HomeMy WebLinkAbout11047 �
CTI'Y OF DiAMOND BAR p�q�
1. � COMMUNITY DEVELOPMENT DEPART �NT '
2I660 G Copley Drive Suite 190 /�
- (909)RCO-3195fax(909)Rfi1-3117 ' �r/� RESS
~'�^`� AUILDINGPERMITAPPLICATION G'FIRMLY
o DDR SS� ��i�K(�� C�a����j� APPLICA N �f � '�� NUMB R�� #/C
DATE �/
c� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER Ff�LC��
LL ADDRES ZONING SETBACKS
o CITY ZIP TEL. REORT RW O
o APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
� ADORESS
� CITY ZIP TEL PROPOSEO USE
�w ARCN/ENG/
w DESIGNER NO.DWEL. N0. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
� DESCRIPTION SQ.FT. FACTOR PSF" ADJ.AREANALUATION
p� OWNER-BCILDER DECIARATION. SFRIADO/REM
O
p 1 HEREBY AFFlRM UNDER PENALTY OF PERJUHY THAT I AM E7cEMPT FROM THE CONTiUCTORS LF GBregE/C9rpOfl
W CENSEUwFOHTHEFq.LOwiN(7REASON(SEC7o71.58U5iNESSANDPROFE5510NSCODE:ANYCITYOR (n
U COUNTYVMIGIREWIRESAPERMITTOCONSTRUCT,ALTER����E,DEMOLISH,OflREPAIRM%STFiUG W patio/Deck
wTURE PRqR TO ITS ISSUANCE.AL50 REWiRE3 THE APRICAnT FOR SUQ1 PER�.irt 70 FlLE A SIGNED
� STAiElAENT TNAT ME Oii SNE IS UCENSED PURSUANT TO THE�ROVISIONS Oi TME CONTMCTOR3 lF
.� CENSE Uw(dUPTER f(ODMMENCINO NATN SECTqN 7000)Of DiVISqN�OF THE BVSiruE55 AND PRO. u- PooVSOe
FESSIDNS CODE)OR TM�7 ME OR SME�S E%EMVT TMEREiROM AND 7NE BA5�5 FOH TME A�LEOED E%EMV•
� TqN.ANVVIOI.ATIONOFSECT10N7071.SBVANVADPLICANTFOFADERA1tT5UBJECTSTHE�P7lICANTTO� z RrRaot
� �CM�PENALTY OF NOi MORE THAN FNE HUNDRED DOLURS(f 500)�:
0 O1�50NMEROFTHE�ROPER7Y.OHMYEMPLOYEESWITMWAGE5A5TMEIRSOLECOMPEN5AT10N, Q Cemmercal
Z W�tl DO 7NE WORK AND THE STRUCTURE IS NOT INTENDED 01i OFFERED FOH SALE(SEC.70U.BUSF J
NE55 M70 PROFE55 WNS COOE:TNE CONTR�CTORS LICENSE UW DOES NOT APP�Y TO AN DMMER OF
� PROPERTYWNOBURDSOHIM7ROVESTMEAEON.ANDN9iODOE55UCHWORKHiMSELFORHERSEIFOq �
CC TMROUGHH�SORHEROWNEMPLOVEES,PRONDEDTHATSUp1IMPROVEMENTSARENOTMTENDEDOR m
W OffEflEUFORSALE1F,IqN'EVERTMEBUILDINCORIMPqpVEAIENTISSOLDN'RNINONEYEAROFCdAGLE-
0 TION,THE OWNEH-BURDER N'ILL MRYE 7NE BVRDEN OF FROVING TM�T HE OH 5HE D�D NO7 OUILD OH
Z MOROVE FOR 7HE Pl1RPO5E OF SALEI
_ ❑I,ASONMEROFiHEGROPERTV.FAIE%CIUSNELYCOMRACTP7GVRiHLIGENSEDCONTRACTORS
Q TO CONSTRUCT THE PROJECT(SEC.70�1,BUSINE55 AND PROiE5510N5 CODE:TME CONTRACTORS LF Valuatim ADJ.AREA
W CENSEUWDOESNOTMPLYTOANONMEROFAPROPEHiYvm09UM1D50HIMPROVE5n1EREON,MiD
� NnqCONTMCTSFORSUCHDqpJECTSWiTHACONTMCTOR(5)I�CENSEDDURSUAMTDTHECDNTRAG QUANTITY DESCRIPTION FEE �
Y TORSLiCENSEUw).
¢ ❑I/ud EXEIAPT UNDER SEC. 8.6 P.G FOR TNIS HEASON U
OO
� �
� OAlE OWNER �'
Z w
�Q LICENSED CONTRACTORS DECL4RATION w
CL IHEREBYI�GFIaMUNDERPENKTYOFPERJURYTHATIMI�ICEN5E0UNDEHGiiO`n510NSOFCMAPTER � �
d g(COAIMENdNOWrtHSECTION70oolOFDMS10N70F7HEBU5INESSANDPROFE55�J5CODE.AND
MY I�CENSE IS N FU.L FORCE AND EFFECT. m (
/� �
�y�/� � �
� LICENSECLASS C3�LIC.NO.____1yl�� � �
v o�rE��Q��corirrucror������?�� a
� WORKERS'COMPENSATION DECLAAATION Q
tD 3� �
� IHEREBYAFflMAUNDERGENALTYOFGERIURYONEOFTHEFOLIOwINGDEClAM110NS: f
� 4
� ��HAVEANDWILLMAMTAMI1CfRtifl�ATEOFCONSENTTOSELF�INSURELOHWORKERS' _
� Q7/APENSATqN,115PHOVIDE08YSECTqN71000FTHEUBORODOEFORTHEPERFORMANCE W
OF TNE WORK FOR WNICM TNIS VERMIT IS ISSUED. �
O
w �IHAVEANDWILLM�AMTANWORKER500AIOENSATIONINSUFLWCE,ASREWIqE�BYSECTION
� Q 77ooOFTHEUBOROODEFORTNEGEFPoRMANCEOFTHEWOPoCWRWHICHTNISPERMITIS
� ISSUED.MYWO/RK�E�RS'COMPE,N./S)ATDI INSURANC CARRIERANDPOLICYNUMBEHME: CONSTRUCTION
jC�RF!ER C�VC.�C � �L PLANREVIEV✓
Z vaicvr��r+ — - ELEC CO
¢
� (RffiSECfYINNE�NOTBE001h�LFTEDOF71fPEF7.�T5iOHONEHI.�,ORED (S70olOfilESS1 `
Z ICERTIFYTHAi1NTHEPERFORM�wCEOFiHEWOFKFOFlN7iip1iNi5vERMIT15155UED,l MECHANICAL
(} SMAIL NOT EMPLOV ANY PERSON M nNY uANNER 50 AS 70 BELOME SU6IECT TO THE
� 1MDRKERS'CAMGENSATION UWS OF CALIFOPNV�ANO AGREE 7lMT If ISHOUID OE�ME W SPECTION FEE
SUBJECT TO THE WORKERS'COMPENS�TqN PFqYI510NS OF SECTIDN 9700 OF THE LABOF
� CODE,I ALLF THCWPLYINTHJqOSEPROVI510N5. �SSUANCE �
� �� %�O •�(,(� ��.. SMIP
`p DATE: APRICANF�/u`%t
� W�RNINa:iAdIlAETO SECURE NtlRKERS'OpdPENSAiqN COVERAGE IS UNUWFUL,AND SWLLlBE ENERGY P/C -
� SUBJECTANEMPLOVERTOCRiMiN�17EN1LLT1E5ANDCMLFINESUVTOONEM»rORED7MOUSUJD EkERGYPERMIT
O0.UR5(5700.000�.IN ADDITION TO TNE C047 Of COIAPENSATqN,OAMAf3E5/�5 PROVIOED FOR IN
_rJ SECTqN77oeOF7HELABOiYC�DE.INTEREST.AND�TTORNEY5FEE5. RETENTIONFEE:
�
oW„ CONSTRUCTION LENDING AGENCY pRE-ALT FEE:
Q INEREBYAFflRMUNDEH7ENAlTYOFPERNRYTNATTHEAEIS�CONS7RUCTIONIENDINaAGENCY
�- FDR TNE�ERFORMANCE OFTHE WORK FOR NM1iiCHTH15 PERMIT IS ISSUE015EC.7097.CIV,CJ. . .
Z
W
� LENDER'S NAME
h' LENDER'S/�DDRE54
WICER7IFY7NATIHAVEREADTH�SAPPLICATqNANDSTATFT41T1HE/�BOVEMfOR1AATqNI4CORRECT. TOTAL FEES �
� I�CREE TO CdAttV WITN JLLL CRV AND COUNTY OFDINANCES AND STATE UWS HEUTINO TO BUILDIN6
� CONSTRUCTION.ANDHfRCBVAUTHORREREPRESENU7NFSOF7HISCOUNTYTOEMERUDONTHE _ .
Z ABOVE�IAEMIONEDPFiOPERT'FORINSPECTIONPURPOSE3. COMMENTS ` �\�
_ ' ' (� . . . � ` ' _\ � ' 1
J
m PERy(1 EE NAA1E IORMIT)�. . ' . . . . � � .
Q �'„� ,Tt`� ' . - �_
tc.vc.au�i
SIG UREOFGERIAIT7EE DATE , � A•
. - . . � • RECPT.NO. PAID BY VAUDATIO ��w
WMITE—DeDartment Copy,YELLOW—fuianc9 Copy,PINK—Assessw Copy,GOLDENROO—Fite Copy,GREEN—ApplicanCs Copy
�cn () � � � � � � � � o n g m � � � � � � � g � � � m � �
m m z Z Z Z D m m m � m y x 2 O O O O � O D m A r m
m� � ' D D D D � m � � � r � O c C c O D O � � � O m � �
'D-I , i � � , r r, r r y v _-I m � Z � r � L� L� G) -n � -n m � � C � � w �-,
'V C7 � b m x (7 37 v c� 7J n � Z D m x x x n z cn D � G) z � -n D �-;
•n r m O � -I r' ln � v m 2 O 2 tn O � O O n .,-_� ��1
�-I fll cmyZ -IrD rzcx � � r. m < � mm � n � c) � �
�D z � (7 _i (n Umi r Z Z � r fn C C m y fn m D D m � r- L� � . �•:
Z .-� Co 9 2 1 � , X D C D O R7 � n -� 31 z -I < � fil � � (n i)
N(n • � � n � z � O � m z n � . r_- � m oo �c m � � �."_ ,`
m m � Z � � -Di ci o � �,�.
z
. I �'� �i � , N .
.. �
' � �
� s-
t� _..��{ . • .
t• '
�
�
� � � � �
�
�� � � Rl � 2 '?1 T O � T p O � � '9 ?i Sl m � T O� � T 'fl C C T T � .
� � z m m � Z z Z m -n O o o z o m � z � - � a z z = � �
� � � - _ ' � '��, � o � � � � � � 000 = � � � � � x � vmm � o Z � ,
� . � m x m N m n m D -{ �n -n m 2 S � �p p -1 r 37 7] m 7J
� �\ 'o -C m � .D p D Z _i m Z m r L7 � Z D O z w � D -n 'n O �- ��� '
\ � m -i z � v G� O D Z m �p G� g z p O m m � r � � ' �il Z ,
• y -�°f z � t�i� � rzn � `_ z � o o � m m �v w -n O o c�n � �, , n �
`�! � o _" � � � � � � D � mZo � O 7J �
1 � � Z G1 � D � Q O C m D
O '� � � m � � � � �
� � � I � o C .
Z '�
0 � �
� � : . - _
� � � '
3 � �
� � � � '
� ; � ,
�
�� � �; B ,
� _ _ . _
� ��