Loading...
HomeMy WebLinkAbout1229t,t cno�u ll ( CITY OF DIAMOND BAR ( PRESS DEPARTMENT OF BUILDING AND SAFETY FIRMLY BUILDING PERMIT JOBSITE 1 ^ � {� 1 ADDRESS y�JUI.'X 7c'l� �• APN LOTS TRACT APPIJDATE CATION ` ��,� Ion NUMB CODE `�I�(��L.CODE ISSUE 0. I TYPEppO�CC. DATE -�_ CONST �TFROUP� CROSS STREET OWNERFRONT ADDRESS L ZONING SETBACKS DAPFKMWNM RW El REAR ❑ SIDE/SIDE STREETRW__ ❑_ L CITY C.� INR ZIP9&71'iTEL9 APPLICANT ANSA P��iArC TELrJ SIDE ❑ CONTRACTOR ADDRESS CITY ale= L�1� ZIP TEL. SEWAGE ❑ PUBLIC PMT 0 DISPOSAL El PRIVATE SO. FT / 100 GAL STATE LIC. NUMBER .����� GRADING ❑ CU. YDS. EXC. CU YDS FILL W, (Wg, TYPE S FT 'F PSS A . AR AL TION _ 1 2ti`•,C; �(,'..' C>.'."� ,� 2 ARCH N c DESIGNER �G J ADDRESS G CIT E ZIP TEL, C3 3 PROPOSED USE S`TR f C .© 4 GARAGE NO. DWEI_. NO. NO. UNITS _ STORIES BEDROOMS— LOT DIMENSIONS I PORCH Imn VALUATION ��?/•%'`> r !� ADO. AREA cauANTITY DESCRIPTION FEf= NO. OF BLDGS HOW ON LOT — USED _ LICEN EO CONTRACTORS with Section 7000) of Dw CLARATION I let by affirm that I am licensed under provisions of Chapter 9 (commencing son 3 of the Business and Professions Code, and my licrose is in lull force and effect' v"y' L'i'r ❑ W OWNER BUILDER DECLARITION I hereby affirm that I am exempt from the Contractor's license Law, la the following reason (Sec. 1031.5. B siness and Professions Code Any city or county which requires a permit to cunstrwi. alter, unprwe, d,in""' or repair any structure, prior to its issuance, also requires the applirant for such permit to file a signed state nt that he is licensed pursuant to the rovislons of Me Contractors License Law (Cha ter 9 (commenting with S hon 1000) of Division 3 0l the Business and Profession Code) a that he is exempt Merehom and the haws Ion t alleged eaemptron. Any vitiation of Section 70315 6y any applicant for a permit subjects the aDPlicant Ia a c' I penalty of not more than rive hundred dollars (S50D) P . (� ✓ _— 1 i�.` 6? fl i ��a't' -+ r's5 a ,•? /y• - '�, / (; tJa9• jr:_s(_].��<-(•�,A .x .; (•i ❑I, as mvnei 1 the property, or trn employees with wages as their sole compensation, will da the wick, aed the structure is not intended or offered for sale (Sac 7044, Business and Professions Code The Contractor's License L aw does not apply to an owner of property who builds or improves thereon, and who does such work himself. or through his own employees, provided that such improvements are not intended ce offered lot sale If, however. thbudding or improvement is sold within ore year of completion, the ownenbuilder will have the burden of proving thae t he did not build or improve for the purpose of sale.):�. , Z Q' ❑I, as Owner nl the properly, am exduswly cantrecuny comb licensed correctors to construct the project (Ser 7044. Bnsinass and Professions Cade. The Contractor's license Law does not apply to in owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) ^, , ❑ I am exempt under Sec , B. h PC (Attach Certificate). PLAN REVIEW Data Osvner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, a a cerinf-te of Workers' Compensation Insurance. or a resolved copy IhaeQ ISec. AkRO,Lab. C.I. ❑ Certified copy is hereby furmahed .i 'ire } Certified copy is filed with the Building Inspection DepanmEht or Department. CERTIFICATE OF EXLMPTION FROM WORKERS' COMPENSATION INSURANCE This section need not be carrpkted ,,,,,..-r; :•'B -'y •-� r pr r'LIIM �.,,/ ,y, -,f•• C CHANICAL; ' CIO'91, ��- � C�C'Nf•� � if the pert is for one hundred (5100) or less 1 certify that in the Ilyfam cpGOF=Lhe wok fa whit this permit is issued, I shall nwt employ any poison in any mqr r4 as opla wEgEcir1o'":Gt�e Nbrkas• compensation Laws of California- • s y �' ;._ '•' p4v "' ,✓ S`MI Nate Applicant U1 IL. PARK FEE SCHOOL FEES � NOTiCE TO APPLICANT. N, alter making Mrs CaLlrate of Epgmption, ,.you should hekoipe sufijecy.ta, •the Nbker's Compensation provisions of the Labor Code. ycd:musl fdrMwilh. corngy wiM'sueh proiiifions a 1hl�perma'hap be deemed revoked DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ❑I hereby certdy that no excavation five (5) a more feet in depth into which a person is required to descend. will he made in connectnm with work wMoraed by this permit. and that to bu" aVuelum. scaltading, fall wrsk, eir demolition or dismantling thereof, will he mere than thirty six (36) feet high (Chep. 3.2, Gip 2, Art 2, See _ i' 341, Title B, CA C.). ❑As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Indtsinal Safety, as noted above, unless such person has a permit to do such work from Iho division. El Division of Industrial Safety Permit No. TOTAL FEES _ r CONSIRUCTION LENDING AGENCY: I hereby affirm that there is a constructoon lending agency for the performance of the work Nor which this permit is issued (Sec 3097, Civ. C.I. Lender's Name ` COMMENTS �" ��'i ��•.. -✓ Ll Lenders Address CERTIFICATE OF COMPLI E O AUT ?JJM OF ENTRY: 1 certify I him reed this application and stab wa r that the in(amation gi rs c t I asin* ' all state laws and city mleti g o building • con$1, two, an tie a reser Depart t of Budding erd Safety to rspm we" n for which h 1 d Nor Perm of king inspedicas. —A0 VV J U `'A, RECPT NO.. PAID BY J VALIDATIO Sgnatae of Apph t or Agent WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy asi 6-1118