HomeMy WebLinkAbout1515 (56)CITY OF DIAMOND BAR PRESS
V - DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT FIRMLY
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APPLICATION PERMIT fe,1=7USE
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DATE NUMBER =. CODE
ISSUETYPE OCC.
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APPLICANT VIC TEL.
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SEWAGE ❑ PUBLIC PMT A
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DISPOSAL [) PRIVATE tSO. FT -/100 GAL
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PROPQSED USE -
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NO. DWEL. f NO. NO.
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UNITS STORIES BEDROOMS
LOT DIMENSIONS
VALUATION -% ADJ. AREA
NO. OF BLDGS HOW
QUAN7#LY .°..DESGRIPTiQN : - ;FEE
ON LOT USED
- LICENSED CONTRACTORS OECIARATION: I hereby alfirm that I am licensed under pmvisioras of Chapter 9lcommencing
with Section 7000) of Division 3 at the Business and Professions Code, and my license is in full torte and effect
CIVINER-BUILDER DECLARATIONS I hereby affirm that 1 am exempt from the Contractor's Laense Law fm the following
' reason ISec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct
alcor, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant far such permit
to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
9 icommencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he is exempt therefrom
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and the basis for the alleged eiemption. Any violation of Sachem 7031.5 by any applicant for a permit subjects
l the applicant m a civil penalty of not mora than five hundred dollars DI5001.).
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'r LSI. 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 ISec. 704 , Business and Professions Code: The Cantraciar's License.
i Law does roit. apply to an owner of property who builds at improves thereon, and who does such work himself.
or througt his own employees. provided that such improvements are not Intended or offered tar sal. If, hawewe
-- the budding or -improvementis sold within one year of completion, the owner -badder will have the burden n1 loati.9
that he did not bold or improve for the purpose of sale.)
[ ❑I as owner of the property, am exclusively contracting with licensed contractors m construcr the project ISec
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7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
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-. buifidsor impraves thereon, and who contracts for such pmgerts with a conrector(s) licensed pursuant to tit Cadractor s'—`-•_--•.�..
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License taw.l
CONSTRUCTION tet, s ayiJ'a...i
I am exempt under Sec - . 8. b P.G. (Attach Geroficafe)
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i' oam avvie,ELECTRIC
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.PLUMBING
hVDRKERS' COMPENSATION DECLARATION: I hereby affirm that 1 have a certificate of consent to self -insure, or
- a cerbficate of Mittens' Compensation Insurance, or a certified copy thereof (Sec. 3800. LA C-1.
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❑��Certified copy is hereby furnished.
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MECHANICAL
ees�L-entified copy is filed with the Building Inspection Oepartment or Department
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GRADING
c_ CERTIFICATE OF EXEMPTION FROM WORKERSCOMPENSATION INSURANCE: This section need not he completed
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if the permit is for one hundred 151001 or less. 1 certify that in the performance of the work for which' this
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• permit is issued, I shall not employ any persmcargarq anno soas,ta be— subject ten the Nbrkers' Compeneatan
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Laws of California. -1_ f ;,
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PARK FEE
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' ate A
fes,
SCHOOL FEES
subject to the Militarist's
a -NOTICE TO APPLICANT If after making flus Cerialaate te of of Exemption. you should hecmte oW
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i Compensation provisions of the Labor Cods, You must forthwith comply with such provispns a this permit shall
be deemed revoked. e i
DIVISION OF INDUSTRIAL SAFETY P�Rh1 -
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�. ❑I hereby certify that no excavation five (51 or more feet in depth into which a person is required to descend
will he made in connection widlwmk,wlluX¢ed Cy -this permit, 2"1no bugdpg structure• scaffolding, fa$eta
or demmdan or dismanding'dbered.' wilf-be more than 1361 feet high. (Chap. 3.2, Grp 2, Art 2, Sec
34), Title 8, CA.C.).
❑As owner buffer, I will hat employ anyone to do work which would require a parrot from the Division of
- Industrial Safety. as noted above, urdess such person has a patent to do such work from the division.
❑Division of industrial safety Permit No.
TOTAL FEES r
y CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agampy for the pnrformen[e
I! of the work for which this permit is issued (Sea. 3097, Civ. Q.
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a Leader s Name
COMMENTS
3 Lender's Address
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I taw read this application and state
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that the information given is correct. I agree to comply with all state laws and dry ordinances re4ti g IO MuHirp
construction, and authorize a representadve of the Department of Building and Safety to enter upon the property
fa which I have applied for this permit for the of making inapeeti�s.
RECPT NO. l PAID 8Y VAUDATION
Signature at Applicant or ' Date
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BS106-11189
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy