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HomeMy WebLinkAbout10727 (5) �i "4 •-- -'� CITY OF DIAMOND BAR �• � COMMUNITY DEVELOPMENT DEPARTMENT ;� l -,..,�I 21660 E.Copley Drive Sui[e I90 (909)660-3195 Fax(909)861-3117 ' � PRESS ':i """', BUILDINGPERMITAPPLICATION FIRMLY '� � JOBSITE � � S l�„i S �' /.�TE CATION ���r-� "�� NU BER V.���' #/C � v ADDRESS t3A � � � ISSUE ' � APN LOT TRACT_ DATE TMPE OCC � °C OWNER �"!�t� CONST. GROUP j o p ADDRE,�S��c� Y' e,c,l �r` � � ZONING SETBACKS � Z CITY J '� �"' ZIP TEL�_�t�;�3�S�5,=,`>',� } FRONT RW � � o APPLICANT �e*��.. �S�-s-�EL._ � � REAR n �' SIDE/SIDE STREET RW Ll ` � CONTRACTOR � �C:.4�7�� S' ,rz:j �j SIDE �7 �. A�DRE S � • �% /r ra � C�ll' Y' r�r : ZIP TEL. PROPOSED USE o ARCH/ENG/ z DESIGNER � ADDRESS NO.DWE4. N0. NO. � CITY ZtP TEL._ UNITS STORIES BEDROOMS N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION �O. OWNER-BI;ILDER OECLAqATION SFRIA�O/REM 0 1 HEREBV AFFIRM UNDER PENALN OF PERJUPV THAT I AA1 EXEIAPT FqpM THE CONTRACTORS U- G8f89B/Caf�70R W. CENSEIAWFORTHEFOLLOWINGflEA30N�SEC.1031.58U51NESSANbPROFESSION6CO0E:ANYCI7YOR (n . .� U� CAUNTyWy{�CHREQUIFESAPFAMI7TOCONSTRUCLALTER,IMPROVE,DEMCl75M,ORREPAIRANY5TRIIF Z' TURE,PPoOq TO ITS I65UANCE.ALSO HE�UIRES THE APPLICANT FOR SUCH PEHMIT TO FILE A SIGNFD W P8110IDBCI( �w'� STATEMENT 7tiAT HE OR SHE 19 UCENSED PURSUANT TO THE PROVISIONS OF THF CONTRACTOpS LI- ��'� CENSE lAW(CHAPTEA 8(COMMENCiNQ WITM SEGTqN t0a0�OF OIYI510N 30F THE BUSINESS AND PRO• V' PooUSpa 'O'�� FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMAND7NEBASISFOHTHEALLEOEDEXEMP• (� V; TIDN.qN7VIOLATIONOF3ECTIDN7037,5BYANYAVPLICAMFORAPENMITSVBJECTSTHEAPCIJCANTTO Z Re-Roof �' ACIVIL PENALTY OF NOT MONE THAN FIVE NUNORED DOLURS(5500).): � ❑I,ASONMEROFTHEPROPERTY,OPMVEMP�OVEESWITNWAGESASTHEIRSOLECAMPENSATION, 0 COf11fOBfCi01 Z�, N7L:DO iHE WOqK,AND THE STRl1CTURE IS NOT INTEVDED OR OFFERED FOR SA�F(SEC.70e{,BUSI- J ��;: NESSAND PflOFES510N5 CO�E:THE CONTqqCTORS LICENSE lAW OOES NOT APPLY TO AN OWNER OF � � PROPERTV WHO BUIIDS OR IMPROVES THEREON.AN�NMO DOES SUCH WORK HIMSELF OR HEflSELFOR ( '�� TXflOUGHHISORNEfl01VNEMPLOY[ES,PROVIDEDTHhTSUCHIMPROVEMENT&AqENOTINTEN0E00R m � 'w' OFFEREDWRSA4E.IF,HOWEVER.iHEBUIIDINGOflIMPROVEMENTISSOLDWITFtlNONEYEqROFCOMPLE- � Z; TION,hIE OWNER�BUILDER WI��HAVE THE 6UH�EN OF PROVING iHpT HE OR SME OID NOT BUIID OR �' IMPROVE FOR THE PUflPOSE OF SAIE). -W. ❑I.RSOWNEHOFTHEPROPEFTV,AME%CLUSIVEL'/CONTRACTING,WITHLICENSEDCONTMCTORS ��p (L 70 CONSiRUCT THE PR0.IECT(SEC,70d.BUSINESS AN�PROFESSIDNS CODE:TNE CON7MLTORS LI- VdIU8�1017 ��� ��✓ ADJ.AREA �'�� �� W'. CENSELAWDOESNOTAPPLYTpANOWNEAOFAPROPERNWHOBUILOSORIMPqOVESTHEREON.AND — �. '�" WF70CANTRACTSFOFSUGHPRQIECTSWITHACQYTRACTOR�SJLICEN5EDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION Y. TOqSLICENSELAWJ. FEE � �0:� — Il i AM EXEMPT UNDER SEC- _,_ _,__B.6 PC.FOR THIS qEASON '. U �V'�h V�j-�. �i c �C, -��.�'. �. � �t�'j fi ��I�+ � OATE_""__ OWNf:R : V– � �S i 'o:: ----- ; w _Q. � �.,�.T�c r vr..( -e � ��.� UCENSED CON7RACTORS DECLARATlON `' W C�4 , •� � {. r� ; -� I HEREBV AFFIflM UNDER PF.NqLTV OF PE0.IURY TNAT I pb1 LICENSED UNOEH PflOVISIONS OF CHAPTER -�" 9(COMMENCINQ WITH SECTION 70oa)OF OIVIS(ON 30�THE BtJSINESS AND VROFE551ONS COOE,AND . Z 'f�`y,. 'i�j �_�.. � '�.�;, MYUCENSE IS M FUIL FOflCEPN�EFFECT. /° � ` Q� ? m ,�;: LICENSE CLASS ��C� �LIC.NO. Lw(�+� {✓� � j '�w �� '�/y� '�~�' �ATE_��� CONiRACTOq � �1`-r��Y^-` .�7 U w � ����. WOFKEAS'COMPENSATiON DECLARATION ry.rT��'' � .;� �l.' IHEREBYAFFIfUAUNDEAPENALTYOFPERIUAYONEOF7HEFOLLOWINGDECUMTION3:v � Z � �� „___IHAVEANDWILLMAMTPINACERTIFICN7EOFCONSENTTOSELF�INSUREFORWORKER6' _ QZ� COMPENSATON.AS PROVIOED 8Y SECTION 37000F THE LA80fl CODE.FOq TNE PENWflMANCE U .�' OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � } w� __1 MAVE AND WILIMAINTAIN WORKERS'COMPENSATION INSURANCE,AS AEOUIREU BY SECTION _ i Q� 37000F THE LAAOR CODE.FOR THE PEflFORMANGE OF THE WORK FOR WHICH T111S PERMIT IS �' � ISSUEO.MY WOflKEFS'CAMPENSATION IN CE CAqRI N AN�POLICY NUMBER ARE: CONSTRUCTION �� J �� j.; CARRIER_���( � v.•��' _.,_ PLAN REVIEW �. �Q.. POLICY NUMOER�� � R�. ELECTRIC _-- _— . . W. (n+LSSEciqNNE�NOTBECOMPt.EiFDOFn+EPEWAiISFOFiavEFax�aEo (S1oo�ORLEs5�1 PLUMBING .t ' . ,'Z.. I CENTIFv THAT INTHE PERFORMANCE OF hiE flK FOfi WHICH THIS PERMI715ISSUEO,I MECHANICAL �` i�� ��'�'' C3:. SHALLN6T EMPLOYANY PERSON IN ANY MANNE SOAS TO BECOME SUBJEC7 TO THE ..—� �-�� �'�' (/y� WOAICERS'COMiEM5A710NLAW50FCALIFOFk M'DAORE HAi!FISHDUIDBECQME INSPECTIONFEE : ? SUB,IECTTOTHEWORKERS'COMPENSATIONP VIS� S CTION37000FTHELA80fl -- CODE,1 SMALL FOR WITH COMPLY WITH THO PRO ISSUANCE �, ��� - f� � p�; DATE: APPLICANT ___ SMIP _ �}^� � �J�% WARNINO:FAILURE TO SECURE WORNERS'COMPE ATION COVERAGE IS UNIAWFUL.ANp SHALL BE ENERGY P/C �.�y; SUBJECT AN EMPLOYERTO CPININAL PENAL71E5 ANO CIVIL FM[S UP TOONE HUNDFED THOUSAND ENERGY PERMIT DOILARS(f100.000),IN AOOITION T07HE COSTOf COMPENSATION,DMIAGES RS PROVIOEO FOR IN �-J�{ SECTION 970BOF THE LABOR CODE,IMEREST.AND ATTORNEV'S FEES. oc RETENTION FEE: d=+ CONSTRUCTION LENDING AGENCY PRE•ALT FEE: '05 — �� I HEFlEBY AFFIRM UNOEq PENALTY OF PEiLIURY TN0.T7HERE IS ACONSTRUCTION LENDINQ AOENGY �nZ'� FORTHE PERFORMANCE OF THE WOflN WH WHICH THIS PERAIIT IS ISSUED(SEC.9097,CIV.C.). — I ,W. LENpERBNAME_ _ �' . ���I--� LENOER'SAD�RESS_ ..;w�� ICERTIFYTHATIHAVEHEAUTHISAPPLICATqNANOSTATETHATTHEABOVEINFORMATIONISLORRECT. TOTAL FEES 1 � p I AGREETO COMPLY i/ALL CITYAND CWNTV ORDINANCESAN�STATE lAWS RELATING TO BUILDING /]�r.-� CONSTRUGTI0.4,AN EREBYAUTHGR2E REPRESENTATIVES OF'HIS CO'JNtt TO ENTER UPON THE g/A��n� ��? ,/ � .�'_ ABOVE-MENTIONED ROPERT'FON INS PURaosEs. COMMENTS �` 0 0 ! �'-� �Tt .r_: -:'°(�� Yh c +� � m� PEfiMITTEEN (PPINT Q. r� (q: SIGNANR PERMI EE DATE � _ . RECPT.N0. PAID BY VALIDATIdN_ ~ WHITE—DepaNment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,OOLDENROD--File C GqEEN— opy. AppllcanYs Copy � �.H_ a,_� � a�___..�_.__�._. .- _ __ . � I us tn � -�--_.__...._...._._�,.._.�___, � �t -ei;� yn �'i e���cn!tnVIo �' I rri cr I�s�s� f3'a -si ao I � �� m rn i-,- i� g Gj`m icn 'R� 'O � � ; � � z ��zID(m�m�nI� r �, 7�ITip�O!0 :7 :a�;7 n � r ��m � ."�^-i � Y�,{'.D �,�Y=iva m '� �°,5Y-C r_�. O�ciC GEp n �'S' � D..pI� y i� . �. 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