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HomeMy WebLinkAbout151 (73)CITY OF DIAMOND BAR PRESS DEPARTMENT OF BUILDING AND SAFETY BUILDING PERMIT FIRMLY JOBSITE �_ ADDRESS S : Ivf tooc,�% = v v ar d? 3 i g: per. ? ^ APPLICATION PERMIT U E DATE % J -/ 3- S�"3 NUMBER —,CODE ISSUE TYPE OCC. DATE — CONST GROUP APN LOT �,�. TRACT CROSS STREET Cl7�AND'aGl 4 AZA�/+a h GA OWNER FAdvz-s VAInl'N ADDRESS -2-34L 9 E G14ANa,FLl el ZONING SETBACKS 'AP1oNE*E"T FRONT RW O REAR CITY.IIAM�rD t3Al�. ZIP gl74 TEL.Z92— SIDE/SIDE STREET RW APPLICANT'^To� 7Ko TEL. �I SIDE Q CONTRACTOR ADDRESS SEWAGE PUBLIC PMT # DISPOSAL El PRIVATE SQ. FT./ 100 GAL CITY ZIP_TEL._ STATE LIC. NUMBER GRADING' CU. YDS. EXC. CU YDS FILL ARCH/ENG/ U} pE SCS: ' FACt ?R; .S , :ApJ ' ARAfALUATION -. DESIGNER �ND//% .l°%C F/✓G. W` 1 t, - ADDRESS 1,2.042 VALGG_ y V',Z E= 1 � 2 CITY (gid POELY CnPo l/k ZIP TEL $9!_22IL 3 PROPOSED US ��5 • NO. DWEL NO. NO. UNITS 1 STORIES a.2 BEDROOMS_ ,,;,� GARAGE � PORCH ���}; LOT DIMENSIONS 2 OX . VALUATION `' ADJ. AREA NO. OF BLDGS / HOW n ON LOT . USED OUAt�tTX C31rSiIPTCN "' I ❑ LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed order provisions of Chapter 9 (comment ng with Section 7000) of Division 3 of the Business and Pratessions. Code. and my license is in full force and effect ter: OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for thefoltowmg reason fSec. -70315. Business andProfessorsCode: Any .city or county which .requires a permd :ro. csnstrucf. Ant, improve, demolish, or repair any shoctae prior to its issuance, also requires the applicant for such permit to file a Signed statement that he is licensed pursuant to. the provisions of the Camractor's license. Law' fChepter 9 (commencing with Section 70001 of Division 3 of the Business and Professions.Codel 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. N"ij': - 6'I - the applicant to a ev I penalty of not more than five hundred dollars (25006);. ❑l as owner of the properly a my employees with wages as their sots compensation. 'will do the work, and '4' the structure is not intended or offered for sale (Sec 7044, Ousiness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds: at improves thereon and Who does such work himself, ar through .his own :employees, provided that such improvements are not intended: a offered for sok. If, however. the budding or improvement is said within one year of completion the owner -builder wall have Me burden of proving that he did not Wild or improve to the purpose of sale.) ❑I, as owner,of the property, am exclusively contracting with licensed contractors to construct the project (Sec 7044, Business and Prefessiens: Code: The Contractor's license taw does. not apply to an owner of property who- (,�� 2i ,p - builds orimproves thereon; and who contracts for such projects with a contractorls) heensed pursuant to the Contractor s License Law) CONSTRUCTION 2 q J_ 1113 ❑ nam exempt oder Sec. , 0.6. P.C.(Attach Certificate) PLAN REVIEW". L,` ry Date owner ELECTRIC _ -_' WORKERS* COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent ro self insure or a certificate of_Wmksrs Compensation Insurance, or a certified copy thereof /See 3800, Lab. C.I ❑ certified copy is hereby ,ornishiol. h.,°, PLUMBING MECHANICAL ❑ Certified copy is filed with the Building Inspection Department or Department GRADING CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section :meed ret be completed * 1 the permit is for one hundred ($100) or less I certify that m the performance of Me wok for which this 4 permit is issued, I shall rat employ any person in any manner so as to become subject to the Workers' Compensation Laws of CaliMrma - �� '- :. ISSUANCE .. f ,j ,- ® _ ft n--- z SMTP] '„� -- - `�°°" F PARK FEE Date 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 forthwrtN comply. with such provisions or this permit shall be deemed revoked. s , SCHOOL FEES: g DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: - ❑I hereby cenlfy that no excavation five (5) or more feet in depth into which a person is required to descend will be meds in connection with work authorized by this Permit, and that no building structure, scaffolding, fakework i— r++ r� tt�7 C1T�( BI' Nil�el 9(,�iV I A; it L r r or, demolition or dismantling thereof, will be mine than thirty-six (36) feet high. (Chap. 3.2. Grp 7. Art 2 Sec RI Al!7IAI ('; 4 C kart A r�-TY 341, Title B, C.A.C.). ` Els owner builder, I will not employ anyone to do work which would require a permit from the Division of Indusbtal Safety. as noted above, unless such person has a permit to do such wok from the division. ❑Division of Industrial Safety Permit No. TOTAL FEES ' J CONSTRUCTION LENDING AGENCY: I hey allium that there is a canstrcetiori lending agency to the performance ;. of the work for which this permit is issued (Ser. 3097, Civ. Q. Lender's Name COMMENTS - & lender's Address s; CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I tertify I haw read this application and state - that the information given is correct. I agree 10 cpmply with all state laws and city ordinances relating to huikirrg construction, and auth"ll a representative of the Department of Building mrd Safety to enter upon the property farwhich I have ap ed to is pe ill the purpose of making inspections. 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