HomeMy WebLinkAbout16609 (23) �� CITY OF DIAMOND BAR � DEPART'IvIENT OF COMMUNTI'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive �'`" (909)8603195 Faa�(909)861-3117 PRESS `'�wti BUILDING PERMIT APPLICATION FIRMLY QJOBSITE ��� � 1' �p��,,�2 L A,�- `J DATE CA710N / _ �.`�-"_� � NU BER � t '�° �i/C`/, � �J O a ADDRESS_ � �.b�/�-�U7 V/ �,(� � � ISSUE TYPE OCC APN L T TRACT DATE CONST. GR P p OWNER �'`' ZONING SETBACKS �r��, �� !' z CI�T� ZIP TEL L FRONT �;py�eKJV `� "'6 ZAPPLICA Tf��_r"�' TE S DE/SIDE STREET RW � Q CONTRAC R�MS �� ..�it/Z- SIDE ❑ o ADDR SS CI MDYJ� P S TE PROPOSED USE w ARCHlENG/ ,�-�,LC' �u�� z �ESIGNER W NO.DWEL. NO. NO. � AD R S J UNITS STORIES BEDROOMS � Ci� /�' ZI d TEL ZO Z� cn m DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFWADD/REM O p I HEREBY AFFIqM UN�ER PENpLTV OF PERJURY THAT I AM EXEMCT FROM TFIE CONTRACTORS LI- GdIflJ8/CBfpOfl W CENSELAWFORhiEFOLLOWINGREASON(3EC.7031.58USINESSANDPROFESSIONSCODE:ANYCITYOR (n C.� COUNIVWHICHFE�UIRESAfERM!TTOCONSTRl1CT,ALTER,IMPROVE,�EMOLISH,ORREPAIRANYSTqUG w TURE,PRIOq TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PEPMIT TO F�LE A SIGNED w Patio/Deck STAYEMENT THAT HE OR SHE IS�ICENSED PURSt1ANT TO THE PROVISIONS OF THE CONTFfACTORS�I� � CENSE LAW(CHAPTERe(COMMENCING WITH SLCiION 7000)OF DIVISION 30FTHEBUSINESS AND PRO- � PooUSpa FESSIONSCADE)ORTHA7HEORSHEISE%EMPT7HEREFROMANOTME9ASISFOFTHEqLIEGE�EXEMP- (� � TION.ANVVIOUTIONOFSECTION7031.SBYAN�APPLICANTFORAPERMITSUBJECTSTHEAFPLICANTTO Z RB-R001 ACIYIL PENAITY OF NOT MOFE THAN FIVE HUNDRED DOLLARS(5500).): � � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION. � COfi1RIBfC18I Z WILI DO TME WORK,AND TME STRUCTURE'S NOT INTENOE�OR OFFERED fOR SALE(SEC.7044,BU51- J � NESS AND PROFESSIONS CODE:THE CON7RACTOFS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERT'WHO BUIL0.S OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OF � THROl1GHHI50FHEROWNEMPLOVEES,PROVIDEOTHATSUCHIMPROVEMEN?SAPENOTINTENDEDOR m w OFFEREDFORSALE.IF,HOWEVEfl,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- � TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT I1E Ofl SHE�IO NOT BUILA OR Z IMPPOVEFOqTHEPURPOSEOFSqLEj. _ ❑I,ASOWNEFOFTHEPROPEflTV,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS W � TO CANSTRUCT THE PROJECT�SEC.7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VOIIJflilOfl ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOYJNEROFAPflOPERTYWHOBUIL[150RIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPFOJECTSWITHACONTRAC70R(5)LICENSEDPURSUANTTOTNECONTRAC- QUANTITY DESC TION FEE Y TORSLICENSELAW.). � J � ❑IAM E%EMPTUNDER SEC. B.E P.C.FORTHIS REASON Q � U LL � DATE OWNER � Z W � LICENSED CONTRACTORS DECLARATION W ¢ 2 I NEREBYAFFIRM UN�ER PENALTV OF PEFJl1RY THAT I AM LICENSED UNDER?FOVISIONS OF CHAPTER � � 9(COMMENCINGWITHSECTION7000)OF�IVISION30FTHE�USINESSANDPPOFESSIONSCOD<',AND Z LLI �Y LICENSE IS M F FOR�C}E AND EFFECT. /1 m � LICENSE 5 v� LIC.NO. � / � J v oarE '� COMRACT a � 1``.�J�+'`OV RK 'C MPENSATION DECLARATION ¢ 7�, � IHERE6VAFFIRMUNDERPENALTVOFPERJURVONEOFTHEFOLLOWI4GDECLARATIONS: Z 0 �I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF-MSURE FOR WORKERS' _ Z CAMPENSATION,ASPflOVIDEDBVSECTION37000FTHELABOFCODE,FDRTHEPERFORMANCE U 4 OF E WORK FOR WHICH THIS PERMIT IS ISSUED. � � 4 _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREQUIREDBYSEGTION �/S{7 /1 3�0o OFTHE LABOR CODE,FOR TNE PERFORMANCE OF THE WOPoC FOR WHICH THIS PERMR IS Ia' y ��� . � ISSUE7,MY K RS'COMPENSATION I ANCE CA/q��IER AND POUCY NUMBER ARE: CONSTRUCTION ` D . � ¢ �iVy PLAN REVIEW � CARAIER I �� Z POLICV N11� I�� f--.— ELECTRIC ¢ , � (1}iISSECTIONNEmNOTBECOMPLETEDOF7NEPERMTISFORONEHUWREDDOLLPIIS(y1aD)ORLESS� PLUMBING W Z I CEflTIFY THAT IN THE PERFOFiMANCE OFTHE'NOFK FOR'NH',CHTHIS PERMITIS ISSl1ED,I MECHANICAL C�3 SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBEfAME5U8JECTTOTHE � WORKERS'COMPENSATIONLAWSOFCALIFORNI NDA [E IFISHOUL ECOME INSPECTION FEE r � Sl1BJECiTO7HEWORKERS'COAAPENSATIO I O E ON3700 HEL480R ISSUANCE ^J�w�V � CODE,I SH L FORTHWITH COMPLY WITH 10 S � 0 ' p DAT � / APPLIC . SMIP J W��N .FAI�E EFS'COMPENSPTIO VERAGEISU W ,ANDSHALLBE ENERGYP/C �y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANO FINESUPTOON H�N EDTHOl15AND ENERGYPERMIT DOl4AR5(i'�00.000).IN AO�ITION TO THE COST OF COMPENSATION.DAMAGES AS PROVI�E�FOR IN ^- — J SECTION3]oeOFTHELA80RCODE.INTEREST,ANDATTORNEY'SFEES. RE�ENTIONFEEa / d CONSTAUCTION LEN�ING AGENCY PRE-ALT FEE: �, O � I HEREBY AFFlRM UN�ER PENALTV OF PEflJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV � FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT 1515SUED(SEC.3o9�,CIV.CJ. Z W � LENDER'SNAME F_— LENDEWSADORESS � w ICERTIFYTHATIHAVEREADTHISAPPLICATIONAM1DSTATETHAiTHEA60VEINfDRAAATIONISCORRECT TOTAL FEES � � �� � _ � IAGREETOCOMPLVWITHALLCITYPN�COt1NTYORDINANCESANOSTATE:AWSRELATINGTOBUILDING �A� ��r � CANSTRUCTION,ANDHEREBV HORIZEAFPRESENtA71VE50FTHISCOl1NTVTOE4TERUPONTHE /) � Z ABOVE�MENTIO PR PE FO INSPECTION PVRP0.SES. 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