HomeMy WebLinkAbout15888 i �
; . ��.
i CITY OF DIAMOND BAR E
� --��-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �4��
i i `� . 21660 E.Capley Drive Suite 190
I (909)860-3195 Fax(909)861-3117 PRESS
( �'�9�, BUII.DING PERMTT APPLICATION FIRMLY
ff � JOBSITE � APPLICATION ` �"}�PERMIT '��� �P/C
; o ADDRESS�'. � � '� DATE �1,�"'NUMBER
� � APN LO TRACT ISSUE TYPE OCC
� °C OWNER� � �� DATE CONST. GROUP
� ADDRESS �� � ZONING SETBACKS
R Z CITY UeL �p • ,5 '' � FRONT _ RW f]__
g APPLIC N - TEL. �� S DFJSIQE STqEET RW CI
E CONTRAC ��'lL (� C SIDE ❑__.__
� � ADb SS �
I p T� l,Yll� �l-�mb PROPOSED USE
CI !1' TEL.__ —
I w ARCH%ENG/ � �
z DESIGNER NO.DWEL. NO. NO.
� � ADDRESS
UNITS STORIES BEDROOMS
i � ClTY ZIP TEL.
� u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLAAATION SFI�/ADD/REM
� 0
0 I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT 1 N.1 EXEMPT FROM THE CONTMCTORS LL � GaragelCarport
� �{7 CENSELAWFORIHEFOLLOWINGREA50N�SEC.7031.60U5ME55AN�PROFE5510N5GO�E:ANYCITYOp .
t.+: COUNTVWHICHREWIRESAPEfiMRTOCONSTRUCT,ALTER.IMPROVE,�EMOLISH,OqREPAIPA!lYSTRUC- ' W Patio/Deck
� TURE,PRIOR 70 ITS ISSUANCE,AL50 RE�UIRES TFIE APPLICANT FOR SUCH PERMIT TO FlLE A SIONED W
STATEMENT 1}iR7 HE OR SHE IS IICENSEO PURSUAN7 TO 1ME PROVISIONS OF THE CONTflACTORS LI�
��' CENSE UW(CHIIDTEF 4(COMMENCING WITH SECTION 7000)OF pIVISION a OF THL BUSINESS AND PRO- ' � PooUSpa
I FESSqNSCODE)ORTHATHEORSHEISEXEMPTTNEREFFOMAN�THEBNSISFOFTHEALLEGEUEXEMP� . �
�� TION.ANVVIOLATIONOFSECTION7031.5BYpNVAPPLiCANTFORAPEflMITSU&IECTSTHEAPpUCANTTO z Re•Roof
� �: ACMLPENALT'OFNOTIAORETHANFIVENUN�REOOOLLARS(85o0).��
C]I.ASOWNEflOFTHEPROPERT',ORMYEMPLAYEESWITHWAGESASTHEIRSOLF.COMPENSATION, 0 COrll(i10fC181 "
. ��' YALl00 TNE WORK,AND THE STRUCTURE IS NO7INTENDED OR OFFEREO FOR SALE(SEC.70I6,OU51- ,.J
'�. � NESS ANO PflOFE5510N5 CODE:THE CANTRACTONS LICENSE LAW DOES NOT PPVLV TO AN OWNEfl OF j
PHOPERTY VA�10 BUILDS OR IMPROVES THEREON,PND WMO 00[S SUCH WORK HIMSELF OR NERSELf OR
��� THRIXH3HHISORHEROWNEMPLOVEES,PpOV10EDTHATSUCNIM7ROVfNENTSARENOTINTENDEDOR m
'i OFFp1EDFOHbALEIF,l10WEVER,THEBUaDINOORIMPROYEMENTIS50LDWITNINONEYEAROFCOMPLE-
'�. ��' 'TION,TNE OWNER-BURDER WILL HAVE THE 9URDEN OF PROVI4G THAT ME OR SHE DI�NOT BIIIID OR
� �.� IMPftOVE FOR THE PUflVOSE OF SILLE). '
� lJ� ❑I,ASOWNEROFTHEPflOPERTY,AME%CLUSIVELYCOMMCTINGWIiHLICENSCDCONTRAC70R5
�' (= TO CONSTRUCT THE PROJECT(SEC.7o1d,BUSINE55 pND PROFESSIONS CODE:THE CQ`1TRACTORS LI� V8IU8IlOf1 .__,_.,___ ADJ.AFEA
W� GENSEUWDOESNOTAPPLYTOANOWNEHOFAPROPERNWHOBUILDSOpIMPflOVE9THEREON,AND
� �� YMbCONTMCTSFOHSUCHPRQIECTSWI7NACONTRACTOR(S�LICENSEDPURSUANTT07HECONTRAC- QUANTITY DESCRIPTION FEE
� TOflSIICENSE IAW.).
io�' ❑IMI E%EMPTUNDER SEC._ __�0.&V.C.FOR TNIS FEASOU ' U
� 3.. -- �
-- ------
u-' oeTe owrrEn _...—. _._.. U
z' _ W
j p�- LICENSED CONTRACfOFiS DECLARATION { W
�� �'-. �MEREBYAFFIRMU��ERPENALTYOFPERJURYTHATIAMLICENSEOUNDERFROVISIONSOFCHAPTER
� � i(COMMENCIN(3 WIhISECTIDN toW)OF DIVISION 90F THE Bl1SMESS AND PROKESSIONS CODE,AN� !' �
7�C MY LICENSE IS IN Fl1LL FOFCE EFFECT. - Z
� u, 'p — ., � � �,
a 0i L�CENSE ct.ASS LIC.ND. r> J
~ DATE CONTRACTOR._ _._..._____— � a
� �:
-���. WORKE S'COMPENSATION�ECLARATION :- ¢
�' U
I � i NEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOIIOWING DECtARATIONS:
i � Z
Q
� t� _IHAVEANOWRIMRINTAINACERTI�ICATEOFCONSENTTOSELfINSUREfORNKIRNERS' �� _
�' COMPENSATpN,AS PROViDE�BY SECTION 9700aF THE LA90fl CO�E,FORTH[PEHFOflMANCE . W
OFTME WORK FOfl WMICH iH15 PERMIT IS ISSUED. �
O
W _IHAVEANUWILIMAINTAINWORKERS'CAAIPENSATIONINSURANCE,ASFE�UIREDBYSF.CTION
Q 37000F1HELq80R COOE,FOHTHE PERFOPMANCE OF iHE WOflK FOR WHICHTHIS PERMIT 15
� � ISSUED.MY�qpKERS' MPEfiSATIQNI(JSURANCE HIERANO�PpOIJCYNUM�ERr�e: .�:. CONSTAUCTION __...___._
� � c�naiea.�, — R�Sd�._ �'� PLAN REVIEW _.....----- ------------ ---
� POLICY NUMBER A 1�1 .�� __ E�ECTRIC ���
� Q �V v♦ � —_._
.—.._
. W.. (nasSEctpr+NE�raorsEo�n�tEooFn�reaxrr�swnoNEuuw�o�owws�siwlon�ss). PLUMBING ._—... II�- �
.
--._.—:
Z. I CENTIFY THAT IN TME PERFOflMqNCE OF THE WOHK FOR WHICH TMIS PERMIT IS ISSUED,I MECHANICAL _._. __ ��
'�j SHNLL NOT EMPLOYANY PERSON IN PNY MANN'cIt SOAG TO BECOME SUF3J[CT TO THE � ) q
� WOHKER5'COMPENSATIONLAWSOFCALIF NIA,ANDAGfiEETHATIFISHOUL�BECOM[ INSPECTIUNFEE _._ �_�.. ` __„�_____
j 5UBJEC TOTHEWORKEHS'COMPENSATI ROVISbNSOFSECTION37000FTHELAEOR � , � /�
E,I FORTHWITH COMP�Y W E PROVISIONS. ISSUANCE ___ .�97''x�a��� J��( 1
. .�� � y
-0 ' � '- SMIP �
�ATE: ._ APPLICANT. _� __—._ ' - �g�
..—_.'_ . . . ' ' "__
W " $ ���------
WARNINGFAILURETOSECUREWOfiKERS'CAMPEHSATIONCOVERAGEISUMAWFUL,ANDSNALLBE ENEAGYP/C ____...,_ .....___.ni'��___—
LL SU&IECTAN EMPLOYER TO CRIMINAL PENFLTIES AND CIVIL FINES UP TOONE Hl1NDRED THOUSANU ENERGY PERMIT
OOII,AflS(j1o0,000),INAODITIONTOTHECOSTOFCOMPEN5ATION,DAMpGE5A5PROVIDEDFORIN ----"'�--- �-------
� � SECTION37080FTY1ELABORCODE.iNTEREST,AN�ATTORNEY'SFEES. RETENTIONFEE: _-.._.__ _ --.___ ---__
pW„ CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IHEREBYAFFIRMUNDERP[NALNOFPERJURVTHATTHEREISACON3TRUCTIONLENDINGAGENCY
d FOR7HEPERWRMANC[OfTHEWORKFONWHICHTHISPEqMITI3133UED(SEC.3oel,CIV.C.j. �--' ���—� ��� � --
Z.
W .. _.'— '_—" __. __
�Z LEN�ER'SNAME_ _ _' —. _—__ . .. .'_—_" _' _ �
�
F 4ENDER'SADDflESS__._ __. _._. _—_ /�
� ICERTIFVTHATIHAVEREA�THISAPPUCATIONANDSTATETHATTHEA90VEINFORIAA7KKJISCORR[CT. TOTALFEES °�� /
� IAOREE TO COMPLY WITH ALL CITV AND COl1NTY RDINANGESANU STATE lAWS RELATING TO BUILDING �
CANSTHU TION,ANOHEpEBYAUTHORIZEREP NTATNESOFTHIS UNTYTO NTERUPONTHE
�, M TION PqOAERTV FOR IN FZT P POS[5. COMMENTS _ _ _
_ ` _ '
� , ' '_'""_ ' _
m TTEE N E(VRl �.'— _—' "
¢ a
� �� —
� sic R PEFlMITfEE" . �.,, �ATE �� .- RECPT.NO. "IJ�PAID BY . j� VALIDATION_.
_ '—
~ WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GFiEEN—AppllcanCs Copy
_�
� �. •_i _� ;— , � , t A i �-�,
� � "ac ' I � : , � ; I� I - ��
.�r I 'i � ,.�a'.
; :'
� .
" . r r ,�u - � � I I ,�'t, � � '� y.
.�x � . "p _ ,4
r � I ' , ' 2
i � i
k ,t f � � ' � 1 1 � i i � J ' .�
Ir
� I I � :
u i Y � _ ' _ . I I 1 } P.:
�
! f - ,.� � �^ ' . ' �� �
i
� �. ' � i -..�. i � - � : �
y �
�I ! i
,: e ' � : , �. j F i i-s
� i
,. „ ,
� ,_
i
E .,_. _ :-'. .. .._..,, , ,. ,;.. . , ; " � - ` ;;.._. _ i _ I
i '
i
{ � I
,
_ �
r, ,
��. . „'. � , , c' �.
; ' '.. ' i ',, i �,. 4 ._. I _
' , '. ' 1 1. I I.. ��
� �.� � � � . I � �� , ' � ! i I � I ' �
: .
t
� ,
� �
� � : i . ' ; � � � fi
, _ ,
r . . : , : . . ' -
, , ' i i ., .:_ , f _ = i - � _...� ,�y
, � i
� ! � i i ; � � `�''
� � ,
' ' i � i i i i �
........ I ; i i
�
,
a . , i i , I ; ' • � j I �
, —�,. [ � i ,
� � ; �� � �, ' � ! ; � � ; � i � ! �i �i � ��, �
� � � � �� � i i �. ' I � .. � � � � ; i � I � i y.
' � . I E j �'.. i f ' , � ' ' 4� :I �
1 i
i ' ` � .�� I i � � ' I .. � A k�� t',
i �
I I 1
I I, � I � 1� �� C - ' ._ ..� � _ fg�3�� ..
� ' �. �' _ _ �. .I � i i���:?.
! � i � . �. � �'� _ �.a
� i � a��
, � � ; �
, ; i i � x
� � � � � � � � i � . � .
�` i
t . . , i . � . - i:p
. . . , - i�-�:,:{
i I .
f � � i �. � � _ �., - '� I �: t ) �55F ' .
4 ' �� � ! ! � I� ', ,��' I 4� � I I � '� ,,.j
' I , � . . I , ( � ,� i ., ',, � ���� .
� ; i
,_
I ' ; � ;� � +y
� • � �
, : , :
, I
,
i � � ' i , i ' � I ! �
, i � t
' �' i � I i , a : i -� � ' � ����
, � . ! ; , �` a
� _
� , , ;
, ,
;
' E � I ` � i i : ' �.r
I ' , I i I ; j P , ` ���„
i i I ` i i _..a ' i ' I I ' I i � � ' V
,
;
i i � � I ;
' � ! ' ' ' I f... j__I � ; ' � I ;_ ��
�
, � � i -
' i � ' � �
i I , i
r i
i : i � ' . . ,. � �, i ,
� � ` � � � � � 1 i7 � � � �� .
' � ._ � 3 , I . I , I I _
,, i..._. ..i '.._ � ;._._ '�,� . . �.... ' . ' , ,. ' � .
�
, i
�
i I I { •
�
i ' . , ; �,. ' i � �