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HomeMy WebLinkAbout17125 ---_�._ __l CTTY OF DIAMOND BAR DEPART'I��NT OF COMMUNITY&DEVELOPMENT SERVICES 2t825 E.CopleyDrive (909)860.3195 Fas(909)861-3117 PRESS '������ BUILDING PERMIT APPLICATIUN FIRMLY o� JOBSITE �i7J ^'� � � �A "� APPLICATION � r � PERMIT �'��•/ P/C ADDRESS r� ^� � � I !c� Ao DATE NUMBER [� p o � / ISSUE TYPE OCC r' APN LOT.�-_c� TRACT �'�' �_ oATE CONST. GROUP p OWNER '�t.. G- `�` ADDRESS �' L(i�—%''"�/ � ZONING SETBACKS OCITY�j2�iVG F_ ZIP�__gp TEL. ,{�c7 J�/'S'D REART RW ❑ p APPLICANT TEL. SIQElSIDE STREET RW ❑ mCONTRACTOR SIDE ❑ o CDDRES �v ZIP TEL,�'',�� Z'%��t� PROPOSE�USE o ARCH/ENG/ �z DESIGNER NO.DWEL.. N�. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECIAFlATION SFR/ADD/R[M O W CENS'ELAW ORTHE OLLOWWGEREA ON�(SEC.�703158USINES8AN�P OFESSIONSCODETANYCITYOR GaYage/CdfF70fl U COUN7VWHICHflEOUIRESAPERMITTOCONSTRUCT,AL7ER,IMPROVE.DEMOLISH.OPREPAIRAYYSTFUG � w TURE,PRIOR TO 17S ISSUANCE.AL50 RE�UIRES THE APPLICANT FOR SUCH PEigdIT TO FILE A SIGNED � Patio/Deck STATEMENT THqT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONiRACNRS ll- � CENSELAW(CHAPTER9�COMMENCINGWITHSECTION700010FDIVIS'ON30FTHEBUSINESSANDPRO� u' Pool/Spa fE5510N5CODE)ORTHATHEORSHEISE%EMPTTHEREFROMANOTHEBASISFORTHEALLEGEDEXEMP- � � TION.ANYVIOLATIONOFSECTION7031.SBVANVAPPLICANTFORAPERMITSUHIECTSTHEAPPLICANTTO Z Re-Root A CNIL PENALTV DF NOT MOpE THAN FIVE HUNDRED DOLIARS(SSoo).): p ❑I,ASOWNERDFTHEPROPERiV,ORMYEMPLOVEESW1iHWAGESASTHEIR50LECOMPENSATION, � CORIRIBfCIeI Z WILL 00 THE WORK,AND THE STRUC7URE iS NO7INTENDED OR OFFERED FOR SALE(SEC.7oa4,BUSI� J � NESS AN�PROFESSIONS CO�E:THE CONTFACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF = PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES Sl1CH WOqK HIMSELF OR HERSELF OR � iHROUGHHI50RHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENOE�OR m QOFFERE�FORSALEIF,HOWEVER.THEBUILDINGORIMPROVEMENTISSOLDWITHINONFVEAROFCOMPLE� 2, TION,THE OWNER•BUILDER WILL HAVE THE BURDEN OF PROVING THA?HE OR SHE DIC NOT BL'ILD OR � IMPROVEfOR1HEPURPOSEOFSALE). w ❑�,ASOYlNEROFTHEPROPERN,AMEXCLUSIVELYCOMRACTINGWfTHLIC[NSE�CONTRACTORS �[ TO CANSTRUCT iHE VR0.IECT�SEC.7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTOFS LI� VBIU8IIOf1 ADJ.AREA W CENSEIAWDOE6NO7APPlVTOANOWNEROFAPROPEFTVWHOBUILDSORIMPROVESTHEREON,ANO � WHOCONTRACTSFOflSUCHPR0.IECTSWITHACON7RACTOR(S�LICENSEDPURSUANTT07HECONTRAG QUANTITY DESCRIPTION FEE X TORSLICENSELAW.). � O IAM EXEIAPT UNDER SEC. 8.&P.G FORTHIS PEASON Q „ �� � ¢ � - i'Q OATE OWNER � ,.�+rr• W � LICENSED CONTRACTOFS DECLARATION W . �,f., �� 2.• Cy 2 I HEflEBY AFFIRM UNDEfl PEYALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � p. 9(COMMENCINGWITHSECTION70o0�OFDIVISION30FTHE9l1SINESSANDPROFESSIONSCODE,AN] z � � S� �X MV LICENSE IS IN FULL Fj,RCE AND EFfECT, m / � �n� ��, t� j /� �`� ^7 � �J� � LICENSE CLASS C LIC.NO. /.n 7 T�J� � ���" �� � � � J � ^ w DATE CONTRAC70R p d �� �,�� t� WOFKERS'COMPENSATION DECLARATION � a 0 :YK �' ��I�� = U � IHEREBYAFFIRMUN�ERPENALiVOFPERJURVONEOFTF7EFOLLOWINGOECLARATIONS: u� ¢ � l/ G3 tvv !t�> 5+� � ._IHAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFOPWORKERS' 2 �^�.� '�D Z COMPENSATION,ASPFiOVI�EDBYSECTION3]ooOFTHELABOFCOOE,FORTHEPERFORMANCE U /<-�L.d'-� � � ' 1 Q OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. � f � ,� ��C �� + • W _I HAVEAND WILIlMIMrAIN WORK'cRS'COMVENSATION INSURANCE,AS REQUIRED BV SECTION Q 370o OF TNE IABOR CODE,FORTHE PEflfORMANGE OF THE WORK FOR WHICYTHI5 PERMITIS ,�^���,J���" f"� � ISSUED.MYWOFKERS'COMPENSATIONINSURANCECARRIERAND LICYNUMBERAaE: CONSTflUCT1ON + w"° �d J J � CARRIFR �LG��' �-' L�/_r,!'l�'� � PLAN REVIEW p ��� .� � POUGYNUMBER_��� '✓ - ELECTRIC Q � (i}IISSECTIONNE�NO7BEOOMREfEDOFTHEPERMRISFORONEHUNDREDDOLLdAS(51W)ORLESSI. PLUMBING � �� Z I CERTIFVTHAT IN THE PERFORAAANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (� SHPLLNO7EMPLOVANVPERSONINANY MANNERSOASTOBECOMESU6JECTTOTHE � WORKERS'COMGENSA710NLAWSOFCALIFORNIA,ANDAGREETHATIFISHOt1LD6ECOME iNSPECTIONFEE � SUBJECTiOTHEWORKERS'COM7ENSATIONPROVISIONSOFSECTION37ooOFTHELABOP - = CADE,I SHALL FORTHWITH COMPLY Wlhl T OSE PROVISIONS. ISSUANCE _ Q �,�t_���i,�(� SMIP OATE: APPLICANT: � � J WARNING:GAILURETO SECURE WORKERS'COMPENSATiON COVERAGE�S UNIAWF�L.AND SHALL 0E ENERGY P/C � SU&IECTANEMPLOYERTOCFiIMINALPENALTIESANOCNILFlNESIJPTOONEHUN�REDTHOUSAN� ENERGYPEHMIT OOLLARS(E1 Do,00o).IN ADDITION TD THE COST OF COMPENSATION.DAMAGES AS PROVIDEO FOR IN � SECTION 3708 OF THE LABOF CODE,INTEREST.AND ATTORNEV'S FEES. RETENTION FEE: � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE O � 1 HERE6VAFFIRM UNOER PENALTI'OF PERJURV THATTHERE IS AGONSTRVCTION IEN�MG AGENCV FORTHE PERFORMANCE OFTHE WORN FORVlHICH 7HIS PERMIT IS ISSIJE��SEC.3097.CIV G). Z W � LENDER'SNAAIE ._–. -._— �,�H�� q"�/'a I,_ LENDEft'S ADORESS � ICER7IFYTHATIHAVEREADTHISAPPLICATIONANDSTAiETkIATh1EA90VEINFORMATIONISCORRECT. TOTAL FEES ���✓ f� , 0. I AGREE TO COM PI.Y Wlhl ALL CITV AND COUNTY ORDINANCES ANO STATE LAWS PEL4TMG TO BUILDING `� � CONSTFUCTION,ANDHERE�YAUTHORIZEREPRESENTATNESOFTHISCOUNTYTOENTERUPONh1E Z A60VEMENfIONE�PROPERTYfORINSPEGTIONPURPOSES. COMMENTS � ✓ � � � m PERMI EE NAM INT) 'd CIJ t � SIGNATU F PE MITTE DATE = fiECPT,NO. 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