HomeMy WebLinkAbout027CITY OF DIAMOND BAR
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DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT
PRES /` '�
FIRMLY
JOBSITE
ADDRESS 417 a �'f%7GL !��
PERMIT USE'
DATE CATION NUMBER CODE
ISSUE TYPE OCC. ,
DATE v CONST: GROUP
APN LOT TRACT
CROSS STREET
OWNER ` MaA LAL -M
SETBACKS fMPFtOVEMENTB
ZONING
FRONT RW El-
]ADDRESS!
REAR El
SIDE/SIDE STREET RW
SIDEUf'
ADDRESS!17 099a l i-- ?Z1.')
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CITY 9- L ZIP TEL.
APPLICANT TEL.
CONTRACTOR CA _ 116f -Ar M17WP r17V
ADDRESS 2 Olt 0-�
SEWAGE ❑ PUBLIC PMT # `
DISPOSAL
❑ PRIVATE SQ. FL/ 100 GAL
CITY_liti,I t ;�77i�i ZIP TEL
STATE
LIC. NUMBER 7
GRADING ❑ CU. YDS. EXC. CU YDS FILL
ARCH/ENG/
TYM . FAir" C3R PS: A ,I AI A111`AIiIATif�N'
DESIGNER P2iV9VAA J'i _ 41,A d5
I..W
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1
2
ADDRESS ILOle'-Z If-::- M j,4 PK"I'l
CITY G �'� 609'> - ZIP TEL.
PROPOSED USE "-Z1 9i clime
4
GARAGE
NO:DWEL. NO. NO.
UNITS STORIES BEDROOMS
PORCH`
IMP
LOT DIMENSIONS
VALUATION ADJ. AREA
NO- OF BLDGS HOWUUANTFfid�
ON LOT USED
DESRIPTitt .._._ FES .„. _.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 Icommencmg
with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect
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OWNER B91LOER DECLARATION. I hereby affirm that I am exempt from the Contractors License Law for the fallowing
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reason (Sec. 7031-5, Business and Professions Code: Any city or county which requires a permit to construct
alter, improve, demolish, or repair any structure, prior to its issuance, -also requires thin applicant for such permit
to file a signed statement that he is licensed pursuant to the provisions of the Contracter's License Law (Chapter
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9 (commencing with Section 7000) of Division 3 of the Business and Professions Cada) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars (SSft.):-
❑1, as owner of the property, er my employees with wages as theirsale compensation, will do the work, and
the 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 ices such work himself
or through his own employees, provided that such improvements are nut intended or offered for sale, If, however
the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving
-that he did not build or improve for the purpose of sale.)
111, as as owner of the property, am exclusively contractingwithlicensed contractors to construct the project fSec
7044, Business and Professions Code- The Contractor's License Law does not apply to an owner of property who'
builds m improves thereon, and who contracts for such projects with a contractorfs) licensed pursuant to the Contractors
Lkense .) - -
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CONSTRUCTION , 00
tam exempt under Sec. . B- & P.C- ertibrute)
D owner
PLAN REVIEW -
ELECTRIC
PLUMBING -
MECHANICAL
RKERS' COMPENSATION DECLARATION. I hereby affirm that ve,a certificate of consent to self -insure or
certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C
❑ certified copy is hereby furnished.
❑ Certified copy is filed with the Building Inspection Department or Department':
GRADING -
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCES This section need not be completed-
ISSUANCE
if the permit is for one hundred (SI00) or less. I certify that in the performance of the work for which this
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permit is issued, I shall nut employ any person in any manner so as to lett to the Vdtrkers' Compensation
Laws of California. -
Date /'� %l r f10 ' ®� Applicant -� --
SMIP
PARK FEE
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SCHOOL FEES -
NOTICIE TO APPLICANT: If, after making this Certificate ofxemp i o should become subject to the Workers
Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall
be deemed revoked- -
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DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
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01 hereby certify that no excavation five 15) or more feet in depth into which a person isrequired to descend
will be made in connection with work authorized by this permit, and that no. building stmcture, scaffolding, falsework
or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2. Art 2, Sec
341. fide 8. CA.0
[]As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
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Industrial Safety, as noted above, unless such person has a permit to do such work from the division.
❑Division of Industrial safety Perm No.
TOTAL FEES -
CONSTRUCTION LENDING AGENCY:I hereby affirm that there is a construction leading agency for the performance
of the work for which this permit is issued (Sec 3097. Civ. C.).
Lender's Name
COMMENTS
Lender's Address
CERTIFICATE OF COMPLIANCE AND AUTHOR12ATION OF ENTRY: I certify I have read this application and state
that the information given is correct. I agree to comply with all state laws and city ordinances relating to building
construction, and authorize a representative of the DepVtfirent of Building and Safety to enter upon the property
f« whit 1 h via led for in7perglit far propos maki spections.
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RECPT NO. PAID BY / T VALIDATI
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Signet of App nt « Went Date
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy
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