HomeMy WebLinkAbout18968 �__, �,,�,� _ CITY OF DIAMOND BAR �+ � DEPARTMENF OF COMMUMTY&DEVEIAPI�NT SERViCE5 �.�; 21825 E.Copiey Drive (909)860-3145 Fa�c{909)861-3117 PR ESS �L'"""A BUILDING PERNIIT APPLICATlON FFRMLY a ADDRESS j`"�`"� �n"��� ` L`i e� ��• APPLICATION 1 + / � �ERMIT P/C � o DATE I ! l � NUMgER�,^ #�,_ ISSUE TYPE OCC � APN LOT T C7 � � � DATE CpNST. GRDUP ¢ p OWNER l: r' p ADDRESS ZONING SETBACKS Z CITY � � '� ZIP TEL. FRONT Ryy ❑ g APPLICANT TEL. REAR ❑_ SIDEISIQE STREET RW p � CONTRACT � I� � ( �j SIRE ❑ � CITY�2�� ZIP J TL'L.�.� n PROPOSED USE • � M V� p ARCHlENG! � G � z 4ESlGNER w NQ.DWEL. NO. NO. d ADDRESS � C17Y ZIP TEL. UNITS STORIE5 BEDROOMS � ---- rn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-6UILpER DECLAAATION SFFVA�D/REM p I HEREBY AFFIq1A UN�ER PEN►L7Y OF PE0.tt1qY 7NAT I MA E%EMpf FfiDM THE CONTMCTORS LI� �afHgB/CSfp011 W CENSEUWFOR7MEFOLLOWINC.REASON(SEC-Y0.9�.58USMESSNJUPROFE55bNSCO�E:ANVCIYYOR {J) COUNT�WHICHpEWIRESAPfRMITTOCONSTRUCT,pLTER,IMPFqVE,DEMOLISH.OAHEPAIqANYSTRUC� �J,j paHolDeck � TURE,PRIOR To ITS 15511ANCE,11L5o qEO111RE5 THE APPLICANT FOA SUCH PEfUAIT TO FILE A SIGNED � STh7�MEM MAT HE OR SHE IS L'CENSEO PURSl1AYT N THE PFOVISIONS OF THE CON7qACTORS U- i CEN5E UW(CHM7ER V{COMMENCINO WITII SECTqN 1o00�OF�IVISION 3 OF�ME BUSINF55 ANO PFO- � PooUSpa Y FESSIONSOOOE)�RTHATHEDRSHEISEXEMPTTHEREFROAIAN�7MEBASISFORTHEALLEOEUE%EMP� (� V TK7N.ANYYqlA7lONOFSECTrON7031.5BYANYAPPLICANTFORAPERMIT5V9.rECTSTHE�PPLICANrTo Z Re-Roof � AC141L PENALTY OF NOT MOqE�HAN FIVE HVNUREO�OLURS�45W�,�: Q ❑I.ASOWNEROFTHEPROPERTY,4RMYEMPLOYEESWITNWAGESASTHE4RSOLECOMPENSpTION, � Commerciel z WSLL 00 iHE WOFll(,tfJO THE STRl1CTUAE IS NOT INTEN�EO OR OFFEREO FOR SALE iSEC.i014,&151 J � NES&llNO PROFESSIONS COOE�.THE CONTRACTORS LICENSE�AW UOES NOT APPIY 70 AN 01YNER OF � PROP£H�Y 1rip g��8 OR IMPROVES THEREON,AND WNO DDES SUCH WORK HIMSELF Oq HEASELF OR � THi1IXlOH HIS OR HER QMM EfAPLDYEES,PPO`�1oED THAT SUCH IMPROVEM£NTS pRE NOT INTENDE�OH m W OFFEREOFORSALE[F,IIOWEYER7MFBUIL�INGORIMP�VEMENTISSGL�WffMINONEYFAAOFCOMPLE- � TICN.TME OWNfcR�BU!L�EF WILL tMVE 7NE 9URDEN OF PRO��NG T.IAT HE OR SHE CID NOT BUI',p DR � IAfPHOYEFORTMEPURPO5EOF5ALE�. W OI,ASOWNEROFTNEPROPERTY,AMEJ(CLlI51VELY('AMMCTINGWITHL4CENSEDCON�MCTOFS [C TO CONSTRUCT THE PROJECT�SEC.1aaa,&15MES5 AND PROFESSIONS CAOE:THE CONTRFCTOHS L4 VBIUdSlOf1 A�J.AREA 41 CENSELAWDDE9NOTMPLYTOAN9WNEROFAPROPERT'WF1oel}LLDSORIMPROVESTHEREON,AN� � � wracoNTw.cTSFOAsucsiprtWEcrswin��cauTfucTor�s�ucEwsEOPuasuuarmTHeoo�alpnc- pLIANTITV SCRIPTION FEE � rorrsuc�nsEuw�_ � ❑1�EXEMPT IiNDER SEC. B.d P.G PoR iHlS REASON Q .� U W � DAY� OWNER U 0 � UCENSED CONTAAGTOR$�ECLAAATION W � IHEREBI'nFFIRMUH�ERPENALTVOFVE{UURY�N47lAA�LICENSEDUNOERPRO`/ISIONSO�CHAPTER � d YSGOMMENCIN[3WITHSECTION]000JqFDIVI510N3OFTHEBUSINE55ANOPROFESSIdJSCODE,AND Z X 1JY LICENSE 45 IN FULI FORCE ANU EFFECY, Q LICENSEClA55 LIC.NO. ���� ' �� �/1 � � �ATE Gr CIXJTRACTOR ,l i �i ll] � pRKERS'GOMPENSATION OECLARATION �i a � IHEREBVNFFIRMl1N0ERPENAITVOFPE0.1L1RYOREOFT}/EKJLLOWINGDECUHAiKN15:J z � O _I HAVE MID WIL�MAINTAIN A GER'fIFICATE OF CONSENT To 5ELFAk3URE FOR WORKERS a � COMPENS0.�ION,AS PROYIDEU BY SECPOfi 37oa OF TkE Ug00.CADE FOR 7NE PERFOqMANCE � � Oi TNE\MOflK FOR WNICH TNIS PERMIT IS ISSUEU. � �I H�VE AND WILL MAMT4IN YYORKERS'LOMPEN5hT�ON INSURANGE,AS REOVIRE�BY SECTION O 37o00F THE LABOR COOE,FOR 7HE PERFORMANCE OF THE WOAK FOR WH4CH THIS PERMIT IS i 1554E0.M RNER'COMPENSATqN INSUAAN E CA R ANp?OLI�Y NLMBE RE CONSTRUCTION j � •� � � PLANREVIEW CARRIER � �ICYNUMBER " ELEGTRIC opr�ss[c7qhiN�ruTeEcar�,nEr000an�a�nrswaouEFa�Eoa.iunns�S� ca�essa' PLUMBING Z !CER7IFY THAT IN THE PERFOqM�NCE OF THE WOP!(FOR WHICH THIS PEF�MIT 7515511E0.I �1ECHANICAL C,�J SHALL N6T EMPLOYANY PERSIXJ IN 0.NY MANNEH 50 RS TO BECAMf Sll&IEC770 TNE �/] WORI(ERS'COMPENSAT:ANLAWSOFCAL:FORNIA,ANDAGflEETHA71FI5HOfILDtlEWME INSPECTIONFEE �r SUBJECTTOTHEMN�RKER.^.'COMPfNSATIONP VISbN50F5EG ' OFTHEL��{1 � COG I Si/A FoqTHWITN COMPLY WITH T E PROVISIONS. ��// ISSUANCE �' / I p �ATE: . �APPLICANT . �v�.J SMIP J WMNIN�:F ILURE O SEGURE WORNERS'COMPENSATqh COVE �E i5 UNLAWNL,ANO SHI4LL BE ENEFiGY P!C �y Sl1BJECTANEMPLOVERTOCRIMINALPENALTIESANOCIVILFlNFSUPTOONEHl1NURE0THOUSpN� ENERGYPERMIT �L4R5{f100.00aj,IN q001T10N TO TME COST OG COMPENSA7pN,6AMAGESAS PROV�OEO FOq IN � SECTION3]080FTHELABORCO�E,iNTEREST,ANOATT4RNE�"SFEES. RETENTIONFEE: 1{ QCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HERE9YAFFlRM UNOER PENAITYOF PEpJUFY TFiAi THERE 5�1 GONS'RUCT�QV IEMOMG AOENCY FOR TWE PER�RMANGE OF THE WORK FOA WHICH THIS PEAMIT IS t55L1E��SEC-�oB"I.CIV.C.J. Z W � GEN�ER'S NAME � F— 4FN�ER'SAWRE55 � ICENTIFYTHATINqVEAEA�TH15RPPUCA710NAN65TA�E7HATTHEA80VEiNfOR7AATiON7S�%ORRECT. 1 OTA�FEES I � d IAGREETOCOMPI.YwIfHALLCITlANUCOUNT��IRO1N!JJGESANOSTAYEUWSR[UTINOTOBUILO�NG CONSTRUCTION,AN�HEAE9Y AUTHORIZE HEPRESENTATIVES OF iH15 Ca1Ml'TO ENTEq UPON THE � A60VE-N.EN�IOkE9P PERTYFORIHSPECTIONPURPOSE$- � N y'Lf� � �Q�C� �v��� �'t� p � C.� CO ENTS � �1,�� �i�lL'�� �.-�..-- m PE (V�IINTI v� � E� � � � - � � SMaNAUREOFPFPMITfE 6A7E j� RE T. PAID BY VALIDATION! 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CITY OF DIAA�TOND BAR ��I\/ DEPARTATENT OF COATA�TLTNITY & DE�'ELOPA�TENT SER�'ICES 2182_5 E.Copley Diive (909)860.3195 Fax(909)861-3117---- PRE$$ JOBSITE ADDRESS A-OY/LA/Cll=�dlC�O O APPLICATION; --- >ERMIT DATE I I NOMBER ISSOE P/C OCC TYPE DATE CONSTZONING SETB_ACKS GROOP �eN LOT z cz owNea FRONT REAR SIDE/SIDE STREET SIDE PROPOSED OSE o ADDRE55 z CITY ZIP TEL.APPLICANT TEL. NO.DWEL.NO. CONTRAC7ToRK2 70e ADDRESS Jqq lm qAt%<a RW° 0 �+. UNITS STORIES DESCRIPTION SO.F7.FACTO SFR/AD2/AEM Rw o O c�rvf2aiig_ZIP--(TEL. IY� A L+ ° Garege/CaIPDrt DJ PatiD/Deck W PooVSpa Z Re-ROOT CDm�rerciel 7 LURCHVENG/m mValuationADJ.AFQUANTINSCRIPTION CITY zip DESIGNER BEDROOMS E ADDRESS TEL._r� Fn OWNER-BUILDER DECLARATION O 1 HERE Y AFFIRM UNDER PENALTY OF=R'-T'AN-.-FROM THE CONTRACTORS U w U GMT FOR SUCH PERMIT TO FILE A SIGNED TUBE,PRIOR T.ITS ISSUANCE.ALSO REWIRES THE APPL v STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS UGENES LAW(CHAPTER I(COMMENpNG WITH SECTION 11XSG OF DNBHON 3 OF THE BUSINESS AND PRO PERSONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP'TOE.MY VIOLATION OF SECTION 7011.1 By.1 APPLICANT FOR A PERMIT SUBJEM THE APPLICANT TO A CIVIL PENALTY Of NOT MORE THAN FIVE HUNDRED DOLLARS(SNA)F I US OMER OF THE PROPERTY.ON MY EMPLOYEES WITH WAGES AS THEIR SWE COMPENSATION O ILL W THE WORK.AND THE STRUCTURE IS HOT INTENDED OR OFFERED MR SALE(SEC.71NOL BUSI Z SS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF h eee P IRITYWHOW 8 OR IMPROVES THEREON AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR POP LD 3ED THAT SUCH IMPROVEMENTS ARE HOT INTENDED ON Q w 2 0 OFFIEFIED MR SALE IF UTNEVER THE BUILDING OR IMPROVEMENT IS SOU)WITHIN ONE YEAR OFOOMPLE TON.THE OWNER-BUiLIER III HAVE THE BURDEN OF PROVING PHAT HE OR SHE DID NOT BUILD OR 0 1.AS OMER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING WTH LICENSED COWRACTORS TO CONSTRUCT THE PROJECT (SEQ 70" BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U CENSE LAW WES NOT APPLV M AN ONMER OF A PROPERTY WHO GUILDS ON IMPROVE. THEREON, MO CONTRADITS FOR SUCH PROBUTS WITH A CONTRACTIONS) LICENSED RJRSUUMTM THE CONITAC Q w D I AM EXEMPT UNDER SEC.B.A P.C.FOR THIS REASON 3 OWNER=DATE Z LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERIUNY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER d 9 (COCMENGINfiVWHSECTION70W) OFONISKNi30FTHEBU$INESSANOPROFE$$IONS CODE. AND MY LICENSE IS IN FULL FORCE AND EFFECT.---JJ7 LICENSE CUSS LID.NO. O DATE V CONTR.ACTOR w CONSTROCTION ORKERS'COMPENSATION DECLARATION t I HEREBYpFFIRM UNDER PENALTY OF PERIUM ONE pL�N Revzew OFTNE FOLLOWING OECURATroNSJ eteczazc h I HAVE AND WILL MAINTAIN ACEN7IFICATE OF OONSENT 705ELFINSURE FOR WORKERS' OfTPENSATION,AS PROVIDED BY SECTION 37000F THE UBOR CODE.FOR ONE PERFORMANCE MECHANICAL INSPECTION FEE HE WORK FOR WHICH THIS PERMIT IS ISSUED. ISSUANCE SMIP \ND WILL MAINTAIN WORKERS COMPENSATION WSURANCE,A$REQUIRED BY SECTION W 7- ENERGY P/C ENERGY PERMIT OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.M RETENTION FEE: RNER'COMPENSATION INSURAV-ECA ERANDPOLICY NUMBE RE. PRE-ALT FEE: IER.',- 7U T1� 5 /'1/1/TV-Y r za 1.�. (MSSECD7iNE81NJ7BE07.RETEDCF7FEPERAT6FN70NENINLNEOCQIAPSRI ORLESSL jq -1 ERTIFYTHA7INTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED,1 SHALL NOT EMPLOYANY PERSON IN ANY MANNER WAS 70 BEMME SUWECTTO THE VYt7RKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBEOJME SUBJECT TOTHEWORKERS'COMPENSATION VISIGNS OFSECTYYL'1 OF THE IA FORIHWITHCAM-PLYWITH7 EPROVISIONS E.WATT:APPLICANT NWG wnaNwo:FiwReoSERE ReWORKERS•COMPENSATION eove eiS UNIAWFDL,MIpSHALL BE TOTAL FEES iOBJECTMIEMPLOVERTOCCMINALPENMSIE.ANDCIVILFINESUPTOONEHUNDREOTHOUBAND DOLLARS (f1N.0071.IN ADDITION 10 THE COST OF COMPENSATK)N.DAMAGES AS PROVIDED FOR IN. 1 �N 37080FTHElABORCODE,INTEPEST,PNOATTORNEY5FEE5 2 STRUCTION LENDWG AGENCY w O I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(.ED 7.U.CIY OI. PAID BY VALIDATION V u(-fUl. 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