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HomeMy WebLinkAbout12-2183 • CITY OF DIAMOND BAR � --�--��`"— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES I 21810 Copley Drive,Diamond Bar,,CA 91765 �. (909)839-7020 Fax(909)861-3117 Building Inspection Notline(909)839-7027 PRESS �'�^'� BUII.DING PERNIIT APPLICATION FIRMLY o� JOBSITE ,7y�1Z� , /� L�� APPLICATION PERMIT IZ. Zf�� P/C ADDRESS G(J Gc_/ ff DATE l Z NUMBER ii o� ISSUE n TYPE IJ�=-C7 � OCC APN�� L�O/��— TRACT DATE � � �� CONST GROUP p OWNER (•�%.Qi L ,f?'/-'� AODFE,qSS� L ZONING SETBACKS oCITY [..�a�� .` ,6Z4� ZIP TEL. FRONT RW ❑ APPUCANT � �! TEL.� . REAR ❑ � SIDE/SIDE STREET RW ❑ q CONTRACTO _ � G�' ' SIDE ❑ Q ADDRESS < 1 �` ��- /-� � � CITY �m�P' ZIP .3 TEL. _ PROPOSED USE I� ,. I7 _,. .,, r1-- � w ARCWENG/ �— z DESIGNER �a ADDRESS NO.DWEL. NO. ) NO. UNITS STORIES 6 BEDROOMS � �CITY ZIP TEI. cn . cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADO/REM O I HEREBV AFFlRAI UNDER PENAL7Y OF PE0.IURY THAT I Ald E%EMPT FROM THE CANTMCTORS LI- G2(2QBICaf�Ofl W CFNSEIAWFORTHEFOLLOWINGREASON(SEC.70]7.SBUSINESSPNOPROFESSIONSCAOE:ANYCITYOR (n . U COUHi'/WHICHREWIRESAPERMITTOCON57AUCT,ALTERIMPROVE,DEMOLISH,ORREPAIRANYS7RUG W Patio/Deck w TUHE,PPIOR TO RS ISSUMlCE,AlSO REOUIRES THE APPLICANT FOR SUCH PEHMIT TO FIIE A SIGNED w S7A7EMFM 7HAT NE OR SHE IS LICENSED PURSUAM TO TNE PROVISIONS OF THE CONTMCTORS U- � CENSE UW(GIUPTEH a�COMMENCING WI7H SECTION 7000)OF DIVISION a OF THE BUSINESS M10 PRO� � PooUSpa FESSpNS COOE)OR THAT ME OR SHE IS EXEMPT THEREFROM AND THE BA5�5 FOR THE ALIEGED E%EMP- � TION.ANYVIOUTIONOFSECTION)031.SBYANYAPPLICANTFORAPERMITSUBIECTSTHEAPPUCANTTO Z Re-Raol � ACIVIL PENALTV Of NOT MORE TFWJ FNE HUN�RED DOLURS(SSOo).): Q ❑I,ASOWNEROFTHEPROPERTY,OFMYEMPLOVEESWfTH-WAGESASTHEIRSOLECOMPENSATION, � COrtIff10fC1aI ` VALL DO THE WOFK µ0 hIE STRUCTUFE�5 NOT INTENDED Ofl OFFERED FOR S/�LE(SEC.7oM,BU51- J � NESS.WO PROFESSIONS CODE:THE COMMCTORS LICENSE Uw DOES NOT APVLY TO A/J OWNER OF ? VROPERfV NRiO BUIL0.S OR IMPROVES THEREON,M1D VM0�OES SUCH WOHK HIA/SEIF OR HERSELF OR [[ THROUGH HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUp/IMPROVEMENTS ARE NOT IHTENDED OR m w OFFERmFORSALEIF,FIOWEVERTMEBUILDINGORIM7ROVEMENTISSOLDWfTHINONEYEAROFCAMPLE- � TpH,THE OWNEREUILDER WILL HAVE THE BUROEN OF PROVING THAT HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PURPOSE OF SALE7. Q� ❑I,ASOWNEROFTHEPROPERTY,AME7fCLU5NE�YCON7MCTWGWrtHLICENSEDCOMRIICTORS TO CONSTRUCT THE PRQIELT(SEC.70a�,BUSINE55 AND PROFESSIONS CODE:hIE COMRACTORS LJ- V81UdIlOf1 ADJ.AREA W CENSE lAW DOES NOTM7LY TOAN OVMER OFA PHOPEPTY WHO BUILDS OR IMPflOVES THEREON,MlD � WHOCANTRACTSFORSUCHPRQ1EC75WRHACONTRAC70R(5)UC£NSEOPUqSUAHTTO7HECONTMG ouANnTv DESCRIPTION FEE � � TO0.5 LICENSE UW.). � ❑1 AA1 El(EMPT UNDER SE4 8.8 V.C.FOR THIS REASON Q � U � � DATE _ OYMER � Z W � LICENSED CONTRACTORS OECLARATION w CC I HEREBY AFFIRM UNDER PENALTY OF PER1UqY THAT IAM LICENSED UNDER PROVISIONS OF CFIAP7ER � � Y(COMMENCINO WITH SECTION 70ao)OF DIVISION]OF hIE BUSINESS AND PROFESSIONS CODE,AND Z X �/Y LICENSE IS IN FULL FORCE AND EFFECT. �f � L7CENSE CLASS �✓ IIC.NO. � ✓ • �� � � J U DATE�Z` '�'�2 CONTRACTOR d W � , WORKERS'COMPENSATION DECLARATION Q ' � I HEREBY AFFIRM UNDER PENAITY OF 7EFUUfiV ONE OF THE fOLLOW WG OECIARAT10N5: U "—' a � I HAVE M70 WILL/AAINTAIN A CEiiTIFICATE OF CANSEM TO SELF-INSURE FOR WOfU(ERS' _ � CAMPENSATION,AS PROVIDED BY SECTION 37000F hiE U9oR COOE,FOR TNE PERWFMANCE `U OF 7NE WORK FOR NMICH 7HI5 PERMIT IS ISSUED. � � w �I HAVE AND WILL MAIN�AIN WORKERS'COMPENSATION INSURANCE.AS REOl11RED 9Y SECTION A Q ]7000F THE LABOR CADE,FOR THE PERFORMPNCE OF THE WORK FOR WHM?I THIS PERMIT IS / �� / � LSSUED.MY WORKERS'COM�P`q�SATI S✓Uanyc E CAARIERA/NO POIICY NUMBERME: CONSTRUCTION �. j CARRIER .4��CiG/-GCy,/��7/��L�l'.(e�/:�t"�/5 PLAN REVIEW 0 POLICYNUMBER �o�d7^/L���� ELECTRIC Q � (IHISSE(.TICNNFIDNOTBEOOhPLEfmCFTfPFAMi6FORONEFUPDRmOCUAi�(StOo�ORLE55� PLUMBING W Z I CERTIFY T1AT IN THE PERFOHMANCE OF THE WORK FOR WHIGi THIS PERMIT IS ISSUED,1 MECHANICAL (� SHALL NOT EMPLOY M1Y PERSON IN ANY MANNER SO AS TO BECAME SU&IECT TO THE � WORNERS'GOMPENSATIONUWSOFCAIIFORNI�ANOAGREETNATIFISHOUl00ECOME 1NSPECTIONFEE SU&IECTTOTHEWOWCERS'COMPENSATIONPqOVI510NSOFSECT10N�7o00FTHELABOR '3 �� � CODE,IS FORfHWITHCOMPLVWITHTMOSE'�IiO�Uf IONS. ISSUANCE O q'/ // � SMIP � � p DATE�`r � APPLICANT: ' /�L—L6-�r . W • ENERGY P/C J WARNING FAIWRE TO SECURE WORKERS'CAA/PENSATION CAVEMGE IS 11NUWFUL.AND SHALL BE J � SUBJECf AN EMPLOYER TO CHIMINAL VENALTIES ANO CNIL FINES UP TO ONE HUN�RED THOUSAND ENERGY PERMIT DOLLARS(5100,0001.IN PDDt710N TO THE COST Of COMPENSATION.DAMAGES AS PHOVIDED FOF IN J SECTION 37oB OF TiE LA80R CODE�N7ERE5T.AND ATfOfiNEY'S FEES. ' RETENTION FEE: Q a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O Q I HEREBY AFFlRM 11NDER PENALTY OF PERIURY THAT THERE IS ACANSTRUCTION LENOIN6 AGENCY �- FOR THE PERFORMANCE OF THE WORI(FOH WHICH THIS PERMIT IS ISSUE�(SEC.7os7,CIV.C.). ✓' � -� , Z W � LENOER'S NNAE F_ LENDER'SADORESS w 1 CERTIFY THAT I HAVE RFJ�7HI5 A7PUCATION AND STATE THAi7HE A90VE INFORMATION i5 CORAECT. TOTAL FEES /��-� �� � I AGAEE TO COMPLY N7TH ALL CfTV M7U CAIRfTY ORDINANCES.MID STATE LAWS REUTING TO BUIIDING (J� � CONSTRUCTION,M!D HEFEBY AUfHOR12E REPRESENTATNES OF 7HI5 CWNTY TO EHfER UPON TiE Z ABOVE-MENTIONED PROPERN FOR INSPECTION VUHPOSES COMMENTS � � i J � �� I m PFAMITT AME(PRINT� , � ��l�' !2 Uj NANHE OF P RMRTEE ATE 2 RECPT.NO. 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