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HomeMy WebLinkAbout100 (5)o� �Mu�l►_H`►K. CITY OF DIAMOND BAR PRESS DEPARTMENT OF BUILDING AND SAFETY er1n1'1 v _V tSUILUINU IrtKM1I sore •sore••. ce JOBSITE APPLICATION PERMIT USE 7. ADDRESS 7 �`1 L-� DATE �I (Q�l— NUMBER ©l� CODE ISSUE TYPE OCC. APN LOT' TRACT DATE CONSTGROI;P CROSSyyE ZONING SETBACKSFa""eh"5 OWNER, % FRONT_ a _�R114� ❑ ADDRE S &L- ✓ -Z/7- zu_z P-0 REAR ❑ CITY zip, 7 TEL? SIDE/SIDE RW ❑ APPLICANT — TE S ❑ CONTRACTOR1 SEWAGE ElPUBLIC PMT A ADDR QISPOSAL ❑ PRIVATE SO. FT./ 100 GAL CITY_ ✓ -0 zip,,TEL. STATE 7 LI NUMBpR "] GRADING ❑ CU. YDS. EXC. CU YDS FILL MARCH/ENG/ I 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 SED_ ON LOT_ USED-- ZffGARAGE 6ERTIFICATE IF FXEMPTION FROM WORKERS' COMPENSATION INSURANCE Ti section need net he compktnl 7 •t inn pecrat 's for we hundred ;S100) nr less I certify that m perlarman[e of the work lar hrch this VALUATION QUANTITY W SMIP PARK FEE I UCENSEU CONTRACTORS DECLARATION I hereby a15rm that I am licensed under pmvistons of Chapter 9 (commencing ! -h Secp 7003, 01 Division 3 of the Business and Pmfessons Cade, and my license is in full force and ;IT,. ❑ W Ib4NE. OUR DER DECLARATION I hereby affirm that I am exempt from tae Corti actor's License law !or The hallowing mason I&:: 70315 Business and Professions Code Any city or county which req, a perms to construct, I fj afterimprove te:nnlls•, or neper any structure, prior to its issuance, also regmres the applicant for such permit I Z to f.le a slgaW. statement that he .s licensed pursuant to Ihr provisions M the Contractors license Law (Chapter M 9 scommencp:g va:h Section 70001 of Division 3 of the Business aM Professions Cartel or that he is exempt therefrom andthe ]ass for d+o allayed exemphon Any vmlalion of Section 7031 5 by any applicant for a permit subjects theapgheart •a a i (VII penalty of act more than five hundred dollars ;55001 I --a ❑ Q : as --,4 the property or :m. employees with wages as the., sole cempenaabon will do the. work and the w ahsetare is no: intended or offered lar sale (Sec 7041, Business and Prefesmons Code The Contractor's License < dues ^.t appm improves y an owner of property who builds or pes thereon, and who does such work himself U urn thrnuf:Ir his awn er,plcy,.e, p,a,,ded that such improvementsare ret intended m offered for sale If however. the huomnc a Improvement is sold within one yea, of completion, the owner builder wrli have the burden of pito ang a tha. ;10 nu: nm build cr Improve for the purpose o! sale • I U Ell, as rwrer cl h`,e preparty, ar excluswety cmuracbng with licensed contractors 10 construet the prosect ISec Ltd 7f144• Basaess a -d Professions Code The Conlratior c License Law does not apply to an owner of properly who au•Ids a' improves thenen and who rantracts Lor such pmiects with a contranor(sl kcensed pmsvant to the Cpnlracto,'s ; I L-) E' I am eneogd order Sec . B 6 PC fAuach Crrtdicate). II Date Dwrer CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING WORKERS' COMPENSATION DECLARATION. I hereby affirm that I have a certriicate of Tansom to celfinsure or r a coarn:ala of %orkers Compensahon Insurance. or a cerrithed copy rhrreof (Sec 3800, Lab Ci 0 Certified copy •s hereby Iwmired to _J MECHANICAL iLXCernhed cacv s fled with the Building Inspection Department or Department < GRADING 6ERTIFICATE IF FXEMPTION FROM WORKERS' COMPENSATION INSURANCE Ti section need net he compktnl ISSUANCE •t inn pecrat 's for we hundred ;S100) nr less I certify that m perlarman[e of the work lar hrch this perm,! is slued s!iall not ploy any person In any manner so ante sub; t m the 4ers' Compensation Laws cl L f rola W SMIP PARK FEE of U- SCHOOL FEES NOTICE TO APPLICANT If. after making this Ceruhcane ate o! Exemption, you shoald oma subject to the Worker's Comparsation provmnns of fro labor Code you must forthwith comply with s h provisions or this permit shall ADJ. AREA he deemed mome DIVISION OP INDUSTRIAL SAFETY PERMIT CERTIFICATION ❑I hereby comity that ra excavation five 15) or more feet in depth into which a person Is required to descent. I _ vi'll he made in connection with work authorized by this point, and that an, building structwe, scaffolding. falseweek, I in demnlluon or dismantling tfereof. will be more than Thirty six 1361 foe! high (Chap 32. Grp 2. Art 2, Sec r _*o BAR 341 Title 5 CAC, ❑ BUILDING AND SAFETY As owner budder, I will not employ anyone to do work which would require a permit nom ibe preen at Industnel Salety as noted ahrrce, unless such person has a permit to do such work from the division LJ Onomm of Indua,rral safety Permit No. TOTAL FEES i CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for when 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 spplkatlan and stare that the informatiun given is correct. 1 agree to comply with all stale laws and city ardinences renting to building r construction. and auth ore a representatme of the Department of Building and Safety ! tom upon erty the prop for which I have ap for this permit tar the p ma N nnspectens Sgnatu a of AppII mar Agent Dote I RECPT NO. PAID BY I WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor copy, GOLVENHOU—File COpy, UHEEN— Applicants Dopy , IG VALIDATION I 1