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HomeMy WebLinkAbout10218 � ��� � � CTfY OF DIAMOND BAR � COMMUNITY DEVELOPMENT DEPARTMENT -,,.w 21660 E.Copley Drive Suite 190 � (909)860-3195 Fax(909)861-3117 PRESS ,'�"'� BUILDINGPERMITAPPLICATION "'"' FIRMLY 1! } JOBSITE // ��-� I APPLICATION (� PERMIT �� /C n ADDRESS o� J�� � C,�/-c��i� �/l�ll��� ��-� DATE � `�l , NUMBER � ISSUE TYPE OCC a APN LOT TRACT DATE CONST. GROUP r; � p OWNEFI � o ADDRESS ZONING SETBACKS �' W FRONT RW f 7 z CITY ZIP . TEL. y o APPLICANT�����-�-:�- TEL. REAR n ;: Q t SIDE/SIDE STREET RW O � a CONTRACTOR V t�___�I`.��t�' SIDE ❑ ADDRESS ,� �Z � �!��.�,�r1•z..��/�� ���- • - 4,. + O s �'``- PROPOSED USE_ ` ?-' CITY T�4: .K1 1�i�C�'1 ZIP 7<t7J�{ TEL. "7�-'r '�l�..i ' o ARCH/ENG! ``� ` v § w DESIGNER NO.DWEL. NO. NO. a ADDRESS jj � UNITS STORIES BEDROOMS = CITY ZIP TEL._ �� cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ' p� OWNER-BI:ILDER DECLARATION SFR/ADD/HEM ��j O �,,� I HEHEBV AFFIRAI UNDER PENALTV OF PEHlURY THA71 AM EXEMP7 FPOM 7HE fAN1RACTOqS LI- G8f89B/C31�foR � � ;' W CEN5ELAWFOHTHEfOLLOWINGREA50N�SEC.7031.58U51NE55AN�PPOFES510NSCODE�.ANYCINOR U COUNTYWHICHREWIqESRPEPMI7TOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,OflREPAIRANYSTRUC- ;) � 7URE.PflIOR TO ITS ISSUANCE,AL50 RE�l11RES THE APPLICANT fOR SUCH PEHMI7 TO FILE A SIGNED W Patio/Deck STATEMENT THpY HE OR SHE IS LICENSEO Pl1PSUANT TO THE PROVISIONS OF THE CONiRACTORS LI- � CENSE LAW(CHAPiER 9(COMMENCIN6 WITH SECTION]ooa)OF DIVISION 3 OF THE BIISINESS AND PRO- V" POOUSpB � FESSIONSCODE)OR7HATHEOR9HEISE%EMPTTHEREfNOMANDTHEBASISFURTNEALI.EGEOEXEMP� (� V TION.ANYVIOLATIONOFSECTION7071.SBYANYAPPLICAMFORAPEHMITSU6JECTSTHEAPPLICANTTO � Z Re-Roof A qVILPENAITY OF NOT MORE THAN FIVE MUNDRED DOLLARS(SSao).): ❑I,AS OWNER OF THE PROPERTV,OR MY[MPLOYEES WITH WAOES AS TNEIR SOLE COMPENSATION, Z WILL DO THE WORK,AND THE STFUCTURE IS NOT INTENDED OR OFFERED FOH SALE(SEC.7040,0U51• � COffIffl8fCl81 � NESSAND PqOFES510N5 COOE:THE CONTRACTOR6 LICENSE UW DOES NOT APPLY TO AN OWNER OF � PflOPERTY WHO 9UILO5 Oq IMPROVES THEflEON,fW D WNO�OE5 SUCH WORK NIMSELF OR HERSFLF OR � THRIXIGH HISOR NER ONTI EMPLOYEES,PROVIUED THAT SUCH N,IPROVEMENTS ARE NOT INTENDED OR m � Q OFFEHEDFORSALE.IF,HOWEVER,h1E9UILDINCORMAPiiOVEMENTISSOLDWITHINONEYEAROFCOASPLE- Z TION,THE OWNER�BUILDER WILL 1iAYE iNE BURDEN OF PROVIN6 THAi HE Ofl SHE DID NOT BUILD OH � IMPROVE FOq THE PURPOSE OF SALE). ❑I,AS OWNER OF THE PflOPER7V,AM E%CLUSIVELY CANTRqCTING WITH LICENSED CONTRACTORS �� TO CANSTRUCT THE PROJECT(SEC.7014,BUSINE55 AND PROFESSIONS CO�E:THE CONTRACTORS LI-� V8IU8I10� ADJ.AREA �� -= CENSElAW�0E5NOTAPpLYTOAI40WNEROFAPROPERTYWMOOUILUSORIMPROVESTl1EfiEDN,ANO ---"— � WHOCONTRACT6FORSUCHPRQIECTSWITHACONTpACTOfl�S�UCENSEDPUqSUANTTOTHECONTMF QUpNTITY DESCflIPTION FEE Y TORSLICENSELAW.). �+y. y � I-1 I AIA E%EAIPTUNDER SEC.__.,_.,. B.&P.Q FOR THIS REASON Q � �, f J� /�%7J L.,� '`L-� � � � � � �''� � � � DATE _OWNER f' / /_ � O .. . W ci � �::_ �i✓��� l�. � �t� �1 � UCENSED CONTRACTOFS DECLARATION � ��„�a� � � ¢ W . f � I HEqEBY AFFIqM UNDER PENALTY OF PEfUURV THRT I AM LICENSEU UNDER PROVISIONS OF CHAPTEfl �' . y n, 9(Wb1MENCINGWITHSECTION7000)OFDIVISION30FTHE8USINESSPNDPROFESS!ONSCODE,AND ,,� w AIY LICENSE IS IN FULL fORC[AND EFFECi. / C 4U�� `' i O /�%tJ LIC.NO.."yc: ::1.,.:..).�.'J 7' � LICENSE CLASS__ � ~ DATE� �~ %��"J`"� CONTRACTOfl � C �—'' �/ C.-"�zc,fL w / � a1 WORKEGiS'COMPENSATION DECLARATION �jj � � .� � �,..✓1 �! ¢ -� � 1 HEREBYAFFIRM 11NDER PENALN OF PERJURV ONE OF THE FOLIAWING DECLqRATIONS:` A j � O _�HPVEANOWIllMA1NTAINACERTIFICATEOFCqNSEMT03El.F�INSUqEFORWORNERS' V { Q CO/APENSATION,ASPRONOEDBVSEC710N370oOFTHE�ABORCODE,FORTHEP'cqWRALVr'CE 7 OF TNE WORK FOR WHICH iH15 PERMIT IS ISSUEO. � 0: W 1 HAVE AND WILL MAINTAIN WOqKERS'COMPENSATION INSURANCE,AS REOUIRED 6Y SECTION � O 37ooOFTNE LABOR CO�E,FOR 7HE PEFFOqMMlCE OF THE WOFK FOq WHICH THIS PERMITiS � ISSUEU.MY K'OHNERS'COMPENSATION MSUPANCE CRRRIER AND POUCV NUMBER AHE: CONSTRUCTION ,_, _ ;� � CARRIEH_____ ____ ___ PLANREV __._ „__ ? �_._� r �~ � '� � FOLICY NUMBER_, ,_, (F'� R� p � � Q � 'I �. (IHISSECIKriNE�NOTBEODMPIEfm�T1EPERMffISFORONEFRJMqEDDOIIJJiS(5100�ORLESSa PLUMBING � 'Z I CEflTIFY7HFT IN THE PERFORMANCE OF THE WOHN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAI (} SHAILNOTEMPLOYANYPERSONINANYMPNNER50A5TOBECAMF5UBIECTTOTHE ''(n�� WORKEHS'COMPENSATION LAWS OF GAUFOFiNIA,AND AGPE[THAT�F I SHOULD DECAM[ lNSPECTION FEE .����..���c... �},�� �' SU&IECTTOTHEWORKERS'COMPENSATIONPqOVI510N50F5ECTION370oOFTHEtABOH ��� ti? --�� � � CODE,1 SHALL FOqTHWITH COMPLV WITH THOSE PRO/VISIONS. �SSUANCE �� � �. - `=^ / �J:� � ---- — p DATE'.��_ APPUCANT. �:�.'nL C , G,/ ' SMIP d J NARNING:FAILURE TO SEIXIFlE WORNERS'GOMPENSATION CAVERAGE IS UN�pWFUL,AND SMALL BE ENERGY P/C . SUPJECTMIEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND �' , �3 Ai �' LL OOLURS(floo,a0�),INADDITIONTOTHFWSTOFCOMPENSATION.OAMAGESASPflOVI�EOFOFIN ENERGYPERMIT _ ��� !�d '� y;�. ) �J� SEGTION3To90FTHELABORCODE,INTERE3T,ANOATTORNEY'SFEES. RETENTIONFEE: � � d CONSTRUCTION IENDING AGENCY PRE-ALT FEE: 2'j � I HENEBYAFFIRM UNDEfl PENALTY OF PER.IUflV 7HAT THERE IS ACONSTRUCTION 1EN01NG�GENCY __ F�RTHE PERFORMANCE OFTHE WORK WR WNICH THIS PEflMIT IS ISSUED(SEC.3087.CIY.C.�. W — �� IENDER5 NARIE __ ___ �� �; LENOEF'SPflORE55 ._._____ � � TOTALFEES �� W ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHAThIEABOVEINFORMATKKJISCOFRECT. :�i � IA6REETOCOMPLYWITHALLCINAN�COUNTYORDINANCE5ANDSTATEIAWSRE�ATINGTOBUILDING b � � �� � CONSTRUCTION,ANDHEREB�AUTHORIZEREPflESENTATIVF.SOFTHISCOUN7YTOENTERUPONTHE Z ABOVE•MENT�pNEDPROPER7YFORINSPECTIONPUqPO5E5. COMMENTS O. r 1 � V.�1 c_.�t ����.a�(�.,' -- �'� m PERMI EENAME�PRIN ' ! Q '� Vi � / ��r.'� � S .. N s� REo PERMIREE A7E RECPT.NO J PAID BY i VALIDATION � WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOI.OENRO ile Copy,GqEEN—ApplicenPs Capy � ,. .. �. __._..��._�...,_ i � � � ��n!� �:° � ° �..... 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