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HomeMy WebLinkAbout16115 (17) _. _ �- - - ._. . . _ . . - ---�----- - .__�__..__ . . , . , . . _ .... -, y,,��-�� �� �,� . , � _1� CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ��,,_° 21660 E.Copley Drive Suite 190 ��909>a6i-3ii� PRESS �'.�w . , BUIY.DING PERMIT APPLICATION _— � � . • -P FIRMLY �' JOBS!TE ' APPLIGATION r �2!v�e PERMIT 1l ' y` P/C y I�J�� n ADDRESS ��� C��.��'iaa�4-t� DATE � t �3 `°�� NUMBEfi `���`.9 # E"f '�,,� ' � ISSUE TYPE OCC APN LOT TRACT �'�Z'I�i� DATE CONST, GROUP p OWNER �` ApDRESS '� ' ,y< Z(�NING SETBACKS Z CITY��'�t'�� ��-, .� ZIP � TEL.�"'���"'�Y1� REART RW ❑ ' � APPLlCAN7 €�t 'i --� TEL. ���'�-t°' SIDE/SIQE STREET RW ❑ I ' � C�NTRAC70H E � � , SIDE ❑ 'ADDRI�SS ��� �,f'�`��6 . PROPOSED USE � ', � cmr��or� r�� ' ziP��i�i�rel�-7=���-7�i7-���I��+ �Yi ARGH/ENG/ z DESIGNER �6"+�'.� � t� ' � AQDR S �"' NO.DV�fEL. NO. I NO. � ClTY , ZIP,�7„_'��e'�TEL, UNITS STpRIES BEDROOMS i DESCRIPTION S�.FT. FACT R PSF A T v� O DJ.AREANALU ION i A ��''� � OWNEA•BUILDER�DECLARATtpN . . ., . � i � I �� SFRlADD/REM "� � ���,e �� . '� ��: 1 HEREBY APFlRM UND�q PENALTy OF PERJURY THAT 1 AM EXEMPT FROA9 THE CONTRACTOFS LI- Gfli'8J8/CBfpOfl � W CENSEiAWFORTFiEFOLLOVdINGIRE450N(SEC.7031.56USMESSAN07ROPESSIONSCOOE:ANYCITVOR (n Y�.� G.�.'. COUNT!'l4HICHREIXJIRESAFE7MITTOCON6iRUGT,ALTER,lMPROVE,�EMOLISH,ORflEPAIRANYS7RUC- ' � TURE,PAIOR TO I75 ISSUMIGE,A1L'50 REQUIFE5 THE APPLICRNY FOR SUCH PERMIT FO FILE A SIGNED PatlolDeck ' � 'STATEMENT THqT HE OR 5HE IS NCENSEd'�FURSUANT TO 7HE PRDV151dNS OF THE CONTRACTORS ll- W � �' 'C@N9E LAW(CHAP7EF19(COMME{VC NO WIFH'SEC7ON 7000)OF DiV150.�N 30F THE BUSINE55'AND PRO- �'�" P��USP2 - ' ' � � � .fESSqNSWDE)ORTHATHE04i�}?EISEXEMPTTNEREFROMANOINEBASISFOATHEALIEGE�EXEMP• Z ' ' , TION.ANYYIOLPT'ANOFSGCTIOf�7a3166YANVAPPLiCANTFORAPEflMITSU&IECTSTHEAPPLICANTTO Re-Roof '� ACIVIL PEPJAtT/Of NQT'MOHE THAN FIVE HUNDRED DOLLAHS(S5C0j.): ❑I,ASOWNEROFTNEPRO ERTY,bRYAYEPAPLOYEESW9TFiWAOESASTHEIRSOLECAMPENSATION, C~j���� Q Commercial . � � � ���WILL DO THE WbRK,AND 7HE��S�RUCTIYRE�.IS NOT INTEM�ED OR OFFERED FOA SALE(SEC.7o4a,BUSI- J � � 'NESSAND PqOFE5510N5 CODE:TIHE I:ONTrlRCT6R$LIGEN$E LqW DOES NOT RPPLY 7C AN OWNER OF � � j � , PF�ppEqTYVhIOBU1LDSORIAAPRqVESTr+EREON�,ANDWHOpOESSUCHWORKHIMSELFORHERSELFOR 'i, I [C",�THROUGHHISORHEROWNE?APIOYEES,pROV10EDTHATSUCHIMPROVEMENTSARENOTI�'7ENOEDOF m �� II�,jl LAJ�,'.OPFEREDFORS/LLEIF.H04VEYE THE9UILDINGORIMPROVEMENTISSOIOWIiHINONEYFAROPCOMPLE- . � Z, ;��'T10N,THE OWNEfl-BUIL�ER WI�HAVE�THE 6URDEN tlFPROVING'HAT HE OR SNE DID P10T Bt11tD OR . � . ,. '� � '.'IMPROYE FOR THE PURPOSE OF$AL�. . . IIj �y,� ❑I,ASOWNEPOFTHFPR4¢ER'iY,AhA',IXCLi151VELYCONTFIACTINGWITHUCENSEpCANTRACTORS 'i [� ',TO CONSTHUC7 TF�ARQIEC"i'(bEC.7W4,pUSINEBS AND FROFESSICP75�DE:TH�CONTRACTORS I.I- VdIllfl416f1 ADJ.RREA � I.kJ ,CENSELAWDOESNOTAPPLYTOIMIOWNEROFAPflOPERTYWH08UfLDSOFIMPROYESTHEFEON,ANO I L '';'',WFdOCON7RACTSFOR5UCHPROJECTSWITHACtlMfPRACTOR�S)LICEP35EUPURSUANTTO7HECON7Rd1G QUANTITY DESCRIPTION FEE �� '�TORSIJCENSFLAVd.). � . ( ��"' ❑i AA9 EXEMPT UNDER 56C. B.8 P.C.FOR ThiS REASON Q ' �/ � �I I�I� �� � � CC � �� 6 , ' . � U"'�i�DATE_ �I � OWNER__. T_ - � y o I . _ - _— __ � ( � �Q, r.ICE�SED�'CONTRACTORS DEC�J�AATION W � � ' ��� �� � y , CC.,�,', INEREBYAFFIqMUNDERPEtJkl. OFPERlURYTHA7IAFALICENSEDUNDEflPROVI510N50fCNAPTER ' � C7 e Wb1MENCINO WITFI SECTfOfi 7000�QF DI`dI51oN 3 OP THE 8U5lNE35AND PP.OFES5IONs COf/E AN� ^� d � ( ) Z I . �MY LBCENSE S Ik FULL FORCE D EFFcCT. m �I �� G'J , � n , � LIO NSE CLA LiC.NO. � � � E 55 _ _ i�Illi , ��, Ili I ._..,..,.�.,;, DA7E � �CON7RACIOR � -� 0- � --.-__. � ��� YJORK�Ei3S'COMPENSAf1l3NDECLARATION ,,�� -^^� � i I � � � �� �, �NEREBY�FFIp/AUNDEflPENAL'ryOPPERJUflYONEOFTHE:9LLOWINGDEGLARATIOHS: Z �'�,, �I HAVE APoO WILL MAINT�N A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' $ � - � ,, �, CAMPENSATtON,ASPR�/IDGqBYSEC710N37o00FTHELA80RCCDE,FO4iTHEoERFORMhNCE U ' . OFTHE WOa4 FQR M/MI6H YNIS PERMfT IS ISSIIEp � �a ie i/"ai I���,�!, ��,�'�, � ' 'aJ I"� �i !I MAVE AND WlLLMAINT�IN N/ORKERS CA>APENSATION INSURANCE,AS RE�UIRED BY SEC710N �l � , y �� I��� �� i �I 3lW OFTHE L400P(�E,FGq TkE PERFORMMICE OF THE WOPoC FOR WHlqi T415 PEPMIT IS `�'— "� ISSUED.MY W KERS COAPPENSRTION I RANCE CpRFIEq AND POIICY NUMBER A E: CQNSTFjUCTION o�" � / � ;y,, .cAwai�R����--���'�� /Irl c5 � � PLAN REVIEW l-- _ :�� � PIX.iCY1+RlMBEN � ELECTSitlC da�� ,."e ' �� A� � �,� CfHSSEC�roYNE�hlo7gEC1JPt�PLE7,:OOFiF+kPEPAaTISfnROP�EMiK1FtE�CIXLWs(SicoloaLEssl. PLUMBING _ � �a a � 8/ '�li I . ��. � - . _�, �i .,Z. IGF.RTIF'lTNATINT}IEf�EflFORM0.NCEOF7HEWOP.KFOFiWHICHTHISPEHMITI51S5UED.l �VSECHANICAL ���•��� � � ��.,e,i � �I! �� � � ((f��, SHALi,NOTEMFLOYAi3y PERy�ONINhUVMANNERSOASTOBECA�SESUBJECT70THE � � '' q�'jj ' WURKER3'CUMPEk5AlI1QNLAW50F�CAlI:-0RNIA,PNDA�REETHAPIFISHOUL�BECOME � INSPEGTIONFEE � � SU&IECfTOTNENk]R ERSWMPENSA710NPROVISIONSOFSECTiON37oGOfTNELABOR d�_ ��� coo�,�swui r-oFrHwaria cc�ena�v wiTH ctose rRov�s�oHs. 4SSUANCE �- � � f '�E°�.�F;i `y v�{s'� �rg �' _ /� ,me -�.A a P� �+ P9 L� sMit� ,a � � _�u'� w�..�;. � DA�E: �IRPPLICANT: . . .�—�'-�=.�—� —___. �. s,��_ �.q `� � NG�FA ' SEC' �WOR�E 'CO?APENS TI ",.bVERAG IS UNIAWFUL AND SH ENERGY P/C I +1 _ � .�„0�. WARNI ILI.RETO JRE 1�RS A ON E AILBE _ , `� SU&IECT AN EMPLOYEfl TO Cfll INAL'�PENALTIES AND GVIL FINES UP TO ONE HUNDRE9 THOUSAND � � ) 41:.' / PE ENERGY RMIT � � : �„�`�tT�^� , II:il�,,���i �; 60LlARS�E700,o0a),IN M1D01TI0�T0 THF,COST OF COMPENSATION.DAMAGES AS PROVIDEO FORIN � ����� �.J SECTION57oBOFTHELA80qCb�E,I TERESTAN�ATTORNEI"SFEES. Iil , �. N • RETENTION FEE. , ,',,�I'ili�,, � C�,OIN57RUCTIONLENDWGACaENCY PRF•ALTFEE: � � � �" 1 HEREBV AFRNM UNDER PENALTI'OF PERJURY THAT THERE IS A CONSTql1CT1ON LENDINO AGENCY __ FOfl THE PERFORMANGE OF TFIiE WORN FOR HICH T7115 PERMIT IS ISSUED(SEC.3097,GIY.C.�. � 5 �' �t'���- � � �� n LENpERS NAME � IEN�ER'SADORESS ' - ,�'�.Ill,lill,l' /� rr `��^ j . Illlllljl, fS �CERTIi'YTHATIHAVEREADTN�.ISAPPLICATIONAN�S7ATETHATYHEABOVEINFORMATIONISCARRECT, TOTHL f"GES ��1 �� � �. ��y�p�,� �� �AGRf�TOCOMPlYW9THA�I.�ITYA�COUNTYORDlNANCESANOSTATELAWSRELATINGTOBUILDING d °•f� � CON9TAUCTipN,AND HF_REBYbUTH�RIZE REPAESENTATIVES OFTHIS COUNTV TO ENTER UPON THE - A � qBOVEMENTIpNE�PROPERTYI FOR I�lspecnord Pun�osEs. COMMENTS - � I��„��I� Q , .. . . J � m PEriMITEENRMElPRl4dT1 � � . aC i�ll � C!� SIGNA7UREbFPERMfT7EE '. C7ATE ' � P � PAI REC T.NO. D BY VALI I N DAT O � 'i _ R o WFi1TE—De artment Co .YELI.OW—Finance Co ,PiNK—Assessor Co ,GOLDEN Oo--F�e C .GREEN idcant's Co P p PY PY Y PY 6+PP PY �� � �������e�� ��r.; x;.��'��i��.w* r:�'^r°�.�'�E . , €m x ��-r."�°" T R n E �s�� "�`i+;F",'b; 4� ��s�e �`�:. �� <,�.. a�;f`�"tC�..� ,w .�..�.'4 �...�'�p� � �-��"a�-'3 �r;�^�.�„�-aa a�. '.� ��.���� `�" ,i�� .�`�ti�,„, ,�- '+�•"���� .,��"��,.� '� a�,a"�e:'w��za'�,�--`�. 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