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HomeMy WebLinkAbout16465 � ,� CITY�F DIAMOND BAR `••,'���:,� � ----��-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SBRVICES �*-:.! 21660 E.Copley Drive Suite 190 •.� !; (909)86(�3195 Fax(909)861-3117 PRESS �'A�"�� BUILDING PERMTI'APPLICATION FIRMLY Q DDRIESS Z���-% C ����:,i'Z'��'E�� � • APPLICATION � r � �� � ,NUMB R ���ty w' �/C p DATE _�� c� ISSUE TYPE OCC APN_� L07 TRACT _ DATE_ CONST. GflOUP � OWNEA �/'E LG��cfr�Cf:� L�v'�• 0 -- o ADDRE`�SS'' '�"'���� _ ZONING SET8ACK5 Z CITY�>_�� ZIP���+TEL. FRONT RW f l � S APPLICANT ' TEL._, _ REAR _ CJ_.. — SIDE/SIDE STREEf ftW !-7___ � CONTRACTOR ���' R�% ��i�"' �� _ SIDE Ll � ADDRESS .'Z/��-� S f�sc^��`✓� �r_�� �'� � pROPOSEDUSE o CITY /�ias,�,@j'n ZIP����.L TEI..p,�_�_�UU�l o ARCWENG/ _ �z DESIGNER___ NO.DWEL. NO. NO. a ADDRESS _ .— UNITS STORIES_ BEDROOMS � CIIY ZIP YEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION N — � OWNER•BUILDF.R DECLAflA710N SFWA��iAEM O p 1 HEREBY AFFIRAI UNDER PENALTY OF PERJURY THAT 1/JA EX[MPT FROM THE CONTRACTORS Lb � Garage/Carport� � W CEMSEUWFORiHEFOIIOWINGRFA,50N�5EC.]031.5811SI��ESSAN�VFOFESSIONSCAOE:ANYCITYOR U CWNIYWHICHREWIAESAPERMITTOCONSTfit1CT,ALTCfl.IMPROYE.DEMOLISH,ORHEPAIqANYSTRUG W patiolDeck ; � TUHE.PRpR TO ITS ISSUANCE,AL50 flE0U1flES THE APPLICANT FOR$UCH PEflMIT TO FILE A 31GNE0 W STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO T7iE PflOYISiINJS OF THE CONTRACTORS LI� i �s' CENSE LAW�CHAPTEfl e(COMMENCINO WITH SECTION 70D0)OF DIVISION 3 OF THE OUSINESS AND PRO- � POOVSpa I 7C FfS5qN5CODEJORTHATH�ORSHEISEXEMPThIEREFHOMANDTNE6A515FORTHLALLEGEqEXEMP� (� V TqN.ANVVqLATIONOF5EC710N7097.56YANVAPVI.ICANTFOHAPEFMITSUF3JECTSTHEAPPUCANT70 Z Re-floof � ACIVIL PENALTY OF NOT AYJRE TNAN FNE HUN�HED�OLIARS(f50Uj.f. — . � OI�OWNEfiOFTHEPROPERTY,OFMYEMPLOYEESWITHWAGE5A5THEIRSOLFCOMPENSATION, � COf11m0fCi�l _ "' WILL DO THE WORK,AND TNE.STRUCTURE IS NOT IIiiFNDED DR OFFEflED F'OH SALE(SEC.7044,BUSI� J NESS AND PROFE9SIONS CO�E:THE CONTRACTORS LICENSE LAW�OCS NOT APPLYTO AN OWNER OF � PROPENTYWlWBUIIDSORIMPROVESiHEPE(]U,ANDVMDDQESSUpiWORNkIMS[LFOPHEFSELFOR � _ (t� THp0U0HHI50qHEflONTlEMPLOVEES,DqOVIDEDTHATSU�iIMPROVEMENTSARENOTINTENOEDOH m W OFFERWPoRSALEIF,HOWEYERTMEBWIOINQOkIMPROVEMENiI550LOWI7NIYONEYEAROFCAMPLE ZTION,7NE OWNER-BUIIDER WILL HAVE iHE 8!JRD'cN OF PROVING THpT HE OR SNE DI�NUT 9UIfA OR � IMDflOVEFOPTHEPUFPO5EOF5ALE�. �_ , ❑I,ASOV.NEROFTHEPf?OPEFiPY,AME%CLUSIVELYfAkTRACT�NGN'ITHL'CENSEDCONTRACTORS � � TO CONSTRUCT TNE PRQIECT(SEC.70M,BUSINESS AND PROFF.SGIONS CCDE:'ME CONTRACTOHS lb V&IU8ti011 __._.._.—.._. ._,___..ADJ.AREA_._.__.... W CENSEUWDOE&NOTAPPLYTODNDWNEROF,IPAOPER7Y4'MOBUILDSORIIAPNOVESTHEFECNJ,AND �� KYqCOMRACTSFORSUCHPH0.IECTSWITHACAN�RACTOR(5)LICEN5E6PUR5UANTTOTHECAN(HAC- QUANTiTY DESCRIPTION FEE Y TORS LICENSE LAW.). ' f �f�,.�,� � nIAMEXEMPTIINDERSEC. J / ��,����'� J�"��,� ., ^ _"'__"'_'_" B.8 P.C.FOA THIS REASON Q + , � — -----— — --- fY � f� _ O� L�LSf'LL � o ' � F -- / r Z OATE "�""'�_"OWNER ___—___._._.— w C. /-]Ci�' �I.�� "��'�C' — a6 LICENSED CON7RACTORS DECLARATION �j LC IHEflEBYAFFIFMUNUEHPF.NALTYOFFEfiIURYTHATIAMLICE45[DUN�FRPROVISIONSOFCHAOTER �. a, 9(COMMENCING WITH SECTpN NWj OG 01`✓ISIOh 3 D'r TME DUSINESS ANO PROFESSIONS CO�E,AM1IJ Z{� _, X MV UCENSE IS IN FULL FORCEAND EFFECT. I m �7 � Lll 0 LICENSE GLASS r�w1C`�S LIC.NO._...��/��.��g�/ _ � ' V �ATE ,��1�4�'�L_�_— CONTRACiOFl!'L�.i_.�_ 0. —___� W �f��� � WORKERS'GOMPENSATION DECI�RATION � ¢ � IHEREBYAFFIRAft1NDERPENAL7VOFPER1UqYONEOFTHEFOLLOWINGDECLARATIONS: U y Z Q _ '_ Q' _,IHAVEANDWILLMAINTAINA:.Ei7��7�ICATEOFCANSENTTOSELF-INSl1R[FOIiwORKFR� t � COMPENSAiIOId,AS PHOVIDED BY SECTION 37fU oF 7HE LABOR CODE,FOH THE PCRFORNANCE � OF THE WORK FOF WHICH THIS VERNI7IS ISSUEU. � U — W _I HAVEMIO WI�L MAINTAIN WORKFRS'CA�.IGENSAT�ON IN5URANCF,AS fi[IX11RE.�BV SECTION Q 37o00f THE I.ABOA m[7E,FOR THE PFRFOHMANCE OF THE WCRK FOfV WHIC!1 TIIIS PEFMIT IS �, �� ISSUED.MYWORKERS' SPrN 71nkiN5UHANCECARRIERMIDPOIICYNUMNERAHE: CONSTRUCTION � _."_" _ ._'___'_ j, CARflIEW_ S LfJ'vJ'�" --q------- -- � PLAN REVIEW .....-- ------.._ —...._..- -------- � � PoIICY NUNBER "l��C—LlyU-{- -�:t� ; ELFCTRIC _.__.___ _„__, � ....'__""'_ _"_—_"_ . � 0. (fWSSC�IqrvNEEDNOTBE00AV'I.ETIDOfiHEPER4V.TSFORavEtaJ�+DrtEoOol.wts(51oo)ostLE5�l. . PLUMBING ,.----. .. ��-��..�+�//—/-� ...__'....�.. Z ICERTIFYTHATINTHEPERFORMANCEOFTHEWORKfORWHICHTkIISPF.RMITI5155UE0,1 MECHANICAL ____�1-1.. .4 .��._ ... . _i�"�,_ (i Ek1ALLNOTEMPLOYMIVPERSONINANY�ANNLN50ASTUBEWME5U0.1ECTTOTHE INSPECTIONFEE � WORKEAS'COMPENSATION IAWS CF CAIJFaRNIA,ANO AGFEE THAi IF I SMOULI)BECOME — ._ ��1, �� �fry�j-���ry�— __,l, ` � SU&1GC1 fUTFiEWORNEFS'CO!APENSATIONPROVIulO150FS[CTiON3�D0UFTNELABOR 1SSUAtJCE � '�� �"•11O' •`�v � Q)�E,i SHpLI FORTHWITH COMPLY WITH THOSE PROVISION3. -- ---�.... .__—._ ____.__ .._ O p DATE:.__..._.._ APPLiCRNP. _ :. SMIP _'�'___'._�_ ' "'_ _ _'__ __ _— __ W �.:., J WARNING FAILURE TO SFCUHE YfORKERS'GOMPENSATION COVERACE IS UNLAWFUI,qNOSHALL BE � ENERGY PIC - � ,..__"_"" '_ ..... ___'""__" SU&IECT Ml EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINFS lIP TOONE HUYDRED 7Fi0USAN� - � ������� � � � � - ENERGY PERMIT � � ..................................._.._., . OOLLARS(flao.oao),INA[)DITIONTO'fHECO5T0`COMPENSATION.DAMAGESASAROVIDEOFORIN ---"'—"-- '—" -----�-�- � SECTION37aeOF7HELABOfiC00[,INTENEST,ANDAI"(OHNEY'SFEES. RETENTIONFEE: ..... .'—_'__ _....._.. _'__"'_""_ d CONSTRUCTION LENDING AGENCY �. PRE-ALT FEE: _______ __.._ __.__ � IHEREIiYAFFIRMUNDEPPENW.TYOFPENJURYTHATTHEREISACONSTPUCTIONIENDINGAGENCV ______ .__ __ n- FOH THF.PLRFORMANC[OF lHE WOl1K FOR WHICII'fHl.ti PERMIT IS ISSUED(SEC.3097.CIV.C.). Zw '—_'_" _ '_'__._' � LENDEfl'S NAME _ .._'__'_—... �- I',_' LEND[fl'SpODHF.55.'__.'—__—'......_.____—_"'.... ---'..._...__.._ i � ICERTIFYTHATIHAVEFiEA�TNISAPPLIGATIONANDSTNTET11AT7'MEABOVEINFORMATIONISCORflECT. � 1 OTAL F�ES �� �J` " p_ IACREEiOCAMPLYW17h1ALLGITYANDf.OUNfYOf7�INqNCESANDSTATELAWSqEIATINGTOOUILUING CONSTRUCTION.AND HENE�Y AUiIiORIZE REPRESENTATNES OF THIS COUN'fY TO F.NTER UPON THE Z ABOYE.NENiIONEDPROPEflTYfORINSPFCTIONPUqPOSLS. COMMENTS ___.. ..__ � �.Cr/c�i�?�l • � ----��r C_���v �/p f� --- ------- - ----- m PEFlMITTEE NAME(V -- � "' —____'__ '_' � Uj ...�---�' . a -- —'------- --- `� �D D –-. .-------.._ SIGNATUH F PENMITT DATE � �� RECPT.NO. PAID BV ^�— VALIDATION � WHITE—Depariment Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—File CoDY,GREEN—Applicant's Copy .�_____ ---- _... _. „_ ... — � , �: �1 � � � �_, ����, � , , � � � � � . 1 � k tF � {� I ' �_ ( � S .�,l a � i t ' ,� � I � .i� . � — : �. i �. _ 1� J y t �I' �, , I �I � .� � i �, �� � ', k i , t f - � ', ,. � i. ' � � ' _'... I _ � , •� ,i i � — �,� �� r , ..: , .� . _ . � i , , c , . . �. � I � I .,,: .... I �� .�. i . , i , ... � � , ' ' ' . i � 7 � r � 1 � 1 _'_^Aa, i �,� ' � � � , , i i i i ' o,�� r° ; i � � � _ , , � ' , ; , i _ , � , I � � ' � . 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