a permit to cunstruct �}" ��, I � . .
o alter.improve.tlemdish,or repai�any structure.prior ta its issuance,alsa requiies the applicant inr such-permit 2r�° �
6; ta'ile a signed stu�emenl tliat he is IicenseJ pmsuant la IAe pmviams ol the Convacmr'a ticense Law iChapt� m; . �
Q. 9(eommencing with Section 7000�af Division 3 of ihe Business and Pmtessions Code)or�hat he is exemDt Merefrom '�„4, f
�., and the hasis for the alleged eeemp6on.Any violation at SecOon 7031.5 6y any appli�am tar a permit subjects �:. �Lj�, - —•-� ��'`��
��- the applicant to a civil penahy nf not mo�e Ihmi fue hu�red dollars(S50D�.1: � � -.1;`.
�.
` �'
pn� ❑I,as aw�er ot th^property,or my employees with wages es their sole rnmpensetion,wdl da Me work,mM --
~`, the nmcture is mt imended or offered�fa sak�Sec.70M14;8usiness and Profassions:Cade:The Commctor's Gcense :(;; `
j'' law does iro1 appiy to an owne�of propenV wha builds or imOrwes ihereon,and who doea Suth work himsell {;�:, �"7 + `� .
�: o�ihmugh his own employees,pmuided tnat such hnp�memeots are nb inteneM or oflered far sale.If,however �; � .
m� the huilding or improvement is sold within ane year af�ompletian,the ownervbuilder will have the hwAen oi Omvinp +�; �
y;_ that he did nat buib or improve for the purpose ol sale.i ,�':. ,
e�ii ❑I,as owrer of fh8 p�openy,am exclusively cantraetiny with liceneed contractoro to caosttuct�he prqect�SeC {�jj�; -
`' 7044,Business anG Professions Cade:The Camractoi s ticense law doez not apply ro an avnei of prope�ty wha �- ' � -
Z� 6uilds or improves ihereon,and who contners br such Orajects witli a tontwttor�s�licrosed ptirtuant lo the Cuntr�cfa s �- --------�.—._....
'¢` '1e"��a`"'� ,` CONS7RUCTION �. ��o �
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�;.❑I am exempt umler Sac. .8_Q P.L.(Anxh Cenitiralel �,;PLAN �tEViE W ��_! ��
o; oa�e oH�e� =ELECTR �(�� , C`.3f"�
Q.' WURKERS'COMPENSAT�DN OECIABATION:I heieby affirm that I have e cerpficete of consent to sdl�insme,a ;•�P M81NG �� ��
Q'� a certificate of Nhrker5'Compensation Insarance,or a certified copy theteot(Sec.3800,lab.C.�, �
�`❑ e�nsed capy is hweby furnished. 'MECHANICAL � �'. C�d
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o, ertified copy is filed with ihe Buiiding Inspection Depa�iment a Oepanmem ��GRADI
W
��. RiIFIGATE OF EXEMPTION FflOM WORKERS'COMPENSATION INSUflANCE:This xction need iat be compkted -.ISSUQ Q - -� -
y,: if the permi]is for one hundred IS700)or less.I certify tAa1 in the pwinrmenCe of ihe xwrk tor�which"ihis �:. , - - )
permit is issued,1 shall not employ arry pe�son in any manner so �ro 6ecome sub� to th¢Nbrke�s'Canpensatian p l
__ laws�ofCalrfornia. _ � JM' � . . , �—`-� � -
� �(�- �� 'PARK FEE
p( Date� Apo�icanl ' _
�_. NOT�CE TO APPLICANT:It,after making ihis Certdkate af Ezemption,you siwuld hecome subjec�to ihe Waker's ��SCHOOL FEES �
—�( Compensation U�ovisianz ot the lahor CoOe,you must faihwith wmply with such prwisions w this permit shall
- �LL::- he deemed revoked. � � -
J
�: qVISION OF INaISfNWL SAFETY PERMIT CEflTIfICATtON:
y
- ❑1 herehy cerMV thai no excavalan frve(51 or more fee�in dept mto w a person is tepuired to desceM
��� will he mede��i conneciron with wmk au0wr¢¢d by Ihis perm tl�;°qo��ucture,xaffolding,f�lse�mrk
�' or demoli�iun ar dismantling thereaf,wi�l he more Man Mrt� JSh�h�gh ap.3.2,Gry 2,Ait 2,Sec
W' 341.TiBe 8.C.A.C.1. ` �; �'� �' =^..' .
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3` ❑As owner�A�aldar,1 will not empky anyo�re to do work which xrould�equire a permit irom tlrc Oivisbn ol -.
h�. ��distnal Safery,as noceA a6ove,unless sucM1 pefson has a permit t0 o such xror�C�r diui5iort
�� "`°� � � ��,��
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W oa�"'�a����'a�s�ery��m'�No. TOTAL FEES � � � i
o..
� CONSTRUCTION LEt�IAG AGENCY:�here6y aHirm d�at there is�canetrue6on I�ndi�g apmcy fa the per(om�srce
Z� of tAe work lai wh¢h mis pemxt fs fssued(S 3097 Crv F�.R-- � , „, , .
�-
� tender s Name COMMENTS �,sL� �/'�. �� ��)2"7'"� [`��
�- Lender's Addiess '-: . :.; ....... , , �, `�
m �„�,�U.S"U�Z.tz irye;,{� CJ�G r�=> '�"_.,
Q CERTIFICATE 0 COIdPL1ANCE ANO AUTlqPoZATqN OF ENiqY:1 catify 1 han med tlda appliution aid shoe
y t�at Me inid eon given is wrect I agree to c�mply with all stau laws and airy ordirunces reqOrq to 6uil�ip .
y: construclion, d autlwrize a r senlative af the pepaztment ol BuiNiig mM Safety ro enW ipm IM property - .
= fw which 1 �e applied tar il lor the pupose af matiiq inspxtions. -��.,�.
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� 6 L7e'��I� , �..�.
� Sipnatae af Appikant o�Agem po� RECPT NO.a�__PAID BYL��� ���' VAUDATION
WHITE—Department Copy,YEILOW—Finance Copy,P�NK-0.ssessor Copy,GOLDENROD—File Copy,GREEN—Applicants COpy .
:"; 85106-17/89 . . .. ... �: ' - .. .. , ... . ��.`��
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