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HomeMy WebLinkAbout18113 (10) c1�oF br.�orrn 8�c � DEPARTMF,NT OF COMMUNTI'Y&DEVELOPMENT SERVICES I 21825 E.Copley I7rive '"'W (949)860-3195 Faac(904)86 i-3 t 17 PRESS ' �%9wg BUILDINC PERMIT AP'PLICATION FIRMLY � DDRESS_ ! r d �?'� dATE�CATION� ,��y �� NUMB R 1�rf 3 #lC c� `� �'S � � �--��'S o� -- tSSUE TYPE OCC APN LOT TRAGT DATE CONST. GRdUP p OWNER I�� ,�-�ry�— ADDRESS�����V'-� 2QNING SETBRCKS � ClTY ZIP_ TEL. u FRQNT --- RW ❑ � AFPLICANT EL. REAR p � SIDE/SIDE STREET RW CJ d t� SIDE C� m� CONTRACT • . — AdDRES � CITY����" ZIP � TE� ���� PROPOSEp 11SE" � r I � ' +�G L� L � ARGHfENGt f,,, -�,� �� �� �z DESIGNER_._ — NO.DWEL. NO. NO. —��� 4 Af3DRESS UNITS STORIES BEdROqMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � pWNER-$UILDER 6ECLRRATiON SFRtADDlREM Q p I NEftE9Y AFF�RM VNDER PENALTY 6F PERlURY THAT i AM E%EMFT FRqM THE CCtNTRACTORS l�� � (jaf890/C2/p011 W CENSEIAWFORTHEFqLLOWINGREASON(S6C.7o9i.58USWESSAN�PftOFES510NSGQDE:ANYqIYQR zCOtMttVWHiCHREWIRESAPERM�i'TOCONSTFUCT,ALTER.IMPROVE,DEMOl15H2ORREPAIRANVS7RUC- � pat��p�� TUftE,PRiOft TQ 1TS ISSUANCE,AlSO NEOl11RE5 TNE APPLiCANT FqR SUCH PERMIT TO FlLE A SIGNEp w STATEMENT THAT HF OR SHE IS LICENSEO PUfl9UANT To TME PRbViSiONS QF TNE CON?RACTORS ii� � ��� .�`�,r CENSE LAW�GHAPTER e(COMMENCINO WiTH SECTION 7000�qF DIVISION 9 OF THE BUSINESS AND PFo- U' P40USpd �ESSIpNSC66E)ORTHATHEDRSHE15E%EMPTTNEREFROMANDTHEBASISfORiHEALLEGEDE%EMP- C7 QTION.ANYVfQLAT10NOf5ECTiONTq3t.58YANYAPPIICANTFORAFERMiTSU&iECTSTNEAPPt,iCAN1T0 Z qe-Foof � A CIVIL PENALTV OF NOT M�flE THAN FNE HUNDRED DOLLARS(f5aoJ.}: � OI,ASOWNEflOfTHEPROPERTYORMYEM7LOVEE3WITHWAGESA$THEIRSOLEGOMPENSATION, G� �Ofii(iiH�C�21 � W�ll 00 7FiE WOflK,AND TFtE STRUCTURE IS NOT INTENpED Op OFFERED FOR SALE�SEC.704a,BUSI� J flES5 ANO PROFESSIONS C06E:THE CONTRACTORS CICENSE lAW DOES NOT APPLY TO AN OWNER OF � PROPERTVNMOBUILOSORIMPpOVESTHEREON,ANDYrt14COES5UCHW4RKHJMSELFOftHERSFtFOR � , [G iHROUGH H15 OR NER OWN EMPIOVEES,pROVIDEd TMAT 5UCH IMPFOVEMENTS ARE N4T IMFNDEP oR m � OFFEREOF4RSALE.IF,HOWFJER,TNEBtALDMdORiMPftOVEMENTiSSOL6WITNINONEYEAROFCOMPLE- Z TION.?HE�WNER-6UI�DER WILi HAYE THE BUftQEN OF PROVWG TNAT HE{}ft SHE 01D NOT BVILO OR � IMPROVEFOpTHEPURPOSEOF5A4E). 7 t,AS OWNER OF THE PROpEpiY,AM E%CLUSNELV CONTRACTING WITN IJCENSED CONTFACTdRS � TO CANSTRUCT TNE PAOJEGT(SEC.70Ad,BUSINE55 AND PROFESSIONS CODE THE CONTRACTOPS LI� V8IU8110f1 �u'�R AD.I.ARFA W CENSELAWOOESNOTAPPLYTOAN�WNEROFAPR�PFAttWHO9UllDSORiMPROYESTHEREON,AMD � WHOCONTRACT5FORSUCHPPOJEGTSWI7HACONTRACTOqy8J1.ICENSEDPUftSUANTTOfHECONTHAG QUANTITY DESCRtPTION FEE Y TOflS LIGENSE iAW.j. - �- CJ I AM E%EMPT UN�ER SEC. 8.&P.C.FQA THtS REAS�! Q � _.._. _..�.._.�.._.._.._._— � 2 u' t7ATE OWNER f" � '�- W � UCENSED COM?RAC70RS DECLARATiON W ¢ — � I HEREBVAFFIRM UNpER PENALTV pFPERJUflY THAT IAM LICENSED VNQEfl PftOVI510NS oF GMAPTEA U, d 9(COMMENCItiG WITH SECTION 7000}OF�IVISION 3 PF TNE BUSINESS ANO PFOFESSION5 CODE,AND z X MY LICENSE I5lN FUIL FOftCEAN�FFECT, - w �, �., � , a LIC[NSE ClA ��r r_'��� �lC.NO._„ ]����,, J � pATG___'���1�./�,"_" CONTRACTOR-_y,��` / ,�� Q- W � a� WORKERS'GOMPENSATION DECLARATIdN -i � ¢ � I HEREBY AFFIflM UN➢ER PEM1ALTY OF PENURY ONE OF TME FOLLOWlNG DECIARATIONS: U C� Q O IHAVEANDWILLMAINTAINACER7IFICATEOFCONSENTT65El.F-INSURE:ORWORKERS' $ CpV�DENSATION,AS PflOVIDED 8Y SECTION 3700 OF TNE LABOR CODE,FORTHE PEqFORMANCE U a __SG-._ WORK fOfl W41CH THIS PERMlT tS ISSUED. � � W I HAVE AND W�LI.MAIN"fAIN WORKERS'COM7EN5 ION INSURpNGE AS RE�l11flEQ 0Y SECTION / � 310o OF THE LA90R CbDE,FGF ixE P FORM E OF TNE WORK FOq WNICN THIS GERMIT IS �T� /�'� ISSUED.MY WOP�K�.jGl�,C�O.M SATI 1NSUR CE C.ARRiER AND POLICY NUMBEfl ARE: CONSTRUCTION „_ ! " � GAHRIER_�( '� � PLAN REVlEW `��,._„_-- � roucvNUMeep__ � _.-..�..�.._..�.-... ELECTR�C _._.._..�..� .. � (THISSECTIOMNE�NOfBEODh7PLETED6FTHEFERhVIISFORONEHUNDREQOpLI.AAS(Stf10lQR4ESS). PI.UMBING __.._ _ W i GERTiFYTHA7 iNTNE PER�OflMANCE OFTHE WORK FQR WHICH TNIS PERMiT I5155VE6,l MECHANIGAL � Z T.. � SHALLN07EMPLOYANYPEftSONiNs1NYMANNEf150A5T48ECOMGSVBJEC7T4TNE Uj WORKERS'COMPENSATION LAWS OF CALIFORN�A,AND AGRE�T� T IF 1 SHl]UlD BECOME INSPEGTION FEE _ SU@JECT TO 7HE WORKERS'COMVENSATION P VISIONS OF ION 81C0 OG THc LA60R �'J ~ GOD, H FORTHWiTNC9MAtVWiTHTH6 PflOV�5i0 . �SSUaNCE — ' � "�' O 7 g� ' .�.y_.Cx....� ....; : �� -'_ �7 ',7 I-: p DATE: � �� nPP�icANT. _ .. SMIP -- - � ENERGY P1C ._ _.. _ J WARMNG: iLUAE TO SECURE WORKEPS'CAMPENSATION COVERA6E 13 UNUWFUL,ANU SHALL BE � SUeJECT EIAPIOYER TO CRIMINA�GENAlTiFS AND CIViI F�NES VP TOONE HUNORED TNOUSANO ENERGY PERMIT . - D(]lU1RS(S10C.000),IN AUDITIONT�THE COSTOF COMPGNSATIO{J.OAMAGES AS PftOVIDED fQA IN � � —��— ��--� JSECTION37080FTHELABORCO�F,INTEfiEST.ANLIA7TORNEY'SFEES. RETENTIONFEE: n ' � � _ pW_, CONSTRUCTION LFNDING AGENCV PRE-ALT FEE: �,_,._. O � INEREBVAFFIqMUNpEflPENAITYOFPF_RJURYTNAT7HEPEISACONSTRUCTIONLENpINGAGENCY , �- FGFi THE PERFOflMANCE OF THE WORK GOR WHICN TN�S PCRMIT IS ISSUED(SEG.3091,qV.C.�. -��~� �� Z W _.. � LENPER'S NAME_._._... �.-...-..._.. _.._. F- LEN�ER5A1}DftF55,,, � ... . .--.. / � IGERTIFYiHATIHAVEREADTHiSAPPLICqTIqNAN�STATETHATTNEA00YEINFORMATIONISCOflRECi. TOTA�F�E� I/"� �/ t"�t� W I 0.GftEE 70 COMPLY WITN AI..L C(TY AND COUNTY ORDINANCES ANO STATE LAWS REIATING TO BUILpING � f� d�� � GONSTRUGTlON,AND HEAEBY AUTHOR F�RESENTATIVES OF TFtiS GOUNTY To ENTEq UPON THE � ABOVE-MENTIONEpCpOPERNFORW ECT NPUftP�SES. z COMMENTS _ ` �, ��: �. ,��ic`>;"! _. _ — — — ._ _� — m VERM�TTEENAFAE iNi) ,.'� /J � • � � `. Q � fq 7[j/1 —.... ._. ��.—.....�. � [� .._ J f�.L ^ ����,Q � SIGNATUPEOFPEflMITTEE ' `�E J '-' • , i `. Z RECPT.NO. " PAID BY ..,,,_VALIDATION� � WHITE-Department Gopy,YELLOW-Finance Cepy,PINK-Assessor Copy,60LQENROD--RIe Copy,GftEEN-AppiicanYs Copy � �w ��'�� ,. .r �, � �` �., �����. � �" ,� �° �3l �:��%� ���aP� _ ���� �'���, �,�� °" �"�� � �'��� s���� ����. — � ����E��s������ ��� a���r- .. .... . .. _. ... . ... _. . .. �- - ������"'��`��"`���'�'� `'�'� u�si ;� .. . .. . .. . ... .. ._ _;���' � `���a � _ _ ,� '������`'�'�"'����, -r� . .. _ . . .. . .. . ._ ... . .. .. .. � �. x3 a � �" . . . �*d���°'�� �' , � s�� ��� ����� ����` . _ .. . .. _ . .. .. .. . . .. s � ����` �,��rw�"�s� j a, : , . . . ... .. .. . . . . . _.. '��,"'� s�' y . ,��'°�" . "�' .... . ._... . . .. . . . ._ .. . .. �. ����� � �G=� y"� _ � � �, ai�. ��+,t � � � ,. F t g i � e . - � � � � ��� �� � _ _ .. ... � _. . . - .�.. t .._ _. ..,. -. . .. . .... — —. — . .,..�s ,.��M� � . .. . .... . � .,.. . . -. -. .._. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY CATIONS� �,� � �I! PAC DATE J NUMBER/ ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE'G r I '��qG. G 6 �vl -t, �- � <; N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM � Garage/Carport W Patio/Dedc � PooUSpa C7 Re-Roof Z � Commercial m Valuation �tJ� ADJ.AREA QUANTITY DESCRIPTION FEE J Q U 2 F- U W J W Z Of] J d J Q U Z Q 2 U w 7�, � �> CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE i<�-� SMIP � JJ ENERGY P/C ENERGY PERMIT- RETENTION FEE: � PRE-ALT FEE: TOTAL FEES /C�� �� 'y / COMMENTS �� RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy