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HomeMy WebLinkAbout10551 (5) 1 4 -- CITY OF DIAMOND BAR r _� � �� COMMUNITY DEVELOPMENT DEPARTMENT V ;,.W 21660 E.Copley Drive Suite 190 �RESS• (909)860-3195 Fax(909)861-3117 ��'""'� BUiLDINGPERMITAPPLICATION FIRMLY y JOBSITE APPLICATION� � Z'- PERMIT � p r-7� P!C o ADDRES DATE NUMBER •.•-'c..• e c� ISSUE TYPE OCC APN LOT_ TRACT DATE CONST. GROUP p OWNER /�ZLGL� _ �" ADDRE ZONING SETBACKS � CITY ZIP��TEL. REORT RW ❑_ APPLICANT TEL. SIDE/SIDE STREET RW [:7 � m CONTRACTOR ID 1� 1 Iww� SIDE ❑ ¢ ADDRESS ' � O C�TM Q�• V ., nl � .3 PROPOSED USE � w ARCHlENG! WaI11Ut,CA 917�3� z DESIGNER N0.DWEL. NO. NO. a ADDRESS UNITS_ STORIES BEDROOMS � � CITY ZIP TEL. � y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION d O OWNER-BCILDER DECLAFiATION SFR/ADD/REM e � � I HEREBY AFFIpM UN�ER PENALTY OF PERJURY iMPT I AM E%EMPT FROM TME CANTRACTORS ll� G8f09B/C0fP01I W CENSEUWFORTHEFOLIOWINGREASON(SEC.7037.SBUSINESSAN�PROfESSION5QJ0E:ANVCITYOR (n � U COUNNWFiICHREQUIRESAPERMIT7000NSTRUCT,AITER,IMPROVE,0EM0USH,ORREPAIRANYSTRUC- W pali0/DBCI( w TUNE.PRIOR TO ITS ISSUANCE,AL50 RE�UIHE5 TME APPLICANT FOR SUCV/PERMIT TO FILE A SIGNED � � STATEMENi THAY HE OR SHE IS LICENSED VURSUAM TO THE PROVISIONS OF THE CQNTflACTORS LI- �. CENSE LAW(CHAP7EH B(COMMENCING WITH SECTION 7a0o)OF UIVISION a OF THE BUSINESS ANO PRO- u' POOUSpB � FESSIONSCOOE)ORTMATHEORSHEISE%EMPTTHEFEFHOMANOTHEBASISFORTHEALLEGEDE%EMP• � � 710N.ANVVIOUTIONOFSECTION7o31.5BVANVAPPLICANTFOHAPERMITSl1&IECTShIEAPPLICANTTO z RQ-ROOf � AqVIL PENALN OF NOT MORE THAN FNE HUNORED DOLLARS(SSoo).): Q � 0 ❑I,RSOWNEROFTMEPROPERTY,OftMYEMPLOYEESWITIiWAGE5A5THEIF50LECOMPENSATION, COf11RIBfCi21 Z WILI DO THE WORK,AND TNE STqUCTURE IS NOT INTEN�ED OR OFfEREO FOR SAIE(SEC.7066,BUSI- J NE55 AND PROFESSIONS CODE:THE CANTqACTOR6 LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPER7YWMOBNl0.SORIMPROVESTMEREON,ANDYMODOESSUCHWORKHIMSELFOFHERSELFOR � � THNOLICH HIS OR HEHOWN EMPLOYEES,PROVIDE�7HAT SUCH IMPROVEMENTSARE NOT IN7ENDED OR m Q OFFEREDFORS/LLE.IF,HOWEVEN,THE9UILDINGORIMPROVEMENTISSOtDWITHINONEVEAROFCAAIPLE• I Z TKKJ,THE OWNER�BUILDEfi WILI.HAVE THE BURDEN OF PflOYIN6 THAT HE OF SHE 01�NOT BUILD OR .I = IMPHOVEFOHTHEPUflPOSEOFSALEI. _— ---- ,w ❑I,RSOWNEROFTHEPROPEfliV,AME%CLUSIVELYCANTqACTING,WRHLICENSEDCONTMCTORS � TO CONSTRUCi THE PROJECT(SEC.70/a,BUSINE55 AND PROF[SSIONS CODE:THE CONTRACTORS ll- V8I118�iDfl ADJ.AREA W CENS[UWDOESNOTAPPLYTOPNOWNEROFAPftOPERTYWHOBUIL�SOflIMPROVESTMEHEON,AND � WHOCANTMCTSFORSUCNPRQIECTSWITHACONTHACTOR(S�LICENSEDPURSUANTTOTHECOMRAC- QUANTITY DESCRIPTION FEE Y TORS LICEN9E LAW.). � u 1 M1 EXEMPTUNDER SEC.,._.,_ 8.8 P.G FORTMIS HEARON Q O '— V � — -- -- ¢ � � DATE___'____._____oWNER U Z W � LICENSED CONTRACTORS DECLARATION W � d � 1 HEREBYAFFIRM UNDER PENALTY OF PEfUUFY THAT I AM LICENSED UNDER PflOVI310N3 OF CHAPTEfl � � � 9(COMMENCING WITH SEC710N 7000)OF DIVISION 30F THE OUSINESS ANO PROFESSIONS CA�E,IW0 Z �X MVLICENSEISINFULLFnORCEANDEFFECT. (..+�f� ��3 m I � UCENSE GLA�y55 �J`�^`Q�� LIC.NO.___ j ` V OATE /'G7y�_/� CONTRACTOR ' a 1 W � � WORKERS'COMPENSATION DECLARATION Q _ � U � IMEREBYAFFIRMUNDENPENALTYOFPERJURYONEOFIHEFOLLOWINGUECLARATIONS: � Z � � ______I HAVE ANO WILL MAINTAINACEHTIFICRTE OF CONSF.NTTO SELF-INSURE FOR WORKERS' _ COMPENSATION,AS PHOVIDFD BY SECTION 370o OF THE LADOH CODE.FOR THE PfHFORMANCE U i ¢ OFTHEWORKFORWHICHTHISPERMITISISSUEO. � � w _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS RE�UIRED BY SECTION � Q 37000FTHELABOHCODE,FORTHEPEHFOFMANCEOFTHEWOPKf-0RWHICHTHISPERMiT15 � ISSUED.MY WORKENS'CAMPENSATI�J INSUHANCE CARRIER AN�POLICY NUM6ER ARE: CONSTRUCTION _ ._____ j cnAnien___— PLAN REVIEW �44 Z POLICY NUMBER ELECTPoC 0 (tHIS5ECT10NNE�NOTBECOMPLEfmOF7HEPERM�ISFafiONEFAAOHED00LLAFiS(SIW)ORL6Sy PLUMBING ��. j � w MECHANICAL n�' � �v Z i CERTIFY THAT IN THE PEFFORMANCE OFTHE WOHK FOfl WHICN THIS P[RMIT IS ISSUED,I �(� SHALL NOT EAIPLOV ANY PERSON IN ANV MANNE{i SOAS TO BECAME SU&IECT TO THE _ �i ;8 '� WOHKEfl3'COMPENSATIDNLAWSOFCAUFORNIA,ANDAGREETHATIFISHWLUBECOME �NSPECTIONFEE f ,F SUBJECTTOTHEWORKEFS'COMPFNSA7IONPfl SIONSOFSEC�ION37000FTHELABOH � CODE,ISHALLFORTHWIT/ICOMPLYWI7HTH PR VI ONS. �SSUANCE {� �y �q � � SMIP 1� � 6 1�L(�Q� � p DATE:�_�� APPLICANT: __ -r�-.. W ENERGY P/C J. WARNING:FAIWNETOSECl1REWORKEfl5COMPENSATIONCAVEflAGE15UNLAWFUL,ANOSMALLBE � LL Sll&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHl1NDREDTHOUSAND ENERGYPERMIT ,� OOLURS�S��.�),INADDITIONTOTFIECOSTOFCOMPEN5ATION,DAMAOESASPROVI�EDFORIN � SECTbN37oeOFTHEtABORCODE.iNTEHEST.ANDATTORNEY'SFEES. RETENTIONFEE: � d CONSTFUCTION LENDING AGENCY PRE-ALT FEE� u � IHEREBYAFFIpMUN�ER7ENALTYOFPERJUflYTHATTHERE15AGON5TflUCTIONLENDINGAGENCY _____ FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.30B7,CIV.C.). X Z W � LENOER'S NAME_ —__ ___ 1— LENDER'SMORE55 . -�--�----- w ICEFTIFYTHAT117FVEREADTMISAPPLICATIONANDSTATETHATTNEABOVEINFORMATIONI9CORRECT. TOTAL FEES �/S � I AOREE TO COAIPLV WITH ALLCI7Y ANO COUNTY ORDINANCES AND STATE LAWS REL4TIN070 9UILDING � CONSTFUCTION,ANDHEREBVAUTHOHIZEREPHESENTATIVESOFTHISCOUNTYTOENTERUPONTHE Z A00VE�MENTIONE�PROPER7Y fOR INSPEGTION PURPOSES. COMMENTS, L�S J � '-- " m PERMITTEE NAAIE�PFiINT) __ Q Cn ` . % - ' ,�' _— . V' ?) 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