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HomeMy WebLinkAbout16670 (32) -----�i-- CiTY�F DIAMOND BAR , DEPAitT'MENT OF COMMUNITY&DEVELOFMENT SERVICES 21825 E.Copley Drive � (909}860-3195Faac(909)861-3117 PRES$ n° ' BUILDIN�P�RMIT APPLICATION . FIRMLY } JOBSITE , �� ���,� "y �a�m , DATEICATION J j � II��S NUMB R ^ � #/C v� �t7�� o ADDRESS ��"� � s ��[� � � � ISSUE TYPE OGC r APN LOT TRACT DATE` CONST. GROUP p OWNER ��� � �� � 'b� p ADDRESS ' ' "�.� �-��^•+t3�s �� ,ZONING SETBACKS W � ��— ZIP'�� °� TEL ��� .� FRONT RW ❑ o CITY �1Ca tn,r.r � � p APPLICANT F TEL.����»Ae� SIDEISIDE STREET RW ❑ z � CONTRACTOR F' ' SIDE ❑ ¢ ADDRESS ;a� ,r°`�,uw C.�, �acl;� " � . °C PROPOSED USE � CITY � ; ZIP EL:_ ,n E;d.r � �_� o ARCH/ENG/ ��� z DESIGNER w N0.DWEL. NO. NO. n_ ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VA�UATION p� OWNER-BUILDER DECLARATIDN ?SFRIAAD/REM � O p I HEREBY AFFlRM UNDER PENAL7Y DF PERJURY THAT I AM EXEMiT PROM THE CON7RACTORS Lb � GaragelCarport W CENSELAWFDRTHEFOLLOWING'',,REA$ON(SEG7031.SBUSINESSAN�PROFESSIONSCODE:ANYCITYOR . U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCi.ALiER.IMPROVE,DEMOLISH,ORREPAIRANYSTRUG W Patio/Deck W TURE.PPIOR t0 ITS ISSUANCE.ALSO REQUIRES lHE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNE� w - � STATEMENT THAT HE OR SHE IS LICENSE�PURSUANT TO THE PFOVISIONS OF THE CONTRACiORS LI� , � CENSELAW(CHAPTERB(COMMQJCINGWITHSECTION7000)OFDIVISiON30FTHEBUSINESSANDPRO- � PooVSpa , � FESSIONSCODE)ORiHATHEORiSHEISEXEMPTTHEREFFON�ANDTHEBASISFORTHEALLEGE�EXEMP� (� V TION.ANYVIOLATIONOFSECTION7031.58YANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTp z Re-Roof A CIVILPENALTY OF NOT MOflETHAN FIVE HUNDRFD DOLLARS(S50o).): - �� ❑I,ASOWNEROFTHEPROPERiY,ORMYEA�PLOYEESWITH.WAGESASiHEiRSOIECOMPEN5ATI0N, � CommefCial - WILL DO THE WORK,ANO THE S7RUCTURE IS NOT IMENOED OR OFFEflEO f-0R SALE(SEC.'044,BUSI- _I �:', NESS ANO PROFESSIONS CO�E:YHE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � - PROPERN WHO BUILDS OR IMPROVES iHEREON,AN�WHO OOES SUCH WORK HIMSELF OR HERSELF OR �'.' THROUGHHISORHEROWNEMPLOYEES,PROVIDEDTHA75UCHIMPROVEMENTSARENOTIN7EN�EDOR m Q„ OFFERE�FORSALE.IF,HOWEVEF',THEqUiLDMGORIMPROVEMEN'ISSOIDWITHINONEYEAROFCOMPLE- , Z�. TION,iliE OWNER-BUILDER WILL HAVE 7HE BUR�EN OF PROVINCa THRT HE OF SHE DID NOT BUILD OR _�, �'IMPROVEFORTHEPUFPOSEOFSALE). � W�� ❑I,ASOWNEROfTHEPROPERTY,AMEXChU51VELYCONTRACTINGWITHLiCENSEDCONiRACTORS ��I TO CONSTHUCT THE PROJECT(SEC.7o44,BUSINESS AND PROFESSIONS CO�E:THE CONTRACTORS Lb Valuation ADJ.AREA ' W'� CENSELAWDOESNOTAPPLVTO/1NOWNEROFAPqOPERTYWHOBUII�SOFIMPROVESTHEREOIJ,AND - F��'. WHOCONTRACTSFORSUCHPRWECTSWITHACONTRAC70R(S)LICENS'cDPURSUANTTOiHECONTRAC- QUANTITY DESCRIPTION FEE Y.', 'TORS 110ENSE LAW.). �', � T ,�"' � �, ❑I AM EXEMPT UNOER SEC, B.8 P.C.FOfl THIS REASON Q �� �'d�.-g,,.•�-�w _.�-,+',,,' ��� � V � �� � � DATE OWNER U � - �;'' W �� LICENSED'CONTRACTORS DECLARATION W .. . ,.. ¢ '�'. I HEflEBYAFFIRM UNOER PENALT,Y OF PERJURY THAT I hM LICENSE�UNOER PflOVI510N50F CHAPTER ,� p,;� 9(COMMENCINGWITHSECTIDN7000�OFDIVISION30FTHEEUSINESSAN�PROFESSIONSCODE,AND Z X'�. MY LICENSE IS IN FULL FORCEAND EFFECT. jj /�g �g y° 1 �7 �y g O'' LIGENSE gGL45�qSq C���,/,�.��y� �LIG.NO. �V d� � /� � V'� DATE�'_]�_'���43' �r 'GONTRACTOR��� a W Q r,y-a . � WORKERS"COMPENSATION DECLARATION a �� IHEftEBYAFFIRMl1NDERPENALTYOFPERJURYONEOFTHEFOLLOWING�ECLARATIONS�. z z. _IHAVEANDWILLMAIMAINACERTIFICA7EOFCONSENTTOSELF-INSUREFORWORKEFlS' 2 Q COMPENSATION,AS PROVI�ED BV SECTION 370o OF THE LA60R CODE,FOR THE PERFORMANCE 'U � OFTHE WOflK FOR WHICH THIS PEPMIT IS ISSUE�. � W� �I HAVEAND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIflEO BY SECTION Q 37000F iHE LA6OR CO��,FOR TH'e PERFORMANC'e OFTHE WORK FOR WHICHTHIS PEFMIT IS ISSUED.MY WOPo(EAS CO�MpPENSATION INSURANCE CAFRI P AND POLICY NUMBERARE: CONSTRUCTION j' cnRaieR $,,.N�'�r�Yfi :��¢.,� . �`�'/?�� PLANREVIEW ��� d POLICYNUMBER '"C�� `� a. _ '� � -- ELECTRIC w`��y-.��Is� � (�FIISSECTIONNEmNOTB��iv1PLETEDOF7HEPEFAARISWRONEHUMREDDd1ARS($iN)ORLESS} PLUMBING 4LJ' Z ICEflTIFYTHAT IN THE PERFORMANCE QFTHE WOflK FOR WHICH THIS PERMR I515SUED,l MECHANICAL �' SHALLNOTEMPLOYANV'.PEflSONINqNYMANNER50A5TOBECOMESUBJECTTOiHE °rl�L,A( � WORKERS'COMPENSAiIONIAWSOFCALIFORNIA,ANDAGREETHATIFISHOUL�BECOME INSPECTIONFEE !"TK•1 �P�Tjl��'frv,., � � � � SUBJECTTOTHEWORKERS'CbMPENSAYIONPROVI510NSOFSECTiON37ooOfTHELAeOR �y�,, � � CODE,ISHALLFORTHWiTHCOMPLVWITFITHOSEPROVIS10N5. �SSUANCE � ��u�'✓'�✓' /�� � �a\ p DATE: APPLICANT: SMIP j WARNINGFAILUFETOSECUREWORKERS'COMPENSATIONCOVERAGEIS�NLAWFUL,ANDSHALLBE ENERGYP/C `) ' SUBJECTANEMPLOVERTOCRIbI,INALPENALTIESANDCIVILFINESUPTOONEHUN�RE�THOU5AN0 � LL. DOLLARS(flDa.00a),INADDITIONTOTMECOSTOFCAMPENSATION.�AMAGESASPROVIOEDFORM ENERGYPERMIT � _ �� � 3ECTION3loeOFTHELABOftCO�E,INTEREST,ANDATTORNEY'SFEES. RETEIVTION FEE: � I��„c��f��j � i R��S����fi'11`a f �� .. ST OCONST�RUCTION LENDING AGENCY PRE-ALT FEE �� ���R � IHEREBVAFFlRMUNDEflPENALTVOFPERJURY:THATTHEREISACONSTRUCTIONLENDINGAGENCY � � FOfiTHEPEHFOPA7ANCEOFTHEWORI(FOPWHICHTHISPERMITISISSUEO(SEC.3D9],CIV.C.). � , ; W —_-- � � LENDER'S NAME ' .F— LENDEF'SA�DRESS � � � ��,. _�:..,-:,,:,...,_.'.�.' .. _.�"^:-��-. W�.' ICERi1FYTHATIHAVEFiEADTHISAPPLICAiIONPNDSTATETHATTHEABOVEBJfORMATIONISGOftflECT. TOTAL FEES�� y�tl F'� 2�� �� �� IAGREE TO COMPLY WITH ALL CITY AND COUNTYOFDINANCES AND STATE L4WS RELATING TO BUILDING �� � CONSTRUCTIIXJ,ANDHERE6YAUTHOftIZEREPflESENTATiVE50F7HISCDUNTYTOENTERUPONTHE Z ABOVE-MEN i IONEO PROPERTY FOR Il�SPECTIOtJ PUflPOSES. COMMENTS 0' `� (�^�� S�.'. � �`.,,�, WF;, m PERMITTE NA E�PRINT) '';9 ' � 4�' , L �-� y �� SIGNA UR OF PEHMITT � ' DATE _ � RECPT.NO. 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