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HomeMy WebLinkAbout1229 (46)CITY OF DIAMOND BAR PRESS DEPARTMENT OF BUILDING AND SAFETY FIRMLY BUILDING PERMIT JOBSITE t ^� ADDRESS �I a ��L1�7�— �• APPUCATION_WE,S MWUMBER CODE DATE ` ���r wTYUM ppO--CC. DATE �— 1 6�— a= CONSTIBROUP APN LOT: TRACT CROSS STREET OWNER K- ADDRESS SETBACKS NAIFI NE►EMTS ZONING FRONT RW ❑ REAR SIDE/SIDE STREET RW ❑ SIDE ❑ CITY C -OSI \ ZIPR0a TEL. — APPLICANT `C Y\ TELS CONTRACTOR ADDRESS CITY ��� ZIP TEL. SEWAGE ❑ PUBLIC PMT # DISPOSAL ❑ PRIVATE SO. FT./ 100 GAL STATE n, 1 LIC. NUMBER ��—``�C GRADING CD CU. YDS. EXC. CU YDS FILL ' tt7. `TYPE Ft' PIiCTaR ADii : i4—yRENV LLYMQM' :... ARC CC DESIGNER �J W e-'� 1 1 .2 ICi (rj 1;-, �oin 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, 5 , K, C i ADJ. AREA 2ESCRIPTIO14 FEE : NO. OF BLDGS HOWOUANrrry ON LOT USED P�,S��IC��C, 4 I GO L et LICE E0 CONTRACTORS with Section 7000) of Owston CLARATION I hereby affirm that I am Ifsmsed under provivms of Chapter 9lrasrmereisq 3 of the Business and Professions Code, and my license is in top lace end effect < e_' FL i� T.7 OWNER -BUILDER DECLA TION:1 hereby affirm that I am exempt from the Contractor's License Law for the fdkavmq reason (Sec 1031.5, B mess and Profesaans Code Any oily or county whish requires a pamil m t4natrael, alter- Improve. demolish a tepalr all structure. prior m i¢ Issuance. also reguues the applicant for sub permit ro Irk a signed state rt that he is Ixensed pursuant m the provisions of the Contractor's literee law (Chapter's 9 lecmmencmg with S tion 70001 of dvisan 3 of the Business and Prohssiors Code) a that to is exempt therefrom and the haws for alleged esempbon_ Any vddafian d Section 7031.5 M any applicant for a permit atgaca the applicant m a c it penalty of not more than foe hundred dopers (55001.1: ❑I, as awn"/ f the or.or my employees with wages as dei; sale compenare", wit do the work. rd de structure Is not intended or offered for sok (Sec. 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 doss such work himself, cr through his own eropli yees. provided that such mrprovemmts are not inasMad a offend fa ale If. however, the building or improvement is sold wrdm one year of completion, to onew-b ilder will have the burdto of proving that he did not build or Improve for the purpose of sale.). ❑I, as owner of the property, am ewektuvefy contracting with licensed contractors to construct the project (Sec 7044. Business aro Piolessans Code: The Contractor's License taw does not apply to an owner of pro" who builds or roamies thereon, and who cenlracts la such protects with a eootractw[s) Incensed pursuant m the Cennactoi s License Law I ,' 1 2 yi 7 / ;,� C P •�, %, `S V 1 L Sys doJy �V .; .� L�/F 7N�_T iZ: ���.� N/. •3, 7 (_s } w CTIO ❑ I am -pt under sac. B h PC (Attach Cerbtieste) PLAN REVIEW Date Owner MBING t �© CHANICAL 2 . 00 WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-irows, ce a certificate of Workers' Compensation Insurance, or a certified copy thweQl ISee. r18p0 Leh. C.I. ❑ Certifled copy is hereby, furnished;,, •t , ,'7 Canfed copy is filed with the Building Inspection Ikpartmil or (`. Department. CERTIFICATE OF EXEMPTION FROM WORKERS" COMPENSATION INSURANCE. This section need rot he completed if the perms is for ore bullied (5100) o 1!3 1Gertrfy ttlnt m dr�pmrlrtse�he oak for which' this permit is issued. I gall rat employ arty petson in airy rol tknl, sl as au Wbrkei Catpenwiwl Laws of CalBornia. ger '� oat` Applicant NOTICE TO APPLICANT if, after making this CertifItale.of Emwion,- yarsM`odd' besane'subieei'.tq the Worker's Compensation provisions of the Labor Cede. yud rpinl f4dredhioepFy with 301 ff! riTs e" INA!, pemlit shelf be deemed revoked. _ L' IUL SMI PARK FEE SCHOOL FEES DIVISION OF INDUSTRIAL SAFETY PERMIT CiRT61C *N: El hereby ready that no excavation five (5) a more feet In depth into which a person is repaired to descent. will be made in connection with work authored by this petmn, and that ro btddkq structure, scaffolding, felsewerk, or demolition or dnmantkng thereof, will be mon, than thirty -ser 138) kat high. (Dep. 3.2. Grp 2, An 2, Sas ' 341, Title 8, CACI. DAs ownervhurldeir, I will not employ anyone in do work which would require a permit him to Ov6ion of Industrial Safety. as road above. unless such person has a permit to do such work ban the division. ❑ °"son of Industrial safety Permit No. TOTAL FEES CONSTRUCTION LENDING AGENCY I he* affirm that dere is a wnstrucoon lending agency, for de per kormene of the work for which this permit Is issued (Sao. 3097. Civ. C.). Lender's Name COMMENTS lJ �• Lender's Address CERfIFICNTE OF COMPLI E AUf OF ENTRY: I costly 1 tune read Eis apgitsles and stile Ueliep crosnKnot oe a sent Dew t of &Adkq ad Sally m we wifefor which 1 h d for perm se of..inspLy that the "formation is . I to w a9 stale laws ad dry �7� X RECPT NO. �y LL PAID BY VAUDAT Signature of Apply t a Agent WHITE—Department Copy, YE' I.OW—Finance Copy, PINK—Assessor Copy. GOLDENROD—File Copy, GREEN— Applicants Copy BS106-17/8