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HomeMy WebLinkAbout12377 (11) � f ��_ CITY OF DIAMOND BAR �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES�"� � � 2]660 E.Copley Drive Suite 190 �,-` (909)860-3195 Fax(909)861-3117 � PRESS � .--' � '��° EUILDING?ERMIT ArlLICATION � FIRMLY � � J06SITE � - � ���1I`��i (,,t.4{,� � • � APPLICATIOfU..�g _ _,. PERMIT C � '. P/C j o ADDRESS 7 f� DATE � NUMBER�#_ � � ISSUE TYPE OCC APN LOT TRACT___ DATE CONST. GROUP p OWNER �.� `�S" J"7 -- � ADDRESS t'' ZONING SETBACKS �" z CITY �� TEL: y '.7.� '' ✓' . FRONT _ RW-- ❑ -- p APPLICANT " ` TEL. �� J SI�SIDE STREET_ RW___ ❑ z — � CONTRACTOR § . f� SIDE ❑__._._ � CITY E��� ZIP�=4TEL����� PROPOSEDUSE '����_6'1f��tl):�S�A��"' ���'��C�- ' - � w a,�cw i -�� �`�—Y,—'�r"���-�-.x---S ` � z DESIGNER �� �� ! W NO.DWEL. NO. /' NO. a ADDRESS UNITS STORIES _L,___BEDROOMS__ NCITY Z{P_�. TEL. u� '- DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANA�UATION Q OWPI.ER•BUILDER DECLARATION SFR/ADD/REM A p I HEREBY AFFIflM UN�FR PENAITY OF PEflJURY THAT I AM EXEMPT FqOM THE WNTRACTORS U- G8f9QB/C9fPOff W CENSELAWFOflTHEFOILOWINGREA50N(SEC.io31.58USWESSANDPROFE5510Y5COD[:ANYCITVOp (n C.� CIXINTYWHICHPEQUIRESAPERMITTOCONSTFIICT,ALTFR,IMPROVE.DEMOLiSH,OflfiFPAIRANYSTflUG W Pg110/DBCK w TURE,PpIDq TO ITS ISSUN'10E,ALSD flEQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W S7ATEAIENT THAT HE OR SNE IS LICENSED PU0.SUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI� � CEN5E LAW(GHAPTEft e(COMMENCING WITH SECTION 7000)OF DIVI910N 9 OF THE 9USINE55 AND PRO= � Po0VSp3 FESSIONSODDEJOHTHATHEOR5HEISE%EMPTTHEREFHOMAV�THEBASISFOPTHEALLEGGDEXEMP- (� TION.PNVVIOLATIONOFSECTION70s1.5BYANYRPPIIGANTFORAPERMITSU&IECTSTHC-pPPLICANlTO Z qy.Rooi A CMLPENALiY OF NOT MONE THAN FIVE HUNDRED DOLLARS(S5o0�.): � LII.ASOWNEROFTHEPflOREFiTY,OflMYEMFLOYEESWITHWAGE5R5THEIq50LEWMPCNSF710V. ' � Commercial � SNLL DO THE WORK,PND THE STRUCTUpE IS NOT INTENOED OR OFFERED fOR SALL(SEG 70d4,BU61- ' �] y NE55 ANO PROFESSIONS COOE:THE CqNTRACTORS LICENSE I AW U9F.5 NOTAPPLV TO AN OWNEfl OF � PflOPFWTY WIiO BUtLOS OR IMPROVES'M[REON,AND WHO UOES SUCH WOPK HIMSELF Oq HCRSE.I.F Oq � � THROUGH HIS OR HER OWN[I�PLOYEES,PROVIOED THAT Sl1CFi IMPflOVEMENTS ARF NOT INTENDED OR ' m GOfFEFiEDFOH3KEIF,HOWEVER,TrIEBUILDMGORIMPflOrMENiISSOLDWITHIN�NEYEAfiOFCOMPLE- � � TION,THF.OY/NER�BUILAER WILL HAVE THE BUPDEN OF VROVING THAT HE OR�HE�ID NOT BUII.D Oq � IMPROYE�-0RTNEPUfiPU5EOF5ALE�. f.II,ASOWNEROFTHEPROPERlY,AMEXCLUSIVELYCANTRACTINGWITHLICENSEDCONTRACTORS , . � Q TO CONSTRUGT THE PRQIECT(SEC.7o4a,BUSINE55 AND PROFESSIONS CODE:THE LONTRACTORS LI- � V8IU211011 "i"1�,_.._ ADJ.AREA„_,.__ W CENSE UW OOES NOTAPP4Y TO AN ONR1Efl OF R PROPERTY WHO BUILDS OR IN�PHOVES THEFEON,AND -""'--'-'-- � �NMOCOkTRAGT5FOfl5UCHPROJECTSWITHACONTPACTOR�S�UCENSEDPURSUANTTO7HECONTRAG QUANTITY DESCRIPTION FEE � TOqS LICENSE UW.]. . � J o ❑IAMEXEMPTUN�ERSEC. .___,____,_,__B.6P.C.FOqTHISREASON � U � � _...."—__..._ � u" DA7E p" ' Z "'_'-'...__-OWNEfl -..._._'____...._..__ U �: W � LICENSED CONTRACTORS DECLARATION �I � I HEREBY 11FFIHM UNDER PENAITI"DF PENJURY TMAT I AM LICENSE�UNDEfl PROVISIONS CF CHAPTER �� � 9(COMMENCINO WiTH SECTION 70W)OF OIVISION 3 OF THE 845ME55 AND PROFESSIONS CODE,A4D � ^ � MY LICEMSE�S IN FULL FO/R`CE AND FECT. m { � IICENSECLA Tr LIC.NO.__ C' � .' � H � ����7f� � J _ � w DATE����.__ CONTRACTOR `�_._/�,_ �- ¢� � � WORKERS'COMPENSAT'ION DGCLARATION , � N I HERE9Y AFFIRM UNUER PENALTY OF PE0.IJRV ONF.DFTHE FOLLOWING OECLARATIONS: U N zQ � �INAVEAADWILLMAIY7AINACEHY�FICA'fFOFCON5EN7TOSELFiNSUREFORWORNERi' _ — CAMPENSATtON.ASPROVIbEDBYSF.CT10N3Y000F7He'iABGRCDOF,FORI'NEPERFORMMICE W OF TXt WORN FOR WHICH THIS PFflM1T IS ISSUED. � � 0 W "_ '. _I HAVLAND WIIIMAIN7AIN WOPo(EFS'COMPENSATION INSURANCE,AS HEQUIRE�(3V SFC110Y /-� - Q 3�ooOFTHELABORCODE,FORTNEPERFORMANCEOFTHE4JORKfORWV{�CHTHISVERMITIS I "Z '"�`,,,� v _ ISSUEO.MYWORKEflS'COMPENSATIONINS CECARRIERANDPDI.IGYNUM6ERAftE CONSTRUCTION __,__,.,__,,,___ _.._______ `_' L ; � j CARRIEH__���}_� .-,--. PLANREVIEW __.... .._- - -- ____ . - --- zaoucv NUMeeR_____ ^ � ' •"r � � ...__. ELECTRIC � ¢ .. _._-- - --� � (iHIB6ECTI0tJNE�NOTBECY)MA_EIEDOFh1Ei'FRMfTISFOq�NEML�OFi�DDOLUaLS(S10D)ORLFSS�. PLUMBING -, .."'_-"_' ..._._..._ __....._.."--._.�. W MECHANICAL � Z I CEflTIFY THAT IN THE PEPFORMANC[OF THE WORK FOR WIIICH TFIIS PEHMIT IS ISSUED.I —.....,.._-_.... _,_.. � (3 SHA�LND7 FAIPLOYANY PENSON IN ANY MFNNLFi 50 AS TO UEGOME SU9JECT TO TF7E �;_ � WOHKERS'GOMPENSATIONLAWSOFCAUFORNIA,ANDAGRE[THATIfISNUU�06CCOMi: INSPECTIONFEE ,,,,,____ _,,._ ✓"-' �1 � F Sl�&IECiTOTHEWORKERS'COMPENSATIONVL7OVISIONSOFS[Cf10N37a00FTHELABOR Lt�,J ; � CO�E.ISH FORTHY�ITHCOMPLY'MTNTHOSEPROVISIONS. �SSUANCE ,_���,__.,__ _"_.—._. '( O /�' ^ � 4 p DATE: PPLICANT:_ �(t� � 5MIP .._._.__ ._.._ V � ., � �"�'�_�"_— _.._.._ . .. 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