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HomeMy WebLinkAbout17435 CITY OF DIAMOND BAR ,��`� �� �- DEPAR'Ii�NT OF COMMUNITY&DEVELOPMENT SERVICES ��� _ _ ' ,; -,.w .. 21825 E.Copley Drive � (909)860-3195 Fax(909)861-3117 PRE$$ ' "'%.yri�'��' BUILYIING PERMIT AFPLICATION FIRMLY o� JOBSITE J /� �°y , p ADDRESS�/��T �L2��J �Jl! DATECAI �C'� �'l NUMBER� #/C � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP o OWNE��_��,/�/�.e�� o ADDRESS ZONING SETBACKS z CITY ZIP /��'�D TEL �} � FRONT R�n/ ❑ � APPLICANT TEL. REAR p z SIDE/SIDE STREET RW ❑ ¢ CONTRACT R . . �� SIDE ❑ ADDRE S � CITY ZIP TEL. PROPOSED USE o ARCH/ENG/ iz DESIGNER N0.DWEL. NO. NO. a, ADDRES& � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUIL�ER DECLARATION SFR/A0�/REM O p � I HEREBY APFIRM UNOER PENALTY dF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORs LI� GBfe e/Ce� rt W�� CENSELAWFORTHEFOLLOWINGREAS�N(SEC.7031.SBUSMESSANDPROFESSIONSCO�E:ANVCITVOR (n 9 � U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTEfl,IMPROVE,�EMOUSH,ORREPAIflANVSTRUP W Patio/Deck w TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOfl SUCH PERMIT TO FILE A SIGNED W � SiATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO iHE PROVISIONS OF THE CONTflACiOFS LI� � ��. CENSE lAW(CHAPTER 9(COMMENqNG WITH SECTION 7000)OF DIVISION 3 OF iHE BUSINESSA��PRO- POOUSP2 0. FESSIONSCODE)DftTHATHEOR5HEI5IXEMPTTHEREFROMAN�THEBASISFORTHEALLEGEDEXEMP� (� V ,TION.ANYVIOLATIONOFSECTION7o31.58YANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANiTo z Re-Roof ACNIL PENALTY OF NOT MORE THAN FNE HUNDRED�OLLARS(5500).)� 0� fII,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHYJAGESASTHEIRSOLECOMPENSATION, � Commercial - Z �WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFED FOR SALE(SEC.7a44,BUSI� J � , NESSAN�PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW�OES NOTAPPLV i0 AN OWNER OF �_ �PflOPEHTVWHOBUILD50RIMPFOVE57HEFEON,AN�WHODOESSUCHWORKHIMSELFORHERSELFOR �CC 'THPAUGHHISORHEROWNEMPLOYEES,PROVI�E�THATSUCHIMPROVEMENTSARENOTINTENDEDOR m , �Q� OFFEPEDFOFSALEJF,HOWEVER,THEBUI��INGORIMPROVEM�ENTISSOLON'ITHINONEYEAROFCOMPLE- .Z �,TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING iHAi HE OR SHE DI�NOT BUILD Oq �� '�,;�IMPROVEFORhIEPl1RPOSEOFSALEJ. � ' .w :, ❑I,ASOWNEROFTHEPROPEFN,AMEXCLUSIVELVCONTRACTINGWI7HLiCENSEDCONTflACTORS '.[[ 'TO CONSTRUCT THE PROJECT(SEC.7049,BUSMESS AN�PROFESSIONS CODE:THE CONTPACTOR3 LI- V81UflflOfl ADJ.AREA W ';�CENSELAWDOESNOiAPPLYTOANOWNEROFAPROPERTYWHOBUILDSOFiMPROVESTHEREON,HND � '��WHOCONrRACT5FOR5UCHPROJECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAC� QUANTITV �ESCRIPTION FEE � �,,;TOqS LICENSE LAW.), �� . ❑I AM EXEMPTUNDER SEC. B.a P.G FOR THIS REASON Q U � OATE OWNER ¢ Z -- U � � LICENSED CONTRACTORS DEC�P,RATION W � � I HEREBV AFFIRM UN�ER PENALTY OF PERJJRV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d �9(COMMENCINGWITHSECTION7000)OFDIVISION30F�THEBUSINESSAN�PPOFES^eIONSCO�E,AND Z O 'MY LICENSE IS IN FULL�CE P[JD EFFECT. � !�7 � .LICENSECLA \./ LIC.NO. � V 'DATE o CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � IHEREBYAFFIFiMUN�ERPENALiVOFPERJURYQ4EOFTHEFOLLOWINGDECLARATIONS: z Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF-INSURE FOR WOPKERS' _ a CAMPENSATION,ASPROVI�E�BVSECilON3]oaOFTHELABOflCODE,FORTHEPERFORMANCE U Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � F I HAVE AND WILLMAIMAIN WOFKERS'COIAPENSAiION INSURANCE.AS flEQVIREDBV SECTION Q 37o00FTHELABOFCO�E,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS � ISSUE�.MYWORJ(E�5'C�QN�P�lS�Nlry$Uf39NCECARqIERAN�POLICYNUMBE9FRE: CONSTRUCTION ��� t,l7 !d�l j CAflRIER ��� � �/a�/�/ PLAN REVIEW � POLICYNUMBEF ,aAJ1 .i%J T`"` -�°W �� �� Q � ELECTRIC 9 �'" �. � `� �- -�;'t�. � (fHISSECTIQYNEmNOTBEODMFLEfEDOFTiEPERMITISFORONEHUNDREDDOlLARS�$10%ORLESS). PLUMBING `� /p w .F�� §��Gtl J-!� � I CERTIFYTHAT INTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUEO,1 MECHANICAL � I@�9'�W ����'� ' C3' SHALLNOTEMPLOYANYPERSONINANYMANNERSORSTOBECOMESLIBJECTTOTHE �� (J) WORKERS'COMPENSATIONLAWSOFCALIFORNIA,PNDAGREETHATIFISHOULDBECOME INSPECTIONFEE O � SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOF�ECTION3�ooOFTHELABOR � J'�` � CAD,I SHAIL �RTHWITH COMPLY WIT SE PROVISIO . ISSUANCE k �o � af � � p OATE: ��APPLICANT: ___ SMIP ° �� _- _' � WARNING:FAILURETOSECUREWORKEflS'COMPENSATIONCOVEflAGEISUNLAWFUL,ANOSHALLBE ENEFGYP/C J � LL SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGVPERMIT DOLLARS(5100.oao),IN AODITION TOTHE COST OF COMPENSAiION,DAMAGES AS PROYIDEO FOR IN J SECTIDN37�eOFTHELABORCODE,INTEREST,ANDATTORNEY'SFEES. 6 �C RETENTION FEE: OCONSTRUCTIONLENDINGAGENCY PRE-ALTFEE: _. � I HEREBYAFFIflM UN�ER PENALTY OF PEHJUflY THATTHERE IS A CONSTRUCTIOtJ LENDING AGENCY FOR THE PERFOHMANCE OF THE WORK FOR WHICH THIS PEflMIT IS ISSUED(SEC.3097,CIV.CJ. � Z � LL � LENDEF'SNAME F- LENOER'SADORESS w ��r ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORflECT. TOTAL FEES � I AGREE TO COMPLY WITH ALL CITY AND COUNTV OR�INANCES AND STATE L4WS RELATING TO BUILDING �� CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTATNESOFTHISCOIJNTVTOENiEiillPON7HE � ABO�-MENTIONEDPflOPEFiTIFORINSP�NvuaaosEs- COMMENTS O � / � m PERMI7T N E(PFI 4 � (J� SIGNATUREOF PERMITTEE �ATE �� pAID BY �� � � � RECPT.�O. VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy . < �:' � � � �'' , . � E. .. ,�., �",��"�� � �f �� s a x ' � d� t� t # : a '4 y : € "i � , a€�a :�� R� � � a� ���� a^ ' �� a� ��� �"� a �ma °�r �,�" "�p�,�; �a �"� �� ..x t g E '' 'a�" �T-E� � I = � j : q a a r s y.� q a ,u P IA.;S I �$:�"��. � 5 p t F �: P #.� * � � C� ' 4 � �x',p'%� � �g S°� L�}Y t": y�,�n���;� ��,���'. �:��; , �.-�,w..I � e '"x� x w .':: _<'� v.v A m;`�.a,� € � € �: . a� a..<.r.�. .� �. 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