Loading...
HomeMy WebLinkAbout12298 (14) ��_ CITY OF DIAMOND BAR DEPARTMBNT OF COMMUNITY&DEVELOPMENT SERVICES � „ 21660 E.Copley Drive Suite 190 ,,,� (909)860-3195 I'ax(909)861-3117 PRESS ��9X° BUILDING PERMIT APPLICATION FIRMLY o^ DDRIESS ��� O r� DATEICATION�l,�,.� T� NUMBER I�� /� #/C 7' c� ISSUE �r IYPE OCC APN LOT TRACT DATE �'Z�`��O CONST. GROUP p OWNER ��v , '� "J�1 �' . a o ADD ESS �� �l� �,� z ' �h�� �(' ZONING SETBACKS z CITY �� � .� ZIP � ��c� TE ._ FRONT --- RW �?- g APPLICANT TEL. _ REAR fl Z SIDE/SIQE STREET RW ❑____.__ � CONTRACTOR SIDE _ f7 � ADDRE S� . r � _ .y i z o CITY � ZIP � i� TEL.1�—_ Z , �"� PROPOSED USE �l ` ^ ti � i H`G w ARCH/ENG/ • � � �z DESIGNER �'�(Y�a, NO.DWEL. � NO. NO. a ADDRESS UNITS STORIES ___ BEDROOMS � CITY ZIP TEL. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADDIREM O p I HEREBY AFFIRM UN�ER VENAL7Y OF PERtt1RY THAT I AM E%EMPT FftOM THE CONTRACTORS LI- � Garage/Carport W CENSEIAWFOR7HEFOLLOWIN6REA50N(SEC.7031.SBUSINESSAN�PROFE�SIONSCO�E�ANVCITYOR C.� COUNiYWHICHREWIIPESAP'cflMi770CqN5TRUC7,AlTER,IMPROVE,DEkOLISH,ORREPAIRANYSTRUC- W pati0/DeCk � TURE,PRIOR TO ITS ISSUANCE,A150 REQUIflES THE APPL'CANT FOR SUCH PERMI7 TO FILE A SIGNE� � � S7ATEMENT THAT HE OR 3HE IS LICENSED PURSUANi TO 7HE PROVISIONS OF 7HE CONTRAC7oP5 U� Sr� CENSE UW(CHAPTER 9(COMMENCINO WITH SECTION 7000�OF DIVISION 3 OF THE BUSINESS AND PFO- V' POOUSP& � T. FESSqN3CODE�ORT}iATHEOR5HEISEXEMPTTHEREFflOMIWOTMEBA515FORTHEALLEGEDEXEMP- � _' V TION.ANVVIOLATIONOFSECTION7o91.5BVANYAPPLICANTFORAPeRMITSU&lECTSTHEAPPLICANTTO Z Re-Roaf # � ACIVIL PENFLiY OF NOT MORETHAN FIVE HUNURED OOLU�RS(SSoa).): S ^ ❑I,ASONMEROFTHEPROPERiY,ORMYEMPLOVEESWI7HWAGESA57MEIq50LECOMPEN5A710N, � CommBfCi81 ; � YNLL DO 7HE WORK NN�TME STRUC7UR[IS NOT IN7EN�ED OR OFFEHEO FOH SALE(SEC.7044,BUSI- J NESS I�N�PflOFESS�ON3 CODE:THE CAN7RACTOR&LICENbF l AW�OES NOT APPI.Y TO AN OWNEq OF � � PqOPER-iYNhfO8U1LDSOAIMPROVESTHEREON,ANDWHO00ESSUCHWORKHIMSELFORHERSELFOR � �' TNRIXIGHHISORHEHOWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMEN75ARENOTIhTEN�E�OR � ' W OFFEREDFORSKEIF,HOWEVER'M1{EBUIlDIN00RIMPROVEAAfNTI550:.DWITHNJONEVEAROFCAMPLF- t 0 TqN,THE OWNEfl$UILDEfl WILL HAYE THE BUR�F.N OF PFOYING THAT HE OR SHE DID NOT 6UILA OR r Z IMPROVE FOR THE PURPOSE OF SALE�. — — � _ ❑I,ASONMEROFhIEPROPEHI'Y,AMEXCLUSIVELYCONTRACTINGWRHLICENSEDCONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.]oa,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VdIll2llOf1 ADJ.AREA __ _________ W CENSEUWOOESNOTAPPLYTOANOYRdEROFAPflOPERTYWHOBUILD50RIMPflOVESTHEREON,AND = WHOCONfMC7SFORSUCHPHQIECTSWITHACONTRACTOR(5)LICEN5E�PURSl1ANTTOTHECONTRAG QUANTITY DESCRIPTION FEE YTOHS LICENSE LAW J. E � J j ^ C I M7 EX£A1PT UN�ER SEC. B-S P.C.FOR 7H!S REASON U � f. S ¢ y LL oeTe owraen -------------- U Z w � � I_ICENSED CONTFAG70R5 DECLARATION �j + � INEREBYAFFIflMUN�ERPENALT'OFPERJUHYTHATIAMLICENSEDUNDERPROVISIONSOFCHAPTF(7 � g d 9(COMIAENCINGWITHSECTION7000�OFOIVISION30FTHEBUSINESSANDPROFESSIONSCO�F.AKU z '.t X MVLICENSEISINFUILFOkCEANDEFFECT.�� m � 0 LICENSE CIASS_��—�C.NO. ����'�;��----—.�--..-- � ''�: U DATE__���_ GONTRACTOFl_ _�.I a � W � WORKERS'COMPENSATION DECLARATION a ! N U � � I HEREBY AFFIRM UNDER PENPLTYOF PEFi.IURV ONE OF THE FOLLOWING DECLAFlATIONS: Z � _IHAVEAN�WIILMAINTAINACERYIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' 2 � � CAMPENSRTION,ASPFlOVIDEDBYSECTION3]ooOFTHEIABORCODE,FOR7HEPERFORMANCE W OF TNE WORK FOP WHICH THIS PFRMIT IS ISSUED. � � W ______.IHAVEAN�WILLMAINTAINWOR%ERS'COMPENSIITIONINSURANCE,ASREOUIREDBVSECTION � � 37000FTNFLABORCOOE,FORTHEPEHFORMANCEOFTHEWORKFORWH:CHTHISPERMITIS '� ISSUED.MY WORAEf�5' MPEPiSATION INSURA E CARflIER M1D POLICY�UMBEF ARE: CONSTRUCTION J _ y, - --------- ----� ------------�/-�-� � ? CAflR1ER J1�-����y �_ . +�-�-.� PLANREVIEW ---- .. .._.-_—_-_— —– � � POUCVNUMBER`�`�. 4�-1� �h ��.__--�� ELECTRIC � � � Y. 0 (ness[cnaarvE�no78emnut�ooFn��wnrt�sroaawer+uror�[��awis�5�ao�oRiEss} PLUMBING .-- --------- — _ � W MECHANICAL Z I CEflTIFY THAT IN THE PEFFOFlMANCE OF THE WORK FOR WH�CH 1 HIS PEFMIT IS ISSUED,I --- — -- (� SHALLNOiEMPLOYANYPER50NINANYMANNEft50A5TOBECOM[SUBJECTTOTH[ ; � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,AN�AGREETHATIFISHOULDDECOME INSPECTIONFEE � � Sl1BJECTTOTHEWOFINERS'COMPENSATIONPROVISIONSOFSECTION370oOFTHELABOR �L�� � = CAD,ISHA FORTHWITHCOMPLYWITHTHOSEpHOVISIONS. ISSUANCE _.,.—.—__.� p . ' • ����� SMIP p DATE:_ _ APPLICANT: -----_--_.___._._ ' _.____ _——._— W `��'_� ENERGY P/C � J WARNING FAILURE TO SECURE WORKERS'COMPF:NSATION COVERACE IS UNCa�FUL,ANU SHALL 0E —"'--"-" "--"'- LL Sll&IFCTANEMPLOYERTOCRIMINAIPENALTIESiJVOCIVILFINESUPTOONEHUNDFlEOTHOU3AND ENERGYPERMIT .__._._____.__ __— � OOLLAFiS(t70(r.0ao).IN ADDITION TO THE COST OF CAMPENSATIO�.OAMAGES AS PHOVIUF:D�OF IN '-' I � SECTION 3708 Of TH[LABOR CO�E,IN fEREST,AND ATTORNEY'S FEES. RETENTION FEE: __. — � W CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � IHER�YAFFIHMUNDERPENALTVOFPGRJURVTHATTHEREISACONSTRUCTIONLEN�INGAGENCY __ _ ___________._._______ � n- FORTME PEflFORMANCE OF THE WOAK FOR WHICH THIS PEflMiT IS IS5UE0(SEC.309�,CIV.C.). Z '___ '--__' "—' W � LENDERS NAME "'_' _ __""_—"'_'_"__"_—_' i— LENDERSAUORESS._ - _____ '_—..._.—...'""'_—__'_ ¢ ICERTIFYTHATIHAVEREAO7HISAPPLICATIONANDSTATETHATTHEAAOVEINFORMATIONISCORflECT. �OTAL FEES I I � "� /�'1 � IAORE�TOCOMPLYWITHALLCITYANUCAl1NTYORDINANCESANDSTA�ELAWSRF.UTINGTDBl11L01NG / / � CANSTRUCTIDN,AN�HEREBYAUTNORIZEfl[PRESLNTATIVESOFTHISCOUNNTOENTERUPONTHE � l% ZAW VE-MENTbNED PROPER7Y FOR INSPECTION PURPOSES. � COMMENTS___ _——..— —_—_ _ ��.��.=. ----.- --- �=�_�= m PERMITTEE� (G INT) � � _... — � ._. � �� � - - ------.-- � &IONATUREOFPER EE D TE � _ � RECPT.N�� PAID 6Y _VALI�ATION__ ~ WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy � $ .._ � ..._ , .. �. . _._ _ ..__ .. .. .. _.... _ . . .. __.__ __._ .. . ... - ---.... � , . : � : , ' � , } i . j . ' : , ' . � . . ' ' � � . . y . � ' ' ! I � � _ . , . • j _ � ' , i . , ' ' i � I . 1 , . : , i � I , , .� . �i � , � i . . � - � : ' i � . � , , � � , � ' : ; � : 1 , � , ! , � , � � s:_ � i � i ; I � ' � c�,�: i i �': i I i � . � i u5,�vy i - . � , ' � ' i , . .x . , . . . - . . � i � „� ",. .._,.._' �. - ._.�. . . "" - '" ;' ." '___ . i' " . . . , , '...; . . '_ . . � g � . � � . � . . . � , ; � �• _ �.: . . I I - : ' � i I . , � ,� - �$Y- i _ i I i � _ I . , i . � i . � - . ! 1 i � . ` � �' '_'__ � ( : � . ' _'. .. ' � ' � - ' ��1 r � 't- �' : . _ �. . . -. ��,�� . ' I I : . � � i � �#. � � : � _ . � � � Z ��. � _ � I - � i , i � ' :S�a i �� ; ; I � 1 F £� � i i I � ��� � }���' I ( . :i�q ' ' I : . � � 1 � i '�� � i ! ! � i � �w 12. � 5 ` `I. � ' ' � ' ' �• ' � ' ' i , I �� ' - �,y �. f �. . 'j . � _ � ' i � _ _ . � , l � r i ! � �I � �� ` i i� � � � � l - � � � � I i a � ��c � -i ; i 2 :i � � � � i p t Y �. ` � �. . �y�4� ��I' - ' .: ...` . . � .__ .. 1 ! i � : I . .0�t. '_ _. . �- 1 _ . ._._.. � _..... . _. . . � , i �.l'B - � � . � . - � . . �ti . � . � . , ' . . ' , , .. � S � � ' ' , ( 1 � 1 � � ' �'9 I ; . ' i . � ' : ' � I ' ' �. � � � : ���� . _ �. , i : I _ : E . � * , • - . � E . � , � ' - I t , , f � I ' � I � � i � � tr� - _ �� � i ��_, - ' I �y 7 �� +� � � � . '�=£ ` � ' � , � . , t . �t�� j _- __ . ! _ �p. ��._.- � --_ " : . �-_ _ -- . � - i ' i - �t i . `I. ,a ; '�-; 1 , . , , , � ' ' ' t'! � , . i '�' ' ' � .� � : N � 1 . , . ��4. ` �__� . . . _� �- .i, _.._.. _. - � _ __'" ' ' � � � i � � . ~ ;K�� . , � . � • . , ' - - Y ��� ' ' �.f���' i � ' _. _ ' • , _ . _ _ 1 - F: . I . � . ' • I . ; � 'S'. " � " � � � . � . ' . :�� ,� _ � � . I . � � ' . 3 xt � - " t . . - �;i ' T. .. I [ � � - , � • � �� L � j 4 A @� .ZI :' � ,• _ :..- ..",. _ ' _ . . 3 - ;� � �C_ .. -:. i ' ,. .�_ . 1 . _. , . _ , �� _.i._ '__.. .......a..... . . _._.. . .. �"' .._�_.__ _ -._ . . .�... ,.._.-.._.�. .... _ ._f , -_..........._. . .. . . ... ... ... .. . . .. . . ..... ._........,. . ...._.�.. _. ..