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HomeMy WebLinkAbout11269 , � �`� �—�'�``� —. CITY OF DIAMOND BAR � _•< f i � COMMUNITY DEVELOPMENT DEPARTMENT � �"„ � 216b0 E.Copley Drivc Suitc 190 PRESS (909)860-3195 Fax(909)861-3]17 �'"""+ SUILDINGPERMITAPPLICATION FIRMLY 0 DDRIESS�[/��id C�I����_� DATE'GATIOIV Z Z �a NUMB R � #/�� o� ( o ISSUE TYPE OCC °,° P�_� / +3► TRACT_������__ pATE CONST GROUP � OWNER �7 OO ADDRESS ZONING SETBACKS z CITY�9��'./YJ%'t�d��P TEL. FRONT RW �J___ __ APPLICANT TEL. REAR � o SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR � SIDE ❑ � ADDRESS Y ' "' t� �f �. CITY� e1C� ZIP / � �TEL.- PROPOSED USE __ __ __ w: ARCH/ENG! �y� Z DESIGNER�����d1'�C.�"r ����� NO.DWEL. NO. NO. �c ADDRESS UNITS STORIES BEDROOMS �; CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION = - �,= OWNER-BCIL�ER DECLARATION SFR/ADD/REM O; p> 1 HCl1EBY AFFlRM UNDER PENALTY OF PEFJURV THAT I AM EXEMPi FROM THE CONTRACTORS LL _ � GafdtJ2/Cafport LLI- CENSELAWFOR7HEFOLLOWINGREASON(SEC.7031.SBUSMESSAN�PRCFESSIOYSCO�F:ANYCITYOq � U-- CAUNTYWHICHREOUIftESAPERMITTOCONSTqUCl,ALTEF,IMPFOVE.�EMOLISH.ORREPAIRANYSTRUG ' W Patio/Deck / Z-- TURE,PRIOR TO ITg ISSUANCE.AL50 REQUIFES 7HE APPLIGANT FOR SUCH PEflM1T TO FIIE A SIGNED -- W O.D I s w�- STATE.M,ENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIOYS OF THE CO`ITRACTORS U �+ �bi � �` CENSEIAW(CHAPT[R9(C061MENCINGW17HSECTION7000)OFDIVISION30FTHEBUSINESSANDPRO- ` � POOUSp2 � ZJ � - � �` FESSIONSCODE)ORiF1ATHEOPSHEISEXEMPTiHEREFRO!dAf�DTHEBA5ISFOFTNEAIIEGEDE%ElAP. � � -�=. TION.ANVVIOLATIONOFS'eCT10N703158YPNYAPPLIGANT`rOftAPERMITSl19JEGTSTHEA?PLICANTTO -Z RB-RCOf ✓ U'� A CIVIL PENALiV OF NOT MORE THAN FNE HUNDflED DOLLAR�(5500)� �=- ~ ❑I,ASOWNEROFTHEPROPERN,ORMYEMPLOYEESWITHWAGESASTNEIRSOLECO�,IPENSAT Y (] _ �"- WILL DO THE WORK,/ND THE STRUCTURE IS h07 MTENDED OR OfFER'c�FOft S�LE(SEC.7o44,BU51 - J Commerciai z. �j_ �_ NESSANDPROFESSIONSCqOE:THECONTRACTOflSLICENSELAW00ESNO7AVPlYTOAN.OWNEROF - ?_ PROPERTVVJHOBUIIASORI.UPROVESTHEftEON,AN�WHOU0E55UCHWORKHIMSELFOftHEPSELFOR m :7 C[=- THflOUGHH150RHEROWNEMPLOYEES,PROVI�EDTHAT5LICHIMPROVEMENTSAflENOTINTENDEDOR ' - - U-1:-�- OFFERE�FORSALE.IF,HOWEVER,h1EBUILDI�vGORIMPROVEMENTI550LOWRHINONEYEAROFCOMPLC- ' � ���TIOY.THE OWNEF-BUILDER WILL HAVE-THE Bl1RDEN OF PROVI�G THAT HE Oq SHE DID KOT BUILD OR �-� I.UPRO`JE FOR THE PURPOSE OFSAIE�. � _ ❑I.ASONMEROFTNEPROPERTY,AMEXCWSNELYCONiHACTINGWITXLIGENSEOGOY7flACTORS ; �` �� TO CONSTHUCT TME PROJECi(SEC.1044.BUSINE55 AND PROFESSIONS CO�E:THE COYTP.ACTORS U t. � VelUefian /Q A� ADJ.AREA - LLl-. CENSELAWDOESNOTAPPLYTOANOWNEflOFAPROPERTYWHOBUILO50RIfdPROVESTHEflEON,AND. � ." �" WHOCOMRACTSFORSUCHPROJECTSWITHACONTf7ACTOR(SjUCENSEDPURSUAkTTOTHECONTpAC-- � QUANTITY DESCRIPTION FEE Y.'-TOPS IICENSE LAW.). - J O�_ G IAM EXElAVT UN�ER SEG _B.8 G.C.F09 TH45 flEA50N G G� � _ U .i �' — ----- OC t �-i ��- DATE OWNFR_ - - 7 F� :" W � ll.L ZO; A � = LICENSED GONTRACTORS DECLARATION ` W t ,� �- ��,��� l� `"_ ¢. CL- IHEREBYA�FIRMUhDCRPENALNOFPERJVRYTHATIAMUC'eNSE�UNDEfiPROVISIONSOFCHAPTEA � - �-= 9(COMMENCINGFVITHSECTION7oo0)OFOIVISION30FTHEBUS:NE55AN�PROFESSIO4SCO�r,AN� - Z . tX- MY UCENSE IS IN FULL fORCE AN�EFFECT - . C.�'' .�r f: m ��� LICENSECLA�S �=�[�3 LIC.N0. t7����/ �__ j __ -�� �,� ~. DATE�� wrZ ��3" GONTr7ACT0 r� a �� F U- T , -r �-� f WORKERS'COMPENSATION DECIARATION � �{ �� F�-�Q � '� � � � - � 1 HEREB -FIRM iINDEH PENPLTY OF PERJURYONE OFTHE FOL�OWI4G DECUR4TIONS: � Z _ (�ZYJ _ �- � � ��- I HAVE AND WILI MAINTAiN ACERTIFlCATE OF CONSEN.TTO SELF-INbL'RE FOR WORKERS' CAMPENSA710Y.ASPROVIDEDBYSECTONa]coOFTHELABOflCA�E,FORTHEPERFORMAq'CE U _ - a- �r�jFTHEWORKFORWHIC!17HISPEPMI7ISISSUED. : � � � / W-- 'j�_I NAVE ANO WILL MAINTA:N WORKEPS'COMPEkSATION INSURANCE,AS REQUIREO BY SECTION � Q, 37000FTHELABORCO�[,FORTHEPEFIFORMANCEOFTHEWOFKWRWNICHTHISPERMITIS - ISSUE0.1dY WO ERS'COMPE SATION INSURMCE C�ARR^IER AN�POLICV NUM ER AR: � CONSTRUCTION J(� C j��-' caaaiEa -- �` .-.G��i�(,.� �� li I6 PLAN REVIEW '1 •i/S P . __ �� POLICV NUMBER 1�����'�—�����_� ���� � ELECTFIC ,a� 4 (iHISSECTIONNE�AOTBECQMPLETEDO'rTHEPEP7vLTISWRIXJEXUrD7EDD�LtANS(Stro)ORLESS) .PLUMBING VF, � - W ICCRTIFYi}IA7INTHEPERFORMANCEOFiHEWOPKFORWHICHTHISPEHMITI51S5UE0,1 MECHANICAL f - � : (� '. $HALL kOT EMPLOV ANV PERSON iN ANv MANNER SO AS TO BECAME SUBJECT TO TXE _ - �_: VlORKENS'CAMVEYSATIONLAWSOFCALIFORNtp,ANOAGREETHATIFISHOULDOECOM.E 1NSPECTIONFEE - SUBJECTTOTHEWORKEflS'GOMPENSATIONPpOV IONS FSECTION�7000FTHELA F �' . ~ � CA�E SHALL OflTFiWITHCOMPLVWITIITHOSE I N� � ISSUANCE � . � . . � SMIP i . p -DATE: � �APPLICANT - - - - W - � - ENERGY P/C ��� � � � -WAFNI :FAIL ETO SECURE WOI1KEflS'GOMPENSATION CAVERAGE IS UNIAWFUL,AND SHALL BE —�r-"'a�„�� . �--SUBJE TANEMPLOVERTOCRIMINALPENALTIESAN�CIVIIFINESUPTOONEHUN�aF�iMouSANI] ENERGYPERMIT ---��-��� . DOLLARS(SIOO.oOo�,INADDITIONTOTHECOSTOFa]1dPEN5ATION,DAMAGESASPROVIDEDFOftIN - �__- SECTION37080FTHELABOflCO�E,INTEREST,ANOATTORNEY'SFEES. RETENTIONFEE: _._„_ � ___ �_ - �-- CONSTHUCiIONLENDWGAGENCY pRE-ALTFEE: 3Z-O�J O - �- INEREBYAFFIRMUNOERPENA�TVOFVEHJURYTHATTHEREISAGONSTRUGTIONLENDWGAGENCY �- FORTHEVEflFORMANCEaFTNEWORKFOHWHICHTHISPEflMIT15155UED�5EC.309],CIV.C). z (�.SS "-' � � .c�tr�� �'���—��� – .F� — — _� LENDEfl'S NAME . ��- LENOFR'SA�DRE55��i�s������ ��' �'-ff�� ' . � ICEfl71FYTHATIHAVEflEADTHISAVPL7CA710NAND5TATETHpTiHEABOVEINFOflMATIONISCORRECT. TOTAL FEES - . �, '� � � IAGREETOGONPLYWITHAILCITYANDGOUNTYOflDINANCESANDSTATELAWSREtATINGTOBUILDING . � CONSTRUCTION,ANDHEREBYAUTHORREREPRESENTATNESOFTHISCOU�TVTOEN7ERUPONTHE _ Z ABOVE�MENTIONE�PROPERTY FOR INSPEC71 N PURPOSES.- COMMENTS � � ��� _ �� m. PERMITTE AME PIN g'` � � � — :a+�- ATU O PE!AITTEE �A7E (� - = RECPT.NO. PAID BY VALIDATION - ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy � � � I l � � � � i� �, � � , �"` t �� � .: �' '�� � 5 J �<� '� � � fi '�.,. `.�'F`y�.'c"'" � ..� t --,�-^"�i , , ; k! i 7 I`.,.� ¢i T P.'i S31�� �'� "3 _;.�` 4, � �� '`� �' 4-y` C,�� .;.�� � � f .- y � ,W ( � � � -� ft� � � � � � i � � �3 4 t � i t:3 la .. t �� _ 4 �� e� 1 i � "�; y s �_ � n r, �1� :i , _ 1� � r { _ . �- t •=` i i a -7 � i �r ��^-, °�. �_-`=�r�1 `'� ' �. � -�i'-1, J .1 � 1 �-, � —� 4-c, :,� t I . i i'.'� ' � � � 3 7I � � i i � ' r�� � E a _ . r �,.� . y ..�rt I : � S�c .i 9 1 I � � �_�i ��If'�i`F1 1 ;� � •� S{3'S�I � 7 I� '. �.S'� � . Y � 4 � 7,t i I � V � q � aa i 3 ' I 1 1 .a i I` �4 .�3 , � � �; ���y� �� .;'1' �,i �. � ���r7; .. ) � � �Ti� ' ( e � Z (` i t t � d i S.� � � � ��' _ i hd fl} ; , � ( � i I' y i � � I'' i � 'i I ; �I , � � . � m� � � I y � i i t � � � ! � '�- � � _I ' 1.—a �—r i�y+- �_!� .. 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