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HomeMy WebLinkAbout10798 � :��'�,� t CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT ry...,.0 • 21660 E.Copley Dnve Suite 190 �` � , PRESS � (909)860-3195 Fax(909)861-3117 � �""" BUILDINGPERMITAPPLICATION ' t FIRMLY f t N JOBSITE /, i APPLICATION C'�� PERMIT ( P/C � o ADDRESS������/,l'�-�Pf2rnr$�� _�a5 DATE v� ' � NUMBEF I �� I # � ISSUE TYPE OCC � APN LOT�— TRACT DATE CONST. GROUP � OWNER � 4. szi�Y � q ADDRESS �� _�* � �'' •, E1 -' ` L/ � ZONING SETBACKS � Z CI'fY� . ZI QI��.5," TEL. ' FRONT RW ❑ o APPLICANT�,'�i-`��,t�i k� TEL.'������ REAR n � Z SIDE/SIDE STREET RW L'J � ¢ CONTRACTOR -' b f�= SIDE ❑ � �.. ADDRESS '•�:a ~. .;;a / y� =..II, E � CITY r.�: s i:�k`L ZIP��` TEL.', _9 f � PROPOSED USE ! �' "' ��✓F=:�4�'P��`�.f'a+ 0 1'��ti �_� ' �' • ,� ..pF—.- � w ARCH/ENG/ z DESIGNER i � j�" ` ' �y w NO.DWEL. NO. NO. 5 a ADDRESS UNITS ��Q � � CIN ZIP 7EL. �af � STORIES �I"�4� BEDFIOOMS � DESCRIPTION SQ_FT. FACTOp PSF ADJ.AREANALUATION t p� OWNER-BI:ILDER�ECLARATION SFRIADD/REM � O I HEPEBY AFFIRM 11NDER PENALTY OF PERJURY THAT I AM EXEMP7 FROM THE CANTMC70R5 LI� G8�898/C21(10A `�y W CENSELAWFOflTHEFOLLOWINGREA50N(SEC.7031.58USINESSIWUPROFESSIONSCO�E�ANYCINOR (f� . U COUNTYWHICNREDUIRESRPERMIT7000NSTpUCT,AL7ER,IMPROVE,DEMOtISH,ORREPAIRANY57RUC- W PetiO/DBCk Z TUPE,PRIOR TO ITS ISSUIWCE,ALSO REQ�IfiES THE APPIICANT FOH 5UCH PERMIT TO FILE A SIGNED W STATEMEN7 THA1 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- W � g CEN5E LAW(CHAPTER 9(COMMENCINO WI7H SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND Pq0- � V' POOVSpB � FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFqpMANDTHEBASISFORTNEALLEGEDEXEMP• (� � V TIDN.ANVVIOLATKKJOFSECTION7G3f.5BVANYAPPLICANTFORAPERAIITSUBJECTSTHEAPPLICANTTO Z pe_q�f �� , �� �`3�" � _ . g`�,"���'C� A CIVIL PENALT'OF NOT MORE THAN FNE HUNDRED�OLLARS(SSaD�.): � C QCJI,ASOVMEROFTHEPNOPERTY,Op1AVEMPLOVEESWITNWAGESASTHEIRSOIECOMPENSAlION, � COrtIfilBfCtdl j � WI��p0 7HE WORK,AND THE STRUCTURE IS NOT INTENDED OR OffEREO FOfl SALE(SEC.7044,BUSI� J � NE55 ANO PPOFESSIONS COOE�TtrIE CANTHACTORS LICENSE�AW DOES NOT APPLY TO AN OWNEN OF N PHOPERTYNRIOBUILD90HIMPROVESTh1EREON.ANDWHODOESSUCHWORKHIMSELFORHEflSELFOR � E C[ THqOl1GHHISORHEROWNEMPLOVEES,PROVIDE�THATSUCNIMPROVEMEMSARENOTINTENDE00R m F�. aOFFEqEDFORSALE.IF,HOWEVER71/EBUILDINGORIMPROVEMEN713SOlDWITHINONEYEAqOFCOMPLE- y Z TION,THE OWNER�BUIL�ER WILL HAVE THE 6URDEN OF PpOVINO 7HAT HE OR SME OID NOT 6NlD OR P � IMPROVE FOR THE PUqPOSE OF SALE). L W ❑I.ASOWNEROFTHEPROPEHTV,AIAEXCLUSIVELYCONTPACTINGWITHLICENSEDCANTRACTDRS s � TO CONSTRUCT THE PROJECT(9EC.70q6,BUSINESS ANO PflOfE5510N5 CODE:THE CONTRACTOR9 LI� V8IU2I10� A�J.AREA F� = CENSEUWDOESNOTAPPLYTOMIOWNEROFAPROPERNWHo6U1LD50qIMVROVES7HENEON,ANO ' -- � WNOCONTRAC73FaR3L1CHPqpIECT5WI7HACONTflACTOR(S�IICENSEDPURSUAMTOiHEODN7HAC- pUANTITY DESCRIPTION FEE �� Y TOqSIICENSELAWj. � Qf-]1 AM E%EMPT UNDER SEC. __, _8.&P.G FOF THIS REASON Q �, � ` _ U � DATE OWNEN � z � � w ¢ LICENSED CONTRACTORS DECLARATION W Ce 1 HEREBV AFFIRM UNDER PENALN OF PERJURY TNAT I AM LICENSEO UN�ER PROVISIONS OF CHAPTER �. # d e(CAMMENCING WRH SECTION 7000)OF DIVISION 30i TME B1151NE55AND PpOFESSIONS CODE,AND Z X ��LICENSF IS IN FUIL FOHCEAND EFFECT. �7 y i � LICENSE CLq55 �•y���_LIC.NO. �� Lr7•'�' / j �� F'"' DATE �� r "'�CONTRAGTOR�f�CSf(,t��f"� 4 i U - �— a W /� [[[��� ; � WORKERS'COMPENSATION DECLARA710N ���-V� 1 . U E � ��� 1 HEREBY AFFlRAI UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z 4� � �.IHAVEANDWILLMAINTAINACERTIFICATEDFWNSENTTOSELF-INSUREFORNqRKEHS' _ � d CAMPENSATION,ASPpOVIDEDBY3EC710Na'IooOFTHELABORCO�E,FOR7HEPERFORMANCE W S OF THE WORK FOR WMICH TMIS PERMIT IS ISSUED. W � � IHAVEAN�WILLMAINTAINWORKERS'COMPENSRTIONINSURANCE.ASREOUIREOBYSECTION � �� ,� [ Q " 3700 OF THE LA90R CqDE.FOR TM[PERWRMANCE OF THE WORK FOR WHICH THIS PERMRIS t� € ISSUED.MV WOIiKER3'CO ENSATION IN UHANCE CARQIF�R AND POLICY NUMBER ANE: CONSTRUCTION � 1 � CAflR1Efl r > � J PLAN REVIEW _ � ; �'-�-- ` ` _�� �iiv� Z POUCYNUMBER Z.y��=.� ,•� ELECTRIC 7 d ; 0 (fHISSEC110NNE�NOT0E00Aq�I.ET�OFiHEPEFtlWTISFOHONEFM1N�DI7FD R�oa1o��Ess� PLUMBING Z 1 CERTIFV THpT IN THE PERFORMANCE OF THE WOPoC FOR WIiICH TNIS PERMIT IS 195U�D,I MECHANICAL - � �} SHALLNOTEMPLOVANYPERSONINANYMANNEqSOASTOBECOME5U13JECTTOTHE � � WORKERS'COMPENSATIONLAWSOFCAUFOflN1A,ANDAGREETHATIFISHWLDBECOME INSPECTIONFEE _ _ SU6JECTTOTHEWORKERS'COMPENSA710NPROVISIONSOFSECTION37ooOFTHELABOR d rf � � ~ CODE.ISHALLF�RTHWITMCOMPLYWITH 105 PRO IONS. ISSUANCE ` ----� � � ;� �` ,�6 � � p oaiE: ��'_�� aPPUCntar � .- ---6 °�t/ SMIP __ r s ,�:��+, , �..; W . a. J �J d"� (.r � � J ENERGY P!C � . ���'` WAflNiN6:FNLURETOSECUqEV10FKER5'COMPENSRTIONCOVEqA6EI5UNlAWFUL,ANDSHALLBE �— ,r.-.-.. — [� �y 5U&IECTANEMVLOYERTDCqIMWALPENALTIESANOCIVILFINESUPTOONEHUNDREDTHOUSANU ENERGYPERMIT P. �OLLARS(5700.000).IN AODITION TO TME COST OF CAMPENSATION,DAMAG�S AS PROVIDED FOR IN � SECTION 3708 OF THE LABOR CADE,INTEREST.AN�ATTORNEY'S FEES. _ k RETENTION FEE: � OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ P � IHEREB7AFFlRMUNDERPENALTYOFPERJURYTHATTHEpE13ACONSTRUCTIONLENDINGAOENCY r n- FORTHE PERFORMANCE OFTHE WORK FOR WHICH TMIS OERMIT IS ISSl1ED(SEC.90B7,CIV.C.J. — W — � LENDER'SNNME _ _ — F— LENDER'SAODRE55,_ ..__ __ � ICERTIFYTHATIHAVEREADTHISAPPI�ICRTIONANDSTA7ETHATTHEA80VEINFORAIATIONISCOpRECT. TOTAL FEES � � y � IAGREETOCAMPLYWI7HALlGITYANDCAUNTVORDINANCESAN�STATEUW3RELATINOTOBUIIDING / ' � CONSTRUCTION,AN�HERE6VAUTHORRERE�RESENTATIVESOFTHISCOl1NTYTOENT[RUPONTHE ` ZABOYE�MENTIONFA PFO,ERTY FOP INSPECTION PURPOSES. ��` � " ��%j�i� � -.�. � 'P}, COMMENTS__ _�__�� � _ .:'�.•me+.h ��. � .3P_ '?t..9;'� i Q PERMITTE MIEIPflINT) '-` y �,:''' ___ � Qd � R ..r p Cn d( �.P' f O'.+r.�„s -� ...�" �r_.�GC.*.a-. J Ij y-y: , � 4 y Z <i v UJ SIGNATUREOFPERMITfE �Y OATE pECPT.NW.',_ PAIDBY .I VAIIDATION � � 2 - ~ WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GHEEN--ApplfcanYs Copy � ..�..��. _- .;�-.�----, , -- T_ _ , ' - ' ' . � � i_.1 + ,---. �.._.. � :,�.�.�.�.. .�,e.....t,m_..v�_,. 3 ! _..a..� „ .: .F . � I. 3 -�.. �j � - ,-' � � ' I � P I i.�.� � � � �_.m�� . �. _ � ' I � ' .I . i .� . . � �.m'�� I �,_ , I` .. �.. 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