HomeMy WebLinkAbout1607 Derringer Lane_Grading Permit 4.13.2020Grading Permit
City of Diamond Bar PR20190001960
c I r r o F A21810 Copley Drive, Diamond Bar, CA 91765
E` 909-839-7040
DIAMOND BAR
The undersigned hereby makes application for Grading on private property at the location described below with the understanding all work is subject
to the provisions of City Municipal Code, the plans and General and Special Provisions approved by the City Engineer. I am aware that in the interest o
public safety, special regulations apply in hillside areas and that geological or engineering reports, or both, may be required before a permit is issued.
If excavated materials are to be obtained from or are to be displosed on a separate, non-contiguous site, located within the City of Diamond Bar, a
grading permit shall be required for that site also.
Permittee shall indemnify and hold harmless City (including its officers, 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, arising from
Permittee's work described in and undertaken under and pursuant to this Permit. Permittee shall 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 attorney and expert fees incurred by
City in the defense of such claims.
Traffic control devices shall be installed per Caltrans Traffic Control Manual and W.A.T.C.H. Handbook before start of construction.
This permit shall expire twelve (12) months after the date of issuance unless otherwise indicated below.
SITE ADDRESS
1607 DERRINGER LN, DIAMOND BAR, CA 91765
LOT NUMBERS BLOCK
11
TRACT NUMBER
24046
OWNER
KAUSHAL AMIT & SANDEEP
MAILING ADDRESS
1607 DERRINGER LN
TEL NO.
909-247-0966
ENGINEER
Jin K. Yang (GOLDEN LAND ENGINEERING CO)
REG NO.
48012
MAIL ADDRESS
2912 Rio Lempa Drive, Hacienda Heights, CA 91745
TEL NO. / EMAIL
626-377-6506/ goideniand8888@gmail.com
Grading Contractor
OWNER -BUILDER
TEL NO.
ADDRESS
PROPOSED USE OF SITE(S)
Construction Type: Grading for new addition, retaining walls, and hardscape/landscape improvements.
CHECK IF SUPERVISED Grading ❑
SIGNATURE OF APPLICANT ( � V�n/
I z
ADDRESS
TEL NO.
PERMIT IS REQUIRED BEFORE COMMENCING WORK. INSPECTION IS REQUIRED.
CALL 909-839-7040 AT LEAST 24 HOURS BEFORE STARTING WORK.
SITE ADDRESS
1607 DERRINGER LN, DIAMOND BAR, CA 91765
NEAREST CROSS STREET
DERRINGER LANE AT SHOTGUN LANE
MAP NO.
STATE HWY YIN
PROCESSED BY
Nicholas Delgado
CUBIC YDS. HANDLED: 5992 CY
PERMIT NO. PR20190001960
USE ZONE
SPECIAL CONDITIONS
SURETY BOND BOND NO
SURETY COMPANY
DATE FILED REC'D BY
CASH DEPOSIT REC'D BY DATE FILED
THIS IS A LIMITED TIME PERMIT
ALL WORK AUTHORIZED MUST BE COMPLETED BY
October 12, 2020
EXTENDED TO:
BY:
P.C. FEE: $1,669.65
PERMIT FEE: $1,282.60
GRADING BOND: $28,000.00
TOTAL FEE: $38,452.25
WORKER'S COMPENSATION DECLARATION
I hereby affirm 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 October 12, 2020 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 dollars ($100) or less.)
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 October 12, 2020
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 affirm 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 full force and effect.
License Number Lic. Class
Contractor Date
❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer acting in my professional
capacity (Section 7051, Business and Professions Code).
Lic. or Reg. No.:
Date:
HOME OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following 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 affirm 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. I agree to comply with all 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: