HomeMy WebLinkAbout1507CITY OF DIAMOND BAR(
�. DEPARTMENT OF BUILDING AND SAFETY
! , BUILDING PERMIT
PRESS
FIRMLY
JOBSITETE2A
ADDRESS CSW
APPLICATION PERMIT §E
DATE NUMBER h� CODE
ISSUE P TYPE OCC.
-
APN LOT TRACT
DATE a CONST GROUP
CROSS STREET
OWNER Bramalea
ADDRESS One Park P1 41100
ZONING SETBACKS a@-FKmrEwm
FRONT RW ❑
REAR ❑
CITY Iry ZIP- 9714 TELSIDE/SIDE
STREET RW ❑
APPLICANT `?" C�i:�f,<f—. TEL /J y`/
SIDE ❑
CONTRACTOR " "x
ADDRESS
CITY rhino ZIP TEL. —6461
SEWAGE ❑ PUBLIC PMT#
DISPOSAL ❑ PRIVATE SO. FT/100 GAL
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STATE 490083
LIC. NUMBER
GRADING ❑ CU. YDS. EXC. CU YDS FILL
C0
TYPE SO FT FACTOR PSF ADJ. AREANALUATION
ARCH/ENG/
DESIGNER
ADDRESS
1
IW
LL
2
CITY ZIP TEL
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3
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4
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PROPOSED USE �ti
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GARAGE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
5
PORCH
m
VALUATION ADJ. AREA
QUANTITY DESCRIPTION FEE
NO. OF BLDGS HOW
ON LOT USEDVC
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LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed odes provisions of Chop" 9 Iconoenci
.allDivisionSection 70001 of Division 3 of the Business and Professions Coda and fry licensers in h8 forte and ails t
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MVNER BUILDER DECLARATION I hereby affirm that I am rumps from the Canraclor't License Law for the Idlow+n
reason Sm 70315. Business and Professions Code Any city or county which repuims a prime to construct,
slier. approve, demolish• or repair any muctue. Prof to as ISSuil e, +Iso tequits tee applunt for Such permit
to Ide a signed statement that Ise if kensed pursuant to the provisions at the Cona+csor't Nesse Lev IChaper
9 (caonenoog with Section 70001 of (Wif.on 3 of the Busness and Professions Cade] a that he is exempt therefrom
ndthe basis for the alleged esempton Any violation of Section 70315 by any applicant fse a permit Suby:cts
the applicant m a cad penalty of Mt more than five hundred dollars 135D011
❑1, as owner of she property. a my employees wallwages as Shoir side compensation, will do the work, and
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the srrucmre u not intended a offered la sale ISec 7044. Business and Protestant; Code The Contractors License
law does not apply to in owmer of property who builds IS, improves thereon, and who does such work himself.
or through his own employees, provided That such enproveremns are not intended or offered for sale If. lowever•
the building or Nmpravermem is sold within one year of eanploton, the owner-bu'ildn will have the baden of povelt
that he did not build of improve for Me purpose of sale I
❑I, as owner of the property. am tecbsaely, comranny with licensed contractors to construct the Pr+letI (SeeW
10-44, easiness ab Piolessons Code The Cantsacur's Limse Law does not apply to in owner of property who
builds or improves derew, and oto controrts la Such projects with a contiaclorlsl IKensed pustuant to Shia Cantfactor'I
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License Law I
CONSTRUCTION
❑ I am rump order $as , B B PC Witch Carofeatel.
VIEW
°ore Ovme1
RIC
MING
MAKERS' COMPENSATION DECLARATION 1 hereby, offvm that I have a eerehcate of consent w INN issue, a
a c rokate of Workers' Compensation Insurance, or a mated copy eteted (Sm. 3800, Lab. C.)
❑ Cerufkd copy is hereby lwasnee
J
MECHANICAL
Crated copy is filed with to Budding Inspection Department or R1 T i 1 r9 i n!T BoPerment
Q
GRADING
CERTIFICATE OF EXEMPTION FROM MAKERS' COMPENSATION INSURANCE. This section needt he tompletM
I fe perms e 1 one huMred It1D01 a less I mirly Cut n to performance of II work hsr which Itis
permd u is . Shia role Yry person in arty manner so as to oma Sublets 10 ft VNakNf Compensation
Laws of C
DANCE D
(�—
PARK FEE
Date /te d of E E
NOTICE TOAPPLICANT Nafter making the CertificateCertificaten, yar shouN become tuhMtn m #k IWIn i
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{1'
SCHOOL FEES
! Compensatrm pwmmns of thc tabu Coda you must forthwith comply with such provisions or thin permit shod
• be deemed revoked
'• DAIMON OF INDUSTRIAL SAfETY PERMIT CERTIFICATION
i ❑l hereby minty that no eruvatm five 151 darn Lt in dpth into which a prsm is np�ired to dacard.
soS be made n eonnectm with work rrthoreed bit this plrmn.'and that to Wiling structure. soallolinp, laloewat,
' or demolition a dismanllng #went• will be mat FW furry sit (381 feet ho. (ChSP 32, Gip 2, An 2, Sec
341. Title 8, CA C 1.
DAs onner-holder, I will rot employ anoW, !" w1v k Qvch 1!� haqune a postal here #k Qvgion of
Industrial Safety, as noted Sho, unless such palmus a pnmT"b do Such work from the drivion
j ❑ Qnnsion at Lndusnul safety Permd No • . " , n
('a
TOTAL FEES . `��
CONSTRUCTION LENDING AGENCY. 1 Irireby affirm••dut there n a construction Iarrdrrlp prey W #k pahimsn"
of the work la which tiv5 permit is isiud ISS. 3087. bw_C 1 yr t.r ',)7 :f
lendei s Name ": `L • ,
COMMENTS
lendei s Address
c CERTIFICATE OF COIOPLWn AND AUTIIOPoIATM O ENTRY 1 certify I have tied Shu app4aaw red waft
1 that thr information, given is carat. I epi to tongly with of stork lows and arty, for lwres nlouq to IraKng
tonstnctm, aoa +uthaise + tepnsentawe al #r Daprinkns d Buldrq aril S+T+tY t r< aspen #r property
fa vdorcA 1 applied b be perms far Ilk Purposesofnuking imparbens
/ AECPT NO.� PAID BY `'I VALIDATION
X -- �n `j
Wangle d Apknt a Agent� (X/Door
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy
