HomeMy WebLinkAbout106 (5) '�w"^,1 i l �
�'� CITY OF DIAMOND BAR PRESS
'-�" �' DEPARTMENT OF BUILDINC AND SAFETY
� BUILDING PERMIT FIRMLY
JOBSITE s� � APPLICATION PERMIT I�� USE 1
ADDRESS •�� � � {SST E ��A�,�NYUQM�ER �CCODE
� APN .__ LOT•.. . TRACT � DATE �� ��1 CONST.�GROUP��"�
Q CROSS S EEf_ � ZONING SETBACKS "'�'"E'^S
°� OWNER�I�� �=�'�-' FRC)NT��. ❑
o ADDRES � !�L- t_ ��i�-�.` _�Q'-.r-�- REAR� ❑
W CITY� s' P� .� ' T�L�%��� 5�'�� � SIC�E/ ET RW ❑
� APPLICAN• TE�.�-Zd�� — E �
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a CONTRACTOR �"�' � L' �-_�`�--3--�--' SEWAGE ❑ PUBLIC PMT#
o ADDRF�S _ - _ ' ,�/"-`�--�1��,__�� DISPOSA�
W CITY .._ZiP-z��,t��� T�L� _. ❑ PRIVATE SQ.FT:/100 GAL
� STATE `" GRADING ❑CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER_ � - 'j`�rp� SQ Ft" �AC'f�R P5 ADJ. AREANALUA710N
y ARCHiENG; � 1 �
�' DESIGNER_
� ADDRESS — _�...� L�t, 2 -�
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Z CITY_ ZIP _TEL. � 3 --�"�
� PROPOSED USE "t--Z- ` Z 4
v � GARAGE
o NO.DWEL. NO. NO. � P�R�
� UNiTS STORIES BEDRQOA,"S_ -
� LOT DIMENSIONS m VALUATl�N AOJ.AREA_
o NO.OF BLDGS H�W QiJANTiTY DESCRIPTlO FEE
w ON LOT__ USED_ Q J t,y�" ' �f�
� U
= CC
~ l IG SEO COMRArT9flS OECLARATION I irerehy alfinn thal I am h�ensed under prwisians al Chapce�S lmmmencmA U
� �.vrtl�Sec�ion 7C00�of Dwision 3 nl the Dus�ness and Prnlessions Cade,and mY license is in lull farce and eFfnct �
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_�r*,VUE�BUIi9EN CE(::4NATION I heieCy al'tirm!hal�am exempt�rom�he Contracta:'s l¢ense Lau!ar the ta!low�ng
��reaeon ISec �L31 5 Bus�ness and Pmfessions CMe Any riry or county w�i�h ieqwres a permn m cnnstruct, (j`
o ahe.• �m r.emolish ar repair any svucture pnor;o as issea�u:e,al=o re0wres Ihe applicanl M�smA pe�mn Z —
Q to hir a�s,gnal cfaiemem;�ai he is I¢ensr�Onrsuam m th?piovmons al tne Canvazmr's l�cense Law IChapter p _
� 31�:mai �vnh Secear 70001 nl�ivrsion 3 0l che Busme�s and Profesnons Codel m tha�hx is eKempt therefrom '� —
d, and•he CasisJ�nr!:i.ellegetl aKemp:ion A�ry mnla�ion ot Seelion T031 5 Lry any aD0lrtant!or�pr.rmn su6lecu �
wt:�e apphca�t m�cm:l perahy el not more Ihan live hurvJreC dallan(55001� a
� �I,as mane�rl IAe p•aperty a m�emVloyues wrth•.vages as!neir�ale compensauan,wdl An ihe wo�k,and
~ me s�ucli�re i5 nnt r.necnae cr of!ered fnr sale(Sec 70u4.O��siness and I'�olessrons�ade The Cannar.als Lice�e
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V w does�ot ap��r tr�an ewn��r af�ioperty whn Euilds oi improves Ih�reon,and r•ho dces such�.var1 hunseN (,) - —
w m iPr„w:h nis�•,v�er.Cl.ryees p�o.i0ed rhat Su[n imprcvemen[s are io1 intended o�ofle�eA k��ale If hmvever y
m tue huilnnn o•inprove.menl is sold w'ithin one yenr nl.ampletian,tha owner-builder•xill have d�e 6urden o+p�ovinp Q
� thai he A��:�a�6wIA or imp�ave fo!:he GwDose uf sale i � I I
y �J�_
y �'.d5 IlW1�P.�::I II'P prapenV ein exclu:rvPry:oNractiny wnh htensed canvactms to cons!ru:t the pm�ect lSec �,�J '�— �
'0�.Busircess arc P•ofessions Coae:The Camractor'i Licensr.law Goes nm apply io ar owner ol pmpeny wha � I
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¢ !:�dtls or inprnvrs therron and who r.on!racis Por such projects wnh a cortraetorjsl licensed pw�cant to the Cantracror's I
�.�e�iS�'-°w; CONSTRUCTION _
o � -
� 'am n�emp:�r.der Sec .B 6 F C IAttach Cerldicalel PLAN REVIEW
o n�'� °x'"" ELECTRiC
,¢ 11f:IRKEFS"fCM11PfNSAiIT1 OECLARA710N I haeM affirm tnat I I:ave n cendicaie M ronsent[o self-i�nre.or
a cenrf¢atr.�f�1brKers Compensahon Insurance ar a cenrfied capy ihereol(Se[3800,Lah C1. PLUMBING _
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¢ ❑�ert4ixa caov�s Irereuy fixmsheA � MECHANICAL
o �_endien copv:s ideA wuh me Bmiomg Inspecuon Oepartment or oepanmem �,d^ GRADING _
W
� CER?IFILATE OF EXEM1IPTION FROM WORREHS'COMPENSAT:ON�NSUAANCE ihis setlion neeA nat 6e conplereA � �SSUANCE
y d tne pe�m�t is for one huntlreA IS7001 ar less i cerldy that in ihe ped mance of the work For whKh th�s
permit�s issued,I hall nol employ any perton in any mannei so as to hec sub�eat to Ihe Nbrk 'Compensation S`�IP
� �aw::�i�t m� —' � � PARK FEE
�
a
o r,��e � � aDUhcant ll- SCHOOL FEES I �
� NOTICE TO APPLICANT If,alter naK�ng ihis CcrtiLcale of Eremptior.,you sMu�d 6e rir.suSl��ro the KMMer's .
C�mOensahon plWISq�S of the lahor Cede,you must forthwnh camply with such O�a�isnns ar ihis permil shall
'i br deeireA re.rokrJ. --
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� DIVISION OF IN�USfRIAL SAFETV PEflMI!CEHTIFICATION —_
W
�- ❑I herehvi ceruly that no ezcavauon frve 151 or mare feM in tlepth mtu which a pason is�epuvetl to CescmO.
o�e wdl 6e nade m connecuun wnh work authm¢ed hy Mrs permiL and that na huiWl�simcture,scaftoldinp,falsewark,
n- nr demolrtmr cr ditmamimg Ihe�eef,wJl he more Ihan 1hir1Y-�R 1361�Cet hfBh (CAaO 32.6N 2.Art 2.Sec __.____
x 341,iide8 CACi � ClTY Qr CtAMld(�!D gAA
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3 ❑As nwne�-cmiAer I wtll no�empby amrone to do work w�ah woultl reamre a perm�t tmm�he pv�sm d � SUl�DIAiCy AND S�E7Y
� h�Jusvia!Sa(ety as nated a6ave,unless su[h person has a permit 10 do sueh wark from the division. —
� '
W ❑fhvisian al IrWusmal Salely Pe�mrt No ; TOTAL FEES ! S��
d
f.ONSfRUf.TbN LEN[11NG AGENCY I herehy aHirm tlial thne ii a tonstrucuon lendi�apenry lor Me pertoimance �
Z cf�M worF Im whi.h Ihis permn is issued�Sec 3097,Cir C) �
� ler.der a Name ; COMMENTS
= lender s Addmss �
m
� CERfIiICA7E OF COtrFt1ANCE A�D AUiFpR12AT10N OF ENTflY I ceru(y 1 hpm read Mis appliotim ard state ,
r� that�he��+famanon grve�s rorrect I agree m comply with atl state laws and[�ry ordi�unrn tel�l�q l0 6uilhiq �
y canstmcnun,and autho 'a reDreunlatne af ihe Depanmem of Buildinq and Safely b enmr ypn ihe praperh
= for wh¢h I have appL or Iha permit Mr wpo5!'_ma6ng inspectwns. �r
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Signamre o� oiicam or ayem pe�� RECPT NO-— PAID BY VALIDATION
WHITE—Department Copy, VELIOW—Finance Capy.PlNK—A,sessor Copy.GOLDENROD—File Copy.GREEN—Applicants Copy
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