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HomeMy WebLinkAbout12700 (11) ��� CITY OF DIAMOND BAR , _�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �; `� � 21660 E.Copley Drive Suite l90 / (909)860-3195 Fax(909)861-3117 / PRESS "��°� BUILDING PERMIT APPLICATION FIRMLY y JOBSITE � t , � �" �, APPLICATION� .,��C PERMIT Z1(J /C o ADDRES �� DATE NUMBER � �'` # � ISSUE TYPE OCC APN LOT-�� TRACT DATE_ CONST. GROUP p OWNER `r,�,��ll,( Il �(_st-Ca./l_.1n�-(:Zi''`� p ADDRESS c�i,��-I �� + { % � ZONING SEfBACKS Z CITY � ` ^ IP� /J TEL. /' .. ��' �-� FRONT RW ❑ g APPLICANT �j �l �TEL. ��5�-I ••� REAR I I � SIDElSIDE STREET RW__ f-1 — CONTRAC _y- ¢? SIDE (J ADDR SS � � CITY ��- ZIP TEL. ' Z� PROPOSED USE w ARCH/ENG/ — � z DESIGNER W — NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES _ _BEDROOMS � v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION pC OWNER-BUILDER DECLARATION SFFVADD/HEM O i HERE6Y AFFIRM UNDER PENALTY OF PERJUHY hIAT t AM[X[MPT fRON THE CDNiRACTORS LI� G8f&9B/CBfPOfI � W CENSEURNFOR7HEFOlLOWINGflEA50N(SEC.7031.5BJSINESSRN�PROFESSIONSCO�E:MYCITYOR (n U WUMTyW�{�Ct{q�(JIpESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIflANYSTRUC- W patio/Deck � W NRE,PPIOR N tTS ISSUANCE,�LSO REQIIIRES THE APPLICANT FOR SUCH PF.RMIT 70 FILE.A SIGNED w STATEMENT THAT ME OR SHE IS UCENSED PURSUANT TO iHE PROVISIONS OF T}1E WNTRACTORS LI� � CEN5E LAW(CHAPTER B(COMMENCING WITH 5ECTIDN 7oDa)OF DIVI310N 30F THE BUSINESS AN�Pfl0- V' POOUSPB FE6SIONS�E)OR TMAT HE OR SHE IS EXJdP7 THEREFflOM AND THE BASIS FOR THE ALLEGEU F.%EMP- TION.ANYYIOLATIONOFSECTION7031.50YANYAPPLICANTFOFAPERMITSU&lECTSTH`eAPPLICFNTTO Z Re-Roo( � � ACIVIL PENAL7V OF NOT MORE TiAN FNE HUNORED DOLIARS(E50o).): � ❑I,ASOVMEROF7HEFROPERTY,ORMVEMPLOYEESWITliWAGESAS`HEIRSOIECOMPENSAT7oN, COR1R18fCi31 WILL DO THE WORI(,AND THE STPUCTURE IS NOT INTENDED Ofl OFFEREO FOfl SAIE(SEC.7094,BU51- Q � NESSAYD PROFESSIONS WDE:THE CANTRACTORS LICENSE LAW DOES NOl'AGPLY 70 AN DWNER OF : _ � PROPERTVNh108U1LA50qIMPROVESTHEREON,MDWHODOESSUCHWORKH11A5ELFORHERSELFOR ' � TMHOUGNNI80RXERONMEMPLOVEES,PROVIDEDTHA75ULl11MPFDVEMEN75ARENOTINTENDEDOR m � OFFEREDFORSALEIF,HOWEVEq,THEBUILDINGOHIMPROVEMENTI550LDWIIHINONEYEAROFCOMPLE- z TION,THE OWNER�BUIlOER WILL HAVE THE BUR�EN OF PHOVING THAT HE OR SHE DID 1:0T BUILD OR � IMPROVEFOfliHEPUflPO3EOP3ALE). �y,� ❑I,�SOWNEROFTHEPROPEfiTY.AMEXCl.U51VELYCONTHF.CTINGWITMLICEN5E0CANTFACTORS � TO CONSTHUCT THE PR0.IECT(SEC.7041,6USINE55 AND PROGESSIONS CODE:THE CAMRACTOR5 LI- V8IU39iOf1 __.._,____., ,„__ ___A�J,AREA W CENSELAWDOESNOTAPPLVTOANONTIEROFpPROPERTYWH00111LDSORIMPR�VESTHEREON,AND Z W1fOCONTMGT5FOR5lICNPR0.1ECT5WITMACONTMCTOfl�S)LIGENSEDPIJRSURNiTOTHEGONTHAC- ' QUANTITY DESCRIPTION FEE � TORSLICENSEUW.). Q ❑I AM EXEMPT UNDER SEC. 8.8 P.C.FOR THIS FEA50N U 3 --- o� � DAYE_ ___ON7:ER___ _____ U Z W Q LICENSED CONTRACTORS DECLARATION w � 1 HEREBYAFFIRM UNDEF PENALTY OF PERJURV 7HAT I AM LICENSED UNUEN GHOVISIONS OF C4IAVTER � � �1���� � d 9(COMMENCING WITH SECTION 7000)OF DIYISION 30F TIIE UUSINESS AND PROFESSIONS CODE,M'U Z �/`6 X MY LICENSE IS IN NLL FOHCE AND EFFEC7. � LICENSE CLASS - r> -.f! LIC.NO.�� �• �__ j H U DATE ��I;�JC�OGy�_ CONTRACTOR�+-f1�( �/"�,� d W � WORKERS'COMPENSATION DECLARATION � Q = U N IHEHEBYAFFIRMUN�ERPENALTYOFPE0.IURVONEOF7HEFOLLOWINGDECLARATION5: � � Q � IHAVEIVd�WILIMFINTAINACEfiTIFICATEOFCONSENTTO5ELFINSUFEFORWOqKERS' S � COMPENSATION,AS PROVIDED BV SECiION 37000F THE LABOR CODE,FOR THE PERFORM.4NCE IU OF TME WOPK FOR WHICM TMIS PERMIT IS ISSUEO. � � IHAVEAN�WILIMAIMAINWORKERS'COMPENSATIONINSURANCE,ASREOUIREDBYSECTION Q __ � 370oOF7HElABORCO�E,fOHTHEPEHFORMANCEOfTHEWORKFORWHICHTHI5PERM1715 _ ISSUED.MY WORKER5 COMPEN�pT1IXJ INSURA�JCE CARRIER PND POLICV NUMBER ARE: CONSTRUCTION _.______ J "_--_—_---"_,_...-__--___- " -' jCARBiER LC/ --�_--- A��-[.f�' _;-=_�li-1C�:------- PLAN REVIEW -----— — ------- � DIX.ICVNUMBER R �i..J�l.� • _�.�-a'��__—_.._._..____ ELECTRIC /y/,� 0 (I}iISSCC'tqMNE�NOTBE071.RF.�EDOFTNEPE.IUN'iISFW�NEHINJ�ftEDDOLLPAS(5700)ORLESS� P MBIN� _ / ! S "��_ Z ICEHTIFYTHATINYHEPEHFORMANCEOFTHEWORKFOflWHICHTHISPERMITISISSUE�,1 MECHANICAL _ d ` ` _ _ (J SHAILNOTEMPLOYANYPEflSONINANYMANNER50A5TOBECOMESUBJEC�TOTHE (J� WORKEFS'COMPENSATION�AWSOFCALIFORNIA,ANDAGHEETHA7IFISHOUTABECOME INSPECTIONFEE ____ � Sl18JECTTOTHE WORKERS'COMPFNSATION PFOVISIONS OF SECTI0437U0 OF THE LlBOR �7 � CODE,ISHALLFORTHWITHCOMPLYW{fM30SEPROVISION ISSUANCE ,_.__,,,,___._.._ ' 11��__ p DATE:�i z�'� APPLICANT: ��'V��"�- SMIP ____'__'_— "'____.__._ _' � ENERGYP/C y ' '�,��. -.----'-.------.-'--'— J WARNIN6:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL.AND ShIALL OE y�-�y�---���J�,1 � SU&IECTANEMPLOVEflTOCflIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSMD ENERGYPERMII �-_� •� � .... OOLLAFS(L100,000),IN ADOITION TOTHE COST OF COMPF:NSAT104,OAMPGES AS PROVIDED FOR IN --���-----�---�— � SECTION37oeDFTHELABORCODE.IN7FREST,ANDATTORNEY5FEE5. RETENTION FEE: ���eil+'���/���,$=TA _ OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: ���D�.��_�.�,.,.s�.iU'C.�TV�_ ._ � IIiERWYAFFIRMUNDERPENALTYOFPERJURY7HATTHEHEISACONSTHUCTIONLENDINGAGENCY n- FORTHE PEREORMANCE OF THE WORK FOR WHIf.H THIS PERMIT IS ISSUED(SEC.3097,CIV.C.j. ---�������— ---- -- Z W ----'-".--'-------_..-----�--'----"--'-'---'-'----'—�-'--'-'--- � �ENDER'SNAME "'_'_'____ _'_"' _ ►� LENDER'SP�DRE55_______ _ ._._--........_....__ � W ICERTIFYTHATIHAVEREAOTMISAPPLICATIONAN�St'ATETMATTH[ABOVEINFORMATIONISCORRECT. TOTAL FEES � y X995 � IA6REETOCAMPI.YWITHAI.LCITYANDCOUNTYOROINANCESANDSTATELAWSREU1fINGTOBUII�ING — ----- _- — -- � � CONSTRUCTION,ANU HFREBV AUTHORIZE REPPESENTATIVES OF THIS COUNTv TO ENTE(3 UVON THE � ABOV- ENTIONED VFOPERTY FOR INSPECTION PUHPOSES. COMMENTS _ � � "'—'__— __"""' _"__'_—""__ J � � � m PERMIiTEENAME(PflINT) _ _ � L�-�""-�...,t_-_.--. /-�' _'�' --�-- ------ --- N SIGNANRE OF VERMITTEE �pTE � �_� .� � = RECPT.NO. 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