HomeMy WebLinkAbout115 '� CITY QF DIAMOND BAR PRESS
�, '"" ` DEPARTMENT OF BUILDING AND.S'AFETY FIRMLY
-� BUILDING PERMIT
JOBSITE -�' ^� �� APPIJCATION PERMIT USE
ADDRESS �'"�`'F"� f�'�''�- �P.��I� �!!�. �'r�n DATE '�NUMBER � �� CODE
ISSUE TYPE OCC.
� APN �OT _ TRACT � DATE � _.CONST. GROUP
o CROSS STREET zONING SETBACKS �'"E'"5
°-� OWNER �-' FRONT ❑
o ADDRESS ' ��' �` REAR ��� "'� ❑
W CITY���% ZIP �1� T � � '�) SIDE�� T �� � �w ❑
o APPLICANT � � A%u i ��E � `�'d� �E ❑
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a CONTRACTOR �� � ''��"' SEWAGE
o ADDRESS DISPOSAL � PUBLIC PMT�
W CITY ZIP TEL. ❑ PRIVATE SQ.FT./100 GAL
W STATE GRADING � Cl;.YDS.EXC. CU YDS FILL
y LIG.NUMBER
y ARCHi ENG/ ��� W NPE �Q FT FA�R PSP - AQl_;,,,AR�ANALUATIdN
`—' DESIGNER �fLl-1 , Y c
Q ADDRE S ����' T !Y . � p .
Z CITY �(fJ� ZIP ' � TE .� �' �f �r g
� PROPOSED USE Z 4
� � GARAGE
o NO.DWEL. NO. NO. � pORCH
y UN�TS STORIES BEDROOMS
� LOT DIMEN510NS m VALUATION ADJ.AREA
o NO.OF BLDGS HOW QUAN7tTY DESCFI{PT'IOl'J �EE
W ON LOT USED � -
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~ UCCNSED CON7RAL?ORS O[CLARATION I Cere6v afiirm ihat I am IicenseG under provisions ol ChaD�9 fcommencing
� wnh Sea�on 700C�of Orvrsion 3 of�he 8usiness and Profess�ons Cade.and my I�cense is in full loae end eNect � � �
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�+- CENVEF�BWL9ER�ECLARAiION I hereby a!firm thai I am ecem0�from the Cantracmr's License Law foi the followinp
rensoc;5=c i031.5,Business and?rokssions Code Any city a�caunry which requires a permit m canslruct, (}
oalter enprove Jemolich,ar repar any stmcture,pior m rts issua�ce,also requues Ihe apphcant lar such permit �
6 �o f�le a s9red s�a�enem ihai he rs Lcensed Dursuam m[he prwisions ot Ihe Conttanar's t¢ense Law iChapner (,y�
� 9(commencmg wrth Sxttmn 70001 0l Uv�sian 3 of the Busmess and Protessions Codel or that he i9 exempt�herelmm ' '�.
d and!he basis Icr the alleged exempLon Any uiolatnn of Sec6or.70375 6y any appiicanl lor a permit suU�ects �
K ihe aDPlxam:o a crvJ penalty�o�w�mwe than li+e hundred dollars 15500�.1 �
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� ❑I,as r.wier oi�he prepeny m mv employees wnh wages as then sole:nmpenulron will da the wo�k,and
~ Ine stmc!are�s nm irtanded or oHved lo�sale�Sec.7044 Business and Prokssrons Cade The Contracbr's License e[
� Law Ar.�s rot aFPIV to an awner of pmperty who Euilds or fm0�a�es thereon.and who Caes such work himsell. (1
�+-� or t6wu9n his own employees prorided ehat such imp:o�emenis are not intended or olhrM kr sale if,however, 2
m �he Uwldm9 c�inA�cvemem rs sold within one year al completion,[he owner-huilder wdl have the burden nl provi� ¢
� Ihat he did ce[Cwltl or impmve 1or the pu�ose of sale.l �
y ^ �
V� Lil,d9 mvr!�o;thr.properly.am exclusrvely comracliny wtlh hcensed�anl�acmrs to cansimct the pro�ect(Se[. �JJ
0 iO4d,9usmess antl?rofess�ons CoAe The Comractor's License Law does not apply to an oxrner of pmpertY who "�
� huJtls o�:mD��'es[herean,antl who[ontracts tor such D�alects with a comracmqs)licensed pursuanl ro the Contracror's f
UcerseLaw� CONSTRUCTION _�aT4�•4t 1r�4 41e�! 7,�, .3S
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''''' ❑�zm eremo�unde:Se� d B P,C IAttah Cenrficatel PLAN REVIEW _� �"� ! � O
�
� odte °u""a` ELECTRI(:
� WDBKERS C�MPENSATION OEGIARATION i hereM affirm that I have a cernhca�e oi consem to self-mswe.ar
a ceruf:caie ef Nbrke�s'Compensano��nsumnce,o�a ce�tif�ed copy rhered ISec 380D.1an C). PLUAABING
Q n v � MECHANICAL
❑Cerirfied co y is he�eb fwmshed.
o ❑Cenihed copy is I�led wnA the Budoing Inspecuon Departmem o� �epartmem � GRADING
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� CEflTIFICUTE Df E%EMPTION FflOM WOpKERS"COMPENSATION INSUAANCE This seclion neeG ro1 Oe compktea (� 15SUANCE _� ( ��, d �
y d Ine pe�mt�s for one hundred IL10D)or less.I cer0ly that m the perbimance of the work br whkh�tl�is ,�.r
permil is�ssued.I shall nol employ�ny person m any manner so as to hecame suh�ect M the Nbrkers'Compeinaban gMIP
oLz.vs of Ca6fomia � PARK FEE
`� n10TICE TO APPLICANT If,after mafung this CertiFicate�M Exemption.you shoilA he�ame su6ject to 1he waker5 �� SCHOOL FEES �'
� Canpensanon prmisions of�he La6o�Code,you must fanAwith comply wrth such pravisw�a�Ihis permtl shell '
� he de�irad revcked
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opVISIIXJ OF INOUSTRIAL SAFETY PEHMIT CERTIFICATIUN. � �M
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�- ❑I here0y certrty Ihat no ex�avatian fiue 15)or more leet m depth mto whic�a person u re7uuetl m descentl.
oe wAI be made m cwnecuun wiUi work auMu¢eA by Mis ppmit,and that no huilding etmature,scafMidinp,falxwork,
� d or demolihor or dismantlirg thereal,w�q he more than thirty-s�v l�l leet hiph.IC1iap_31,Gip 2.Art 2,Sec
W 341.Title8,C0.C1 /'�ITV !1C I'1:ANJt(111I1 17A�
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3 VAs owneo-Guilder I will nM empky anyone to do work wh¢h would rBqwie a pnmit han Ihe Gvuan oF pl 111 1'lihfl�Af�'!"1 C AGCT V
1... InAuslna!SafMy,as nated a�ove.unless such per5on has a permil to do such work from me Orvi7ion. . 9—vR'fv�vr�rt—P
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❑Drvisior of I�dusawl Safety Permn No TOTAL FEES �,
� CONSfRIICfqN 1EN01NG ASENCY:I h
erehy affirm Mat�Mre ia a wnatra�ion knd'up pency ior the perlmmmce
= ot ihe work lor whit�ihi5 peimn is i55ued(Sec 30.97.Ln.G.I
� tende�s Name COMMENTS
m Lender's Atldress
Q CEH'fIFCATE OF COMPLIANCE ANO Al1TFI0p12ATI0N OF ENTHY I eatify I have read this applkation and etak �
�a ihat the mfwmatmn given rs carreci.1 apree to compM whh all state laws antl eiry ordnarces relalinp to 6uikiip
yconstrucnon,and authonze a rep�esematrve ol Ihe Oeputment of BuiMinq and Sahtr to mtd yqn the properry
= for whrch I have apDl�ed ta�Mis permit lor tM puryose akinp inspectanc.
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s�gnaw�e oF Mp�mant o� t k � RECPT NO. PAID BY VALIDATION
WHITE—Department Copy,VELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—Fle Copy,GREEN—ApplicaMs Copy
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