The URL can be used to link to this page

Home My WebLink About15524 (20) W 1� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � . 21660 E.Copley Drive Suite 190 (909)860-3195 Fsx(909)861-3117 PRESS �''H�° � BUILDING PERMIT APPLICATION FIR o� JOBSITE 23(� / 7 G'D�VT� S�f��s APPLICATION � � �� PERMIT Y�j� P/C ADDRESS DATE NUMBER �-� # $ ISSUE Cr �y� TYPE OCC APN L/04T � �ACT DATE � CJ � CONST. GROUP ¢ OWNER � OO p ADDRESS Z 3 C'�U O �l✓1 ZONING SETBACKS W CITY D A" Oilll7 IP 9 6 S TEL. 6 OZ FRONT RW ❑ � APPUCANT 1I-�NL l G /QDD /A�TE . b ZO�� REAR CI SIDE/SIDE STREET RW fl � CONTRACTOR� � �� SIDE ❑_ ¢ ADDRESS �D � pROPOSED USE 6��O� eg r�o - S r e�f � ciTv Lorrt i R� ZIP�TE a �a ,_.Z� � ARCH/ENG! .K DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CIIY ZIP_ TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION � ¢ OWNER-BUILDER DECLARATION SFR/ADD/REM p 1 NEREBV AFFIRMI UI�AER PENAL�Y OF PERNRY 7HAT 1 AA1 EXEMPT FflOM 7HE CANTMCTORS LI- G8f8gB/CBfpOrt W CENSELAWFOflTHEFOLLOWINGHEASON(SEC.7031.58USINESSANDPROFESSIONSCODE:ANYCITYOR (n ZOOIINTYWHICHREWIRE3APfHMITTOCONSTpUC7,AL7ER,IMPROVE,OEMOLISH,ORNEPAIRANYSTHUC- W pa�i0/D6Ck T1RE,PRIOFl TO ITS ISSUANCE,11L50 NE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO � STATEMEM 7H�T HE OR SHE IS LICENSED PUii3UANT 70 THE PqOYI510NS OF THE CONTRACTORS LI- W � CENSE LAW(CXAPTER 0(COMMENCIN6 WITH SECTION 7D00j OF�IVISION 3 OF THE BUSINE55 AND PRO- � POOUSpd FESSIONS GODE�OR THAT HE OR SHE IS EXEMPTiHEFEFROM AND THE BA515 POH THE ALLEG[D EXEIAP- TqN.ANYVKKATIONOF5ECT10N7o31.58YANYAPPLICANTFORqPERMITSU&IECTSTHEAPPLICANTTO z Re-Roof � � ACMLPENAL7VOFNDTMORETHANFIVEHUNDRED�OLLARS(5500).): � ❑�.ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIflSOLECOMPENSATION, � COrtIfIIBfCl81 WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENOED OF OFFER[D FOR SALE(SEC.70/6,9U51� J NESSAND PROFESSIONS CODE:THE CCNfRACTORS LILENSE LAY!�OES NOT APPLY TO AIi OWNER OF y PROPERNWf108UIlASOR�MPROVE&THEREON,ANDWHOOOESSUCHWORKHIMSEIFORHERSELFOR � � TMROUGMHISOqHEHONRJEMPLOYEES,PROVIDEOTHAi5UG11MPROVEMENTSARENOTINTENDEDON m L�1 OFFEAED i'OR SALE.IF,FiOWEVER 711E B111L01NG OF IMPROVEMEM IS SOL�WITHIN ONE YEAROFCOMPLE- `A' 7pN,THE OWNER•BUILDER WILL HAVE THE BUADEN OF VROVIN�THAT HE Oq SNE 010 NOT BUILD OR IMPROVE iOR THE PURPOSE OF SALE). W !]I,ASOVMEROF7HEPROPERfV,AMEXCAUSIVELYCANTRRCTINCWRHLICENSEDCONTFiACTORS ,y � TO CONSTRUC7 THE PROJELT(SEC.7o4t,BUSINE55 AND PROFESSIONS CODE:THE CONTMCTORS LI- V81�dIlOf1 ) pDJ.AREA, _ W CENSEUWOOESNOTqPPlYTO/WOWNEROFAPHOPERTYWN09LIILDSORIMPqOVESTHEREIXJ,AND � WXOCANTRACTSFORSUCHPRQIECTS'hITHACONTMCiOR(SjLICEN5E0PUfiSUANTTOTHEGONTRAG QUANTITY DESCRIPTION FEE � TOHSLICENSELAW.). J � J I MI EXEMPT UNDER SEC._____ B.8 P.C.FORTHIS PEASON Q � -- -- � �LL' DATE, OWNER___.,. � ui � LICENSED CONTFACTORS DECLARATION W � 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I p1A LICENSE�UN�ER PPOVISIONS OF CHAPTER � � 9�C9AIMENCINO WITH SECTfON 7aao)OF�IVISION 30G THE BUSINESS FND PROFESSIONS CO�E,AN� z `L� MY UCENSE IS IN i'ULL FORCE AND EFFECT. 0 IJCENSE CLASS �r� m LIC.NO._��5�� V DATE ��_d� _ CONTRACTOR.A~'�bM G G.I a W ��,��. � WOflKERS'COMPENSATION pECLARATION � U � I HEREB�AFFIpM UNDEfl PENaLTY OF PERIURY ONE OFTHE FOLIOWING DECIARATIONS: cn Z ¢ � _IHAVEANDWILLMAINTpINACER7�fICATEOFCONSENTTOBELF-IN9UREFORWORNERS' _ COMPENSATKKJ,ASPROVIDE08YSECTION37ooOFTHELA80RCODE,FORTHEPERFORMANCE �U OF THE WORK FOR WHICH THIS PERAIIT IS ISSUED. � Q '._.."_"'_ _ � _I MAVE/WD WILL MAIPlTAIN WOFKERS'COMPEN5ATION INSURANCE,AS RE��iHED BV 5[CTION Q 97000FTHE LABOR CODE,FOHTHE PEFFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS � � �� 0 ISSUED.MY WORKEFS'COMPENSATION IN5URANCE CARRIER ANO POLICY NUMBER AFlE' CONSTFlUCTION _ _, J j cnaniEn_ ----._....-.------- PSAN REVIEW Z aa�crNUMeea_ _� ELECTRIC _ _,__..___—_ .__.._— _ Q •r� ., .. y::, � (fl{ISSEC710NNE�NOTBEWNFIFimOFh+EPERhYI"ISFORONE1rt1t�DFlEDDOLLAFiS(5100;ORLESS� PLUMBING ;?-..._. .. . ...--.—. ------------ ZW I CENTIFYTHAT IN THE PERFOPMANCE OF THE YJORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL ''_'_ _'_"'___ __"'"'_'_ � SMALL NOT EMPLOY ANV PEFlSQN IN ANY MPNNEH SO AS TO BECOME SUOJECT TO THE � WORKERS'COMPENSATIONlAW50FCAUFORNI0.ANDAGREETHATIFISHOULD�[CA INSPECTIONFEE ___.__�_,___ y�__ SIIBIECTTOTHE WOPKERS'COMPENSATION PftOVISIONS OF SECTIOV J'Ioo OF THE R (�i;";_� � � CCCODE,ISHALLFORTHWIhICOMPLVWI SEPROVISION6. ISSUANCE . ��'__ '. __ __ _ ___ ry� � Q4TE:� �D APPLICANT: ' _—"_"_ SMIP _':4-i-,x ' ". ,. . .. ... _ .�.;., —"'--_�•'� w � /'x=-: ;>.—:_; ,.:.:..,,.;. . , ENERGY P�r� . '��T+ �,-`,T i��. J WAqNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVER IS NTI1L,AND SIIALL BE �,�;:i�� " +�;M1� � �—"—' -'—'- - � SUBJECTANEMPLOVER70CRIMINALPENALTIESANDCIVIIFINESU TOONEMUNDFEDTHqU5AN0 ENERGYPEFtF111P"i3"' "�� _ _ �_..__—_ DOLURS(5700,000),INAO�ITIONTOTHECOSTOfCOMPENSAfION,DAMAGE5A6PROVIDEDFOFIN --—�--- - — � SECTION3�o80FTHELA60RCODE,INTEREST,ANDATTORNEV'SFE[5. RETENTIONFEE: _____ ____,____.._ a CONSTRUCTION LENDING AGENCY PREALT FEE: ____.__ _____—.__ � IHEHEBVAFFIRMUNDERPENALTVOFPEHJURVTI�IATTHfNEISACONSTRUCTIONLENDINGAGENCY __.____ ,_____, _ � FORTHEPERFOfIMIWCEOFTHEWORKFOflWHICHTHISPERMITI51S5UED�SEC.3007,CIV.C.7. � Z '..'""' .. ._v.. W � LENDEP'SNAME ___.__- ._-.._�-- H LENDEP'SADURESS __.___Y_.__.__ /�, � ( ) � ICERTIFYTHATiHAVEREPDTHISAPPLICATIONANDSTATETNATTHEABOVEINFORMATbNISCORRECT TOTAL FEES �� 'V w I AGREE TO CAMPLY WITM RLL CITY AND CALINTY ORDINPNCES AND STATE UWS FELATIYG TO BUIL�ING � CONSTRUCTION,ANDHEREBVAUTHORIZEREPRESENTATIVESOFTHISCOUNTVTOEMERUPONTNE ZA90VE�MENfIONED7ROPERTVFORINS7ECTIONPURPOSES. COMMENTS � _��M�S �6��5 -------- -- � 7E IT AME(PRINT) �/��9 � "---.— —__— � " �_� 4 .___"_ s '__ � SI ATUREOFPEHMITfFE DATE = RECPT.NO.___. PAID BY ______VALIDATION_ __ ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy n : . ' ' . , '� � � i ' ' . . . " .. _ � . - . . ; . .. � � . : � � : � ' . . . . ,. ; � . . . Ft' ' � ' . . . . . . , , . , ' , � ' ' , � ' . _ ' ' 1 ' . . . ... � ' . - . . � i i � _ . . ` .' , � - . . . ' . i . - ' . . � . . . � ; .;. ; �. . .. � . : . . . . , � i . . . .._ , . . . , . . . , „ . . ; . , . . , .. . ... , a, -_:... ... � , � , � ..._ _ � . � - :� � '` i � . . ' . ; i : . ' ' _ . � . . , .. - j . . ' . ` j , ' . � � .. . . . �"� ' __ _ _ 4 ._... � ., . ... . _ . _ _ , _ � . J�g ' , . I . ' , ' . . ' . . . � . � � � i � . . � . k k . , .c q , . i • i ' . . , . . . � _ .'I. . . . . . . - , . ,- , , . _ ' -- . . � -�� I �:.�. .�. l . , . - , l "i .. � � - � -. ' - . . � _ . .��_ � . _ , .. - . ., � ..� i . . . ; . �_ .t�s _ . _ ' . . . . - . � . - . � : , ' . . e 4 . , ...._ . ..-' ..._ .... . _ .. . . . .. . , � _ _ _ _ ; i � i � , i , ` �' �� , � � � ` � � � � � � � y.. I �� . . ' � . . � ' , g ; , : . �.$ . ' ! : a`O - ' ' r , , s � � Or ; , ; _ . � - ... _. _. . _ � . . � : ai ; , ' �- ' ' �: j , _ - , , � :.. � _ ; - � , > , � , - _ ' i f �s�� = . _ . _ ._ .