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HomeMy WebLinkAbout13330 (14) ,� �-. � CITY OF DIAMOND BAR � � ^- ��--i DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICBS � 21660�.Copley Drive Suite 190 PR�SS � (909)860-3]95 Fax(909)861-3117 � ����^'� BUILDING PERMTT APPLICATION FIRMLY o DDRESS_��1� ���. D/�D71A` �9Cy�L��. DATECATION -�4/J'"q�UMB Rr .����✓#/°�-121 I �N � issue - rvPe occ f APN LOT�_ TRACT� T_ DATE__ CONST. GROUP � p OWNER i � � � i o ADDRESS ZONING SETBACKS j � CITY� ZIP EL. Iz�.CG�]� REARr RW n _ � APPIt ANT _ TEL._ SIDEISIDE STREET RW_� ❑ � � CONTRACTOR /� SIDE �� f ADDqESS � r � CIN ZIP TEL.�1 PROPOSED USE � �C oARCWENG! —! F z DESIGNER cu NO.DWEL. NO. NO. � a ADDRESS, � CITY ZIP TEL. UNITS__„ __ STORIES .. BEDROOMS � u� -- g cn DESCRIPTION SQ.FT FACTOR PSF ADJ.AREA/VALUATION F O OWNER-BUILDER DECLARATION SFR/ADD/REM � Q �HEREBY AFFlRM UNOER PENALTV OF PERIURY THAT I AM EXEMPT FFlOM THE CONTRACTORS Lb G8f8JB/C2fPOit .��. W CENSEUWFORTMEFOItAWINGqEASON�SEC.70a1.5BUSM[SSAN�PROFESSIONSCOOF:ANVCITVOR (n __ y� C] CWNIYWFIICNREOUIPESAPERMiTTOCONSTRUCT,ALTEH.iMPRUV�DEMOLISN,ORi1EPAIRANVSTAUC- W TURE,PRIOR TO ITS ISSl1N10E.M.50 REOUTAES THE APPLACANT FO(i SUCH PEflMIT TO F2E A SIGNEO W Patio/Ueck �' � STATFMENT THAT HE OR SHE IS LICENSED PUfiSUANT To 7HE PROVISIONS OF THE CONTPACTORS ll� � { � CENSE LAW(CHAPTER B(COMMFNCING WITH SECTION 7000)qF 01YISIDN 30F THE 6U51NES5 AND PR0- POOVSp7 } FESSIOMSCODf)OATHAT1iEOpSHEISEXEMPTTHEREfROMANDTHF.l1A515FORTHEALILCEDEXEMP- (� � V TION.ANYVIOUTIONOFSECTION�031.SB7ANYAPPLICANTFONAPERMITSU&IECTSTHEAVPLICANTTO � Re-Roof � ACIYI PEN�LTY OF P10T MOR'c THnN FIVE HI1hDRED DOILAFiS(5500).): A � ❑I.ASONT7EfiOFTHEPROPERTY.ORMYEMPLOYEESWITHWAGE5tiTHEIR50tECAMPENSATION, COfI1RIBfCidl > NAII�O iHE WORK,AND iH[SiRUCiUfiE IS NOT IN7ENDE0 OR OFFERFO FOP.S�I.f(SEC 70A4,8U5�- � p N NESS ANO PROFESSIONS CODE:THE CON fRACTORS LICENSE LAW�OES NO i APPLV;O M O'tlNER OF ? p PROPEqTY WVIO BUILDS OR IMPROVES 7HEREON,ANO WNO�ES SUCH WORN HIMSELF OR HEHSELF OR WTNJiDUGH HIS OR HER ONM EMPLDYEES.PROVI�W THATSUCN IMPROVEMENTS ARE NOT INTFNOF.�OH m ' Q OFFEREDFORSALE.�F,HOWEYER7HEBUILOINGOqIMPflOVEMENTI550IDW1THINONEYFAROFCOMPLE- 1 Z TIDN,7HE OWNER�9l11lDEFi WILL HAVE iHE BURDEN OF PFiOVING THAT HE OH SHE�IU NUY Ol11LD OR I � IMPfiOVEFORTHEPURPOSEOFSALF.). i W ❑I,ASOVMEROFTHEPF#OPEH(Y,AMEXCLUSIVELYCOhTP.ACI'1.NGWIfHI.ICEh'SEDCANTMCTOAS � � TO COPISTRUCT iHE PR4IECT(SEC.7044,BUSIN[SS h4D PROFESSIONS COOE.TNE CONiRACTOHS LI� V8II18110f1 I ��� � ADJ.AREA CENSEUWDDESNOTAPPLYTOANOYYNEROFAPPOPERTYWHUBUI 'OFIAIPROVE5TNEREON,lV� --�--"-�"+�-- -""---"""""' "-"-'-- WFIOCONTRACTSFORSUCHPR0.IECTSWITHACONTflACTOR(S)LI EDPURSUANTTDYHECCNTRAG QUANTITY DESCRIPTION FEE � Y TCPS LICENSE UW�. ___, _ � P � L7IAMEXEMPTUNO[RSEC.-_- _,.__B.BP.0 FORMISNEASON Q /V Q ` � U j, �= DATE O - __"___"_.. .____-'� U { � �__' — " � LICENSED CONTRACTORS DECLARATION W 4 � IHEREBYAFFIR1Al�NDFNPENALTYDFPERJUNYTHATIAIALICENSEDUNU[RVFOVISIO�SD%CHAPTER � P p� B(COMMENCING WITN SEC710N 7oao)OF DIVI510N 30F THE B1151NES5Ni�YROfE55IpY6 CODE,AND Z _ ^_ � '� ,ANLICENSEISWiULLFORCEANDkFFECi. m �+ F � LICEN^E C C� ��LIC.NO. _� j � � � J � V DATE, _ CGNTHAGTOR__,. _ _ W � � WORKEq COMPENSATION DECLARA710N ��`r `U — � � INEREBVAFFIPMUN�EHVENALTVOFPERfURYONEOFiHEFOLLOW'WGDECLARATIONS: Z t 0 _I HAVEMID WdL MAINTAIN A CERTIfICATE OF CONSENT TO fi[LF-IN5l�RE FOR WURi(ERS' y � � COAIPENS/TXJN.ASPROV!DE�9YSECi!ON31�oOFTHEIABGFCO�E.FORTHEPERfORMANCE CU _ � OP 7HE WORK FOR WHICH iM15 PERA9IT IS ISSUeD. � ` W `- �1 HAVE AND WILL MAINTAIN WORKEHS'fAMPENSATION INSUHFM1ICE,AS ReQUIHED BY SECTION �J ,.�, j Qa]OOOFTHf.IPFiOHCODE.F�STHEPERFORMANCEOFTHEW�4KFORWHICHTHISPEHM1T15 � /'1����I /, � _ ISSUED.MYWORKERS' MPENSATIONINSURl�YC[ RRIERANDFOLICYNl1M�ERARC� I CONSTRUCTION -✓ (� J �-�j_'_�__'__"'_"' "'_-.....__.. '. fCARRIFq '�'_��1'..._. . PLAN REVIEW � .,. _�t�_J_,�J�. ......--'_-. h 0 POLICYNUMBER___., (' - � � ... -.... - � Q ,'� � ELECTRIC - ---...._.-- .��__,--"-----�-- � � � 0 (MLSEECfIDNNE�NOTBE�CfEDCP7kEPE?M�T(SFOH(N1EfNNpF2ED�Q'L+A.,(b1 • LLSii PLUMBING _.__'.___'.'___ . `-..•�. .___'_ "_ � Z I CCRTIFY THAT�N THF:PEqFOFMhYCE UF THE N'UHK FOH WHiCH 1HIS PERMIT IS ISSUF.D,I MECHANICAL ___,._____ _,___,_ ___ � C,rJ SNALLNO7FMVLOYANYYEflSONIN/INYMRNNENSOASTOBECOMESUAJECTTGTHE :, .:;�, . . � _ (n WORKERS'COMPf.YSATIONLAW50FCALIFOPNIA,ANUAGREET-!ATIFISHOULDCII:COIAE INSPECTIONFEE ____._,_ ��.--�� �+ ('-�`,"--__ �'°". � �_ SU&IECTTUTHEVdORKERS'COMPENSATIpNPiiOVISION50FSFCT0:137000F?HcIABON ' ' '• i„ '�; +c%r.�+- ��L� f � GOOE,ISHALLFORTk1WITFICOMPLYWITMTHOS ROwsious. ISSUANCE ����""''" �� �q � _.x.:.l�': �. . y��y *- ----'- - - --- ----- SMIP t^i�.l_ .-,,..-.--"— -_ !�� 0 DATE:_. � APPLICANT ',�` ..:s . �-`..:. w - -,...5'..1';,._: .�. - .�� ,.;'. ENERGY P/C � �- �,r.,.'..,;�... � � WARNING:FAwURETOSECU EWOqKERS'COMPFNSATIONCAVF.HAGEISUNLAVJFUL,ANUSHALLBF ���� "" _"___""'_ .. .. .:..._ ..._ ` '_-_ �y SU&IEGTANEMPLOYERTOCRIM!NALPENALTIESNNDGIVILFINESUPTOONEHUNDREDTHOJSAND ENERGYPERMIT DOLIARS(f1W,000),INPDDITIONTOTHEC�STOF�OMPENSATIGN,DAMAGESfSPROVIDEDFOAIN �-�--� ��--- ---�-------- � SEC71DN37080F7'HELABORCO�E,INT[fiEST.MURTTOANEY'SFEES. RETENTIONFEE: __ I __ " __"__ __' "'__'. .......- � CONSTPUCTION LENDING AGENCY PRE-ALT FEE: ..___ . � - '- - -- --- Zi HEREBY AFFIRM UNOEfl PENALTV OF PLHJURY THAT THERF.L CONSTRUC710N I.FN�ING AGENCY �_O� � FORTHEPERFOFMRNCEOFTHEWORKFOfiWHICHTMISP IiISI55UED�SEC.3o87,CIV.C.). I -"-- - -"'-""' --""--- _ __ ' _ � __`-_' '__ ___ � LENDER'S NAFAf_'__-_'__ _-' __'__ __.__'_-' I�'}' : '___'_-_ __- � F- LENDER'SADDRESS_ _""' "-"" '_""' ' �� ' � � . � ICEHTIFYTNATIHAVERFRDTII'�SAPPLICFTIONANDSTATETHATIHEAd9VE1NFORMATIONISCUFiRECT. TOTAL FEES � W IAGflEETOCOMPLYWITHAILCIT'AN�CAUNTYOROINANCFSANDSTATEIAWSHFIATINGTOBUILDING � CONSTfllICiION,ANOHERFBYAUiHORR[FEPRESENTATIVESOFTHISCOUNTV�OENTERUPONTHE ZABOVE�MEMIONED PflOpERTY FOFl INSPECTION PUNPOSE6. � COMMENTS _.._.. r,,, j�j/ ---..._---- ---- -- J �-J�� � "_ ___' - —__ _'""" _'_'"'___ '-_"_ _ m PERMITTEENAME(Pf11N Q '_-__' _' "' _"'_ � �-��y/�7� � SIGNATUREOFVEA�.�I1TEE - '��� --f --" "--'-��_'_'__'_-___�`�r VAIIDATiON_ --- = RECPT.N0.,._ PAID 6Y ~ WkITE-Department Copy,YELLOW-Finanoe Copy,PfNK-Rssessor Copy,GOLDENROD-�-File Capy,GREEN-Applicanfs Copy . __ __..._..- - . _ . ... � . � . : ._ � , , � . i . ` _ ; � ' ; , , �.;- : , �� '_ , ' ' ' . . ' � /, ' � , � -.. _ , j � , , � . , , ' ; . , " ' - ' _ .. .'E - �' ' . " . ' , ' , ' ' - ' , . ' ,' .. .. . .. ' . _ "" ' ' . .. � . .. . . - � � . ' � • _ , �. i . . _. .. .. .. . . . � . _ . . .. . _ ._..... . . .. ... ... ' , _ . . . . '"" ' ._ " _ . I � , ' v�s- ' � . " , i . I . . � � � - _ - � . � . ..� ' � ' . 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