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HomeMy WebLinkAbout16965 (667) CITY OF DIAMOND BAR - I��` -- DEPARTMENT OF COIvIl�1UNITY&DEVELOPMENT SERVICES � _ �,,� 21825 E.Copley D�'ive (909)860-3195 Fax(909)861-3117 PRESS ``'-.v�^'� BUILDINGPERMITA.PPLICATION FIRMLY o� JOBSITE I �/ APPLICATION � PERMIT �I P/C ADDRESS,LS��D S.VQ�IEL�__y_J�� Ik'iV2 DATE � NUMBER 1 # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER�j�m.py��0.r dh.l-n.el'S Ll� �fL, D �� ADDRESS Zb2.f� IUItLn S�{� Sd-f•SOL� 1�IQ��NlD, ZONING SETBACKS z CITY �Ju�n�e ZIP 12�1y re�.9�9 �za19�`o FRONT aw ❑ o APP4ICANT g,r M Me�4eani,cal,1nC� TEL.'Jr�{ ��15-959� S DE/SIOE STREE7 RW ❑ z "� "' Q CONTRACTOR f� .�! .�r��vt,_�t�I� �l�L.. _ SIDE ❑ ADDRESS �A,-,�.�%S �. IA PdLrn A. Xl✓� � CITY�G{�1 f,rrr� ZIP�_ TEL.�11 y �OqS-�S�}(p PROPOSED USE � ARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. 0. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNEfi-Bl11LDER DECLARATION SFR/ADD/REM O I HEREBV AFFIRM 11NDER PENALTY OF PERJURV 7HAT I hAA cXEMPT FFOM THE CONTpAC70RS LI- G8I89B/CBfpOfl W GENSEUWFORTHEFOLLOWINGREASON(SEC.7031.58USINESSANDPROFESSIONSCODE:�ANVq7YOR (n ZCOUNTVWHICHREOUIRESAPERMIiTOCONSTRUCT,ALTER,IAAPROVE,DEMOLISH,ORREPAIRANti''STRUC- W Patio/Deck TURE,PRIOR TO ITS ISSUANCE,PLSO REOUIRES THE APPLICANT FOF SUCH PERMIT TO GICE d SIGM1'ED w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROYISIONS OF 7HE CONTq0.CTORS LI- W � CENSE LAW(CHAPTER 9(COMMENCING WI7N SECTION�000)OF DIYISION 3 OF THE'BUSINEB$AND PRO- � POOUSPB FESSIONSCODE)ORIFIATHEORSHEISE%EMPTTHEREFROMqND'HEB,451SFORTHEACIEG���EXEMP- (!S � TION.ANYVIOLATIONOFSECTION7�I.SBYANYAPPLICANTFORAPERMITSUaJECTSTHEAPPLICANTTO Z Re-Roof � � 0.GVIL PENALTY OF NOT MORE h7AN FIVE HUNDRE�DOLLARS(SSOD).): � -� O ❑I,ASOVJNEqOFTHEPROPERTV,ORMVEMPLOVEESWITHWAGE5A5THEIRSOLECOMPEN$ATION, ❑ CORIfT10fC13I � WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC,70<4 BUSI- J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF j PROPER'�Y WNO BUILDS OR IMVROVES THEREON,AND WHO DOES SUCH WOFiK HIMSEIF OR HEb�ELF OR Q THROl1GHHI50RHEROWNEMPLOYEES,PROVIOEOTHATSUCHIMPROYEMENTSARENOT�A'jYEI�bEDOR m � OFFEREOFORSALEIf,HOWEVER,THEBUILDINGORIMPROVEMENTiSSOLDWITHINONEYEAR�OKi`AMPLE- Z TION,THE OWNER�BUILDEfi WILL HFVE THE BUFDEN OF PROV�NG THAT HE OR SHE DID NOT 8171LD OR � IMPROVEFORTHEPURPOSEOFSALE). ❑I,p50WNER OFTHE PROPEFiTY,AM EXCLUSIVELYCO4TRACTING WRN UCEN5E��Y1tJTRACTOPS � TO CANSTRUCTTHE PR0.IECT�SEC.7044,BUSINESSAND PROFESSInNS COOE:7fi��CdNTRAC`YOflS LI- VelU011011 ADJ.AREA W CENSELAW�OESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUII�SORIMPROVESTHEREON,AND = WHOCONTRACTSFOflSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITV DESCR�PTION FEE �` TORSIJCENSELAW.j. Q O ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR 7HI5 qEASON Q � V tL � DATE .. OWNER U � LICENSED CONTRACTORS DECLARATION W � I HEREB�AFFiRM UNDER PENALTV OF PERJURY 7HAT IAM LICENSED UNOER PROVISIONS OFCHAPTER � Y r„ I� /`a [L 9(COMMENCINGWITNSECTION7000)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE;AND Z 1� �C.� '\J 'X MY�ICENSE IS IN FULL FOPCEAND EFFECi. m p /� �..-��o.,7� LtYl. P.� tJ r LICENSE pGLA'55 L� �� LIC.NO.__�a � � r2ven.{+P.rs U DATE�,.j)..II�nIOI CONTRACTOR_��,j}�, d � y P�-- � •�.X-r C���OAKERS'COMPENSATION DECLARATION � I HEREB�AFFIRM UNDER PENALTY OF PEiiJURY ONE OF THE FOLLOWING DECLARATIONS: � � � iMAVEAN�WILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' ^. /— �]�,� D A'C Q COMPENSATION,AS PROVIDED BY SECTION 3�0o OF TNE IAPOR CO�E,FOR THE 7EAF�RMANCE �J �" ✓ S^� OF THE WOftK FOR WHICH THIS PERMIT IS ISSVED. � I 1 ���/_..J o r' p 1 r��G Tw� W �I HAVE ANO W",ll MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BYSECTION - Q 3�0o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WNICH THIS PERMIT IS �i ISSUEO.MYW}-O�RKERS'COMPENSATIO.N�IN;S,,URJANCECARFJERANDPO�ICYNUMBEHARE: CONSTRUCTION ? CARRIEF r�h'l.� -+-+1G1e.1'Yl.✓Lf.�h I� PLANREVIEW Z POLICVNUMBER Il l�nR3Z302 I ELECTRIC Q �y 0 (IHI33ECTKKJNEmNOTBEGONPLEfmOFh1[PERMTSWRONEHUNDREDOOLLARS(y100)ORLESS). � PLUMBING ' - �ll Z ICERTIFVTHATINTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSIiE�,I MECHANICAL (�} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECTTD THE � WORKERS'COMPENSATIONLAWSOFCALIFOflNIA,ANOAGREETHATIFISNOUL�BECOME INSPECTIONFEE ' SUBJECT�O THE WORKERS'COMPENSATIO'J PROVISIONS OF SECTION 37oa OF THE LABOR ( � � CODL,I SHAIL FORTHWITH COMP'.V WI�oISE PqOVISIONlS ISSUANCE .�.i�A l � �yJ//�J�/� / SMIP DA : APPLICANT: S:/�`� G WWA IN : AILUR TOSEC�UPEWORKERS'COMPENSATIONCOVERAGEISUM1'LAWNL,ANDSHAILBE ENERGYP/C � SUBJECTANEMPLOVEHTOCRIMINALPENALTIESAN�CIVILFINESUPTOONENUNDREDTHOUStiND ENERGYPERMIT DOLLARS(5100,000),W ADOITION TO THE COST OF COMP[NSATION,�AMAGE$AS PROVIDED FOFE�IN J SECTION 3]oB OFTHE LABOR CODE.INTEREST,AN�ATI'ORNEV'S FEES. RETENTION FEE: � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O CL IHEREB�AFFIRMUN�ERPENALTVaFPERJURVTHATTFIEREISACONSTRUC710NlENDINGAGENCY 0. FORTHE PERFORMANCE OF THE WOFiK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3oW,CIV.CJ. Z W � LENDEF'S NAME � _—_ w LENDER'S ADOR[SS ���1 �� � I CERTIFV THAT I HAYE READ THIS APPUGATION AN�STFTE THAT TME ABOVE INFORMATION IS CORRECT. TOTAL FEES � IAGREETOCOMPLVWITHALLqTYANOCAUNTYOFDINANCESANDSTA7ELAW5REUTINGTOBUiLDWG � CONSTRUCTION,ANOHEFiEBYAUTHOR2EREPRES'cNTATIVESOFTHISCOUNTYTOENTERUPONYHE � AeOVE-MENTIONEOPROPERTYFORINSPECTION�URPOSES. � COMMENTS � S'hA,r�rti.J �.�P��'.l�e,,�-� _ � P�Yfi E NAME(PRIN'.� / ¢ � ��--CQ-� �' I�I� � � SIGNATURE OF PERMITTEE ATE T� 1 = RECPT.NO. 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