HomeMy WebLinkAbout1649 '"� � CITY OF DIAMOND BAR ��P --
DEPARTMENT OF BUILDING AND SAFETY �RES�- �
BUILDING PERMIT FIRMLY
JOBSITE 20930 PASCO DATE CAT10N NU B R � CODE
ADDRESS ISSUE TYPE � OCC.
' � APN LOT TRACT DATE �� �_�� CONST. GROUP
o CROSS STREET SETBACKS •���
°D OWNER NR. SHIN ZONING �0� � �
� ADDRESS_ 2�A�c1 aascn REAR 0
,� CITY nT aMnN� RAR Zlp A� 7�S TEL. SIDE/SIDE STREET RW 0
o APPLICRNT BOB KELLER TEL. 5�� SIDE 0
_
a CONTRACTOR PETERSON JONES
o ADDRESS 3190 E. WILLOW SEWAGE. � PUBUC PMT�
SIGNAL HILL 90806 2/988-003 DISPOSAL Q pR�VATE SQ.FT./100GAL
W CITY ZIP TEL.
z STATE 528710 GRADING � CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER
y ARCH/ENG/ (n �PE' � � �C�p RS • ` -'AOJ::�IIREANA�:UAT10N , =
`—' DESIGNER W: 1
o ADDRESS �; 2
.,,�„
Z CITY ZIP TEL. ,�; 3
� PROPOSED USE Z, 4
� ��; 6ARAGE
o NO.DWEL. NO. NO. 3; PORCH
y UNITS STORIES BEDROOMS
s LOT DIMENSIONS m,; VALUATION ADJ.AREA
o NO.OF BLDGS HOW � �;aUANt7'iv;;DES= RiPTIOM .� <� ,.; . �-:FEE �. Y='..� . .�Q'�,
W ON LOT 1 USED �Q;
c U;
W ❑ '�
~ LICENSEO COHTRACTONS DECLAflATION:I herehy��firm tA�t I�m IicensN wdn provuims ot CMpta 9(commennnp f�
Y with Section 7000)of Oivision 3 of the Businesa and Pmlessions Code,and my licrose is in hll Porte md eftect ,,,,;W:
3 "�
❑ �;
� OWNEfl�BUILDEfl DECLAflATqN:I herehy�ifirm that I am eampt Imm the ContruW�'s Lcense l�w la�the Idbwinp
z rason�Sec. 7031.5.Business�nd Pwfessions Cade:Any city or cwnry which rtpuira�perme ro construct �(�i
o al�er,impmve,demolish,ar mp�ii�iry nructure,Drior to its issuance,dm reyuues ihe�ppliunt fo��eh pnmit ���
1- to file a mipned atatement that he is licensed purswnt ta the prwi:ions ol the CmV�tOor's Lieme law(Ch�pta mi � /�
¢ 9 Icommmcinp with Section 7000�ol Oivision 3 af the Busina:and Pmleuione Code)or M�t M is eurtpt Medmm :�'�
d and the ba:is tor�he alleped eRemption.A�ry vid�tion ol Section]031.5 by any�ppliunt ki�permit wbjtc8 �, '
� ik applicant to�civil penalty ol nm mom�han liw hundred dollus(55001.1: i�'J:�
W
� ❑1.as owner af the m rt.or '�a�'
� p pe Y mV�Ployees with waqes�s their sok compmsa6on,will da ihe xnM1,nd
� tM stmcmre is not intended ar offered lor sale(Sec.1044,Bucinns and Professbns Code:TM Cmtnctm's license Q� �
v Law daes not apply ta an owner of Dmperry who builds or improves therem,��who does such wark himtelf ,(U':
' or�hmugh his awn employees.pmvided that sucA imprwemmta are not intendM or ofl�md lor s�4.II,however s��' . " ��
m the huilding or improvemem is sold within one yeu of completion,tk wm�rbuildn will hm�M burden ol provi�p :��
y �hat he did not 6uild or improve tor the purpose of s�k.� F*�-.
H ❑I,�s owner of the pmpuly,am ecclmively contnctiny wiM liceroed cm�qcrors to wnstruct Ihe prqect�Sa .zi�`
0 1044.8usiness a�Professiane Code:Tk Cantnctor's license lrw doet no��pply m an owner of propeny who ;1:�;��;
� = huilds or impmva�hereon,and who comncb fa such pmjects wiM�mnirxmr�f)liunsed pwsiunt to the Lmtocta's �
6 �ice�se��W.1 , :CONSTRUCTION
, o
� ❑I am emmpt u�der Sa. ,B.fi P.C.(A�ish Cerofiute) �� ;,'.. PLAN REVIEW
o Date �'^�� .A��' ELECTRIC
� VAflKEflS'COMPENSATIQI DECLAMTIpJ:I hereby�Ifum�h�t I Am i certifiute of crosmt to itll�inwe,n €°����' – �
�cenifitate ot Nbrktts'Compensetion Insurance,or a cnufied copy thereof(Sec.3800,leh.C.�. LUM�
o � �
_ ❑Certified copy is here6y turnished �,:���
Q
o ❑Cenified copY is filed with tAe Buildinq Inspection Deputmem m opumrm Q�::GRADING �
W
Z CEHTIFICATE OF EXEMPTION FflOM N9flKEflS'COMPENSATION INSUfiANCE:Thn section nad��n��o��� ; ISSUANCE
� if �he permit is tor one hundred�5100)a Iess.I certify ihat in ihe perlarmrce of IM work la whiM thu
y rmit is issued,I shall rot em rmn in a manrcr so�s to baome wh'mt tn tlr Nbrtei ntatmn ��.��.:;' S`M�P
P� DbY��Y D� �Y I ��� s
= Laws of Glifomi�. ��� y c,� a�
o ria� 4 S' ,�.:
p Oate . ,, ���.��'��.w.:, � W` PARK FEE
� NOTICE TO APPLICANT:N,after nuking Mia Ce`itifcate ol Eumpuon,yau should hecome s�ject m tlr WarYer s ���.: SCHOOL FEES
� Canpensmion prwisims ot th 4hor Code.yau must farthwitli cemply with sah pwisiom a this permil th�p P"��.:
� 6e damed revaked. • � ' �'�k�
� - - ��y. .. -
W pVISION OF INUUSTHIAL SAFETY PEpM1T(_CE�ICAil�li `cy _���� ;�. ;'
v f i.
d ❑I herchy certAy ihat n0 evt�wlpn live(5�or mare het in depth inro whzh�pwm ie rquirtl m dncad
� will he mede in connation with worY�utharced by thu p�rme.�nd tMt m,6uildi�q sVuetun,wlfaldiiry,t��work - . �
ar demolition ar dismanttinp thereot.wdl he mpe„��tun thury;tiz 1381.feat�hiph.�Oup.3.2.Gry 2.An 2.Sec �� t•:
W' 341.TitleB,CAC.I. 1 Ci � {„�: 1., ...�, � LaF�,j� :
x • . . . � r..� ,�-- - —._.F..� ���; .
3 ❑As owner6wWer.I wiA not e 6 ��to'dolwak�whitli waJd'r � � � �"':. - .
mV Y��b• Wuii��pamit hom tlr Oivoim d s a: .
� Industri�l S�My,as w4d�6ow,unlets such penan lus a pami�Oo do wch wark Irom tle division. §€�3;`;, . .
� ....�:. � . . .
W ❑a��=��o�����,���s.��ry Po�m��No. TOTAL FEES `?(���
a
� CalSfHlICfON LENNNG AGENLY:I heraby�Hirm Ew there u�cantrucum kndinp�peney for tM perlpminw
= of ik werk for which this permi�is usied�Sec.3097,Civ.C.�. .
� iMa�rs wme COMAAENTS
m i��xr:aea�e::
Q CEHTIFCATE OF COMPLIAlCE AND AUTIOPo2ATO�1 Of fN111Y:I artily 1 luv�md thu�pGcNim md rbp� . . .
H that the inlvme' piven is cuncl.I�pra to amply wilA dl stau laws md cily ardi�ncn nhUnp lu hilmnp .
ycan:tructian.� ue�repnfenudre ol Deprtnnt d BuAdi�q�d S�My Oo mhr�qon IM paqrry .
= fu whih I pplied for tliis il of mticirp i�eetiau.
~ / r `�'�
� ,� K�,�„�,,, � v md RECPT NO. � A41D BY � ���-/ VALJDATION '
WHITE—Department Copy,YELLOW—Finance Copy,PINIh/\ssessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
BS106-tt/es
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