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HomeMy WebLinkAbout15141 �, ���� i _____.��__ CITY OF DIAMOND BAR (`_./ � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive 5uite 190 � (909)860-3195 Fax(909)861-3117 PRESS � ro"°`� BUILDING PERMIT APPLICATION FIRMLY I I � JOBSITE � • /? � C . APPLICATIOf�j� PERMIT J�I P/C -�J_ o ADDRESS (� DATE NUMBER� # � � $ ISSUE TYPE OCC APN T TR Z DATE CONST. GROUP p OWNER C /✓ LL ADDRESS C� - � ZONING SETBACKS 0 W C�N �j FRONT _ RW ❑ � � TEL. -- APPIICAMT TEL. REAR n � SIDElSIDE STREET RW ❑ CONTRACTOR '- Az5 SIDE U � � CDDRESS v Z�P 7EL - PROPOSED USE�Q'r x I S� /g7/� (�� � w ARCWENG/ � Z ADD E5S NO.DWEL. � NO. � NO. UNITS STORIES BEDROOMS � � CITY ZIP 7EL. E �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � p� OWNER-BUILDER DECLARATION SFRlAD�fREM d O p I HEREBY AFFIRM UNOER PENALTY OF PER7URY THAT!AM EXEMPT FROM THE CONTRACTORS LI- Ga189B/CBIpOf1 W CENSEUWFORTHEFOLLOWINGqEA50N(SEC�o31.50U51NE55ANDPROFE5510N5CO0E:ANYCITYOH (n ° � COUNiYWHICHNEO(IIfiESAPERMRTOCONSTRUCT,AL7ER,lMPROYE,DEMOLIS4,ORREPAIHANYSTNUG �Pgti0/DBCk ��j � TUFE,PRqR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED � STATEMENi THAT HE OR SHE IS LICENSED PLRSl1AMT TO iHE PqOVI51oN5 OF THE CONTRACTORS LI� � � CENSE LAW(CHqPTEfl 9�COMMENqNG WITi SECTION 70ao)Of DIVISION J OF THE BUSINE55 MO PRO� POOUSpB FESSIONSOOOEjOflhiA7NEORSHEISEXEMPi7NEREFAOMANDiNEBASISFORiHEALlE0E0EXEMP� (� TION.ANYVIOLATIONOFSECTION7o31.5BVPNYAPPLICANTFORAPEHlAITSU&IECT5IHEAPPUCANTTO z qe-Roof F 11CMLPENFC7YOFNOTMORETHANFNEHUNDAEDDOLIAFlS�S500).): — ( � ❑I.ASOWVEHOFTNEPROPEPTY,ORMYEMPLOYEESWITNWAG[SASTHEIRSOIECAMPENSATION. O COrtIf118fC181 WILL DO iHE 1V(NU(ANO�HE STRUCTURE�S NOTlN1ENDED DF OFFEFED FOfl SALE(SEC.704a,BU51� J � t�8S AND PROFE&SIONS CODE:THE C0.YTflAL`TOFlS LICENSE LAW fIOES NOT APVLY TO AN OWNER OF � pROPEqTY NRq 6UIL05 OR IMPROYES THEREq4,AND 4VHD OOES SUC41 WORK HIMSELF OR HERSELF OFl Q THROUGMHISORHEFOWNEMPLOYEES.PFOVI�EDTNATSUdi1MPROVEMENTSAqENOTINTENUEUOP m � OFFEREDfORSAIE.fF,HOIYEYER7HEBUILDINGOAIMVqOVEMENTISSO��WITMINONF.YEAROFCOMPLE� � TION.THE OWNER�BUIIDER WILL HAVE THE BURDEN OF FROVMQ THA7 NE OR SFIE OID NOT BUILD OR � IMPROVE FOR THE PLHPQSE OF BpLE). '+ w [II,ASOWVEROFTHEPflOPEFlrV,AMEXCWSIYELYCONTfUCTNCNATHIICENScOCbNTRqCTOpS — , � 70 LON57HUCT TNE PFlWECP�SEG 7044.BUSINE55 AND PROFESSIIXJS CADF::THE CONTRACTORS LI- Vy1U211011 _.__/��� �ADJ.AREA � LLI �NSEUWDOESNOTAPPLYTOANOSVNEROFAPROPERTYWHOBUILDSOHIMPROVESTMEHEON,ANO ' "—"-"�- — --' '-- -- � N}K)CONTAACTSFOASUCNPRpIECTSWfiFIACONiR0.CTOR(S�UCcNSEDpUftSUAN1TOTMEWNTRIIG QUANTIN DESCRIPTION FEE � � TORSLICENSELAW.). n U ❑I MA E%EMPT UNOER SEC._ . ___B.8 P.C.FOR TMIS qEA50N Q � � _ U F LL _ —_ —' '— _—_— � f' DAiE _ONTJER_ .,___`�_.._ ___ U ' Z w . Fa IICENSED CONTRFCTORS DECUiRA710N w I 2 I HEREBYAFF�RM UNDER PENAl7Y OF PERIUFY THAT IAM LICENSED UNOEq PflOV15'ONSOF CHAPTEH �j � � D(WMMENCINaWITMSECTION7000�OF�IYISION30FTHEBUSINESSANCPflOFE5510NSCO�E,AND Z ; ��� MY UCENSE IS IN FUtL FORCEMiD[FFECT. m � LICENSE CLA 5 �_LIC.NO,�� 4�I � � � � �—_ J V DATE _ CON7RAC70 � a _ — w � s � V`dORKERS'COMPENSATION C Q ; � IHFREBYAFFIRMUNDEflPENRITYOFPENURI'ONEOFTNEFOIlDYi�NGDECLARATiONS: Z ~ � � .___IHAYEANDW1Llb1A�NTAiNACERTIFICATEOFCON5EN7TO5ELF-IHSl1RF.FOHWORNF:RS' a ' _ COMPENSATIIXJ.q3FROVI�EDBYSEC710N3700OFTHELABOflCODE,fOP.THEPEHFORMANCE W �. OF'ME WORN FOR WHICH TH1S PENMIT IS ISSUED. � • � W �I HAVEAND WtLl.MA7MAIN WOAKEP,S'(bMPENSATION IRSURANCE,AS REOUIRED BV 5[CTION Q37000F7HElFHORCODE,FOfiTHEAERFORMANCF.O�IHEWORKFORWHICHTF1157Eq411T15 : � ISSUED.MYWORK 'COMPENSATYJNINSUFlANCECFARIERANDPOLICYNUMBER E CONSTRUCTION . 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PLUM6ING '__ '___ _"__'_""_. ..._ : 'T.� I CEHT�FY THAT M Yt1E PcRFORMANCE OF THE WOAK FOR`h'HICH TI IS PERMIT IS ISSUEq I MECfiANICAL . _ __.�__ .,____,. _ ___ x '�j SHPILNOTE4APLAYRNYPEfl50�JINANV SOASTOBECOI SU6JFCTT07HE � �jj WORKER6'COMGEtJSAT70NLAWSOF IFCRtJIk NDAGREE7 A IFISHOULUHECOME INSPECTIONFEE _ _ __ ________,_�4_ ,y,� - � ._ ' - SU0.IF:CTTO Th E WORKF_RS'CGMPE AiION PftO ISIONSOF C N 9]OOOF THE lAFl0I1 ' � -� ' � cooe sr+at FOliTN'MTMCOMPLY inrrn aov N ISSUANCE __. _ ��- U r/ � p �A7E�f- _ _ APPUCaNT: —.- - _ — SMIP _.. ..'—_ ,--_.--— .-_-'- � 1 w J WAflNING.FAIIUflEYOSECUflEWORKER3'COMPF.NSAT:ONCOVERAG 'UNIAWFUL,ANUSHALLBE CNERGYP/C ______ ____,_______ ____ � SU&IECTANEMPLOYERTOCRIMINALPGNALTIESANOCIVILFINESUP ONEHUNDREDTHOUSANO ENERGYPERMIT � OOLLAHS(SiC0.00o),INADDITIONTOTHECOSTOFCOPAPENSA710N.DA AGESAS7HOVI�EDFORIN -------- ----- -�-�--- �----- �� � SECTION37080FTHEL>BORWDE.INTER[ST,RNIIATTORNEY'SFEES RETENTIONFEE: � _ _. ___ � d CONSTpUCTION LENDING AGENCY pRE-ALT FEE: 4 � lHERf.eYAFFIRMUNDEFPENAITYOFPEFlJ:IRYTHAITHE:REISACONSTfiUCTIONLCNDINuAGENCY _ __ _ �� __ � i FOR TNF.PERFORMANCE OF TH[WORK FOR WHICH 1Mi5 PEqMIT IS 1SSUE0(SEC,309],CIV.C). — W '_'—'—"_'_____.__ ..'__ '_ — i � LENOER'SNAME.__,____.__..,__.,,_ —.____.._ � F— LENUFH'SADDRE55_"_'___..._"'_'_"__"_""___"'_ --- ' . _ '_"' _— � TU7'AL FEES , � i W I CEflTlFY TlIA71 HA4E READ THIS APP�ICAIVONANO STATE T4iAT THEABOVF.INFORMATION IS CqRRECT. � 1 A(+H[E TO COMPLY WITH At L CITY PN�Wl1NTY O 5 ANfI STAiE LAWS RELAi1NG TO BUR�ING q ///��� ; CANSTRUCiION,ArvbMERE[iYAUT RI � ENTATIYESOFTHISCOUNTYTOENTERUPON7HE� y�,�!„/I�� I �� � . 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