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HomeMy WebLinkAbout10594 (5) CTTY OF DIAMOND BAR I �` COMMUNITY DEVELOPMENT DEPARTMENT V..� �,.� 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 '�� BUILDING PERMIT APPLICATION FIRMLY o DD ESS y�7�� i� `�� " � SSUECATION !' v � TYPE ER �:P -/ +#/COCC � APN LOT TRACT DATE CONST. GROUP p OWNER ���.4�7��—� ' :1�,1 �•rfi� .. " ADD ESS �•• a.1 ZONING SETBACKS w ,.— •s_., FRONT RW ❑ Z CITY � ZIP�_ TEL. � � APPLICANT ' � 2 TEL. ' �'•-��(CS REAR ❑_ i o � SIDElSIDE STREET RW ❑ i � CONTRACTORC�L�F C`.£fix�+�t �`�.�-��.�=C�-S SIDE ❑ � � ADDRESS /l : - �� �>� � PROPOSED USE_ � CITY � ctt f' ZIP �2�'I-?`)_TEL.(`��° ����-G�(�r� w ARCWENG/ � z �ESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION , � � � OWNER-BCIIAER DECLARATION SFRJADD/REM �� � I HEflEBY AFFIRM UNDER PENPIN OF PEflJURY THAT�AM E%EMPT fROM THE CONTRACTORS LI� GefBQB/C2fpOfS .�� W CENSELAWFOqTHEFOLLOWINGREASON(SEC.�031.68USWESSAN�PROfE5510N5CO�EANVCITYOR (f� , U CWNTYWHICHREWIqESAPERMITTOCONSTFUCT,ALTER,IMPROVE,�EMOLISH,ORqEPAIRMIYSTPUF W Patio/Deck Z TURE,PRIOft TO 1T9 133UANCE,A190 HE�UIRES THE APPLICAM fOFl SUCH PEliMR TO FILEA SIGNEO w ;i � STATEAIENT THRT HE OR SHE IS LICENSED PUHSUANT TO THE PROVISIONS OF THE CANTRACTORS LI• � CENSE LFW(CHAPTEfl 9(COMMENCWO WITH SECTION 70oa)OF DIVISION 9 OF THE BUSINESSAND PRO� LL POOVSP8 FESSIONS CODE)OR 7HAT HE OR SNE IS E%EMPT THEREFROIA AN�7HE BA5�5 FOR THE ALLEGEO EXEMP- {' V' TIDN.MlYVIOLATIDNOFSECTION7031.5BYANYAPPIICANTFORAFERMITSUBJECTSTHEAPPLICAN7T0 Z RB-RDO� � F A CIVILPENALTY OF NDT MORE THAN FIVE HUNOREO DOLURS(f50o).): f71,A50WNEROFTHEPROPERTY.ORMYEMPLOVEESWITHWAGESFSTHEIfl50LECOMPENSATNXJ, � Commercial �j Z WILI DO THE WORK,AND THE STRUCTUflE IS NOT INTENOED OR OFFEq[D FOR SALE(SEC.7014,BU51- J tI NES3 AND PROfESSIONS COOE:THE C�NTFACTORS LICENSE LAW ODES NOT APPLY TO AN OWNER OF f} � PHOPERTYWHOBUILDSONIMPROYESTHEREON,ANDWHO�OESSUCHWORKHIMSELFORNERSELKOR � �j 2 THROUGHHISORHEROWNEIAPLOYEES,PROVIDEDTNATSUCHIMPROVEIAEN75ARENOTINTENDEDOR m W OFFEREDFORSPLE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTIS50tDWI7HINONEYEAROFCOMPIE- � TION,TNE OWNER-BUIIDEH WILL FIAVE THE BUHDEN OF PROVIIJG THAT HE ON SHE DID NOT BUIID OR Z IMPROVE FOR THE PURPOSE Of SALC-). = L:11,ASOWNEROFTHEPROPER7Y.AMEXCWSIVELYCON7FACTINGWITHLICENSEDCONTRACTORS W TO CONS7HUCT THE PROJECT(SEC.7064,9USINESS AND PROFESSIONS CADE:TME CONTRRCTOflS LI� V21U2f1Of7 _ A�J.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPEflTVWHOBUILOSORIMPROVFSTHEqEON,AND �' WHOCONTRACTSfORSUCNPqpJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECON7FAG QUANTITV DESCRIPTION FEE Y TOHSUCENSELAWJ. O. ❑IAM EXEMPT UNDER SEC. B.8 P.4 FOR THIS REASOM U ;f � a .:� li" OATE ___'_OWNER—'__�-- — V .� Z W ¢� LICENSED CONTRACTORS�ECLARATION �j � OC I H[REBV AFPIfiM UNDER PENALTY OF PERJJRY TNAT IRM LICEYSED UhDER PROVISIONS OFCHAPTER � _ 9(COMMENCINGWITHSECTION7000)OFDIVISION30FTHE 11SINE55 D Q�S DE.NJD + � 'E�"�LL�S�� �'�'."-';`�-.2 ''' ' � � MV LICENSE IS IN FULL FORCE AND EFFE9i� �'"' ���"f� p Jy Z ! �� �' /�,� �t ,L}(�� `� �� �� '�.�:.�`!� �� UCENSE CLAS U�'�`¢' LIC.NO. ��(�7��� ' � V DATE CONTFIACTOR �� �A.�.L�e�NI t3.J e�.._ d w �_.'_�_—_ � �; WORKERS'COMPENSATION DECLARATION 4 :� � U I HEFEBY AFfIqM UNDER PENALN OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: (ny a t ��' _IHAVEANDWIILMAINTAINACERTIFICATEOFCONSENTTO3ELFINSUREFORWORKERS' _ COMPENSATION,ASPROVIDE09YSECTION37000FTHELABORCODE.FORTHEPERFORMANCE `U �� OF THE WORK FOF WHICH THIS PERMIT IS ISSUED. O � w I HAVE AND WILL MAINTAIN WOHKERS'COAAGENSATION MSIIRANCE,AS HEQIIIRED BY SECTION Q 3700 0F THE LABOR CO�E.FOR THE PERWRMANCL OF THE WORK FOR WNICM TNIS PERMtT15 ��'� � 55UEO.MY WORK fl3'GOMVENSATION INSURANCE CARRIER AND 70lICY NUMBERAFlE: CONSTRUCTION t'^^="-�°� �. '�',� :_. PLAN REVIEW i?t� �_ � CAHRI[R dC..C�G=-n.f ` ... --- .. -- ' C-�.J � POLICV NUMBER___' ��S U ..��'.'-�f� �i� � ELECTRIC � Z �`- � �.'��� p (fH15&ECTKINNE�NOTBE0.�MR.ETEDOFTHEPEM1t�l5WF10�NE/gX�DPEDDQlf$S(S )ori�Essl PLUMBING ,7 �'_. \ � 3��`�"� Z' ICEHTIFYTHATINTHEPEFF ANCEOFiHEWOflKF WHICH � PENfAITI5ISSUED,1 f MECHANICAL ��� �.� � y. ��' (}_ SHALINOTEMPLOVANVP SONINANVMA�INENS 5708 �J�CTTOTHE � INSPEC710NFEE \\\ �y, WOpKERS'CAMPENSAT LAW50FCALIFOFiNI OA HA� ISy6ULD9ECA!! _ y J ? SUBJECTTOTH WORKE S'COMPENSATIONP V SE N�/OOOF Etr �� �/]� COOE,I HALL OHTHWIT OMPI�jj}jT ROV s �..' ISSUANCE � vY ' ■ N � {� ..•' � � , � p DATE:_(.-'_ � APPLICANE _ _._ .%.Y_/� SMIP __ _ ? � c'" ` ENERGY PIC _ 7 WARNING.FAILURE SECUREWORKE COMPE ATIO RAGEISUNLAWF,L,ANDSH�LLBE � SUBJECTANEMPLOVEflTOCRIMINALP ALTIES DCIV FI! �TOONEHU DREDTHOUSANU ENERCaYPERMIT � DOLURS(S1o0.a�0I.INRDDITIONTOT ECOST COMP NS 10. AM/GES PROVIDEDFORIN ¢� SEC7qN 37080F TNE LABOR CODE, 1ERE ,AND A1T R Y'S F RETENTION FEE: W CONS RUCTION LENDI CY PRE-ALT FEE: �. � O� " � 1 HEREBYAFflHM UNDER PENRLTYOF PEF3JURY THAT THEf7E IS A CONSTqUCT10N LENOING ACENCY s FOR iHE PERFORMANCE oF THE WOPK Wfi WMICH 7MI5 PENMI715155UED(SEC.9097.CIV.C.�. .� Z W � LENDER'SNNAE_ _--. F- LENDEI7SA��RE35 - — � ICERTIFYTHATiHAVEREADTHISAPPLICATIONANDSTATETHATTHEAeOVEINFOKMATIONISCORRECT. TOTAL FEES �j �' IACREETOCOMPLYWRHALLCITYAN�COUNTVOROINRNGESANOSTATEIAWSRELATIN�TOBUILDING CANSTRUCTION,ANDHEREBYAUTHDAIZEREPRESEN7AT�y�S�OF-7HIG,.�OUNN70EN7EHUP T E CJ pNEf1PR ,fip7�VFO�RINSPF�Jau RPOSES. ^"=� COMMENTS � - vi.S'i' /� —,� i.0(��(� — — __.� : PE EEN NT) '� /l � 1��� -- —_�—' _ . ., � �� _ � .�� el OF I� DATE , a- � RECPT.NO..' PAID BY VALIDATION ITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Capy.�OLDENROD-flle Copy,GRE N—Applicant's Copy , _. . ___ _._ _ g• �_ .�. _ _ . ._er , i .. ._ ... .. ; . ,.�_. �_ _-r-.� (" i p y :s2 fn� � ' C�i -�. '� -n'-n I`� �',j m�c�� vs f c �(� m 3��}i�t��]7;� sf�C j-� tr. � n ��m � ttil fll i Z z z � b r� r1t �^ -u m y.�j .s O O O�O'� °J D � 73 �i � r!� : � I '; I � Q � �D D�D'alr,im�z�� � �- :-, r��c�c �o!A o -� ���'�o '" �'� � �-,ii � �'a �r �"' � � DI'�i-^9.m ,� � �'�' �G �`i�G7. 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