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HomeMy WebLinkAbout10693 (5) I i �� - CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMEfvT � :"•C • 21660 E.Copley Drive Suite 190 (909)86U-3195 Fax(909)861-3117 PRESS ,"'""', BUILDINGPERMITAPPLICATION FIRMLY � JOBSITE � r f _ APPLICATION � �/� PERMIT /C� 1 P/C o ADDRESS ��( �� ���I �C�1 �-Q atJ f7 DATE � � , � � NUMBER o� � �'� # � $ ISSUE NPE OCC APN LOT TRACT DATE CONST. GROUP °C OWNER J�.L>:'�iJ1�t: "a 1`��!1[.C� 1`��j"�-. O WADDRESS ff j 1 i�� +)c%� h i:s� �e"!ra�� ZONING SETBACKS aTv Oiet��c�c::�d a,.Yc:t.i" ZIPt�(c>:� TEL.�'�r�C��-�ei''°�;�i FRONT RW ❑ �p APPLICANT _ �.'.;'ik r3�l,�.' �yj-j"# TEL. REAR rj Z SIDE/SIDE STREET RW ❑ � CONTRACTOR SIOE �7 � ADDRESS f` �/c✓�-J _- -�'" f�•'G:�'. � CITY ZIP TEL. PROPOSED USE �.=� o ARCH/ENG/ z DESIGNER w. NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS N N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION O OWNER-BI:ILDER DECLARATION SFR/ADD/REM (j I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT 1 AM EXEMPT FROM TiE CANTflACTORS ll� G8f9g8lCe1POR ' W CENSEUWFORTHEFOLLOWINGREASON(SEG70S7.5BUSINESSANDPROFESSIONSCODE:ANYCITYOq (n U COUNTyWHICHFEOUIRESAPEHMIi70CANSTRUCT,ALTEF,IM7ROVE.DEMDLISH,ORFEPAIRANVSTpUG W Pg�lO/DBGk W TURE,PPIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR 5UCH PERMIT TO FILE A SIGNEU W � STATEMENT THAf HE OR 5HE 19 LICENSED PURBUANT TO THE PROVISIONS OF THE CONTRA(.'TORS LI� � �: CENSE LAW{CFIAPTER 9(COMMENCING WITH SECTION 7WU)OF DIVISION 3 OF THE BUSINESSAND PRO- POOIISp2 O. FE3510NSCO�E�ORTHATHEDRSHEISEXEMPTTHEREFROMANDTNEBASISFORTNEALLEGEDEXEMP� � U iION.ANYVIOLATIONOFSECTION7091.58VANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � A CIVIL PENALiY OF NOT MORE THAN FNE HUNDRFD DOLURS(SSOO�J: 0 YI.ASOWNEROFTHEPHOPERN,ORMVEWPLOVEESHATNWAGESASTHEIRSOLECOMPENSATION, � Commercial � Z� �WILI OD THE WOPK,M1D THE STRUCTURE IS NOT IMENDED OR OFFERED FOR SA�E(SEC.7o46,BUSI� ,..� � NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE LAW OOES NOT APPLY TO AN OWNEfl OF PHOPERTYWFIOBUILDSORIMPROVES7HEHEON,AN�NIHO�OESSUCHWORKHIMSELFORNERSELFOR � ��' THROUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCH4APftOVEMENT9ARENOTINTENDEDOR , m, W� OFFEREDFORSALE.IP,HOWEVERTMEBUILOINGORIMPPOYEMENTISSOLDWI7HINONEYEAROFCqAPLE� ' �' TKKJ.7HE OWNER�Bl11LDER WILL HAVE THE BURDEN aF PROVING 7HA7 HE OR SHE OID NO78UIL0 OR Z' _ IA/PROVE FOR THE PURP0.5E OF SAIE). W ❑I,ASOWNEROfTMEPflOPERTY,AMEXCLU5IVELYCANTRACTINGWITHLICENSEDCONTRACTORS � TO CANSTRUCT TNE PROJECT(SEC.70a4.BUSINE55 AND PpOFE5510N5 CODE:7HE CON7HACTOPS Lb VdlUetiOn ADJ.AREA W, CENSELAWOOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPFOVEShIEflEON,AN� -- ' �': WFIOCONTRACTSFOR9UCHPRQIECTSWITHACOMRqCTOR(5)LICENSEDPURSUMITTOTHECONTRAP QUANTITY DESCRIPTION FEE Y TOR5LICEN5ELAW.�. d ��, fIIAME%EMPTUNDERSEC. _.__. 0.8P.C.FORTHISREASON Q C C�-y � " ��"� �,, ,7�, U ,f � Z� DATE_� . E�• OWNER ��+•g-f_T. f d � � U �Q`, LICENSED CONTRACTOAS DECLARATION `" W � [L�, IHEFEBYAFfIFMUNDERPENALTYOFPERJLRYTHATIAlAL'CENSEDl1N�EFlPAOVI510N50FCNAPTEA :� p_•< D(COMAIENCINGWITHSfCTqN70a0)OFDIVISION30FTHEBUSINESSANDPROFES31011SCODE,ANU Z MY UCENSE IS IN fULL FOflCEAND EFFECT. �! m ��, LICENSE CLA55 LIC.NO._. � f ~' OATE CONTRACTOR____ 0� US --- � w; , ���,� WORKERS'COMPENSATION DECLARATION a � �' I HEREBYAFFIRM UNDER PENaLTV oF PEfL1UFlYONE OF THE FOLIOWING DECLARATIONS: z A� _IHAVEANOWILLM0.INTAINACEFTIFICATEOFCANSENTTOSELF-INSUftEFORWORKEFS' _ - - �; COMPENSATION,AS PqOVIDED BV SECTION 37000F iHE UiBOR COOE,FOR THE PERFORM0.NCE U Q OF THE WORK FOR WHICH THIS PERMIT IS I$SUEO. � � w' _t HAVE AND WILL MAIN7AIN WORKERS'COMPENSATION INSURAtiCE,AS REOUIRED BY SEGTION p�- 37000F THE LABOR CODE.FOR THE PERWRMANCE OFTHE WORK FOR WHICHTHIS PERMIT IS ISSUE�.MY WORKERS'COMPENSA710N INSURANCE CARRIEFiAND POLICY NUMBEF ARE: CONSTRUCTION J- ' — j�. CAqRIER_ _._,._,_____,.__ PLAN REVIEW PoLICYNUMBER -- ,��- Q -- ELECTRIC,�� / � p. (IHISSECTqNNE�N0TBE00AWlE�EDOFTrI[PEqMf�SFORONEMXJDREDDOLWi6(E1C0)ORIESS} � PLUMBING '�.� W � Z: �CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THI5 PERMIT IS ISSUED,1 MECHANICAL C3 SHALLNOTEMPLAYANYPERSONINANYMANNEPSOASTOBECOMESUBJECTTOTHE �'=" ' � (J):. WORKERS'COMPFNSATIONlAW50FCALIFOFNIA,ANDAGHEE7MRTIFISMOULDBECOME INSPECTIONFEE �� ���'�L'�' SUBJECT TO THE WORKERS'COMPENSATION PFOVISIONS OF SECTION 3700 OF THE IABOR � CODE,I SHALL FORTHWITHCOMPLY WITH THOSE PflOVISIONS. SSUAN�, ' T� 0 p DATE: APPLICAM: __ SMIP Y��"""°rt X'j, 1. ����� _ J WAflNINO:FAILURETOSECUREWORKERS'CAAIPENSATIONCOVERAGEISUNLAWFIIL,ANDSHALLBE ENERGYP/C ��9 -' ��:n.�' � SU&IECTANEMPLOYERTOCRIMINALPENALiIESPNDCIVIIFINESUPTOONEMUNDRE0TFi0U5IWD ENERGYPERMIT DOLLAHS(5100.00OI.�NADOITIONTOTHECOSTOFCOMPENSATION.DAMAGESASPHOVIDEDFORIN - � J SEC�ION97080FTHELABORCODE,INTEHEST,/WDATTORNEV'SFEES. W RETENTION FEE: _ �' O CONSTRUCTION LENDING AGENCY PREALT FEE: _ � I NEFEBYAFFIRN UNDER PENALTY OF P[0.1UqY THATTHERE IS ACONSTRUCTION LEN�ING AGENCV FOR THE PERFORMANCE OF THE WOflK FOR WHICH THIS PERMIT IS ISSUE�(SEC.3087,CIV.CJ, Z W � LENDEF'S NAME —_-- ;� F" LENDEH'SADDRE55 i � ICERTIFVTHATIMqVEHEADTMISAPPLICATIONANDSiATETHATTNEABOVEINFORMATIONISCOHRECT. TOTAL FEES �� � s� �' IAGREETOCOMPLYWITHALLCITYANOCOUNTYORDINANCESANDSTATELAWSRELATINGTOBUIIDING � CONSTRUCTION,ANDHEREBYAUTMORIZEREPRESENTATIVESOFTHISGOUNTYTOENTEFiUPONTHE Z ABOVEdAEMKKJEO PROPERTY FOR INSPECTION PUHPOSES. 0 /� COMMENTS �, � (.-v N'.i`rtq vt,2.�;- /(. t�;`�T r� -- _ m PE EENAME(P INT) �- � Q � � ��� �„� � �v �C:�►�u�•�r , �c�. s � SI�U�E OF PERAIITTEE OA1TE—��— — �a � r, � , �,,� RECPT.NO. •..�j f�f PAID BY !�.��+ �,✓ C VALIDATION WHITE-Depaement Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-ApplicanYs Copy � I� .__._.,:�._.._ R >_��I __. } -, 'z�z`z z`D(rri�m r��x; ,-i _..� �_�6.� _...�__ i��m� � : � � I �`�I � � � ; � `� ;�I�'x�'rsl E_ m�� � ri���i����0 � �Im � rl0 � ��� ; � . � .. �* � ��� ee��cn m � cs�� evi,u>i T � m'� ! � i ,r± m��n =' �� � � .Y3-�i ���' � I -�C� i. � ���_ Pti � � T/���.33:Y � y�,D I i T i I r} � G7 �' ''7�I2�� i� D � ! 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