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HomeMy WebLinkAbout16754 (10) �z� CITY OF DIAMOND BAR �''�' DEPARTMF,NT�3F COMMt7NT1'Y&DEVELOPMENT SERVICES I 21825 E.Cap(ey Drive (909)860-3195 Fax(909)861-3117 PRESS '<��^ BUILDING PERMIT AE'PLICATION FIRMLY n JOBSITE i � ' f �� APPLICATIfJN "J� � PERMIT �r'� P/C ( � ADDRESS�L�t—�„_��'I.��J� _ — 4ATE i NUMBER�1�� � #� '.'" ''1 . ! +�, TYPE OCC � APN �t}T TRACT D TEE t� CONST. GROUP p CIWNER +. � " � p ADDRESS , �Cl r w S �-c �' Z4NING SETBACKS � C17Y �f�,_ �. ��.Z(L,t' fiEt. FRONT RW ❑ "�.P�ICANT J�,�' �l �� ' �2 , ���}���j��j ig REAR � r ��� -� �"'*"' � SIDElSIQESTREET RW___ ❑ � GONTRACTQR_._ SIpE � ADDRESS , a Ci7Y ZIP TEL. PROPOSED USE � _ _ oARCN/ENGI -- z pE51GNER � � ADQRESS NO.DWEL. NO, NO. � CITY ZIP TEL. u���s STORIES __.__ _BEDFt�MS � DESCRIPTiON SQ.FT. FACTOR PSF ADJ.AREANALUATtON � OWNEF-BUILDEF DECLARATION p SFFitADDIREM [� I HEREBV AFFIRM UNOFR PENALl'Y OF PERJUqY THAT I AM EXEMPT FROM THE CONl RAClOpS LI- G8f2QB/CdfpOfl t11 CENSEtAWFqRTHEFIXtpWiNGREASON{SEC.70.47.SBUSINf5SAN4PROFESSi6NSGWE:ANYC1T74fl (J} C.7 COUNTVWHICHRE�UIRESAPERMITTOCONSTFIlCT41.TER,IMPROVE.OEMOLISH,ORREPAIRANYSTRUC� � TURE,PRIOR TO ITW ISSUNJCE.AL50 REOUIRES T41E APPLICANT F�R SUCH PERMIT TO FILE A SIGNED W Patio/Deak .� 5TATEMENT TtiAT HE OR SFE�.4 L3CENSED PURSUANT TO THE PR6Y1StONS pF THE C�NTRACTCRS l�� ' � CENS�LAW(CHAPTER 9(C4�MMENCIN4 WITN SECTI04]Oq0)OF DIVISION 3 Of THE 6USINESS AND PRO� V' PooUSpa FESSIONS CtlUE}Ofl THAT ME OR SNE IS E%EMPT THEREFROM AND THE 6ASIS FpR THE ALLEGED E%EMP� � V 71ON.ANYVK7LATifN+10FSEC7tON7631.56YANVAPP4ICANTFORAPERMiTSU&IECTSTHEAPPIiCANTTO Z Re-Roof A CIVI�PENqL'ry OF NOT MOFE THAN FIVE HUNDREC)DOLUAqS(S5oo).�: � ❑I.ASOWHEROFTHE�ftQPERTY,OftMYEMPtOYEESWfTHWAGE5A5THE�RS4iECOMPEN5ATiON. � Cam�pgtGidl � WILL Dq THE WORK,AND THE STRUCTURE�5 NOT INTENDED OR OFFERED FOR SALE(SEC.70bq gU61. J � NE55 AND PROFES910NS CODE:THE CbNTqpCTORS LIC�NSE LAW DOES NO'f APPLY TO AN OWNER OF � Pt�PERTY WN6 EUIlOS ORlAbPROVES THERE4N.AND WHO DOES SUCH WOftK HIMSEIFOR FiERSELF Qfl WTNROI,IGH HIS OR FiER OWN EMPLOYEES,PRpVIDEp THAT SUCH IAAPRDVEMENTS ARE NOT INIENOED OR m � pFFEREDFORSALE.IF,MOW'cVER,THEBVILDINGORIMPROVEMEN71550LDWITHINONEVFAROFC(�MPLE� TpN,TNE OWNER�BUtIOEft Wi�t.HAVE THE OURDEN OF PpOV�NG THAT HF PR SHE 6�D NOT BWLD OR W IMPFlOVEFOHTMEPURPOS=OFSALE), �� L71.AS OWNEfl QF 7HE PHOPERTY,AM EXCLUSIYELY CONTflACTINtl WRH UCENSED CONTRACTORS [[ TO CONSTflUCT 7HE PROJECT iSEC.7944,BUSINESS AND PFOFESSIONS CODE:TH6 CON7flACTOPSIb V2IU2ti0n ADJ.AREA W CENSELAWDQESNbTAPPI.YTDANOWNEROFAP40PERTYWHOBUIlp50RIMPRGVESTMEREbN,ANp ' — � WHbC4NTRACTSFORSUCttPROJECTSWiTHACANTRACTqR(S}(,ICENSEDPURSVANTTOi'HEGCtNTRAG QUANTITY DESGRIPTIQM1I FEE � TORSUCENSELAW). d :J i AM EXEidPT UFiDEFt SEG. ,,,,,, 8.&FC.FOR TNlS REASON Q � / U � —....^. ''�_ , _ — tL T j . . � ,`—",��"� . � i �..—_... �_ Z U � IfCENS_D CONTRA T4RS DECLARATiON W ¢ CC IHEREBYAFFIRMUNDERPF.NAITY�FPER.fURYTNATiAfAUCENSEDi1Ni7EftPROViSN?NSOFCkiAP7ER � � p„ 9(COMMENCING WITH SEC'f10N 7000)OF D'iVISION 30F TNE BUSMESS AND PROFESSIONS CO�E,AND Z � MV LICENSE IS M FULL FORCE AND EFFECT m � UCENSE CLASS�___ _LIC.NO. � � � �� � pATE _„�__ CONTRACTOR,_„ _, . a . W � WrJRKEflS'COMPEN5A7ION DECIARATION � I HEREBYAFFIRAi UNO£F AENA{,'Y�P£RJUFiY ONE OFTHE F6I.lOWINC.�EG.AAATKKiS: Z � �i HAVEAPIO WILL M4INTAIN AGEHTiFl4"RTE 4f fAN5ENT TO SE4.f-INSURE fOR WORKERS' a 2 ,y� CAMPENSATION,P:>PRQVIDEDBYSECTION3��OOFTHEIABORCo�E,FORTHEPER'roRMANGE U � OF7NE WORK FOR WHICHTHI.5 PERMIT IS ISSUE�. � � __�„I HAVEAND WILI MAINTAIN WqRKER3'COMPENSATION INSURANCE,AS RE�UIRED 9V SEC710N '[C 37DOOF THE LA80�'',COUE�CIH THE PEflFQRMANCE oF THE WORH FCIR WHICtf 7NI5 PEqMIT15 (��~ ^) / �/ �� � ISSUED.MV WORK:RS'COMPF.NSATIC7N�NSURANCE CAqRIER AND POLICv NUMBER ARE: COFISTRUCTIOM13 " ', • SJ`(f J — �—.__.._.._ y cnaR�se_..,. _„ _ ,i PLAN REVIEW ���— � . � PouCY NUMBER.._.._......_. —...—... ELECTRIC L7 ( ¢ ,.. . � �i17LSSEGTM:'MNEEC�NOTp.ECOMPLETEDOFTHEPERMf11SFORIXJEHUNDRED00lIAH5�b10qOfILESS). PLUMBING � W — � i CERTIFY TNAT IN THE PERFORMANCE OF THE WORK FUF wHiCH TNIS PEqM1T t5 ISSUEU,i MECHANiCA(. C� SHAl.LN07EMPLOVANV7ERSONIM1ANY MpNNER50ASTO0ECOME5U6JECfTU'ME �' '— [J) W6R%ERS'C6MPE:NSAFi�tAWS OF CALIFORNIA.ANO dGR=E THAI iF i SNQULQ BEfAME ��SPECTION FEE � SU&IECTTbTHE1NORKERS'CpMPENSATION?ROVISIONSOFSECTICINJ]OOOFTNEUBOfl CODE,1 SNALL FONTHWITH COMPLV WITN 1'HOSE PROVISIONS. ISSUANCE � p �ATE: APPLICAN7; SMIP L.ry� W .._— —.. ..— C � � WAi1NING:FA�LURE To SF�IIRE WOFKERS'COMPENSAiIONCOVERAGE IS UNLAWrUL,ANp SHAiLBE ENERGY PIC .,,,,, _� � SU&IECTANEMPLOVERTOCRIMWALPENAI.TIESAN�QVILFINFSUPTQONENUNDREDTHqUSAND ENERGYPERMiT D{N.LAflS{$10D,OW}.IN A(JDISION TOTHE C0S7 OF CGMPENSAT16N.OAMAG£S AS PRtJY�E6 FOfl IN J SECTICIN 3lqe OF THE LAP�OR Cf7DE.INTE9E5T,ANp ATTORNEV'S FEES. �—_' �--- Ct RETENTIONFEE: �'" r .��1,J � CpNSTRUCTiON LENDING AGENGY PRE-AlT FEE; �,_ � � 4 HERGBYAFfiFM UNDER PENA(.7Y OF PER.IURY TNAT THERE 1S ACONS7RVCTION LENDING AGENCY _ FOF TNE PERFORMANCE OF THE WOpN FOR WHIf.N THIS PERMIT IS ISSUED(SEC.a09],CIV.C.i. "' ' ' � � W — � LENDER'SNAME_.^_,,.. .,_ . ..�... F— LENOEH'SAODAESS � ICERT6YTHATIHAVEREPDTNI3APpt.iCATipNANpSTATE7HATTHEA90VE#v'FOftMATiONISCORftECT. TV�AL�EES �� �1 r J( � �� �. {�,�(f, W IAGREE TO COMPLV WIT�I ALL CITV AND COUNTV ORDINANCESAN�STATE LAWS RELATING 70 BUILDING � � CON9TRVCT'ION,AND HEIxEBY AUTHpR2E pEPRESENTAI'IVES OK iH15 COUNTV TO ENTEN UPON THE � ABOYE-MENTIONE PfiQt'ERTY f-0R INSGECTION PURPaSES. COMMENTS � �"' _ _ �-��`�t:;��'��- __ m E N�E{PAIN)j .q „ , ,. .—__....... -- ,.�._�"L�f 'Z.-_ !� � St�fA�' PQF ERMITTI_f ' pATf � —'-�-' " RECPL NO. PAI6 BV VALIOATiO� ~ WHITE—DeRaRmBnt Co YEILOW—Finance Gopy,PINK—Aases5or C � py, apy.GOLDENRO�—�i4e Copy,GREEN—Applican s Gapy � �� ��, , d € � � „ ���a � �r�� �'�w �n,-�, �"s .� '� _ _ iw 3°a��ta.�d a i �»,�e�, t��i _ .. . . . .. . . . . . ._. . , ,s�a... �� � ���, .. . ` . e . . . . .. . .___... . ... . . . ... ... .... . � ,� �� :: . ..- . . ... ... . . .... . . .. .. .. . ... . . . � . ,.. � .. .. �.'_ t. � .. ... 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ISSUE �, TYPE OCC DATE � CONST. GROUP ZONING SETBAC KS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM � Garage/Carport W Patio/Deck � PooUSpa Z Re-Roof � Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U U w J W Z 00 J a U 2 Q U W /�� �,1 yl CONSTRUCTION � v PLAN REVIEW � ELECTRIC v �� PLUMBING I-: . MECHANICAL INSPECTION FEE ISSUANCE � SMIP t: 11 � U ENERGY P/C ENERGY PERMIT RETENTION FEE: �� �� PRE-ALT FEE: TOTAL FEES �-�,�,� � I� )-(r�� COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicants Copy fZ�cijG 501LEt2t0 .SvcUtj uraJE Z SL43 .t�v STc plpc Al-7 caX'2C,-I 7 J�ffr' « iNf�4._