HomeMy WebLinkAbout114CITY OF DIAMOND BAR PRESS
`• DEPARTMENT OF BUILDING AND SAFETY
13UILOIN411 PERMIT FIRMLY
WHITE—Departme`riTtopy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy
JOB' SITE— /
ADDRESS LL. �& .
APPLICATION PERMIT � �USE
DATE __Ii ems_. NUMBER _CODE
ISSUE TYPEOCC
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APN LOT _ TRACT _
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DATE CONST_ GROUP_
CROSS STBEE
OWNER
ZONING SETBACKS
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NO. DWEL. NO. NO.
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, CF, . ". CUh'TRACTDRS BECLARAiIOFJ I I•eieby alfinr pial am licensed under provisions of Chapter 9 (commencingY
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—1i ° A C;v s:nn 3 of the Business and Pcalessams Code, and my license or ,, full force and effect
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:bVNFR [I Ill. DER 7FCI ARATION I hereby affirm Ihe1 I am exempt hum the Contractor's License Law lar the following
• Ser: JO.1 5 5nsness ar.d nrolessiors Carte Any city or county which requires a permit to construct,
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s,zr mprovr J,nar;ish air repair any structure prior to rs :ssuante also requites the applicant In, such permit
t:: ' le a ;glued slater^ert tea: he is licensed pursuant to the proonsmns ,it Me CanOanw's License Law !ChapterCal
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P Hmel rr,r. w!o &:rt:cr 7030; of O.,wrn 3 of the Business and Professions Cade) or that he is en rcpt therefrom
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aur• ex S;rss I:• IF, ajeged Pxamolmn Any vmlanur of Soi 70315 by anv appbcam 'or a permit seblects
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'In, appllcv; •r. a rid penalty cf not more than Sve hundred dollars 1S5001 s
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I ❑I n aw•Pr of •he property or my 2mplWeca with wages as weu +ale compensahon w:li da the work, and
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'to, srr,o1j,, s -cit wend!ad or afle•ed Ina sale ISnc 7044, Bi.s:ness and Pmfess,uns Crile ?he. Cohmarliv s bre—,
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Lew !;:es int apply to an —,a, of property who builds ur Improves thereon and who does such work himself
u Ijlrmrgn his own •,mplcvees, prov.ded that such improvements are not intended or elferea for sale V however,
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I :bis b,..!,,I no Imr.•acemert is sold are year o1 completion the awner-budder will have the harden of proving
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at :r•; .!rel nn' '•,::r. .+r :m^,rr.ve far the purpos, of sale.,
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�I is ;.worn of •ire praoerty a•,, exclusively contracting w:th licensed contractors to construct the project (Sac
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7044 Ef—i-s ;:nit rroassors Cade The Contractor's License Law dues vol apply to an owner of property who
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-usdds :r improves inewe.r arm who contracts for such projects with a mntractorls) heensad pursuant to the Contractor's
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CONSTRUCTION
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'tar"' Law'
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, I tin exempt order Se: B 6 PC iAttach Certifili
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PLAN REVIEW
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Iain_ Owner
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ELECTRIC
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yV9RKFP.S' COy+PE NSATI(iN DECLARATION i hereby affirm that ! have a certificate rel consent to sell ensure, or
hcse 4erkers Compersation Insurance,
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PLUMBING
q « r: of at, a certified copy thereof (Sec 3800. Lab C 1
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I— CWIi copy Is Farah; furnished
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MECHANICAL
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t _ •Card:ed ca;y :s 4144 with the Building Insperecor Department at _, Oeparrment.
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GRADING
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;:ERTI-!GATE OF [*MPTION FROM WORKERS COMPENSATION INSURANCE This section need not be compkted
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ISSUANCE �
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.f ore. permit , for ane hundred (SION at less I certify that In the perlatmance of the work for which this
Fermi'. is issued I s•Iall real emptier any person In any manner so as etome srblect to the Y+6 'compensahon
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laws of Ca!rfor
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PARK FEE
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' NOTICE TO APPLICANT Ifafter making this Carl:ficate of Exemptive, you should beglione subject to the Worker's
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SCHOOL FEES
C,mpensatmn pr -Incas of the Labor Code, you must forthwith comply with such Inevitnuns w this permit shall
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ed aced
he deemrry
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DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
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❑I be•ehy certify that in excavation five (b1 or more [eel in depth Into which a person is required to descend.
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DIAMOND
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be made :n cnnnechcr w:tn work authorized by this permit. and that no building structure. scaffolding, forework.
d,—W.", dismantling feet
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ur a' thereal, will be more then thirty-six (361 high (Chap 32, Grp 2. Art 2, Sec
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BUILDING D SAFETY
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0A, owner budder I will not employ anyare, to do work which would require a permit from the Mviswn of
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Indus,.! Safety as rioted above, unless such person has a permit to do such work from the division
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❑O:vmor: rel Industrml Safety Permit No
TOTAL FEES �5
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CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agenry for the pmformarxe
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of the work Int which this permit rs issued ISat. 3097, Civ C I
of
Lenders Name
COMMENTS
. larders Address_
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CERTIFICATE Of COMPLIANCE AND AUTHORIZATION OF ENTRY. I eerfily I have read this applicatim and stare
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'hat she :nformaunn quer is correct I agree to comply with At state laws and city andintrces rehoung to building
mrstnrnpr., and doth ae a representative of the Department of Building and Solely to far up" the property
whrth I (rave aFP Inc tha permit !a the perp . a i sperlpns.
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I 9 App ea r Agent Gate
RECPT NO. PAID BY VALIDATION —
WHITE—Departme`riTtopy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy