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HomeMy WebLinkAbout17536 CTL'Y OF DIAMOND BAR �" �- �`--- DEPAR'fMENT OF CONIMUNITY&D�VELOPMENT SERVICES � �ur�rvun�uu ,,ti� 21$25 E.Copley Ihive (409)860-3195 F�(409)861-3117 PRESS '"%.v��'��' BUILI3INGPERMITAPP�,ICATION FIRMLY � JOBSITE ���} !'_,�.r,r�q,y ,,(�� APPLICATION PERMIT P/C o ADDRESS / Ce�ii�r•�� ��� DATE � � t3�- NUMBER # � ISSUE / / 1YPE OCC APN �LOT � TRACT DATE f �/�"'� CONST. GROUP p OWNER .��'�b3 p ADDRESS ��t-- ZONING SETBACKS z CITY_-�--�� ZIP TEL. t�f(pl' ��o FRONT RW ❑ ' o APPLICANT 'v °ing�5.1=-(. - '��= TEL.��y �-g�� REAR ❑ Z --f- SIDE/SIQE STREET RW ❑ m CONTRACTOR ��e�1�N��L r �C`.s �_ SIDE ❑_�_ � ADpRESS �S-L12- C�ca�n� S'tl` PROPOSED USE ��'a r� 1 P'IS-�� � CITY�'" �oa'Ef�- ZlP,� TEL. (l t� � ARCHlENG7 6� � � Z DESIGNER NO.DWEL. p � NO. NO, a ADDRESS UNITS = CITY IP T I STORIES �BEDROOMS � � DESCRIPTION S�.FT. FACTOR PSF qDJ.AqEA/VALUATION oOWNER-BUILDER DECLARAT�ON SFR/ADD/REM Q I HEflEBY AFFIRM UNDER PENALTY OF PERJURY 7HAT I AM EXEMPT FROM THE CONiRNCTORS LI- � Garage/Catport 'W C6JSELA1YFORTHEFOLLOWINGREASON(SEGTo31,58U51NE55ANOPROFE5510N5CODE:ANYq7YOR U COUNTYWHICHREQUIRESAPEflMITTOCON57RUCT,ALTER,LMPROVE,OEMOLISH,OflREPAIRANYSTRUP � I z. TURE,PflIOR TO IiS ISSUANCE,AL50 REol11RE5 THE APPLICANT fOR SUCH PERMIT i0 FILE A SIGNE� W Patio/Deck W STATEMENT THAT 19E OR SHE IS LICENSED PURSUANi TO THE PpOVISIONS OF THE CONTRACTORS LI- W � 'CENSE LAW(CHAPiER e(COMMENCING WITH SECTtON 7Wo)OF DIVISION 3 OF THE BUSINESS AND PRO- � PoOUSpd � � �FESSIONS.COpE)0�7THAT'HcOFSHEIS�EXElAPTTHEREFROMAN�THEBASISFORTHEALLEGEDEXEMP- (� � � TION.ANYVIOLATIONOFSECTION"l031.58YANYAPPLICANTFORAPERNITSUB1ECiSTHEA?PLICANTiO z Re-Roaf ��A qVIL PENALTY OG NOT MORE THAN FIVE HUNOflED DOLLARS(5500)J: � ❑I,ASOWNEFOFTHEPflOPERT'.ORMYEMPLOYEESWIiHWAGESASTHEIR50LECOMPENSATiON, � Commercial - ��' 'WII.L 00 THE WORR,ANO THE STRUCTURE I5 NOT IN?EN�ED OR OFFERED FOR SALE(SEC.7044,BU51- J � '�NESS AND PROFESSIONS CODE:iHE CONTRACTORS LICENSE LAW DOES NOTAPPLY i0 AN OWNER OF = PPOPERTY WHDBUILDSOR IMPROVESTHEREON,AND WHO DOESSUCH WORKNIMSELFORHERSELf OR � �THROUGHHISORHEPOWNEMPLOYEES',PROVI�EDTHATS�CHIMPROVEMENTSARENOTINTEN�EOOR � m �,Q' .OFFEREOFORSALE:IF,HOWEVER,THEBUILDINGORIMPfiOVEMENTI550lDWITHINONEVEAqOFCOMPLE- �; TI�N,THE OWNER-BlJIlOER�WILL HAVE 7HE BUR�EN OF oROVING THAT HE OR SHE 01�NOT BUIL�OR IMPROVE FORTHE PURPOSE OF SALE��: w ❑I,ASOWNEROFTHEPROPERI'Y,AMIXCLUSIVELYCONTRACiI�OWITHLICENSEDCONTRACTORS ,-Q� ���'Ttl CONSTRUCY THE PRQIECT(SEC.7a4#,BUSWESS'ANO PROFESSIONS CODE hiE COM'RACTORS LI- VdIUdI10� ADJ.AREA. lL CENSELAWDOESNOTAPPLYTOANOWNEqOFAPflOPERTYWHOBUILDSORIMPROVESTHEREON,AN� �,�,"{NNOCONTRACiSFORSUCHPRQIECT5WI7HACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAG QUANTIN DESCRIPTiON FEE Y TORS UCENSELAWJ. � � ❑i AM E%EMP'f UNDERSEG B.8 P.G F�i THIS REASO,Y � � U u: ' � oare , owNEa U z ' W s LICENSED CONTRACTORS DECLARATIQN � �� Q � � IHEflEBYAFFIqMU1JDERPENALNOFPERJURYTHATIAMLICENSEDUNDERPROVISIONSOFCHAPTER � � ' p� ,�9(COMMENCIN6'WITHSECTION7o0ojOFDNI510N30FTHEBUSiNESSANDPROFESSIONSCODE,AND z �f MV LICENSE IS'IN FULL FORCEAND EFFEGT, � LICENSE CLASS �'��" � LIC.NO. ��.y������� j ~ DATE � �--I��Z.–� CONTRACTOR�/,��_j a W �T'T� !/ / � WORKERS"COMpENSATION DECLARATION � Q = U � I ER VAFFlqMl1N�ERPENALTYOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS: Z �� �I�HAYEAN�WILLMAINTAINACERTIFICATEOFCON3ENTT�SELF-INSUREFORWORKERS' _ COMPENSATION;ASPROVICIED�BVSECilON3]ooOFTHELA80RCODE,FORTHEPERfORMANCE �U, OFTHE WORK FOfl�WHICH 7HI$PERMIT IS ISSUED. � 0 OW _IHAVEANDWILIMAINTAWWOFiKERS'COMPENSATIONINSUflANCE.ASRECUIREDBYSECTON 37000FTHELABOflCO[jE,FOFTHEPERFORMANCEOFTHEWORKFOP,WHICHTHISPERMRIS ��o�� � ISSUED.MYWORKER$'COMPENSATIO Sl1ftANCECA/flR`IE�flrANOPOLICYNUM9EflARE: CONSTRUCTION j� cnRRiER j� ���s������ t `""S�'��`r�'9- PLAN REVIEW 0 POLiCYNUMBER �w�� �'P�'LL�Y /'-'O'1 ELECTRIC Z ¢ (iHISSECTiONNEFDNOTBECOMPLEfE�OFTHEPERMRISFORIXJEHl/NOREDDOLLARS(5100)ORLESS). 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