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HomeMy WebLinkAbout13329 - 1155 SOUTH DIAMOND BAR BLVD (2) r . �� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 �'°^'� BUILDING PERMTT APPLICATION FIRMLY o� JOBSITE � h��� �. _/ ,,Q���,�P DATECATION "�..(�"��NUMBER ���� #/C I��I�� ADDRESS �j,C Qt3C�/ � � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GRDUP p OWNER ` p ADDRESS � .�' ZONING SETBACKS � gCITYQj�tQ�6 ZIP T �0 I — REART RW ❑ � APPUCANT TEL.____ SIDE/SIDE STREET RW rl � � CONTRACTO SIDE ❑__ _ k o CD�D��RE S Z � T�L pROPOSED USE /� l.�.A��+/'LQ f oARCWENG! � �� ' �S� ��-�� � z DESIONER -- NO.DWEL. NO. NO, �,�, ADDRESS UNITS_ _ __ STORIES _...._.— BEDROOMS__"_ � CITY TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION ¢ OWNER•BUILDER DECLARATION SFR/ADDIREM O p I HEPEBY AFFIRM UNOER PENALTV OF PERJl1R1'7HA7 i AM F.XEMP7 FAOM THE CONTAACTOAS lF G8�eQ0lC2fPOf[ W CENSELAWFORTHEFOLLOWINGREASON(SEC.70.tt.5Bl15MESSANOPqOFES510N5CA�E�ANYCITYOR (n ' U CpUNNNh11CHAE0UIRESAPERMRTOCqNSTRUCT,AI.TER,IMPflDVE,DEMOLISIi,ORFlEPAIFiANYS7iUC- �LI patio/Deck Z 7llRE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT�OR SUCH PERMIT TO FILE A SIGNED � STATEMENT hIA7 HE Oq SNE f5 UCENSEO PURSUAN7 70 THE PqOV�51(hY5 OF THE C.ONTRACiORS L! � C CENSE LAW(CHAPTER o(COMMENCIN�WITH SECTION 7000)UF DIVISION 3 OF THE BUSMESS MID PRO- POOUSPB i, FESSqNS CODEJ OR TNAT HE OFl SHE IS EXEMPT THEFEFFOM AN[7 THE BASIS FOR THE ALLEGED EXEMP. V TION.ANYVIOLATIONOFSECTiDN7031.68VANYAPPUCAN7FORAPERMIT5U&IECTSTHEAPPLICANTTO � RB-H001 � � ACIVILPENALTYOFNO7MOFETHANFfVEHUNDRED�OLLiR5�E5ao).): � UI,ASO:M1NEROFTHEAROPERTY,OflMYGA1P�OVEES:NITHWM1GE5A511iFIR50!.ECOMPENSATION, � Commercisl ? Y/ILL DO THE WORK,hND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEL.70aa,BUSr i �J k � NE33 AND PROFESSIONS CODE:THE CONTRACTORS LIC'eNSE UW GOES NOl'AP.LV TD AN OWNEF OF �_ PROPENTY WFiO BUILDS OR fMPftOYES THEqEOtf,ANU tNHO DOES SUCFI WORK HIMSELF OH HFRSELF OR WTHRDUGHNISORHEROWNEAIPLOYEES,PROVIDEDTHATSUCHIAIPHOVEMENTSARENOTINI'ENOEDOR �m� —' -- g � _OFFENEDPDRSPLEIF.FIOWEVER,iMEBUIL�INGOpIMPROVEMENTIS50LI)WITHINONEYEApOFCOMPLE� 3 � TpN,YHE OWNER-BUILD'cR WILL HAVE THE BURDEN OF PqOVIhG hIAT HE OR SHE Di0 NOf BUII�OR � = IMPROVEFORTHEPURFOSEOF3pLE�. Ll i,A40WNER OF 7HE AROPERTV.AM EXCLl131VEL'(COMRACTING WITH LI�F:NSED CONTRACTORS /� � TO CONSTRUCT THE PRQIECT.(5EC.7044,BUSINESS AN�PROFESSIONS COL`E:i HF.IXAVTAAC70RS LI- +V/alUell0fl �__.y,r/OB ADJ.AREA = GENSELAWDOESNOTAPPLYTOANONMEROFAPROPERTYWhIOB41LDSOflIMPpOVESiHEREON.PND �"--- ' F WFIOCONIMCTSFORSUCHPFWECTSWITHAODN7RACTOR(SjLICENSEDPUHFUAN7TOTHECONiRAG (](JQNTITY QESCAIP7ION FEE Y roas uc�rusE uw.�. � o ❑i AM EXEMPT UNDER SEC.______ B.8 P C.FOq THIS REASON U C/1' � � .. � '__ ___..._ ._"'_�� � __ � OATE R____'__'._- O -`- U — � � LICENSED CONTRACTaRS�ECLARATION W � � - i 1 HEREBY AFFIRM 11N�ER PENPLTY OF PF.RI'JRY THAT I AM LICENSE�UNllEFl ViiOVISICNS OF CHRPTEH � (L 9(COMMENCING WITX SECTIUN 70007 0F ONISfON 3 0F iHF BU51NE55 AND PROFESSIOM5 COC�,PIJD Z iL� MY LICENSE IS IN FL1LL FORCE AND EFFECT. m {�- �./ � � � LICENSE CLASS„_�y__. L.IC.NO. � I T`�- � ~ DATE_. CONTfiACTOR._..._ � � --- w -�=-►�j-- - - - - � WOR.KFRS'COMPEVSATIONDECLARATIUN �j,�t_ � U — — — 1 4 � I HEREBY AFFIRM UNDER PENPLTY OF PE0.1URY ONEOf iHE FOLLON'll\G DECLAFATICNS: � � � __IHAVEANDWIILkAINTAINACEqTIFICATFOFCONSENTTDSELF-INSUR'cf-0RWOf1KER� ¢ -- S � COM9ENSATqN,ASPROVI�E06YSECT10N37000FTHELf.BO�CODE,FOR'fHEGENFORMANCE �U OF THE WOflK F�R WMICH THIS PcPMIT IS ISSUCO. � W _--' IHAVEAND WILLMAIMAIY WORKEFS'COMPENSAi:O�INSURANCE,AS HEQUiRF'D 9V SFCTION y� Q 3700 OF'fNE 1A90R CODE,FOR THL PERFOFMANCF OF TY{F WORK FOR WHICFI TF�IS P[RMIT IS ' / = ISSUEO.MYWORKERS' MPENSATIONINSURANCFGARRIERP,N�POLICYNUN�6ERARE' CONSTRUCTION __ _ __ -( �� r� Jy�� ��� {� � CkaRIER���L$�/� _I'Q__..�59-�:G.`� PSANREVIEW ___"'___ ,...) / n(��)/��� i. A POLICV NUMfiER.'__—.�.�\r _ ."��� ELECTRIC ---' �----' --- �- ----.....-----li•-�L. l " � p (rwesEcrpnn�a�nnieEcoNr�f'EuoFT!cv�a,ar�srcx�on:tirx�oa[000unrs�sim�oaussl PLUMBING -.-;------,--- ----_.--•— � ICERTIFV7HATINTNEP'eRFONMANCEO(THEWOHKFOflW'IICHTHISPERMITISISSUF.D.I MECHANICAL _�:�:;�___ _ ___,___ � (� SHPiLNOTEMPLCYAMYPERSONIN0.NYMANkEflSOASfOBECOM.ESt1BJECiT07HE � �' � WORKEHS'fAMPENSATIONLAWSOFCALIFOPNIA.RND0.GREETHlTIFISilOu!O[3ECO41C INSPECT�ONFEE __ _..______, ..___ ___________. i- i S 51J&IECTTOTHEYJORKERS'COMPEkSAliO4PROVI510NSUFSECTION310oOFT1{F-lAfiOR - �' CODE,ISHAILKUf1THWITHCOMPLVWITHTHOSEP I5� ISSUANCE _' '_____.._'_� / �`� t; . � �" APPLGANT: _ _..-__ _ - _.__-.___- � SMIP ._. ..Va� :,,� � .3,i;._."'__-............. _��a f p DATE:-� - 1�r 7� r} f e � ENERGYP/C "t• ��. ' '� � J WARNING:FAILURE'IOSECV EVlORKEFlS'COMPENSAiIONCOVEflAGE15 NLAWFl1L,ANUSHALIBE +M1„f��--s�--���;..=;--=�-jY-:_�-?-:.�-� - ----- �y SUBJECTANFMPLOYERTOCRIM!NALPENAI_TIESAN�CIVILRNFSUP700NLHUYDREDTHOUShY� �NERGYPER IT'�- � ' '' �\ DOLUftS(5100.000),INPDDITION?OTHECOSTOFCOMPENSATION,UAMAGESASPROVIDEDFORIN M��Jfy � ' '� =------ ' " _.,_-_ -�'-�} � SECTION e�Oe OF THE LABOH CODE,INlEREST.NJD A'RORNEV'S F F5. ' � 1�J �/ __ RETENTIONFEE: _____.__.___.____ W ------...-----`- - p„ GONSTRUCTION LEN G AGENCY p,Fi�•AL,T FEE: p �_ __........-'.-----.... � 1 HEREPYqFFIqM UNDER PENAL7Y OF PERJURY Tf IAl' IFHE IS ACONSTRUCTION LEhDING AGENCY j+k�`�� � FOR 7hIE PEf1FORMIWCE OF iHF'NORK FOft WIIIGH THIS AERMIT IS ISSUED(.SEC.J997,CIV C.). � -�� -"----""-'- -'--- Z ��_ � . .."_ '_"___' "'—' --'"_ � LENbER'SNAAIE .'�__'__' "'_--___'_ "' __' -_--.. .._. .."_'__"___ H IENDERSADURE55_.__ _ _.__ ...— _ _. - ( � ICF.HTIFVTHATIHAVEAENTHISAPPLICATION�NDSTATCTIIATTHFA90VEINFORMAYIONISCORRECT. TOIP'1L F�EJ � , ! W IAGREFTOCOMGLYWITHALLGIIVANDCOUNIYOR�INANCESANDS�ATF.IAWSRELATINGTOBUiLDING � CANSTflUCTION.ANDHEREBYAUTHOfiIZEREPRESENTATIVF.50FTHISCOUNTYTOENTERUPONTHE � Zl�VE-MENTIONE�PROPERTYFORINSPECTIONPURPOSES. COMMENTS ,�_____,., _,.._.,__..-_____ ___ � J � ��-kS�� ------ ------ ----- --- m -- -- -- Q PEflMITTEEN/ME(PAINf! --_'-__ '_- _____-" � ""___ � _""__'_'__'_ "__"'_ -'-""�� ...._"_"_ • V� SIGNATUHF.OF PERMITTE[ UATE = RECPT.NO. �� PAID 8Y •�i VALIDATION_, ~ WHITE-Department Copy,YELLOW�-�Finance Copy,PINK-Assessor Copy,GOLOENROD-File Copy,GREEN-App(icant's Copy t . . • � . . . ' ' ' - � _ � . . � , . � ' ' � , � . - ' - , . . . , _ . - . ' . � . ' . � � ' . . . • . ; ' . . ; • ' � � . . , ' ' . � . � . . ,. . . - ' . � ' � � . ' ' ., _ . � '-' . ' ' . . . 1 . ' � . " . � .. ' . _ , • •. , j . - . ' . ' � . ' � � . � � .i . .. . . _ � ' . . - . � • � � � i . � � ' ' .... .. ' , . . . � . i . ' � . ' , . .�+ . � , � • .. � :E..�' _ ." . - . . . . . . •. 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