HomeMy WebLinkAbout12-758 (8) �� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21810 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS �"9M' BUILDING PERNIIT APPLICATION FIRMLY � JOBBITE -�' �° � �� ' APPLICATION , �� PERMIT �i ''"�`�b P/C _ Y^ 1 � o ADDFiESS ` � `; '� °�_ �� �` " � �� DATE ` �� NUMBER` ' � � # � � � ISSUE f * � ' ` � y TYPE ; OCC � APN . � LOT TRACT: . � -DATE ` � �� " E� � `"C�NST. ' GROUP , , , w °� OWNER%� o. � ` � � ��ZONING SETBACKS ADDRESS � � �� oCIN r ZIP, : TEL.,-� '_ �' REART RW ❑ � p APPLICANT TEL. � SIDE/SIDE STREET RW ❑ QCONTRACTOR � '�� � � '�' '��� SIDE �❑ � " s - � �� � ADDRESS =f d �ro� � � �� °�' � CIIY'��� ` t ' ` " �� ZIP ' " '� TEL �' ` N �����: � PROPOSED USE,` ' � ` �`` ., �f , � > � ,m a � � �. � . � . � � �;.. � � , �;r�. w ARCH/ENG/�,' �, �_x'� � � � iz DESIGNER �` � ' � NO.DWEL NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AFiEANALUATION cn � OWNER-BUILDER DECLARATION SFFVADD/REM O �� p � I HEREBY APFIRM UNDER PENALTY OF PERJURY THAT t AM EXEMPT FROM THE CONTRACTORS U� (3y(g9B/CBfPOfI W CENSEUWFOflTHEFOILOWINaREASON(SEC.7031.6BUSMESSANDPROFESSIONSCODE:ANYCITYOR (n . G.� COUNTYWHICHREDUIRESAPERMITTOCONSTRUCT,ALTER.Ib1PROVE,DEMOLISH,ORREPAiRANYSTRUG W Patio/Deck W TURE,PRIOA TO ITS ISSUANCE,AL50 REOUIpES THE APPLICANT FOH SUCH PERMIT TO FILE A SIGNED W � STATEMENT THAT HE OR SHE IS UCENSED PUflSUANT TO THE PROVISIONS OF THE CANTflACTORS LI- g CENSE LAW(CHAPTER 9(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpB FESSIONSCOD�ORTHATHEORSHEISExEMPTTHEREFRO1dANDTHEBASISFORTHEAllE0E0EXEMP- (rJ � TION.ANYVIOLATIOtJOFSECTION7031.5BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPUCANTTO Z RB-ROOf . � A CMLPENALTY OF NOT MORE THAN FIVE HUNORED DOLLARS(f500).): � � � � ❑I,ASOWNEqOFTHEPROPERTY,OAMYEMPLOYEESWITHIVAGESASTHEIRSOLECOMPENSATION, � Commerciai - , Z Wlll DO THE WOAK,AND THE STRUCTURE IS NOT INTENDEO OR OFFERED FOR SALE(SECJo44,BUSI- J � NESS AND VROFESSIONS CODEi THE CONTRAGTORS LiCENSE LAW DOES NO7APPLY TO AN OWNER OP � � PROPERiYYM08UiLOSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSEIFORHERSELFOR � � Q THROUGHHISOHHEROWNEMPLOVEES,PftOVI�EDTHATSUCHIMPROVEMENTSARENOTINTENDE00R m Q04�EPEDfOflSALEIF,NOWEVER,THEBUILDiNGORiMPROVEMENTISSOIDWITHINONEYEAROPCOMPIE- . Z TION,THE OWNER-BUILDER WILL HAVE THE Bl1R0EN�OF.PROVING THAT HE Oq SHE DID NOT BUIID OR = IMPROVEFOHTHEPURPOSEOFSALE). ..O I,AS OWNER OF THE PROPERTY,AM EXCLUSNELY CANTRACTING WfTH LICENSED CONTRAC70RS � TO CONSTflUCT THE PR0.IECT(SEC.7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U0[IDO" " ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOHRJEROFAPROPERTYWNOBUILDSORIMPflOVESTHEflEON,AND . � ,WHOCONTRACTSFOASUCHPROJECTSWITHACONTRACTOq(S)LICENSEDP�RSUANTTOTHECONTRAC- QUANTITY DESCRIPTION , FFlE � TORS LlCENSE LAW.). _ , � „ p^t i .., ,, , , . � I t ';e ." ..� ,„� � :tJ`I AM EXEMPT UNDER SEC. B.A P.C.FOR TNIS REASON Q � l�x r � � � � _ . , � � M � , r, ,�. � t r , ,G , � DATE�' � � - OWNER� �„§_. F t t `� '� . Z,. .`�. . ` . � f..v'�= ' - ' � , f � � UCENSED CONTRACTORS DECLARATION �j � '`FWF � yl HEPEBYAFFIRM UNDER PENALTY OF PERJURY THAT ItJA LICENSED UNDER PROVISIONS OF CHAPTER � , � ��' - � d ee(COMMENCING WITH SECTION 7000)OF DIVISION 70f THE 8U$WESS AND PROFESSIONS CADE,AND � :-'X !AY LICENSE IS IN FULL FORCE AND EFFECL — , � W m E . = m"�": f 0 UCE[JSEGLASS LIC y0.`=` - `" � '�`�� � Dq�E � ' CONTRACTOR � ��� d - U t'4fi�. �r � � ,:_ . , , ; , , � .,. , , � , , ,� . .� , , z .�:.. �.- W � � '�i � e s ". ;..Ir. ,.. � -. r"{f a � c6 WORKERS`COMf'�NSA�ION GECLAt�ATION Q �' i� '" ( ' N .;f s� b � � U �' � IHEREBYAFfIRMUNDERPENALTYOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS: — Y � F� �. �, J � _IHAVE'ANDWILLMAINTAINACERTIFICATEOFCONSENTT03ELFIN9UREFORWORKERS' 2 ��� � '�t � " � �f; � �r' �� �� � COMPENSATION,ASPROVIDEDBYSEGTION37o00FTHELABORCODE,FORTHEPERFORMANCE `U � r OF THE WORK FOA WH�CH THIS PERMIT IS�SSUED. � � w _i NAVEAND WILLMA�MAIN WOPKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION � Q37000FTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKiORWHICHTHISPEHM�TIS , _ ISSUFA.MY WORKERS'COMPENSATION INSURANCE CARRIER AN�POLIGY NUAIBERARE: CONSTRUCTION ' '� ���' , � � PLAN REVIEW ���� � � CARRIEfl �.�� ; Z POLICY NUMBER ELECTIaIC � Q 0 (iHiSSECTIONNE�MDiBEODA�'LF�EDOFiHEPER�MltSFORIXaEMA^DFlEDDOl1M5(5100)ORLESS} PLUMBING W MECHANICAL � ' Z I CERTIFY TNAT IN THE PERFORMANCE OF7HE WORK fOR WHICH THIS PERMIT IS ISSUED,I . (,� SHALLNOTEMPLOYANVPEf1SONINANYMANNERSOA5TO8ECAMESUBJECTTOTHE � � � � WORKEPS'COMPENSATIONLAWSOFCALIfORNiqANDAGREETNATIFISHOUIDBECOME MSPECTIONFEE � SUBJECTTOTHEWOFKER8'COMPENSATIONPAOVISIONSOFSEC710Na7o00FTHElABOR � , . . � CO�E,1 SHALL FORTHWITH COMPLY WIiH THOSE PROVISIONS. .. .. ISSUANCE � '^� � ' ' �"� � SMIP r _,. DATE � F`�" � '�." APPLICANT: '"': ,� ` �� w ` y � �� ENER(iY�PJC . '�° WARNINO FAILURETOSECUREWORKEFiS'CAMPENSATIONC�VERAGEISl1NLAWFUL,ANDSHALLBE � SUBJECTANEMPLOYEfiTOCRIMINAI.PENALTIESANDCIVILFINESUPTOONEHUNOREbTHOUSANO ENERGYPERMIT � ' ' DOLLARS(5100.000),IN ADDITION TO TNE COST OF CAMPENSATION.DMIAQES AS PROVIDEO FOR IN . � SECTION370BOFTHELABORCODE,INTEREST,ANDATTORNEY'SPEES. - RETENTIONFEE: '� ��� �� , � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFlRMUNDERPENALTYOFPEfUURYTHATTHEREISACANSTRUCTIONLENDIN6A�ENCY ��� ����� � � f��} �� � FOA THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30B7,CIK C.). „, . Z W � LENDER'S NAME F_- LENDER'SADDRESS ; j .,� ��-r # � r_, *: wICERTIFYTHATIHAVEflEADTHISAPPLICA710NAND5TATETHA7THEABOVEINFOAMATIONISCARRECT. TOTAL FEES � ` � IAGREETOCOMPIYWITHALLCITVANOCOUNTYORDINANCESANDSTATELAWSPEUTINGT08UiLDING CANSTRUCTION,AND HEREBY AUTHOFIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE � � ABOVE-MENiIONED PROPERTY FOR iN3PECT10N PURPOSE3. COMMENTS � � � "�' '"' � ' '�',��� �,�".�;� ��' � � � � x 6 -� t 1 t`.. tJ`�=:� �`J! r , _�� . � < � m PERR117TEE NAME(VRINTj ��, ,,'.;.; n',� ; �,,. ,F"'`� . . Q , � , . . . � . �� >> . . a -. , r � , �., , '. �. � �_ ��� . - , . ...- �,_,._ ... , � , , . � � � .. ��� . . � . > � �SIONATUREOFPERMITTEE � DATE � ``�� ` � " �_� '+�; . , , Z RECPT.NO. ` ` .� �z""� PAID BY�� � �' �VA41DAT10N � �' � '� �`���`•� ~ WHITE—Department Copy,YELLOW—Ffnance Copy,PINK—Assessor Copy,GOLDENRO�File Copy;GREEN—ApplfcanCs Copy