Loading...
HomeMy WebLinkAbout17089 _ __ ._ . _. . _ n....,_,...,....,.,__. _.._ _.... CITY OF DIAMOND BAR �"""R �- --"�� - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES '�� �, �,w , 21825 E.Copley Drive ,�/1 (909)860-3 L95 Fax(909)861-3117 � PRESS ��v�^� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE � f /'`��' / ¢ ADDRESS I �� -�-�-��/(��/ DATEICATION �' �. NUMBER �r��,j� P/C � �^`� � — 4J # v� J �° APN LOT TRACT ISSUE TYPE OCC p aWNER ,� P � ,�p!'� ,� �;� — DATE GONST. GROUP � ADDR SS �' ` 1 i; ZONING SETBACKS 0 z CITY� ZIP TEL.��-��� FRONT Ry� � p APPLICANT TEL. REAR � z SIDE/SIQE STREET Ry�/ ❑ Q CONTRACT ��� � ..,� '�( - _ .��- SIDE � ADDRESS ' "� ra�s ' � ' � C17Y Z�p � ti� PROPOSED USE `� � �'• W ARCH/ENG/ —( �C?�� " � z DESIGNER � a ADDRESS NO.DWEL. NO. Np, � C��1' ZIP TEL. UNITS STORIES BEDROOMS y `n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDEF DECLARATION p SFR/ADDlREM � I HEREBV AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI� G8f8J8/CBfpOfi W CENSEUWFORTHEFOLLOWINGflEASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITVOq (n � COUNTYWHICHRE�UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOUSH,ORREPAIRANYSTRUG W patl0/DeCk w 7URE,PRIOR TO ITS ISSUANCE,AL50 REDUIRES THE APPLICANT FOR SUCN PERMIT TO FILE A SIGNED W � STATEMENT iHAT HE OR SHE IS LICENSED PURSUANT i0 THE PROVISIONS OF THE CONTRACTORS L6 CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF�IVISION 3 0F THE BUSINESS AN0?RO- LL POOVSpe � FESSIONSCODE)ORTHATHEORSHEISEXEMCTTHEREFROMAND7HEBASISFORTHEAL�EGEDEXEMP- (� U TION.ANYVIOLATIONOFSECT�ON7o37.5BYANVAPPLiCANTFORAPEHMI7SUBJEC7STHEAPPLICANTTO Z RB-RoOf � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(E500)�: � ❑I,ASOWNEROFTHEPROPERN,ORMVEMPLOYEESWITHWApESASTHEIRSOIECOMPENSATION, � Commercial Z WILL DO THE WORK,AND THE STRUCTUflE IS NOT INTENDED OF OFFERED FOR SALE(SEC.7044,BUSb �J � NESS AND PROFESSIONS CODE:THE CAN7PACTORS LIGENSE LAW DOES NOT APPLV TO AN OWNER OF � PqOPERTY WHO BUILDS oR IMPHOVES THEREON,AtrD WHO DOES SUCH WORN HIMSELFOR HERSELF OR w THROUGM MIS OR MER OWN EMPLOYEES,PFOVIOEO THAT SUCH IMPROVEMENTS ARE NOT INTEN�ED OR CO � OFFEREOFORSALE.IFHOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWi7HINDNEVEAROFCOMPLE� Z TION,THE OWNER-BUILOER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DI�No7 BUILD OR � IMPiiOVEFORTHEPURPOSEOFSALE). w ❑I,ASOWNEROFTHEPROPERTV,AMEXCWSIVELVCONTRACTINGWRHLICENSEDCONTRACT09S . � TO CONSTRUCT THE PR0.IECT(SEC.7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V8I113(IOf1 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBU�D50RIMPROVESTHEREON,AN� � = WHOCONTRACTSFORSUCHPR0.IECTSWI7HACONTRACTOR(SjLICENSEDPURSUANTTOTHECONTRAG FEE ~ TORSLICENSELAW.�. QUANTITY DESCRIPTION Y p ❑I AM E%EMP7 UN�ER SEG e.&P.Q FOR THIS REASON Q —' '�G��y.g � U � � DATE � OWNER H � ��• Z (> � LICENSED CONTRACTORS DECLARATION W � I HEREBV AFFIRM UN�ER PENAL7Y OF PEFJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z 'X MY UCENSE IS IN FULL FORCE AND EFFECT. m 0 LICENSE CLASS LIC.NO. � H � U DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q � ��r � U � � I HEREBYAFFIRM UNDER PENALTV OF PERJl1RV ONEOFTHE FOLLOWING DECLARATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' ¢ Z = � CAMPENSATION,ASPROVIOED9VSECTION37ooOFTHElA80RCODE,FORTHEPERFORMANCE U OF THE WOF1K FOR WHICH iH15 PERMIT IS ISSUEO. W � � 0 W _I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS FEOUIRED BV SECTION 37oDOFTHELA80RCODE,FORTHEPEfiFORMANCEOFTHEWORKfORWHiCHTHISPERMITiS �'`� J ISSUED.MV WOFKERS'COMPENSAiION INSURANCE C0.RRIER AND POLICV NUMBERAPE: CONSTFUCTION N \J j CARRIER PLAN REVIEW Y" z POUCYNUMeEA ELECTRIC r . ¢ � (MISSECTIONNE�NOTBE�v1PLEfEDOF7HEPERMTISFORONEHU�OFEDDJl.1AR5�5100)ORLESS). PLUMBING _, p �'`� Z 1 CEFiTIFYTHAT INTHE PERFOPMANCE OF THE WORK FOR WHICH?HIS PERMIT IS ISSUED,I MECHANICA . -. {,J C7 SHAILNOTEAAPLOVANVPER50NINANVMANNERSOASTOBECOIAESUBJECTTOTHE � /p.,, i i'-�� (J� WORKERS'COMPENSATIONLAWSOFCALIFOqNIA,ANDAGPEETHATIFISHOULDBECOME INSPECTIO F ��Y���t"f�'� � � SU ECTTOTHEWORI(ERS'COMPENSATION RRVISIONSOFSECTIOM1'37a00FTHELA80R , � , � E,I S ALL FORTHWITH COMPLY WITH T R I510�/5 ' ISSUANCE Q ,��( [` p DHTE:��� APPLICANT: ���V` SMIP q� .I.�,� j WARNING:FAILLIRETO SECl1HE WOqKERS'COMPENSATION COVERAGE IS'JNL4WFUL,AND SHALLBE ENERGY P/C� � '� — SU&IECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVII FINES UP TOONE HUNDRED THOUSAND ' � A � OOLLAflS(3100,000),IN A�DITION TO THE COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR IN ENERGY PEM� IT � .y � � d . J SECTION370BOFTHELABORCODE,MTEREST,ANDATTORNEY'SFEES. ���--.�.;- � -... -- OC RETENTION�E:._.. .,....,.,..',�,. . .b�-... . ... 0 CONSTRUCTI�N LENDING AGENCY PRE-ALT FEE � � � � 1 HEREBV AFFIRM VNDER�ENALTV DF PERJVRY THATTH=qE IS A CONSTRUCTION LENDING AGENCV FOR THE PERFORMPNCE OFTHE WORK FOR WHICH?HIS PERMIT IS�SSUED(SEC.309],dV.C.). Z W � LENDER'S NAME � \ `l...V � LENDER'SADDRESS � W I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATETHAT iHEABOVE INFORMATION IS CORRECT. TOTAL F S ��� 1` 'F,�V �- d IAGqEETOCOMPLVWITHALLCITYANDCGUNTVOR0INANCESANDSTATEL4W5PELATINGTOBVIL�ING . �V �J � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES Of THIS COUNTV TO ENTER UPON THE 1 � z ENT�NED PROPERTV FO�E�qTION PURPOSES, � ,aY /�`I �. -,7 _�� COMMENTS � l��` t. !C� m P I NAME l] � �c;.��'-z-�- l��C'f (J� SIGNATUREOFPERMITTEE ' DATE - � RECPT.�O. PAID BY VALIDATION WHITE—DepaRmen[Copy,YELLOW—Finance Copy,PINK—Assessor Copy,G LDENR06—File Copy,GREEN—Applicant's Copy �,, a:..:; . ;;,.� , , . . .. � ,..,..ron:.R�,:..�.�8,x�, .aa..;��. . , �.:,:�,:<k�spv .-..� .. �.:<r%" .,..,.. ...:�, .-..:ti��� _ . .i.;a:', g §�',�b°$ �i �9 ��:.k€ ^,�."�i� 8?i�,ffi'���,�� o-.�:''.�d R-?� . F S.�%'F rt x �l.:iro� �e s�.:vt��-� R:b'���B zm �� ��� �s:�� � ��� �s'�Xe�.����:�����������:. �r� �;�� � ��� � �'e �"� ,��� �����;a ��� � "� a� ��a��� .mB� � `��s+ ;. "';� �: � a� �� �; � .� :* �i �� "�°����`��� � . ��f��a � ����a � � � "� ��� ��� � �: �,a �-- � �� ��.. .�� � ����� ����� . ��3� ��� ��''����� � � ��� �.� `�`' . �- a-v'� �:°,�m....^.���#?€;�Y ��` _P. ,d�;.:��a '�_�...?�.. xa�-�'a,'tn�:�� t'��� �� '��.�.�s.� �iw:�:.._w��,a���a �&�t�a�`:�+. � '��..,�: m.���ti_.4r�a�t .:, .�.,.�'m.,.-:� a� - a? s,. .,�� :_. � I E € .. � d 3 � . � „3 'F �t €� �. .. .. . ... _ . _. _._ .__ " — .. ..._ .. . ,_._.; : __ _ ........ E t� E F ��`� � i �.._ ; : _ �_�. !L.-�t ....�� � . _ �_ . . _ . � ----__. .. ._� .� , ; � � €�„ � +�� G 7`b � k ,� �3 �; }� � � . �..._�..__ � _ : .L ...._.. ........_. ....._ _.. . _. _ ._ ..�.. ........ __........__—s _ _ � � �'��"'3 �3 � ` ;1 wg . a t.^� x -� �.a r-*�"1"^� P6 �g� € 1 o ._. _.. __..._.____�� ,» . .....__ <............ ... ...__ ._. ....... i ._. .... . .� ..._ _ __...._...._.. ,_.......... _._........._.. ........_.._._.�._._.. _ ¢-' ;— _...... � .e....ik:7 . �4:..�L'.: : ' ::���.: "� . .:' �, 't�j i€ �° .p : ..,.,..,., � ...... _ ............... ...__._�_ ....____ '. ....._.._. ."""_.....,..........._'____"__ .._,.._ .: .. . �.. -.. .. ,.._.._._..__........ ................_............. .,.. ..............M.w-........._. � y-,xk a?�r'., -< ' ' � �.'� � 3 t € ��f��'�`' �t +���:§ -t-��__..._._..�...�:....,.J.,.,..__...,...,. ___. .�.._ .__..._.�........ .....__......_.....__.._._.__.__......�..... .'- o -___ ..W ....... . . .. ......._._..._. . �_.. � PPid:t�* �:� �,., ' . .,:'I l�`$S � s� �...r:r� . I , . .._ .. . .... ..,_p .. ._�..._ ,,.,Q.. _..._....__.. ._._... �._ . , ....... .., _ .�.._.._�. ....�._ __.__._... _ .__....._ ..__. ri?4i ��i�.I' �)i�¢�� �1�i�:.�� . l�✓�� �z° s@�� y'$ g .. p^ _... .. ._. �.� � .__ .... �.. .... .,.._. ......,...�_ ... �:....,_.......�..a. t� 3 € I ��.� F . . - I �` . �..,_ .'< 1 4� ... '"'� l t ��.:z I 4.'T t ' �� .6S .....�� rY � 5S �J 1 � . . .... _..':_ .. .. .._ ... ... _ .. . . - � . ; r �t: � ��,t �� �o p �s��� � �a �� � � __.. � � _ __ _ �c-�i�g t��.��; ra: 1. rn .1��'`.:�.m 4 � i ,� t,� i._, . .. � .... . � . -....,.. . ..__ . � . ..�._ . ' ..m.,.. _.. ....,.__. .....-_. . ..�....-. ,:� �-�. �-� � �p-E-d�. . p--r j� � � €, � w �, , � _. � _ _ �rv _. _ _ _.�._ ______ __. _ �._ __ = � ��� ,�, � � � , E,�� 4.�� � � { � �, s���� � a,�� �;��.� � . __ __.._ .__ . : �. _.w... _. .. _.. _ � � ('.� —� � ...f?�s�8 �,.'41 r-"� -,ht E '°t f i_...�i f<-,. ...� �.... . .... _.�.. ._�... .__..._ ��,._.. _ . ._____...,,...... � . . _ .�._._� ._.... .. ........___ ..,_..._ _..� ...........— . :'.:+1�. �,i .:'�:�. ;�7illd,'t I, � '�3k 11)t :'..t��..�a.. � ..) E � .. ._ ... ..._.,_..,. .._.._...... . . ._ e._. ........_ .. ....... ........_ _. .. ..... ... . ...... ... ._..�.____ ...._ . ;-._ @ ��a';_ 2'L .. �. { .o, _�(�•J r l�._(y P � � �;.,,'�'.r o �r E°: �� . _ :_._... . ..,,. � � ....... _. ._ ... . . !...._ .w.W........ ........_ . . ...... '. --{3 °�, 'y �§-.3 ( .�.�Q ~��\ � f'_�k t, ... ft �.... . . . ._. � a � ':''�'s ' i�a Yi3 $ --: ��t 0 1 r 1 H.� /G�°i .... �' l r ��.e �� k__.. . .. .__.,. �. _. .... __ . . . .__m .._........ _ � _ . _ � � ' , � �;� � ` _ . _._..� _ _._�..__.___.. .,.._.__. .._._____._ ... �___. _ �__ _ W .__ _.._. . �__. _________________. =� d a.� ,x�.: ` � ?�.,«: �e�ai.x, .. lt-��F<�'. , -� :: _ � � _ . __ .._. . �.___._,_____ ._ ...._ ._. .........�._..........�_ _ � _ __...m__ ._. _..�. ___ __-___._...____ ..__._..._ ----- � �..� J � __-; �'� . „,� � ���� ���i� r_. ` ' Es� � ;L���,���. � ' �_ w'� _.._. . .______�_�.__--.__ .____.._.__........ ...____.____._ � _... _._____ _ ___ __ ___._ _......____ _ __ �,;�. �@ � ,.. _._. , ______ _...: ,. � � r,� ; s� .. ._...._._ e.. .... ___._..�__.___.____..W......._._a _._.�._. a.__ _ __.�.w__._. ._. ___. _.._.�_._�. �._._�_� ,.� _ _. '., , _;'_ m�.�._ ... , �li`:�°„ .�..,. .,g�. � : ''_ti° � ._ _'s � .:��dr�'�V`_. . � '..w � E _ ._ .._.._ ..._. _.i-- _ . . _. _ . ............ _. ... .. . . �, e � ... � . - , � �S'�'�� �1 �' (�.� ��i , . r ..a..�.. .. ..w............ . .� ..._.... _.. '� _... ....._...._.._... .. �..""'__. _ .._..._...._. ..._....... _....,....r....__�.._ � _.„,... ...,.... __ .I ; -i 3�`+ ... �,,..s.. r, : . � , iG's' �I. �I _ x,. .,: t' ?.7% , a 4 t:..a= �£i ..) 9 r _... _ _- — _.___ __ — — -- >---- - � � .;'�'°= 4l_.:��,; �� .:�� ° � � , __._....,_._. .:..� � .�...._....... . __ ..... ..__.. _. ... .._._ .__ ._�..___ :�~ __..... .. __._ ... ..............__�...� __.__..... _...._.. ___ � � _._. �___.. _ � . m_��_ ' � _ _._.__-_.___ __.__ �� � � i , � � e�� �����': � �_"a ' ' ';��� o.U_ . ,�,.,a�����,�� ��': ..�_„ _ _..�_._... __ . . ____.._--- 1 # �.�,,a.a �� .�� ....�, f :..,��:.� ��a�"'.:, a € -_`" � s � . �.�.._... ......_._._._....,........_�..,.,_._..____..__......_._......._......... ........_._._ _...._.._.�......__.__.... .._.._.__..__...____..._.._........._..... � . '.......�......_.._.�_�...._........_...___..___..._... _____.__ ._..._.__._.._ _......._.. ------ --..___.._. _._.. S _.__ ._...._....�.___.__-_---�._.._.._._._._ . ......._____.___� . . _.__.._�._.,._..._ i y__ .......... ___..__._........... ....._.._..___...._._.....____.,_.__�..........._......,....,,..._.,... .._.�_...,,..�__.._..._....._...._......... . � ......_..._.__..,......._._..._....__.'_�"'.._.... ..___.........._..__ .._....,....�...______"'___�_............._..... ' . '........._,__..___�__...� i '�._._..,...�....._.......m.........._.....................__._,�.._ ...........____...,,............„ � ........._._. ....____.._.....�..._.........,..._......._._.................__.__......_ ..._........_...____._�._........,...._.. : ...._.w.__.__._..... ._.....__,_._,._._._._._ _ ._._. ......,......,.-...- . ........ ... ...�.... . .� �_... __....._..._ ___..._ . ....... ..... ._ .._...__ ....,.... . _..... ......_..._ .. _r._.._. ...._... . �...... . � �._...�.__ .._�....,..� _.__._ -- .._.�_ _........ _.-.._ ._ _ ..................._ - - � _----. __ __._.__ ._. _.. __ .._'_' __ ._� I :„... , a� ,..,�.w " ��....s ���..� ��:^�`i ..�'.�'.'.- � � ..._...,_..._..,,._,._....,. f ..,, €.,..a.g-t-. � p ..,, ........... .. .�_.._._. ..........._.. . ...........-. ,�.'.��� tl 3 x J B' ..................�..,...,,,........_...._._._..._.__.........__...................... ............_.,_.�____,................_ a.- j:w �� � .. ...�......_ � �� " : ����� , ���g� ...._.._............._.r.._........_.._......._.........._......,..,......__..........._.. ...._ ...,...,,......__._...... ....._ @ ......................._.�..._.,.....,,._. ......_......,..._�_____.�.._..._. ...._..._.__�.........__........_..._._..._�......... ...i e .. ��.:. �`�. ����. ' � , � ° �� ��... ' ,q':��� .�� �� " ..._i _�.�._... _. � , ��.�. : _ ..... ...m...,... __._... .. ..._ . _.. _._._ ... .._. _�._.�._...................w...__-'___. . .. � � � � � ������ ,.. � � ���..�� �� �� �,y. _ _ __.. ___ . _.. �_ _____ � �r ,.:�r �������� +� '� ....._...__._..._....... .........___..._.__...�.__.�_ ....._. ..__._........� ._.......... ...._...._.__. �.__...... _.._.�..�.i � � ��� :� ..� ___� ...... ,........_...._ _.._�_....... _ . k 4 ��:� ������� � ! � a�������'' �� � � _ _... _� __..... � �.. .. .__... _. .... ..... . _ __ . .__._.. _...__ ___..___ _.._ � ������� ��.�� __ _ _._ __ ___.._ ' _.._ _ ,,��`�� �,� �,���a- _ ; � �r��*�� :..��a �a�w� ����a -__ __... ..___....� __ . . .__.,w.__.. __.. _ .. ____ _ _; _ _. ___ __. ___ _. �_.... . . *.,.,....,..,m« ...,�,�.�,�.,�..v.. ....m��, .,..,...M,..�.�_M�,....�,.«���_�..,,..�.�,__......:.�:�.....,�,� .._�a..,...»....m„�A_�M..,.....���,,.�.�.»�....�.��<��...< .,.m. .»m.. _ �,..,�.��,..!