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HomeMy WebLinkAbout16845 (671) CIT�'OF DIAMOND BAR �,.�' ' �."�' j� DEi'AR"TMENT OF CO�TY�DEVELOPMENT SERVICES � I 2l825 E.Copfley Drive (909)860-3195 Fax(909)861-3117 PRESS ` "`%»��"�' BUILDINGPERMITAP�LICATION FIRMLY w¢ ADORIESS •�� �� F"1� �tf e����"N ��' APPLICATION l ���a�� PERMIT P/C DATE NUMBER # W ISSUE TYPE OCC APN LOT TRAC7 DATE' CONST. GROUP p OWNER __��_' �PPl" �� p ADDRESS 2 iJ�1=�.'� PG �i S ZONING SETBACKS ' w ���� � �� FRON7 �}yy ❑ z CITY t i�3At2 IP TEL. p APPLICANT TEL S DElSIDE STREET F#W ❑ ¢z SIDE ' ❑ CONTRACTOR � ADDRESS � CIN ZIP TEL. PROPOSED USE o ARCWENG/ �Z DESIGNER NO.QWEL. NO. NO. a ADDflESS UNITS STORIES BEDR�OMS = CITY ZIP 7EL. m cn DESCRIPTION SQ.FT FACTOR PSF i ADJ.AREANALUATION � p� OWNER-BUILDER DECLARATION SFA/ADDiREM - � � � p 1 HEREBY AFFIpM UNDEfl PENNLTV OF PERIURY iHA7 I AM EXEMPi FROM THE CONTRAC?ORS LI- Gef8gB/C8lpOfl �' W CENSELAWFORTHEFOLLOWINGREASON(SEC.I031.5BUSINE35ANDPPOFESSIONSCODE:ANYCITYOfl (f) _ i C.J COUNNWHICHREOUIRESAPERMITTOCOIJSTRUCT,ALTER,IMPROVE,PEMOLISH,ORflEPAIRANYSTRUG W Pyt10/DOCiC � W TUHE,PRIOft TO ITS ISSUANCE,AL50 REOUIRES TNE APPUCANi FOR SUCH PERMITTO FILE A SIGNED w ' SiATEMENi THAT HE OR SHE IS UCENSED PUFSUANi TO.THE PROVISIONS OF THE CONTRACTORS L6 ,�� CENSE LAW(CHAPTER 9(COMMENCING WITH 5ECilON 7000�OF OIVISION 3 OF THE BUSINE55 AN�PR�. V" POOUSPB �' FESSIONSCO�E)ORiHAiHEOR5HEI5EXEMPTTHEREFf101ARN�THEBASISF�RTHEALLEGcDEXEMP� � �� oTION.ANYVIOLATIONOFSECTION7o31.5BYANYAPPLICANTFORAPERMITSUBJECTSiHEAPPLICANiTO z RB-ROOf ' � ACIVILPENAL7YOFNOTMORETHANFNEHUNDREDOOLL4R5(3500�.): '� � . � ❑I,k50WNEROFTHEPROPERN,ORMYEMPLOYEESWITHYJAGESASTHEIF50LECONPENSATION, ❑ Commercial �I -' ,�Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFED FOR SALE(SEC.7044,BU51- J - , � NE65AN�PROFESSIONS CO�E:THE CONiRACTORE LICENSE LAW DOES NOT APPLV 70 AA'OWNEP.OF � ' PROPEFi�V NMO BUILDS Ofi IMPROVES THEREON,AN7 WHO DOES SUCH'NORK HIMSELF OH HERSELF OR . � [[ TNfiOI.IGHHISOflHEROWNEMPLOYEES,PROV10E�THA7SUCHIMPROVEMENTSARENOTINTENDE00R m �I '� � O OFFEREDFORSALE.IF.HOWEVER,7HEBUIL�INGORIMPROVEMENTISSOLOWITHINONEYEAROFCOMPLE �' Z TpN,THE OWNER-BUILDER WILI HAVE THE BURDEN OF PROVINO THAT HE OR SHE�ID NOT BUIL�Ofl � , � IMPROVEFORTHEPURPOSEOFSALE). I ❑I.AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WfiH LICENSE�CONTRqC70RS � �.. ' � i0 CONSTRUCT THE PPOJECT(SEC.7044,6USINE55 ANO PROFESSIONS CO�E:THE CONTRACiORS LI- V0I112tI0f1 ADJ.AREA �� � � W CENSELAWWESNOTAPPLViOANOWNEqOFAPF74PERTYWHOBUIL�50RIMPP.OVESTHEfiEON,IW� �' �' , � WHOWNTRAC75FOp5UCHPflOJECTSWITHACONTRACTOR(S)LICENSE�PIJRSUANTTOTHECONTRAG �QUANTITY DESCRIPTION FEE �� ., , Y TOflSLICENSELAW.�. / i � � � ❑IAM EXEMPT UN�ER SEC. ,V � B.&P.0.FOR THIS REASON U ! , I /,�.:. , � . ',. '�� ' u" �AiE�S���.Q7___ OWNER U d , � LICENS6D GONTRACTOR DE RATION W ' �, ¢ � '� I HEREBYAFFIRM UNDEA PENALN OF PERJURV THAT I AM LICENSEO UNDER PROVIc_IONS OF CHAPiER � . 'i �p_, 9(COMMENCWC.WITHSECTION7000�OFDIVISION30FTHEeUSINE55AN�PROFE5510NSCO�E,ANO Z � � .Xw MY LICENSE IS M FULL FORCEAND EFFECT � m � LICENSE CLASS ' LIC.N0. � ' , . .V OATE GONTFACTOR a . '. ' W � WORKERS'COMPENSATION DECLARATION a '�� � I HEREBYAFFIRM UNDER PENALN OF PERJUflY ONE OFTY.E FOLLOWIN6 DECLAHATIDNS: � �� Cn Q O� _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTiDSEIF-INSI1REFORWOHKERS' _ � � � COMPENSATION,ASPROVIDEDBVSECilON37ooOFTHEIABORCO�E,FONTHEPERFORMANCE �U OF THE WORK FOR WHICH THIS PERNIT IS ISSUE�. � . � 'W `I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION '' Q 37o00F THE LABOR COOE,FOR 7HE PERFORMANCE OF THE WORK FOR WH:CH THiS PERMiT IS ISSIJED.MY �RKERS'COM?ENSAdTlO�INSURANCE RRIERANDPO NUM6E RE CONSTRUCTION ...-- � CARRIER 1 PLAN flEViEW � _._ �'. t , ',� POLICY NUMBER — ELECTRIC y („� Q .� (�HSSCCIIONNEmNOT6EWMPLEfE�OFhiE?ERMITISFORONEHUNDRED�oLfARS�yta�ORLESSj. PLUMBING Z I CERTIFYTHAT INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMR IS ISSUEO,1 MECHANICAL „_ '� '('j SHALLNOTEMPLOYA�YPERSONINANVMANNERSDASTL1BECOME5u6JECTToiHE INSPECTIOPJFEE ' � � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANOAGREE7HA71FISNOULDBECOME �''`'' . ,a, SUBJECTTOTHEWbRKERS'COMPENSA710NPROVISIONSOFSECTION37000FTHELABOR f '9 /� �� �p "� = COOE,I ALL FOPTHWITN COMPLY WITH 7 OSE PflOVI510N5. �.� g 1SSUANCE y� f"r'a—"'''�� f "1�Y 7'% � . � II � �AiC>1 SMIP 9 l � �,p DAiE: �A,PJ�,J6,�NT. 1 ��I g p cq rynry�d . I �w t,1L.y ENERGY P/C � 1�J� � �+ x �!ll I 7! � � J WARNING�FA ET S UREWORKERS'COMPENSATIONCOVERAGEISUNIAWFUL,ANDSHA4LBE fi �, �y SUBJECTANEM OYERTOCRIMINALPENALTIESANDGVILFINESUPTOONEHUNDREOTHOUSAND ENERGYPERMIT� DOLLARS(51QO.oco),INADDIilONTO?HECOSTOFCOMPENSAiION,DAMAGESASPROVIDEDFOpIN ' � ' � SEG710N 87oe OF7HE LABOR CODE,INTEREST,ANDATTORNEY'S FEES. RETENTION FEE:��� � e ___ d CONSTRUCTION LENDINC�AGENCY PRE-ALT FEE �' """""` �""` - ��� ��� � - � IHEREBYAFFIRMUNDEflPENAL7YOFPEFJUPYTHATiHEREISACONSiRUCTION4EN�INGAGENCY I ' �, � � Fa�iTHEP'cRFORMANCEOFTHEWOR'�{FORWHICHTHISPERMITISISSUED(SEC.3oa7,CIV.G�. '�— . Z W � = LENDER'S NAME . � I F_ LENOER'SADDRESS � � I � ICERTIFY?HA7IHAVEFEADTHISAPPLICATIONANOSiPTETHATiHEA80VEINFOflMAiIONISCORRECT. TOTAL FEES I� P y�� � ' w I AGREE TO COMPLY WITH ALL CITY AND COUN7YORD;NANCES AND STATE LAWS RELqTING TO BUILDING I ' � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESGNTATNES OFTHIS COUNTY TO ENTER UPON THE ' I � z ABOVE-MEMIONED PflOPERTY FOR INSPECTION PURPOSES. �� `6�' ' � � � COMMENTS � � � QPEflMITTEENAME(PRIN F � �� C • ��--�r — � �� SIGNATUREOFPERMITTEE DATE t - RECPT.NO. 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