HomeMy WebLinkAbout1078 '"� CITY OF DIAMOND BAR PRESS
, DEPARTMENT OF BUILDING AND SAFETY F�RMLY
'�^ BUILDING PERMIT
JOBSITE APPLICATION PERMIT USE
ADDRESS _ 21040 RIEGO �DATE NUMBER CODE
ISSUE � �� CONST. GROUP
� APN LOT TRACT DATE
o CROSS STREEX ZONING SETBACKS �E��
O° OWNER MR. YOUNG �OM Ryy ❑
o ADDRESS 21040 RIEGO REAR ❑
W CITY DIAMOND BAR ZIP�..Z TEL. SIDE/SI�E STREET RW ❑
Z APPLICANT_ BOB KFT.T.FR TEL.594-51nn SIDE ❑
0
0
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a CONTRACTOR_ pETERSON JONES
3190 E. WILLOW SEWAGE ❑ PUBUC PMT�
W CDDRE S ZIP EL. - $ISPOSAL ❑ pR�yATE SQ.FL/100 GAL
z STATE 528710 GRADING �CU.YDS.EXG CU YDS FILL
y LIC.NUMBER_
y ARCH/ENG/ y T�P�'' � � ��� AC�I. AREA�/ALUATI N
� DESIGNER_ �' �
o ADDRESS (W 2
= CITY ZIP TEL. (e�, 3
� PROPOSED USE Z 4
� d fiARAGE
o NO.DWEL. NO. NO. � pORCH
y UNITS STORIES BEDROOMS
o� LOT DIMENSIONS � VALUATION ADJ.AREA
o NO.OF BLDGS HOW 'aUAN�'rtY Q� �]p�'�Q�[ ��E
W O OT 1 USED �;
W
S (�'
~ �I ENSED CONTRACTORS DECL�4flAT10N�.I here6y afM1rm that I am licrosed mNe provi�ians ol CMpur 9(wmmn¢mp �';
Y wnh Secnon 7000�ol Oivisron 3 ot the Busmes:aM Professqns CoOe,aM my Icenu is in lull for[e aM elltal
� W
3 ❑ t�t7' �
�+- OWNEF-BUILUEH DECLARAipN:I herehy alfirm Ihat I am e�empl Irom the Contrxtnr's licenu Law ta�tl�e Idbwing �..
x reasan I�ec 7031 5 Business and Professions Cade�Any city or county which reqwres a permil to contiru[t (,ry� �
O alter imprwe,tlemdish,or repa�r any slructure,D��w ro its rssuanee,also requires tAe appGum for wch permn �„��:
Qin IAe a sigred s�aiemem thai he is licensed purswm m the pwisions of Me Cantractor's lke�ze law(CLapld p�; '
pp 9 Icommencing with Seciion 70D0�ot Divislan 3 of Me Buslness aM Profeubm Code�a Mal he Is emmpt Nx�ham ��,.:���.f�
d antl the basrs lar the alleged eremption.Any vida4on ol Secuon 7031.5 6y airy appliont ki a perme whjects ��.�,.�'.
� Ihe apph�am to a civd penilty ul not more than fm hundred dallars(55001.1: a:.
W
� ❑I,a owner of ihe pmperry,or my employees with wages as their sole compensapon,wiN do Ihe work,and
� tAe stmcwie�s not intenAed or alhred Im sale ISec.704M1,Business aM Pmlessans CoAa The Cmtnctor's hcense q'
� Law does noc apDly m an owner of oropeiry who 6uilds or improves iherem.and who dces such work himttlf L)
W or through his own employees provided that sucA imprwemems are not intended a ollered lor sak.tl,hvnwer �,,
m the hmld ng or�mprovement s wld withln one yeer ol canpktion,the owner-6uilder will have ihe huden ol qmm8
� that he did not build or impmve for tM purpose al sak.� �d�:���.���.
H �.
H ❑I,as ownei ol the prope�VL am eeclusivety contrx�ing WIIII IiCCn3ld C01If]CIOf3 IO fA05IfUCt tAE p10�KI�SN
0 7044,9usiness aiM Pmfessions Cade�.Tk ConVactor's licenu Lew does nol apply to an owner of aupertY wM10 '.;::'����,
6 6uilds or impmves�hereon,and who cantraats ler such pmjccts wtth a contrattalf)licrosed pxauanl m the Cmtrutor's
0
`"a"Se`a'"' CONSTRUCTION
� ❑I am exempt under Sec._ ,B.6 v.C.IAn+�h ceruhunl �.: PLAN REVIEW
o �a�e �'^�� :ELEC �
� WOHKERS COMPENSATqN Of0.AflATION:I hereby affirm IAa�I hm�arfifiute of cansml to uN-msue,a
a rendiwte o1 VJorkers'Compensation Insuraae,or a cnufed topy Ihereol(Sec.3800.1a6.C.I-
Q ❑Cerufied caoy is heie6v furnrshed � MECHANICAL
O ❑C rtf eE copy is liled w�th ihe Bwlding Inspeclion Depaitment w �epartmenl ���.GRA��NCj
W
� CER7IFICATE OF El(EMPTIDN fHOM WDAKEflS'COMPENSATIW INSUqANCE:Thn uclion need not ha�o�,.a . ISSUANCE
y I th permit�s�or one hundred IS100)a less.I cenify Mat in Me pnfpmr¢s M tlm wrck lor which the
� permn is Issuetl,1 sAall rot emyloy airy person in any manrer sa as m Eecpre wDj[tt u Me 1Wrkers'Gampensatm �. SMIP
� Laws of Ca6fomla.
� � PARK FEE
0 oa�e _..��, ���,, -.
� NO11LE TO APPLILANT�.tl atter maMinp Mis C{fLJ,�NIeS�t�On,,,;�u sMdd hecume iWK[t ro the WorNers ��.SCHOOL FEES
—_+ Canpensation aovisans of tM Lahor Cade,yo�nust(fur c with wch pwkwis rc tlws peimn shal
LL be deemed revoked.
J
W pVISION OF INWSTPIAL SAFEI"Y PEflMIT CEflTIFICATION: E,��{'�
0 ❑I herehy certity that no e�nvatron„��e��dep�,��ieh a person o rpuind p dmeend,
� will Oe made in conne�tpn w�M wort au M IMI no Witlinp sVuctun,sUfl0ldinp,IWIMqrk,
or demoliuon a dismantling tlereof,will he more�lun thirry�siv�36�hn hiph.ICh+e.3.Z.Grp 2.An 2.Sec
i W- 341.Title 8.CAC.) ,y.;
_ ._•.� �`.;,,) �."..
3 ❑a:owoe�-a��iaer,i will nn�e�j`nybne�id do Work�wJixG woyld+p�p.i�p1i(mil hOm tlM Divom d
� Industrial Salety.�s noled ahovn unlesy suc¢�eesn fuk�.�,h¢daiuA ivdk hbn Ihi d'uision
' � LONS7XUCTqN LENOING AGEN(,Y:I nereby�aflirm'��, . ��:
F_-
�� ❑Qriswn d InEusu�al5afery Permil No. �0��� ����
NN tlMn it i[oMtru[IOn IIIbMq�IICY Id IM pM�01mM1[! �
= of ih uvor4 fa which tAis pamt is iswed(Sec.3097.Ci.�.C.I.
� Lender's Name COMMENTS
mLender's Address
6 CEfifIFICATE OF COM1IPLIANCE AND AUfIqPoZATIdI DF ENfRY:1 cerrily I hw+rp1 Ilit�pplkatim np�q
va that tAe mipmation gven is carre�t.I qee to comqy wiM ap sule Iwvs md ary�a nbinp to biitlinp
y constructwn,ald Morue�iepeunta0ve of th Oprtmr�t d Buideip�d S�My Eo w�tx�qd�Ihr peyMy
tr
= fa wlnch I ha�e ed for Mis pumn d mdinp impstlpu.
F—
X ,•,;. �,�`" '
S i� ^ �� RECPT NO. � PAID BY VAUDATION
Sqnature ol Applkmt a Apent p�1�
WHITE—IDepartment Copy,YELLOW—Finance Capy,PINK—Agsessor Copy,GOLDENROD—File Copy,GREEN—ApplicantS COpy
BS10s-11/89
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CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT
PRESS
FIRMLY
JOBSITE APPLICATION PERMIT USE
ADDRESS 21040 RIEGO DATE NUMBER CODE
ISSUE
TYPE
APN LOT TRACT ()
DATE CONST.GROUP
CROSS STREET ZONING SETBACKS ItWytaWMEMM
OWNER MR.YOUNG nONT RW^
ADDRESS 21040 RIEGO REAR^
CITY DIAMOND BAR ZIP 91765 TEL SIDE/SIDE STREET RW^
APPLICANT-BOB KELLER TEL.594-5100 SIDE EI.
PETERSON JONES
CONTRACTOR
SEWAGE
3190 E.WILLOW
^ PUBLIC PMT
ADDRES
IGNAL HILL
pISPOSAL
S 9 EI PRIVATE SQ. FT/ 100 GAL
CITY
ZIP EL.
STATE
GRADING EI CU.YDS. EXC. CU YDS FILL
LIC. NUMBER 528710
ARCH/ENG/ Cn TYPE SQ FT FACTOR PS ADJ.AREANALUATI. N
DESIGNER W 1
W
ADDRESS L
2
L
CITY ZIP TEL 0 3
PROPOSED USE Z 4
J GARAGE
N0. DWEL. N0. N0. 5 PORCH
UNITS STORIES BEDROOMS
LOT DIMENSIONS M VALUATION A DJ.AREA
N0.OF BLDGS HOW
QUANTITY DESCRIPTION FEE
1
0 OT
USED
LI ENSED CONTRACTORS DECLARATIONI hereb
affirm that I am licensed order
ter 9(commencin
rovisions O1 Cha
Y
P
P
w
9
with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect
� W
OWNER BUILDER DECLARATION: I hereby atfirm that I am exempt from the Contractor's License Law for the following
reason (Sec 70315,Business and Professions Code Any ciry or county which requires a permit to construct.
It
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prove,
,or repa
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ruc
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ts issuance,a
so requ
res t
ca nt
e app
or suc
permit
to the a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter
9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therehom M.
and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects
the a
licant to a civil
enalt
of not more than We hundred dollars($500)
)
PP
P
Y
a
^I
,as owner of the property or my employees with wages as their sole compensation,will do the work. and
Q
the structure Is not intended or offered for sale (Sec 7044,Business and Professions Code The Contractor's License
Law does not apply to an owner of property who builds or improves thereon,and who does such work himself U
or through his own employees provided that such improvements are not intended or offered for sale.It, however,
the building or improvement is sold within one year of completion.the owner-builder will have the burden of proving <
that he did nor build or improve for the purpose of sale.) _
� W
I as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec
7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of property who
builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractor
s
License Law I CONSTRUCTION
^I am exempt under Sec._, B. 6 P.C.Attach Certificate). PLAN REVIEW
Date Owner ELEC
C
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure,or
I
a terbticate of Workers'Compensation Insurance,or a certified copy thereof(Sea 3800, Lab. C.L
^Certified copy is hereby furnished J MECHANICAL
^Certified copy is filed with the Building Inspection Department or Department GRADING
CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE This section need not he completed r
ISSUANCE
If the permit is for one hundred (5100)or less.I artily that in the performance of the work for which this
permit is issued,I shall not employ any person in any manner so as to become subject to the Nkrkeri Compensation
SMIP
Laws of California
W PARK FEE
a
t,
NOTICE TO APPLICANT H.after making this C t e Ot
LL SCHOOL FEES
u should become subject to the Worker's
Coro nsation provisions of the Labor Code,
tie yon-x��irtust((&cdd with such prwbiab or than permit shah
be deemed revoked
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
^I hereby certify that no excavation e
d�r7vl tiF h a person is required to descend.
will be made in connection with work au nil that no buildup structure,scaffolding,fabeewrk,
penn
or demolition or dismantling thereof,will be more than thirty-six(36)feet hph. (Chap. 3.2,Grp 2.An 2.Sec
341.Tide 8. CAC(rZ
^As owner-builder,I will not en[ -" 1 1 y�og one id do Work vii ph„world "VW i p)(ntil from the Divisor at
Industrial Safety
as noted above
enles4 saa
eron hek a
er�iQ;kk do swh ivo ban the division
FP
P
^Division of Industrial Safety Permit No. T 0
CONSTRUCTION LENDING AGENCY I h
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TAL FEES
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on
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no arc
f th
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e wor
or w
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s pant is issued (Sec. 3097,Civ.C.).
t
Lender's Name
Lender's Address CO MMENTS
CERTIFICATE OP COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have mad this application and aim
that the information given is correct I agree to comply with all state laws and city adiancs training to building
constructand thorue a representative of the Department of Building and Safety to oar repair Sw poepuety
for which I haw and fa this permit b ue al making irnpaetisna
V-^ <V T
Q
CPT N0. PAID BY
Signature of Applicant or Agent gab RE VALIDATION
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WHITE-Department Copy,YELLOW-Finance Copy. PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicants Copy
BS106-11/89
�R'1"d�ACC.
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