HomeMy WebLinkAbout1307 (54)CITY OF DIAMOND BAR
t_. PRESS
ll11 DEPARTMENT OF BUILDING AND SAFETY
P"OA 9 a `�' BUILDING PERMIT FIRMLY
JOBSITE j
ADDRESS 3�
APPUCA71ON-PERMIT r SE
IDAT�EE �� ��f�`�LNUMEBER � CODE
DATE '� `� CONST._ GROUP
APN LOT TRACT
CROSS El"
OWNER .
ADDRESS
ZONING SETBACKS
FRONT RW ❑
REAR ❑
CITY ZIP ' TE4_5q13W
SIDE/SIDE STREET RW ❑
SIDE ❑
APPLICANT TEL.
CONTRACTO
SEWAGE ❑ PUBLIC PMT ft
ADDREt
CITY ZIP ' TEL.
DISPOSAL ❑ PRIVATE SO. FT./ 100 GAL
STATE
LIG. NUMBER 0
GRADING ❑ CU. YDS. EXC. CU YDS FILL
!A
TYPE SQ FT FACIDR P ADJ. AREWALUATION
ARCH/ENG/ / A.
DESIGNER lWSA-
ADDRE S C
W
�" ' `i l n • —�
U,
2
3
CITY QVAPor ZIP
PROPOSED USE 12
4
GARAGE
NO. DWEL. NO.NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
=
PORCH
m
VALUATION "ADJ..AREA
OUANTITY DESCRIPTION F'EE'
NO. OF BLDGS HOW
ON LOT USED
Q
U
t)C SED CONTRACTORS DECLARATION I hereby affirm that l am licensed under provisions o1 Chapter 9 (commmuing
FC
FC
W
with Section 7000) of Devotion 3 of the Business and Prrhssouns Code, and my teens is n tell force and effort.
❑
W
ONNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the fallowing
lesson ISec 7031.5. Business and Professions Cade Any city or county which requires a permit to construct,
after improve demolish. or repair an structure, prior to its issuance, as request the app cr nt for such perms
in file a signed statement that he is licensed pursuant to the provisions of the Conaacdrs License Law (Chapter
9 (commencing with Section 700D) of 0wnion 3 of the Business aril Profession Codel a that he is exu l therefrom
and the bans lot the alleged exemption, Any violation of Section 70315 by any applicant fon a permit subjects
the applicant to a civil penalty of not more than five hundred dollars (115OO) I
01, as menet of the property, or my employees with wages ole Mau ink compensetion. will do the work, and
the structure is not Intended or offered for rale (Sec. 7044, Business and Professions Code The Contractor's License
j Law does nut apply to on owner of property who builds or improves thereon, and who pass such work himself
or though his own employees provided that such Improvements are not intended or offered for sale R, however
i the building or anprovement is said within one year of mmplenan, the owmir.bpddw will have the burden of paying'
i That he did not build or improve lot the purpose of sale 1
i
( ❑I as owner of the property, am exclusively contracting with leaned comma[ to construct the project (Sec
i 7044. Business and Professions Cade The Cuxractar's License Law doe. not apply to an owner at properly who
builds or impel thereon, and who contracts far Such prole la with a camnaclalSI licensed pursuant re dile Cmlracbtt S
License Law I
0
'Z
'
.�
;J
¢
'<
:T,
.2
iU
;W
..
ON STRUCTIO_Ni
i
❑ 1 em exempt under Sec .8 h PC (Attach Catchiest)
PLAN REVIEW
Date umasr
ELECTRIC
PLUMBING
MECHANICAL
f YORKERS' COMPENSATION DECLARATION I hereby affirm pert 1 have a certificate of consent to aa" ensure, or
'. ate of Workers Compensation Insurance, nor caetied copy thereof [Sec 3800. Lab C.)
t
robed spy is hereby furnished
i Certified copy is filed with the Buldmg h spacum Department a Department
GRADING
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This rect need net be coorgletaid
155UA
d the permit is far one hundred 1111001 on lis I certify that m e perfor arcs fEgig
. permit Is rs$Wd. I shall not employ any person to any manner so restores [act t Nb ' Centralnm
� Laws of C darns
a �yisr�s�
a Oale � 'J/J� AppleantPLj
hgTCF TO APPLICANT N, afar mating This CanlKxe of E lido, yid Chadd lapame subRct te Na Ybdkm•a
rARKFEE
SCHOOL FEES
Compensation provisions of the Labor Code, you mist landowner comply with such provisions a this permit shit
he deemed revoked
OMSIOf OF INDUSTRIAL SAFETY PERMIT CERTIFICA + !
5 01 hereby Unity that no eacavalean five (5) ur more fret in depth ata which a permit a reopened to discard.
will be made m tonneclpn with work enthaued by this permit. and that ice hdddng structure. rcalfaldong, fab~k.
or diumire n or dismenthmip thereof, will be mole than thirty-sm 1381 Istel Fhighhk(Chap 32. Grp 2, An 2, Sol
361 Tnde B,CAC)
JUL 2 3 1'-'.90
As wasr-buw, I wdl not employ anyone to do work which woud rsgan a parol hem tla Dilndn d
CIA.CIA.od
Industrial Salary, as rated above, anlxs such perm has a paid to do such weak from the division.
❑Ow.srm of Irdaxrtal safety Permit Nil c, 2i
TOTAL FEES r ,
a COiSfRIICTM LENDING AGENCY I ha of dip.,bar lhera is . eanetrrcsmn mdk4.%6o for ilia wb mens
at the work fa which 11xe permit a issued (Sec 3007. Gov C).
Lerdars Name
COMMENTS -k & 41�l = r) D
'L ,�} �L-1L J
Lender's Address
r CERTIFICATE OF COMPLIANCE AND AUTHORIZATION Or ENTRY. I wily I her red shin opp[ ital and p ale
a pat the wren even twop"
e coly with ad omalaws and Lary adirwices reducingre Oaldinoharemveofof Building aha Sally Ia eater ppm div properly
ns r Ili a makidq inspachona.
RECPT NO. �� PAID BY_�0 S i— . VALIDATION
X1AW
d Appkunt a Agent pia
pErk-l'tON FIECORD
t MI.
11-A i
. . . ..........................
fj
Ak
A A A
xiii
g-qq
. .. . .... .. . .... .... .. . ....
IIS,
..........
L 01,`3, A ICN 5
EP
71,
....... ... .... . .......
C E FE F , N A L
D: „ // V. F E E S r I D
4 llrc&D_
.. . . . . .......... ... .
. ....... .... . . ....... ....