HomeMy WebLinkAbout1878 (183) '"� CITY OF DIAMOND BAR ���`'� �� ^ � ��
�� �' ' �" DEPARTMENT OF BUILDIMG AND SAFETY PRESS
`�^ BUILDINC PERMIT F'IRMLY
!JOBSITE j , /� APPUCATION � �']„�`., PERMIT � USE
ADDRESS � d2- �. t��• ����'G�^ �sF-� DATE � • (/` �� NUMBER��CODE
ISSUE TYPE OCC.
6 APN __ LOT TRACT DATE �, �,"��� ��' .l CONST. GROUP
`� CROSS STREET 'M a��✓ SETBACKS �E��
°-° OWNER r � �• c� ZONING �ONT RW ❑
o ADDRE S �t�i � � REAR ❑
W CITY ` �� ZIP °��'S TEL.� �"" B SIDE/SIDE STREET RW ❑
o APPLICANT Ma�e+�r nts�3' TEL�7-�'��� SIDE � ' . ❑
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� CCNTRACTOR '�"'`���� �'"� SEWAGE
o ADDRESS �3 3�7 C:u•erY•. �A, DISPOSAL � PUBUC PMT'�
„� CITY [G��`r.v ZIP�TEL ���?3 ❑ PRIVATE SQ.FT./100 GAL
y LIC.NUMBER �3���� GRADING ❑ CU.YDS.EXC. _ CU YDS FILL
y ARCHi ENG/ u} TYPE SQ F7 FACT[)R PS AOJt. A ALUATION
�' DESIGNER �'.inR_. (4=5 .�r it`E� W 1 � f � �i " 1 ��ti- �
o AUURESS � 2 f _�,
= CITY ZIP TEL. �r 3 1
� PROPOSED USE u� � S � 7`— 4
� � GARAGE
Z NO.DVJEL. NO. NO. �� pORCH
�, UNITS STORIES BEDROOMS m
� LOT DIMENSIONS VALUATION � � ADJ.AREA
o I NO OF BLDGS HOW QUANTR'Y DESCRI (ON F'
w ONLOT USED U V 4
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~ IC 'EC CONTRAC'�FS DECLARATION I nerehv alfirm!ha!I am i¢ensed untler pmaisiors ot Chapter 91�ommencing - �� _
� mnF Secuon'0001;t O�.v,sion 3 ni the Busmess and P;olessmns Code and my hcense:s i�full force and effecl W
3 ❑ W
�±-�ibVNEP BUILDEd�E�L:.9A'ION!herehy aiiim•^�at I am exem��Irom the Contracror s lrterse LaH�loi Me toilowmg �1 �
= ezscr ISer '0319,3usiness and�roressmns Coae Any rny ar coumy wh¢h requues a permn to crostruct (% '�,,�' t�s ��
o n;;er �npiovc,demohsh ai reoa�r ecv str::cture orn;to ns issuance.also reamres tlie aoul�cant b�such ce�mit Z - -
Q I�o I�le a xiyre�ti�atement ihzt he is Lwnsed 7ursu�m m the provisions of Ihe Controctor's L¢ense Law!Chapter m .-1 � �
s i 9;<ommencmg ar,P ce,por.7CI10;�o'D�vis;rn 3 of the Business and Pmfessmns Codel a that he is e.empt therefmm � r r
d antl che::asis Icr che allegeA eve�puon Airy oimavon of Seciion 7031 3 Oy any apD�icanl toi a permit xub�ecis �
W •hF:n�Dlvant�a�m.D�a�h•ol rc'Rmre�Can hve hwdreJ do!la:s;5500�; �J
M ❑I as r.nrei ol"ie prcparty or mv employees,vrth wages as thert sole compensatron wi�l do the warF,and
ihe sv�ctere•s noi�n:entled or�Iterr:iw sale�Szc 7ai4,Bus:ness an0 Proiessions f.ode The Contracto�'s L¢ense fj '1
v lau�noes no�applv Ie 2n ownei o'C�operty who bml0s er�mD�oves Ihe:eor,anc who dxs such work himsel( U ��G
� or,nnu,`h�s own em;rovees.prov�uec thai sucC impm�emects are ocl inlenaed or olfereA fa sale N,howeve�, z
= d:+!m�ld�g or norcvemer•t rs suld w:tl�m o�e yea�ol comp�encr.,;he owner�huilder w,ll na.e ihe burden ol proving Q
y Ihal h�:diA not C�iIC•]r�m�fCVe l0:IF.e pur�Ose ni Shc¢.1 �
y �I as ewrer•�f:hr.p:r.pe•!y an exclusivety ceriracnny w�tG hr.ensetl[oc�rac:ors to cerslmc:IFe pra�ec:(Set. W
o '04a,Basmess an0°iokssiorvs Code Thc Corlractor�s Lirense Law dces nm ae��V!o an ownei uf OroDeny wha � _
Q �uicPs ci unprmes tae:eor,aM wno contraus loi sed�om�ects wuh a ro�vacrorlsl hcensed pursaant m the Canvactar's ��
L:rcnselawl ����� �� t
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¢ l� �a�r eyempi areei se� ,s a ve ia�a�n ce�t�,,�a«i. PLAN REVIEW_ � � � t�� % "J l�/
p 7nlc p�,ner r="'—."`�+� .T� ���
J C G%�
� V�'INKERS C�MPENSATIpp;OECLAFATION I herebv alhrm�hat I have a rertl¢au ol cunsem io seH�msaie or - �""'� /��
a rer,d•cale i}'Nmkeii Com�ensalion I�surance,or a cerF.fied:opy Ihe�eol;Se[3800.LaC CI - ��� �LJ
� ���-�—
Z ❑LerdieJ cony is hEfPI1Y�WNSIIBA _�xA���`
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p 7mihed cupy ii'ixa nah the 8w�dmg Inspecaen DeCartment oi Jepa;imem � GRADING
W (�e� �y��
� :ERTIFIC�TE nF EXEMPTION FROM WORKERS'COFiPENSATION INSURANCE This secucn ne�n not 6e canpleteA ISSUAN,r )�++.�( /
y d �he Demrit:s Icr nne hundreC;S10�I ai less I cendy that ir the pertormance of the work lor whmh Ihi.c �, ._ -
peim�:is issued,I shall rnt emplay any person m any manner sa u to hecome suh;eu la Ihe N.6rke�s'Compensauon C'�` (� _ � `'�
� Laws o'Calrfur:na (�� ���
� ��- 2- `�G� •. �,p� ��,cK+<..�x W PARK FEE
p Oatv , ',Apphtanl
J.NO71CC '0 A?PLICCN7 I� afler maMmg th�s Cerrilcate ol Exemptmn,yau should become su6�ect ro the Nbrker's �- SCHOOL FEES _
Campensa:mr p!owsions al tne Labor CoAe, qou must Mn�wph comU�Y wnh such pmvisians ar this permit shall
� I;e AeemeC rewkec J �+ �y, �y�
� �IVISION OF IN�JU5TAIAL SAFETY PENM�?CERTIFICATION L� (✓'f. ���"'i ��� .{7�����/V'
� ❑i hemhy remty iha;nn e.caaanon(rve°(5(`or�rore�!ret in'��pth'in{o wAicn a yerson a reQuued to detemd. �_ � �
� will 6e madr.:n conrecuon wnh wark author¢ed bY�s pe�mit and thal'.A�a Wilding slrncture,soafkldinp,hlsework,
rn Ucrt:olitin:i or�ismantling tice�eof,N�ill he more t�an Ihn�y�si��761 feet Ngh�Chap 32,Gry 2,Art 2,Sec
2 341 Title B.C d L 1
_ ' , : ;'7_ , . . ... _ . . . ...
3 ❑as owirer LudJer I wdl not emplay anyone to do.work ivhich would reQmre�a permit iram Ihe pvism d
1— :rAi,sir.al Safety.as no!ed above,unless sucn person ha:a pamit to da sueh work 1mm the drvisian —
� . ....,
w ❑Uvrsion ol hMustnal Safety Pe:mn Na TOTAL FEES �� .
�
� CONSTRUf.T10N LENOING AGENCY I here6y affirm that Ihere is a con3huctian kndmg agency for the pertormance
= al fl�e wark tor wh¢h th�s permit is issued�Sea 309),Crv.C�. � a
� Lenaer s Name COMMENT$ ¢ '�
= Lertler s AAOress I
m
Q CEHTIFICATE OF COMPLIAAICE AND AUTHOHIZATIQJ OF ENTRY�I cnritv I have read Mu applicaiian and su�e
y �hat�he mfwmauon grven rs conett.1 agree to oomply with all slate Iaws a�d ciry orEinances reA�mp to Wdd�rp
yconstrucUun,and authur�ee a repreuntanve ot the Oepenment of Bwldnq and Safety n enter upon the pruperry
= for wn¢h i have applied loi this p��e�m''�n for the pwpose oF inak� 'nspeCtions
� /\ i b'�1^�'e.. �[J�G�/�.�Y`�[.a./�
'�- 2 —�� RECPT N0.4'���—PAID BY '� ��� VAL IDATION ��
Signatwe ot Applican�ar Agent Oate
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Appiicants Copy
BS'06-1 1189
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