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HomeMy WebLinkAbout13227 (14) I 1� CITY OP DIAMOND BAR � ( . DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �W , 21660 E.Copley Drive Suite 190 � \•;._....,,,., (909)860-3195 Fax(409)861-3117 PRESS '�M BUILDING PERMIT APPLICATION FIRMLY ;, r JOBSITE n 1�/�� an� , ^i,.��I��„7 ��` APPUCATION �-.-,/���%I PERMIT � �� 7 ')."'� P!C � o ADDRESS 'Cx�"�'Ey (.>,1..��� :. � DATE 1 I NUMBER ��r�" # � issue TYPE OCC APN LOT TRACT_1_�� DATE CONST. GROt1P p OWNER _ ��%(�T7� � LL ADDRESS l CC��� �' 1 � L� ZONING SETBACKS '.i o '� gCITY z � ZIP TEL. � '-:~, .L FRONT qy� ,� APPLICANT TEL. REAR n_.._. i! Q � —_' SIDE/SIDE STREET_ RW___ U_.._._�_ ` � CONTRACTOR ��--� �l.� _ SIDE ___ � � ADDRESS � _ ' �Jt � CITY ZIP� TEL. ` � - PROPOSED USE j w ARCH/ENGI - � 3 � DESIGNER ' NO.DWEL. NO. NO. v a ADDRESS � CIlY ZIP TEL. UNITS STORIES _ BEDROOMS � � a cn DESCRIPTI(7N SQ.FL FACTOR PSF ADJ.AREANALUATION ,,;{ O, OWNER-OUILDER DECLARATION SPRlADD/REM k � p�; I HEHEBY PFFIRM UNOER PENALN OF PERIl1HY THAT I AM E%EHIPT FROM THE CONTRACTORS LI. '� W� CENSEUWFORTMEFOLLOWIN6RFASON(SEC,7031.58USINESSTNDPROFESSIONSCOOEANYCITYOR �� � Gerage/Carport �� U� COUMyWI{ICNRFANHESAPERMITTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,OftREPAIRANVSTftUP .. W Patio/Deck r' - 7URE,PRIOR TO ITS 13SUANCE,ALSO REOUIRES 1HE APPLICANT FOF SUCH PERMIT TO FRE A SIGNEO '4 � STATEMENT THAT HE OH SHE IS LICEN5ED Pl1fi5UAM'TO THE PRWISIONS OF THE CONTRACTORS LI� " W ;1� ��" GENSE LPW�LHAPTER B(COMMENCING WITM SECTION 7000)OF DIYISION 9 0F THE BUSINESS AN�PRO� '" �'�' POOUSP� ��.� FESSqNSCO�EjOpTHATHEORSHEISEXEMPTTHEflEFROMANDTHEBA315FORTHEALLEGEDE%EMP� � (� � TION.ANVVIOUTION�FSECTION7a31SBYPNVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Re-Raof � ,�'., ACML PENALT!OF tJOT MORE THAN FIVE HUNDAED DOUARS(SbOo).): Z ^� y ❑I,A90WNEROFTNEPROPERTV,ORMYEMALOYEESYlITHWAGESASTHEIRSOIECOMPEN5AT10N, �'�- (] . �� WILI DO THE WORIC AND TH[STRUC7l1qE IS NOT IN7ENOfD OF OFFERED FOF SNLE(SEC.7a44,BU51� J CommefCial �i �' NESS ANU PROFESSIOHS COOE:TME COMTRACTOflS LICENSE lAW DOES NOT APPIY TO Ml OWNER OF- � ��' PqOPERiYVhiOBUIlD50A1MPROVESTHEflEON,ANOWHQDOESSUCHWORKHIMSELFORHERSELFOR � �� ; �� 7MRWGMNAS�AXEHOWNENPLOVEES,PROVIOE�iHATSUCHIMPflOVEMENTSARENOTINTENDEDOR ""m, 3 W OFFEREDF9RSALEIF,MOWEVERTIEBUILDINGOflIMPpOVEMENTI550LDWITHINONEYEAROFCAMPLE- ) Z: ���iION,7HE OWNEfl$UVLUEfl WILL HAYE THE 9URDLN OF PROVIN�THAT HE OR SHE DID NOT BUILD OR � IMPROVEFORTHEPURPO5EOFSAIE). 'i j�',. ' ❑I,ASOWNEfioFTHEPflOPENTY,AMEXC1.U31VELYWNTRACTIkGIMTHL'CENSEDCANTRAC70R5` 4 i p[: 70 CONSTqUCT T11E PRO.IECT(SEC.70N,BUSINE55 qND PROFESSIONS CODE:ThIE CONTRACTOqs LI�. �� VylUBllOfl _ _,,,„__„_, ADJ.AREA.____,... .._._._.._ W'� CENSEUWWESNOTAPPLYTOANONTlEflOFAPROPEHiYWHONUILDSORIMPROVLSTNERFON,AND� _�� WFiOCONTMCTSFOHSUCHPRQIEC'fSWITHACONiRACTOF(5)LICENSEDPURSUANTTOTNECONTRAC� QUANTITY DESCRIPTION FEE ~. .TORS LICENSE LAW.�. 7 �` i .g�� � CI IPA1 EXFMPT UNDEA Sf.C. __ __B.8 P.C.FOR THI5 REASON '. Q _ , V � �.�, ;_ � ..: � � . . . - � � -- ---__... it'. DATE� —"_OWNER_—"'_ _'_'__ �'. U :ry Z' -- :e� W �� .�' LICENSED CONTRACTORS DECLARATION ;",' � j � _ ' IHEflEBYAFfIRMUNOEflPENALTYOFPERJU%V7HATIAMLICENSFDLINOERPROVISIONSUFCMAPTER ,�., � � � � p��. B�COMMENCINOWITHSFCTION700o)OFDIVISION90FTHEEUSINESSANDPPOFEBSIONSCOGI,AND ,. Z _ !• � ' X MY�.ICENSE IS IN FULL FOFlCEAND EFFECT. � ,a . LO: �w^�J �� `.� ;� � .:. � �`3'��1��.��'`)C.r__T _ _ �1 �, UCENSECIASS [�,.•�_,L��e`*___ LIC.NO._� __.___ �,; � � ���V DATE_.__ L:�"'S ,.`.C �—CONTHACTOR ......_—..._— r.. a � L � �L ���1: WORKEHS'COMPENSATION DECLARATION Q �� .����., IHEHEBYAFiIRMUNDERPENALTYOFPERJIIRYONF.OFTNEFOLLOWiYGb[CLARA710NS; Z q .G- ___IHAVEANOWILLMAINTAINACERTIFlCATEOFCONSCNTTOSELf-INSURF.FORWOHKERS' � 8 COMPENSATION,AS FROVIDED BV SECiION 37W OF hIE LABOR CODE,FOR THE PEFF�(1MANCF. U � "�� �THEWOflKF0�9WH!CHTH!SPF.P.MIiI51S51.IF.U. W i 'W� __I HAVE AfJD WILL MAINfAIN WORKEPS'CONPENSnTiON INSL�qANGE,AS REWIAED BY SECT!O� � � Q� 37000F THE LPEOR CODE,FORTHE PERFOfIMANCF:OF THE WONK FOFl WH;CH THIS VERM!T IS + 'p' ISSUED.A!Y WOqi(ERS'WMVENSATION INS HANCE CAFRIER AN�POLICY NUMBER ARE- CONSTRUCTION ��.:� �q ..._—.. . ..............--_"' � �, CARiiIER_'_�G� ��y _(.�'�L.�r_� _�e._ PLAN REVIEW _._---.... _..—...-- --------- � �,::.� .POLICYNUMBER____'_�.,d]„�+�l�•�'//�_ '�C.! .._-- . ELECTRIC __... -- �_ _...__._... -/_�—�cFy. j ��.SSEc.�rsEoraraeoxm�ereooFn�vewar�s�crvenurv�tnoa�ans�s�w;ora�Essx PLUMBING JG� p j i` . � __—___ .---..--T.,..---- --...__._ . i a .;.�Z ICERTIFYTHATIN7HEPERFORMANCEOFTNE'N�F7KFORWHICHiHISPERMITISI5Sl1E0,1 MECHANICAL ...____ ��.i��+�:�..`�.___,,.,_ ___ ��(} SHALI NOT EMPLOY AN'/PERSON IN ANY AIANNER SOAS TO 6[COME SU�JECT TO TNE _ .,�..� ,YIOPNE(i5'CAMPENSAilONL0.WSOFCALIFORNIA,ANDAGREETIIATIFISHOULDOFCOAIE INSPECTIONFEE ... ___.—_.... SMIP _....... . � i,i"t�`� :J --.....� "� _ Sl1BJECT70THEWORKERS'CAMPENSATIONPqOVI510NSOF5E N37ooOFTMELABOft �� �.�y � "�' ��-� ��CODE,1 M1LL F THWITM COMPLY WI7N SE PROYISIONS. 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