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HomeMy WebLinkAbout1229 (43)d,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 ` \VE,1V mCMIER`�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.� 1 N R 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 ttl, (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 ZIP3%L')- [r. 3 PROPOSED USE S`TR f C .© 4 GARAGE NO. DWEI_. NO. NO.. UNITS _ STORIES BEDROOMS— LOT DIMENSIONS PORCH VALUATION ��?/•%'`> r !� ADO. AREA OILIANTITY Q9SC;RIPTION FEE NO. OF BLDGS HOW ON LOT — USED��� ' - 0 C. UCEN EO CONTRACTORS with Section 7000) of ow 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 ❑ 1X3 DINNER 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 requirespermit to cunstrwi. alter, a rprove, demolish or repair any structure, prior to its issuance, also requires the appla icant for such permit to file a signed state nt that he is licensed pursuant to the rovislons of the Contractors License Law (Chapter 9 (commenting with S hon 1000) of Division 3 0l the Business and ProfessionCode) a that he is exempt therefrom and the basis Int t alleged exemption. Any violation of Secuon 70315 by any applicant for a permit subjects the applicant to a c' d penalty of not more than five hundred dollars 1411 . (� ✓ _— 1 i�.` 6? fl i ��a't' -+ r's5 a ,•? /y• •z '�,� / (; tJa9• jr:_s(_].��<- � •�,� .x .; (•i '--'� ❑I, as mvnei 1 the pmpeny, or my employees with wages as their sole compensation, will da the wick, aril the structure is not intended or offered for sale (Sac 7044, Business and Professions Code The Contractor's License law does not apply to an owner of property who builds or improves thereon, and who does such work himaell. 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 ownerbmlder will have the burden of proving thae t he did not build or improve for the purpose of sale.):�. , Z Q' ❑I, as Owner of the property, am exdusialy cantractmy with licensed correctors to construct the project (Ser 7044. Bnsiress and Professions Cade. The Contractor's license Law does not apply to in owner of property who builds or improves the eon, and who contracts for such projects with a contrastor(s) licensed pursuant to the Contractor's License Law.) ^, , ❑ I am exempt under See , B. b PC (Attach Certificate). PLAN REVIEW Data Dwner 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 ll jeQ ISec. }RflDllah. C.I. i` s. ❑Certified copy is hereby furmahed .i 'ire } Ceruhed copy is filed with the Building Inspection Delusion ht a Department. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need not ca carrpleted ,..,,.r-r.:B-'y •-� rpr r'LIIM �.,,/ ,y, -,f•• C CHANICAL; CIO ��-� C�C'Nf•�� if the pernnt is for one hundred (5100) a less 1 certify that in the flyfam cpGOF=Lhe wok fa whkN this permit is issued, I shall not employ any poison in any mgrm as opla So=,!ir1o'":Gt�e Nbrkas• Compensation Laws of California- y �' :_ '•' p4v ,✓ S`MI Nate ApplicantIL. PARK FEE SCHOOL FEES � NOTiCE TO APPLICANT. N, alter making this CerLlrate of Epgmption, ,.you should hekoipe sufijecy.ta, •the Nbker's Compensation provisions of the Labor Code. ycd:musl fdrmwith. comply with'such proiifions of 1hl�perma Shap be deemed revoked DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ❑I hereby certdy that no excavation five (5) or more feet in depth into which a person a required to descend. will he made in connectam art work autttaaed by this Perron. and that to buBdig Wuclttb. staltddinp, fatsework, w demolition or dismantling thereof, will he mere than thirty six (36) feet high (Chop. 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 Industrial Safety, as noted above, unless such person has a permit to do such wok from ttm division. 1:1 Division of Industrial Safety Permit No TOTAL FEES v Wy CONSIRUCHIN LENDING AGENCY: I hereby affirm that there is a constructoon lending agency for the prfamms of the work Nor which this permit is issued (Sec 3097, Civ. C.I. Lender's Name � 4 ` COMMENTS ��''/ ��•.. -✓ L1 Lenders Address CERTIFICATE OF COMPLI E 0 AUT ?JJM OF ENTRY: 1 certify I him reed this application and stab in* ' all state laws and city rabli g jus building r that the in(amation gi rs c t I aswa • con$1, two, an ue a resent Depart t of Budding aril Safety 'A sspm go" to which h 1 d Ia perm of king inspeetioas. JU y n VV RECPT NO. -L_ PAID BY J VALIDATIO Sgnatoe of Apph t or Agent WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy asi 6-1118