HomeMy WebLinkAbout114 (5)._.,• • . .
W ''-*-- CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT
PRESS
FIRMLY
JOBSITE
�. �L
ESS ! 3 Lag g � �
ADDRESS
CATION
DATE UM
�� 80) NBER �CODE
ISSUE TYPE OCC.
DATE __1l CONST.S h-� GROUP
-_— —
�APN LOT TRACT
! CROSS £ ET
I OWNER
ADDRESSf_)A/ '5
ZONING SETBACKS "-ROUEMEYts
r FRONT- ❑
I REAR ___ ❑
I SIDE,��TREET ^ RW ❑
I CITY>,� j� �'-e P �2J TEL.`/may{' 3�/'
A—PP—LICANT r_ TEL—29,4
I CONTRACTOR�—
ADDR-;1CL
CITY1 IIII ZIP ��%�ta TEL
J SIDE ❑
SEWAGE ❑ PUBLIC PMT
DISPOSAL ❑ PRIVATE 50. FT./ 100 GAL
GRADING ❑ CU. YDS. EXC. CU YDS FILL
STATE J
(0
W
TYPE
1
SQ FT FACTOR PSF ADJ. ARE LUATION
ARCH/ENG/ --
I DESIGNER
ADDRESS—
LLL.
2
CITY ZIP TEL.
t'3
Z
3
4
PROPOSED USE f!5_c --
®
GARAGE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
PORCH
Uj
-
VALUATION ADJ. AREA
QUANTITY
DESCRIPTION FEE
NO, OF BLDGS HOW
O�j,(N LOT USED
jY
! :C'.NSED ..ON'TNACTORS IECLARATION 1 hereby afhm: That I am licensed inner provismns of Chapter 9 (commencing
V—
liA
�•• 4,I 70Mcl D-eno 3 of the Rushress and Pro{essmns Code. and my Intense is in full farce amf ahem
!JJ
itvyYt.�+ RLIILDER CFC. ARATION I hereby alhrm that I am exempt from the Contractor's License Law for me lollowmg
i Iea,,.1 isic %C37 5 Business and P:alesa,n (:Me Any city or county wluch requires a permit to construct,
inti• mgrnw ':r.^rlis^, a repair any structure. pro' to Itsissuance also requires the appficant far such permit
lea angled $dr in mat he is 41 nmm pursuant ro the innprovisionsPi.fa , the ConCando a,cth s e is se Law !Chapter
• ru•rmari•r w m Secau: 7G;10i n1 Orvmon 3 of the Business and P:olessions Cpdm or that he is exempt therrhom
(;#
—
2
m
�
�n rhe ha4is :st h^.e allegnd erema cm Ary vmlanon M Section 70315 by any appkinst Mr a permit rahlects
ter ap1'h-art Io a -1 rervalty of not more than live hundred dollars (S5001;CL
..a
i f JIas rnvnor vt !^.x property, or my employees with wages as their sole compensation will do the work, and
rl the sn ;Noce ,s cul n!erded or Me- for sale Get, 7044, Business and Professions Code The Contractors License
I law 9 rs rrt apply to a ,caner o° progeny who builds m mproves thereon and who does such work himself,
�–
<
0
Z
Q
—I that such uaprovements are at otended n• Mlered for sale If however
'he :n III I r imp•avumeof .s sold wn!•m one year of completion. The owns hmlder -will have the burden of prawng
i rn tl•m;nlc his uwr o"r,,.
I,hr d d +ri Wr IA or improve ear the purpose of sale I
JI, as owrei •:I !;:; ^rpm:y. arc exclusively cantrachn5 with licensed contractors to construct the protect ISec
1144. Bus�nes did ornfessm�s Code The Contractor's License law does not apply to an owner of praperty who
wildsh mPraves tie•oor. ar u who caPliects for such prgecls with a [antraclorlsi licensed pursuanl to the Ortractor's
7:
YU
Law r
CONSTRUCTION
ar cramp; II Sec . B Er PC (Attach Certificate)
I
PLAN REVIEW
Dale Owner
_
ELECTRIC _
PLUMBING
MECHANICAL
WDRKFRSI COMPENSATION DECLARATION I hereby affirm that I have a certificate of c'"sent to self -insure or
s cert•hrate if Mira- Cumpersabun Insurance, or a certified copy thereof ISe[ 3800. Lab CI
t L� e:[aieu copy is emev hxrnshed
1� Cerefic1 rapt/ �s [dad will me Bmtmng Inspection Department or Department
GRADING
V\
i ;:EriTdt;ATE OF E%EMPTION FROM WORKERS COMPENSATION INSURANCE This serhan need not he. completed
ISSUANCE = c
i d the prom: �,s for ane umsdred i51D01 or less i rectify that m IM performance at the work for which this
IICrmlt is issued I hall not employ arty person in any manner so as ha me sutitech to the Nos C perecanon
I Laws If t:�Afp'm T r .i am 9 �j
lIl `
DOT>Appsiaa"
� NOTICE i0 APPLICANT If after making this Cprvin:ate of Exemption, you should iatte sublttt to the Workers
0
LL!
LCL.
SM IP
PARK FEE
SCHOOL FEES
C hmpensaunn prnws:ons at the Labor Code you must forthwith comply with such provisions of this permit shall
be leeriwl revo4ed
1
--
IN6151ON OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
i
i . El hereby r.ertdv that na eacavatron Iwo (5) or more feel in depth ..Is which a person is required to des[md,
t�
CITY ®F DIAMOND 13A
will he made al Initiation with work autho•ued by this permh. and that ro budding structure. scaffaldmg. falsework.
u demoannn or che— hng thereof will he more than thirty-six (36) feel high. (Chap 32 Grp 2• Art 2• Sec
1 Sri 1. Tine B, CA C.I
BUILDING AND SAFETY
• l 1_7As owner budder I will not employ, anyone to do work which would require a permis from the Division of
Inhrsura: Safety as noted atiave, unless such person has a perm., to do such work from she diwsimi
1
❑Dr-mr: at Indusluai Safety Permit No
TOTAL FEES z 0
s CONSTRUCTION i.ENDING AGENCY I hereby affirm that there is a co.,strutnnn lending agency Ion the performerxe
cf the wink far wh;rh this permit is issued (Sec 3097. Civ C I.
i Lorde(s Name
COMMENTS
jantler's Address
' CERTIFICATE DF COMPLIANCE AND AUfNOR12ATEIN OF ENTRY 1 mortify I her read this appliatmn and state
I
a mat fl, enlormanun .,wen i arrect I agree to comply with all state laws and city ordinances relating to building
corsrrurnon. and authon P emotive of the Department of Bunldinq and Safety to en upon the poperry
fur winch I have app - orp or t� the p i fdkmg inspect s `
RE NO. _ __ _�_ PAID BY VALIDATION
Signature of Applant o' Algiers pa�
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy