HomeMy WebLinkAbout1503(--� CITY OF DIAMOND BAR n PRESS
DEPARTMENT OF BUILDING AND SAFE1 Y
1 RU1LDING PERMIT FIRMLY
JOBSITEl
ADDRESS �b'
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APPLICATION PERMIT SE
ISSUE DATE TYPE ER OGCCODE
DATE CONST. GROUP
APN LOT TRACT 256
CROSS STREET
OWNER Bramalea Calif Inc.
ADDRESS Que Park -131. #1100
SETBACKS tk.,aoElEhdrs
ZONING
FRONT RW ❑
REAR ❑
CITY TEL
SIDE/SIDE STREET RW Cl
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APPLICANT TEL. /� /
SIDE ❑
CONTRACTOR viciJee Electric, Inc.
ADDRESS 91708
CITY MjpQ, ZIP TEL
SEWAGE ❑ PUBLIC PMT s
DISPOSAL ❑ PRIVATE SO. FT./ 100 GAL
GRADING ❑ CU. YDS. EXC. CU YDS FILL
STATE
LIC. NUMBER 490083
[1)
TYPE SO FT FACTOR PSF ADJ. AREA/VALUATION
ARCH/ENG/
DESIGNER
ADDRESS
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1
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2
CITY ZIP TEL
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3
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4
PROPOSED USE PSG
j
GARAGE
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
5
PORCH
m
VALUATION ADJ. AREA
QUANTrrY :DESCRIPTION FEE
NO. OF BLDGS HOW
ON LOT USED
a
IN
LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed oder provisions of Chapter 9 kommercing
with Section 70001 of Owuron 3 of the Business and Professions Code. and my (cense is in full force end affect
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OWNER BUILDER DECLARATION I hereby affirm that I am exempt Irom the Contrscur's Li:eme Law For the fdbswng
reason ISet 7071 5. 0ain't% and Professions Code Any tidy or cowry which requires a paint to construct
Oiler. improve_ demolish, a repay any nructure. prior to its issuance, also recluses it* applicant for such permit
Mfile a signed statement dist he a kensed pursuant to the PrensanS Of the Conoxar's LKemt Liv (Chapter
9 (commencing with Sedan 70001 of Owsim 3 of the Business and Psolessans Code) or that he is exempt thnelrom
and the basis for the alleged exemption Any violation of Section 70715 by any applicant for a permit subjects
the applicant to a cod penalty of rot mon Nen (we hundred dollars ($500) )
❑I, as Owner of the property, Or my employees with wages as thenr sok compensation, will do the work, and
tlr luchare a rot intended or offered la rule ISec 7046, Business and Professions Code The Contracv's License
Law does notapply to an owner of property who builds or snprovts thereon, and who does such work hmulf.
how.
or through her Own employees. pronded that soh enproements sea not intended m offered for sok Mhowever.'Z
the building or xnpOvement is sold within one year of cornortan, the owrrrbuik* wig heirs the burden of poop
that he did not build a eprove for the purpose of sale )
❑I. as owner OI the property, am eakawely Canon Iliny with licensed contractors to construct the project ISec
7D44, Business and Professions Code The ConII1i IitenSt Law don not apply to in owner of property who
ch pmpa2 with a contrKwels) licensed pursuant to to
buN& or impedes thereon. and who contracts for suContractor's
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CONSTRUCTION
(] I am exempt wrier Sec B 6 PC.IAnach Couf atel
PLAN REVIEW
Date Owner
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L (TME I -
PLUMBING
MECHANICAL"
WORKERS' COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to sell mune, or
a « rblcate Of Nbkets Canpensatm Insurance. at a caused copy thereof (Sec 3800. Lab C)
❑ Cerolri copy is hereby furnished
IS Clofrd copy is filed with the Budding Inspection Dapatiosut a R11 1 fi i ng f7epartinent
Q
GRADING
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE'. This union need not be Cw*md
d the perms is faro hundred IS TOO) a less. 1 arufy Nat n th ramanca d the oak for which this
Tonnul is issued. I h rot Iso airy person in airy Inymnel eS ane WDIeet re the klkfia:• Compensation
', Laws of Cof,lor
Dat` ��^r f
W
u-
SUANCE �J e
SMIP
PARK FEE
SCHOOL FEES
NOTIOE TO APPLICANT If. slur nutrng Itis Certificate ate Exemplar, you should become aubjat a fry Vwrler's
COmpensatm prmisran, of ane Labor Code, you must fathwM can" with such provrson or this perms shallbe deemed «caked
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION v�
�.. X.
❑I Ii csrtdy that ro excavation (iw (5) Or me�lett x depth into which a person N rapord a dencand.
so p st,uctws. Scaffolding, f lsomork,
will be, made in co'netlur with nark Infrared by On formal. and del butdn
• a derrnbuon or dismantling thawf, will be mat than dwrpsh 136) featrA.4 32. Grp 2. An 2.
YI I, Title B, DAD,, D I I
u
❑As owner -builder. I sok sot employ arrynne to do work which would require a permit from fir o.isan of
• Industrial Salty, as noted above, unless such pinion has a Perrot in do such work frac tlr dahlin.
❑OmonofIndustrial SafetyPormn No. rt' • '
TOTAL FEES 579 1 q
CONSTRUCTION LINDNG AGENCY I hereby affirmwt there is a construction In dip aIPCY la hr perfamaKa
of the work for which Itis perms is issrrad pec. 3007, C. C.).
Linda's New
COMMENTS
Linda's Addns
CERTIFICATE OF CONptWa ANO AUTHONZATKN OF ENTRY 1 partly I have read On Application and nal
I dist the lnformatis0 prion is went I agree, to comply, wM all stage laws and tine erdvwca scup to building
o0nstrauen• & robe a rapeunterwe d the Caparmrm of &adep orad S+k4w N ry to w rProperty
la which I pled For nut psrmj IN tle, purgi o"Pri irrspechons.
RECPT NO. PAID BY v / " VALJDATION�
Spnatua d Applicant a Agant Dane
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Capt', GREEN— Applicants Copy
BSI06.11/89
114SPEC T ION 1.1 -COR
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