HomeMy WebLinkAbout1510 (20)nl,�nusu u.�K
CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY FIRMLY
BUILDING PERMIT
JOBSITE ,i n n A�M� n
ADDRESS 1 < L KV 'O
APPLICATION PERMIT USE
DATE NUMBER CODE
ISSUE TYPE OCC.
DATE – CONST. GROUP
APN LOT TRACT
CROSS ST13E, -T
OWNER ,/V�C
ADDRESS 9&0&9_*
AD RESS
CIII TYAt, e ZIP 9/?Llt TEL.
ZONING SETBACKS DNFKW fm
REAR ❑
[:]FRONT RW 0 -
SIDE/SIDE STREET RW ❑
APPLICANT TEL.
SIDE ❑
CONTRACTOR
SEWAGE ❑ PUBLIC PMT A
ADDRESS
CITY ZIP t'L TE
DISPOSAL
- _ _ ❑ PRIVATE FT/ 100 GAL
GRADING ❑ CU. YDS. EXC. CU YDS FILL
STATE
LIC. NUMBER 39
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ARCH/ENG/
DESIGNER
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TYPE SO FT FACTOR PSF ADJ. AREANALUATION
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CITY ZIP TEL.
PROPOSED U.Tni/ /' If U a
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4
GARAGE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
NO. OF BLDGS HowQUANTMY
5
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PORCH / L
VAI UATI ADJ. AREA
DESCRIPTION FEE
ON LOT USED ���
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LICENSED CONTRACTORS OECLARAT13N I hereby effort that I am lensed oder provisions of Chapter 9 (commencing
with Section 70001 of Uwsion 3 of the Business end Prolessions Code, and my license is in loll force and effect
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OWNER MILDER DECLARATION I hereby affirm that I am exempt from the Cotracmi s License Law for the following
reason (Sec 70315. Business and Professions Code Any city or county which requires a permit to construct,
alter, improve, demolish, or repair any structure, prior to its issuance. also requires the sppb«nl for such permit
to file a nvd slaterni that he is licensed pursuant to tit provisions of the Contractors Lksme Law (Chapre
9I(m"arcmg with Scum 70001 of Dr isms 3 of the Business and Profession Code) or that he is nomill thereleom
end One basis for the alleged exemption Arty vwlatm of Section 7031.5 by any applicant for a permit subjects
She applicant in a cad penally of not more than fm hundred dolas 1=500)1.
❑l, as owner of the property. or my employees with wages n thnr sok cermpensation, win do She work, ad
She structure a not intended a offered la sale ISec 7044. Business and Professions Cade The Contrxmr'S License
i Law does net apply to an owner of property who builds o imports thereon, and who does such work hansefl.
or through his own employees, provided that such enptrvements are not intended or offered M sale O, however,
n the Wilding or improvement is sold within one year of completion, the owner -builder will hart the burden of prwip
r that he did nor build or improve for Me purpose of sale.)
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a 1:31, as owner of the property. am taksively contnclay with licensed convactvs to construct the Protect I,SK
7644, Business and Professions Code The Contractor's tic"m Law does not apply to sit wirer of preprty who
Wolds or improves thereon. and who contracts for such projects with a epmracta(s) kctnled pursuant to the Centractar's
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License Lawl
ONSTlov '
PLAN REVIEW
❑ 1 am tempt under Sec. - . B b PC lAnxh Corollate).
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-
ELECTRIC
PLUMBING
MECHANICALus
YORKERS' COMPENSATION DECLAMATION. I hereby allvm the ! hart a rntlkste af consent m sell insure. a
ai Conpensaum Insurance, a a Satisfied copy thrmof ISee. 3800. Lab C).
' a E:'
❑ hereby lurmshed
lied with the Buldug Inspection Department or Depabmnt.
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION HSLIRANCE. This actten need not be eempkmdISS
CE
it the permit e M one hundred ILIODI or less I terbly that n the performance of IN work lot which this
permit is issued. I shag rot employ " person in any manner so as So become arbsect to the W orkai ComFensatmn
Ft
SMIP 1L-7
Laws of California
E
' °ereApplicant
SCHOOL FEES
NOTICE TO APPLICANT. M, after making this Cnlmate df.obtcerne tDKtm 'LL
Compensation prowsons of the Labor Code. you must kr*W do Sari ;wed such proruons or thinPermit SNL
- be deemed revoked t"' L --"'L , r
'- DIVISION OF WOIISTRWL SAFETY PERMIT CERTIFICATION
� ❑I herehy, tertdy slut no excavation five 151 or mite let in depth nm aMcAta penin o raRnird IQdeaend.
– wild be made n connection with wok wtMvN ��yy ��1tes pemri(. 'ghat aha Ineiip atructert, "falling falswvak,
a demeHnn a dismantling tleeeol, tell he m6ie lahw:thirgan,136) Iaec Tiplh. (CND 31. Grp i. An 2. Sec
c 341. Trak 8. CA C.)
I% ❑As ewmr-builder. I will Soot emplay viywo wto de week vrbidh Wald require a permiel loom the Cavities 41
–_ Industrial Safety, as noted above. ruins Seth yawn his t permit Sol do such wok JIM she division
Sol mss; rnr rl .. - •_ k i
❑&visor of Industrial Safety Porik flt.
-.
TOTAL FEES —
CONSTRUCTION LINONG AGENCY. I hereby affirm that than So I co'mu'lo r lending spiny fir 1N pamforrxe
e oI the work for which this pend in issued ISK. 3097, Civ. Q.
r Landa'sName
COMMENTS
p Lender's Adders
IC CERTIFICATE O CFIMPLWNCE AND AITHMZATM OF ENTRY. I worly I ban mad this apicaen end state
7 that the nlamation yven a spree m tavrply with old sate Iwvs and ek'I er61n1r[R reletip m Dutlrq
tpnstruI=. abs of /N Department of &ri kq and Safety to sited open de Property
C for which apple el atekiry iapactiont
RECPT NO. PAID BY VALIDATION MK
srgrreture a ant a Agent
WHITE—Department Copy, YELLOW—Finance Copy. PINK—Assessor L;opy, UULutrvnw—elle copy, UHLt:N— nppicama L opy
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:Pl`f� TANK SIZE
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:Pl`f� TANK SIZE