HomeMy WebLinkAbout1512 (20)CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY FIRMLY
BUILDING PERMIT
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APPLICATION r PERMIT SE
DATE i.sf 2— CODE
ADDRESS %L E)Yl VC1�
_NUMBER
ISSUEg, -moo �p TYPE OCC.
DATE CONST. GROUP
APN OT TRACT
CROSS STREET
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ZONING `� SETBACKS IMPROVEMENTS
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APPLICANTS Uf flG A,,23 04L
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DISPOSAL ❑ PRIVATE SO. FT',/ 100 GAL
CITY U&C ZIP TEL-9ff-Laicg
STATE
GRADING ED YDS. EXC. CU YDS FILL
LIC. NUMBER
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TYPE SO- FT R PS ADJ. AREANALUATION
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DESIGNER
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PROPOSED USE CW /M M -VQ
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GARAGE
NO. DWEL• NO. NO.
If BEDROOMS
PORCH
UNITS _i- STORIES
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LOT DIMENSIONS
VALUATION ADJ. AREA
NO. OF BLDGS HOW
QUANTITY DESCRIPTION FEE
ON LOT USED
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LICENSED CONTRACTORS DECLARATION 1 hereby sffure that I am licensed under pmvisims of CNpw 9 Icomnpumtp
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wnh Section 70001 of pvisron 3 at the Business and Professions Code, and dry hcnser is in full force and effect
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OWNER BUILDER DECLARATION I hereby affirm that 1 em gre"t Itom the Contrscmr's leenu Law IN the following
reason (Sec. 70315. Buyers and Professions Cade Any edy at county which regarrs a Permit to construct.
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alter. improve, aemalish, of repair any structure, pia to its issuance. also sepu+n the applcwt Nor such Permit
to file a signed statement that he is Icensed pesoanl m the Provisions of the Cnticmi s License Law IChaper
9 1[ammennng with Section 70001 of °vision 3 of the Business and Professions Code) a that he is senjpt therefrom
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and Me bels for the alleged is"Ition Ant vwnbn pf ;coon 70315 by any appfaanl la a Perms subjects,
the applicant m a civil mi of rot m Utthal frJr bundsed,dodars 11150011CL
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01, as M., of the property. a my =Ploy ps viiia `wages -is then sok eompenutian, will m the wok, and
Ih structure a not intended or offered dor as ISec. 7044. Business end Professions Cade The Cntracmr's License
i Law does tut apply to an owner at popery who builds at improves thereon, and who does such work himself.
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a trough his own employees. po,ded that such nprown,onts are not intended or attend M sok 11, hmvewr,
the him,np or imprswmenl R and rvthF.be year d onpW-fai IIW owner buffer will haw the bade of p1maq
that he did not bu,la a improw for,1tka�rrPese of sok IJJU
i ❑I, as dune, of the property. am escluvwb contia0grN with licensed contractors m construct the Project (Sc
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704.7, Business and Prtifetwit Cade The Conoacmr's Icrosr.1aw dos not Appy, m an awns of property who
kids or improves lherem, dens hTbsdmyicts la �sah woiecn with a[nh]cwW lcnsed pursuant m the 0antrata'1
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License law) Sr • E
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CONSTRUCTION
r ❑ I am exempt endn Sec , B fi PC 1AnacA Lerolcanl.
PLAN REVIEW
Date °vin"
ELECTRIC
PLUMBING 0
COMPENSATION DECLARATION I hereby alfine thal I hove a certifcak of consent to soft reure. ot
a,,�ce/rtificate of Workeri Compenution Insurance, or a caroted copy thereat ISec 3800, Lab C).
IICCatdeacopy uhereby fani:heal
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MECHANICAL
❑ Cerbled copy a filed wish the L"ng Inspection Derivations or Dominant
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GRADING
LEftTO1fATE OF EXEMPTION FIIl7M WORKERS' COMPENSATION INSUMNCE This section rad nth [mpleted
ISSUANCE
d IN pent is la tee hundred (SIDE) a less 1 arcly that m the pnfamace of Pe work he which This
Pe employ any Perste n am mentor m as m becomes subject m de Nbrkeri Compensator
permit w issued. Isbell rot
SMIP
Laws d Caldor" '
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PARK FEE
Applicant
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SCHOOL FEES
a NOTICE TO APPLICANT M, alw mekinp that Lnelcme of fcmpror, you chum ht:ane subject m The Walker's
mutt forthwith curdy with such orisons a this Shia
. Compe^seam powsms of the labor Code. you p Damn
- be domed revoked
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= DVM O INDUSTRIAL SAFETY PERMIT CERTIFICATION
5 ❑I hereby cntdy that ro e.cawtor five 151 a nae leer n dept item which a person le endeared a dac,nd,
will be me& m connection wrath work srthriled by flus Penns, and INN Its buildap structure, IWmNp, IsIre k,
- a demolman or dismantling tiered. will be mere Win thutysti, (36) Mt kill ICW 3.3. Grp 2, Art 2, See
341. Tide B. CA CI.
❑As a~ bMelder. I will not smoky anyanr m do work who wad rqun a pormt ham ted Dwain of
- Industrial Safely, as noted show. mins Rich prrmn has a paint m do such work from ted bdWm
❑Dvncn d Industrial S.lery Perron No.
TOTAL FEES
CONSTRUCTION LENDING AGIFO. I hereby offs- shot there is a comlembon bdmg agency fin the pafamance
d the wok la which Itis print is issued ISec. 3097, Civ. Q.
Leader's New
COMMENTS
lender's Address
C CERTIFICATE OF COMPLIANCE AND AtfrNOIZATKX OF ENTRY. I artery I how sed O s sulcate n and aleck
2 out the idormaten pwn is cane. I spa m wolf with N slaw laws and airy, enterica rekaeq to bnaNdeq
conseuchon, ad euthor4a a rpwesenuaw d this Dpet ed of Bildt" ad Salery a ~ fpm the Drs"
e la which I Ma applied M *,a p�s fa 14 pupae N ming iaP,rkens
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Sgreture d Applicant a tut Dia .
RECPT NO. PAID BY VALIDATION
V WHITE—Department Copy, YELLOW—Finance Copy, PINK --Assessor Copy, GOLDENROD—Fib Copy, GREEN— Applicants Copy.
BS10G-11/89