HomeMy WebLinkAbout1504 (8)CITY OF DIAMOND BAR
y DEPARTMENT OF BUILDING AND SAFET a
l . n RI -In nipiG PFRMIT
PRESS
FIRMLY
JOBSITE
APPLICATION PERMIT/ SE
ADDRESS
DATE G� NUMBER TYPE_CODE
ISSUAPN
LOT TRACT
DATEE 6262— CONST. GROUP
CROSS STREET
OWNER Bramalea Calif. Inc.
ADDRESS OI7 ark El . If I 100
ZONING SETBACKS ''"i0"�"fa
FRONT RW ❑
REAR ❑
CITY 71P TELA
SIDE/SIDE STREET RW ❑
APPLICANT P TE
SIDE ❑
CONTRACTQR "
ADDRESS r" x
CITY Chino ZIP TEL -6.
SEWAGE
DISPOSAL El PUBLIC PMT
❑ PRNATE SO. FT./ 100 GAL
STATE
LIC. NUMBER 490083
GRADING 13CU. YDS. EXC. CU YDS FILL
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TYPE SO FT FACTOR PSF ADJ. AREWALUATION
ARCH/ENG/
DESIGNER
ADDRESS
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CITY ZIP TEL
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PROPOSED USE G
GARAGE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
PORCH
m
VALUATION ADJ. AREA
ouANTrrY DESCRIPTION FEE
NO. OF BLDGS HOW
ON LOT USED
l® SED CONTRACTORS DECLARATION I hereby off.- that I am Licensed Olde pwians of Chapter 9 III—emmit
with Section 7000) of puisan 3 of the Business and PmlesSrns Code. and pry license is in lull force and effect
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OWNER BUILDER DECLARATION I hereby &than that I am exempt from the Contractor's License Law M the Idlornnp
mason (Sec 70315. Business and Prorssors Code Any my Or eanty which tquirea a permit to construct.
alter, mP,—. demosh, a "p, any structure. pia to its Issuance, also requires the e apIa such Perna
to Me a aimed stnement that he is licensed pursuant at the provisions of the Contractor's License Law (Chapter
9 le"M rg with Section 7000) of Qra,on 3 of the Business and Pnofessam Code) at that he is exempt therefrom
andthe basis lot the alleged tsempuon Any violation of Section 70315 by any applrant for a permit subRcts
theapplicant to a cud penalty d tot more than IM hundred dollars (9500) I.
[:]as owner of the property, or mr, employees with wages as Mer sok compensation, wyl do the wort, and
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the slrucwre a not intended or offered for sale (Sec. 7044. Business and Professions Cade The Cmtracex i license
Law does rot apply to an owner of property who builds or improves Merton, and who does ouch work himself.
or though his own employees, provided that such inpnovemens Are not intended Or offered lar isle 8, however,
to building or irprovement is sod within one yew of completion, the owner builder Ola haw the burden of prong
that he did not build w improve Por the purpose of sale 1
❑I, as owner of the property am eacluswely contacting with kcemed contactors to conrnuct the protect (Sec
7044, Business and Professions Code The Cantrxtor's License Law does rot apply to an 0`7` al property who
builds or improves them, and who connacts lot wch prones with a tmllaalar(i) lmensed pursuant In the Contractor's
License LawI
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CONSTRUCTION
❑ l am erempr under Set . B b P C. (Anach Certificate)
PLAN REVIEW
°icer NIse
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LEC R l 70
PLUMBING
MECHANICAL
YORKERS' COMPENSATION DECLARATION I httry affirm that I hart a teraf tate of Cmxed Io Self insure, x
a certificate of Workers'Pnmpensalan Inwraae. a a certified copy Meed (Sec 3800. Lab C1.
0Cer0led copy is hereby lumshed
Cara I d copy is filed with the Building Inspection Department aR�E3i n Cj Department
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE. This wool need rot he cmpleted
d to perms c la one hundred (5100) ar kss I artily that in to I mince of the wick la which Nie
empl y and persort in any manner wbfact to de Wbrkxi Compensation
Daws d c
Permit is issu0E.07!?00
DaneAppkant
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SSUANCE � • �
SMIP
PARK FEE
SCHOOL FEES
NOTICE TO APPLICANT. 8, cher nuking ions CeExemption.lcate of Exemption. You Should 6ecane suAplct to tle Worker's
C"Pensatrm provmas Of Ili Labor Code. you must Forthwith arpty, with such proruam ar this Permit shall
be deemed reviled. _ , ", I• ?.•"'^
DMSION OF INDUSTRIAL SAFETY PERMIT CERTFICATgN;', '� ;•�-:'
❑I hereby certify that no e.watan I" IV) a mice Feet m depth into which a person is required to deuced.
'
WIN be made in connector With Werk outmost by ted perms, and Mat M WAduq sburtur. Scaffolding, falanaak,
a denalmm a dismantling thereof. WAS be mere Man dwty.s. 1381.f4r t high. low 3Z, Grp t. Art Z, Sec
341, Title 8. CACI. Q A.l
' CIA, owner builder. I Will not employ anyone to do wale which would return a pxmt from am Oivnion d
Industrial Safety. as noted shore, unless W person hes a punt to do Such Work limn ar division.
i ❑Or"—dIndustrial Safety PumsIda.' •Y � ' = � •- 'T'�
TOTAL FEES J �1 (�
thea etccon krWtg atlercy hen to pxhornmo
CONSTRUCTION tfMXW AGENCY, "I he* offset ax n s ars
of the work la which as Permit k issud (Sec 3091, Gtr. CL
Lenders haw
COMMENTS
lemdei s Address
CERTIFICATE OF CDWtWXE AND Al1TR01aZATION OF ENTRY, I patty 1 here arms am appdicatixn and sues
that me nla usbon pwn is mien I spree to comply, WAS as Sense I-% and edy adwaes rising to building
connructor, and .me a rapreaenlabre of She Department of Brldrng and Safety to • K aeon The Ifrs"
ked whclt I d kr as perms for the prpo s d among nepcbm.
RECPT NO. �-� PAID BY VAUDATI
I Ae !�7 Q
Signature d Applicant a Agent OafoIF
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy
BS106.11/89 '
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