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HomeMy WebLinkAbout11965 CITY OF DIAMOND BAR ��"-7����' --�'� -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SBRVICE - - � _ � . 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)561-3117 PRESS ��ro^'� BUII,DING PERMIT APPLICATION FIRMLY y JOBSITE � APpLICATION PERMIT P/C Q ADDRESS a I�. , p -- DATE ; : �_NUMBE � # � ISSUE � TYPE OCC APN LOT RAC7 DATE CONST. GROUP p OWNER 0 ADDRESS ����nr�,..+� ,��t� �'d° ZONING SEfBACKS Z CITY .� rZIP TEL. ' FRONT RW n__ g APPLICANT TEL. REAR ��__ z¢ SIDE/SIDE STREET _ RW ❑ ___ � CONTRACTO -1 f" IY� .,�t::���— SIDE ❑ � ADDRESS� •r' � � CITY ' ZIP r TEL. 7 PROPOSED USE :�•� vt(�"�I�I uCi� '���_�{,'�. oARC , ' 6`,�i a �����i�.�{�-'vs.'��.",� ' -- z DESIGNER ` " w NO.DWEL. NO��r' �•° ` `• 'NO. 2� n. ADDRESS �-��� � UNII"S _ STORIES BEDROOMS" � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � . OWNER-BUILDER D�CLARATION SFR/ADD/REM O Q I HEHEBY AFFIRM U4�ER PENAITY OF PERNRY THAi I AM EXEMPT FflOM THE COMPACTORS LI� G8f0(Je/C81POA W CENSELAWFOflTHEFOLLOWIYGHEA50N(5EC.1031,58USINESSANDPHOFESSIDNSCADE:ANVCITYOR (n � COINJfYWHICHREd11RESAPERAl1TTOCONSTRUCT,ALYEP,IMPROVE,DEMOLISH,ORFEPAIRANVSTflUF W (�ali0/�BCk TUHE,PRIOfl TO ITS ISSUANCE,ALSO REOUIfiES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO � STATEMENT h1A7 HE OR SHE IS LICEN5ED PURSUANT TO THE PROVISIONS OF ThIE CONTRACTORS LI• '� CENSE LAW(CNAPTEN 9(COAIMENCINO WITH SECTION 7000)OF DNISION 40F THE BUSINESSAND PRO- u' POOUSPB FESSIONSCODE)ORTHR7HEORSHEISEXEMPTTHEREFROMANUTHEDASISfORTHEALLEGEDEXEMP- � (� V TIDN.ANYVIOLATIDNOFSECTION7031.5BYANYAPPLICANTFONAPEftMIT5U9JECT5THEAPPLICANTTO Z Re-Roof � ACIVILPENALTYOFNOTMORETHANFIVEHUNORED�OLLARS(SSao).): . � CJI,ASOWNEROFTHEPROPEHTV,ORMYEMPLOVEESWITiWAGESASTHE11i501F.COMPENSATION, 0 Commercial �� WILL W THE WOqI(AND TNE STRUCTURE IS NO7INTENDED OH OFFEFED FOR SALE(SEC.70da,BUSI- J � NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PtiOPENTYWH09UIlD50RIMPROVEShIEREON,ANONRiODOESSt1CN WOHKNIMSELFORHERSELFOR CC THROU�HHI90RHEROWNEMPLOYEES,PROVIDED7HATSUCHIMPROVEMEMSARENOTIN7'EN�EDOR � � OFFEREOWFSN.E.IFFIOWEVERTMEBUILAINaORIMPROVEMENTISSOLDWITHINONEVEAROFCOASPIE� Z TION,THE OWNERBUILDER WILL HAVE THE 8U(iDEN OF PROVING THAT FIE OF SHE D:D YOT BUILD Ofl ' � IMPROVE FORTHE PURPOSE OF SALE�. W UI,RSOWNEROFTHEPROPERTY,AMEXCLU5IVELYCANTRACTI4GWITHLICENSE�CANiRACTORS � TO CONSTRUCT THE PROJECT(SEC.7044,BU3INESS AND PqOFES510N5 CODE:THE CONTRACTORS LI- VdI118110(I � _ �� ..____qDJ.AREA ' W CENSELAWDOESND7APPLYTOANOWNEROFAPROPER7YWHOBUILD90RIMPHOVESTHEREON,AND -'-'—�---- �E ---�— '� NRpCONTMCTSFORSUCIIPROJECTSWIiHACONTRACTOR(SILICENSEOPURSUANTTOTHECONTRAG QUANTITY � DESCflIPTION � TORS IJCENSE L4W.). 0 ❑IAMEXEMPTUNDEH5EC. .,.,._.__B.Bp.C.FORTHI5REA50N Q � U u' OATE OWNEii � o - _' _"_'_"_-_ W �Q LICENSED CONTRACTORS DECLARATION w LL I HENEBV AFFIqM UNOEN PENALTY OF PEFUURY THAT 1 AM LICENSED UNDEF PROVISIONS OF CHAP7FR � � Y(COMMENCINQWITHSECTION7000)OFDIVISION30FTHEBUSINESSANDPROfES310N5CqDE,NJ� z X' MY LICENSE IS IV FULI FORCE AND EFF[CT. m LLI 0 UCENSE CIAS �� LIC.ND. ���''�� �__ j _�"'.__-__ V UAYE_' __'_ CONTfiACTOR �"��` fl — W ! � . WORKERS'COMPENSATION�ECLAHATION ��{�i'� U - � I HEHEBY AFfIRM UNOEN PENILLTY OF PERJURY ONE OF THE FOLLOWING OECLARAYIONS: 1 Z � �INAVEANOWILLMAINTAINACERiIFICA7EOFCONSENTTOSELF-0NSUHEFOHWOqKERS' _ � COMPENSATION,ASGROVIDEDBYSECTION37000FTHELA60RCODE,FORTHEGERLORMAk'CE U OF TME WOflK FOR WHICH THIS PFRMIT IS ISSUED. W ' 0 � QW _I HAVE ANO WILL MAINTAIN WORKEFS'fqMPENSATION INSURANCE,AS REQUIRED BV SECTION , f 37000FTHELAOORCO�E. ORTNEPERFORAIANCEOFTHEWORKFORWHICHTHISPEfiMITIS l �., ��7� ISSUED.MYWORKEH �p ENSATION/ysURANC CARRIERANOPOLICYNUMBEHARE: CONSTRUCTION _,,.,_,,._._____,._ '�'�� j�` �y -' _'_- � CARRIER ��' • 'T' ` '�� _____`__ PLANREVIEW ���. ��� � __.....---- ----- -- ,.. z PouCVNUMBER , • ' ___..__-- ELFCTRIC '. , a �a. �.:._:..�. — - —---- 0 (M138ECTONNE�N0T6 n+ede §wriauew�taoaE000unrs iuo�ora�Ess�. PLUMBING ---._..__ .-.--.._------ Z ICERTIFYTHATINTHEPERFORNANCEOF7HEWOFKFORWHICHTHISPERMITISISSUE0.1 MECHANICAL ..,____ �r} SHALLNOTEMPLOYANYPERSONINANYMANNEqSOAST08ECOMESUBJ£CTTOTIIF � � �� — � (n WORKER5'COMPENSATIONUWSOFCAUFORNIA,AN�AGREETHATIFISFIOULDBECAME INSPECTIONFEE �''��yy :�� --____ ._...�].. � . � S�&IE TTO THE WORKEFS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOfI � 0 " �� � CADE, SHALLiORTHWITHCOMPLV WIhiTH05,PROVISI 5 � ISSUANCE _______.__ � O - - ...—._...""_'___-- p� �ATE: �� APPLICANT. �� __'__. SMIP ..__...__'_ _"._' I L � ;. ___-__.._F_ J WARNIN :F ILURE TO SECURE WORKERS'COMVE ATION� VE AGE IS UNLAWFUL,AND SHALL BE ENEAGY P/C _—"'...'_-..._'_' '___' . : � SU&IECTA EMPLOVERTOCRIMINALPENALTIESANDGVILFlNESIIPTODNEHUNDHEDTlIOl/SANf) ENERGYPERMIT � '� UOLLARS�SIOU.OW),INAODITIONTOTHLCOSTOFCOMPENSATION,OAMAG[SASPROVIDEDF9FIN -----��-�----�-������- � J SECTION 37080F THE LABOli CODE,INTCHEST,ANO ATTORNEY'S FF.ES. RETENTION FEE: � _'' . �..:.. ..r:.., _'___._,..... .�_—__"'"" . W ;i::6;;; �.;" :. , � CONSTRUC?ION LENDING AGENCY PRE-ALT FEE: "':��' ' i��� � ���' �..:��. . ���� ----.... � O �x�u.:.:.:.:.,.uo-:..,. ----------� � I HEREBY AFFIRM UNOER PENALTY OF PEflJURY TI1AT 7hiERE IS ACDNSTRUCTION IENDING AGENCY ___ ���� _ _ FORTHE PERFOFMANCE OF 7HE WORK FOR WlIICH'fHIS P[RMIT IS ISSUED(SEC.309],CIV.C.). _- z „ w --.. -� �� LENDER'S NAME__,__.__ _'_""___ '__' .—... F- LENDER'SAD�HE55 ._._______.__._____ ._ w ICEflTIf-YTHATIHAVEHEADTHISAPPIICATIONAN�STATETHATTHEA80VEINFOHMRTIONISCOflflECi TOTAL FEES ! � IAGREETOCOMPLYWITHALLCITYANUCOUNTYOHDINANCESANUSTATELAWSRELATINOTOBUILDING � CONSTRUCTION,ANDHEREBYAUTHORREPEPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE / Z ABOVE-MENTIONF.DPflOP T FOR IeNSPECTION PURPOS[S. }� g,� COMMENTS_�,.-, � . YJ ___��w'_��___ � i"'_ ' '. 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