HomeMy WebLinkAbout1446 �1 - �_ C. _ `�
-'��'� CITY UF QIAM4ND BAR PRESS
<� ' " ' DEPARTMENT QF BUILDtNG AND SAFETY
`� .»: BUILDING P�RMIT �IR��L�
JOBSITE _ APPLJCATIt3N PERM-� � USE
�,;- �,�- DATE ����'� �t' NUMBER�,L- CflDE
ADDRESS.��� � �I jZ�� ' �- t r--e �cC � ISSUE � TYPE OCC.
� APN i.OT"� TRACT���L'�'�f DATE �`I�Y ��' C{NJST. _GROUP
`� CRC}SS STFiEE'T '`�-Z 3 � ' — ZON�NG SETBACKS `�`'"'b"�"�
=° OWNER.�:� L � �: FRONT R1V ❑
� ADDRESS l =�7 � � - - . ,�� _� REAR �
� CITY �7���� � �' ' IP£� TEL� 8 ���' `1 �' SiDE/SIDE STREET RtiV ❑
q APPLIGANT,.. TEL. SIDE ❑
m GONTRACTtJR_��'�' I��If �„ j��:�`��`r '
,c ��"�� SEWAGE ❑ PUBLIC PMT#
o ADDRESS� `-� �-" DtSPt}SAL ❑ PRIVATE SQ.FT./10i)GAL
�.�., CITY ��i�t �-,:k.._+���_ C� Zy �!7G'� TEl.��'_c . ;.-
s STATE ,� �L„�___
,,, c, �-_ 1, , GRADiNG CU.YDS.EXC. CU YOS FILL
� L.IC.NUMBER_ 2�
� AftCH1ENG/ . �} NpE S4 FT F A0.1. ARE�+NALUATION J
`-" QESIGNER�11 '-�- 1� I L.�� �_ �W 1 1`I� ' ���5,.r��''' -
o ADDRESS l;�1 �.3 �.�' , - LL � c� S:.�/D .]7G`l ``S.�.S.i:y__
c"'.� CITY.�=.i1:�-1�1G:'1�.�� ZIP T � :` ��/J:'� 3
a �
w �- 4
� PROPOSED USEi; � �•-���t= �
� �y �� 4-�'� �. ,,,� 6ARAGE
; NO QWEL. � NO. Na. = pORCH �.'
� UMTS STORIES BEdROOMS
y _ �p � ,.'-'...._AQJ.Af2t�A
c,c LQT DIMENSiONS�. VALUATit?N
o NO-(JF BLCIGS HOW QUANTITY DESCRt IOtV �EE
� dN�dT USEd � , " �
w � oC *r-� l L-a
�
~ IICENSEn CONTRACT�RS DECLARATION.I herebq atM1rm�hat I am ficensed unde[pmvisions ol Chapte�9{rommencmg � '— ,
� wrth Srsimn 760ai nl�i�:spn 3 ot rt,e Busmesa and t'rniessra�Code,znd my Ikeose Vs in tu0 Mrce and effect W
�Q � ..�
I 3 � �
w ']WNFA NWLLIFR�ECLARAT10�:i heru6y a1Lrm that I am e.empi Imm Ihe Convactor's Licenso Law Im Ma fdlowing "'
Z season ISec )G3f 5 2us�nes�and Fes1¢ss�ons Gode Am nty oi cou��ty whuh rcyuirzs a�+m��to eonsiruCt. {} ��
o alie� imprcve.�emoli5h ar re,Vau nny slructure,puor ro its�t5uance.also reqwres the appllcant lor sueh permit Z
h- ta�de a siyneA statemem�hai he�s�+cen5ed pu�suan4 Io tfie G�ovisions of ihp Cantracmr's Llceate law(Chepte� p�
� 9,commennrg wnh fiasiun 7GOOi nf Dwrs�un 3 of the Busmess and Profeuions CoAe{a Mat he is eKempt therefmm "� """"� ��—���
�y and�he has�s �a the allegetl eaempeon Any viola�ion u�Section 7031 5 6y any epplicei�l fo�a permi[su61e��5 �
W ine eppecaoc�o a cv�i panatrv�t na�mare than trve hwrtlretl ea�ars(550�)i �
� ��I,as owner at tM pro0ert4.o�my emDloyee4 wiln wage5 ds 1Mir sole compensatmn wdl do the wark,and ��
� ttre cnucaue ix no�,mended or offered to�sah',Sec 70C4 Bu.�ness and Professwns Code.The Cantrxtor�s��ceme Q
~ Law dues��ot avply Io a . +er af pmpeny who 6wlcs or impmves thereua,and who dues wch wo�k hlmsel�. (�
U r nw
� (n tb�nuyt'ha own ei7piuyeeS.pf6v�de�i t,hat sucn�mp(avtments ate ttat�ntCntl2il 6 Of�[etl f4r sak.It.hV+Cvei, 2
= the nwltl�ng or mpro�r,mem is sald wnhin une year of complebpn the awna�buildei wdl have ihe 6urGen ril omvmg Q —�—
� ;hai 4e tl�d noi 6wid ar imp�eve tor�he p+�r�ase ot cale-1 � �
cn �I,as owner of thp prnp¢rt��.am e�[lusrvely r,onirac��ny w�th licensed conva�tors�o construc�ihe prqect(5ac. �{J
� ?f1dA Susuress and°rofesswn;Gotle.The Camrxinr�s I.ieensa taw daes nnt apWY to an owner d propertT whn �
0
� . Id o impr)ves thereon and nho contra[ts ior suth pro�Ptls with a conVac[orlsi�icensCb pulsuanl tD the CnntlaCtol s / ,j �
Lc s-lawi {�i{�N.S��UCiT��N�.�C--: -c- �
w �i a���e.m p�unAer Sec u 8.6 PL.IAnaU Cenifi[atel PLAN REVIEW ' '��-'���� �� � � l�
o Date 6wner 'C"L�r..TF{��i • �l /
• � Jvf�RkER$�CCIMPFNS.4IIf7N N:CIARATION V here6y att�rm that!have a ce�tificate of cnnseni to sN1 insure,a �}LUM���G ....� —�
a�en�hcaie o�VJorke�¢�Campnisauor insurence,ur e cereFied copy ihneot�Stc.3800,Lah C)
0
¢ J ro,onea;oov�ne�aeY f�a„�sr„a ,,,�,,,,,�yjr MEC'.HANICf�L
o L�Carurrea eopy is lilea wnh ine Bmlemg Inspec4un oeparimem or Oepartmem. L ,(�',11RA��NCi
W � ._,_.C��__ ,� n�� �
'� f,EATiFlCATE Of EXEMPTIDN ffl�M WOflKERS�GUMPENSATION INSUAANCE This secoon need nnt 6e comD�eted
� rt the permu is tor one hundred 4S1aQ1 w less.I catidy ihat ir.�he pertormance of ihe wwk tor which thim
� w i is�ssuxd.t shafi no�emyio ar e�snn�m an � ���P � � �''�7
�.rmi y y p y manne�sa as m become wh�eci to the Xbrkms'Cmnpensatfon ,
� �aws o�cz�.irnmia �
a w tf��EE --
o aa�e aoai��a��_—. V.- SGHQOL FEES
W NC710E T�APPiiGANT H att�r maM�nq�Ais Gertiiica�e of Erempt�an,you siw�d Cecume sub�cct m ihe Ntsker's �—
� Com ensatmn ons o�the C mpY p a"
p p�avis ��pj�� udR.Yw4�usl formwnh co I wtth such raviso�s or tAa rmA sheil
�- np tleemea iev�keU. —'—"—"......--,"i
�
� I�NVISIUN OF M�USTAIAL SAFETKpEfl�IT�CEfiT(fMATY1N�
� t-�
uI herehy certity ttai no ercavatwn frve i5)m moie Feet�n deptfi into wFKh o person n cequued in descend. -----�����—
� wiu be made m connncnon with work auth�¢ed bY m�s permiL a�d that na hwldnp structwe,swffoWing,falsewo�k,
¢ or dPn,o�r�n�o�dasmantiTg tl+{.iot.+�i�i 6nmwe.�!lm�.�ty�src{�Bt ice�hi�.{Chap 32.6ry 2.Art 2,Stt
w 941.Title e.C A C I .. . . �
x '`
3 �As�ownei�buiide�.I wiii not empioy anyaM ta do warM wAich waVd repwre a permn lian�he Divisron ot
� Industr�al Salety.as noted alwve,unless such person ha5 a permlt to O4 Sut�worM frOm the diviSun.
� � , .,.., . . . : �. . ..,
� ❑a��s�o o���„�.�,5a��,y�,��No TC?TAL FEES �: "� � ;
� _
� C.ONSiRtiCIKIN LENOING AGENCI.i hereUy affirm Mat there ia a wnstruction�endinp agrncy ior Ihe perio�mmce
= nl ihe wark lur whrth this permd rs issued Bec.3097.Ca.C.L � � _ �
� te�aer,Neme GOMMENTS 3 ' ^�" ' �
,o zp�a��s naa�ess
�e
"Q CfA71fICATE pF COMPLIANCE ANO AUTHORRATIO!�FNTFV�.I certify I Mve road d�is ayplicatun and sbk i
en mar�he mtormatwn�ven ts cnrmct.k agree m compiy wGl��stare ia.vs a�+d ciry nf6ini�ee=rkawy m OuiMNeq
� cons��uc�ur�.and authorize a�eDreumame ot Ihe Depa�7ment oi BuiWi�q and Safcly ro enter urym tlr qopettY
= la whicA�I h����c�,applaed ihu fot ihe purpo so)maYinp inspettnns�i
~ �(:�.,� �����.�-_�-.�X (� f"7 ��S �1' r� �
� �
��a,�e�r�F�i o ��, �) �n RECPT NO. '� PAID BY �'��_;c { VALIDATI{7N
WHITE--(�epartment Copy,VELIOW—Finanae Copy.PINK—Assessor Copy,OQLDENFOD—Fiie Copy,GREEN—AppiiCBnts Copy
BSt46-71l89
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CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT
PRESS
FIRMI�Y
JOBSITE
APPLICATION-PERMIT USE
ADDRESS.')C k
DATE NUMBER CODE
c f-e(
ISSUE TYPE OCC,
APN LOT J TRP,CT..YG J DATE CONST._GROUP
Q
2C
k-lcl L
SETBACKS awROyENEaTs
Z-
ZONING
CROSS STREET
FRONT RRt y^
OWNER L L„,t! +L t�
ADDRESS >�'?r REAR^
CITY»6��N,_�g,k. IpG t TEL62B K �I SIDE/SIDE STREET Fity^
APPLICANT TE�. SIDE^
CONTRP,CTOR 4, he/,/L 2ef,,."If
ADDRESS L31 SEWAGE^ PUBLIC PMT
DISPOSAL
CITY F�c.�_ZI'17G_?TE�Y?K- EI PRIVATE SQ. FT/ 101)GAL
STATE
LIC. NUMBER GRADING^ CU.YDS. EXC.CU YDS FI�L
ARCH/ENG/ U TYPE SQ FT F ADJ.AREPJVALUATION
DESIGNER C--�,I�iz W i I q
ADDRESS-C, .E_' . W 2
CITY Gl L.t
3
ZIP
{D
PROPOSED USE
Z 4
F
J2Ci
NO
GARAGE
DWEL
N
Co PORCH
O. N0.
UNITS STORIES BEDROOMS
LOT DIMENSIONS VALUATION
AD).AREA
NO OF B�DGS HOW
QUANTITY DESCRIPTION FEE
ON�OT
USED 2
�
LICENSED CONTRACTORS DEC�ARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing
- 4��
with Section 70001 of Oiv;lion 3 of the Business and Professions Code,and my license is in fuil force and effect
I-I J
LJ W
OWNER BUI�DER DECLARATION: I hereby affirm that I am exempt from the Contractor's License t
f
f
I I
i
th
or
aw
e
ow
ng
0
C!
reason iSec 7031 5 Business and Professions Code Any city or county which requires a permit to construct.
Z
alter nnprove demolish or repair any structure
prior to its issuance also requires the a
licant for such
erm
t
pp
p
m
i
to file a signed statement had he is licensed pursuant to the provisions of the Contractor's�icense Law(Chapter
9 commencing with Section 70001 of Division 3 of the Business and Professions Code)or that he is exem
t therefrom
p
and the basis for the alleged exemption Any violation of Section 70315 by any applicant for a permit subjects
the applcant to a cwi penalty of net more than five hundred doilars($500)I J
^i as owner of the property,or my employees with wages as their sole compensation will do the work and
the structure is not intended or offered for sale(Sec 7044, Business and Professions Code The Contractors License Q
Law Ones riot appiy to an owner of property who builds or improves thereon,and who does such work himself
or Ilrouyb his own empioyees provided that such improvements are not intended or offered for sale If. however,
the budding or improvement is sold within one year of completion the owner-buiider wiil have the burden of proving <
that he did not build or improve for the purpose of sale-I I
^I as owner of the
ert
am exclusivel
ro
W
cont
ti
th I
d
p
Y
p
Y
rac
ng wi
icense
contractors to construct the protect(Sec
7044 Business and Professions Code.The Contractors�icense�aw does not apply to an owner of property who
builds or improves thereon arid who contracts for such
ro
ects with a c
ntr
t
I li
d
h
I
C
p
t
0
ac
or
s
CONSTRUCTION J �
cense
pursuant to t
e
ontractor
s
L"ens,law'
[-)I am exempt under Sec B 6 P.C.Attach Certihoatel P�AN REVIEW I Oy I;
Date Owner E�ECT..."._Rf--.,
C
WORKERS COMPENSATION Of CLARATIOJ I h
b
ff
I
h
lh
if
ere
ya
irm t
at
P�UMBING
ave a cert
icate of consent to sell insure,or
a certificate of Workers Compensation Insurance,or a certified copy thereof(Sec 3800, Lab C.)
^ Certified copy is hereby hamxnad � MECHANICAL
^Certified copy is filed with the Building Inspection Department or Department ,,,,
GRADING
<
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE This section need not be completed
fIl
CE
i
f
i
ie permit
s
or one hundred(5100)or less I certify that in the performance of the work for which this
permit rs issued. i shail not employ any person in any manner so as to become subject to the Nbrkers'Compensation
SMIP
Laws of Caldorma
out,Applcant UJ PARK-FEE
NOTICE TO APP�ICANT If,attic making this Certificate of Exemption,you should become subject to the Worker's U-
SCH00�FEES
Compensation previsions of the�poor Codfi,you, RW51 forthwith comply with such provisions or this permit shall
be deemed revoked
DIVISION OF INDUSTRIAL SAFETIrPERNBT CERTIFICATION
^I hereby certify that no ex.avation five(5)or more feet to depth into which a person is requited to descend.
Ilb
d
wi
e ma
e in connection with work authorized by this permit,and that no building structure,scaffolding,falsewoek,
in demoimnn or dismantkryy tnyztof.yfiil tiny mote.Nlaei flirty six(36)feet high(Chap 32,Gip 2,Art 2. Sec
i�
341.Titie 8. CAC(
^As owner-budder I will not employ anyone to do work which would require a pent from the Division of
Industriai Safety as noted above, unless such person has a permit to do such work from the division
�
usb
t
P
r
Div s on of Ind
ial Safe
Y
e
mit No
CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constr
t
I
di
TOTA�FEES
f
h
f
uc
ion
en
ng agency
ur t
e per
ormance
of the work for which this permit is issued(Sec 3097
CryC)
Lenders Name
L COMMENTS)'9
enders Address
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION Of ENTRY I
f
certi
y I have read this application and state
that the information given is correct I agree to comply with all state laws and city ordinances relating to building
const
0
b
d
h
i
an
ruc
aut
on, or
ze a representative of the Department of Building and Safety to enter Wort the property
for which I h ve applied
this for the purpol making inspections
X
t
Signure of Applicant or A
RECPT NO. PAID BY VA�IDATION
ent-O-'D
9
a
BS 106-1 1 J89
-Department Copy,YE�LOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicants Copy
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