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HomeMy WebLinkAbout14532 (20) ,q j.. � ��_ CITY OF DIAMOND BAR DEPARTI��ENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 „ (909)660-3195 Fax(909)861-3117 PRESS � � `'+�°. BUII.DING PERMIT APPLICATION FIRMLY o DDRESSL.�L��t� 11O`�Q�'� � , DATEICATION L --�1�,`./� NUMBE� L� ! �/ P/C � ISSUE TYPE OCC � APN LOT TRACT DATE CONST. GROUP p OWNER LR�INIC.�R- p ADDRESS ZONING SETBACKS Z CITY IP TEL. FRONT RW ❑ g APPLICANT TEL. REAR ❑ SIDElSIDE STREET RW fl _ � CONTRACTOR l3 {� SIDE IJ_. _ p� ADDRESS 3�'f�'Z�, PROPOSED USE f � CITY C�^I NO ZIP��1� TEL:�(�Ek'� � w ARCH/,€NG/ � �z DESIGNER � L-�C�'I'Tc� NO.DWEL. NO. NO. o. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. -------- � uNi DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � p� OWNER•BUILDER DECLARATION i � SFR/ADD/REM Q i HEHEBY AFFIRM UNDER PENALTY OF PENURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- � Garage/Carpon q W CENSEUWFOFiTHEFOLLOWINGREA50N(SEC.7031.SBlISINE55AN�PR�FE5510NSCO0E:MlYCITypq S U Cp�PJTYWHICHREWIRESAPERMRTOCONSTRUCT,AL7ER,IMPROVE,OEN.OIJSH,ORREPAIRANYSiRUC- W P8Ii0/DOCk W NHE,PRIOR TO ITS ISSU/WCE,ILLSD REIX11RE5 THE APPLICANT WR SUCH PERMIT TO FILE A SIGNED � W � S 9TATEMENT hIAT HE OR SHE IS LICENSED PURSUANT TO 7HE PflOVISIONS OF 7HE CONTFACTORS LI• LL � CENSE UW(CHAVTER 9(COMMENCW�WIT4 SECTION 7000)OF�IVISION 7 OF 1HE 9l1SINE55AND PRO� POOUSPe { 4 FE99qNSCODE)ORTHATHEORSHEISEXEMP7THEflEFROMAN�THE8A5I5FOR7HEAlLEGE�EXEMP• (� I �) TION.ANYVIOLATIONOFSECTION7031.58YANVROGLICANTFORAPERIAITSU&IECTSTHEAPPLICANTTO z qe.ppof i � AqVIL PENALTY OF NOT MORE THAN FNE HL'NDRED DOLLARS(5500).): � ❑I,ASOYMEROFTHEPROPEHTY,ORMYEMPLOYEESWITHWAGESASTHEIRSnLECOMPFNSATION, � Commercinl ; VALL DO THE WORK,AND THE STRUCTURE IS NO7 INfENDED OA OFFF.RED FOR SALE(SEC.7044,BUSI� J y NESS AND PROFE$SIOtJS CADE:THE CQNiRAC70R5 LICENSE LAW DOES NOT APPLV TO M OWN&R OF ' N PiIOGEHTYWFIOBUILDSORIMPROVESTMEREON,ANUYMODOE33UCHWORKHIMSEIFOFHERSELFOR � ( Q 7}IpOUdHHI50RHERONMEAIPLOVEES,PROVIDEOTHATSUCHIMPRWEAIENTSARENOTINTENOEDOR m I QOFFEREDFORSALEIFFiOWEVERTIIEBUILDINGORIMPHOVEMENTI550lDWITHiNONEYEAROFCOMPLE- Z �TION,THE OWNERAUILDER WILL HAVE THE 9UROEN OF PHOYMG THAT HE OR SHE�IO NOT BUII�OR = IMPFiOYEFORTiEPURPO3EOF3ALE�. W� ❑I,ASOWNEROFTHEPROPERTV,AMEXCWSNELVCONTRACTINGWITHLICENSEDCOMRACTORS I � TO CONSTRUCT i}IC•PRO,IECT(SEC.70V,BUSINESS ANO PflOFESSIONS CODE THE CONTqACTORS LI- VBIUeIIOn ADJ.AREA__._ W CENSEIAWOOESNOTAPPLYTOANONMEROFAPROPERTVWHOPl11l�SDRIMPFiOVES1HEREON,ANO . F WFIOCOMMCTSf-0q3UCHPR0.IECTSYATHACONTRACTOR(S)LICENSEOPURSUANTTO7HECONTMP . QUANTITY DESCRIPTION FEE � 1DR5 LICENSE LAW.). � J � ❑IAM EX6MPT 11NDER SEG _ 8.8 P.C.FOiiTHIS REASON d ! L � � � OATE OWNER f' Z _ _ _ W i I � UCENSEp CON7FACTOFS DECLARATION W � � ' � 1 HENEBV�FFIHAI UNDER PENALTY OF VE0.IURV THATI AM LICENSED UNDER PROVISIONS OF CHAPTER � 1 a 9(COAIMENCINpW17MSECTION7000jOF�IVISION30FTHE8U91NESSANDPROFESSIONSCA�E,ANU z � `L MYUCENSE IS IN iULL FORCE AND EFFECT. 1�r�� n � � o LICENSEC SS��J� LIC.NO. ��1�_� J � V DATE _ CONTFiACTOR.._...- a ! W � WORKEHS'COMPENSATION DECLARATION Q ; y U f� 1 HERE9VAFFIqAI UNOER PENALTV OF PERIUflV ONE OF THE FOLLOWIN�DEqARATIONS: z � _IHAVEqNDWILLIAAINTAINACERTIFICATEOFCONSEMTO6ELFINSUpEFORWORKERS' • _ . ' p COMPENSRTION.ASPRONDEDBYSECTION37ooOFTHELASORCODE.FORTHEPERFOHM.4NLE W `( �JFTHE WOFK FOA WHICH THIS PERMIT IS ISSUED. � ` C] �' W �I HAVEpND WILL MAINTAIN WORKERS'COMPENSATION INSUAANCE,AS RE�:IIRED DY SECTION �. Q 37000FTHEU60flCODE,KORTHEPERWRMANCEOFTHEWORNFORWHICHTHISPERMITIS � q ISSUED.MYWORKERS'CAMPENSA INSURANCE RHIERANDPOiJCYNUM9ERARE CONSTRUCTION ___.___. ___..._._._.___._- � _' - ..__ PLAN REVIEW .---- --,------._._ '_ �' CARRIER� ---_ ZPOLICY NUMBEH� __ -_._._ ELECTRIC __.__._-_. � Q a �nussEcro,vti�r�oreEox.mEtEooFn+EaEwarr�swaavErain�aeooal.aas�sioolon�css� PLUMBING -�., — — - � . w MECHANICAL ��f'' '� } Z ICEflTIFYTHATINTHEPERFpRMANCEOFTHEWORKFORWHICHTHISPERMITISI55UED,1 ---------���'_ --___.'_ _- Lj' SHALLNDTEMPLOYANYPERSONINANYMANNERSOASTOBEGOMESLIBJECTTOTHE i � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULD�ECDMC: INSPECTIONFEE -_ __ � ___G�� , S Sl18JECT TO THE WORKERS'CAMPENSATION PqOVI.SIONS OF SECTION 37000F THE LABOq , : CO�E,ISHPLIFORThIWITHCOMPLYWI7HTHO5EPPOVISION6. ISSUANCE e.� f��."ty ' _ --_�_P__. t . � ��tF' S�f.�F3 a p OATE:__ APPLICANT. _'_'_. "'_____ SMIP __'.�3"'�tl�_�: ....--__._ ( W Y>�r a,�� t � ENERGY P1C Y�ev.-S,.y;...'i,}Z��'•,�_y at�,i4.------ --- � J WARNING FAI�URE TO SECl/RE WORKERS'COMPENSATION COVERAGE IS UNLAWFl1L,RNU SHALL 8E ���,��' � SUBJECTANEMPLOYERTOCRIMINAIPFNALT�ESANDCIVILFMESUPiUONEHUNDREDTHOUSAND ENERGYPEflMIT l�'•�'� � �' ' � J��" __ � pOLLAqS$t00,00D,INM01T10NTOTHECOSTOFCOMPENSFTION.DAMAGE5A5PflOVIDEDFOHIN ( 1 e.e,l. e.�`�'..'_'... � SECTION37080FTMELABORCODE.INTEfiEST,ANDATTORNEY'SFEES. RETENTIONFEE: ____. —. � Q CONSTflUCTIONLENDINGAGENCY pRE•ALTFEE: __,__.,____._._ ._.___ � � IHEREBVAFFIRMUNDERPENALNOFPERJURY7HATTHEREISACONSTRUCTIONLENDINGAGENCY _ _____ _.,, ____,,,______ i FOfl TME PEflFOFMFNGE OFTHE WOHK FOR WHICH THIS PERMIT IS ISSUED(SEG 3097,CIV.C.). --- _ � W -_' _--_... � LENDEH'SNAME__ -. "'---...- ._ ___ '__ N L[NDFf7SAD�RE55 ._ _- --- ? ` � ICERTIFYTfIqTIHA1/EREADTHISRPPLICATIONAN�STATETHATTHEABOVEINFORMATIONISCOqftECT. TOTAL FEES � �// " W IAGREETOCAMPLYWITHALLCT'ANDCAl1NTVORDINANCE5RND5TATEIAWSREIATINRT00UIL�ING � L / F � GOIiSTRUCTION,AN�HEREBV AUTHOFIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE pqpy. TbNED DROPERIY FOF INSPECTION PUHPOSES. � Z � � COMMENTS._ _—_ — . 0 � — — � PE 1T7EE (R 1 � -. - ' � Q -� N r �. _. : SIGtUT �A � � RECPL NO. ,��PAID BY � ` � ALIDATION _ / WHITE—Departmen[Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDEhROD—Fiie Copy,GREEN—Applicant's Copy P . _.. . . � . � ._ . _ . .. . . . _ _ _ _ . ._ :. _ _ . ., _ : , � . . ._ .._ � ? ; , : ' • ; j ! ' . , , � � i I- � . � � � , � . ; � � : i i k_'� '� � � � I ,� i , � � - . ... . � 1 ( � I �- �. - � ! . �i ' � . . _'� � ' , - ' 'r�4au. - - t . ' . . , j '� 1 I I � � .. " rv�. � � - . � . � , . t ` ' S��� � �� ' � , i j . , � , �� ! i i I 3 . � — '. . � . � i ' � , I ' . � � . ' ! � 1 .. '1�� �' � ' � _ ._ " ` .. ' � �' {� �� � i� ' ! f . , ���� ' - ,�� � 1 i ! �� i � � � .• ' . I � i � '��±\ � � ' . 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