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HomeMy WebLinkAbout12395 (6) �.. � � -- "- CITY OF DIAMOND BAR � � COMMUNITY DEVELOPMENT DEPART NT :,•C •� 21660 E.Copley Drive Suite 190 PRESS (9(�)860-3195 Fax(9U9)861-3117 ��'�'"", BUILDINGPERMITAPPLICATION FIRMLY a ADDR'ESS��_.7 � �( ��°V�t�C� k7 �..� APPLICATION I � '� � � PERMIT �1 P/C o DATE � NUMBER �� # � � APN LOT TRACT _ ISSUE TYPE OCC DATE_ CONST. GROUP p OWNE��GI��— � " ADDR S ��"m I� ' 5��� ZONING SETBACKS z CITY ZIP_�_ TEL.y�� FRONT RW LJ � � APPUCANT TEL. REAR ❑ � Z SIDEJSIDE STREET_ RW L1_ 3 Q CONTRACTO ��d C SIDE ❑ ri p� ADDRESS p � .��'� PROPOSED USE_ � CITY� ZI ' / TEL.�_ ,� w ARCHIENG/ z DESIGNER a ADDRESS NO.DWEL. NO. NO. � � UNITS STORIES BEDROOMS � CITY ZIP_` TEL. � N. N. DESCRIPTION SQ.FT. FACTOR PSF ADJ.ARE/WALUATION � OWNEA-BI;ILDER DECLARATION SFR/ADD/REM O � 1 HEREBV AKFIRM 11NDER PENALTV OF PERJURV THAT I AM EXEAIPT FROM THE CANTRACTORS U- G3f09B/CafPOft �W� CENSELAWFOHTHEFOLLONINGflEA50N(SEC.7031.5BUSINESSANDPFiOFES510N5CO0E:ANYGTYOR (n U� COUNTVWrIICHREOl11RE6APEflMITTOCONSTRUCi,ALTER,IMPROVE.DEMOLISH,ORflEPAIRANYSTflUC- '� Z' TI1RE,PqIOR TO ITS ISSUANCE,AL50 qE�UIRES 7H[APPLICANT FOR SUCH PEqM1T TO FIIE A SIGNED � w PatiolDeck ,'�j W STA7EMENT THAT ME OR SHE IS LICENSED PUHSUANT TD THF PROVI910N5 OF THE CANTpACTORS LI- W � � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000�OF DIVISION 3 OF THE BUSINESSPND PRO� � PeoUSpa � FESSIONSCODE�OR7HnTMEOftSHEISEXEMPTTMEREfROMANDTHE8A515FORTHEALLEGEDE%EMP• (� U TION.ANVVIOLATIONOFSECTION7031.SBVANYAPPLICANTFORAPfRM1T6U8JECTSTHEAPPLICANTTO ' Z R8-fl00( � A CIVIL PENALTY OF NOT MORE THAN PNE HUN�FE�UOLL4RS(5500).�: � ❑I,ASOWNEHOFTHEPFOPERN,OflMYEMPLOVEF.SWITkIWAGESA5THEIR50LECOMPENSATION, ..� CORIt110fCi81 Z, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OF OFFERED FOR SALE(SEC.7044,BUSI� � J � �'� NE55 qND PROFfi5510N5 COO[:THE CqNTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF : � _ �PROPER7Y WHO 6UIL0S OH IMPROVES THEREON,AND WHO OOES SUCH WORN HIM6ELFOR HERSEIF OR (L" THROUGN HIS OR HEH OWN EMPLOYEES,PRDVIOEO THAT SUCH IMPROVEMENTS pfiE NOT IMENOE�Oq � m Q� OFFEREOFOfiSALEIF,HOWEVER,THE9UILDINOORIMPflQVEMENTISSOLDWITHINONEYEAqOFCOMttE� � Z, 710N,TNE ON1NEp.9UILDER WILL HAVE THE�URDEN OF PqOVING THpT HE OR SHE DID N070UI1D OP �, IMPROVEFORTHEPUPPOSEOFSALE�. C7 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELV CONTRACTINC 4VTH LICEN5ED CONTfiACTONS d ��' TO CONSTflUCT THE PftOJECT(SEC.�a9e.BUSINESS AND PROFESSIONS CADE:Tf1E CONTRACTORS LI�: V011J2ti0� _ ADJ.AREA a W: CENSELAWDOESROTAPPIVTOANOWNEROFAPROPERNWHOBUI�pSORIMPROVE6THEPEUN.AND� — — � .�' WHOCANTRACTSiORSl1CHMiOJ[CTSWITHACONTFACTOR(5)LICENSEDPURSIIANTTOTHECONTRAC. OUANTIN DESCRIPTION FEE TOqS�ICENSE LAW.j. Y � �� ❑IAME%EMPTUNDERSEF_.___ _____B.6P.C.FOflTHI5REA50N ; Q � U � � --.._--'. —. —_... '------ � � � LL' �.0.47E _OWNER.._____— F' Z� ' W � �'. LICENSED CONTRACTOR5 DECLAqAT�ON �, : W '� �; 1 HEHEBV AFFIRM UNDEfl PENALTY OF PERJl1flYTHAT I AM LICENSED UNOEFl PROYISIONS OF CHAPTER �'. � _ .�� d•� 9(COMMENCMG WITH SECTION 7000)OF DIVISION 3 0F THE OUSINESS ANO PROFESSIONS CAOE,FND � Z _ XY MY UC[NSE IS IN FULL FORCEAND EFFECT. / L^�-s. / • �L ��, LIGENSE CL�ASSry � � UC.NO.�!�� �`f'} •; �j d � U�:� DATE�y_P '�.,._____ CONTfiACTOR_�' R a ± W; �-� WORKERS'COMPENSATION DECLARATION ��� � i � Q ��� �:I. INEflEBYAFFIRMUNDERPENALTYDFPE1L1UfiYONEOFTHEWLLOWINGDECLARATIONS: :' Z ;37 0� _INAVEANUWILLMAINTAINACEPTIFICATEOFCANS6NTTOSELF-INS{1REfORWOflKER5' � S , �� Z"� COMPENSATION,AS VflOV10E0 BY SECTION a�0o OF THE LABOR CODE,FOft TXE PEpFORMANCF. �, 1U ¢��`� OFTHEWORK�OPWHICHTHISPEHMITISISSUED. W � �I MAVEANO WILL MAINTAIN WORKER5'COMPF.NSATION INSUflqNCE.AS RE�UIflED BY SECTION �� d 37ooOFTHELADORCODE,FOpTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMlTlB -----_' � �� ISSUED.MY WORK]E�a 5J'rCOMPEN6ATION INSURANCE CAPRIEF AND POLICV NUMOER AHE: CONSTRUCTION � j�� CAFFIEq_��!.,''�- �p�y--- _- PLANREVIEW _ _ � � Z' POIICV NUMBER�'' 9. � � �.��"'�./IJ .._�_ GI LA4RR:�n. ' y�.,....' � � ¢: _� w, ��ssEcnorir+Emraraecar.w�ErEooFn��wxr�sForsrsor�E�000uaRs(airoloa�Ess�. PLUMBING ---- -- �y Z I CERTIFYTHAT IN THE PFRFOpMANCE OF THE WOqK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICA� ''�]m SHALLNOT EMPiOY ANY VERSON IN ANY MANNER 50 AS TO BECOME Sl1H.l[Ci TO THE (n', WORKEHS'GOMPENSATION LAWS OF CA�IFOHNIAAN�AOREE THAT IF I SHOUL�BECOME INSPECTION FEE ,_ _ o' � _'' SUBJECT TO THE WORKFHS'COMPENSATION PROVISIONS OF SECTIU4 3'!0o OF THF.LABOR ISSUANCE _ �� COOE,I6HALLF HTHWITHCAMPL7WITMTMOSEPROVISIONS. � �' / �-�� - --- - - ---- p DATE:Li�D'� APPLICANT: SMIP _ w� ENERGY P/C � WARNINO:FAILl1RE TD SECUFE WORKERS'CAMPENSATION CAVEfiAGE IS UNLAWFUL.AND SHNLL BE � J. � SUBJECTANEMPLOYERTOCRIMINRLPENALTIESMIDCIVIIFINESUPtOONEHUNOREDTHOUSANO ENERGYPEfiM1T _ _ ODLLARS(f100.Iw0�.IN AOD�TION TO THE COST OF COMVFNSATION,DpMA�ES/5 PROVI�EO FOR IIJ ''J� SEC710N 3708 OF THE LABOR COOE,INTERESL AN�ATTOflNEV'S FEES. RETENTION FEE: : � 'W; ^ ...., CONSTFlUCTION LENDING AGENCY PRE-ALT FEE: • f 4. � O _"I,«�`i__� .,.� �' IHEREBVAFFIRMUNDEAPENALNOFPER.NRYTHATTHEqE�SACANSTRUCTIONLENDINGAGENCY `"`''%�' � ' '3 d' FOR THE PERFORANNCE OF THE WORK FOR WHICH THIS�ERAIIT IS ISSl1ED(&EC.3097,CIV.C.), � �•,% %�•u ��: . ,j w', _ .'y:.,-. i �T' LENDER'S NPME_, "__" '_""_ _"__""� _' �� f—' LENDEP'SAODRESS_._ __. _.. . /� w ICERTIFVTHATIHAVEREADTNISAPPLICATIONAN�STATETHRTTHEA90VEINFORMATIONISCONRECT. ' TOTAL FEES J � � � IAGREETOGOMPLYWITMALLqTYANDCOUN7YOPMNANCESAND9TA7EUwSR[LATINO708UILDINp — -- � CANSTfiUCTION.ANDNEREBYAUTHORIZEREPRESENTATIVESOFTHISCOl1NTYTOENTEHUPONTHE Z ABOV^E-MENTIONEO PROPERTV FOR INSPEGTION PURPOSES. COMMENTS j � .YI�''��R A� �. � .� Q PERMITTEE NAME(PFINT) ._ --�� � cn _ 7 ��� _— •�' _ � �'1 � 1 ��� >'1 � I ! � SIGNANREOFPERMITfEE OATE . � _ � RECPT.NO. � __PAID BY ! 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