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HomeMy WebLinkAbout14521 "s �CITY OF DIAMOND BAR � t r �--- DEPARTMENT OF COMMUNITY B�DEVELO� T SERVICES ��p " " 1 21660 E.Copley Drive Suite 190 ���pRESS � .r � (909)860-3195 Fax(909)861-31 l7 QC'j n � ���•ti�"��f� BUILDING PERMIT APPLICATYON •? �t; FIRMLY r� � JOBSITE 9 APPLICATION I 1 PERMIT P/C � 0 ADDRESS� DATE 1 NUMBER1� # "' ISSUE TYPE OCC � � APN _ LOT TRACT __ DATE CONST. GROUP � OWNER � Q ZONING SEfBACKS W CDDRESS a. ZiP f �TEI� C� FRONT RW ❑ � � APPL CANT ����i� TEL. REAR ❑ y � ' — SIDEISIDE STREET RW__ CI _ '; SIDE C� CON7RAC70 ,�— " � ADDRESS � Q CITY,�/� :`/Y�s9.0= ZIP 7EL. •'S -�i PROPOSED USE � t9 � o ARCH/ENG/ -- ; ; z DESIGNER NO.DWEL. NO. NO. a a ADDRESS UNITS STORIES BEDROOMS � � CITY ZIP TEL._ � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ;{ o OWNER•BUILDEFi DECLARATION SFR/ADD/REM Mt �, I NEREBY AfFIRAI UNDER PENPLTY OF PEHJURY THAT I MI E%EMVT FROM THE CDNTRACTORS LA� G8f9QB/CfifpOf( " W- CENSEUWFORTHEFOLLOWINGREASON(SEC.7o31.5BUSINE55ANDPROFE5510NSCO0EANVCITVOR (f� `� U COUNTYYrtiICMREWIflESAPERMITTOCANSTRUCT,ALTEfl,IMPROVE,DEMOLISH,ORflEPAIRANYSiRUC- W Patio/Deck " Z TURE.PRIOR TO ITS ISSUMICE,ALSO REOUIRES THE APPUCANT FOIi SUGH PEHMIT TO FIIE A SIGNF.D W �( W'� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTqACTORS LI- q �!'.. CENSE LAW(CMAPTER e(COMMFNCINO WITH SECTION 7aa0)OF DIYISION 30F THE BUSINESS AND PRO- V' POOVSpB '� ��. FESSIONSCODE)ORTHATHEORSHEI5EXEMPTi}1EREFROMANDTHEBO.SISFOflTF1EALLEGEOF.%EMP- (!j - TKKJ.ANYVIOLA710NOFSECTION7031.5BYANVAPPI.ICANTFOHAPEHMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � ACIVIL PENNTV OF NOT MOflE THAN FIVE HUNDREU POLURS(5500).�: .j ~' ❑I.ASOWNEROFMEPfiOPERTY,ORMYEMPLOYEESWITHWA0E5A5THER50LFCOMPENSATION, 0 COrtIf118fC121 " ��� WILL DO THE WORK,AND THE S7RUCTURE IS NOT INTENOEO aH OFfERE�FOfi SALE(SEC.7044.BU51- J - NESS ANO PROFESSIONS COOE:THE CONTRACTORS LICENSE lRW OOES NOT APPLV TO AN CWNER OF y PROPERiYWH08UILA50RIMPROVESTHEREON,MID1NF10DOE55UCHWORKHIMSELFORHERSELFOR m �_ __ _ .[L; THPOUGHHISOqHERONMEMPLOYE[S.PROVI�EDTHATSUCHIMPHDVEMENTSARENOTINTENDEDOq ' W� pFFEREOFORS/Y.E.IF,HOWEVEH,THE9UIL�INGORIMPROVEMENTIS50l11WITHINONFYEAHOFCAMPLE- ��` TION,THE OVdNER�BUIIDEF WILL NhVE TNE BURDEN Uf AROVING THAT HE OF SryE DID NOl'6NLD OR � �Z' NIPROVEFORTNEPUNPOSEOFSRLE). ' � _' ❑I,ASOYVNc'ROFTHEPROPERTY,MIF.XCLUSNELYCOMRACTINGWIfHLICENSEDCONTRACTORS � �W TOCONSTRUCT7HEPRQIEC'f(SEC.7o44,8U31,YF33ANDPROFES510N5COi7E:THECONTRACTOR5l1- VdIUa110f1 .........___.__..._..._.._____.___._ '�,� CENSEtAWDOESNOTAPPIYTOANOWNEHOFA7HOPERTYWHOBU1l�50RIMPflOYESTHEREON,AND _` ADJ.AREA �': VhiOCONTMCTSFORSUCHVRQIECTSWITHACONfW1CTOR(S�LI�NSEOPl1R5UpNTTOTNECANTRAG QUANTITY DESCRIPTION FEE � � , TDRSIICENSELAW.). __— �[ ------- ���� L]IAMEXEIAPTUNDERSEC.,_____ B-SP.C.FORTHISREASON Q �� U . - �f i -------- --"--' ¢ � V"�� OA7E .__ OWNER .._'_'_______...___- U — -- Z' W ��"� LICENSED CONTRpCfORS DEGLARATION u� �` � �,�,` IHEREBYAFFIflMUNDERfENALTYOFPEflJURYTHATIAMLICENSL-DUN!7F-ANROVISIONSOFCHAPTER � i '.y�': 9(C06AMENCIN6WITHSECTION70W)OFDIVIS!ON30fTHEBU51NE55ANUP40FE5510NuCO0E,A'�'D Z_ 'i �:X�.;. MY LAGENSE IS IN FULL FORCEMID EFFECT. � � �a� ��' UCENSE CL4SS_�s��LIC.NO. �'�3��.�- .., J , `►-, � / :U'• DATE�L�� CONTfiACTOR��_ a ' w' �'��;E�" �v-r-�R j -'-t�"� WORKE.RS'COMPENSATION E A . ¢ $ ,'�'!;. � U �� INEfl�YAFFIHMUNDERPENALTYOFPE!UURYONEDFTHEFOLLOWINGOECIARATIONS: � �' ZQ " -0�:� IFUVEhNDWILLMAINTAINACERTIFICATEOFCONSENiTnSELF-INSIJREFOflWORKFRS' 'L COMPENSRTION.AS PROYI�E�BY 5EC710N 3700 Of'TME LA.dOH COOE.FOR THE PEflFORMANCF. U � �� OF THE WONK fOR WNICN 7'HIS PEHMIT IS ISSULD. w 3 �'[7, � _' "_ p '�`. _IHAVEANDWILLMAINTAINWORKEFS'COMPEYSAT:ONINSUHANCE,ASPEOUIFEDBY5ECTION 't .Q' �7000FTHE LA90R WDE.FOR THE PERFORMNJCE OF THE WOR%FOfi WHiCH THIS AERMIT IS � '.�;. ISSUED.MV RKEHS'COMPENSATKKJ IN5URAIVCE CARRI/ER��AND POLICY NUMBER ARE: ' CONSTRUCTION .____......______ � ....j� CAHRIER,�_��A'��!�jJ7.-��.�/s., -i.-��I�......_— PIAN REVIEW --- � C), P(AICYNUMBER_��'1 � Ll -.�rA - ELECTRIC ;� Z ��T _...____-.-_'_..". .-- __ ' �...._ . ...�r,.--'_'._...._..._.__....'__..._ � . � . ... : :., .' � 0. QiiSS.F.Ct10NNE�NOTBEIXNlPLE(F_DOFTHEPEFBMISFORONFFALYXiED00l.LARSrytOG)ORLESi). PLUMBING .,�� �. .. .. ._.-_..__.."_....--__- _._' .-'......_ ......, .... ... W� MECHANICAL `�' -------- WHICH THIS P[RMIT IS ISSUED 1 -- ��.Z I C[fiTIFY THA7INTHE PEfiFOR�UANCE Of TfiE WORK FOR . ; '•'�(j�; SHALL NOT EMPLOYANY PERSON IN ANY M�kNEH SO AS TO BECOME SUI7JFCT TO1'I1E , r..,rr 3 �� WOHKERS'COMPENSATION I.AWS OF CALIFORNIA.ANO AGI7EE THAT If I SHOUI.D BECOAIE INSPECTION FEE � _ +y- __ _ � - SUOJECT TO THE WORKERS'COMPENSATIUN PROVISIONS OF SECTION 3loa OF THE LABOR �— — _— _�_y� _ /� ) � �, � CAOE,I SHALL FOflTHWIlH COMPLY W M HOSE PROVISIONS ISSUANCE '�-� .._ K..y�f /// �'O- � � SMIP � W�, DATE:�/�APPLICANT� -- i a .. .. �y .'_-."".' ' J WARNING:FIIILURETOSEWHEMlORKEHS'COMPENSATIONCOVEflAGEISUNLAWFUL,AN�SHALLBE [NERGYPlC �� ` ��-y 3U&IECTANEMPIOYEfITOCRIMINALPENALTIESANDCIVILFINESUP700NEh1UNURFDTHOUSAND �='���'' � �� � �, ; . ENERGYPERMIT �_��.•�:t^^'� ��' � DOLLARS(S1 W.0001.�N AD!)ITION TO THE COSTOF COMPENSATION,DAMAGES AS PROVIDEO FOR IN .�5 ,.¢� SECTION37060FTHElABOfiCADE,INTEREST,ANUATTOflNL-Y'SFEES. RETENTIONFEE: _._._..__. _ � � CONSTPUCTION LENDING AGENCY PRE-ALT FEE: _.__._.......-.-____.___._._-__-._._.. ; "�' INEREBYAFFIflMUNDERPF.NAL7YOFPLRJURVTHATTHERLISACONSTfiUCTIONLENDINGAGENCY , . �. __'___...___ —_'__—""-__' ' FOH THF P[RWRMANCE OF THE WURK FOR WHICN THIS PENMIT IS ISSUED�SEC.3097,CIV.F�. f Z -_.__"__' ---__'____'- '_"__ — �{' LLJ � '_,. � LENDER'SNAME_'—"__ "'_'_'_-__'_ ____"'__.... F- LENDER'SADDPESS '___' -___--- -..---- �' '��� I CER71rl'THAT I HAVE R[AU TNIS APPLICATION ANU STATE TiATTHE ABOVE INFOf1MATI0N I5 CARRECT. TOTAL FEES ��• � ,,� W I A(iHEE TO CAMPIY WITH ALL CITV AND COUNTY ORDINANCES AND STATE L4WS RELATIN6 TO BUILOING � � CONSTRUCTION.AN�HEREBY�Uf170RIZEFiePRESENTA7iYE50FTHI5COUN7YTOENTERUPONTHE .�� AUO EMENTIONED PROPERTV FOR INSPECTION PUHPOSES. —_— __ � Z COMMENTS_.._._._ .. � --��'=-f-�c.r.bd.E�.�-�"�.^�c-.- - _ ���'.1�.—. �i , � SEfl A�ND�PflITTEE `"—" _'—_' _---"__ _ _—___ '_ '___ ' ' �� = RECPT.N0. _,.__..._ PAID BY __� VALIDATION___ � + � WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assassor Copy,GOL�ENROD-File Copy,GREEN-Applicant s Copy . � , . , , , . , , � � �. �� � � , � �` �� � � � � , . . � . ..; ,.�� . ; . , „ , . ._ , `j 4��, ,, '� . . ,.. , . . ', � '_S . , . �. . . � ' � . . �. ' � + r . � .., . . . . . .:. . -;.. `c ..,t �. �: .', . . : 'I . , : ,.� ._ _ .. ' - , , " ' , . . ' 1 ' � . i, . ' ':. ' ' ', . h S.�.. �I � _ ' _ . . � , . , ., ' ' k _ � . j i � f . r ' _ _ . r i Y i � � , ` r , � f � ' � �� � � �� � � �� � �v k ! ' � I � ` , . ' " �� , ; , , � . 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