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HomeMy WebLinkAbout10708 (5) i -�- CITY OF DIAMOND BAR � COMMUNITY DEVELOPMENT DEPARTMENT � ;�j ;,.� 21660 E.Copley Drive Suite 190 � PRESS (909)860-3195�ux(909)661-3t17 „'""'" BUILDING PERMITAPPLICATION FIRMLY o AD R�ESS II / 7?� ��i� APPUCATION 'r�,� =9 C,��J p�^.Sj P/C `�" - � �,��- � `�,�`r-�' � PERMIT / c. DATE NUMBER � p � ISSUE �.� " Ty r°; TYPE OCC APN LOT , TRACT �"� �� DATE ;s �'C� ';� ,� CONST. GROUP i o OWNER �`�i� J.'L'i(l_'�; c. �►'r'"7: -� I o ADDRF�SS M1 G��AT_�9[-L.. `y:'�f �,�J y ZONING SETBACKS i � CITY {:J� F��-Y_- ZIP''II i�`� TEL. ' .�'.�f� FRONT RW ❑ APPLICANT +r TEL. REAR �]_ � � ✓ SIDE/SIDE STREET RW ❑ � m CONTRACTOR �'`'. ' �' � �r4 ,i7�;.•L';,�'f, .' SIDE ❑ ` � ADDRESS 11'�+,4� 3- ;t{�' i`r i-�`t� ��.�r=�� - � PROPOSED USE ��A�`�� ?>'� f„�C✓'�,��:,',r�Z�.. �" �J>, I � CITY 1 , �'��,�� ZIP �;�-TFL.�-��i`"�=,.7�=,c��+� � w ARCH/ENG/ ZDESIGNER •-�'�` �.a%��;' ,�.. - w �. , — NO.DWEL. NO. NO. n. ADDRESS •f '. �"' �.�• �� u� , .� � , ,� . 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'j'2�a--_'"G.r„'3 <n DESCRIPTION SQ.FT: FACTOR PSF ADJ.AREANALUATION p� OWNER-BL:ILDER DFCLARATION SFR/ADD/REM O � 1 HEREBV AFFIRM UNDEH 7ENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONfRACTOflS LI- G2f898IC2/P01I W CENSEIAWFORTMEFOLLOWINGREA50N�5EC.)031.SBUSINESSANDPROFES510N3CO�E:ANYCITYOR (n U COUN7YYMICHREWIRESAPEHMITTOCqNSTRUCLAITER,IMPROVE.�EMOLISH,ORREPAIRANVSTHl1C• W PBIIO/DBCk y � TURE.PNIOR 70 ITS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT THAY HE Ofl 9HE 19 UCENSED PUHSUANT TO TXE PROVISIONS OF THE CONTflACTORS LI� � OCENSE LAW ICHAPTER 9(COAIMENCING WITH SECTION 7000)OF DIVISION 9 OF THE BUSINESSAND PRO� POOUSpB � FESSIONS�E�ORTHATHEDqSHEISEXEMPTTHEREFROMANDTHE9ASI3iORTHEALLEGEDE%EMP- � U TION.ANVVIOLATIONOFSECTION703I.SBYANYAPPLICANTFORFPERMITSUBJECTSTHEAPP�ICANTTO Z Re-Roof A CIVIIPENAI.TY OF NOT MORE THAN FIVE HUN�PEO OOLI.ARS(i500).): � ❑I.ASOYMEROFTHEPROPERTY,OHMVEA/PLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial Z� WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFEO FOR SP1E(9EC.7044,BUS6 �J N. NESS AND PROFESSIIXJS COOE'.THE CONTRACTORS LICENSE UIW OOES NOT APPLY TO AN OWNER OF � PROPERTV WHO BUILDS OR IMPROVES THEREON,AND NMO OOES SUCN WORK HIMSEIF Oq HERSELF OR �. THROUGHHISORHEROWNEMPLOVEES,PROVI�EDTHATSUCHIMPROVEMENTSARENOTIMENDEOOR m QOFFEREDFORSALE.IFHOWEVERTHEBUIIAINGORIMPROVEMENTISSOlDW1THINONEVEAROFCOMPLE Z iION,7HE OWNER�Bl11LDER WILL HAVE THE BlJROEN OF PROVING THA7 HE OR SHE DID NOT BUILD OR = IMPqOVE FOR THE PURPOSE OF SALE). ❑I.AS OWNER OF TME PqOPERTY,AM EXCLUSIYELY CONTRACTING WITH LIGENSED CONTRACTORS / � TO CANSTRUCT THE 7ROJEC7(SEC.7oaa.BUSINE55 AND PFOFESSIONS fAOE:THE CON7fiAC70RS LI� V81118ti00 ! � � � ADJ.AREA W CENSELAWDOESNOTAPPLYTOANONMEi70FAPROPERTYWHOBUILDSORIMPROVESTHEREON,AN� � WIiOCONTRACT8FOR3UCHPRQIECT3NATHACONTflACTOR(5)LICENSEDPl1R5UANTTOTMECONTRAG QUANTITY DESCRIPTION FEE TORS LICENSE LAW.). Y � �EXEMPT UNDER SEC._ B.8 P.C.FORTHIS REASON Q t O Y _"_ _ _'"_'__-- U Z.� �ATE OWNEfi _'__ � �., LICENSEO CONTRACTORS DECLAFATION W �� 1 HEREBYAFFIHM 11N�EA PENRLTV OF PE0.1l1RV TNATI AA!LICENSED UNO[F PflOVISIO4S O�CHAATER � � B(COMMENCINGWITHSECTION7000)OFDIVISION30FTHEBUSINESSANOPROFESSION6CO�E,AND Z � MY LICENSE IS IN FULL FORCEAND EFFECi. m 7 ` � �;� UCENSE CLA ��`y i� LIC.NO. . � � �j, OATE � e�M CONTRACTOR,__..� Y� . ,� ,� �{'�.,. „ d �: �� WORKERS'COMPENSATION DECLARATION a �� 1 MEHEBYAFFIRM UNDEfl PENAITY OF PERIUflV ONE OF THE FOLLOWING�ECIARATION$: z � __IMAVEANOWILIMRINTAINpCEflTIFICATEOFCONSENTTOSELF�INSUREFpRWORKERS' � _ ¢ CAA/PENSATION.AS PHOVIDED BV SECTIOM 3�on OF THE LAAOR CODE,FOR 7HE PEFFOFMANCE W Q OFTXEWORKFOqWHICHTMISPERMITISISSUED. � � __t HAVE AND WILIMAINTAIN WORKERS'COMPENSA710N INSURANCE.AS RE�UIRED BY 9ECTION .^� -"' : Q 37000FTHELABORCODE.FOBTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMRIS � ���, �� a � � ISSUED.MY WORi(EfiS'COMPEN6A710N INSURANCE CARRIER AND POLICY NUMBEAARE: �.�STRUCTION "^� k "" ° Q �-:-.,.�ym„a�-c' 7 ? cnRRiEH------"----------- --- PLANREVIEW —'---- -- Z POLICYNUMBEH ELECTRIC d � (IHISSECIIONNE�N0T8ECOAREIEDOFTffPEHM1ttfISWfiONEMN�DRED00WJ1S(S1W)ORLE66} PLUMBING W Z I CERTIFY THAT IN THE PEPFORMANCE OF THE WORK FOR WHICH THIS P S IS5UED.1 MECHANICAI U' SHALLhOTEMPIAYANYPERSONWANYMANNERSOASTOBECAMESI�IECT THE - [/�� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANUAGftEE j�IFI5H0ULD �OJM INSPECTIONFEE _ _ �:� " SUBJ TTO HEWORKERS'COMPENSATIONPROVI510 ECTIO��A37000FT PU{ �-��"""'�-+ _y" " "�; ` f J' ei�,,..e E COD.ISH FONTHWITHCOMGLYWITHTHOS isiorvs. / � . ISSUANC ( ..� ' p �� "`�..-u� � ,��./ SMIP �� . ,�4°� p DATE: � . APPLICANT: F �"�.. . _' _' J WAHNIN FAIL E TO SEWNE WORKERS'COMPENSATION CAVERA I UN UL,PND SHALL BE y ENERGY P/C _ l��"" _ � SU&IECTpN EMPLOYER TO CRIMINAL PENALTIES AN�CIVII fINES U TOONE MUNDRED Tl10USAND ENERGY PERMIT � �� � � •• '� DOLLARS(5700,000),INADOITIONTOTHECOSTOFCAMPENSATION.D ADESASPROVIDEDFORIN � SECTION 3708 OFTHE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: _„ ___ d CANSTRUCTION LENDING AGENCY PRE•ALT FEE: O --- � 1 NEREBYAFFIRAI UNDER PENAL7V OF PERIUFV THAT THENE IS ACANSTRUC710N LENOING AGENCY _________ FOR THE PERFORMANCE OF THE WORK i'OR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z w — � LENOER'S NAME _ h-� LENDER'SADDRESS _ w ICERTIFVTHATIHAVEREADTHISAPPLICqT10NANOSTATETHATTHEA80VE1NFORMATIONISCARRECT. TOTAL FEES 1�� /'>� � IAGREETOCAMPLVWITHALLCIiVANDCAUNTVORDINANCE5AND5TATElAWSFELATINGTOBUIL0ING G/ � CONSTRUCTIIXV,ANDHEREBYAUTHOHIZEREVRESENTATIVESOFTHISGOUNTYTOENTERUPONTHE Z AflOVE•AIENTIDNED PROPERTV FOH INSPECi(CNi PIYHPO5E5. COMMENTS 0 ` � '�������� f m PERMITTEE N IFIf) fn t'� � �/:e�. ' � 6IC TUREOFPERMITTEFy DA7E y = RECPT.NO. %S�" �t I PAID BY L._f���'�'"f VALIOATION ~ � WHITE-DepaAment Copy,YELLOW�inance Co PINK-Assessor Co GOLDENROD-File Co GREEN- pY. PY� PY, ApPlicenPs Copy ..�i, ..�. .�.....__.. _,-._ .,_._M - -�.,_ . ._� _ , �_..�.:� � '_ _ i ! 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