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HomeMy WebLinkAbout17463 -_ . __ -- - __ �ITY OF DIAMOND BAR l �" --��'�---- DEPARTIvdLNT OF COMMUNITY&DEVELOPMENT SERVICES �'� V 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRE$$ '�'�s*v�� BUILDING PERMIT APPLICATION FIRMLY o D�RESS �/�'�� ������� �-/�-'" • DATECATION �s`� �j'i NUMBER___�_,f�#,C /�bo ��� oro ISSUE n t TYPE OCC APN LOT TRACT DATE �i��s�/ CONST. GROUP °C OWNER �' O ' o ADDRESS � /� E1�� ZON(NG SETBACKS z CITY . ZIP_ '�+� TEL. '� ,� FRONT RW ❑ � APPLICANT . TE4. REAR ❑ � SiDE/SIQE STREET RW ❑ ¢ � CONTRACTOR � i�a' i2' �.'� SIdE ❑ o A'dDRESS " �' � s' �Y�,,,_ �y PROFOSED USE ��L�h/G�� �7ClR/��efC7`` CITY ' - ZIF� TEL. �. o IARCWENG! iz DESIGNER NO.DWEL NO. NO, d ADDRESS UNITS STORIES BEDROOMS a CITY ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION I � �p��� OWNER-BUILDER DECLARATION SFAJADD/REM O �. . '�p, .I HEREBY AFFIRM UNDEP PENALTY OF PERJURV THAT I AM IXEMPT FROM THE CONTRACTORS LI- G&I'8J0/CefP011 �W 'CENSELM1WFOHiHEFOLLOWINGPEASON�SEC.�o31.58U51NE55PNDPROFESSIONSCODE:ANVCITYOR (J� , '.0, CpJNTVWHICHREQUIRESAPEFi1�ITTOCAN5TRl1CT,ALTER.iMPROVE,DEMOLISH,ORREPAIRANYSTRUC- �jf pail0/D@Ck '.'',w' 'YURE,PFIOR T�'J�ITS ISSIJANCE,q�.50 REOUIRES THE APPLICANT FOR SUCH PERMIT i0 FILE A SIGNED W " '�STATEMENT THFT NE�OR.�SHE JS IIGENSE�PVRSUpNi TO THE PROVISIONS OF THE CONTRACTOflS LI� ��,� 'CENSE LAW(CHAPTEF 9�CAMMENC�NG WITH SECTION 7000)OF DIVISION 3 0F iHE Bt151NESS AND PP0. � POOUSpO FESSIONSCO�EJORTHAiHEOR$HEISEXEMPT7HEREFFOMANDiHEBASISFORTHEALLEGEDE%EMP- (� 'i��� TION.ANVVIOLATIONOFSECTIDN;7031.58YANYqPPLICANTFORAPFRMITSUeJECTSTHEAPPLICANTTO z RB-ROOf '� �pC1ViLPENpLTYOFNOTMOfiETHANFIYEHUN�REDDOLLARS(E5o0).): '�i� ���❑I,AS9`NNEROfTyEPROPERTY,OqMYEMPLOYEESWITH3NA�ESASTHEIRSOLECDMPENSATION, � Commercial - .,�,.iZ.i �WILL D�THE WOAK,ANO THE STRUCIURE IS NOT INTENDED OR OFFEREq FOF SALE(SEC.7044,BUSI- .J ".�;,� .;NESSANq�.PROFESSIONSCODE:�TNECONTRACTORSLICENSELAWDOESNOTAPPLYTOANOWNEROF � PRORERTY WHO Bl1jL�5 OP IMPROVES THEREON.ANO WHO�OES S11CH WORK HIMSELF OR HERSELF OR I'.'� 7NFi0UGHMISORHEROryMEMPLOYEES.PROVIbEDTHAiSUCHIMPROV@AENTSARENOTINTEN�EDOR m ' �,�i� OFFEREpFTJRSALEIF,NOWEVEP.THEBUILDINGORIMPftOVEMENTI5SOIDWITHINONEYEAROFCOMPIE i 12 YION',THE OWNER OUIL�ER WIIL HAVE TNE BURDEN OF PROVMG THAT HE OR SHE pID NOT BUILO OR IMPHOVE FOR 7HE PURPdSE OF SALE). .�O I.AS ONINER OF7NE PROPERTY.Aly1 EXGLUSIVELV CONTflACiING WRH LICENSED COfYTRACiORS ��'�� 7D CONSTRUCT THE PRWECT(SEC.7044.�USINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- Vdif1811W1_.__ ADJ.AREA '�IJ:1 ,.CENSELAWDOES'NOTAPPLYTOANOWNEROFAPROPERTYWNOBUILDSORIMPROVESTHEREON,AN� -- — - �;���I �WHOCOMRACTSFORSUCHPROJECTSWITHACONTRACTOP(5)LICENSEO�URSl1ANiiOTHECONTRAC- QUANTITY DESCRIPTION � FEE ,;Y TORSLICENSELAW.). . �ill� � '� ❑I AM EXEMP7l1N�ER SEC. � 0.&P.C.FORTHIS REASON U � � '� . . � . , . 'OA7E OWNEH V �, ��Id �� LICENSED GONTRACTORS DECLARATION i j �� ;�CL f�.IiEREBYAfFIpM UNOEfl pENALN OF PERJURY THAT I AM LICENSED UNDEF PpOVi510N5 OF CHA{'iER � . il��- 9i(COMMENCINGN�ITN'SECTIO�J7(po)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z �✓C MV LICENSE IS IN FULL'.FORCEA�NwO EFFECT. � � IIQENS€�CLASS��� t"�� IIC.NO. Y�v� /,�/ j r _ ,�; �bATE � �__�CS,I� CONTRACTOR��2 �- LLI j f'�j��,� �WORKEFIS'COMPENSATION DECLARATION a ��J�i�,a.E�eG� t �,�'�,� ��'. I HEREBYAFFlRM UN�ER dENALN OF PERJURYONE trFTHE FOILOWING DECLARATIONS; U � �� ��aQ�^y� " �� ���lINAVEANOWI4LMAINiAWACERYIFlCATEOFCONSENTTOSELF-INSUREFOpWORKERS' COMPENSATION,ASPpOVIOEDBYSECTION37ooOFTHELA90RCO0E,FORTHEPERFORMANCE U OF THE WORK FOF'�WHICH THIS PEPMIi IS ISSUE�. � � __INAVEANOWIL4MAINTAINWORKEPS'COMPENSATIONINSLIRANCE,ASREdUIRE�BVSECTION 'd , ' 37aoOF.THELA90PCo�E,FORI'�HEPERFORMANCEOFTHEWORKFORWHICHhIISPERMITiS � ISSIIE�.MYWOFiK RSCOMP NSA710N.LM�;y,pANCECARRIEFAN�POLICYNUMBERAflE: CONSTRUCTION '� � caaaieH� ���� / "�'-� - PLAN REVIEW ��I � PoucvNUMeEa �' �,�'�is7�� ��Jr'� ELECTRIC _ St � (�HIS5ECilONNfimNOT9ECOMPLEfEDOFhi[PERM((ISWRONEHUNDREDDOIlARS(yYW)OFLESS). PLUMBING W, � �y�,' ICERTIf1'THATNTHEPEF{KORMpNCEOFTHEWORKFORWHICHTHISFERMITISISSUED,I MECHANICAL + � ��� . a9 "I(J� SHALLNOTEMPLOYANVRERSON�NANYMANNERSOASTOBECOMESUB.IECTTOTHE WORKERS"COMPF SAT�ONLAWSOFCALIFOflNIqAN�AGREETHATIFISNOULD6 COME INSPECTION FEE �� SlIBJEbTYO THE�pFK6fi5'�COMPENSATION PROVISIONS OF o"EC7 37oa OF OR ��,�, CODE,I��H;ALL'r�b+1FjTHWITHCOMPLVWITHTHOSEPRO ISSUANCE � : DATE:��=�'+U��APPLICANT.__� � ..-� - SMIP � WAW�IING,FqILUR�TO$6GUREWOFiKERS",COMPE NCOVERAGEISUNLAWFl1L,ANDSHALLBE ENERGYP/C � I Sl18JECTANEMPLQVEFiTYSCqIMIIVHLPENAL71E5 CNILFWESUPi00NEHUNDREDTHOUSqND ENERGYPERMIT _ DOLLARS�b70o0oQ)WqdbItIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIUEDFORIN � � �,,,SECTIONS7aBOFTHEL,AgORCODE;INTEREST,ANDATfORNEY'SFE[5. RETENTIONFEE: --�• � �'� � � CONSTRWCTION LENDING AGENCY PFE-ALT FEE: � �'�,�;I HEREBV AFFIRM IlNDER PENALTY OF PER:IURV THAT 7HERE�S A CONSiRUCTION LENDMG AGENCV .';FORTHEPFRFORNIANC6O�7M�WORKFORWHICHTHISPERMITISISSUED(SEC.30W,GN.C.�. 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