HomeMy WebLinkAbout1339 (78)CITY OF DIAMOND BAR PRESS
.!- DEPARTMENT OF BUILDING AND SAFETY
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JOBSITE
APPLICATION PERMIT USE
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OWNER N
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SIDE/SIDE STREET RW ❑
APPLICANT TEL
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CONTRACTOR 6-a
SEWAGE ❑ PUBLIC PMT A
ADDR SS e ,
DISPOSAL ElT./
PRIVATE SO. F100 GAL
CITY.. IP TEL.
STATE
GRADING 13CU. YDS. EXC. CU YDS FILL
LIC. NUMBER
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TYPE SQ FT FACTOR PSF ADJ. AREANALUATION
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DESIGNER
ADDRESS
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CITY ZIP TEL.
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ROPOSED USE
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GARAGE
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NO. D NO. NO.
UNITS STORIES BEDROOMS
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VALUATION ADJ. AREA
LOT DIMENSIONS
oUAWIFTY :DESCRIPTION FEE '
NO. OF BLDGS HOW
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ON LOT USEDU
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tICENSEO CONTRACTORS DECLARATION I hreM affirm that I an licensed under provisiors of Chapter 9 (commencing
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with Section 7000) of Division 3 al the Business and Professions Code, and my license is it Idl force and effect
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MVNER BUILDER DECLARATION I hreby alliin that 1 am a empt Iron the Conoactoi a License law fa she following
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reason ISec. 7031.5. Business and Professions Code Any city a county which relf6ra a permit to construct.
IV such
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p slier, improve. demolish. or lepail any stlu jVe. prior to its issuance, also requires lie spplKanl Pasant
to Isle a signed statement dial be is kcersell puesuanl to the provisiom of the Cmnactai s License Law (Chaptef
he is t
- 9 [commenting with Section 70001 at Divisor 3 of the Business and Professions Codel or that exempt erdrom
and the basis for the alleged IsemDtan AM valation of Section 7031.5 by any applicant fa a permit wbtecls
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C d% applKart to a civil penalty of rot more than fly hundred dollars 11150011.
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❑I, as owner of the property, or my employees with wages as thoin sok eompensahon, will do die work, and
die Iltucture is not Intended or oflued fol sale (Sec. 707:. Business and Prafesswi; Cade The Contractor's Dcenm
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Law does not apply to an owner of property who builds or improves thereon, and wills does such work himself,
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J or deough his own employees, Provided that such improvements ve nal intended or offend for sale If. however.
3 the Wilding a impnovemeol is sold within one ye■ of completion. Ili owner -builder will have the burden of proving
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mat he did not Wild or vnpsove for the purpose of sale.I
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❑I, as owner of the property. m eaxklslvety Untnctwg with licensed contractors or construct the project (Sec
7044. Business ad Professions Code The Contractor's License taw does rot apply to an owner of property who
c builds or improves low. and who Untncts la such projects with a centrata(s) IKensed Pusuenl to tlu Cmuacbr'e
License Law)
CONSTRUCTION
❑ 1 am exempt under Sac . B. b P.C. lattarh Cetiliaan)
PLAN REVIEW
Date Owner
'LEC
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PLUMBING
= WORKERS• COMPENSATION DECLARATION I hereby dfem that 1 have a certificate of consul 10 self.msat, De
w a culkate at Wbkett Compensation Insurance. a a testified appy dicreal ISec. 3300. Lab C)
fi;KZastihed copy is hereby fu(nland
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MECHANICAL
❑ ratified copy is Wed wish the Balding Inspection Department a Departmenl.
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e CERTIFICATE OF EXEMPTION FROM NgIKERS' COMPENSATION . This action need not be hick ISO
for chis
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GRA
SUANCE 0v
al which
n B the punt is lot ane hundred ISI00) a loss I Unity Cul in la a o! aha wok
Permit is issued. 1 shat rot employ y person m an manner so as bar w rkas Compensation
Laws d Caldorna
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PARK FEE
APO
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SCHOOL FEES
+' NOTICE TO APPL CANT H, 84, matng this Cesalicae al E pia^. you hexanes t m
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Compensaim provisions of de Labor Code. you must lata vrth caryly with such povisicm a Mn .
+- be deemed revoked.
as,OMSION OF INDUSTRIAL SAFETY PERMIT CERTIFICAiTIOli /'.'".x w t 1 1'1
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�- 01 hereby candy dist no excavation Inn (5) or mase IUt in depth into which a poison is taquld in descend.
= .4 h made n eorminn with wok authaved by this permit, and dist so Wilding structure, scaffolding- felUwork,
�•• a d—lim or dismantling 1lhtrml. will be Ione than mwty sit (36) feet high (Chap 3.2. Grp 2, An 2. See
y 341.Ltle8.CACl JUL 2 6 i3�0
� ❑As ownnbuilder. 1 will not emoby anyone to b wart which would nqun a pasan hon the Cuvcot al
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Industrial Safety, as noted abase, unless such person has a permit n do such work Inn the division.
PE 71 C;Alii
❑Orvicion of industrial Safety PVmxl o.l1Y fr I„�'��� x��•�-
TOTAL FEES a
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CONSTRUCTON LENDING AGENCY. I I um 1hol.mae is A Outltlllsel lending �y 1a M pesfamaKa
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at 1M wok fa which mit pant u iaswd (Sex 3097, Cit. W.
Lender's Name
MMENTS
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LendWs Address
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CERTIFICATE OF COMPLIOUANDilkUTIOWI OF . 1 eatify I have rod ova appkat- W maser
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IMhe informationI information 64 v tan I agrU m In asp store 4ws anis tiry ad:wsa nlatiry to 14i16ng
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amtrBuKnL aha Safety as Wan rawly
Cucticm, and go Lear a taD senUov a tient d
ha which I have a IN thr a nal iespactiom.
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RECPT No. PAID BY vAUDATI A -MO
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WHITE—Depandtent Copy, yELtxAN—t-inance copy. rmrrnsW3sca1 wVy, ..war..,..+ . vy. • y
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I C E I L I N CT IN_SO'L.-ATION
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FINAL HEATING HEALTH DEPT. FINAL
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COMILIENITS
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