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HomeMy WebLinkAbout1229 (42)MVIONDaR CITY OF DIAMOND BAR PRESS DEPARTMENT OF BUILDING AND SAFETY FIRMLY BUILDING PERMIT JOBSITE t W^�- � ADDRESS �I � ��L1�7�— �• APPUCATION�WE,S MWUMBER CODE DATE ` ���r U4UUM ppO--CC. DATE �— 1 6�— a= CONSTIBROUP APN LOT: TRACT CROSS STREET OWNER K- ADDRESS SETBACKS NAP110NEtEMTS ZONING FRONT RW ❑ REAR SIDE/SIDE STREET RW ❑ SIDE ❑ CITY C -OSI \ ZIPofi:0a TEL. — APPLICANT `C Y\ TELS CONTRACTOR ADDRESS '1__5kDISPOSAL CITY � LNC ZIP TEL. SEWAGE El PUBLIC PMT # ❑ PRIVATE SO. FT./ 100 GAL STATE (: 1 LIC. NUMBER �—``�C�� S ' GRADING CD CU. YDS. EXC. CU YDFILL tt7. W `TYPE e-'� Ft' Plit"T�C)R /4C1:�: i4—yREi4iiC LLYMQM' 1 1 .2 ICi (rj S r �o ARC CC DESIGNER �J ADDRESS ADDRESS CITYCIA4AUA ZIP TEL. 2 i � 3 PROPOSED USE 5TR t 0 4 GARAGE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS LOT DIMENSIONS PORCH VALUATION 706, - , K, C i ADJ. AREA 2ESCRIPTIO14 : ; FEE NO. OF BLDGS HOWOUANrr ON LOT USED I GO L et LICE EU CUNTRACTORS with Section 7000) of Or v CLARATION I hereby aifkm chat i am Ifcensw under provisions of Chapter 9 (cammercimg stun 3 of the Business and Professions rude, and my license is in full lace end effect < "� ems' '�" ' o C t; T.7 OWNER -BUILDER DECLA TION:1 hereby affirm that I am exempt from the Contractor's License Law for the foltawnrq reason (Sec 7031.5, B mess and Profesalens Code Any oily or county whish requires a permit m t4nftrael, alter- improve. demolish a repair any structure. prior m i¢ tsswrce. also requires the apppcant fa wch pwmii ro file a signed state ni that he is Incensed paswnt m the provisions of lfie Cantrxtar's liurme lnw (Chapter's 9 (comniencmg with S tion 70001 of Divisan 3 of the Business and Prohssions Cade) a that he is awempt therefrom and the basis for alleged ecamphon_ Any violation d Section 7031.5 by any applicant for a permit fueeth the applicant ro a c it penalty of not more than fore hundred dopers (55001.1:: ❑I, as awne/ f the or.or my employees with wages as their &die compenaoon, wit do the work. rd de structure is not intended or offered for sok (Sec. 7044, Busuress and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who doss such work himself, cr through his own empdcRes, provided that such mrprove-m. are net intended or offered fin sok If. however, the building or improvement is sold wahm one year of completion, the miner-mrilder will have the burden of proving that he did not build or improve for the purpose of sale.). ❑I, as owner of the property, we ewe4orvafy contracting with fcenfed contractors to construct the project IS. 7044, &&v aro Pnolessans Lode: The Contractor's License taw does not apply to an owner of property who builds or ininies thereon, and who couniracts Ia such projects with a eontracton(s) kcedsed porswnt m the Cmnactoi s License Law I 1 L Sys doJy �V .; .� L�/F 7N�_T iZ: ���.� N/. •3• 7 (_s - } tgf CTIO ❑ I am .-rot under sac. B Is PC (Attach certificate) 'PLAN REVIEW Date Owner MBING t �© CHANICAL 2 . 00 WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to sdl•neun, w a certificate of N4rkei Compensation Insurance, or a cehfied copy th. Isere. r18p0 Lab. C.I.PIU ❑ Certified copy is hereby furnished;,, •t , ,-7 Cernfed copy is filed with the Building Inspection Depat4l a �`. OMarnnnt. CERTIFICATE OF EXEMPTION FROM WORKERS" COMPENSATION INSURANCE" This section naw rot he completed if the perms is for vrur humored ii1001 0 leas I [entity tiler m dr�omrlrjse�he work for which' this permit is issued. I gall not employ arty person in any ma�ii�r(sl as au Hbrkeri Carpewim Laws of Caldnrma. ger '� oat` Applicant NOTICE TO APPLICANT if, after making this Certil'ca)e,ol F;reluiWioq- yarsM�dd'besarre'asrbieei'.tq the L6xxker's Caopensraon provisions of the Labor Cade. yid rpint f¢thwdh.comgby w`nh'sochr iwu. gi, thr�pemin shelf be deemed revoked. _ ' S•MI , Lj D PARK FEE SCHOOL FEES OVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATIUN: ❑I hereby ceady that no excavation live (5) re more feet in depth nm which a person n regufred m dNand. will be made in connection with work aWrrow by this proton. and that no building structure, scaffoldils felsewwk, or demolition or itsmantkng thereof, will he more than thirty -m 138) kat Leigh. IDQP. 3.2. Grp 2, Art 2, Sas ' 341, Title 8, CACI. DAs owner -builder, I will not employ anyone td do work which would require a permit ham ilk Division of Industrial Safely. as road above. unless such person has a permit m do such work ban the division. Brown of Industrial safety Permit No. TOTAL FEES CONSTRUCTION LENDING AGENCY I he* affirm that there is a wnstrucbon lending agency for de per famerae of the work for which this permit is issued (Sao. 3097. Civ. C.). Lender's Name COMMENTS C� la �• Leader's Address l3:RfIFICNTE OF COMPLI E AUf OF ENTRY: I conily 1 have read this appEoles and Thee that theerfamaaon is . I to w an star laws ad dry teYteg Wldp crosirucT. oe a sent Della t a firilhug end Sally to kc qct property for which 1 h d for perm se of .. inspacaana. i X D Ly RECPT NO. PAID BY VAUDATICItIQL Signature of Apply t a Agent WHITE—Department Copy, YE' LOW—Finance Copy, PINK—Assessor Copy. GOLDENROD—File Copy, GREEN— Applicants Qw BS106-17/8 i + II � I 4 _ -- I I I 1 {3' L3�= UJ LC3 ti C�..tEci G�'7,i I� UJ=lCpl{j'F-:,cty CL b 0 T_' C1.t3 -CC 4u zE C1 t3` ? '�� �' F"EL"}; (Cgulu�QaazOazt. turc)W;wzwl> I • tie 1S I fa` =d` .a }» 0. .1 CC IIff i ( icS 7}.. 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