HomeMy WebLinkAbout10409 i
- =' CTTY OF DIAMOND BAR
COMMUN[TY DEVELOPMENT DEPARTMENT
:,,,c 21660 E.Copley Drive Suite 190 PRESS
(909)860-3L95 Fax(909)861•3117
�'�'� BU[LDiNGPERMITAPPLICATION FfRMLY
� JOBSITE APPLICATION PERMIT P/C
o ADDRESS -� DATE ���'��� NUMBER/���� #
ISSUE �' / �j�ry TYPE OCC
$ APN LOT TRACT DATE ��/,��'��-/ / CONST. GROUP
p OWNER �� T—
" ADDRESS ZONING SETBACKS
w FRONT RW I.I
Q CITY ZIP TEL. REAR f�)
o APPLICANT TEL. SIDEISIDE STREET RW C]
� CONTRACTOf3 " � SIDE ❑
p� ADDRES " ':3– PROPOSED USE `� `�
� CITY v Z.IP TEL. �-' "'
w ARCH/ENG/ 3��
z DESIGNER ��� NO.DWEL. NO. NO.
� d ADDRESS UN�TS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT: FACTOR PSF ADJ.AREANALUATION
�
� OWNER-Bt;ILOER DECLARATION SFWADD/REM
O
p' i HERE6Y AFFIHM UNDER PENIILTY OF PERNIRY TMRT I AM EXEMPT fflOM THE CONTMCTORS LI• G8f8gB/C81�011
W CENSELAWFOHTHEFOLLOWINGREASON(SEC.7031.5BUSINESSM70PROFESSIONSCODE:ANYCRYOR (n
U COUNTYWHICHREWIRESAPERMITTOCONSTRUCT,ALTEN.UAOqOVE.DEMOLISH.ORREP4IRANY3iAUC- W patio/Dack
W� TIIRE,PRIOR TO ITS ISSUANCE,ALSO flEWIRES TNE APPUCANT FOR SUpI PERMITTO FILE A SIGNED
� 9TATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONiMCTORS U-
� CENSE LAW(CHAPTER 9(COMMENCINfi WITH SECTqN 7000)OF UIVISION 70F THE BUSINESS AND PRO- LL' POOVSPB
FESSIONS CODE)OR hIAT ME OR SME IS EI(EMP7 THEREFpOM AND THE BASIS FOH TME AILEGED EKEMP-
0 710N.ANYVIOlA710NOFbECTIOP17037.58VANVMPLICANTFORAPEfiMI7SUBJECT5THEAPPLICAMTO Z Re-Roaf
� ACINLPENALTYOFNOTMORETHANFlYEHUN�PEDDOLUNS(5500�.7:
� ❑I,ASOWNEHOFTHEPflOPERTY,ORMYEMPLOVEE6WITHWAGE6ASTHEIRSOLECOMPENSATiON, O COffIfPIBPCiBI
Z. K9ll DO TNE WORK,ANO TNE STRUCTURE IS NOT IN7ENOED�i OFFEREU FOR SALE(SEC.70��,BU51- J
NESS AND PROFESSIONS CODE:THE CONfRACTORS LICENSE UW DOES NOT APPLY 70 AN OWNEH OF �
� PROPEHTYYM09UILUSOHIMPROVEShIEREON.ANDWHODOES3uCHWONKHIMSELFORHERSELFOR =
�' THRWaHHI50RHEROWNFMPLOVEES,PROVI0E0TNAT5UCHIMPHOVEMENTSARENOTINTENDEDOR m
w OFFEREDFORSALE.If,HOWEVERTMEBUILDINpORIMPROVEMENTISSOtDWIiMINONEYFAROFCOMPLE
Z� TION.THE OWNER�BUILOER V�ILL HAVE THE 6UNDEN OF VROVING THAi HE ON SHE DIO NbT 9UILD OR �
� IMPRO4EFORTHEPUflPO5EOF5RLE).
W C]I,ASOINNEROFTHEPROPERTY,AMEXClU51VELYCON7MCTINGWITHLICENSEDCONTRACiOR5 �.
(_'. TO CONSTRIICT THE PRQIECT(SEC.7044,BUSINESS AND PROFESSIONS CODE:T7E GONfMCTORS LI- V2W9110I1 � �� ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEHOFRPROPEN7YWHOBUILOSORIMPROVESIHEREON,MID �
�. WHOCANTMCTSFOHSUCHVHQIECTSVM�THACONTRACTOR(5)UCENSE�PURSUANT70THECONTFAG QUANTITY DESCRIPTION FEE
�� TORSLICENSELAWJ.
J
0 ❑I AM E%EMPT UNOER SEC. 8.6 P.C.PDR TW&flEASON . �
�. �
LL DATE OKTlER V '
Q4 LICENSED CONTRACTORS DECLARATION W
2
1 HEREBYAFFIRM UNOEF PENALT7 OF PERJURYTHAT I Mi LICENSED UN�ER PROYISION$OF CHAPTER �
p,, e(COMMENCINO WITH SECTION 70ao)OF DIVISION 90F THE BUSINESS AND PROFESSIONS COOE,AND Z �
x MYUCENSE iS IN FULL FO AND EfFECT. m `
W..: I�i � 5
� LICENSE CLASS UC.NO. /� j
U: OATE CONTRACioF�� ^�... r�� ry, d .
W,;
�� WORKERS'COMPENSATION DECLARATION �� A Q
� U
� IHEREBVAFFIRMUNDERPENALTVOFPERIURVONEOFTHEPoLLOWINGDECLAMTqNS:
�' Z
Q
�` _I/UVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKEfiS' S
COMPEN6ATION,AS PROVIDED 8�SECTON]]Oo OF THE LABOR CODE.FORTHE PERf-0HlAANCE U
¢ OF ORK FOR WHICH THIS PERMIT IS IS5UE0. � '
O
W INAVEANDWILLMAINTAINWORKEflS'CAMPENSATIONINSUMNCE,ASREQUIREDBYSECTION
Q 37o00F THE LABOR CODE,FOR THE PEHFORMANCE OF T E WORK FOR WHICH hIIS PEHA11715 " - ��, �� '
ISSUE0.AIY WORKER P TI INS CE G1 IEHAND POLICYNUMBERARE: CONSTRUCTI� )
� CARRIEP �'� PLAN REVIEW �
� POLICVNIIMBER � ELEC'TRIC
a l � �
�_. p,
w. �ssEcrrs�r��rro7eEa'7�a«oofTEaEtaM�s�oNEMx�FDDounFSRtaoloR�ss} PLUMBING ������¢;;,;��9 s��r
Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WH�CH THIS PERMITIS IS5UED.1 MECHANICAL ~��_
(r} SHALLNOTEMPLDYANYPERSONINpNYM SOASTOBECOME3UBJECTT07HE " '
�� WORNEFS'COMPEN9ATION LAWS OF CALIF RNI,AND AGREE THAT IF�SH4ULDBECOME iNSPECTION FEE . r�
= B,IECTTOTNEWORKERS'CAMPENSA P V�SION50FSECT N37000FTHELABOR U p ` , ',
E,I SHALL FOflTNWITNCOMPLY WI7 � P ISIONS. ��'� �� �'" " �
o �/]-,,- ��'���..... SMIP �;��' ,_'�".;
`p DATE: �'"'�� APPLICANT: „
� ENERGY P/C
J
WAi1NING.FAILUNE TO SECUHE WOHKERS'CDMPENSATION CAYEflAQE IS UNUWFU�,AN LBE
LL SUBJECTAN EMPLAYEH TO CIUMINAL VENALTIES AND CIVII FINES UP TO ONE HUNDRED T SANO ENERGY PEflMIT �
'OOLURS(5100,000�,INADDITION TO THE COSTOF COMPENSATION,DAMAOES AS PROVIDED FOR IN
QSECTION37o80FTMELABORCOOE.IN7EHES7.ANDATTOqNEY'SFEES. RETENTI�NFEE:
a CONS7RUC710N LENDING AGENCY PRE-ALT FEE:
� IHEHEBVAFFIRMUNOEN7ENALiVOFPERIURYTHATTHEHEiSACONSTRUCTIONLENDINOAGENCY ��
FOR THE PEflFORMANCE OF THE WOF1K FOR WHICH THI6 PERMIT IS ISSUED(SEC.3ou�,CIV,C.). /N . � S
�
W
� IENDER'S NM�E
H IENDER'SRD�RE55 :
� TOTAL FEES C��'
W ICERTIFVTHATIHAVEREADTMISMPLICATIONANDSTATETHATTHEABOVEINFORMA710NISCORRECT. �� �
d IAGREETOCAMPLYWITHALLCITYANDfAl1NTYORDINANCESANDSTATELAVY3flELATINGTOBUILDING
CONST ,AND HEREBYAUTMONIZE REPHESENTATIVES OF TMIS COUN7V TO ENTER UPON TNE ry/
Z ABOV-MENT ED PROPERTY FOR INSPEC710N PURPPSES. COMMENTS '��'� '^"/�� � �� �''�-- ';
s � � ` t
_
� PE 1 ENAAA INn
Q �.
N r �7 A�/ � N�e� 3.
y SIONA7UREOF P E DA7E RECPL NO.����c' PAID BY(�(��J 7 I VALIDATION
� � WHITE--Depahm t Copy,YELLOW--Finar�ce Copy,PINK—Acsessor Copy.GOLDENNOQ–Fl�e Capy,GREEN—Applkant's Copy
t
�__�,�._.__ ........._..._ ___ m rn �___.._..p�.�--
r._ ._ .. ( I_.. � �� '
. . , . �� m�a� °1 � n�ol�lp4� � �I�f_..�� , �luil-o����:n ���'� -tl�n u�r;" -��ri
�s�y� i ' -n -n�-n -n 17 tr.I cn c��s n �'t I ( �
�- i rr� -�a � m ��io��!�Ip'�D � � ��a ol� cil�
:'0-I� � S r rlr`rIA � mlc Z�_� i�c GC7�G3.�•7��i � -ri 'ni�I� C � � [u . .... �.
� , �� �.mxc� - � �(� � . z � msarcizur'Dvi� � � ma
'Dni �. � � .�-�r-I�.I�I3F .. �I. � �;-�����i Imi2`C3�IG� T.fnIO �.G n O �
'.��-I; �1 rrS D�Z � � D r 2 C:=I r r �+ G m �'T. � D v .
�DI ( �. � �y.�Ci _il� � r��l ZiV� ��C/)ICICIPtt'y ill��4� D' � R1 � +n ��I���� -.
�� . � '��. � C6� ��� -I � , � � �� C ��C7I W I� '��'� 17-�;,� � C �7 f'i,C a3 (
��nl �� � � (�.ic�f�'?I Cn r I �.� � O�Z -i����l�l .:�-.� m� ��W a f-�-I � � ..
° ��mN� - � ��� `. � i � _ � I�' ,I �I l�l� z,"�It�i��'�Int� a � � z z m .
� �.I Rl �� � f � �.� .�!. � �� r..�� � I. � --{ �I :G3�� r .
i-
{J � � � �, ., I'�, I 'i . �:� �� �I � , �i--� .r .� I � j: � i� ,� � � .
1 .' ' . I�'. I . � -�� F � - .
� I �-- fi I� L i
�. � � ��j � ; I��, - � � 'i i� �r �. . .
1 �L i� �
� �� �� r� i � I I ' I \ I �I � � I,i I � � � j } I s
� ` � , I i ''i I � 1 - � � �VI -�-- -� � I_�f I'I i�_ i � _
f �-,�� � � I �! 1 �
�' � � .
_1 E �� ��� � , �� , , ,� . r � �. r �
1 I I , � , , �� , � , = I ; i ' � � ;� i ,� I , ,
I ' � � 1 ' � � � j � i f � � � '� ' ' ' i' � �� ��; '�
' i � � � ; ,� � I ; ; �
� ! � I . �
�. , ; _ ;
� ,i ��- ',' � � ' ' � � I � , � t � � ; �! : ; , , � � �
; ' I �`` I � , � .{ , � , I - i s �—
� i, � . _ i , i �: :r � �` ; , :i , i s�;:�
, �L �
�., i : , = � _
� x , , ; � ' � � -- 1� - �-- ���� �1 _� � : �c�
. _ ` , - -
r: ' . ._ ' � I G.�._ I 1 rTiG r -i!� O -o v:�vl,i���� ,z,l�,j��nl-n c � -iT� ���7
. . . . . . . _.... . � ..,. ... � .., �..... � I . � r���I. _. r�IJ Ir.,-- D..c! I��r r r � ^�'i..(31 Ir-1 I2Iz7.�v 7`'ilfn�vl� � ��� =,
_ 'y �' S "r1 _ _
_ i. I_..... . , � i �.< i ':: �s... � � =ia Qj�jo �i���'7 alolc'!= � D � z��;rn rv �I�,mlo , � �
m � z z � ni O D'�O O
t � 1 n i �f��� 'T� o
I f ` ( . I. � m Ca I F sa� t�.-n.l C] �-
I.. � I ` � � I - � C ������;�I�f�f u, p � �I'T' x�:��7 o'z � p jc� :� r �-.� ^ -. 9 4 9-�
� �� � il �a -r i � � � mv �ilz'�t�'n z � riC'���ti A n� ��,� � z �1"' m C7�0 -i�cn : ��3
I ;__� � �) I�p ,_.�I Gy vy r I v;�'7 z:� ��.�o � � m 0-I m I�i O °J o:��
i I . �pll� D � '�� � "7 �y7:�� Z.:ZI � '�t1�D 5,,��0 JJI1l- � . �..�
? " 1 `I I.�. f., �+� � D., 'TS�' I 7 �! .,i ; �_,�
i � :I � �, z r , i � I ,I I j. ,5�, ' � p!Z .� C. �
� , i � -� - � �: .,� D . iG�i I ;I � 1 I '� I�i �'� ID �- �I !� . .� �.
' , . : ��� . . .. 1 i
;
i :1 I i�.. �� � r � �r � '� j --"I '� � ! ' 7'I�j1.IG -�i .,i c� . .�
� I-:. � � � � � .:;� ^' � i:= �I ' �_�, I � � :I , � 1` ( �� �jzl� '
P i 'i :.I � �� � � L � � ��-, � �:,i � _I. �,. �� i� � � ,
� � I � � j � i � � � �" � � ' �.�. � {- � — �� '=1
� ; i i — � � ..�-_ i i I
i ; I ' � l' � `� ' � jy � I .I I � ! I i. I � � o. ,.
i . ' CI ,I � i :�I I I j` li i � �'� I __ � � G:. , :� � �
� I � ' ' ! ' ��� � i- i� � :I �_ E �- ' � `�
�� � � i j i�s
E ��"�~ ' :I � '� �_ ' �� �f.: _
f � � � _ , ,1 �� w� � r, ; i �
:� ,�
' � � � I � I ' � ! � ' ' + ,�
5 � ,
� i � =I � _ � �I �~ ; � � g
I �
i � � � � � �� � '�`� i � I
a , � - , I � I t t � ( �,
� � � � { I � ;'� � _i � � I � �°�' � �.
Y
Y � � ` : ' . ..1_ j � , ,
..
,,
I ! � . -� � _� I , ,� , .. -� � � � -�� �. i � �: j:.
_._.,�_ ,�I_.���.=�.�l.�m�..�._�. r - --_�___.. �..__�.m.�.,1. �__.�_.�.._i ._�_.I._ _!___1__�_ '�,__�,_��.�..�...�'�M._�_,.�.��_ .._
!___,�_�v�