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HomeMy WebLinkAbout17571 (10) __ _ _ _ - - �.�_ CITY OF DIAMOND BAR � DEPART'MENT OF COMMLR�IITY&DEVELOPMENT SERVICES �.� 21825 E.Copley Drive (909)860-3195 Faa�(909)861-3117 PRE$$ '�-.Y»�°� BUILDINGPERMITAPPLICATION FIRMLY o ADDRIESS��-� ��,��`�-rr�_ DATECATION � NUMB R a� ��/ #(G c� ISSUE NPE OCC APN LOT TRAGT DATE CONST. GROUP p OWNER o ADDRESS ZONING SETBACKS Z CITY ZIP TEL FRONT RW -] o APPLICANT 7EL. SI E SIDE STREET RW 7 z Q CONTRACTdR '� � "�` SIDE ❑ � ADDRESS p PROPOSED USE CITY ZI ��TEL � ���� o ARCH/ENG/ z DESIGNER W NO.DWEL. NO. NO. a ADDRESS UNITS STORIES / BEDROOMS � CITY ZIP TEL. c� v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� � OWNER-BUILDER DECLARATION - SFR/A�DIREM O � I HEqEBY AFFIRM UNDER PENALTV OF PERlURY THAT I Md EXEMPT FflOM THE CONTRACTORS LI- � GaragelCarport W CENSEIAWFORTHEFOILOWINGREA50N�SEC.7a31.56USINE55AN�PROFESSIONSCODE:ANVCITYOfl U COUNTYWHICHREQUIqESqPERMITTOCANSTRl1CT,ALTER,IMPROVE,DEIAOLISH,OaHEPAIRANVSiRUC- W patio/Deck Z 'Tl1RE,PRIOR TO ITS ISSl1ANCE,ALSO flE�UIqES THE APPLICANT FOR S�GH PERMIT TO FlLE A SIGNED w' STA7EMENT THAT HE Ofl SHE IS UGENSED PURSUANi 70 THE PqOVI510N5 OF THE CONTRAC70R5 LI- W �. CENSE LAW(CHAPTEfl 9(COMMENGING WITH SECiION�000)OF DIVISbN 3 OF THE BUSINE55 AND PfiO- � PDOUSpa FESSIONSCODEjORTHATHEORSHEISD(EMPTTHEflEFROMAN�THEBA515FORTHEALLE0E0E7(EMP- (� O�'' rION.ANVVIOLATIONOFSECTION7031SBYANYAPPLICANTFORAPEqAdITSU&IECiSTHEAPPLICANTTO Z Re-Roof � ACIVIL PENALTY OF NO'I MORE iHAN FNE HUN�RED DOLLARS(5500).): �; ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITH=WA3ESASTHEIRSOLECOMGENSATION, L] Gommarcial -� Z�, WILL W THE WORK,AN�THE STRUCiURE IS NOT INTENDED OR OFFERm FOR SALE(SEC.7�d4,BUSI- J '. �' .NE55 AN�PROFESSIONS CODE:THE CONTpACTORS LICENSE LAW OOES NOTAPPLY TO AN OWNER OF ? PflOPERTY WHD B111L05Ofl IMPROVES iHEPEON,AN�WHO DOES SUCH WOflK HIMSELF OP HEPSELF OR 2', ��THROUGHHISOflHEfl�WNEMPLOYEES.PFOVI�EOiHATSUCHIMPP,OVEMENTSARENOTINTENDcDOR m Q�, �OFFERE�FORSALE.IFFqWEVERTHEBUILDMGORIMPROVEMENTISSOIDWl7}iINONEYEAROFGOMPIE- Z j ".TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINQ THAT HE OR SHE OID NOi Bl/1LD OR _'� 'MPROVEFORTHEPURPo5EOF5ALE). �,y� ��I,ASOWNEflOF7HEPROPERTV,AME%CLUSNELVCONTRACTINCWITHLICENSEOCONTRACTORS ��, .70 CAN5TRUCT THE PROJECT(SEC.7a44,BUSINESS AND PROFESSIONS CODE:THE CONiRACTORS LI- VdIU8t10l1 ADJ.AREA W'� CENSELAWDOESNOTAPPLVTOANOWMEROFAPROPERTVWHOBl11LDSORIMPROVESTHEREON,AND � 1 WHOCANTRACTSFORSUCHPROJECTSWITHACOMRACTOR(S)LICENSE�PUFSUANTTOTHECONTqAC- QUANTITY DESCRIPTION FEE F- YDRS LICENSE LAW.). � �. ❑I AM EXEMPT UN�ER SEC. 8.&P.G FOR THIS flEA50N Q � U ,� a DATE OWNER U � W r LICENSED CONTRACTORS DEGLARATION w ¢ CC I HEREBV APFIRM UN�ER PENALTY OF PERJUflY TNA71 AM LIGENSED UNDER PROVISIONS OFCHAPTER � d. e(COMMENCWGYYITHSECTION7o00)OFDIVISION30FTHEBUSfNESSANOPROFES510NSCODE.ANO Z X MY UCENSE IS IN Fl/LL FORCEAND EFFECT. Q UCENSE CLASS � LIC.ND. �/�!'�� � U DATE �'�'����`i.1` CONTRACTOF��s�� ��i�'� a . W � WORKERS'COMPENSATION DECLARATION Q �, I HEREBY AFFIRM UNDER GENAITY OF PERJURV OYE OFTHE FOLLOWING�EGLARATIONS: � , Z __IHAVEANOWILLMAINTAINACERi1FICATEOFCONSENiTOSELFINSUREFORWORNERS' y ' Q CAMPENSATIIXJ.ASPROVIDEDBVSECTION37o00FTHELABORCODE.FORTHEPERFORMANCE �U OfwTf1E WORK FOR WHICH iH15 P6RMIT IS ISSl1ED. � � 0 �`. W'', �'� INAVEAN�WILLMAWiAINWORK�RS'COMPENSAT70NINSURANCE,ASFE!]UIREDBYSECiION � �� � Q �370o OFTHE LABOfl COOE,FOR hIE PERFORMANCE OFTHE WORK PoR WHICH iHIS PFAMIT IS ISSUED.MYWORKEAS'COMPENSATIONINSURANCECARRIEFANDPOLICYNUMBEfiARE: CONSTRUCTION jcpaqiER PLAN REVIEW � POLICVNUMBER ELECTRIC . � (IHISSEC'fM)NNEmNOTBEQ�PEfEDOFhIEPERMRISPoRONEFAIIJ�REODOLlARS�5100)ORLE55). PLUMBING ' z ICERiIFYTHATINTHEPERF-0flMqNCEOFTHEVlORKFOflWHiCHTHISPERMITISI55l1ED,l MECHANICAL .,_ (,�}' SHALLNOTEMPLOYANYPERSONINANYMMIh'ERSOASTOBECOME°UBJECTTOTHE ' [/}� �WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THA71F I SHOULD BECOME iNSPECTION FEE � Sl1BJECTTOiHEWORKERS'COMPENSA71ONPflOV15 NSOFSECTION3]a00FTHEU80R ISSUANCE ��.�g�� COpE,ISH��A,'rLL-FORi�H_W�17HCOMPLVWITHTHO ,P Oy�l �� DATE: I:l ��APPLICA� �" '� SMIP � ��L�. O. J�.�� ENEAGY P/C � WARMNG fAILURE iOSEGURE WORKER5 GOMPENSAiION CCyb�AGE IS UNLAWFUL,ANO SHALLBE �', SUBJEGTHNEMPLOYERTOCRIMINAIPENALTIESANDCIVILFINESUPi00NEhiUNDREDTHOUSAND ENERGYpERMIT '�DOLLARS(51oa,000),IN ADOIiION TO THE COSTOF COMPENSATION,DAMAGES AS PROVDED PoR IN —�------- J'�'. SECTION 97oe OF THE LABOR CODE.IMERES',ANDATTORNEV'S F6E5. RETENTION FEE: � d. � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEREBYAFFIPMUNDEPPENALTYOFPERJUfiYTHATTHEREISACONSTRUCTIONLENDINGAGENCY FOR THE PER W FMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3091,CIV.C.). . Z w — — 2. .LENDER'S N.4ME � , I— LENDER'9 ADDRESS � TOTALFEES � ICEPTIFYTHATIHAVEREApTHiSAPPLiCqT10NANp5TATETHATTHEA80VEINFDRMATIDN:SCORRECT. w�.' IAGpEETOGOMPLVWITHALLCITYAN�COUNTYOR�INlNGESANDSTATELAWSRE�TINGTOBUIL�ING ��'. CONSTRUGTION.ANp HEREBV AUTHORIZE REPRE3ENTATNES OF THIS GDUNTYTO ENTER UPON THE � B � Z� A80VE�MENfIONE�PROPERiY FOR INSPEC710N Pl1RPOSES. / / � �� Q COMMENTS F,,.� J . �', _ _--_»_._ —'— ' m��"� PERMITTEE N ( �INT� � � �s--.,��""r��.. �'„ciGNATURE PEFM TT �ATE / = RECPT NO. PAID BY � VALIDATION ~ WHITE—De artment Copy,YELLOW—Finance Co PINK—Assessor Copy,GOLDENRO File Co GREEN—A IicanYs Co � P PY� PY, PP PY _ _ _ _ _ T �:; ,. , ,..,..�_. x� � ._ , � � � _._— m . :.�'. � �,` , €N',.��" �`E , � *����. 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