HomeMy WebLinkAbout1273 (3) '� � CITY �F' DIAMOND BAR "�'` PRESS
� .� '-�" " DEPAFi'TMENT OF BUILDING AND SAFE1 t
�. -� BUILDING PERMIT FIRMLY
JbBSITE .y,� "'�(� APPLICATION PERMIT J� SE
ADDRESS �'f-�� '��� t�"� S UE "—jyP��R �CODE
� APN OT�7G TRACT�i� DATE � �` CONST. GROUP
o CROSS EET �� – ZONING ETBA KS '�"�
°.° OWNER FRONT RW ❑
o ADDRESS !�3 Y$.� �+`' +C+ � REAR ❑
W CITY �-�`��ZIP��TEL.'S�"� SIDE/SIQE STREET RW ❑
g APPLICANT ���°+N' TEL. SIDE ❑
z
a CONTRACTOR i�^'�d��''�� '����$�� SEWAGE ❑ pUBLIC PMT�
o ADDRESS � �:+ �'b���°f�' DISPOSAL
W CITY �:��� ZIP � �'� TEL �"'�� ❑ PRIVATE SQ.FT./100 GAL
z STAT[
w ��('' � CzRADING ❑ CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER § ��
y ARCH/ENG/ {ry TYPE SQ FT FAC�OR PS ADJ. AREANAILUATYOIV
� DESIGNER W �
� ADDRESS tL. 2
o -
= C�TY ZIP TEL. ____ C3r 3
� PROPOSED USE � d
� d GARAGE
o NO.t�WEL. NO. y� NO. � PORCH
y UNITS�-STORIES BEDROOfv1S_-
oc LOT DIMENSIONS � VALUATION ADJ.AREA
o NO OF BLDGS HOW OUANtI7Y DESCRIPTI�N FEE . • '
� ON LOT USED �����Gv' .
W � - `�L�•�-
�
� °C ---�-� �'
fNSE�CUNTflACTORS OECLARATION I herehy aNum�hat I am Ifcensed untlei prrnisfa:s of Chapter 9 Unmmencinp � �'�
ownh Section 7000i uf prvision 3 nt the Busme�s aM Pmkssions Code,and my I�cense is in lull torce and eflect �
3e [] lJJ
Y OVVNEP BUILDEB�ECLAqATION I herehv affirm tha�I am eaemp�Irom Me Cantranm's lkense law for�he Idlowing
reasen(Sec 10315.Busmess an�Pmtestioes Ca1e Any ciry or county wh¢h reqwres a permtl ro conctrucL ('j
O airer nnprwe tlemonsn ur�eDar any svuamre,wior to its rssuance.also rcymres the apDlicam Mi such cermi� Z
r- to;;le a agned statem�t:ha�he�s Lcensed pa�suant to Ihe provrsions of ihe CanVaetar's Liae�se Law IChapter m
Q 9;cammencmg wnh Secuon 7000)al Guismn 3 a�the Busiress and ProMssions Code)a Ihat he rs exempt thaefmm �
uann ihe has�s Im!he ailegetl�rempoan Any vfolation of Stttian 70315 hy any apphcanl tor a permit suhje[ls �
W !he aaolir.ar.t to a a�a pr.nanv of not more 4.ar Irve hundred dallme i55001 i a
� ❑i as owner�f��e pmperty,or mV emD�oMees wrth wa9es a5 their sale compensaimn will do the wark and
~ tM1e slnrc�ure is not mir.ndr.d or ollered�or wle;Sec.7044 Busmess and Prdess�ons Cade The Contracmr's U[ense a
V Law Aoes�ol aOPly m an awner o1 DraPerty who 6uilds or�mproves thereon and who dces such work hmself, U
W oi Ihmuoh h¢ewr employees,provided Ihat such impmvements are nol mrended or olferetl for sale If,Aowever. �
� ihe cuiiCmg m imp�nacment rs sald wrthin one year al completian,the a+rner6udder will have the 6urden at O�ow�^A 4 �
y ihat Ce d:J nm huild or impiave 1or Ihe pu�pose af sak I �
V� �1,as owrer of ihe p�operly,am exclusrvely conUactiny wnh I:censeo conva[tors to constru[f the pro�ect�Set �
0 7f1a4,Business ara Pmfessions CoOe TAe CantnGoi s licenu law does no�apply to an ownei ol properry wha �
y dudds m imD�aves ihere.an,and who controcts tor such pro�ecls with a cmitracror�s)Lcensed purswnl eo the Contracto�'s
4 Licersclawl CONSTRUCTIDN
O
W �I am exemp;ander Sec .B 6 PC IAttath Cenilrtatel PLAN REVIEW
�-- --
� °a1e °'""" LECTRIC �
� WDPKEHS'�OMPENSATION�ECLAflAiIpJ I hereby affirm that I have a ceinlicate of mnsent ro self��nsure,or PL 'N�
a cern�¢ate al Workers Compensation Insurance.or a cenAied copv thereaf(Sec 3600,Lah C 1
0
Q C Cenihe.copy�s Cerelry furmshetl ,J MECHANICAL
p .e�uLed copy�s�ded wrth Me Bwitlmg Inspechon Ikpartm�t a �e0anmem � (�j{�
� CEflTIFICaTE OF EXEMPTION FflOM WOHKEFlS'COMPENSATION INSURANCE This section need not he cnmpkted SSUA��iy-^ ---���� �
y if Ihe permrt is ro�one hundred jS100)a less I ceiufy t5at m Ihe perf ance ol ihe wwk lar wh¢h Iha ',�, �
permii u iseued.I shall not employ arry pe�son m any manner so as ro hec su61��ro tM VWrters"Compensatim SMIP •
� Laws of Cahfnrma
o �. ,-- i PARK FEE
0 oa�e ���'�^pv���a^� LL. SCHOOL FEES
W NOTICf TO A7PUCANT If,aher making 1h�s Ceinfiate'spf�EKdnpu�,yAu sTiqiiA 6e[ome�u6ject to Me Worker's
� Compensauon prov�swns of Ihe Lahor Cade.yau mus#;:.I�ii�Mrilb;� �ly'Witli'sUr.h provl5b�5 a IhiS Dermii shall
� he deemed revokcd 1': "
� OIVISION OF INWSTHIAI SAFETY PERMIT CERTIFICATION: —
W
� ❑I here6Y ce�idy that n�eccavauon 1rve(5���feet�P d�int�;'"i�8�person ia repwred ta tlescend.
eG wdl 6e made m[on�ctwn with work autha¢d 6 rmi�.�nd 1 iroyhui tructure.statlaldinA.falsework.
�- o�demohtion or Aismantlf lhereaf,will Ee ihiiry six 36)feet�' (LM1aD 7 2.Grp 2.An 2.Sa
W 341.Title 8,C AL 1
S '' r�'.4'�.'�
3 ❑ps owner-6uildr,i will not ertpby alryane-�o•dtYWEt1 wl�ich=Woutl�re�uM'�a pn�ni[.hom 11k Division al
� Industrial Safety,as noted above,unless su5h.persn�hai Y p&mit to do suah.Wo�k fipli fhp divifwn
� ... .,: �. �.','..._. :'.t�..., :: . . . .,.
W ❑a.,s,o�a������,a�sa�e����m,�No :� ,,-..._ TOTAL FEES ���C�''.�
� CpJSTflUCTION IENdNG AGENCY�I herehy aHirm Ihat ihere is a canshuctpn Imd' 1or 1M farmmke
^�A�Y D�*
Z of the warN for whch this permil u iswed IStt 3087.Civ.C 1 �
� Lender's Name COMMENTS - ����-
mLenAer's Address
'¢ CEIfTIFY'.ATE Of C PLIANCE ANU AUTNORIZATION OF ENTNY�I certilr I luve read Miis�pplcMian and state
rn that�he infmm �grven is caren-I agree fo camply wen all staee laws aM tiry aliiunw reklinp l0 6uilAi1p
ycans�rucnon, alhonie a representatrve of Me Oepenment ol BuiNinq and Sehty Oo mrcr�qon iAe praperty
� b�whrth I e epplcd for thrs po�mil 1or the p�xpose of making inspectims.
F� "
�'� r � � ' RECPT NO. PAID BY � �\ VALIDATIO `
Signa of ApDlkam m Agmi ' Octe
WHITE—DepaAmenl Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy �
BS106-11189
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