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HomeMy WebLinkAbout14808 (19) fi � ,.„ '"" � , , �t _ CITY OF DIAMOND BAR r---��� � DBPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� 1� , / ;1 ,,� 21660 E.Copley Drive Sirite 190 ��r�,,/ ii (909)860-3195 Fax(909)861-3117 PRESS ��'»�'J BUILDING PERMIT APPLICATION FIRMLY � a DDRiESS� � � ' � � 0 APPLI(:ATION PERMIT p/p p _ DATE �NUMBER # $ i ISSUE TYPE OCC APN_ LOT TRACT DATE, � CONST. GROUP °C OWNER .�C.�+ . ^ 0 p ADORESS__���'Tr- ZONING SETSACKS �W CITY ZIR. TEL. FRONT RW__ r� APPLICANT ` ''"" TEL. REAR ❑ _ SIDE/SIDE STREET_ RW ❑___. � CONTRACTOR N�al� ab. �G SIDE __ _ ❑____ ADORESS � � CITY o ' ZIP _- TEL. �0 PROPOSED USE c. iS�' -'���L�'�" w ARCH/� G/ '�t rr-'�rni� �". a/v � _ � H " � ADDRESS NO.DWEL. —��-�� '�•NO. � CITY _ ZIP TEL. UNITS _ STORIES _�_BEDROOM � N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANA�UATION � O OWNER-BUILDER DECLARATION SFR/ADD/REM Q I HEREBY AFFlRM UNDER PENALTV OF PEfUURY THAT 1 AM EXEMPT FFOM THE CONTRACTORS LI- G21898/CBfpOR W CENSELAWfOH7HEFOLLOWINGREA50N(SEC.�031.56USINE55ANOPROFESSIONSCODE:ANVCITVOp (n U. ODUNTYYM�CHREWIflESAPERMITTOCDNSTRUCT.ALTER,IMPROVE,�EMOLISH,ORREPAIFANYSTRUG ^ W NRE,PRIOR TO ITS ISSl1ANCE,ALSO REIX11RE5 THE APPLICANT FOq SUCH PERMII'TO FILE A SIGNED �, w PeIIOJDBGI( � STATEMENT THAT HE OR SME IS LICENSEO PUflSUANT TO iHE PHOYISIIXJS OF THE COM1TRACTOflS LI� � � ' CENSE LAW(CHAPTER 9(COMMENCINO WITH SECTION 7oaoJ OF DIVI510N 30F THE BUSINESS ANO PR0- - POOUSPff � � FESSpNSOODE)ORTNATMEOq5HEI5EXEMP7THERF.FROMANDTHEBASISFOqTHEFLLEGEDEXEMP- (� � V TION.ANYVIOIATiONOFSECT10N7031.5BYANYAPpLICANTFORAPERM17SU&lECTSTHEAPPLICANTTO � Z Re-Roof j F ACMLPENAITYOFfVOTMORE7HqNFIVEHUNOfiE�DOLLARS(SSOD)J: ❑I,ASOYMEpOFTHEPROPERTV,ORMYEMPLOYEESWiTHWAGESA6THEIflSOLECOMPENSATION, � COfI11170fC181 �: WILI W THE WORK,11ND TME STRIICTLRE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.7044,0U56 �� � ' � IJESS AN�PppFE&SIONS CODE:THE CANTRACTORS LICC:NSE LAW DOES NOT APPLY 70 AN OWNEfl OF � � GHOPERTYK'HOBUItASOqIMPROVE5THER[DN.ANUVhiODOESSUCHWORKHIMSELFORHERSFLFOR '� � hlfiW6HHISORNERONTJEMPLOYEF.S,PROVI�EDiHATSUCHIMPROVEMENTSARENOTINTENDEDOR ' m � OFFEqEDFOR5A1E1F,HOWLVERTMEBUILDINGORIMPqOVEMENTI550LDWITHINUNEYEAROFCOMPLE- � � TION,TXE OWNER-BUIL�ER WILL MAYE THE BUPDEN OF PROVING TMAT HF OR SME�IO NOT 9IlIL0 OR ; � IMPROVEFORiHEPURPO6EOFSALE). . �y,� l]I,ASOWNEROFiHEPqOPERTY,AMEXCLUSIVELYCANTflACTINGWfiHLICENSEDCONTRACTORS � Q. TO CONSTRUCT THE PRQIECT(SEC.7oad,HUSIN[55 RND PFOFESSIWJS CD�E:THE CONTRACTOflS LI•. . V2111fl[IOfI .__._.__ADJ.AREA W� CENSEIAWDOESNOTAPPLVTOANOWNEFOFAPFOPERiVWNOBUILDSORIMPROVESh1EREON,AND ' -�-"-'-" -'-"' ---- �? WNOCOMMCTSFORSUCHVROJECTSWITHACONTRACTOR(S)LICENSEDPURSIIlUJTTOTHECONTRAC- •� QUANTI�Y �SCRIPTION FEE TORS LICENSE uW.). _ 1 �.. ❑IAM EXEMP7 UNDER SEC. ,__,_ _B.&P.0.FORTHIS R[ASON �� Q � U � - -- ------- �� � LL OATE` OWNER � o. _- "._"-'.._ "_.._.._ W � � ��. LICENSED CpNTflACTORS DECLARA710N W � � 1 HEREBYAFFIRM UNDER PEiJAi.TY OF PERJURY 7HA71 AM LICENSFD UNDER PFOVISI045 OF CH�PTER � �, B(COM�fENCINOWITHSECTION7000)OFGIVIa'ION30FTHEBUSINESSANDPRO�ESSIONSCODE,ANU Z �_ X' MY LICENSE IS IN FULL FORCE AND EFFECT. m — � - LLI 0.. LICENSE CIAS �:-� LIC.No.___ � �J/ %. . j ' ,�- �i�----- J Qr� �j.� �ATE .__ CONTRACYOR._.�S�,�jqt��+'-" d ;�, �� W. /7! �: WORKFRS'COMPENSATION DEC.ARATION �' � Q �-; � _. � ��'� IHEREBYAFFIqMUNDEHPENALT'OFPERIURYONEOFTHEFOLIOWI.4GDf:CLAqATIONS: Z � 0� y� IHAVEANDWIILMAINTAINACERTIFIGAiEOFf.ONSENTTOSELFdnSURFFORN'ORKERS' _ �. -°\ Ca7MPENSATION.AS�qOVIDE06VSECT70N37000FTHELABOf1CODE,FORTHEPERFORMANCE `U _ OF THE WORK FOR WHICFI THIS CERMIT IS ISSUED. Q' � Qw _I HpVEM1D N7LL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION � o/'7 pe 370.70F THE IAHOR CODE,FOR THE PERGORMANCE OF THE WORiC FOR WHICH THIS GEpM1T IS //�/ J ISSUED.MY WORKERS'WMPENSATION INSUflANCE CARFlIEH AN�POLICY NUMBER AFiE� . CONSTRUCTION ,___,. ,_ V � .,. � __..._ "'__'-_' . j CARRIER_'_"_"_'�'����.(di1�j���-.."-.-_-.— , PLAN REVIEW ._ .. _-... ..---�—�--. __...._.___.._ .. ZvaICYNUMeER � ` ' - ` ._.._- .--- �� ELEGTHIC ... Q ./ ��--- -- --��------ -�---- W (iH4S5EC1pNNEH1NOTBEOd.pI.EfEDOFTI�EPERbtf ISFORIXJEHUPARED�OIUpS(51W)(MLES6} ' PLUMBING ' ._.._'" '.-... ..-_ Z I CERTIfyTHAT INTHE PERFORMANCE OF THE WORN fOR WHICH THIS AEflMIT IS ISSU[U,I �� MECHANICAL �- (}' SFIALINOTEMPLOYANYPERSONINANVMANNFRSOASTOBECOM[SUBJECTTOTHE � __ "__' (n� WORKF.RS'CqMPFNSAT:ON�AWS OF CALIFOR�IA,AND ACRE[THAT IF I SHOULD B[CAMt INSPECTION FC'E ___.__ � � � • �^ ' �� SUBJFCT TO THE WORKERS'COMPENSATION Pf10VIS10N5 OF SECT�ON87o00F THE LA90R � � �-1� _ _.. = C/JOF,I ALIP�qTHWITHCOMPLVWITHTNOSEPRbVI51�N5. ^ � ISSUANCE _„_..,_,_ ,___ '��� — - /��'�-- O. .� � _-�� '-,., . . . SMIP —�bF-- ' �ATE: .. i� y'CAPPLICANT: ' '___"_ —_— -... _- • � p —_-._ V� ' ENERGY P/C �• WAflNINGF LU(iGTOSECUREWOAKERS'COMPEN T N � RqCEISUNlAWFUL,AN�SHALL�[ -��--��- ��-�-�---.- --.-____._ � �� SU0.IECTANEMPLOYERTOCRIMINALPENALTIESA ILFINESUPTOONEHUN�REDTHOUSAND ENERGYPERMIT OOLLARS(f100.000),INAD�ITIONTOTN[G�STOF PENSATION,OAMAGC3ASPNOVI�EDFOFIN � ----�-- -�---.-... _...._..__...- �. SFCTION37080FTHELABORG�DE,INTEREST,ANDATTORNENSFEES. RETENTIONFEE: _,_. . _ _ - O� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: .___,_ ___ . ______.__,_ �: I HEFEBYAFFlRM UNDEfl P[NALTV OF P[RJURY THAT THERE IS A CqNSTFiUCTION LENDING ACENCY d WftTHEPERWRMl1NGEOFTHEWORKFORWHIGHTHISPERMITI5155UE�(SEC.9097.CIV.C.�. �---�- ----' ' --' Z w �'- --- -'--� �„ LENDEF'S NAME ____. � ...___"' � F- LENDER'SAODHESS__.._.__""__'_ . _ '---- '"'—'.... _.— 6 -.... W ICERTIFYTNATIHAVEREADTHISAPPLICATIONAND51'ATETHATTHEABOVEINFOPMATIONISCORRECT. TOTAL FEES i\ p /^ .r � IAGREETOCAMPLYWITfiALLC1TYANDCOIINTYOFDINANCESANDSTAT[LAWSRELATINGTOfiUILOING s�// II W !i'� � CONSTHUCTION,AN�HEflEBYAUiFIORIZEREPAESENTATIVESnFTHISCOUNTYTOENTEHUPONTHE /_�G� �J �V� ZABOVE�MENTIONE�PROPERTYFORINSPFCTIONP rtvosEs. COMMENTS Y Q �� __._....... ..-"' J _'"__ � �--�-��- ------ -� '-- — --- m PERMITTEE NAME(P INT) Y ��j � a � '7 f� vv� -- ..—. -- � y SIGNATUREOFPER --- E J- ..—'--' '--' -- -� ' . �� { RECPT.NO. _PAID BY . VALIDATION _ � WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—AssAssor Copy,GOLDENROD--File Copy.OREEN—Applicant's Copy 1� ..,�--.m.°..... & C'"�� � � �. --.._ _ ' ' m �'j f :7� � z �a� 7 '. � �� 1 � ��� .. t " � ` i � !�� � ��.� ��, � .� � � ���� � I _ �,.' 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