HomeMy WebLinkAbout1495 (19)CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFE71
BUILDING PERMIT FIRMLY
JOBSITE ! n .,
ADDRESS ALJ rZPrE
APN LOT 45 TRACT4256
UCATION PERMIT SE
NUMBER CODE
i —G�/� TYPE OCC.
DATE DD �� // CONST GROUP
CROSS STREET
OWNER—Rr�nalea Calif. Inca
ADDRESS Ong Park Plaaa. #1100
ZONING SETBACKS ""0NE*115
FRONT RW ❑
REAR 13 -
CITY
CITY ZIP TEL*1111.2
SIDE/SIDE STREET RW ❑
1:1SIDE
APPLICANT TEL.
❑
CONTRACTOR "T" McGee Electric, Inc.
ADDRESS P.O. Box 1111
CITY Chino, Ca. ZIP 91708 TEL.591-646
SEWAGE ❑ PUBLIC PMT#
DISPOSAL ❑ PRIVATE SO. FT./ 100 GAL
GRADING ❑ CU. YDS. EXC. CU YDS FILL
STATE
LIC. NUMBER 490083
N
TYPE SO FT FACTOR PSF ADJ. AREANALUATION
ARCH/ENG/
DESIGNER
ADDRESS
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LL
1
2
CITY ZIP TEL.
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3
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4
PROPOSED USE 7 np
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
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GARAGE:D
PORCH
m
VALUATION ADJ. AREA
NO. OF BLDGS HOW
OV LOT USED
OuAwrTY DESCRIPTION FEE
UCENSEO CONTRACTORS DECLARATION I hereby mi that 1 am licensed under provisions of Chaptr E Icomimenc
with Session 7000) of Division 3 of the Business end Piolessions Code. W my license is in full force and dhc
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OWNER BUILDER DECLARATION I hereby affirm that 1 am esempr from the CmlfKta's License Law for the following
reason (Sec 70315. Business and Professions Code Any city or county which requires a permit to construct,
alter, improve, demolish, a "par any stnactue, prior to As issuenn, also requires the sgalcsnt la such Fermi
lofile a signed statement that he is licensed purswnt to the prmisions of the Conams ta's License law (Chapter
9 (commencing with Section 70001 of Divisor 3 of IN, Business and Professions Code) or Out he is eampt Eerehom
W the Mus fm the atleped exemption Any vidation of Section 70315 by any applicant la a parol subjects
the SPgcant to a evil penalty of int mon than Bre hundred dollen ($500)1
❑I, as Owner of the property or ON employees with wages as their sole eompenutm. wed do ft work. W
IN structure is rot intended or offered for sale ISK 7047, fdusrness W ProletSms Code The Caruacter's License
Law does not apply to an ower of property who builds or improves shreon, and who does Such work Iwnsed,
a through his own employees. provided that such onprwenents are nut intended Or offered forsok If, however,
the building or improvement is sold within one year d compknon. Ile owner -builds writ have the burden of proving
that he did not build a improve for the purpose of sale)
❑I, at owner of the property. am exclusively, contranmg with Incensed C.IIKtr7 b t4nrtrun IM proton ISI
7044, Business W Professions Code The ConuKtor's License law does rpt apply to an owner of property who
builds or improves thaton, and *no contracts la such protects with a conirKtaOl licensed pursuant b the COM1K10r's
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CONSTRUCTION
❑ 1 in tompl under SK . B B P.C. IAKxh Certificate).
1
P VIEW
Irate Owners
J
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PLUMBING
MECHANICAL
WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 haw a certificate of consent to saw insure. or
a certificate of Veemkiii Compersaton Insurance. or a fouled copy Owed ISI 3800. lab Cl-
❑ Cernf.dcmpyawebyfanshed
'3 Carl, ad copy a filed with dna Building Inspect at Departinent in. R I i 1 id l rig Department.
Q
GRADING
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION R&RAMU. This section Owed not be completed�IlSS�U
d to permit is la One hundred IS100) or less I certify that in to performance of Me wait for which dws
permit n issued, I Shaw not employ any person in any, mariner b become sublets 10 dr ftlues ration
Laws d C
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Nate a
NOTICENOTICEE TO APPLICANT E, miter arcking this Certificate
te ofmpmd E.n, you 4becameald became fiApct b Yk
the rtl
Conpensanm provisions of ton Labe Code, you must forthwith *6 Lch prowsas or Eves commit thaA
be deemed revoked
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- / • (0d
SMTP
PARK FEE
SCHOOL FEESw
DIVISION OF INDUSTRIAL SAFETY PERMIT CIRTIFICATIOF
❑I hereby tariff that no enervation five 15) me me her in depth into which a parson is "wed to thousand.
will be merle in connection with work audprvN by was game, and Eel no hINMYg pywctire, U*Wd a falaewmk.
Or demobtm a dismarthn; saved, w/ be mese nary sok 13FI MreMpB,i OaF 32. Grp 2, Art 2. SK
341, Tice B. ICA C1 A u L
OA. ewrw-budder, I wig now employ ankorm Or do work wW wer\ oru�lda rogwa,a pare`.thew ee Divisor of
Industrial Safety, or noted above, tales much pus. Me a pan b N `ipark from the WFsimJ
G,.v.�r `Ji' '.' s• . CTS l
❑Or-winef hrdu tnal SaletyPrmt►N � ' .. ,. ^' ..'' �'
.
TOTAL FEES
CO NSTRIICTIM 1EN01NG AGENCY. I Mnby off— that dove is a constKtran Iroa6y agency M 0. pile m ei
of IN work to which this permit is issued (1 3087. Cow. C).
Larders Nam
lander's Address
COMMENTS
UROflCATE OF COMPLIANCE AND AUDMZATION OF ENTRY. I artily 1 hew sod dais oppkKien W am
dui the retornebon Own u Cana. I gin to toeply won N stat laws and dh ardilo , "lasing is bdiay
rmstrKtm. inOliorue a npaensinw of Er Dopwtb t d B+:d�q W S"y to sr gen Elle property
1m whch Ism the pant hr the pirgawe rung imsFecMws.
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RECPT NO. 1 �� PAID BY VALIDATKW
Signature at Appecam a agent pee
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy
BS106.11189