HomeMy WebLinkAbout1049 p��° ��� ����{
'('� � CITY OF DIAMOND BAR PRESS
, DEPARTMENT OF BUILDING AND SAFETY FIRMLY
•^� BUILDING PERMIT
DDRESS�3��� � �� � DATECA?lON _ - '�JNUMBER ���`�j� CO E
� APN lOT TRACT DATE � - � �~��h ONST. GROUP
� CROSS TREET SETBACKS "p"°"'E"E"'s
°= OWNER�J,.��" ��� ���-'� ZONING FRONT RW ❑
� ADDR SS � REAR ❑
W CITY ZIP—y��TEL. �'.. SIDE/SIDE STREET RW � �
o APPLICAN - TEL. ��� SIDE � �
x
� CONTRACTOR SEWAGE
o ADDRESS _ 0 PUBUC PMT#�
DISPOSAL 0 pR�VATE SQ.FT./100 GAL
W GITY TEL.
z, STATE �
4J. GRADING ❑ CU.YDS.EXC. CU YDS FILL
y: LIC.NUMBER----.— -- .�— -�---- •—
y. ARCH/ENG/ 7YPE: S �T . .Clt'�Fi A A /Cl.li/tTlON. �
� DESIGNER � � c ,
o ADDRESS tJ„ 2 �
= CITY ZIP TEL. (� 3 �
� PROPOSED USE � ' � � 4
� L...C�%_>l r.i i.�''�'. / � GARAGE �
— - J S
= NO.DWEL. N0. �NO. � pORCH �
_ UNITS STO�FiIES BED�ROOMS m _ � __ �
VALUATION ' �'� ADJ.AREA
0o LOT DIMENSIONS � X � '��—_ �
o NO.OF BLDGS �� NOGJ r7� du�t�tTYtY D�S 1P'�1E�N �EE• r
W ON LOT j3'?'L�—.� USED
s �
W ❑ V
H
LICENSEfI CONTRACTOBS OECLANATIOM 1 here6y athrm Ihat I am h�enud u�m pronsions ot CAapter 9�cwime�ciip
� -wnh Secuon 7�00)ol auision 3 at the Busmess and Professions Code,aid my 1¢ense is in luli face and eHett �w �
3 � b
LL QJJN B�B11110ER OECIAAAT10N�I hzreGy afhrm that I am erempt 1mm ihe Coniruior's LKense law for the Idlouring �
reuxon(Eec 70315.Business and Pmlessrons CoCe�Any ciry ar ooumy whMh requirrs a permn to wnrnmt, 1.�� ' '
o alter,impmvr..Ee.mrAis�,ar repair any structurz,Orioi lo�Is uwanu,also repuies Ihe appticant lor such pe�mit •� —
Q ta file a s�gneA statement tAa1 he is IKensed pursuant to tAe prwiaons of Me Conhaciw's lianse law(Chapin ;(�:
ec 91�ammenciny with Section 1000)uf pvision 3 of Ihe Business an0 ProfeEsioix GOAe1 w��he is exempt NMNian „�.�
p� and the 6aas far the allegrJ eismption.AnY vidation af Setlion 7031 5 by arry appliCant iw a peimit Suhpcta .�
K ihe a plir.am to a crvil penalry of nor more ihan Irva hundred doliars 13500�.�. ��'�..�' ---- -
W
� I,as nwner of the property,or my employees wnh wages as tlrcir sde mmpensalion,will do tAe xrork,a�d � —
~ t tr�ctwe is nm imeMed ar ofleiai fm sale ISec 1094.Business anG PioFessnns CaCe:The Contrectar's license � �
r,~j Law does not applY�a an awrer of prepeny who 6uilds or imp�oves tAeieon,a�who dces such woik himuH. � �
�++� or ihiough Ms awn emqoyees.OraviAeE IAat such imDrwements are nm intended m oflweA lor sak If.howevz�, ����
m the baildiw�o�imp�ovemem�s sold wnhin one year of compktroq the ownerbmWn witi hava�he hurden ol proviig
� � ihat he did not hwW or fmp�we far the D��rpose of sek.i � `
y F
h ❑I,as mvner at the praperty,am erdusively tantretlmy wah I¢ensed contrumrs in cortslrutl tM pro�ect(Set �j�
7044,Busirmss a�Professions Code.Tle Cankactoi s License lew dces irol apply to a�owner ot propeny wlro � �
= buJds oi imp�ovqs therean.and who contracit for tceh pro�eals with a mnl�atlor�s�licrosedpusuam to 7he Coniruta's '---� �
a License law� CTION ���r�f Z_.7 �
W ❑� �AN REVIEW " �1�f-�_}„� �
I am e�empt in�Aer Sec .8 P Attach ndicat . � �`' �
o nai� ^ •- � � � � ELECTRIC
� WVRK RS'COMPENSATION OECLARA71pJ i heratry�Hirm ihat I have a cerEficate nt tonsenl lo sel4msae,a ,��� �'
a cend¢ate ol Warkers'Compensation�nsuronce,or a oe�tifiea oopy merea�ISec.3800,tah.C.�. ' � PLUMBING _
Q ❑CendieJ copy�:nereny����snee. .�� MECHANICAL _ _ �
o ❑Gertahetl copy u fil¢d wilh the Building(nspeclim Oepartment a Oepartment. �"�L GR
� CERTIFICATF OF EI(EMPTION fNOM WOBNENS'COMPENSATION INSUAANLE:TM1is setlwn need not he tompkted ISSUAN E '�7����
y il IhG peimn rs lor one hundfed�S1Q0�or less I ceitily thai in the pnlorman�e ol tM wak Ia WhKh'IAis �.. �
permn is issued,I shall w�employ a�ry perwn in any manrei m as m heeane v6�x�m�he Nhhris Campensation ? JC�
e �aws n�tautomia � pARK FEE�
�
o na� App�uant � SCHOOL FEES i
� NOTICE TO APPLICANT.II,afur making this Cartileaie ol Exempinn should 6ecome su6ject m tice Ytlhrkei's
—+ Compensanon provis�ons ol�he tahor Cade,yw�,., Iof;tl�yvithS{'t�iriM s¢h prwisons a this permit sheA
� he tleemed rewkeJ. i.;� �c''''M �;,�� �:�
T � s •
� pV1510N OF INWSTAIAL SAiETY PERMIi CERTIF TI � ,
W
� ❑I herehy cenAy that no excavation live(5�a mae Poet in dpth inl0 whkh�persan iz reQuired to destend,
� wtll 6e me0e in camiecuon wiM wark autha¢ea hy fhs peimu and np avu[ture,xaHofdinp,fs�e�rurk,
w demoldim ur d�5maniNng theieoi.wiC h(yr�PeTl�an I�i�Iy�iw Im�.ICIuD 32.Gry 2.An 2.See
W� 341.Ltle 8.C.A.C.) �•@�H�,4 uI
x
3 ❑As aw�rer�builder.I will nol empky anyone to Go work whkh wouid reQuirj.,a;y�q��Irom Ihe Oivqion of
�— Indistnal Safety,as noted aho�x,unkss su,5h�pf M�h'0?!m!!,W da�"sLr�?4qk f�pm Yhe'tlivision.
lt ;�';" , . ±,�.
y rs,'_,_...,� l
W ❑� �� , �`",.' ���.�'' .' L.4 TOTAL FEES
Qnsim ot Industrial SafeN Perm f{4. . ...
� CONSfNUCTqN LENOHJG AGENCY:1 here6y aflirm�ha�tkre is a rnmhu�tion k�diq peiey lor tlie perfartnante � 0�^—' 3
' '_____
z al ihe worY Iw whch Nis permn a issued ISx.3087,Crv.GI� �
� tender's Name CUMMENTS_ ----
mLendei's AAAieu — �— -- —
Q CEf(TtFICATE OF COMPl1ANCE ANO AIRNOItl2A7pN OF ENTRY:I arMy I!uw n�d thie�ppferoon ud p�r �
r/J that Ihe inlormation gven w tmett 1 apree ta[omply with aA staoe laws and Nry wdin+nca rMruy Io huiHinp
y constructwn,and aNhorue�repre5mlative of tM OpYtmml oi BuiNHq and S�My m m�r upan tle papxly
= for whi�h I�ave applKd for Ns permit la the qryase d mskmp mspecGons. .-�.
� X �� � � .�,
Sgnature d Appli[ant a Agml p� RECPT NO._ _ PAID BY VAUDAT , I
WHITE—Department Copy,YELLOW—Finence Copy,PINK—Avsesaor Copy,GOIDENROD—File Copy,GREEN—Applkants Copy
BS706-17/69
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