HomeMy WebLinkAbout10091 / • - CTI'Y OF DIAMOND BAR COMMUNTCY DEVELOPMENT DEPARTMENT :,.¢ . 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3 t 17 '""', BUILDINGPERMITAPPLICATION FIRMLY � JOBSITE ) � . APPLICATIO PERMIT P/C o A�DRES3'�� � � D�L�`S -I� DATE_____n ( "� NUMBER_��� # c� ISSUE 7YPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER � �Z- "" AODRESS G � � J J ZONING SETBACKS oCITY .. � ` ZIP - TEL�' FRONT RW ❑ APPLICANT TEL. REAR ❑ � ! � SIDE/SIDE STREET RW ❑ � CONTRACTOR�f����`�} �-c��r�{f�. SIDE U � A�DRESS " � ' PROPOSED USE o CITY����tlrl R�._ ZIP� TEL, d ` � r o ARCH/ENG/ z DESIGNEA NO.DWEL. NO. NO. a ADDRESS UNITS STORIES �"' BE�ROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O- OWNER-BI:ILDER DECLARATION S�RlADD1REM � I HERE6Y AFFIqM UN�Efi PENALTY OF PENJURV THRT I AM EXEMP7 fHOM THE CONTflpCTOHS LI- ('jBffiJB/C81pO1L W CENSELAWFORTMEFOLLOWINGREASON(SEC.T031.SBUSINESSAN�PHOFESSfONSCADE:ANYCIT'Op (n U COUN7YWHICHREOUIRESAPERMITTOCONSTqUCi,ALTER,IMPRpVE,DEMOLISH,ORpEPAIRANYSTRUC- - W Patio/Deck W TURE,PRIOR TO ITS I&SUANCE,ALSO REQUIRES 1HE APPUCAN7 FOR SUCH PERMIT TO FiLE A SIGNED ' w SiATEMENT THqT HE OR SHE IS LICENSED VURSUANT TO THE PqOV1510NS OF THE CONTRACTOqS U• � CENSE LAW(CHpPTER 9(COMMENCING WIiH SEGTKKd'l0001 OF DIVISI�N 3�F THE BUSINE55 AND PRO- u' POOUSP9 FESSIONSCODE)ORTFIRiHEOR5HE13EXEMPTTNEHEFROMANDTHEBA5ISFORTHEALLE6EDE%EMP- (� � TION.ANYVIOLATIONOFSECTION'l03t,5BYpNYAPPLICANTFORAPEflMITSUBJECTS�HEAPPIICANTTO Z Re-Roof � ACIVIL DENALTV OF NOT MORE THAN FIVE HUNDRED�OLLARS(lSaa).): Z [JI,ASOWNEHOfTNEORaPERTV,ORMYEMPLOYEESWITHWAGESASTNF.IR50lEC0!APENSAT�ON. ❑ COffIfI1B(Ci81 � WYLL DO iHE WOAK,AND THE STRUC7URE IS NOT INTFN�ED OR OFFERED FOR SALE(SEC.7a44,8U51- J NeSS AND VROFESSIONS COOf,THE CONTPACTORS LICENSE LAW�OES NOT APPLY TO AN OWNER OF � PROPERTYWIi08UhDSOqIMPROVE57HEPEON.ANDWFfODOE55UCHWOAKHIIASELFORHERSELFOR � Q THROU6HHISORNEHOWNEM�IOVEES.PROVIOE�TMATSUCNIMPRaVEMENTSARENOTIMENOE�OH m QOFFEREDFORSPLEIF,HOWEYERn1EHUIlDINGORIMPROVEMENT1550LDWITHINONEYEAflOFCOMV�E- � TION.THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIL�OR = IMPROVEFORTNEPURPOSEOFSALEj. , .w � 1'7 1,RS OWryER OF THE PROPEflTY,AM E%CI.1151VELY CONTRACTMG WITN LICENSED CONTRACTONS Q TO CANSTflUCT TME PROJECT(SEC.7u44.BUSINE55 AND PRpFE55fINJ5 CODE:THE COMiAAC70R5 LI- VBIU8110f1__ ~ADJ.AREA W CEN9ELAWOOESNOTAPPLYTOANOWNEROFAPROPERTVWH09UILDSORIMPROVEBTHEflEON,AN� � � WNOCAN7RACT6FORSl1CHPqpJECTSWITHACONTfYACTOR{S�IlCENSEDPURSUANTTOTNECONTqAG QUANTITY DESCRIPTION FEE TOHS LICENSE LAW�. �r �� � ❑I AM ENEMPT UNPER SEC.__ _ .,_B,&P.C.FOR 7NIS REASON Q V �P�%'L° � .—' ---- " U u.. � � DA7E"_ '__ oWNER _.. � V I .� _ � `v W �' � LICEIVSED CONTRAC70RS DECLARATION W � � IFiEREBYAFFIRMUNOERPENALTYOFPERJURY7HATIAMLICENSEDUNDERPROVIS10N90FCHqYTER � p' � B(COMMENCINO WITH SECTION 7o0D)OF DIVISION 30F THE BUSINESS AN�PROFESSIONS CADE,AND Z I v X`� MY LICEN6E�&IN FUII FORCE Af�W EFFECT. j f LLI P��F� � �v i/ � LICEt�78E CLA LIC.NO.__h J�S u�� � _ p�"'r-�T' � < J � � I V DATE ' � � CONTRACTOR, d -- � W � WORKERS'COMPENSATION DECLAPATION U � '�� * � � IHEREBYAFFIflMUNDERPENPL7YOFP[RJURYONEOFTNEFOLLOWINGOECIARAilONS: � Z Q 0 _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUHEFORWOHKERS' _ CAMPENSATION,ASPROVIDEDBV6ECTION3'IaUOFTHElA80HCA0E.FORTHEPFFFORMANCE U ¢ aF THE WORX FOR WHICH THIS PERMIi IS ISSUED. � � W ,_1 HAVEAND WIIL A�AINTAIN WORKERS'COMPENSATION INSURANCE,AS PEQU!RED BY SECT:CN � / Q 37000FTHELABORCODE.FORTHEPERF�RMNNCEOFTMEWOFKFDqWHfCN7HISPERMRI3 .yj1_�� � ISSUED.MYWO EFS�' °MPE SATIO NSUflANCECARflIERANDPOLICYNUMBERAflE: CONSTRUCTION I-!' d �� �1,; PLAN REVIEW � CARRIER�_ __ _ Z POLICY NUMBEfl__.� _ — ELECTRIC Q ' (IHl55K.'tqNNE�NNOT8E006�EfEDOFiHEf'EfVMISfIXiIXJEFIIN(%1ED00LIA�L(5700)pqLESS} PLUMBING _ � '�'�' � 0 Z ICERTIFYTHATINTHEPERFOqMANCEOFTHEWORKFOqWHICHTHISPEFMITISIBSUED.I MECHANICAL _ (} SHALL N07 EMPLOV ANY PERSON IN ANY AIPNNER 50AS TO BECOME SU&IECT TO THE � WORNERS'COMPENSATIONLAWSOFCA4�FORNIA,ANOAGREETHATIFISHOl/L�BECOME INSPECTIONFEE _ = SUeJECTTO TNE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR — COOE,ISHALLFORTHWI7MCOMPLYWI7HTHOSEPROVI510 S. , ISSUANCE �� O .. , ��6�e � p DATE:��+��� APPLICANT.�_ '_ __ SMIP _._ ti P� _ w ENERGY P/C J WANNIN: AIUIRE T05 CURE WOflKEHS'CAMP A710N VEPAGE IS UNUWFUL,AND SHAILBE -- � Sll&IECTANEMPLOYERTOCRIMINALPENALTIES� OCIVILFINESUPTOONEHUN�RE�THOUSANO ENERGYPERMIT DOLLAR5(ff00,000),INADORIONTaTHECOSTOFCOMPENSATION,ORMRGE5A5PROVIDEDFORIN — — — � SECTION37080FTHELABORCA�E.INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE:. _ d CONS7RUCTION LENDING AGENCY PRE-ALT FEE: _ � IHEREBYAFFIqMUNDEHPENALiYOFPERIURYTHqTTHEflEISACONSTflUCT10NLENOINGAGENCY � FORTHEPEFFOfiMANCEOFT7IEWORKFOHWHICHTHISPERAl1TISISSUED�SEC.3ooi,CIV.CJ. Z W � LENDERSNAME___ __ _.__ (, _ F— LENDERSADDRE55 __ ..._ _, — W I CERiIFY THAT I HPVE READ THIS APPIICATION AND STATE THATTHE A80VE 1NFORIAATION I5 CAH(7ECT. T�TAL FEES � 1 AGREE 10 COMPLY NATiI ALL CIT'AND COUNTY OROINANCESAND 57ATE LAWS RELATING TO BUILDING CON57RLICTIIXJ,AN�HEREBY AUTNORRE REPRESENTATIVES OF 7HI5 COUNTY TO ENTER UPON THE Zp80VE-MENTIONEDPROPEHTYFORINSPECTIONPURPOSES. COMMENTS _ p `� r J � m PEN EEN IE�vRiNTI y� � _' '— [n SIG . 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