HomeMy WebLinkAbout153CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY
'1 BUILDING PERMIT FIRMLY
JOBSITE
ADDRESS SS$O(�J•pIplMOlnt3p JARU�
APPLICATION PERMIT USE
DATE NUMBER =' CODE
ISSUE TYPE OCC.
DATE _ ->' %� CONST. GROUP
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DESIGNER
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ADDRESS
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PROPOSED USE i
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NO. DWEL. NO. NO"
UNITS STORIES BEDROOMS
LOT DIMENSIONS
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VALUATION :2 ADJ.
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NO. OF BLDGS HOW
QUANTITY
DESCRIPTION
FEE
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LICENSED C01,1711ACTORS DECLARATION I hereby aflirm that I am licensed under provisions of Chapter 9 (commencing
with Section 1000) 01 Dwismn 3 of the Business and Pralessions Code, and my license is in lull force and effectull
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OWNLH BUILDFH DECLARATION I hereby aflirm teat I am exempt ham the Contractor's License Law tot the following
reason (Sec 7n:i1 5 Suss— and Professions Cede- Any city or county which requires a permit to construct,
alter improve demolish, or repair any structure, prior to its issuance, also requires the appbcam tar such permit
to file a signed slatement Thal he is licensed pursuant to the prnwnons of the Contractor's License law (Chapter
S �oommemmng with Section 7000) of Division 3 of the Business and Pralessions Code) of that he is exempt therefrom
antl the bass fur the alleged exemption Any violation of Section 70315 by any applicant for a permit suntans
the apphcnnt to a _I penalty of nor more than five hundred dollars (6600).1.
❑I as nwner 01 the property, or my employees with wages as then sale compensation, will do the work. and
tfie structure is not intended or offered for sale (Sec 7044. Business and Professions Code The Contractor s License
Law does not apply to an owner of property who builds or improves thereon, and who does such work himself.(,)
ar ihrnugh his awn employees, provided that such improvements are not intended or offered for sale 11. however,
the budding or raprovement is sold within one year of completion, the owner -builder will have the burden of paving
that he dill not fauld err mprave Ior Ile purpose of sale.)
❑I, as owma nl'the'proyertY, am exclusively coniracuny with licensed caniractWs to construd.ihe prgect ISec.
7(144, Business and Pofessons Cade. The Contractor's License law does not apply to an owner of property who
Lwlds m nupmwes thereon, said who contracts It, such projects with a mnlpelorls) licensed pursuant to ..... ontractor's
License Law) x
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'CONSTRUCTION
Ll I am sin, pi under Sac . B h PC. tAnach Certfcatel
PLAN REVIEW x , o f� - ,
Date Ovare,
.4_5r
ELECTRIC
WORKERS COMPENSATION DECLARATION. I hereby aflirm that I have a certificate of consent to setl•msure. or
a caruhcala of Workers Compensation Insurance, or a remhed copy thereof (Set 110, tan 11
Caroled copy is hereby furnished
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PLUMBING
MECHANICAL
REI Certified copy is filed with the Building Inspection Department or Department.
_
GRADING _.
CERTIFICATE OF EXEMPTION FROM WORKERS' CO pM,FA'SAHBNtNSO/et is section need not be completed
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ISSUANCE---
rt the permit is for one hundred (S100) or less cac,l, that n e rl ee of the work too which this
permit is issued, I shall not employ any person in any manner so a m solo[ o the Workers' Compensation
Laws If Caldmma
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Ate oant
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SMIP
PARK FEE
SCHOOL FEES W ii ll '�3 19.89
NOTICE TO APPLICANT It, alter making this Certificate of Exemption, you should become subject to the Worker's
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be doonsed revoked
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
CITY oP 1 .
Ill hereby tartly that no esuavation five (5) or more feet in depth into which a person is required to descend.
w l be made m rnnuechun with work authorized by this permit, and that no building structure. scaffolding, falsewark,
or demohnnn or dismantling therm( will be more than thirty.- 136) teat high. [Chap 32, Grp 2, Art 2, Sec
CUILDIiiija
341. Title 8. C A.0 h
❑As owner builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from the division
❑Orwsion,, of Industrial Solely Permit No.
TOTAL. FEESn
CONSTRUCTION LENDING AGENCY I hereby affirm that there is a wnshuctwlending agency for the performance
at the work for which this permit is issued Sec. 3097. Cer C.).
Lender's Name
COMMENTS
lender's Address
CE " IfAUTEIORIZATgN OF ENTRY: I cattily I have reed this application and state
at the asimm inn give care agree to comply with all slate laws and city ordinances relating to building
c anshuchun, ar author. resent a of the Department of Building end Safety to enter upon the property
for which I he or th permit for purpose of making inspections.
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RECPT NO. 6S PAID BY x. ° VAUDATION
Signature at Applicant or Agent mete
WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN— Applicants Copy
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