HomeMy WebLinkAbout1513 (20)CITY OF DIAMOND BAR PRESS
<W__ DEPARTMENT OF BUILDING AND SAFETY FIRMLY
BUILDING PERMIT
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ADDRESS Ti��
APUSE
PLICATION ATE CATION PERMITNUMBER �CODE
ISSUE TYPE OCC.
APN LOT 11A TRACTAV; 81
CROSS STREET
OWNER I
ADDRESS
DATE CONST. GROUP
ZONING SETBACKS ddPlafA�eEA1as
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RIW ❑
CITY ZIP!Anc TEL. z
APPLICANT TEL
SIDE ❑
CONTRACTOR
SEWAGE ❑ PUBLIC PMT #
ADDRESS
CITY_ ZI
DISPOSAL CR'PRIVATE SD. FT/100 GAL
GRADING ❑ CU- YDS. EXC CU YDS FILL
STATE19
UC. NUMBER
N
W
TYPE SO FT A PS AD.J. AREWALUATION
16
ARCH/ENG/
DESIGNER
ADDRESS
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3
CITY ZIP TL.
PROPOSED USE
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GARAGE
NO. DWEL. NO. I NO.
UNITS STORIES eh BEDROOMS
LOT DIMENSIONS k
NO. OF BLDGS ( HOW
ON LOT USED @�i11M�CaI
PORCH
m
VALUATION ADJ. AREA
OUANTITY DESCRIPTION FEE
LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chspur B ldommecing
with Section 70001 of Division 3 of the Business and Professions Cade. and my license is st h11 farce and effect
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OWNER BUILDER DECLARATION I hereby all— that I am exempt iron the Cxnreemr's License, law for the fallowing
reason ISec. 70315. Business and Professions Cade Any gory or county which require a parrs or construct
alta impion, demolish, a repair any structure, prior to Its issuance, also requaef the applicant for each permit
to fife a signed stateroom that he is licensed pursuant to the pe wiswns o1 the Canoactor's License Law IChapter
9 (commencing with Section 7000) of 06wsim 3 at the Business end Prolsssims Code) or that he a wrion dpralroin
and the basis for the staged exemption Any violation N Section 7031.5 by oil applicant fp s Permit eablects
the applicant to a civil penalty of not more than fn hendred dollars IS500))
101, as awmr of die property, as my employees with wages as their sale canpensaton, will do she work. will
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the structure is not imended or offered fee sale ISac 7066. Business and Pfoleauons Code The Caitraet m., Licrosa
erlon. and who dm hnnN.
Law does nor apply to on owner o1 property who builds or universe problem. on web war
a through his own employees. provided that such improvements are not intended or offered for fele It however,
the budding x mprovement is sold within me year al complete,". the ewmr-builder will have gw burden of proving
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That he did not bald or improve for the purpose of sale.)
❑I, or owner of Ube property aro eectaerely cuntractiou with licensed convocmrs or construct the protect IS
704, Business and Professions Code The Conxeter's License Law does not apply to an owner of property who
builds ar mprovK there,". end who contracts for such projects with a Cmtracror(sl Incensed pxsuanl to the Cmtrocea's
License Law)
•hlAN REVIEW �./C / "�L7
❑ 1 am exempt under SK . B b PC (Attach Conductor).
i Data Owner
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ELECTRIC
PLUMBING
MECHANICAL
AORKERS' COMPENSATION DECLARATION I hereby affirm that I have a nrMicne all Cannot to seI-iesure, x
a certificate of Miller' Compensation Insurance, or a cehlied copy thereof ISI 3Bo0, Loh. C 1.
❑ Crashed copy u hereby furnished.
❑ Certified copy is filed with dor Building InspKuon Department in Depxtmenl
I
i CEfITIFCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This satin need rot be Completed
i A the permit rs for one hundred IS1001 a Ins. I certify that in the Performance of the awrk he which this
permit is issued, f shat rpt employ any person in a nun ner so as es bKanu able" th the pbrkxi Compensation
Laws of California l,, 1P, .
Geta „ �. ceor
, slur rng this Certificate, of Exemption. yea should be subject a the W rkx'e
NOTICE TO APPLICANT Ieeli
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U-
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G'E— 6 ,
PARK FEE
SCHOOL FEES
Compensation prwrsims d the Labor Code. you mist forthwith comply with such provisions or this With shall
be deemed revoked g�
DIVISION OF INDUSTRIAL BIIF(P,rli
❑1 hereby txtdy dot m avatam five 15) x store but in depth nn which a Penn it required or descend.
will be made in connection wrth work eattlabed by thus perms.led One. so *MR mocture, gdloldnng, IWewark,
• re demobte" or dismantling thereof, •will be. arae Then Miny-vix (3G).fiet high. (CW 3.2. Grp 2. Art 2. Sac
' 341. tle R,CA CI �• c,;, t.,r ;
As owner-bwNx, I ppwkA jikjh by entire is to work which would sewn a pmt loom h Division d
Industrial Solely. as note�'ibdire. unless such person Ns a poorest to So each work from M d xisbn.
❑Dwsim at Hanrol Safe" permit No.
TOTAL FEES p
CONSTRUCTION LENDING AGENCY: I hereby &flan Isar owe is a mmbuction k riding agi my for pie Wtosmasa
of ds work fat which this parous a roswd ISK. 3097, Cr.. Q.
' Level come
COMMENTS
Lender's Address
c CEFTICATE O COMPLIANCE AND AUTHORIZATION OF ENTRY: I'or* 1 haw rand tis tip h mini and state
a chit alp edaroatpn given is carats I awn w somov with IN test. laws and airy adinmeK Wring to loading
Contmilon. cru mthaue a ropmeantadva d dor agww ml d Budding aid umv 10 reason upon Pte smarm,
: for =h 1 have applied for this permit M ON prapore of makinnggynpyadsn.
Sips aun d Applicant a t te�!
RECPT NO. PAID I VALIDATION
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Asseaaor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy
BS106-11199
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