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HomeMy WebLinkAbout12813 (11) i �`_ CITY OF DIAMOND BAR _-_..� ` DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES "�� � > > i 21660 E.Copley Drive Suite 190 � ��=`J> � i (909)860-3195 Fax(909)861-3117 � PRESS I ��'9N"�`W BUII.DING PERMIT APPLICATION �_.�--�'"�� FIRMLY , 0�� JOBSITE {� 0).t�� ,�,�J p �{ APPLICA710N�2 ,*��_�� PERMIT �� �lC p� �d�/ f ' ADDRESS ���� �J. �r�f/!O/1f��/� 4C✓D '7 L ' DATE ZJ NUMBER / ��� � � � ISSUE TYPE OCC �' APN LOT _ TRACT DATE �Z'I�'� CONST. GROUP � p OWNER _ � p ADDRESS _ ZONING SETBACKS w FRONT _� RW Cl_ ' z. CITY ZIP TEL. j � APPLICANT TEL. REAR `�--- � Z SIDE/SIDE STREET_ RW fl ; �4 CONTRACTOR 1 Ct�• SIDE G_._.,_^ ` . ADDRESS �"�l,�fL �J. L fA?l��i __ � PROPOSED USE 3 � CIN �� ���_ ZIP �^f 7EL. - o ARCH/ENG/ �— — � Z DESIGNEFi NO.DWEL. NO. NO. � a ADDRESS UNITS STORIES BEDRODMS = CITY ZIP TEL. --- � cn E- cn DESCRiPTION SQ.FL FACTOR PSF ADJ.AREANALUATION ! OOWNER-BUILDER DECLARATION SFR/ADDlREM �` p I HEREBY AFFlRM UNDEH PENAL7Y OF PERJURV THAi I AM EXEMPT FROM THE CONTpACTORS LI� � Garage/Carport P W CENSEUIWFORTHEFOLLOWINGREASIXJ(SEC.7031.50USINESSANOPROFESSIONSCA�[:ANYCITYOF C.� COUNNWIiICHqEWIRESA7ERMITTOCONSiRUCT,AI.TER,IMPFiOVE,OEMOLISH,ORREPA1qANY57RUC �JJ pdiio/D9Ck � � TURE,PRIOR TO ITS ISSUANCE,AL50 REQl11RES THF APPl1CANT FOF SUCH PERMIT TO FIIE A SIGNE� W ` � STATEMENT TNAT HE OR SHE IS LICENSED PURSUANT 10 THE PROVISIONS OF THE CONTRACTOfiS LI� � � � CFNSE LAW(CHAPTER g(COMM&NCING WITH SECTION 7000)OF DIVISION]OF THE BUSINESSAND PRO� � POOUSP2 � FESSIONS CODE)ORTNAT XE OR SHE IS EXEMPT THEREFflOM ANO THE BASIS FOfi THE ALLEGED EXEMP� TION.ANVVIOUTIONOFSECTION7o31.5BVANYAPPLICANTfORAPEHMITSU&IECTSTHEA?PLICAN7T0 z Re•Roof � ACML PFNALTY OF NOT MOHE iHAN FIVE HUN�HED�OLLARS(5500j.�� E f71,AS OWNEfl OF 1HE PROPER7Y,OR MV EMPLOVLES W ITH WAGES AS THEIR SOLE C9MPENSATION, � p Commercial � WIIL DO THE WOAK,MID THE STflUC7URE IS NOT IVTENDSD OR OFFERF.O FOR SAI.E(SEC.7044,BU51� J a � NESS AND PRCiE5510N5 CODE:THE CONTRACTG�HS I.ICENSE UW DOES NOT APPLY TO AN OWNER OF � � Pf�PER1YWViOBUilD50AIMPqOVESTHEqEON,ANDWri000ESSUCHWORKHIMSELFOPHERSEIFOR � � THROUGMHiSORHERONTIEMPLOYEES.PROVI�F.DTHpTSUCHIMPROVEMENTSARENOTIN�ENDE�OR � w OFFEREDFORSRLEIF,FiOWEVERTNE6UILDINGORIMPROYEMENTISSOLDWITHINONEYFANOFCOMPLE� � Z TIOPI,THE OWNER�9UILDER WILL HAVE THE BUR�EN OF PROVI4G THAT NE.OH 5HE DID NOT BUIID OH i IMPROVE FOR THE PUFPQ9E OF SALE). ' w f.lI,A50WNEROFTHEPROPEFTY,AMEXCLU5IVELYCONTRACTINRWITNLICENSE�CONiPACTORS A §' p[ N CONSTRUCT hIE PR0.IEGT(SEC.�044,BUSINE55 AND PRaFE5510ti5 CODE:THE CONTRAGTORS LI� V81U8t1Of1 fJ `�� A�J.qREA € W CEN5ELAWDOESNOTAPPLYTOANONMEROFAPROPERTYWHO�UIIDSOFIMPHOVESThiEREON,AND � -- ---- ! F WMOGONTRIICTSFORSUCHPRQIECTSWIiY!ACONTRACTOR(S)UCENSEDPUR5UANTTOTMECONTRAG QUANTITY DESCRIPTION FEE s' TORS UCENSE LAW.). f j Q ❑1 AM EXEMPT UNDER SEC._ ___,__ B.d P.C.FOR THIS REASON Q �/✓�'��J�I��' I � (� � � — --- V � . � � �E' '�f� -(3%/Y�f%! j � OATE OVYNER_ Z _ — W � QLICENSED CONTRACTORS DECIARATION w OC 1 HEREBV AFFIRM UNDEH PENAITV OF PEH.NRY THAT 1 RA1 IICENSED UADER 9ROVISIONS OF CHAPTER � k � 8(OOMMENCINOW1IHSECTION7000)OFDIVISIOY30FTHEBUSINFSSANDPROFE531ONSGCOF.,AND z �j� MY UCEN&E IS IN FULL FORCEAND EFFECT. CLl � � LICENSE CLASS G�"� UC.NO.__, �i • � C F- p - ~ DATE /7 �1C J U ,�_Se�� . CON7RACTOH_.�,_'..�--� 0- � W �—! �__ _ d� WORKERS'COMPENSATION DECIARATiON -� r � �� i. � INEREBVAFFIRMUN�EfiP[NALTYOFPERJURYONEOFTHEFOLLOWINGDECIARATIONS: uj Z , Q � _IHAVEANOWILLMAINTAINACEfITIFICATEOFCONSENTTOSEIF-INSl1qEFORWOHKEIIS' _ � CAMPENSATION,ASVqOVIDEDBYSECTION37000FTMEl�90RCO�L.FOflTHEPERFORMANCE W __ _ OFlHE WORK FOR WHICH THIS PF.RMIT IS ISSUED. � f w ! _1 HAVE AND WILL 1AAINTAIN WORKEqS'CA1APEkSATIDN INSURANCF,AS qE�UIRE��Y SCCTION .+� 0 3�oaOF7HELADORCOOE.FOfl7HEPF.FlFORMqNCEOFTNEWORK!-OAWMICHiHISPENM1T15 �'�'�t- y�� Clgy ' — ISSUED.MYWORKEAS'COMPENSATIO41NS11RAN�ryCECAHRIERAN�POLICYNUMBERD.R[: ONSTRUCTION _..,,_ _,,,____ ,,.__.._ y✓-- ll�s' i '4 �^y/y Y LAN REVIE > � Cy� � _�7.1-L! , �j CARRIFR'__' __ ""_'___ _ ___ '—_-..._'_' • /_. � POLICYNUM[iER � � ��s� � z -�-`)�n���--�'�G���— TRIC .- ----�---�----- � 1.�✓ i d i � (fHSSECTANhE�Id�TO[ITYJPI.E7EDOFTIIEF'ERMTlSFOAONEM1MNi[DWLUIRS(5100)O �Ess� PLUMBING __ _____. _ _._._ __.______ ;_ w Z ICERTIFYThIATINTHEPERFORMANCEOFfHEWOANFORWHICIITHISPERMITISISSUED,I MECHANICAL _ ________ ____,,,,_ � C} SHALLNOiEMPl.OYANYPEFl50NINANYMRNNfR50A5TOBECOMESU�JFG'�TOTHE (n WORNERS'CAMPENSA710NLAWSOFCAUFOFIN10.ANOAGHF.FIHA'fIFISHOULDOECOM[ INSPE `EE ,_,__ _„_„ ___, _"'_' —"' - SU0.1ECT70THEWORKERS'COMPENSATIONPROVISIONSOFSECTION3]ooO�7HELABOFi /�` �D� ' � CA�E.ISMALLFOFTHWITHCAMPLYWIiHiHOSEAROVI510N5. SSUANCE __ _.__—.�,.,���__,___ �V�I�',✓ � � • ,/✓% p DATE:�]��P� APPLICANP. ___� _ _ —.__ .- '.—'.'__ _'____...__...___�s�'_v � �� ENF_RGY P/C --- � J WpHNING:FRILUflETOSECUPEWOPKERS'CCMIPF:NSATiONCOVERAGEISU�LAWFUL,ANUSHALLBF. ---�-- i, LL SU&IECTAN EMPLOY[R TO CRIMINAL CEN4LTIES ANO CIVIL FINES UP TOON[HUNDRFD THOUSAND ENEFIGY PERMIT ��_ _��_���� � DOLaAS�5100.000),INAODITIONTOTHCfOSTOFCOMPENSATION,OAAAAGESAiNHOVIUFDFOflIN � - /� • J SECTION3YOBOFTIELABORCODE.INi[REST,AN�A�TORNLY'SFEES. RETENTIONFEE: _��"" � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: T������}yrj�7'7�T � {� __ I� � IHEREBVAFFIRMUNDERPENALttOFPCRJUFYTHATTHEAEISACONSTRUCTIOYI.F.NDINGAGE�CY +�+R-11Ls✓llr����L �{ n- FOHTHEPERFORMANCLOFfHEWORKFORWHiCHTNISPENMITISISSUED(SEG:Oe�,CIV.C.). �� � � '--�� ���� W --'. __.—...._ _ "' -- �i I{ � LENDER'S NAME__. ..._ -' -_ ___ —_"' '_____ -'—_-- I1 1- LEN�F.H'SADDflE55._ .' "-"'.. ._._"___ � 1 CERTIFV TMAf I HAVE REAO THIS APPIICATION AND 5TATE 7HAT THE ANOVE INFORMATION IS COliflECT TQTAL FEES /§ t? w 1 AGREE TO CAMPLV WITH ALL CIiY ANf1 COUMY ORDINANCES AND STqTE IAWS HELATING TO BUILOING / '3 � CONSTRUCTION,ANDHEREBYAUTHORIYEREPRESENTATIVESOFTHISCOUNTYTOENTERUWNTHE _ -/ � �� i} Z A60VE•M5NTIONEDOROPERNFO(iINSPECTIONPUf7PO5E5. COMMENTS__. �� ' � //�/� ♦ J/ _ _ �..'_ �9 � "_�_l.--c.'�_��� __v!/ '-- -"""" __-'"_ "_' t; m PEflMITTEENAME(PRIN7) _"'_"' __' '_'___ '_ z G ��_� s � SIGNATl1REOFPERMITiE �C� r~^ DA7E ^7 +� '� = RECPT.N0.__ _ PAID BY Z� [7_ _VALIDATION c a ~ WHITE—Departmant Copy,YELLOW—Finance Copy,PINK—Asaessor Copy.GOLOENROD—File Copy,GREEN—Applicanl's Copy �� � - - - _ ��_.. _ ._ _�_ .�.. __. .., _.. .. . - -- - ... .... .. . _ . �z�� � : , I � ! � i � 4 I ; + .' E , ; ' , i _ � , , ' s . • i , i � �` i I I � ' , i i , ' � i � ' � � I , �_ ' � i ' � . i , � , � ��`�k _. � i , . � . 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