HomeMy WebLinkAbout1406--
>:.
- �
CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY PRESS
BUILDING PERMIT FIRMLY
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy
21:3106-11;89
JOBSITE
�'® �
APPLICATION PERMIT USE
6
c
ADDRESS ' t
NUMBER CODE
SSTUE /j PE 0I
DATE W 10 _�S.n! CONST. GROUP
APN LO
_ T' TRACT> 31S50
='
CROSS STREET,�r�t%1�i►QG'
SETBACKSPAPFAmktwm
ZONING .. FROPJT °• RW ❑
K
OWNER F(�$41 5 1°= QNU
y;
REAR __'_— ___ Ely;
ADDRESS/ . A- i? _
CIT 1 ti ZIP I !Ii TEI`�i L:
I SIDE/SIDE STREET RW ❑
z
APPLICANT _V -s-- TF4?
J SIDE _ _ ❑
3
CONTRACTOL
==;
�5_.—
ADDRESS%%S
SEdaVAGE ❑ PUBLIC PMT #e
DISPOSAL
' �.' �
'.
❑ PRIVATE SQ. FT./100 GAL_
ED
CITY�4'1-P� i�%EIKk�u� INCJ ZIf TE4.L�t'"$" '��i
GRADING_P _❑ CU. YDS. EXC. CU YDS FILL
_:
vs
STATE
LIC. NUMBER
a'
1:o
TYPE SQ FT
FACTOR PSF ADJ. AREANALU_ATION
ARCH/ENG/
DESIGNER _
LLI
1
I_ I
ADDRESS
LL
—'�
2
1
3
ti'_;
CITY 7_IP — TEL.
PROPOSED USE Cr rV tI itr11Y11Vf s
4 —
�_
—
ci
NO. DWEL. NO. NO.
�
PORCH���
u
UNITS STORIES BEDROOMS _
VALUATION QADJ. AREA
cc:
LOT DIMENSIONS �_ _
e=
NO. OF LDGS HOW
OLIANTITY
DESCAI FEE
>
ON USED__
a
o
Ir
f-
--
----
~'
HCENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
W
ac
•" Section 7000' of M%isian 3 of the Business and Professions Code, and my license is In full force and effect
•+.
PNNEH BUILDER DECLARATIONhereby affirm that I am exempt from the Comrmmr's License Law for the following
•easen 1Sec 7731 5 Busiress and Professions Code Any city or county which requires a permit to construct.
E3
z
�e
C5
;d¢•r improve vemvksh, at neper any mructwe, poor to its issuance, also renunes the applicant for such permit
gQ
l
-�
�;:
to f11a a signed statersent that he is licensed pursuant to the provisions of the Contractor's License Law Chapter
ac:
co.
9 ;romon ring with Senior 7000) of Onnsum 3 of the Business and Professions Code) or that tie is exempt therolmm
and thebass Inn the alleged oxampbon Any violation of Sechor. 70315 by any applicant for a permit subsects
'1 .-^�•'-f,��� r`�
u:t
the applicant Ic a civil penalty of not mom than live hundred dollars 1$5001—
a.
~-
❑I as uwrrer rr the pmpmry, or my employees with wages as their sole compensator will do the work, and
Q
(�
�} ._ r1
! ' s � \ A ,
the sit•acture is not Intended or offered Ia sale jSec. 7044 Business and Ptatessions Code The Contractor's License
Low eves int apply is ap owner or property who builds or improves thereon and who does such work himself.
or dhrough ills own employees.provided that such Improvements are not intended or offered lot sale If, however.
Z
yr
a/
9,c bullmi, 3r improvement is sold wnhm one year of completion, the ownerbuilder will have the burden of proving
ci
mJt he cm not build or Improve fpr the purpose of sale ;
v:_i
C -I ps owner of Irr. property. am eacrosvaly contracting with licensed contractors to construct the project (Sec.
Idyl
aS
i —
7044, Bus ,ecs and Professions Code The Contractor's License Law does not apply to an owner of property who
�sC
builds m Improves thereon and who concraris for such projects with a connactor(sl licensed pursuant to the Centracta's
Ir.:arse local
s. ..• : ".
ONSTRUCTIO14
u:i
L, I am ox -pt under Sec - B •6 PC (Attach Cerliticatel
PLAN REVIEW
,
Date- Ownm -
y �.•
ea
2
� i
..LRii.- ✓ice
�-r'��h`— + �^+� l l
WORKERS ' COMPENSATION DECLAflATION hereby affirm that I have a certificate of consent toseltmsure, a
u : erhhcarr. of WorkersCompersation Insurance, or a certified copy thereof (Sec 3800, Lab C I.
�n
.
Certified copy is hereby lamshed
12
co
4J
h led copy is feed wrath the Building Inspection Department or Oepartmenl
GRADING --
L�
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need ,at be'comploi19§j4-hid,
_
_-"d
v9
II the permit :s for one hundred (51001 or less I centdy that �n the performance of the, work for which this
-
permit is issued, I shall riot employ any person in any Importer porter so as to become subleti the Workers Compensation
_••
Laws of CahFnrnw cv/-
Dare L a Applicant - 'G'Lr !"'-
PARK FEE
co
t-"
LL
SCHOOL_ FEES
NUT TO APPLICANT If, after making this Certificate of Exemption. you should became Ielect to the Workers
-__r
Compensation provisions of the Labor Code, you must forthwith comply with such pros res or this permit shall
'i-
>-
be deemed revoked
c::
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
a-
❑I hereby certify that no excavation five.l5i al -mine leef,m depth Into which a person is required to descend
will be made it connection with work autlgareed h'% ihis`pe nut: and that no building structure scaffolding, false i
n_
air demoldmn or dismantling thereof, will be more than thirty -ss 136) Feet high (Chap 3.2, Grp 2. An 2. Sec
---
341. Tide B. C.A C 1
i
3^
C As owner -builder, I will not em�luy't Yore ito d6tvyo4:a.Ih -ovoid require a permit from the Qwsiore of
-
Industrial Safety, as noted above, unTess.slicle'person ha"s9 p iradi' Ao such work from the division
�r
y,I
o_
E] Division of Industrial Safety Permit No -
TOTAL FEES
CONSTRUCTgN LENDING A6ENDY, I Hereby affirm that there is a rdrshtibUon lending agcmcy for stir performances
7'.
of Ilia work for which this permit ts Issued (Sec .• 3097; Civ. C I.
a5
Lender's Nam "'---�
COMMENTS._.-._�
lender's Address
an
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY. I certify I haw read this application aril state
sc
III
that the informal gown is earect I agree to comply with all state laws and city ordinances retailing to IariNing
CJI
construction, and authorize a representative of the Department of Building and Safety to trier upon the property
3:
k"X
for which I haw appl�pwmitse d making mspstions
/3
' —' I
✓
RECPT NO. PAID BY VALIDATION
Sgnatae of Kant or Agent pate
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy
21:3106-11;89
