HomeMy WebLinkAbout1049 Banner Ridge Rd_Grading Permit - (9.12.2017) ,r Grading Permit
�� � � City of Diamond Bar
21810 Copley Drive,Diamond Bar, CA 91765
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909-839-7040
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The undersigned hereby makes application for Grading on private properiy at the location described below with the understanding all work is subject
to the provisions of City Municipal Code,the plans and General and 5peciat Provisions approved by the City Engineer. I am awaze that in the interest o
public safety,special regulations apply in hillside azeas and that geologicai or engineering reports,or both,may be required before a permit is issued.
If excavated materials aze to be obtained from or aze to be dispiosed on a sepazate,non-contiguous site,Iocated within the City of Diamond Bar,a
grading permit shall be required for that site aiso.
Permittee shall indemnify and hold harmless City (including its o�cers, employees and agents) from and against all claims, causes of action,
liabilities, losses and damages for injuries to persons and property, including reasonable costs of defense and attorney and expert fees, azising from
Permittee`s work described in and undertaken under and pursuant to this Permit.Permittee shal]promptly pay the amount of any judgment rendered
against City(including its officers,employees and agents)for any such indemnified claims,and reasonable costs and attomey and expert fees incurred by
City in the defense of such claima
Traffic control devices shail be instailed per Caltrans Traffic Control Manuat and W.A.T.C.H.Handbook before start of construction.
This permit shall expire twelve(12}months after the date of issuance unless othenvise indicated helow.
' S17E ADDRESS
1049 BANNER R1DGE RD, DIAMOND BAR,CA 91765
LOT NUMBERS BLOCK
' TRACT NUMBER
OWNER
LIANG ANTON
MAILING ADDRESS
1049 BANNER R1DGE RD -
TEL NO.
909-348-2795
GEOTECHNICAL ENGINEER
JACK LEE
REG NO.
2153
MAfL ADDRESS
576 E LAMBERT ROAD, BREA,CA 92821
TE�NO.
714-671-1050
' Grading Contractor 7EL N0.
N/A
ADDRESS '
PROPOSED USE OF SITE(S)
SLOPE REPAIR
Construction Type. SLOPE REPAIR
CHEC IF SUPERVISED Grading ❑
SI�� TURE OF LICANT
/E
ADDRESS
1049 BAIVNER RIDGE RD
TEL NO.
PERMIT IS REQUIRED BEFORE COMMENCING WORK. INSPECTION IS REQUIRED.
CA��909-839-7040 A7 LEAST 24 HOURS BEFORE STARTING WORK.
SITE ADDRESS
1049 BANNER RIDGE RD, DIAMOND BAR, CA 91765
NEAREST CROSS S7REET
MAP NO. STAT�HWY Y/N PROCESSED BY '
Fabian Aoun
PERMIT N0. PR20170009982
USE ZONE SPECIAL COND{TIONS
SURETY BOND
N/A BOND NO
SURETY COMPANY
DATE FILED REC'D BY
' CASH DEPOSIT REC'D BY DATE FILED
THIS IS A LIMITED T{ME PERMIT
ALL WORK AU7HORIZED MUST BE COMPLETED BY
9/12/2018
EXTENDED TO: BY�
P.C. FEE: PERMIT FEE:
ISSUANCE FEE:
' TOTAL FEE:
WORKER'S COMPENSATION DECI.ARATION
I hereby a�rm that I have a certificate of consent to self insure,or a certificate of Worker's Compensation Insurance,or a certified copy
thereof(Sec.3800,Lab.C)
Policy No. Company
Date Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
(This section need not be completed if the work involved by the permit is for one hundred doilars($100)or iess.)
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws.
Date Applicant
' NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers'Compensation provisions
of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
LICENSED CONTRACTORS DECLARATION
I hereby a�rm that i am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and
Professions Code,and my license is in fu{t force and effect.
_ �icense Number Lia Class
Contractor Date
❑ I am exempt from the licensing requirements as 1 am a licensed architect or a registered professionai engineer acting in my professionai
capacity(Section 7051,Business and Professions Code).
Lic.or Reg.No.: Date:
HOME OWNER-BUI�DER DECIARATtON
i hereby affirm that I am exempt from the Contractor's License Law for the foliowing reason(Section 7031.5,Business and Professions
Code):
�I,as owner of the property,or my employees with wages as their sole compensation,will do the work and the structure is not intended or
offered for sale(Section 7.44,Business and Professions Code).
❑ i,as owner of the property,am exclusively contracting with licensed contractors to contstruct the project(Section 7044,Business and
Professions Code).
CONSTRUCTION LENDING AGENCY '
, I hereby a�rm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec 3097,Civ.C.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is correct. !agree to comply with a!!City ordinances and State
' laws relating to building construction,and hereby authorize representatives of this City to enter upon the above mentioned property for
inspection purposes.
Signature of Permittee: Date:
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