HomeMy WebLinkAbout11004 (5) � � �`�'��I
--- CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
' :o� . 21G60E.Copley DriveSuitc 19b PRESS
(909)860-3195 Fax(909)861-31]7
'°"'�� BUILDINGPERMTI'APPLICATION FIRMLY
o DDRESS IY��� �1f�ff%Er•..Z� C-�Y�✓�� Ui3 DATEICATION �Z.- � -'� Nl1MBER� ��/� #/C
$ APN LOT TRACT �SSUE TYPE OCC
DATE__, CONST. GROUP
p OWNER _L_�L � � �
p ADDRESS � � C - `' 'I��� ZONING SETBACKS
Z CITY I/ Q 21P�TEL. '� '_��;t=a`_ 7 FRONT RW ❑
o APPLICANT TEL.�`�'�'�l�- REAR _ _ f I_
z SIDE/SIDE STREET RW �l
a CONTRACTOR ` � �'�{„�-f SIDE _ ❑
� ADDRESS I
p C�.�,� „ r� ��P����/��[ PROPOSED USE_
o ARCH/ENG/
iz DESIGPJER NO.DWEL. NO. NO.
a ADDRESS - UNITS STORIES BEDROOMS
� CITY ZIP TEL. —
� --
�n DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATIDN
p�. OWNER-BCILDER DECLARATION SFRIADD/REM
O
� I HEREBY AFFIPM UNDER PENALTY OF PER,IURV THAT 1 AM EXEMPT FROM THE CONTRACTOHS LI- ' G8f7]g/Cdf�lOf[
W. CENSELAWFOHTHEFOLLOWINGflERSON(SEG.7031.SBUSINESSANDPROFESSIONSCOOE:ANYGITYOR : (f� '
U CWNTYWHICHREOUIRESAPERMITTOCO45YFlUCT,ALTER,IMPflOVE,DEMOLISH,ORREPAIRANVSTPUC- ' � patio/Deck
w�. NRE,PRIOR TD 175 ISSUANCE.AL50 REOUIflES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNEO '
STATEMENT THAT HE OR SHE IS LICENSEU PURSUANT TO iHE PPOVISIONS OF THE CONTRACTOPS LI-
� CENSE LAW(GHAPTER 9(COMMENCING WITH SECTIDN 7000)OF DIVISION 30F THE BUSMESSAND PRO. V' POOUSpO
� fE6SIONSCODE�ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXfMP� (�
V TION.ANYVIOLFTIDNOFSEGilON7031.5BYANYAPPLIGANTFOFAPERMITSU&IECTSTHEAPPIICAN770 ' Z Re-Roof
A GVIL PENALT'OF NOT MORE THAN FIVE HUNDflED DOLURS(f50o).):
0 LII,ASOWNEROFTHEPROPERTY.ORMYEMPLOYEESWITIiWFGE5A5THEIFSOLE.CAMPENSATION. ; � COTrtIBfC13�
� Z WILL DO THE WOflK,AND THE STRUCTURE IS NOT INTLNDE�OR OFFERED FOfl SAL[(SEC.7044,BUSI- J
NESSAN�PFOFESSIONS CODE:THE CON7RACTORS LICENSE LAW OOfS NOTAPPLY TO AN OWNEfl OF
� PR07ERTYWHOBUILOSOPIMPROVESTHEREON,MIOWHODDESSUCHWORKHIMSELFORHEFSEIFOR �
2 THROUGHHISONHEROWNEMPLOYEES,PRDVI�EDTNpTSUCHIMPROV[MENiSAFENOTINTENDE00R m
I Q OFFERE�FORSALE.IFHOWEVERTHEDUILDINGORIMPftOVEMENTI550LOWITHINONEYEAROFCOMPLE-
Z TION.THE OWNER-BIIILDEN WILL HAVE THE BUR�EN OF PROVING THAT HE OR SNE DID NOT 6UIL�OR
� IMPflOVE FOR THE PUflPOSECF SALE).
�y„� fJ1.A5OWNEFOFTHEPROPERTY.AMEXCLU5IVELVCONTRACTINGWITHLICENSEDCONTflACTOFS
� TO CqNSTRUCT THE PROJECT(SEC.704I,&1SME55 AND PROFESSIONS CODF�.THE CONTflACTORb LI- Vellldfi0fl __ ADJ.AREA
W CENSELAWOOESNOTAPPLYTOANOWNEROFAPROPFRTYWH06UILOSORIMPROVESTHEHEON,AND
��. � WHOCONTRACTSFORSUCHPRf]I[CTSWITHACONTRACTOq(S)LICEHSEDPURSUANTTOTHECONTRAC- DUA I DESCRIPTION FEE
Y TORSLICENSELAW.�.
� ❑1 AA/EXEIAPT 11N�EN SEC. 9.8 P.C.FOfl THIS REASON Q
�� � _'""'_'_"— . , .
(� ,
�'. .------ -'----- --- — �� � � ..
LL' OATE..__ '_'__'OWNER __'_'_ __' U
Z w
�� LICENSED CONTRACTORS DECLARATION ' W
� IHENEBYAFFIRMUN�ERPENALTYOFVERJURYTHAT!aALICENS£�l1N�ERPROVI510NSOFCHRPT'eN �. �� 2
d 9(COMMENCING WITN SECTION 7000)OF DIVISION 3 0F TNE BUSINESS ANp PROFESSI045 CODE,!�D Z
`X A7V UC[NSE IS IN FULL FORC[AND EfFECT. m ^ a
O � �� .
�. LIGENSE CLA55.___ ��G.N0.__.. � .� +_ � �
V DATE Z.+� CONTRACTOR. . _ z:.. d
�.'.
W
�� WORKERS'COMPENSATION DECLARATION ��� Z
1 HENEBV AFFIqRI UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARAT
Z� _I HAVE AND WILL MAINTAIN A CEPTIFICATF.Of CANSFNT TO SELF-INSURE fOR WOqKERS' _ -��
CAMPENSAiION,AS PflOVIDEf7 BY SCC710N 37000F TNE LABOR CO�E,FOR TME PERFOFlMMICE U f
a O E WOflK FOR WHICH THIS PEHM1713ISSUED. � i
� ;
w I HAVE AND WILLlAAIfJTAIN WORKERS'IXMAPF.NSATION INSURA�CE.AS REOUIRED BY SECTIIXJ �
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCe OF THE WORK FOR WHICH THIS PEFMR IS . €
ISSUED.MV WOR�NEn(iS'�CO,,MVENSAfION INSUqANC�E CAfiRI�EN AN�VOUCY NUFIBER ARE: CONSTRUCTION _,____ _
j CAHFIER�SL _3_:Gl'"�G"'�� ----- PLAN REVIEW _..----_ —
ZPOLICYNUMBER�;��/_T����1�, ELECTRIC _ __
Q
� (ililSSEcipNNE�IJoieEoc4FtEfEDOrTi�EPEFiAvrISWRaNeHlx�ltF.�DOLLAfiS(Staa)ORLE551. PLUMBING _ __ � �
� � ' I CERTIFY THAT IN THE PERFORMANC[OF THE WOHK FOR WHICH THIS PERMIT IS ISSUEU,I MECHANICAL _ ,
(� SH�1LL NOT EMPLOY ANY VERSON IN ANY MMiNEfl SOAS TO BECOUE S110.1CCT TO THE r
� WORNERS'LOMPENSATION IAWS OF CAI.IFOPNIA,AND AGREE TMAT IF I SHOUlO PECOME INSPECTION FEE __._ _, I \ •� -.:
r SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOF IONno00FTHElABOR �. y,,,. 3
� . CQDE.ISHALL ORTMW(TMCAMPLYWITMTH ov�swNs. ISSUANCE eF��x+ ":,�;����_ __
� ��'j���APPUCANL _�_. SMIP '�;j_
p �ATE. -_._ . `---'
J ;WARNING`.FAILURETOSECUREYlORKERS'COMPENSATIONCOVEHAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C _____ ___ _,_, ___
LL SUaIECTANEMPLOYERTOCRIMINALPENALTIESAN�GIVILFlNESUPTOONEHUNOREDTHOUSAND ENERGYPERMN
-DOLUflB(5100,000),IN A�DITON TO THE COSi OF COMPENSATION.DAMAGfS AS PROVIDED FOR IN �p. ---- —
� 'SECTION3708 OF THE LA80R CODE,INTEREST,AND ATTORNEY'S FEES. C..���—
RETENTION FE�� __
�W., CONSTRUCTION LENDING AGENCY ___ __,_
o PRE-ALT FEE:
� IHEREBYAFFIiiMUNDEflPENALiYOFPERJURVTHATTHEREISAfANSTRUCTIDNLENDW6AQENCY
a- FOR THE PERFORAIANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSl1E�(SEC.3097,CIV.C.�.
Z
w —--- — —
� LENUEH'S NAAIE,.,, _____ ______ ._ _ _
F= LENDEA'SADDRESS
¢ I CERTIFY TNAT I HAVE READ THISMPUCATION AND STATE THAT THE ABOVE INFOPIAATION IS fAfiRECT. TO 1 AL FEES ��'� ��
w IAGHEETOCOMPLVWITMALLqTYANDGOUNiYORDINANCE3AN�SiATEUN�SRELATIN6TOBUILDING
� CONSTRUCTION,ANDHEREBVAUTHORRERGPRESENTATIVESOFTHISCWN7VTOENTERUDONTHE
� A60VE�MENTIONEO PROP[RTY F fl INSPEGTI N PURPOSE5.
z COMMENTS
_ `"f"�/� �C°t�. _ __�QL.. �L G� �C.3
m PERMITfE ! NT)
d � � I J_...�� -------- .--
� N �
= SIGNATl1REOF EFMITTEE A7E
RECPT.NO., PAID BY '�' � VALIDATI
� WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicanfs Copy
__w_ �� Y._,.._ ..__. . _._ -__ _._ .._.�, . . .., . ...
�Y I,m��ii �i� cncn L'� I'T'r���n(.,n���� va usi�a c� ��m cn � �I���'� ����� in �i'r�r- ��m
y ' �II��^ mmI � � 'I t'j ,) Iz z �I�I�I�m�� mis, x�x O ��o a) o z�� �IA m G,I-a
tn� I D. > Diy, tn miv ��� ��r.��Ip c C C1C) s" O -� � w O�C� ayi
� � 1 :) �:� �. r-*r r r�yi'vi-i ..Ip�� � r�f, � {,�IG��L7 r � � mTi�� L?'�C -1 iil� �
I i € - n
-.�.C9 � :t . � �.�..R Ii S C1 �I'�7 � 77 D � Z � m S 2 a�n.� L� 'Cs ZI� Q��
i ', . � � :r.. �m�� �t�i -I � �� __ L'l:i �TIIm2:0� 7iTO�p:I01- p .
C � � i?1
fs°i 3 � ,r < �
I �� I
-� -i• c,� m �
�'r
I z r I �
�.1, i _ � � � .C};_i�uy mf..._�Z ��. ��� Iv_�IC clm a m:rn r a7 � m r G: ��:�
C f: I l �; a� r -{ < c T m
. . . .S. *t 't7 -i J I � .
:� � C�'� i a-1- � '3 9 I
� � . Z�� _ � � i_
: f r . o z
- .(n X ; I IJ� . (.. ' . "�. �. �I ��.';(71n1..; "�I ; �� A O. �+m a3�Dl�.l: '_�,S C���.- ��O v)-
N i f l � . S 7 � ��- r� Z 'it i� W'C m �
��� ; � � � ; � �,u. o � � �,�� � 1� n � Q �
I ; { � ; , r ` � � � ; �. �z
I I � { .�. L _�__ �_ � �. _�,: � �— �
i ; ' �� i. I I � �' I I � �
� ' � � i � ' ' '��� ' ' �
, �
���� � � � I � r� I : I �i I i ' ���� ���� � �� ::� i � �� ' � � � ��,�� � �
.� rv� I i .�^i` 1 I �. -" A 1•'� � � �
3. I. � � � ' �t, ;� I ' � � I �
I I �- _ I � .�..� � i �, � � � i i I _
' I I (
I _ � � � i �� �x� ; ' � � ;
_ : � �. ` � � � I ; � ! � ri �. f ` 'i �i �:
� I ' � � , k, I ; � i I , ;I : : l �
.
�. � � , i � , ` I , :� � �. ..
�
� ��� 4 � � � � � � � � � � ,' � � �� �� � �� i i I I � • �a� :�
' �. i � ;i � I {I i , ; f�/ � I � � � �°,�
,
� - �
� �:' . :.. .i f ,: '' � :i '_ F.._:t� �,' -� -�-,�_L—'_.} -{- .i..- �:-�� ..-T� � �'� .
�
„ . � . � 1_-_-�'- .� � . . .,i�...
' , . �. . � .I.__ i � _..) � ,...- . � T 'i1i'J I' _ � ��- . I ._. _ _ IC =�•� _a` ..
... :'.:..j . / `l T , y I I��37I�IC ...�
. p ,S 'r9 O ,'�. � � V T 'A C.7'T/ "'I�� '+�
` i � � ���Iz n;T O�v OIZ O � T� z.T�� z,� �� �i �
i In
_1 . I � ' _ . � � � �m� p �� ❑•��O O O -Ic �Im,D��l m�ml���o �+ � x.
� . . . ' .' � .. . ' . -� �� .. � I'�,I�IC.��pim.i�I�.i�Imlz m�r �I�I,��� z � JI�I�.iTIT.��j.� �.;�
� i I � . . i I � 2 i � .
� ' � � m =� '`� � �,D O z m�i� 3, d i � � �� �
� � I � .�.I � . � � I . � i r�-i�Z�� �I., 10 � D�.zI.j�IDl�ii i��� � � m�m rJ10 �'.�°. '� �� :
�� � 'o -4 �Iz:vlm z i i_ .a p,a �z � I � 4�. �
,•'� � ..,.� � .:��I ��s i. � i ( D�-d�Z��fm�� I(n� � I?� p�� . �7iW frt � p'�.p�� 7�7 � � .�
t I � � a "� I�'��I a��. � ("' ��c I� �ai� �I�i� � o �.�� <
� � �� I - � ' ( �z (�, i �E I �� r�l� � � �
r
' - i � ° _ � i ...� a D � _ ` � i j. ; i � � �{����I��p l ' �:� �
;
,, � �". � ; i� �. i E. � �:_j I�-�o ��,� .� �
' � � �:��� � �� � �. � � z� ;
� �� � � � � � � ��� i .�„ i � ��-; �_� � �h•�� .
; i 1 I` „�> ' ��j , , � 1 -- —�--�-�—I �
: , / �
� %� > � : � ,. l i � ; i '' , ;,I .�,
� 'f .� �
� ',� ::� �� i� i I ` G � i
, � ' � . ` ° �f s � � '- � � I � �
� € N �
��. _ :I, ,.� � i �.,, } i ,;1 ; _
�..
� . ' i `� � ': -- , r - --- ,,
i � I
�
_ �' i- r '� � 'r ` � � � I� ; �_. _
�� ` _� -� �' ` lv' I I � �. � � � �; � � �' i �
I � � -
�' � , I I i �.
� � �
� _ ' � � - � �� � �� � � � :� ��. .
; ', (; I I• i I i � . �
�.I � + ;� �' . , ' ' � , K �` }' . � - � I 1 � I , I ,� ' r , � �
bI I.._.�!. � � 14. .,.� !'. ,:II; r,. i: � ,:,,) ; �. � _.` C �.::. f �I :�i. i. � j_ ;I. �..: � :.
� I _ q.,J_.�L._���.J----��_..�..__�.___1_�_ __ __.. _____.__ .__.I.�..�... _ :.�..�, �..,,�...1..,.,_..._�..L i_,.i..._�_1__,..i.._.� �.... -