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HomeMy WebLinkAbout1533 (17) - ------- -- ----- ------- ---- �- � - ��.� � � -. _ __ _- CITY OF DIAMOND BAR `� pRESS ., '��" �' DEPARTMENT OF BUILDING AND SAFETY �� BUILDING PERMIT FIRMLY JOBSITE APPLJCATION PERMIT �_> USE ADDRESS � ��� S�`��ni�rl Q��"' DATE ��-f.-�'��--?NUMBER�-� =�ZCODE ISSUE /� r-,�,� TYPE OCC. 6 APN LOT TRA�T DATE �"� ^`�=�_�CONST. GROUP � CROSS STRE T 1 SET�ACKS ��� � ZONWG �° OWNER � FRONT RW ❑ � ADDRESS � � r ' REAR ❑ W CITY �QV�G���i.ir,ZIP T�L. t' 3 SEDE/SIDE STREET RW ❑ o�APPLICANT �C�t`�.L I��3��l a T�L. � � � sF� O a Q CONTRACTOR SEWAGE o ADDRESS ❑ PUBLIC PMT# DISPOSAL ❑ pe�SVATE SQ.FT./100 GAL W CiTY ZIP TEL. 2 STATE GRADING ❑ CU.Ys�S.EXC CU YDS FILL y LIC.NUMBER y ARCH/ENG/ � ��E Q � FAC'rof� F�$ JkC�I. AREANALUATION `=' DESIGNER__�,� W � ! � ;���..i� G�C ! J��rc,�7 � ADDRESS � 2 O - Z CITY ZIP TEL. (!j 3 � PROPOSED USE - � `'��C z 4 � � 6ARAGE o NO.DWEL. NO. NO. � PORCH � UNITS STORIES BEDROOMS � LOT DIMENSIONS m VALUATION { �r,� ,C�C�ADJ.AREA o NO.OF BLDGS HOW QUANtrrx p�$��� [Q� F�� W OiV LOT USED a -- :__.. _ � W ❑ � S ~ I.ICENSE�WNTRdCTOBS�ECLARATION�I herehy aflum that I am licensed under provaions of Chapter 9(tommenti�q � �.v,th Sectior 7�COi of�ivisim 3 of�he Busfness acd?rofeanns Cade anA my Imense is n full face antl elfect. W O J 3 w �+- LM�9EP�W1ILDEA QECLARATION�I hereby affirm Ihai I am eaem0��rom the Con�ro[mr's Ucense Law tar me fWlowirg aasnn�Sec 7031 5.Business and Professions Cade Any ciry or canty which reQui2s a permil to cunstruct (�} Oalter improve.JemoiisF.,m repau any stmcture.O�ior Io 05 issuance also requires tFe applaant for such permit Z � te`:le a signetl statement Ihat Ae is Lcensetl pmsuar.t to the pm�•isions of t�e Cantrxmi's licente Law IChapter m pe 9�commentmy•.vith Seclion 7�001 0l Divaion 3 0l the Business anA Prclessions Codel o�Ihai he is exem0��hnefmm r'y a ar.e ihe.has�s�ai ihe alle9ed:rem�tian Any vidation of Seotpn 7D71 5 hy any applicant for a permit su6�ecis � W ihe aCCl�.cant to a cmJ penalty of not mare[har,Lve hundred ddlars 1550D1;: a � ❑I,ns owne:oi fhe properry,cr my employees wnh•nages as their sole compensatmn will da the work,and ~ tl�e s�mcture is not iotenAed or olleied Im sale ISec.7034,Business and Proiessions Code The Con[nctor's lacense v Law tloes sr,t applV ta an mvner of properry who uwitls or improves Iherean.aM wha Aces SUCh work himselC C? W a�[hmuyh his awr enployees,7mviCed ihal such impmvemems are not mUnded ar ofleied foi sale.M,however. Z m the hwlEirg o�imprwement is suld within one year oF compleuon.the owirer-builder wiN have the 6urden o�prwing Q � Ihat Fe did no�6uJd or improve for the purpose ol sale.l U y y C� as owrer at me gmpenv,am eMdusnely comracuny wnh hcensed camracrors m co�tmct tM1e proixt(Sec {jJ � 7[194.Rusiness anU Professians Cade The ContractoYs l¢ense Law does no�apo�V ro an owner ot pmperlY who Si, __—_ ¢ 6udds oi;mprOves iher¢on,and who conira s br such pro�ecis with a cantrac Qs�licensed Dmsuant ta Ihe Cantractor's � Licerselani ��j. �j; �N RUCTION�7 � ❑I am eMempl unJei se� �' r� ' `.-/" ��`,`B.6 P.G(Alixh C¢Nficale) p�q � i �.. p Oate Owne� ELECTRIC � WORKERS'COMPENSATIIXJ OECLARATION I hereby affirm Ihet I have a ceruficale af consent to seN�insure,w pLUMBING a cenfiicale of Nbrkers'Compensahan Insuronce,ar a e¢rtified capY�he�eol�Sec.3800,la6 C 1 —_ 0 Q ❑ce«,r�ea mpy is he�eUy Iwmshed � MECHANICAL p ❑CertifieA cooy is tlled wnh Ihe Building Inspection Deparlment oi o�vM�m•��. Q GRADING W � � CERTIFICATE OF EXEMPTION FROM WORKEflS'C�MPENS0.TIDN INSUflANCE This section need not be completed �S''S` � ����� �� N d fhe permii is fa one hunereG IS10�1 ar less I cerulV thal m the perlorman[e ol the wdk for w�kh"Ihis �,,, - �,' �'`� — � permr is rssueC I shall irot employ a�ry person m any manner so as to became sub�ect lo Ihe N6rkers'Compensanon SMIP �( J p Laws ol Califnrma PARK FEE p Date "Po'�°°^' ��- SCH�OL FEES � NOTICf TO APPLICANT If,aller maNing tAa Certi6cate of Eaem on,y,qu s�puld become suh�eot to the Worker's , � _ -�+ Compensation praursions of the Labor Cade,yau must�orthwith"�mp.[q;.wit6isuth'ti�masans w this permil shall LL he dr.emed revoMed - � � DIVISIOAI Of IN�USTRIAL SAFETY PEPMIT CERTIFICATqN: W d- ❑I herehy cenrfy thal no euavauon live(5�or rtwre teet in depth�Mo which a persm rs reqwrd lo descmd, p�e will be made m connectmn with work aWhrc¢ed 6y thiy�pnitr,8fd that Mf huildilp��siru�l�re uallaldinp Idsework, d or demnlnion ar dismantling IMrenF,wil he rtrore M�n,(jfirtymr�36)�eet high.�(�7'p�fp';31.Gry 2.An 2.Sec W� 341.TitleB.GA.C1 "-' . S 3 ❑As ownrr-builder,I wJl no1 emplay a�ryone to_do,work,whxh wouM„repulle a permLfrdn,Ihe Uiviam a} � Indusmal Safety as nMed ahove,unless such peradn hxs p peimi�io do suc`h wod,�rom 1M divkjon,.' — � . , ... :, � . . . . ._ .. . , � � ❑Dmsion oi Indusinal Sakty Permn No --�-�- �-� ' `�� ' "� � �� � � � TOTAL FEES �-1 � CONSfNUCfqN LENDING AGENCY�I heretN aifirm�thal there�is a�canstruction IeMing aqency Pot the peloima�e + �: � x of the work fa wnich this permit is issued IStt.3097,LN.LJ � lender's Name COMMENTS m lender's Address 6 CERTIFp:ATE OF CDMPLIANCE AND AUfIIOPoZATIdY OF ENTNY.I cnfity 1 M1airc reW this apokcotion a�M sute Vs iha[Ihe infwmauon pven is crcrect I agiee ta mmply wnh all stau laws a�d ciry ordinw�ces reWting Io huildi� ycansirucuan,and aulhoiia a representatrye ot p�e Dep2nmeM o�Buildinp and Safely Oo enter�qm 1M1e piaperry = lor whxh I M1ave appl�ed for Mit permil for t pupose nt maWng inspe�toes. -- r X � �x �'- 1� ��,- �.�G, �' � t�l Sianature at nao�kam ar�nn pa� RECPT NO. 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