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HomeMy WebLinkAbout14644 � � _ ��_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � �w . 21660 E.Copiey Drive Suite 190 � , (909)860-3195 Fax(909)861-3117 PRESS �����°�.� BUQ.DING PERMIT APPLICATION FIRMLY t � JOBSITE �] �I! n APPLICATION � PERMIT f`f P/C o ADDRESSL,3� �� ���l� S��I�9S D'`� DATE � NUMBER/ T # � issue TYPE occ � APN LOT TRACT DATE_. CONST. GROUP , p OWNER I��� ADDRES � Z � II �9� ZONING SETBACKS � Z CITY �� u ZIP�11$�1 Q�L`� s . �• FRONT RW ❑ � g APPLICANT iZ!?t>�''L�S'A �(,. " Q_ REAR ❑ � � 7 SIDE/SIDE STREET RW �J____ : n n � SIDE L_.._ I CONTRACTOR C A��I��IIC �Q�S ADDRESS��� ' TH. T �-- 's PROPOSED USE � � CIlYl3��Pil� ZIPan� ��,L� �T �i`� fl � w ARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. } � ADDRESS UNITS STORIES __. BEDROOMS ' � CITY ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNEH-BUILDER DECLARATION SFR/A��/REM O 5 � I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I A!A EXEMPT FROM THE COMRACTOqS LI- � Garage/Carpor[ �, W CENSEIAWFORiHEFOLLOW�NGHE0.50N(SEC.7031.5BUSMESSANDPROFESSIONSCO�EANVqTVOP � COl1NfYWHICHRC-0UINESAPERMRTOCONSTRUCT,AL7ER.IMPROVE,DEMOLISH.OHREPAIRANYS7RUG W pat�o/DBCk r ' TURE,PqpR TO ITS ISSUANCE,ALSD REOUIRES THE APPLICANT(-0R SUCH PERMIT TO FILE A SIGNED W h � STATEMENT hiAT ME OR SHE IS LICENSED PURSUMIT TO THE PROYISIONS OF THE CAN7RACTOflS LI- ' ?: � CENSE LAW(CHAPTER D(COMMENCING WITH 5ECTION 70D0)OF DIYISION 80F THE 9USINE55 AN�PRO- V' POoUSPa K FESSIONSCODE)OR7HATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (� � TION.ANYVIOLRTIONOFSECTION7031.58YANYAPPLICANTFORAPFRMITSU&IECTSTHEAPPLICpNTTD Z Re•Roof ¢ t„� A CML PEN/LLTY OF NOT MORE THPN FIYE MUNOREO DOLUIRS(E500).1: ! � ❑I,ASOWNEPOFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � 0 COfnRl8fCi8I MfILL DO THE WORK,AND THE 9TRL'CTllRE IS NOT INTENDED OF OFFERE�FOR SALE(SEC.70a4.BU51- J t NESSAND PROFESSIONS CA�E:THE CONTRACTORS�ICENSE lAW�OES NOTAPPLY TO RN OWNER OF � � PROPERNNhiOBU1L0.SOflIMPROVESTHEFEON.ANOWHODOE5Sl1CHWORKHIMSELFORHERSELFOP m . � THqOUONHISOtiHEROWNEMPLOYEE3,PROVIDEOhIAT&UCHIMPROVEMENTbAREN071NTEN�EDOR # QOFFEFEOWRSALEIF,HOWEVERiMEBUILDINGOflIMPROVEMENTIS50LDWITHiNONEYEAROFCOMPLE TION,THE OWNEREl11LDEF WILL HAVE THE EUROEN OF PflOVING THAT HF OR SHE DID NOl�UIl.O OR � � IMPROVEFORTHEPURPOSEOFSpIE). ` W LII,�SOWNEROFIHEPflOPERiY,M1E%CLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS k Q 70 CONSTPUCT THE PROJECT(SEC.70M3,6USINE55 AN�PFiOfES510N5 CADE:THE CONTRACTORS ll- V81U2tI0n ADJ.AREA � W CENSELAWDOESNOTAPPLVTOPNONMEROFAPROPERNWHOBUILDSORIMPROVESTNEpEON.AND + � W!{OCONTRACTSFORSUCHPR0.IECTSWITHACONTFlACTOR(3)tJCEN3EDPUPSUAMTOTHECONTqAG pUANTITY DESCRIPTION FEE # � TONSLICENSELAW.). p�[. {� �/� 1 _ �_ ❑i AM E%EMPTUNDER SEC. B.8 P.C.FOF THIS FEASON Q � :`^' "^ ���T'\��V F � —_— _ __""" '...__ � d � � OA7E _ OWNER__.__ U e W � � LICENSED CONTRACTORS DECLAF7ATION W � � 1 HEREBV AFFIRAI UN�ER PENAL7Y OF PE0.NRV 7HAT I AM L.ICENSED 11NDER PROVISIONS OF CHAPTER ` � e(OOMMENCINOWITHSECTIW�17000jOFDIVI510N30FTHE8U51NESSANDPROFESSI045CA0E,AND � � MYLICENSE IS IN FUL!FORCEAND EFFECT. Z LLI /y `� m {y} � UCENSECLA55____�LIGNO.��v`�•r � p� r.� ry� /�' � 4 � pq'� ���ZJ`�+'CD CONTRACTOR W�5`�+''����-�.Y�Y�� a S W � � WORKFRS'COMPENSATION OECLARATION � Q � I HEREBY AFFIRM UNDEfl PENALTY OF PERJURY ONF.OF fME FOLLOWING UECLnRa7roN5: V ; � Z : 6 � O IHAVEANDWILLMPIMAINACEfiTIFICATEOFCON3ENTTOSELF•INSUREFORWORKERS' _ � CWAPENSATION.ASPROVIDE09YSECTION37aoOF7HELA90RCODE.FOH7H[P[RFORMANCE W _ ` OF hiE WOHK FOH WHIGH THIS PF.RMIT IS ISSUED. � b n � W IHAVEANDWILLMAIMAINWORKERS'CAMPENSATIONINSURANCE,ASRE�UIREDBYSECTION S, Q 3700 OF THE LABOR CODE.FORiHE PERFORMPNCE OF THE WORK FOR WHICH THIS PEHMI7IS � ISSUEO.MV WORKERS'COMPEN ATION INSURANCE CARRIER AND POLICV kl1M�ER ARE: CONSTRUCTION > _...__"_""' .._...'___'--...._"_""' � `.- ` r --- PLANREVIEW _._. . ------ � -.._i_....--- --�---:� .. �, � CARRIEH_v�� � �`� � Poucv NUMBER��-_-�S__— ELECTRIC ���— � d �IHISSECIIONNEmNOT6EtOA�PLEfIDOFTHEPF����NEF0.I�EDDOl1AH515100)ORLESSA PLUA761NG ___.'_'__T. . . , ' i Z I CERTIFYTHAT IN TH[PERFORMANCE OFTHE WOFK FOFl WHICH THIS PERMIT IS ISSUED,I MECHANICAL __,_.,___.__—'__—__.___._.__.__....._._ _ g (f SHALLNOTEMPLOYANYPERSONINANVMANNERSOASTOBECOAAESU&IECTTOTHE ` � WORKERS'COMPENSATION LAWS OF CRLIFOflNIA,AND AOREE THAT IF I SHWL�BECOML INSPECTIDN FEE ._,,.— _— + SU&IECT TO7HE WORKERS'COMPENSATION PROVI510N5 OF SECTION 370o OF 7r1E UBDH - '— F � CADE.ISHALL�FONTNWITHCOMPLYWITH7FIOSEPROVISIONS. ISSUANCE ._ - __.—_ i � �.•�/C1 "�.. �,_.. � ' 4 p �ATE: L�J V� APPLICANL .___ —_.—_____ SMIP __'_—_'_'.'—_'._"'_— � J ENERGY P!C � J WARNING:FAII.UR[TO SECUflE WOHKERS'COMPENSATION CAVERAGE IS UNIAWFUL,AND SHALL BE —'�"-'--- -'- --" "'--'----'"" -----' " '� d � SI!&IECTAN EMPLOYER TO CRIMINAL PENALTIESAND CIVIL FINFS UP TOONE HUNDFFOTIIOUSAND ENERGY PERMIT § DOLLAflS(5700.00o1��NAD0ITIONTOTHECOSTOFCOMPENSATION,DAMRGESASPROVIDEDFORIN —' -""--""'— '— -"'--'--'— — � � SECTION37080FlNELABORCOOE,INTEflEST,ANDATTORNEN5FEE5. A�7ENTIONFEE: _.___.._._--._.— —..--- � d CONSTfiUCTiON LENDING AGENCY PRE-ALT FEE: _ ..--- � O � �HEREBYAFFIFlMUNDERPENALTYOFPEFiJURYTHATTHEflEI5ACONSTRUCTIOYLENDIN0A0ENCY _.______ � n- FOR THE PERFOPMANCE OFTHE WORK FOR WHICH 7HI5 PERMIT IS ISSUE�(SEC.3097,CIV C.). � � W --" '_ '_"—'_'__'_ '—_" � LENDEA'SNAME ___.— ' '—'_—_'--- _'_ '_--_'__ '— s F� LENDEWSADDitE53. _____ .___. --- �� � � ICEFiTIFYTMATIHAVEREADTMISAPPLICATION/WDSTATETHATTHEABOVEINFORMATIONISCARRECT. 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