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HomeMy WebLinkAbout14669 CITY OF DIAMOND BAR ���� � `"' y��`�'- — DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ��� � 21660 E.Copley Drive Suite 190 `� ����9���`w BiJQ.DING PERMIT APPLICATtON FIRM Y o DDR S���S/7Z--��/ZA ��- �� oAPECATION � � NUMB R� / #/C � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER �� '•- ZONING SE7BACKS � CI SS Z T � FRONT RW ❑ APPLICANT i TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ CONTRA � � G' SIDE ❑ p� ADqR�S - PROPOSED USE � CITfi(�� Z o ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS_ UNITS STORI ES BEDROOMS � CITY ZIP TEL. � DESCRIPT{ON SQ.FT: FACTOR PSF ADJ.AREANALUA710N u� � OWNER-BUILDER DECLARATION SFfllADD/HEM O Q I HEREBV AFFlflM UNDER PENALTY OF PEHJURV THAT I AM EXEMPT FROM THE CONTRACTORS L!- � Garege/Carport � CENSEUWFORTHEFOIIOWINGRFASON(5EC.7o31.68USINESSAN�PROFESSIONSCODE:ANVCITYOF COUNTYWHICHREOUIPESAPEAMITTOCONSTPUCT,ALTEF,IMPROYE,DEMOUSH,ORREPAIRANYSiRUG w pati0/OeCi( TURE.PRIOR TO ITS ISSUANCE,ALSO REDl11HES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNE� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTPACTORS LI- � CENSEUW(CHAPTERe[COMMENGINOWITHSEC710N7000)OFDIVISION30FTHEBUSINESSANOPRO• � POOUSPa FESSIONS OODE�OR THAT HE OR SFIE IS EXEAIPT THEAEFROIA AND THE BASIS FDR iHEALLFGED EXEMP• TION.ANYVIOLATIONOFSECTION7031.6BYAN�APPLICANTFORAPEPMITSUOJECTSTHEAPPIJCANTTO Z Re-Rooi � AqVIIPENALTYOFNOTMOtiE7HANFNEHUNOREODOLV�RS(SSoo)J: � OI.ASON�NEROFiHEPROPERTY,ORMVBAPLOYEESWIhIWAGESASTHEIRSOLECOMPENSATION, 0 CommefCi81 - WILL DO THE WOPK.AND THE STRUCTURE IS NO7 INTENDED OR OFKEREO FOR SALE(SEC.7oM,BU51- J NESS Ml�PROFESSIONS CODE:THE CONTRAC70RS LICENSE lAW DaES NOTAPPLV TO AN OWNER oF � PROPERTYWFIOBUILDSORIMPROVESTHEREDN.ANDNMODOESSUCHWORKHIMS9.FORHERSELFOR = � THROUOIiMISORHERONMEMGLOYEES,PROVIOEDTHATSUCNIMPROVEMENTSARENOTINTENDE00R m � OFFEREDFORSALEIF,HOWEVERTMEBUILOIN60RIMPROVEMENTISSQL➢WITHINONEYEAROFCOMPLE• Z TION,TNE OWNEP-BUILOER WILL HAVE THE 9URDF.N OF pROVINO h1AT HE OR 3HE OID NOT BUIID OR � p.IPRDYE FOH TME PUflPOSE OF uALE). W ❑I,ASOW9dEROF7HEPROPERTY,AME%q11SIVELYCONTRACTINGWITMUCENSEDCONTRACTORS � TO�'AN5TRUCT THE PRQIECT(SEC.�a44,BUSINESS AND PROFESSIpNS CODE:iNE CONTRACTpqS LI- V811J0910n _ ADJ.AREA W CENSELAWD�ESNOTAPPLVTOANONMEROFAPPOPERn'WHOBUILOSORIMPROYESiHEHEON,AND � VA/OCONTMCTSFORSUCHPAOJECTSWITHACC:NTFL.CCTOR(5)LICENSEDPURSUdMTOhIECONiMG QUANTITY DESCRIPTION FEE � TOHSLICEN9ELAW.). o ❑IAM EXEIAM UNOLR SEG ,_ _B.&P.C.FOR THIS REASON U � � � DATE O'.�MER V � W — LICENSED CONTRACTORS DECLAFATION —� � w f HEREBY�FFIRM 11NDER PENALTY OF CEFJUR'�THAT I AM IICEN5E0 UNDER PROVISIDNS OF CHAPTER � � ,) � 1. � G(COMMENdNOWITH5FCT10N70o0)OF�IVISION30FTHEBVSINESSANDPROFESSIONSCODE,PND _ X MY UCENSE�S IN FUII FORCE AND EFFECT. m� W �1 �y� �j � UCENSE�CL4SS -� LIQ NO._�fS�yF���— _ j ! Y"" a DATE _L.—_.L�-- COh1TRACiO�5.� W � WORKERS'CdIdPEN5AT10N DECLAFiATIGN Q = U � I HEREBY AFfIRM 11N0ER PENALTY OF FEP.IUM ONE OF TNE FOLLOWING CECLA�ATIONS: � � Q L] INAVEAf3DN'ILLMAINTPJNACER7IFICATEOFCONSENTTOSELF-INSl1REFORWf)RKERS' T � (�lAPENSATqN,ASPRCbI0ED6'/SECTIDI337o00FTHELABORCODE,FORTHEPERFOftMANCE � OF TNE WOFK i'61i WNICFi TH1S PEqMIT IS ISSl1FD. � � ,I HAVEAND WIU.MAINTAP!WORKEFS'COMPENSA710N INSURANCE,AS REOUIREO BV SECTIDN Q 37o00F:.1E LA60H CpDE,fOR THE PERFO%MANGE OF THE WORK FOR WHICH TH!S PGRMIT IS ISSUEO.lAY1YC%iKERS'COMPENSA710NINSURANCECARRIERANDPOLICYNt/MBERAPE: CONS7RUCTION jcnkaiee �__...____� _ PLAN REVIEW _ � aoucv Nuueea__ — — ELECT`91C�}, 7��w � (iHISSECTfONNEGJNOTBEOCMRE7fl10FTkEPERIMi5K1RONF.ViIN�fiE0001.t.1P5(S10�OFlLESS} PL�BiflG ��T�i 4 W I CERTIFYTHAT Iti TH[PERFORMANCE OF THE WOfl HIC . 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F,_- LENDER'S ADDRESS � (/.�� W ICERTIF/THATIHpyEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORREC2 TOTAL FEES � �' p � I AGREE TO COM ITH AlL CITY AND COUNTY ORDINANCES AND STATE LAWS flEIATING TO BUILDINO r� a CONSTRUCTI ,AN HEREBY AUTHORRE REPHESENTATiVES OF THIS COUNTV TO ENTEfi UPON THE z ABOVE�ME NED PERNFO INSPECTIONPur�pqsEs. COMMENTS � �/`_��/��_�' f� m � PERMRTEE ... flI/dT � ���� � r � SIGNATUR Of P E DATE = RECPT.NO. ___PAIDBY VALIDATION ~ WHITE—De aRmant Copy,YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN— iicant's Co p pY, Py� PY� APP PY . • ... . .. - �. ;. .. , . t- ..i... ,... . �j. � . . ,. �� . . .. �� . . . � . • . ... . ... '�k�. ,....��'�.1.. �.���..°� ��' �:d����.'�i���� ��� ������ ��C� _ � ��`.a�� ' , _..,.� �; ���,�`'�x�-" a� �� ��`�'��"� .a"�`e�a°' '.m s �.:.::.� .: �' �. �� :.� ��. � �`: :a"�: �ww,���� ���� � '$ � � �ae �e �z �'�� �; �'��� �� �: � ������ �4-k � "'� � ��7 a���� . ����.° . 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