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HomeMy WebLinkAbout16319 (22) CITY OF DIAMOND BAR ---� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �, .x � . 216b0 E.Copley Drive Suite 190 � (909)860-3195 Fax(909)8613117 PRESS 'ti�"� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �j APPLICATION I /� ''�J � PERMIT f f Pl� o ADDRESS��J C� � 6 S'' 4N�7 DATE � "�� �� NUMBER 1 G� i�� �# � APN LOT TRACT ISSUE � �!1 NPE OCC DATE__� �Y � CONSt GROUP p OWNER ��I/�}�T �`"� � p ADDRESS G ZONING SETBACKS Z CITY ZIP_ TEL. . - � REART RW n � APPLICANT TEL.�T��tT SIDE/SIDE STREET_ RW CJ � CONTRACTO ti �1/4 1"l(��v� } '�] SIDE �7___ O ADDRESS • ' -%ta._(�— "fl-��� pROPOSED USE �U cti , lC�- i l��-iTI�(.L. � � 1� CITY �l.�l. ZIP TEL. (-^ w ARCti/ENG/ -� ` � � � - L - c, �� DESIGNER NO.DWEL. NO. . � �� NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � - -- tn DESCRIPTION SQ.FT. FACTOR PSF ADJ.ARErWALUATION Q OWNER•BUIL�ER DECLARATION SFR/ADDlREM O — p 1 HERE9V AFFIqM UNDER FENALTY OF PERtt/RY TNAT I AM E%EMPT FqOM THE CONTPACTOFS LI. G8f3gB/CBfpOfS W CEHSEUWfORTHEFIX.LOWINGREA50N(SEC.7031.58USINESSANDPROFESSIONSCAD[:ANYCITYOR jn V COUNTYWHICHqEqU1RESAPEflMITTOCONSiRUCT,ALTER.iMPROVE�EMOU5h1,OqREPAIRANYSTRUC- W NRE.PHIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR Sl1CH PERMIT TO FILE A SIGNEU W Patio/Dock STATEMENT iHAT HE OR SHE IS IIf,ENSED PURSUAN7 TO TNE PROVISIONS OF THE(:ONT(iACTORS ll� � CENSE LAW(CHAPTEfl e(COMMENCIVa W17H SECTION 7000)OF DIVISION e OFTHE BUSINESS AND PF0- � P�USpa FESSqNSCOOE)ORTHATHEORSHEISEXEMP77HEPEFROMMDTHE6ASISFORTHEALLFCEDEXEMP- (� TION.ANYVIOlAT10NOfSECTION7o31.56VANYAPPLICANTFORAPERMITSU&IECTSTHEAPpLICANTTO � Re-R00( �,�, AqVILPENAL7YOFNOTMOFtETHANPIVENUNDREDDOLLARS�fSoo)J: � ❑I.ASOWNEROFTHEPROPERTY,ORMVEMPLOYE[SWI7HWAGESASTHf-1RSULECOMPEN5A710�. ❑ CommerCial WILL DO THE WORK,AND TNE STRUCTURE IS NOT INTENDED OR OFFERED FCR SALE(SEC.7044,BUSI- J _ � NES9 AND PqOPESSIONS CODE:THE CONTRACTOFIS LICEIJSE LAW COES�IOT 0.PPLY f0 AN ONINER OF � PROPEHTY VhiD BUILOSOR IMPBOVES THEREON.AND WHO W ES SUCH WORK HIM56LF OR HERSELF OR 4 � TH110UGHHISORHERONMEMPLOYEES,PROVIDED7HATSUCHIMPROVEkENTSARENOTINTENDEDOR m � Q OFFEREDFORSALEIF,HOWEVERTMEBUIIDINGORIMPflOVEMENT1330LDWi1HINONEYEAROFCOMPLE- Z TION,THE OWNfR�&1RDEfl WILL MAVE THE BURDEN OF PROVING�HpT HE OR SHE DIO NOT 9UILD OR I � IMPHOVEWRTHEPURPOSEOFSALE). �y� C71,ASOWNEROfTHF.PflOPERTV,AME%CI.USIVELYCONiMCTINGWITHLICENSEUCONTRACTORS Q TO CANS'fRUCT TME PR0.IECT(SEC.7044,BUSINE55 AND PROF[55!ONS COUE:THE CIXJTPAf,TORS LI� Valu2lion ._ ADJ.AREA W CENSEIAWDDESNOTAPPLYTOANONMEROFAPflOPCRNWHOBUILDSORIAlPROVESTHEREO4,AND --------�-�-- '— F WFIOWNTMCT6f'OR6UCHPH0.1EC7SWITHACQNTRACTOR�S�IICENSEDPURSUANT'fOTNECONTMC- QUANTITY DESCRIPTION FEE Y ronsucer+seuw.�. � ❑1 AAi E%EA:PT UNDER SEC _ B.n P.C.FOR tH15 PEASON � Q —""_'—'________'__"" U LL � . — �A7E _,__ OWNEfl__.._--_.__'___.__-.__'.. .--. U � W � LICENSED CONTRACTORS DECLARATION W _ 1 HEREBY AFFIRM UN�ER PE�IALTY OF PERIUFlV THAT I AM LICF:NSf:�11N0ER PPOVISIOYS OF CHqVTEfl � � � 0(COMMENCIN(iWITHSECTiON7000JOFDIV�510N30FTHEDU51NE55A�DfiHCf'ESSIONSCOOC.,AND Z _ ��� MYLICENSE IS IN FULL FORCEAND EFFECT. m � � UCENSE CLA55__�._!_[___"LIC NO. .""___(�_L_,�D�!-.'Z'-_....'_ � H UDATE �'�I Z.7 I O I _ CONTRACTCA___y� jC.�.i.a_�_ a -- W � � WORKERS'CUMPENSATION DECLARATIUN -�� cA Q � 1 MEftEBY AFfIHU UNDER YENALN OF PENURY CNE OF THE f-0LLOY/iNG OEGLARA710N5: z L� IHAVEANOW�IIMAINYAMACERiIFICATEOFCONSENTT05'cLF-INSUFlEF"ORWONKERS' � � COMPENSA7IUN,AS PflOVIOED BV:ECTION 3iW OF THE LAHOR GODE,FOR T:1F.VEFFORNANCF `U _ _ _ OFTHF WORK FOR WHICH 7H:5 VEHMIT IS ISSUED. � t � � � _IHAVEANDWILLMA�,MAINWOHKEHS'COA�PENSATI�NINSUHANCEASRFCUIncpfiYSFGTION ((('"`• �'��"/�'� � �,Q� 37o00F THE LA�OR CODE,FONTHE PEflFORMMCE OF'fi1E WOflK FOR WHICH RIIS PERMI7IS ��� "�J/ _ ISSUED.MVWORKE9S'COMPEN59TIONINSURAIVCECP.HFiERpN�VOLIC'lNUMBERARE� CONSTFiUC(ION __._..._..______ __._.__ ___ � � � �_.,._�Y,L= `'�_ _ PLANREVIEW �1 CAFRIER__'_'�_s_ � POLIGYNUMBER_GiJC'.' —_.___........._—_.—__'_'.__."___".—' _ . �=�—�. —.�.f.��:�� — ELECT�RIC ----._. .. --- � Q ---'--- 0 (nussEcronr��uriorArax�trmoFnfrr��sa,ar�sroaor;EnuwREoo�nr+s(a�oo�oq�Ess). PLUMBING � w � Z �CEflTIF1'THATItiTHEPEFFOPMANCFOFTHF.N'ORI(FOflWHICHTHISPEflMITI5155UED,1 MECHANI ___.____,__._____ (�} SHALLNOT EMPLOY ANY PEfiSON IN ANY MANNFR SU PS 70 B[COME SU6JECT TO i HE .�. -��^ "•��-� "' �/� WOFIRERS'CAMPENSATIONLAWSOFCALIFC1ftNIA.ANDACHEFTIIA'fIf15VN:IliUH[COMF INSPECTI t` .._..___..__..-... ' - � � � SU&IECT TO THE WOFKEFiS'COM�E4SATION PflOVISIONS OF°ECTICN 37C0 OF THE LABOR O CAUE,I SHALL FafiTHWI7H COMPLY WITH THOSE PROVISIONS. ISSUA�ICE ' t` �����_ ,��" -> � y- ���--� � / ,� - [] DATE:�� �I RPPLICANi' _ . 4-- t� , SMIP ._.__—._ ..'_.'.'_—.__._--_�--____'......_'..V_...�T_l..d _...__ W _ �___. J WRflNINGFAILURETOSECUReYlORKERS'COMPENSA710NCOV:IACEISUNIAWFUI.ANDSHALLBF: ENERGYP/ _____. ____.—.._,,,__..— J �y SU&IECTANEMPLOVEfiTOCRIMINFLPENALTiESANUCIVILPINESUPT00NEHUNDR'cDTHOUSAND ENERGYP lY� ----"�� DOLLARS(5100.000),IN ADOITION TO THE f.UST Of CAMPENSATION,DAMACES AS GROVIDED FOR IN - J SECTION37080FTHELAOORCADE.INTEREST,AN�ATTbRNE1"SFEES. RETENTIONFEE: Q .. .__...... ._— __'--'_— ___ OCONSTRUCTION LENDING AGENCY pREALT FEE: ___ � 1 HERFBY AFFiFiM UNOER PENALTV OF PEHJUHY THpT 7HEPE IS ACONSTRUCT!ON LENDING AGENCV n- FOATHE PER WflMANCE OF THE WONK F�R WHICM iM15 VGRMIT IS ISSUED(SEC.JOY7,CIV.C.). --� � � �� � �� — ����-��— - { W @ � ...'._-_._—."_—. —_ _— .'._--__� � � LENDER'SNAME"'""__ —_...._.__._""'_" � F- LENUER'SAO�RESS__...""__--_—___.. .._ / W ICEflTIFVTHAfIHAVER[ADTHISAPPLICAT70NANDSTATETHATTHEABOVEM�OHMATIONISCORRECT. TOIAL FCCS � �w �Y "/ ( � � d IA(iflEETOCAMPLYW1T11AllCI7YANDCOUNTYORDINANCESAN�STATELAWSRELATINGTOBUI!.OING •X• � d� (:ONSTRUCTION,AND HEREBY AUTHORIlE REPRESFNTPTIVES OF iH15 CUUNTY TO ENTER UPO�THE � ZABOVE�MF,NTIONE�VROPERiYfORINSPECTIONPURPOSES. COMMENTS. � J , � - � ��J !?_- ----._�-� --------- ----- m PF.HMIT7 E AM (PRINT) ._._ _ � a � ' ��_� � � � "'P rf '1 � � � SIGNA UR F PERMITTEE `.---" — DATE � I T'--� -- = RECPT.N0._!��.�. PAID BY -��_;--�';`VALIDATION..-- _._�- ~ WHITE—DepaAmeni Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy , � i , . 'Y' - � �, . . . .� ' . . ' . � ' . . � . - . . � � , . . . - � . . � ' � ' ' .. . - ' ' ' . .. . . I � � - . . , . . � ' I - . , � � , ' . . � . � . . ' � . � • ' i , . . - � . . . , . � . . . . . - � _.. . . .. . ... .. _ - ._.. _ .�_ __. _._ .. . . . � . . i ' . - . . - � ' . - ., " . ! . i . � . . . . , . , . ' . _ . , � � . _ � . :. ,_ " � - I' . . _ '___ � , i" : - _ �-__"_ ' . . : ' ' . . � • . � ' : � � . i _.. � �' ' . ' � ' "�•,.� � - � � . , i � . � � . _ � _. F � � . 'q� _ .. , " , - .. . " � , � , . - . . _ = , . . � . , , • ,. f! � . . . . �, . " ' � � _ � . _ � �� � r � -- ` . F„ i � � I' ; i �� - " i I , , . � � , � � � : (!� i ! i , i i ' ' i � i . , � : � _�::' . � --_-— - q , � , � �- ; ', � � f. ; i . , N «a_ i �a � i f,' (`�'% � ' ' ... �- __, " : , - - - ; � t � , ' . - • � . . ; , . 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