HomeMy WebLinkAbout1603 (9) �
�"` CITY OF DIAMOND BAR pRESS
� DEPARTMENT OF BUILDING AND SAFETY FIRMLY
,�. BUILDING PERMIT
JOBSITE 21050 RIEGO CT. pA�E ATION �<�:�J _Cjr� �RMgER f� �'� CODE
ADDRESS ���E .- C T1(pE pCC.
r APN LOT TRACT DATE C�-��� �� CONST. GROUP
� CROSS STREET SETBACKS "fi°"E'"E"'g
°D OWNER MR. SALAZAR ZONING FRONT RW ❑
o ADDRESS 21050 RIEGO CT. REAR ❑
,� CITY DIAMOND BAR Z�p 91765 ��_ SIDE/SIDE STREET RW ❑
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o APPLICRNT BGB KELLER TEI.. 594-510 SIDE ❑
a CONTRAC70R_ PETERSON JONES SEWAGE ❑ PUBUC PMT�
o ADDRESS 210� F WTTT�W ST_ DISPOSAL
SIGNAL HILL 90806 2/988-0 9 ❑ PRIVATE SQ.FT./100GA1.
W CITY ZIP TEL.
z STATE 5Zg710 GRADING ❑ CU.YOS.EXC. CU YDS FILL
y LIC.NUMBER_ TYPE SQ F� �R P5 ' Ata,J� AWEANAI.U/kTl N
y ARCHlENG/ � � �
y DESIGNER W
� ADDRESS V- 2
� CITY ZIP TEL. (:j, 3
z , Z 4
� PROP05ED USE �- Y � �
� .,,,� GARAGE
o NO.DWEL. NO. NO. m PORCH
� UNITS —STORIES BEDROOMS
s LOT DIMENSION,3 VALUATION ADJ.AFiEA
Z NO.OF BLDGS 1 HOW OU+�tta�trY L)� 1PTlUN F�E �
= ON LOT USED
W
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~' LICENSED CONTHACTORS�ECLNflATION�.I hereCl�affi�m Ihat I am licenud under pmvlums ol CAappr 9(coimienciry _�'�.
Y wnh Sxoon 7000)ot Oivision 3 d the Busineas and Professans Code,aM my licmu rs in full farce and efte[L ;..W.
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3 �FA-g�llL�EN OECLAflATqN 1 herehy atfi�m ihat I am e�emD��rom the Contocmr's licenu L�w lo�the lolbwmp ��
Z reason I�ec.70315.Businas and Pmfessions Code:Any city or cwnty which requins a qrme lo cons6at, (}� ' �.�^
o alter.improre,demoluh,ar re{air arry 5lruciure,prior Ia ils issua�rce.�Iw iryures lM1e appiwm for such pmmn ��. I
Qm hle a sAned statement Ihat he is 6cenxd Durswm to the p�wisron:of Me Cona�cmr's Lkeixe Ww(CMpta m: i ,. (,�
s 9 Icommencing with Sectmn 10i)0�ol Diunim 3 0l the Butiness and Pmleuions Codel a Iha�he is eamql IMrdrqn ,g�.
a and the basis lor ihe alleged:xemptian.Any violaoon ol Section 7031.5 by�ny applinnl far�perme m6pcu ���.
W Ihe apph�ant to a civil penalq uf nai morz�han live hundred doNars(25001.b .,.��.,
� ❑I as owner of Ihe D�openy,or my emDloyces wnh wapes as tliei�sole compensation,wiY do�he work end �
~ the structure�s nm intended or oihred fq sale IS¢.7D46.Business and Pmfesspns Cade:TM Cmtriqar's hcrose
�,�j Law does irol apply to an owier ol propeny wM 6uilds or improves thereon.anE wha Aoes su[h wrck himself. ,
,•• or tArough his own employees,pmvided that sucA imprwements arz not inunded a oHertd for sak.If,howwu, ��.� -
= ihe 6wldmg or Impmvemem is solU wBhin one year of cqnpletion,the mvnerbuilder will hm tM buden of prwnp .Q,.
� �ha�he dld not�uila or impiave lor ihe purpose ot sak.l �{��
u� ❑I,as ownei of�he pmpeny,am eadumveN�OOIteC�lny WIN IICEnSEd COnbiCWfS IO WnSlfutl�h[Pf0�eC1 I� #�1'..
7044 Buicess ane Pmfessions Code�.TM Comrxtor's L¢ense l dar�rot apply to an oemer of proplrry who "�-..
6 budds m impr e ai,and nho contrxta for such pro nlr tultl liuns�d pusuam m Ihe Cmtncta's
L cense Law.l � ��.Ci�N.�.TRUCiT��N
� ❑i,m „�mp� �ee �nxnc�rnnr�nl PLAN REVIEW
� oa,e ow'"� �LECIEII_�
� WONKENS'COMPENSATION�ECLAMTItlJ�.I hereby atlirm Ihe�I h�ve a ronificete ot�o�u��io sM�-insure,a `�i PLUMBINCs�-- ��� � e--'r ''� -
ar ica�e of Nbrkns'Compensatim Inwrance,ar�mtAied copy ihereol(Sec.380Q la6 C1. __
� c«ce�a�oo�,:ne,env r�.��:n�e �'MECHANICAL —___
C ❑Cerufied copy is fileU witl.�Ae Bwlding Inspectian Depxtment or ��1 �-:GRADING
W
Z CENTIFICATE OF E%EMPTION fROM WONNEflS COMPENSATION INSUflANCE�.This sectian need mt he��w .ISSUANCE
� if Ihe permit Is tar o�re hundrtd(5100)a kss.l-u�lily tlwt in the�per�amance M Ihe warM la wM1ih Ihp
y permil�is�ssued.I shall rot employ airy peraan in airy mmne�sa as b he[am!wbjxt to 1he NbrYers'CampenLOon �'�� S'M�P
� �awz oi ceiao���a . . , �'pARK FEE
0
� °a1e `�DP��°� �;SCHOOL FEES
W NOTICE TO APMICANT.II,afier mak�ng Mi3 Certitiute el Eiemplion,yau sMdd hetome su6let�M 1Ae Nbke�s
J
� Compensation piovisions of tle lahor Code,��Ep��wiWi�adwilh�omply�wNh�¢uM prwniam a Mis perme thd
'� Ee Aeem¢E feVokM. � ' —_._.._.___
�
� pVISION OF INWSfRIAL SAFLTY PEflMIT CEflTIFlGA710N:�
�
o ❑I herehy cenify that nn e�wv�tqn live I51 a�e feet in dpth nW w�icl��penm is repuired m dpcwd
� w�ll ha made�n cm�cec�ion wnh worli wtlwrved M Ihis D��me.rid IMt no hiNld�q sVueture.sGfbldinY.IilMwak.
rc demolnian m tismantlinp�kreol.wAI 6e mare Nwn ihlrry-:u(36)het AipA.I�D-32.Gry 2.Art 2 Ss
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3 ❑As ownei�budder,I wdl iwl empby�nyone to do warY whch wpYd rpuin�prml trom tle Oivuqn d
� Indusvial Sabety,as noad aha✓e,unkss such permn Mt a permil M da weh worY iran the diVifion.
� „
W oa�a����,.��sa�.����m���. ' TOTAL FEES � ��� r��
d
� CONSfNUCfIDN LENDING AGFNCY�I herehy alli�m tlul Uwe ii a rnmtrucliof lend�q pincY�a tM prlwm�na
= of ihe war4 in whKh Nis permif is uwed(Ssc.3087.Cn.C.1. / j
� COMMENTS `' ' F '� C�
lender's Name
� Lender's Address �''
m
� CEN�IFCATE OF COMPLINCE ANO AUTIqfMUT�I OF ENf1iY:I prlily I hrv�m0 hit�pplitMbn�M sh! .__ y'� "
rn �hat the�nlarmatisn giren rs carcc�.I pne m comply wiM atl�uee I�ws rd eiry ordiurcn�iEn�to 6ullbnp
ymnsvuction. auMor¢c a repreum�liw d ihe tmmt d Buiinp od SaMY b NYr ya�Ihe paprb -
ta wliicM1 applie0 Poi tl�is perm[tar matinp mrysaom. ..
� 2 ��(� E^ l_
Z "`� �`� `� � �� RECPT NO. ��i� R4lD BY � ` VALIDATI " �
sq�w.e d �t or a�em o�w -
WHITE--Department Copy,YELLOW—Finance Copy,PINK—ASsessor Copy,GOLDENROD—File Copy.GREEN—Applicanb Copy
BS106-17l89
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CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT
PRESS
FIRMLY
JOBSITE APPLICATION C PERMIT,� USE
21050 RIEGO CT. DATE NUMBERL CODE-
ADDRESS
C TYPE OCC.
ADDRESS -
ID
GROUP
T
CONS
APN LOT TRACT .
DATE
CROSS STREET
ZONING SETBACKS tkow4oyEk*NM
A ^
R
FRONT RW
OWNER MR. SALAZ
ADDRESS 21050 RIEGO CT. REAR^
CITY DIAMOND BAR Zip 91765 TEL- [:]
SIDE/SIDE STREET RW^
APPLICANT BOB KELLER TEL. 594-510 SIDE^
PETERSON JONES
AGE^
CONTRACTOR
- SEW PUBLIC PMT A
ADDRESS 31 0 r WILLOW ST_
DISP
OSAL
' SIGNAL HILL 90806 2/988-0
9 ^ PRIVATE SQ. FT./100 GAL
CITY ZIP TEL
u .
STATE 528710 GRA YDS. EXC. CU YDS FILL
DING^CU
NUMBER
LIC
W3 . TYPE SQ FT FACTOR PS AWe AREANI LUATI N
ARCH/ENG/ W 1
DESIGNER
LU
ADDRESS LL 2
0
CITY ZIP TEL 3
���
4
PROPOSED USE 0
_j GARAGE
N0. DWEL. N0. N0.
5 PORCH
OOMS
UNITS STORIES BEDR m
S2 MENSIONS VALUATI ON ADJ.AREA
LOT DI
o HOW
OUANTITY DESC IPTION FEE
N0.OF BLDGS
1
U
W ON LOT USED
c
W
^ Fr
Z
� LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing
15 -
with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect
W
3 J
W
OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following
n
reason (Sec 7031.5. Business and Professions Code Any ciry or county which requires a permit to construct, rg
alter improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
Z
o '
s License Law(Chapter
m /,•(,
to file a signed statement that he is licensed pursuant to the provisions of the Contractor
pp 9(commencing with Section 70130)of Division 3 of the Business and Professions Code)or that he is exempt therefrom
and the basis for the alleged exemption Any violation of Section 7031.5 by any applicant far a permit subjects
sX the applicant to a civil penalry of not more than five hundred dollars($500).): d
o ^I as owner of the progeny,or my employees with wages as than sole compensation,will do the work,and
I.-
the structure is not intended or offered for sale(Sac. 7044. Business and Professions Code.The Contractor's License
<
- If
U
hi
s mse
Law does not apply to an owner of property who builds or improves thereon,and who does such work
or through his own employees provided that such improvements are not intended or offered for sale If, however,
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rp
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prov
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the building or improvement is sold within one year of completion,the owner-builder will have the
y that he did not build or improve for the purpose of safe.)
H ^I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec
W
Business and Professions Code The Contractor's License L does net apply to an owner of property who
7044
and who contracts for such pro etc tale)licensed pursuant to the Contractor's
reon
builds or im
P
CONSTRUCTION
Lic ense Law.l
^am xempt nee PC.IAtxhcerefcaa). PLAN REVIEW
p Date Owner ELECTRIC
WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-insure.at
t PLUMBINC
certificate of Workers Compensation Insurance,or a centilied copy thereof(Sec 3800,Lab.C.1. 1
Certified copy is hereby furnished ...) MECHANICAL
t
a
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^Certified copy is filed will the Building Inspection Department or Department. GRADING
W
Z CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE This section need net be completed
< ISSUANCE
e7 if the permit is for one hundred ($100)or less. Itestify that in the performance of the work for which"this
permit is issued,I shall not employ any person in any monies so as to become subject to the Wxkers'Compensation
SMIP
Lawn of California id PARK FEE
L
o Date"t'in'
LL SCHOOL FEES
NOTICE TO APPLICANT If,after making this Certificate of 6cemption,you should becomes subject to the Werker'a
W Compensation provisions of Are Labor f.dl,(ypY^vnWl foaYwilh;comply with such proveiona or this perms shah
/
be deemed revoked.
sac DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
th into which a person is required to directed
e feet in de
fi
�
(5
P
ve
)or mit
I hereby certify that no excavation
will be made in connection with work auMxaed by this permit. and that no bolding structure.steffoldinp,Waxwork.
Gr
Art 2
Sec
3
2
2
t hi
h
(Cha
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e
36)t
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P
a
9
P•
rty-s
han t
or demolition or dismantling thereof. will be more
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341,Title 8,C AC 1
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^As owner-builder,I will not employ anyone to do work which would sessions a partial from do Division of
3
Industrial Satiety,as noted aboe,unless such person has a permit to do such work frees the division.
Oowson of Industrial Safety Permit No T OTAL FEES C)_
CO
cl- CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending Spancy,ffor,the pakrrhirloe
co
of the work for which this permit is issued (Sat 3097. Cis.C.).
CO /
= Lender's Name MMENTS
rs0 Lenders Address
CERTIFICATE OF COMPLIANCE ANO AUTHORIZATION OF ENTRY: I candy I have read the appkMOni ad atom
ly with all stow laws and ciry oriental naYtng to bailing
ree to com
iven is correct I a
- ti
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n
th
t th
f
9
P
9
e in
orma
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H a
construction authorize a representative of the invest of Boling and Safety to Near upon the property
in
ecreaas
it f
ki
f
thi
for which applied
or ma
ng
sp
C,_..j
or
s perm
. --y
11
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2 2 VAUDATI
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2•,d PAID BY
CPT NO
Signature of.ant or Agent Do .
WHITE--Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicants Copy
BS106-11/89
CITY OF DIAMONC
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