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HomeMy WebLinkAbout10478 CITY OF DIAMOND BAR , COMMUN[TY DEVELOPMENT DEPARTMENT �,.0 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS �'"'"� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �/�o��? APPLICATION PERMIT f� /C o ADDRESSi� `--1� DATE 7 NUMBER U # � � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER " ^ �` ADDRE55 ZONING SETBACKS 0 � CITY o � ZIP�f��,j= TEL. REART RW ❑ APPLICA� TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE ❑ ADDRESS � CITY ZIP� TEL. PROPOSED USE w ARC NG/ z DESIGNER w NO.DWEL. NO. NO. Q. ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � rn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BI;ILDEF OECLARATION SFR/ADO/REM O p I HEflEBV AFFIRM VN�ER PENRLTY OF PERJURY THAT I AM E%FMPi FRdA THE CONTRACTORS L6 G8f89B/CBfPOf� W CENSEIAWFORTFIEFOLLOWIN6REA50N(SEC.703t.5BUSINE55MlOPROFESSKKJSCODE:ANYCITYOR (n U COUNTVNT11CHqEWIRESAPERMITTOCON57RUC7,ALTER,IMPROVE,DEMOLISH,ORNEPAIRANVSTRUG W PetiO/DBCk Z TURE,PRIOR 70ITS ISSUANCE.AL50 REWIRES THE APPLICANT FOR SUq1 PERMITTO FILE A SIUNED W STATEMENT THA7 HE Oq SHE iS LICENSED PURSUANT TO THE PROVISIONS OF 71/E CONTRACTORS L4 W � CENSE UW(CHAPTER B(COMMENCINO WITH SECTKKJ 7000)OF OIVISION 1 OF THE BUSINESS AND PRO. u' POOUS(19 FESSqNSCOUE)ORTFUTHEORSMEISEXEMPTTHEREFRdAANDTHEBASISFORTHEALLEOEDEXENP- (� TION.ANYVIOUTKKJOFSECTION7031.6BVANVAPPLICANTFORAPEflMITSU&IECTSTHEAPPUCANTTO Z Re-Roof � A CIVIL PENALTY OF NOT MOqE THAN FIVE HUNDRED DOLLARS(f5ao).�. � ❑I,ASOWNEROFTHEPROPERT/.ORMVEMPLOYEESWITMWAOESRSTHEIRSOLECOMPENSATqN, COAl171BfC181 WILL W THE WORK,MIO THE STRUCTURE IS N071NTENDED OR OFFERED FOR S�LE(SEC.70{I,BU51� � � NE55 AND PROFESSIONS CODE:THE CON7MC70R5 LICENSE UW DOES NOT AVPLV TO AN OWNER OF j PROPERTY WFIO BUILDS OR IMPNOVES iHEREON,ANO VM1IO DOES SUCH NriRN HIMSELF OR HERSELF OH � THROUGHHISOHHEHOWNEMPLOVEES.PROVIDEOlHATSUCHIMPROVEMENTSARENOiIN7EN�EDOR m Q OFFEREDfORSALEIF,HOWEVERTMEBUIL0INGDRIIAPROVEMENTISSOLOWITHINONEVEAROFCOMPIE� Z TION,TME OWNEF�BUILDER WILL HAVE TXE BUROEN OF PROVING TNAT HE OR SHE DID NOT 6URD OH � IMPROVE FOHTME VURPQSE OF SALE�. �,y� ❑I,ASONMEROFTNEPROPERTV,NAE%CLUSIVELYCONTMCTINaWITHLICENSEDCONTMCTORS [[ TO CONSTRUCT TNE PROJECT(SEC.70N,BUSINE33 AN�PROFESSIONS CODE TME CONTRACTORS LI� V8IU8I10/1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFIIPROFERTYWH09UILDSORIMPROYESMEREON,ANO � W11000MMCTSFORSUCHVROJECTSNATMACONTRACTOR�S)UCENSEDWRSUANTTOTNECONTMG QUANTITV DESCRIPTION FEE � TORS LICENSE UWJ. 0 ❑I AM EXEMP7 UNDER SEC. 8.6 PC.PoR THIS REASON Q � � / LL' UA7E OWNER H 0 W �Q LICENSED CONTRACTORS DECLARATION W � � ,` 2 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT 1 AM LICENSED UNDER PPOVISIONS OF CH�VTEH � d Y(COMMENCINO WITH SECTION 1000)OF DIVISION]OF TME BUSINESS AND PROFESSIONS CODE,AND Z X YV LICENSE IS IN FULL FORCEAND EFFECT. m � lL Q � LICENSE C SS L,j� UC.NO.�j���/�' j � V DATE CONTRACTOR a , < < w � ( WORKERS'COMPENSATION DECLARATION Q NI HEREBV AFFIflM UNDER PENALTV OF VEfiJURY ONE OFTHE FOLLOWMG DECLAMTIONS: Z � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELf�INSUREFOqNqRKERS' a 2 COM7ENSATION,AS PROVDED 9V SECTION 370o OF THE LABOR CODE,FOR THE PERFOqMANCE U Q OF TNE WORK FOR VA11CH THIS PERMIT IS IS6UED. � QW _I HAVE Ml�WILL MIUNTAIN WOqKEHS'COMVENSATION INSURANCE.AS REWIRED BY SECTION / 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORI(fOR WHICH THiS PERMIT IS � ISSUED.MV WORK RS' PENSATION IN5URAN CARqIEH AND POLICV NUMBERARE: CONSTRUCTION J j c�RR1ER PLAN REVIEW ZPOLICY NUMBER ELECTRIC � � ' ¢ � __-s p (nessEc.'r�r��r�oTeEm.�TmoF a�w.rtsro�+oriEM�r�000u�wsR�ml��ssl PLUMBING Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C!� SHALL NOT EMPLOV ANY PERSON W M!V MANNER SO AS TO BECOME SU&IECT TO THE � WORKERS'GOMPENSATpNUW50FCALIFORNIAAN�AC+REETMATIfI5/KKILDBECOME INSPECTIONFEE SU&IECT TO THE WORKEfiS'COhIVENSATION PROVISIONS DF SECTION 3700 Di THE UBOR � � S CODE 1 ALL FOFTHWITHCOMPLV WITM THOSE PROVISIONS. ISSUANCE 0 p DATE: APPLICANT: SMIP J WARNIN(3:F TOSEGl1REWONKEfiS'COMPENSATqN VERAOEISUNLAWFUL,ANUSHALLBE ENEAGYP/C LL SU&IECTAN MPLOVERTOCRIMIWLLVENALTIESANDCIVIIfINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT D�LUHS(S7 00.0001.IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROYIUED FOR IN J SECTION 3708 OF THE I.ABOfi COOE.IN7EREST,AND ATTORNEYS FEES. � RETENTION FEE: OCONSTRUC710N LENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIRM UJOER PENALTY OF PERIURY 7HAT THERE IS A CONSTRUCTION LENDING AGENCv �� ' FOR THE PERFORMANCE OF THE WORN fOR WHICH THIS PERMIT IS ISSUED(SEC.3oY1,CiV C.). Z W � LENDER'S NAME F- LENDER'S�DORESS W ICERTIFYTHATIHMEREADTMISAVPLIGTIONANDSTATETHATTHEABOVEMFOqMATIONISCORRECI TOTAL FEES � � 1 AOREE TO CAMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE LANS REUTING TO BUILDING � CONSTRUCTION,AND MENEBY AUTHORIZE REPRESENTRTIVES OF THIS CWNTY TO ENTER UPON THE Z ABOVE#IENTIONEO PROPERTV FOfl ,SPECTION PUflPOSES. 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