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HomeMy WebLinkAbout10861 (5) �� �� ���� �E�- CITY OF DIAMOND BAR �� �' �` COMMUNITY DEVELOPMENT DEPARTMENT -��"� � F �� ��� .;,.,� 21660E.Copley Drive Suite 140 �� PRESS (909)860.3195 Fa�c(909)8613]17 d ��'�� � BUILDINGPERMITAFPLICATION > �� ��f �a ` FIRMLY � JOBSITE '�'� � , ,.,�;: 'Af'PIJQATION PERMI7 p �'j(p' P/C <C AD�RESS '� ' � ' DATE NUMBER � # $ ISSUE ' `� TYPE OCC � � APN LOT TRACT DATE ! CONST. GROUP p OWNER �.� a. �� "' ADDRESS t� � t��;2�s, �°-� t�'&._ ZONING SETBqCKS� z CITY t�� p FRONT RW ❑ �'��f ll� TEL. � APPLICANT �-� ' '' `�'� ''v�� ��'��EL. REAR ❑ Z � SIDEISIDE STREET RW ❑ Q CONTRACTOR �"���-' ��:��"�'��� �„_�' ,= SIpE ❑ p� ADPRESS c�`�'^R� ����� �S�- � �+ PROPOSED USE �=s��'�� � ,CITY��9�..�R�Giw �4���— ZIP �'��lA'Z�a TEL.��1'.�°�Q'-��3r P ,, w ARCWENG/ z DESIGNER �� �+�� � �``��� NO.DWEI. NO. NO. a ADDRESS��3'-Y`� i�,,�'a�lve,et'k ���. UNITS STORIES BEDROOMS � °iTv���;�� ziP �'�� .. re�.. ��� �."��� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAI.UATION � OWNER-BCILDER pECLARA710N SFR/ADD/REM �� � � O � 0 I HEREBV AFFIRAA UNOER PENALTY OF PERJURY TNAT I AM EXEMPT FROM THE CONTRACTORS LI� � �arage/Carporl � W CENSEU1WFOflTHEFOLIOWINGREA$ONISEC.7o31,5BU51NES5ANDPROFESSIONSCO�E:ANYCINOR C) COUNTYWNICHHEOUIRESAPEBMITTOCONSTRUCT,AITER,IMPROVE.DEMOLISN,ORREP.URANVSTRtJC- W Pg1iO/DBCk - � WTURE,PRIOR TO ITS ISSUANCE,ALSO REWIRES TNE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W ' .� SiA7EMENT 7HAT HE OR SHE IS UCENSEO PURSUANT TO THE PROVISIONS OF THE CONTFiACTORS LI• , . .�, 'CENSE LAW�CHAPTER 9(COMMENCIN�WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. � PooUSpa p�. FESSIONSCO�E)ORTHATHEOHSHEISEXEMPTTHEREFROMAND7HEBASISFORTHEALLEfaEDEXEMP• (� V �TION.ANYVIOLATIONOFSECilON7o3L5BYANYAPPLICANTFORAPERMIiSU&IEC7S7HEAPPl1CANTTO Z Re-Root � 'ACIVILPENALTY OK NOT MORE THAN FIVE HUNDpE�DOLLARS(s5o0).�: , Q ❑I,ASOWNEROF7HEPR0?ERTV,ORMYEMPLOVEESWI7HWACaESASTHEIR50LECDMPENSATION, 0 CUrt1A19fC181 ' � � Z�� '�WILL W THE WOflK,ANO TFiE STflUCTURE IS NOT INTENDED OR OFFEflEO FOR SALE(6EC.7041,BUSI- J NE65 AND PNOFESSIONS CO�E:�iTHE CONTRACTORS LICENSE UW�OES NO7 APPLV TO AN OWNEF OF � PROPERiYWHOBUILD50RIMPFiOVES,7HEREON.ANDWHODDESSUCHWORKHIMSEIFORHERSELFOfl � ' � � CC� �THRWGHHI90RNEHOWNEMPLOYEES,PfiOVI�ED�THATSUCHiMPROVEMENT6ARENOTINTENDEDOR m . , ', Q� ,OFFEREDf-0RSALE.IF,HOWEVERTH�BUILOWGORIMPROVEMBdrISSOLDWITNINONEYEAROFCOAIPLE- ' �., '�.TION,TME OWNER�BUILDER WILL 11AVF,THE BURDEN OF PROVING THA7 FIE Ofl 3HE DID NOT BUILA OR = IMPpOVE FOR THE PURPOSE OF 6ALE): ❑I,AS OWNEROF THE PROpERTl AM EXC WSIVELY CONTRACiWG WiTH LIGENSED CONTRACTORS Q"� TO CANSTPUGT THE PROJECT(SEG.7044,BU3INESS AND PROFESSIONS CO�E:THE fANTMCTOflS U� V8IU8IIOf1 �OOO ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPpOPERNWHOBUILDSORIMPROVESTHEREON,ANO ��' �WHOCONiRACT5FOfl5UCHPflOJECT$W17HACONTRACTOq�S)LICENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION FEE � TORS LICENSE LAW.�. �p � �' O ❑I AM EXEMpT UNOER SEC, B.&P.Q FOq THIS REA30N U ��S.�T �' � �a �_ `'� 2 .�'- .t+f,� . Z ,DATE OWNER F" ����p _ �i � W �r> q. m td � LICENSED CONTRACTORS DECLARATION W ^ �� � �.�. �,I HEREBY AFFIRM UNDEfl PENALTY OF PERJURY THAT IAM LICENSE�UNDEFl PROVISIIXJSOF CHAPTER '� '�11��: g��„ g,�"'���� � � }� � r� ••� p:�����.9(WMMENCINGWITH�SECTION7000)OFDIVISION30F7HEBUSINES6ANOPROFES6�ONSCADE,AND i + �'V4-`� �+d?�!'.+&�'f' `X� MY LICENSE IS IN FUt1 FOFCEAND EFFECT. -.y ��- o ���; ��� , ` ,�� '�, .a 0�� ,UCENSE CLASS,�E"�� _ UC.NO. �Cd�L�'�Q� g U..� ,DATE �I s�i�'8'Y� CONTRACTOP �. - �'�.f,�'4.'�'t 8Jg . W.' � � WORKERS'COMPENSATION DECLARATION —+ � � I HEREBY�FFIRM UNDER PENAI,TV OF P�RJURV ONE OFTHE f-0IIOWING DECLARATIONS: Cn C]�� IHAVEANUWILLMAINiAINACEFTIFICATEOFCON5EN7TOSELF•INSUREFORWORKERS' � ¢� CAMPENSATION,ASPROVIDE�BYSECTION37000FTHELABORCODE,FORTHEPERFORMANCE OFTHE WORK FOfl WHICH THIS pERMIT IS�SSUED. W HAVEAND WILL MAINTAM WORKERS'COMPENSATION INSUqANCE,AS REa1JIRED BV SECTIIXd B�.'� 37000F THE LAfiOR CODE FOR THEPERf-0RMlWCE OF THE WOPK FOH WHICH 7HI5 PERMIT�S /3�•7 c� �� ISSUED,MVWOFiKERjS'COMPEN3yATIONIN�iSURANCECARRIERAN�D°POLICYNUMBERARE: NSTRUC � , � CARRIER �4f0f�C�Y,G✓dr 5!A•e M� �� �✓�;e . PLAN REVIEW Z POLICY NUA/BER 1L�i��.a: ��a�..� �'d'�L C°s � LECTRI � "'f a fni�ssEcra�vNea�rprsea�ai:Er�oF��w.ur�sraRa+eHuwnEoocu,ws�siao)oA�ssF PLUMBING 0 z I CERTIFV THAT M THE PERFORAjANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL . � SHAI.I NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJEGT TO THE � WORKERS'COMPENSATIONLAWSOFCAL�FORNIA,ANDAGREETHATIF U COME INSPECTIONFEE � SU&IECTTO THE WORKERS'CAAAPENSATION P 5i OF 5 N 37 F_1iE LABOR SUANC � � ` � � CODE I SHA -FOR�HWITH COMPLY WIT ION �� � ..� _ SMIP � .� p I �ATE:� � l APPLICANT: � '�,WAHNING:FAILUR TOSECURENH]RKERS'COMPENSATiONCAVERAGEISUNLAWFUI,ANDSHALLBE ENERGYP/C �y '�,SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNpREDTHOUSAN� �,NEflGYPERMIT ,�OLI.ARS(5100.tlOD),IN PDDITIONTO THE�COSTOF COMPENSATION,DPAIAGES AS PflOVIOED fOR W �"� 'i SECTION370BOFTHELABONCOOE,WTEREST,ANOATfOflNEV'SFEES. RETENTIONFEE: � °Q� � CONSTFUCTION LENDING AGENCY PRE-ALT FEE: O � � IHEREBVAF'rIHMUNDEpPENALTVOFGERJURYTHATTHEREISACONSTRUCTIONLEN�INGAGENCV FOq7l7E PERFORMANCE OFTHE WORK FOfl WHICH THIS PERMIT IS ISSUED ISEC.3oB7,CIV.C.). � . . W �Z; �IENDER'S NAME — �� ! F— 'LENDER'SMORESS . . c � �I CERTIFV THAT I HAVE READ THIS APPLICATION ANO STATE TIihTTHEA80VE INFORMATION IS CORRECT. TOTAL FEES "t!.� �l � 'g�/�� � � /J �, ,�,IAGREETOCqMPLYWITHALLCITYAN�COUNTYOR0INANCESAN�STATEIAWSflELAiMG708UILDING R�'��� � i 5 � . ' ' ' �',, „CONSTRUC'fl0li,ANDHEflEBYAUTHORREREPRESENTATIVE50fTHISCOUNTYTOENTENUPONTHE . . '� Z',�, �ABOVE-MENTIONED pROPEHTV FOF INSP�CTION PURPOSES. COMMENTS �'I �" �L�� Q ..'PFAMI E T) ... � � '�.�I � �� � �'�� :IGNATUflEOFPERMI DATE � �t► �� _ � RECPT.NO. � PAID BY l�Z VALIDATfON ~� �� WHITE—DepaRment Copy,YELLOW—Financa Copy.PINK—Assessar Copy,GOLDENROD—Fife Copy,GREEN—Applicant's Copy- - � _ .,. <., .. ,.,. - , . , . . ,,, ., - . , . .... ,. � ,. ,:.,.�. ,�:: y 4 .. ..:.:;. d'1�L.:i.,., 7 . ��: , a� ��� �' i�+° �' J�i�'�`�,�ti�����d� �'�� _. ���.��'�''�'�F� .,;���� �`�.;�,������ � � , . � �y a .wb' �,�; �;.� Yfa �.�� � 3 '.P s-, py.� �..� 9. M . . { ' ,� � � � .. � � , � �wta �i���� � 3-, �, � -�: ,, �� , � I . � � r ' . + -. 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