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HomeMy WebLinkAbout100CITY OF DIAMOND BAR PRESS DEPARTMENT OF BUILDING AND SAFETY mins'l v _V tSUILUINU rtKMI I is re JOBSITE APPLICATION PERMIT USE ADDRESS 7 �`1 L—� DATE �I_��1— NUMBER ©l� CODE ISSUE TYPE '� OCC. APN LOTTRACT DATE CONST GROUP CROSS�SE -- ZONING SETBACKS �wFao+leMerts OWNER, / % FRONT_ r _ —Rlil f ❑ ADDRE S L ✓�� � e) REAR J ❑ CITY zipXr_Y71C—TEL? SIDE/SIDE RW ❑ APPLICANT — TEL; S ❑ CONTRACTOR SEWAGE El PUBLIC PMT # ADDR QISPOSAL ❑ PRIVATE SO. FT./ 100 GAL CITY_ ✓ —0 ZIP TEL. STATE 7 LI NUMBpR "] GRADING ❑ CU. YDS. EXC. CU YDS FILL MARCH/ENG/ W W LL C3 TYPE Si iDESIGNER _ (ADDRESS _ 2 CITY ZIP TEL. 3 PROPOSED USE Z— =r� INO. DWEL. NO. NO. UNITS_ STORIES BEDROOMS_ LOT DIMENSIONS NO. OF BLDGS HOW ON LOT_ USED_ ZffGARAGE 6ERTIFICATE IF FXEMPTION FROM NURKERS' COMPENSATION INSURANCE Thm section need net be wmpfewd 7 •i inn penia, 's tor we hundred fS100i nr less certify that m perlarman[e of the work lar bleb this VALUATION QUANTITY I SMIP UCENSEU CONTRACTORS DECLARATION I hereby aIfum that I am licensed under pmmsrons of Chapter 9 (commencing ! -h Seep 7003, 01 Division 3 of the Business and ss PrafeonS Code, and my license is in full force and ;feel. ❑ W OVINE. BML 9H DECLARATION I hereby affirm that I am exempt from the Contractor's License law ter to ftlowimg I reason I&:: 70315 Business and Professions Code Any icily or county which requires a permit to crnstreel 1 0 ahs, improve se:nnlns•, or mpar any structure, prim to its issuance, also requires the applicant for such permit I Z to f.le a sgned stat -era that he .s licensed pursuant to the provisions M the Contractors Iisnse. law (Ch. pie, M 9 [commencing wi;l• Settimt 70001 of Division 3 of the Business and Prof—ions Cartel or that he is exempt therefrom andthe ]ass for the alleged caempren Any violation of Section 7031 5 by any applicant for a permit Subjects theapgllnrt •e o i nvnl penalty of not more than five hundred dollars 1S5D01 I ❑ --a Q : as --,4 the property or ay employees with wages as these srle cempenaal- will do the. work and the w a^hseta:e is - intended or offered lar sale (Sec 7041, Business and Prefessmns Code Thr. Contractor's License stn dues.t app'y fa Im an owner of property who builds or prems thereon, and who does such work himself, U orr lhr IJi Ns awn er.ployees p,gvnded that such improvementsare ret intended m offered for sale If however. the hudmnc i, Improvement is surd within one yea, of completion, the owner builder well have the burden of proving a tha. ;1e nu: nm hudd cr improve for the purpose o: sale - El1, os cwnrr cl r`,e property, ar exclusively centractmg with licensed contractors to construct the pronect ISec Ltd 31144, Bosmess a -d Professions Code The Conlraclor c License Law does not apply to an owner of progeny who ,adds a' improves thenen and who rantracts Lor such protects with a contranor(sl kcensed pmsvant to the Contractor's ! -'tenAefew) I1 Ei I am enempt order Sec . B 6 PC fAuach Crrtdtate). II Date Owner CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING WORKERSCOMPENSATION DECLARATION. I hereby affirm that I have a certificate of consent to self insure or r a cernh,:ala of %orkers Compensabon Insurance. or a certified copy thereof (Sec 3800, Lab Ci 0Cert4md! copy •s hereby. Iwmired to MECHANICAL iLXCernf ml tory s fled with the 8oilding Inspectmn Department or Department _J < GRADING 6ERTIFICATE IF FXEMPTION FROM NURKERS' COMPENSATION INSURANCE Thm section need net be wmpfewd ISSUANCE •i inn penia, 's tor we hundred fS100i nr less certify that m perlarman[e of the work lar bleb this perm,! is slued shall not. ploy any person in any Wanner sit eine suit; t It the 4ers' Compensation SMIP Laws cl L f rola NPoa ot'� W LL PARK FEE SCHOOL FEES NOTICE TO APPLICANT If. after making this Curuhcabe te of Exemption, you should ome subject to the Worker's Compersation prov¢rnns of the Labor Code you must forthwith comply with s h provisions or this permit shall ADJ. AREA to deemed revakea 1 J •� DIVISION Oc INDUSTRIAL SAFETY PERMIT CERTIFICATION Vis+ [98-9 ❑I hereby certify that ro excavation five 15) or more feet in depth into which a person is required to descend. I _ wdl he site in cit iseelen with work authorized by this point, and that not building structure, scaffolding. falsewerk, I or dmnnllhon it dnsinantlm0 ,Mico(. ill be more than Thirty six 1361 foe, high (Chap 32. Grp 2. Art 2, Sec 341 T-le5 CACI tLE)ING AND SAFETY Bid ❑As owner budich der, I will not employ anyone to do work whwould regorre a permit hum Me Oivuen at Industnal Safety as noted above, unless such person has a permit to do such work from the divisbn LJ Owramm of Indo„real safety Permit No. TOTAL FEES i CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency lar the perforrnance of the work for which this permit is issued (See. 3097, Civ C I i Lender s Name COMMENTS ..__. Lenders Address CERTIFICATE Of COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read ibis application and state drat the information given is correct. 1 agree to comply with all stale laws And city ordiiurces rowing to building r cpnstrunion. and truth ice a representative of the Department of Building and Safety ! to orman the property for which I have ap for thrs permit tar the p ma rN ,nspectens Sgnature of Appin mor Agent Date I RECPT NO. PAID BY I WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor copy, GOLVENHOU—File copy, GHEEN— Applicants Dopy , IG VALIDATION— , ALIDATION 1