HomeMy WebLinkAbout1055 �
�����'"� CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY PRESS
BUILDING PERMIT FIRMLY
JOBSITE � i APPLICATION �� _ �-� pEq(� � .��� E
ADDRESS �/ Q �'S �� C16 1��' �E � � �, � � NYl�i�BER � � � �CODE
� APN LOT TRACT DATE ) � � � CpN� G�p
� CROSS STREET
o SETBACKS .�nae�s
m OWNER �f S � SS�� � ZONING �OM. � ❑
� ADDRESS -Z� b SS"' �i'cs U �� � R� ❑
„� CITY �yLar�/d /�!9 �- ZIP 9/7 LS TEL SIDE/SIDE STREET Ryy ❑
a APPLICANT L ��, SIDE ❑
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� CONTRACTOR_pc?c G•S o HJ -7-p�aS ❑ �B� �T�
o ADORESS 3 � gQ E c.�,'//�l D SPOSAL
W C I T Y S'��U�� /�.�/I Z I P 9 a�T E 1 1�3 9�d a ❑ PRIVATE S�.Ff./100 GAL
= STATE
y UC.NUMBER �� A `I / � GRADING ❑CU.YDS.EXC. CU YDS FILL
y ARCH/ENG/ cA NPE � �� � �Ql. AREANALUA"fiON
" DESIGNER_ 'W 1
o ADDRESS � 2
= CITY ZIP TEL. �r 3
� PROPOSED USE ' '`'• " '���- �r 1� Z 4
� � �C �L�' 1 � GARA6E
, o NO.DWEL. NO. NO.
y UNITS STORIES BEDROOMS � PORCH
� LOT DIMENSIONS m VALUATION ADJ.AREA
I o NO.OF BLDGS HOW QUANTmr pESCRiPFFON FEE
W ONLOT USED Q
°G � U
W �
2
~ LICENSEO CONTMCTORS OECIARATION:I herehy affirm that I am Ircmietl u�Ms provuim:af Chapor 9 Icomnwionp �
¢ vnrh Sxnon 7D001 al�iv�swn 3 of tM Busmezs and Prohuions Code,aM my licp�se i�in IuN fo¢e and efhct W
3 � J
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� OWNER-BNLOER�ECLARATqN�i Miehy atfirm tha�I am eaampt Irom�M ContrxmYs Lkmse law fp�he Idlow+rp
Z �eason ISec 70315.8usmess and Prof�sxane CaOa�Airy cny or counry wlnch ieqwra i qrmn ro canf[ru[t (� -�
o alte� implove.0lmd6A.a rePb1 a1ry SlruCiWe.pfia!to i1s issWrce,a150 ttQulres Ihe dpplKillt fa SYCh plfllNt Z ' � "
� m��k a signeE snumeni ma�he�s Iice�se0 owswnt ro the p�rnisiais of iM Cmrtacioi s tKnne l�w�Chapta m � � .`�'C +� � . C'
¢ 9 Icommennng wrth Sx1an 10001 al Llvrs�m 3 0l�he Bus�uuu�nd Vrofwwm Codel a�h�t M ia wmpl tMefrom '�, �
a, �ne me ea:�s ra�m�alNgeE e.empfan AM��da�b�ol Secuon 7031 5 6y,m aopaa��ta a PwTn wepn: >
K rhe apD��cant�a a crvtl pnalry ot rot morc than frv��unOretl OOIIUS(5500�J J
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� ❑I as rnv�rci at�he rr a a
D�'Y. mY�7�s witli w�qes a�ihMt SON cmpntatmn wM do IM work.yN
� tle:nuctwe�:noi intoMed ar oHned td ule iSec.lOCd.8usiness aM Professans Cade:The Convxtp's License Q
� Law Eces w�applv�o an ownx ol prapelty.rho Mnks or imD�wn tMrem.aM who das suN worY hunalf, (�
' a through hrs own emoloyn�.Drovided that suc�imprwenrnts�re nm intentletl a olfercG for sW If,howwer, Z
m rtie�wl0ing m improvement rs wIU wiMin wie yex of completpn,the owner-huddx wil haVe the DurdM ol ywiiq Q
y Ihdl 11!dIC noi hU�k M iR10�0VP.IOf I�1[p11fpOS!]�Si�l.� _
tn ❑I as owner ol the O�oW�tY.m exeMwvep mmrazuny wim irtensed cmvacrors m wnrnuct ihe prqu�ISec. ��W �.
0 70q6.Buvness m0 Rol�sswns CoAr.TM Canlraeror s Liunu Law don nol apqy to an ownai of pruqrty who �
2 hwka or impmres�ha�m.and wna contrxu iw such pm�wt:w�m�cantrxmqs)licensetl pusum��o tlu Cmirxtp�s
� `"`°"`'"" CONSTRUCTION
c
'+' 0 i am e.emp���ax S�r_ e 6 P4�Anxn cerueote� PLAN REVIEW
- r-
p o�te Owner
� N9flKEflS�COMPENSATIW OECLAPAi1dY-I MrMy�ffirm tha�I hwe a nreliau of canmi ro sNl-Naue,a � ,
�cenihnn ol Workws�Campens�iwn Insunnce.or a catdied copy therml($¢.3800.l�E.CI � PLUMB�N . �- ' `'
6 ❑c""'.'°°�u""'a'''"""'"° � MECHANICAL
G ❑Cnuhed capy�:tikd wim me BudMng�nsptcwn Opnmimt a o�o.m�. � GRADING
W
� CEfRIFICATE OF E%EMPTqN FFOM WORKENS'LOMPENSpT10N INSUqpNCE�.Yhn srttpn nad rwt M co�bud ISSUANCE
y it iAa permil is far�AuMrM(51001 a less.I cerUfy tlut in the pnfamanee of tlr rwk fn whch tAn
F pmm�u issu�d.I shaN mt employ airy permn�n am�m�mer so as m b�cmie mbNct lo the NbrWs'Cmpenatron SMIP
= l�ws ol Caldornu.
o �,� �� W PARK FEE
J �MITICE TO 4PPLICANT M.�f�n mNn M � �� SCHOOL FEES
� CuMMytwn pwpim�al the L�bor Cudt� c rnM wcAK�s��to the Nbkx'� .
LL he dw�d iawk�d. �.. ��� P��s a 11Nf pMme SMM
r
� OIYISION OG INqISTRIAI$AFETY PEfl1�9f CERTIFCAiHl1�
W
o ❑i nereW crMv�hai m exovatan Fnn 151 a ma�lem m�y�h nm wkcn a pmm��r.qw�ro ancw.
� wiu he mNr in cmn�c�m rntli�Ei � m huldiip muctue.tdldliiq,1a4wark.
e
a eemoln�on u dsmamlMq iMrnf. ei th� tMr 1 twt hiph.(LTp.32.GO z.An z.S�c
Z� 3�I.TVtkB.CAC1
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3 ❑ns own.�euJd�. �wq.�n�«�y.�ry.■fu,ao y�«w..wnsn..yvWa r}�n a yrnw xo.IR.owoian d �
f.-. IM�svid SaMv,as roW atiwr.inl�s fwk yrfon Ain�N�n��7CdoisqJl:wqr�c�lma�iM dwiaiaa
� -...,�. �.:•.�... n y--.. � ,__.,-. i
W ❑6.,smdi�ewSat�TvlKr'Tp'i,"'•`.: :-�;,✓ :�r.i:_; ;
� � TOTAL FEES `� C • E� C�
� COIiSiRUCfION lE�ldlr'GGENCY�I Iw�hy aflirn�hat Ur�u a wmbs6m WdYp pmcy 1p dr
= of tM vurY ta whcA M pmm�aauN IS�C.7081.Cn.CI.
� lendn�z Nwna
m i�s�w COMMENTS
� CERfIfIfATE Of CpARWCE AIO AIRII�ZARM OF ENTA1'�i�wMy 1 hM mi tlw apieaii�al uw
�a mn Ihe�nlmmnm qu�n if�anet.I a�ro�e�qly wM dl aYY 4wa�N dry«inrKa nyfp m ppiYp
yconstrucnw.and �t i��d tM bmnl d BWO�q ai/$May O wM yp�M pqwry .
= ta wMch 1 � fa An W1M hr tll� m�kwq�n1pC00�
F� � " .
�-; _ �,C,('� ,,,�'y,.r. .�; `�
sy�m..d aop�c.A�m ayrn p,�, RECPT NO. �� /r �' PAID BY ' � W4LIDATI �
WHITE—Department Copy,YELLOW—Finance Copy,PINK—/liaes9or Copy,GOLDENROD—Fde Capy,GREEN—Applica�Copy
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ADDRESS�/Q�s���C�a� �
APN LOT TRACT
CROSS STREET
OWNER�f S� :SSA�s-�/
ADDRESS-2�0 SS^ ��c�U 1 � �'
CITY y�H/t��'�Ar-ZIP��TEL
APPLICANT'j,�/T� �(�L TEL,
CONTRACTOR_pC?c G•S a aJ -Ta.v nS
ADDRESS 3�90 E eeJ,'//Qct�
CITY S'r�I1L�/�•r/�ZIP9a �TEII/3 9�da�
CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT
esnaea�tets
APPLICATION�� �I PERMIT� lr� E
DATE-� NUMBER 1 � � �CODE
ISSUE
DATE�,--��� r CONST. GROUP
ZONING SETBACKS
I,
SEWAGE
DISPOSAL
STATE
LIC. NUMBER•-� �q�� �
ARCH/ENG/
DESIGNER_
ADDRESS
CITY
ZIP TEL.
H
s
0
0
W
W
0
0
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H
S
W
Z
0
0
3
Z
0
C
X
W
W
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H
H
Z
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0
J
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Z
a
W
Z
0
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PROPOSED USE'i �'Y-�" >!„ Lt��� ��r=� , }-1�
t�. >C t GL�� 1 �.
N0. DWEL. N0. N0.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
N0. OF BLDGS HOW
ON LOT USED
LICENSED CONTRACTORS OECIARATNIN: I Mrehy affirm that I am Ircrosed urda provisions of Chaprr 9 Icwrwtrcirl8
wrth Secnon 70001 of Oiwswn 3 d !M Business and Prohssions Code,and my liunse rs in fuN force and eMetL
OWNER-BUILDER OECLARATgN: I Mreby affirm that I am exmmpt Iran tM Contrecmr's LKanse Law fa the lallowrng
reason ISec 7031 5. 8usmess and Prohssans Cade:Arry my or county which requires a permit ro construct,
alter improve.demdssh,a repair arty rnuc[ae. pray to ds rsssurce,also requres Me applicant fa such pasmt
to hk a signed statement that he�s licensed pwswnt m tM prrnlsans d tM Cmvactor's Lkerlse Law IChapta
9 Icanmerrcmg wrth Satan 10001 01 Ckvlsron 3 01 the Busiceu and Professam Cpdel a that M is exempt thenfram
and me hasrs for Me alleged esemptan.Arty wdation of Sactan 7031 5 6y airy applicant for a perms subjects
tM apDOCant to a crvd penalry of rat more than fhe hundred dollars If50011
^I as nwcer at tM properry. a my employees with wages u their :oN carpawtron wrN d0 IIM work,and
the structure�s sat intended pr offered to ule ISec. lOx4. 8lssmess and Prdessans Cade:The Canvacmr's license
Law dces not apply to an owner of property who bdks or improves tMrem,and who does srrrds waY himsaN
a through his awn employees. provided that such imprwemants are nd intended a Blend fa sar It however,
tM bwking a improvement rs sold wiMln one yex of cempktron,the owner-Milder wdl have tM Daden of provirsp
that ne did not dub a improve for tM purpose of sak.l
^I as owner of the progeny,am esduswep contrazuny wim I�ensed contractors m wnrnuct tM prgect ISec.
7044. Business arN Professans Codr.TM Contractor's License Law does not apply m an owner d property who
hwlds or improves thaem. and wM contrxts fa such projects with a mntrxmrlsl licensed pusmnl to tM Contmtor's
Ucense Law I
0 I am exempt urda Sac_. B. b P C. IAnads Ceruliurof
Date
yyORKERS�COMPENSATN3V DECLARATION: I Mreoy afMlrm Chas I hwe a rtrolkar of cosrsent to sNt�insue,a
a ceruhryn of Workers Corrgensatan Insaarce,or a cerfified copy thaeol(Sat. 3800. lab. C.I
^Caulled copy is tlerMy IumisMd
^CerulrM copy n Nled wIM me BurlMrlg Inspettlm Oeparnrwrlt a Oepatmem.
CERTIFN;ATE OF E%ENIPTNIN FROM WORKERS'COMPENSATN7N INSURANCE:Thu secirn rwd rat M corrgbrd
d Ina permit is far ace hlrrWred if1001 a less. I cerMy that in me performance d IM work fa which thu
perms a isslwd. I shah rat empty airy person m airy maruer so as m become subpct to tM NbrWs'Cmpensation
laws of Caldornta.
Oau Applium
NOTICE TO APPLgANT R. after mekinq M d you should became subpct m the Yderker's
Campensatan provulms of the Labor CodgAA��w�s�c.'e. �plyr wits web provisims a this qmm shah
M deaard revokd. �'7
OIVISIad OF INOIfSTRIAL SAFETY PERNNT CERTIFICATDN�
^I hereby tardy tMS no estaMrn Five 151 or more leaf In depM ism which a penm u r
wrN M mWe In cmcectaer vnN �� r��,
a demoMion a dsmanrkrq tlwnk,wW'mor�th��i Ihir ra hkldislq svucttae. sdkllirrN,fahevrak.
�1 het high. (Chap. 3.2. Orp 2.Art 2. Set
36I.Tltk 8,C A C 1
DAs I wAamo-.mp*,4wo!m-us.do work�Ischwaulmil pom from do Divamor,of
Industrial Sakly,as nomm! aim. Millis OWN Wunhisstamind;oLdwSK6 the division.
E]Omsm of Industrial SaixpirW We.
3
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CONSTRIICTNIN IEIfO11D AGENCY I MrebY affirm that thre is a narntrrcbon IrsIWsN aprcy hr dr pafamara
of tM waY to whiN Sus permt n issued (Sac 3087,Civ. C.1.
Lersdn�s Ilarrw
LerWer's Adkea
CERTIFICATE OF COAIPEIAICE AID AIRRpMUTDII OF ENTAY: I prsily 1 true rW tllia appkeatierr aM stale
that tM inlormatan yven n caner. I aRee r rsmplq wM aN star laws ad dry arslinrrm rertsrq r brdisp
constructran. aM tlrrite a repnsenlaM d tlr firsts d Bulirq aN Satery r wr rspa sfr prstlary
fa whch 1 havIW fa tlus pasts hr tYr making inspeekarrs.
Sipnsue d Appkcaas a Agsm Oer
PRESS
FIRMLY
^ PRNATE S0. FT./ 100 GAL.
GRADING^CU.YDS. EXC.CU YDS FILL
Tlf PE
1
2
3
4
GARAGE
PORCH
^ PUBLIC PMT
FRONT RW ^
REAR ^
SIDE/SIDE STREET RW ^
SIDE
�
SQ FTI FACTOR PSa�
PAID BY
VALUATION ADJ.AREA
1
v
QuANTmr�DESCRIPTION
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W
c7
2
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Q
V
2
Q
2
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CONSTRUCTION
PLAN REVIEW
J
MECHANICAL
GRADING
ISSUANCE
SMIP
PARK FEE
SCHOOLFEES
IW;
EtL
TOTAL FEES
COMMENTS
RECPT N0. ��J� '�
ADJ.AREANALUATION
FEE
L
�'crC
I��
t�:
�������
W W DATIO
WHITE-Department Copy,YELLOW-Finance Copy, PINK-/Weasor Copy,GOLDENROD-Fde Copy,GREEN-Appliearkls Copy
CITY OF DIAMOND BAR
. PELT RECORD
PECTCON I DATE I INSPECTOR