The URL can be used to link to this page

Home My WebLink About11912 � � CITY OF DIAMOND BAR —� ---�1� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES • �—� � - 21660 E.Copley Drive 5uite 190 � (909)860-3195 Fax(909)861-3117 PRESS � '9^° BUQ.DING PERMIT APPLICATION FIRMLY A DDRiESS � �� s f DATEICATION r/�� NUMB R i��q/C / T�'PE OCC � APN OT • TR CT D TEE CONST.� GROUP p OWNER �1T ��/� IJI� � C�_ o ADDRES S_�d,� r�s � Z ONING SETBACKS z CITY ZIP TEL. FRONT Ryy n $ APPLICANT TEL. REAR � — � — SIDE/SIDE STREET _ pW U CONTRACTO j ' ( � �"� SIDE -- � ADDRESS � � .-- ' a� �--- o CITY (��(J�/�,(•{— ZIP_ TEL. �� ... PROPOS[D U5E�z� _ wi,--. ' .� �j,91hC� � w ARCWENG/ ` � ` � z DESIGNER Z-�� a ADDRESS NO.DWEL. NO. NO. UNITS_ y C17y Z�P TE� _ STORIES ____�____BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION O SFWADD/REM p I HEREBY AfFIRM UNDER PENALTV OF PEHJURY 7HAT I AM EXEMPT FHOM THE CAN7NACTOBS LI. Gafege/CB�pOff W CENSEUWFORTHEF�.LOWINGREASON(SEG7037.58USINESSANDPqOFF5510N5CODE:ANVCITYOR (n WCOUfJTVWHICHqEWIRESAPEHMI7TOCONSTRUCT,AL7ER,IMPqOVE,DEMOLISH,ORREPAIRANYSTRUG � �p A NRE,PRqq TO ITS ISSUMICE,ALSO qE�U1RE5 THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNE[1 W Patio/Deck ��,,�� STATEMENT 7HAT HE OR SHE IS LICENSE�PURSt1ANT TO THE PROVISIONS OF THE CANTpACTOR6 L6 � CENSE LAW(CHAPTEq p(CWdMENCING WITH 6ECTION 7000)OF OIVISION 9 OF THE BUSINE55 AND PRO� V' POOUSPB � FESSqNSCODE)Ofl1HATHFORSHEISE%EMPTTNEREFROMANI)TME�ASISFOfl7HEALLEG[DEXEMP� � T�ON.ANYVIOLATIONOFSECTION7037.6BYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPUCANiTO Z Re-Roof � ACMLPENALTVOFNOTMOREAi{WFNEHUNDREDDOLURS(5500).): � ❑I,ASOWNEROFTHEPROPERTY,ORMYEM.PLOYEESWITHWqGE5A5iHEIRSOLECAMPENSATION, � Commercial . VtILl00 THE WOHK,AND THE STRUCTURE IS NOT INTEN�ED OR OFFERED FOR SAIE(SEC.7044,9USI- J N NESS ANO PROFESSIONS CO�E:THE CONTRACTORS LICENS[LAW DOES NOTAPPLY TO AN OWNEfl OF � PppPEqfYW110BUILD50RIMPROYESTTIEHEON,ANDWXO00E55UCHWORKHIMSELFORNEHSELFOR -' � THROUGHHISORHEROWNEMPLOYEES,VROVIDEO7HATSUCHIMPfiOVEMEMSAqEKOTIN7ENDEDOR ' CD W OFFEREDWRSALEIF,HOWEVER7MEBl11LDINGORIMPROVEMEN7135oLDWl1'NINONEYEAROFCOMME- �.� TION,THE ONRJER�BUILUER WILL HAVE THE BURDEN OF PROVING TNqT HE OA SHE OID NOT 9UII.0 OR � IMPROVE FOR TME PURPOSE OF SALE). f.11,A50WNEROFTHEPROPEfITV,AMEXCLU5IVELYCONTRACTINGWITHLICENSEDCONTRACTORS ' �� TO CONSTRUCT TH[PROJECT(SEC.70M,BUSINESS AND PROFESSIONS CODE:TME CONTRACTORS U� � V81Ufll10� ADJ.AREA ' S� CENSELAWDOESNOTAPpLYTOANOWNEROFAFROPERTYWH09U1LD50HIMPFlOVESTHE(iEON,ANO ' —""' -" -------- �--�---�--� F: NRfOCONTRACTSFORSUCHPRQIECTSWITHACONTRACtt1R(S)�ICENSEOPURSUIJJTTOTHECANiHAC- i � QUANTITY DESCRIPTION Y Toas ucENSE uw.�. FEE o; O IAM EXEMPT UhOER SEC._ _____,__B.$P.C.FORTHIS REASON - Q ' �. U LL' DATE'__ ONTIER... ' __' � A. w � Z. _'_._..__.— U C.�-� �� LICENSED CONTRACTORS OECLARATION W � . . I HERFBY AFFIRM L'h'DEfl PENALTV OF 7ERJUHY 7HAT I AM UCEN3ED UN0[R PROVISIONS OF CHAPTER � �� p.�, 8(COMMENCINO WI7M SECTION 7000)OF DIVISION 30FTME BUSINESS ANO PROFESSIOV5 COD[,ANU Z X MY LICENSE IS IN FULL FORC AND EFFECT. • �- m W. � d' LICENSE CLASS „ LIC.NO. �� _ � � ; � V��. DATE_ w � I � CONTRAGTOR !` d W. �� WORKERS'COMPENSATION DECLRRATION G'j"'� � Q �' IHERE9YAfFIRMUNOERPENALTYOFPERIIJRYONEOfTHEFOLLOWINGDECLAHATIONS��t/� i /� U U� IM1_ f; Z 0. IHA AND�LLMAINTAINACEflTIFICRTEUFCANSENTTOSELF�INSUREFORWOHK. ��,` a �' P = �. PENSATION,AS PROVIOED BYSECTION 3lo0OF THE LABOR CODE,FOR TIIF PERF M�NC U F TME WOqK FOR WMICH THIS PEiiM1T IS ISSUE�. W W> � � _INAVEANDWILLMAIMiAINWORK[F75'CAMPENSATIOQNINSURhNCE,ASR[OUIRFUBYSECTION � — Q. 37000FTHE1_ABORCO�E,GORTNC�GRFORMANCE FTHEWORKFORWHICHTHISPERMITIS J � ' S� DPOLICYNUNC a -: CONSTRUCTION .._ .__ y , . ._...—. "'__ � : j. CARH ER Y WOP.KE _OMP IS TI iNsuRa .%qqRieR r p�pN REVIEV✓ �G _".... ...._... :' Z� POLICYNUAIBE .j. • �c� ELECTRIC � f � .. Q � i�'�� -------- ..._—..... __....—f._--_t_3 ', � (MISSECiI(NJNE�NOTBEWM1�IEfEDOF7HEPERMfT13F'ORIXJ[INMMEDDOLWRS(b10D)OfiIESS}� PLUMBING .._,_____._ W ...—._._ ._.. ..—_"— Z. I CERTIFV THAT IN THE PEHFORMANCE OF THE WORK FOR WHICH THIS P[RMI71515SUED,I MECHANICAL CJ.. SMPILNOTEMPLOYANYPERSONINANYMANNERSOASTO�EC.OM[SUOJECTTOTHE �� - '--' '-'---- .;� (q WORKERS'COMPE4SATIONLAWSOFCALL�OHNI AN�AC,REETHATIFISHOULDOCCOM[ INSPECTIONFEE __,.___._._.. �f_ � • _'� SUBJEC T�T��KERS'COMPENSATIONP !SIONSOFSG�37000FTHELABOfl -- � �--- "—��rr � COOE,I MA4 T 1WITH COMPLY WITH THO R I IONS. ISSUANCE �,.+, �, W' DATE:__'_ �, . APPLICANT: � SMIP ,� � : J WARNINL.FAIL RL TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNUNTLIL,AND H L BE ENERGY P/C J . .._'_—' "'—"___....—__._. �`. SU&IECTANEMPLOYEHTOCHIMINALPENALTIESANDCIVIIFINESUP100NEMUN�REOTH AN� ENERGYPERMIT .___ ..____., __ f .� OOLURS(f 700,000).IN ADDITION TO THF.COST OF C�MP[NSATION,DAMAOE5 AS PROVIDED FOR IN J, SECTION 37080F hiE LABOR CODE,INTEREST,AND ATTOHNEY'S FEES. OC� RETENTION FEE� O, CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �, • _ � �: 1 HE{7E6Y AFFIHM UNDER PENALTY OF PEiUUii`/THAT THERE IS A CONSTRUCTION LENDING AG[NCY �' FOftTHEPERFORMANCEOFTHFWORKFORWk11GITHISPFRM171SISSUED(SEC.3097,CIV.C,). —"'— �a --.—_ w �� I.EN�EWS NAME __' .. __'_"" ""_"' —.' "_' '—._. F— LEN�Efl'S.M1OOflC55__,__ / w 1 CERTIFYTHAT I HAVE READ THIS APPLICATION AND STAI"E THAT THC ABOVE INFORMATION IS CCRRECT TOTP.L FEES . �i'f�� j( D � 1 AGREE TO COAAPLV WITH All CITY AND COUNTV OHDINANCES AND STATE LAWS RELATING TO BUILUINO / � � CONSTRUCTIDN,qND HEflEBYAUTHOflIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON TME /- `� Z �80VEMENTKKJED PFOPERTY WR INSPECTION PUHPOS[5. COMMENTS_�y�� .�J O� 0 � � __ J � � —'_' ' _'_'—_ m f+ERMITT AUE( INT) C5�7/v r -- _"_' Q �//y��► .— �ry SIGNANqEOFPERMITfEE DATE r �� —' ' . � RECPT.N0. __PAI�BY J�� . VALIDATION_ I WHITE—�epart Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �.� 4�S'k+ � r na t � .�� -r---��-- -�^�- _� .;,�.,.�_ i �t � i � �'.r ..� �' � �" �y"� �k� �� s . 6 � �° k �; i �e � -�3�^�� '" '�:� i� � � 1 i . � _��`II � � ��„� � q�ro9 �� r� r �� ,{� _ � . ��j � ( �� r ,� � �I � � , � � ��; : k� : �,� a ,, ��,�_ j � � { � � I � 1� r ' ' r' r ' � - � - v�ua " 1 �� a.� ¥ �E � � p � .i � �, i i � .� �- i � �I :� ,�c � ' I � ) ��x� . . 'e�� i � e s i � � ; i - �. �I � c,. � "4 i {�w,�'a fig � i i � � I ! � � � .�,� �° , ' ''' �',.,. �--� r I I i _ a_ !. ,.:� � i �� , i �� .. �k� � , . ` ..:�i i ,_ � ..__ .� i : � -i �� V � ,§8i�ripd i R �k . I I l �. 9._' �� , 4� � � t��..,a�e �•. # y I � I i � � i 1�� I\ t I ' � � i 1� i ` � ��, �t �v ��1 ( � � �' I i � \' I ( � � � �� I' ' � , : I � x . � , i , ; � � � � ` �� '� � � ' � �-' � . ,. " ...�,. � � _,— . ��: -.-1- - -� � � , E : � ; F a ' � � � 1 �� , � } � ; � ', � - I i l � � � �� : i � , . �. � i I �i ; i I ,, , ' .� , � i I � -. � F ' � j i I i I i � i !� I I � � ( ' k , I �� i � i � r ; I I ' E � , f 1 � .�rr � � ( i � ` � ; � � � � 1 ( � � � ` �i � �� i � r I � �r� �� , � I ` f 1 � i r , � � � I � �� i e<� ,� � � � � ' i I � I � ' i � I I I � � ''. i I �� S5b � I � � ' � ( ! � � � I � . I ,.' ! , ' �.'..' I ; 1 ; ' tb,,� r �,J � i�-, _� �..�-,._�._I "`�� : ' .'� � ��„ ��} � � :� v � � , ' j , � � � � k I �� I - I� r �� , ;I �� ;? � �, �� a . � ; � ( �. §�� T• ��.i jf ,� .' w� i �.u� . _+`� � ' � � � � � i i ��, r � ��; �� '; �� -� ' i r � � ' � i `i�, ��' � r� i ; t , �� I �,- �� - i > � � t , �� h: � zl ' i Cs �,i , �*��; � :� t a,ic' II�� r i � r� ,aa � ! j � , � I '� : I � �:�, �i i � �: i a a .� ; r C u i ��; a�.� � :I �.� I I� �, �� € ; i � �� i I- I � - � � _ � �-r �� i qc � �� a "�� t � ( I � � , � � I ( �� ,I �i i ' I � �� j I� I I I=i x'1 I" � ��; �.' � � � I � � � ' C'�� ' ! I � '� i I . ,�. I �=� C''�i ' �i 2�� i � � ' I ', , , - � ! ' � ,; i I � � ��` i I ., . i � pry"�s ' � r �, I � � � � � � 1 � � � i }`�;� ..__ � � �_..�_ , }._ � .....__ .�. ........ _ � R � I � i � I � '� '__ � ; i f � � i � � , I j ' "� i � i � i j � ' � f , '� 1 ; � , i I I ��': � � , i ° i � i ' ��3 � � � ', i � � � , i I i , � � I , I I �� , ; , �` i ' i � '_. ' j_. _._ � � i � � �- , �-- { i� � � � � ; ' ' � � � � ' ; , i I' i i i. � i I � , � � � � � i � � K a I �� , ' I � i ' ' i: 1 j i I � j � i ' i � i �i'� �; , t � i �� t 'i � i I i � � I i � � . � i i � , ' , � ' , � I i ; ' � � � , i I � , � i i I € � � i I � ' �Aa�' . . , . . ' I � . 4 4� i �� ._SS�mp ��' . i � i , . ( I � � '� � � i� . � I , ��". ! i • � , � � i �........... ... __ _-_.__. ..... . � , , __ .�,. , : ! , _.�_._ ,,_�, . .....�_ _.. .. _ LL_... _... _..:.. .._� _.._ ._.. �__.... . . ..__ ._,�_ __. _ _. . . _. .. , ..... . ' �'