HomeMy WebLinkAbout1229 (45)CITY OF DIAMOND. BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY
RtJ1I nING PERUIT FIRMLY
JOBSITE , �y 1�r^ r�
ADDRESS CL_\t_ ��1i- ��J
APPLICATION IT USE
_T ���� 5 , ` ffl MBER 12ke CODE
SUE DATE I ~1 ,�v� ,U TYPE pO-CC.
DATE �" �►o CONST `FROUP
APN LOT TRACT
CROSS STREET
OWNER
ADDRESS Com iia ��—�-
ZONING SETBACKS
FRONT RW 0
REAR ❑
CITY C09 —ZIP]02k TE
SIDE/SIDE STREET RW ❑
APPLICANT b AI &SA S"t' iiii, TEL
SIDE 13
CONTRACTOR
ADDRESS
CITY GL��� ZIP TEL,
SEWAGE ❑ PUBLIC PMT #
DISPOSAL D PRNATE SQ. FT./ 100 GAL
GRADING ❑ CU. YDS. EXC. CU YDS FILL
STATE p 1 1
LIC. NUMBER ��-\"C
U
TYPE 80fT FflCii APS - ADI,AREAtV N
I ,25.60 G 6 57, &
ARCPQRrY
DESIGNER `� �
ADDRESS
CIT E ZIP TEL.b&M
Ij,
2
0
3
PROPOSED USE `J'TR t
Z
4
GARAGE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
PARCH
VALUATION 706o -ei C ADJ. AREA
NO. OF BLDGS HOW
P�Si3�X'
ON LOT USEDo
01JRMMY &Scs"PTION
, } pp L 7 c�c" _�• d C)
UCEN ED CONTRACTORS
with Section 7000) of Diu
CLARATK)N, I barely alhrm That I am keened uprounn ioof ehapler 9 (CNWW eilq
own 3 of the Business ectal Professions Cade, and my license is in full face and effect
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OWNER BUILDER DELL TK1N: I hereby a15rm that I am erempt frons the Cuntractw's Lcenae Law la du fallowing
reason ISec 70315, messend Pmlesaitins Code Any city or county which requires a permit to cautruct.
alter, improve, demolish a repair any structure, prim to as issuance. also requires the applicant for sash permit
m file a signed stale nt that he is licensed pusant to the provisions of Cs Contraaw's Lirane law 1Clepta
9 (commencing with S tort 70001 of Division 3 of the Business and Prohissnns Code) ce that he is exempt therefrom
and the basis for alleged exemplon. Any violation d Se ion 7031.5 by airy applicant for a permit suhiecb
uta applicant m a c 4 pian,", of Mt mare than hi hundred dollars ($50061.
01, a5 owner t the property, a my employees with wages as It sale compensation, will do the work, and
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tlrz structure c nor intended or offered fa sale (Sec. 7044, Business and Prolescions Code: The Contracca's Liume
Law does not apd, to m miner of property who, builds a improves thereon, and who does surA work hllnadf.
or through his awn employees. provided their such wtiprmsmmN are not intended a offered fa sNe. R. however.
die building a improvement is old within ope yea of campletim, the awnm-alder w41 haus the burden of proving
that he did not build a improve for the purpose of sale.)
❑I. as minter of the property. am exdus illy cantraainy With licensed cantrectaS to construct the protect (Sas.
7044, Business and Professions Code. The Coolliclor's License Law does not apply m m owner � property who
builds or imps— Ifierem, and who Contracts Ice such projects with a =[,aawls) gcaned pursuant er Ila Cantraster S
Won. Law.)
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❑ I am asempt order Sea . B. 9 P.C. (Artach eartilcare)
PLAN REVIEW
Date Dwne
'
,
MBING
HANICA F g e Q
'MIKERS' COMPENSATION DECLARATION I hereby allirm That I have a ceniiicare of cunsmn er se"-nsere, or
a cenilicare of Nblkeri Cmpansnsn Insasnce, a a certified ceP1' tAaeb (Sec I'La6. e.).
❑ Certified copy n hereby famished. � Ep t3 :i
Certified copy is filed with me Building Inspection Depv i a Opartmerml
CERTIFICATE OF EXEMPTION FROM MKERS' COMPENSATION IfpSIIRANLE This section seed rant he completed
d the permit d, (s ane hundred (3 100) o Mas. I cerkfy that m gtq a� oaks mpen Ihis
permit is issued. I shag im empty any person in airy mat i}r}s[t as eLe1e yIhSLNra' Cotrtpensalon
Laws of California • s ..
SMI
Date Appli—t
[U
PARK FEE
SCHOOL FEES
NOTICE TO APPLICANT U, ,her making this cesegrate,m Exclow"; Y-,— 0. (he Worker's
Compensation locumions of the Labor Code. vise l fOtTbwd uiomi with sufT pro"vaptn_I)r,tOa� permit dY
be rimmed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTRICATION'
❑I hereby ready that nn excavation lice (5) or mate feet in depth into which a person u ugoieed m descend,
will he made in cunnectan with work authorued by shin perm", aha that re) bow" Strucsue, ararbNng, 1.1n,
a demllnion er d oure"eg theuvol, will be orae Them thirty Sv (36) Net high'nsp..1 2, Ase 2, Sec
341. Title 6. C A.C.)
❑As owe r -builder, I will rat empty aurone to do wok which would require a permit from do (kaatlrl of
Industrial Safety, as noted ahow. unless such per$. las as permit to do such wart trona the division
❑D iron of Iadusinial Safety Permit Na.
TOTAL FEES
CONSTRUCTION LENDING AGENCY: I hereby all that there is a rnmtrasom leisdinq e0." fa toe pelatmrn
of the work la which this permit is issued ISarc. 3097, Cry. C.).
Leader's Name
COMMENTS P cQ b— 3;o!4
Lender's Address
CERTIFICATE OF C OF ENTRY: 1 cedly 1 hum read die appTamlken lid ji
nut she mlatmaian n f to cep slaw lams said a+T7 stlMiq fleiidiry
CmSlrnetim. ere a team Cup al BYikkrlg ectal SaNdl to M 1� property
rat wI.I d ter perm of inq in5peclme
X 5y „n e al t a yen,
\'w� ,
RECPT No. PAID 8Y WWDA
WHITE—Department Copy, YELLOW—Finance Copy. PINK—Aaaeaeor Copy, GOLDENROD—lade GM, GREEN— Applicants copy
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