HomeMy WebLinkAbout1388 (16) '"` - CITY OF DIAMOND BAR + ��� ����� t'
� - o��A�rnnENT oF BuiLDiNG AND sAFETv PRESS
BUILDING PERMIT �IRMLY
JOBSITE �Q�r1 t O� pATE CATION�� -��'j NUMB R CODE
ADDRESS T� —� �� ISSUE TYPE OCC.
� APN L D�TRACT DATE �'"��� � CONST.' GROUP
o CRQ�S STREET ZONING SETBACKS '"'�""E"'S
°—° OWNER FRONT RW �
o ADDRESS p ��� REAR �
W CITY� ZIP TEL. SIDE1SiDE STREET RW C�
o APPLICANT � ���� TEL SIDE 0
x
';a CON7RACTOR -- SEWAGE 0 PUBLIC PMT�
o ADDRESS DISPOSAL Q pRWATE SQ.FT./100 GAL
W CITY _ TEL.
z STATE
�.,; GRADING �CU YDS EXG. CU YDS FILL
y; LIC.NUMBER
y ARCH/ENG/ � T���. SQ .. ;'Fi�l ;:.� +
:~..a� .A �'�C #JIA�I£?
"' DESIGNER �"� 1 � �
o; ADDRESS 1�3�; 2 L.�? • G�
Z CITY ZIP TEL (;�; 3
�' PROPOSED USE 4
� E' ^J GARAGE
�:
o; NQ DWEL. � N . NO. �
y UNITS STORIES BEDROOMS "
'�' LOT DIMENSIONS
�. VALUATION ADJ AR A
n, NO.OF BLDGS HOW -• L�URt37lT'�F,{I'3�-_, ;.i . l�`,..�,.. �.. � �� .,...,.:�o,...
•�' �N LOT USED
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.# > tl❑CENSE�C�MRACTORS�ECLAHATIUN:I her�y atfirm that i am Iicensetl uiMer qmvisions af Chapler 9(commmoing � �
- Y�� wHh Sectinn 70U0)of Division 3 of the Busi ss and Professions Code,and my lieenae is in ful�force and eftect ���� .
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%�= E L �e y dFfi�x lfi mp� the ntractor's license Law far the fdlowing � �
Z`- son IS .7037.5,8usness�andpwiessians Cade:Any ciry nr caunty which requires a perm0 to consVcet {�}�" .
6°.alter,impmve,demufsh,�m re0air any�iructure,prior to iis issuance,also repuires the appGcanl}or wc��peimtl � -
�--� m file a signed statement that he is licensed Pursuant ro the pmvisi0ns of the Contracfor's License Law(CM1apter -
��, 9�commencing with Section 70001 oi Division 3 ot the Business and Prafessians Code1 a that Ae id exempt therefram �
,a.:-and the hasis for tAe alleged esempdon Airy violation ot Sec�ian 7U3L5 by any app�rcant fw�a permrt suhjec�s
j W< the applicant ta a civil penalty oi�rot more�han tive huntlred dollars(3500�.b� � � ""�'
�-
�,�, ❑I,as Mv�r of ihe property,m my employees with wagez as their aWe compensation,will ao the wmk,md " _
,�^ the structme is not mtmAed or oNereA fw sak(SecJD44,BuSiness afM Fmfessions Code:The Contraitm's'licer�se .
����. ,Law does not apply�o an owner at propeny wiw tuilds ar impwves thnem,and who does such work himself _
� ,�� br ihmugh his own employees.provided 1ha�such impmvements are not iMended o�olFered Im 58k:��,howeuer ' - . � �
';��ihe 6wWing or imprmement is sold within one year ot canpletion,ihe mvneo-6uilCei wi11 haue the hwAen af pinvinp �.�;�� . _
� y`-.7044.Butl not build oi imprnve for the puryose of sale.l . .' . . �.
, that he di . . . , ,.. .
-�- - �y ❑1,as-owner of ihe-D�Oe[�Y,am.exdusiveW cOnUaetiny wiN�icensed-comractad W con57ruct lhe pro;ect�See �� ' :" � �
siness�arid Pmfess�ns Code ihe Contractar's license Ww das-aot apply.co an�owner of prap9ny whn ",�',� - - - --
��'�,6uilds or improves thereon,aiid who contmats ior aah prajects wit6 a rnnnxioqs)Iicrosed pwivant ro the ConVacror s � .
., Cicense law.) � QN •
Q�Q._.... ' � .� , . _. . c. -.: - . -
�F , � ,8.B P.C.IAnach Certifinn „
�'�i am exempt unAer Sec.� �
c om� u°"°� ;: ELEC7R �
=4.� NURKERS'COMPENSATIIXJ DECIAHlQION�i he�e6y affirm that I have a cerGficate of emsem to sNl�insme.a ,� � -
- y- a cenificate of Workers'eompensatian inswa�e,or a cerufied copv ihereof(Sec.3800,tab.C.I. '-PLUMBING ,,
c
'� ❑cgetiee copy i:her�furnished. �,w�.MECFIAN�C•AL
,;`p, C�f.ertified.copy is fikd with the 8uilding Impection bepariment rc �Deputmem �k�- _ _ _
_Z �
`-; CEPTIFICAiE OF El(EMPiION FHON WOHKEBS'C�lAPENSATION INSUMNCE:This section need rat he campktad (�`E
y._ if the permit is for one hundred IS7001 m less.I certify ihat in the perlormance ol the wak for wAich'th�s .
-� permit�s issued,I shall mt employ airy person in any manngr so s�come wbject ro the VWrkers'Compensation �": SM�P 'r
-_ �-�- i�s oi esi�ro���. �� ��"� €��r ;� � PARK FEE
F o � � : _—
� o"e �`d"��A{� �'SCHOOL FEES
W�. NOTICE TO APPLICANT�.If,after making this CertArcare of Exemptron,you should hcaane subjttt to Me VkrMe�s
��`�` Cvmpenwtion U�ovisians of the Labor Code,you must fathwith comply with sueh prmisia�a this permit:haN
{::�+-; be deemed revoked. -�:'%"�-��
�� OIVISION OF INWSfflIAI SAFETY PEPMIiv TIOfi:° , d �?µ. . .
- --�- . .. _ ..
�. ❑1 hereby cetlAy that no excavetan five(5)��ieet in depth inro which a persm is requfrcd b dntceM
��:�� will 6e made in can�coon witM1 worY autharued by this permit,and�J�at�o�JA�'nQ svycture,s[altoiding,�alsewark
m demolition a dismanlling there4i,��L¢��.Jhan i�i[�;5��.1,38�'h4L1Ai�li!ICAaB 32.Grp 2,Art 2.Sec
.�W�. 341.TitleB.C.A.G.1. �c� �_�, . �-1 ti- t�;„`.:;'t�`3 .
• x �4 �...`v�°v.., a. : a t. t ::
. -"��� ❑As awner�buiWer,I will irot empby anyane Io do xrorM whcA wouid require a pnmit han IAe Oiwsion al �
��,,,r Indist{iel Sefety,as noled ahove,uniss such person has a permit to da such veak from Me diuisron. . -
� oa��s��o,��,�,�sa}ery��m„No. � TOTAL FEES
_,; � CONSIitUCfqN LENOING AGENCY:I herehy affiim Mat thert is a wnso'utvon kadinp epenty ta the pataimence �� ��
:�2 ���wmk fa whicA mis permit is iswed(Sec.309),Civ.C.).
' � tender'sName COMMEN S s
� ��, m Lender's Add�ess �1
- '��- "t CER7IFICATE OF COMP�IANCE AND aUTHOPoZATION OF ENTRY:1 tdtily I heve read tlxs�pplk�tim rd s4te .O , -
�-. va mat roe informatian qiuen is carect.1 agree to comply w�h aN stete laws and ciry ordimncm rehti�q fo Wild'uq �
.-�y construciion,a�authorue e repreuntative ot the Depatment of Buildinq mM Satety m enHr�pm tlie prupnry
..-= tw wM1ich 1 have appfied fa Niis permil lar tFe pupose of nakinp inspeetians. �
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sy�at e o auent � RECPT NO,�. t PAID BY ��VAUDATION
WHITE—Department Copy,YEILOW—Finance Copy,PINK—Aasessor Copy,GOIDENROD—FNe Copy,GREEN—Applicants Copy
..� 85106•11/89
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