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HomeMy WebLinkAbout13098 , �x {r? ^ �` CITY OF DIAMOND BAR r J/ DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � ,� , 21660 E.Copley Drive 5uite 190 (909)860-3195 Fax(909)861-311% PRESS �`'°�"� � BUO.DING PERMTl'APPLICATION FIRMLY 0 DDRIESS /Z.�/^� �-/�� �: DATE CATIONr�//, �G� NUMBER #/C '" ���./�/� �____— °D A �r ��� LO � TRACT y�S�� DATE ONST. GROUP p OWNER �/C- TB�� y " ADDRESS Zz- �s� �f° ZONING SEIBACKS W CITY . Z�P r �f TEL4l1� FTGO � FRONT RW LJ � APPUCANT ' /� ��GL �u�i�TEL.'j�y �t.S S�iN ',a' ' REAR ❑ Z SIDE/SIDE STREET FW fJ � CONTRACTOR •G �CS Ct�--��' SIDE r'_ _ ADDRESS 7io L 4*5 ,.�i� a� •4�✓�L / PROPOSED USE P��r�t Li,-- r � CITY�}�. �✓� ZIP�/� TELG�d�5�S9m� /� � Y�.C✓�tt�? /�� ! /TNT/y/�-�!�s+� .:�/r"L- w ARCHlENG/ — WDESIGNER NO.DWEL. NO. NO. � AD�RESS : UNITS STORIES _i__ EiEDROOMS CITY ZIP_ TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREAlVALUATION Q OWNER-BUILDER DECLARliiION SFR/ADD/REM Q 1 HEHEBY AFFIRM UNDER PENFLT'OF PERJURY THqT 1 AM EXEMP7 FNOM THE CONTRACTORS LI� GBfflge/CflfpOf[ W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBU6MES6ANDPROFESSIONSCAOF:ANVCINOR ' (n U �NfVWNICHREOl11RE5APERMITTOCONSTRUCT,Al7ER,iMPROVE,OEIAOIISH,ORREPAIPANYSTRLIC- �W P8l10/DBCK W TURE,PRION TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT POR SI1CH PEflM1T TO FILE A SIpNED •w � STATEMEM THAT HE ON SNF IS LICENSED PURSUflNT 70 TfiE FROVISIONS OF�HE CON?RACTORS L� � CENSELAW(GTIAPTER9(COMMENCINGWITHSECTION7000)OFDIVISION30FTXEBUSWF.SSANDPRO� ' LL POOVSpB FESSIONSCODE)ORTH4THEORSHE.ISEXEMPTTHEPEFROMAND7HEBASISFURI'HEAI.lEOEDEXEMP- .� TION.MIYVIOIATIONOFSECTION7031.58YANYAPPI.�CANTFORAPEfiM1T5UBJEC75THEAPPLICANTTO �:Z RB-fl001 � ACMLPENA{,TYOFNOTMORETHANFIYEMUNDFED�OLLARS(S50o).): � ❑�,ASOWNEROF7HEPROPEfi7V,ORMVEMPLOYEESWITHWAG[SASTNEIRSnLF.COMPENSATION, �C� Commerciai �' �. WILL 00 THE WORK,AN�THE 5TflUCTURE IS NOT INTENOE�Ofi OFFERED FOR SALE(SEC.70aa,9U51� _.1 � NESS AND PROFESSIONS(?�UE:YNE CO4TRAC70PS LICEN9E LAW�OES No7 APPLY To AN O`NNER OF :� PpOPEHTV NIHO BUIIDS OR IMPROVE5 THEREON,AND VMO OOES Sl1CH WOfiK HIMSELF OR HERSELF OR OC iNF10UGH 11150R HER O1YM EMPLOYEES,PROVIDEU THAY SUCH IMPROVEMENTS AflE NbT INTEkDEU OR � QOFFEREDWRSALEIF,HOWEVEfl,TMEBUILDINGORIMPROVEMENTISSO;DWITHINONEYEAROFCOMPLE� _ � 710N,THE OWNER-9111L0ER WILL HAYE T7iE 6UPOEN OF VROYING 7Hq7 HE OR SHE DID NOT BUII.D OR � IMPflOVEfON7NEPURPO5EOF9ALE). OI,ASOWNEROF7HEPROPERfY,A/.1EXCLU5IVELYCANTRAC7IAGWIiHLICENSEDCONTRACTORS . • � TO LON5TRUCT THE PRQIECT(SEC.7D49,BUSINESS AND PROFESSIONS CODE:iHE CONTRACTORS LI- VeIU8ti0n ________� ._,_._ADJ.AREA_.__.,.____ � W CENSELAWDOESNOTAPPLYTOANONRJEAOFAPROPERiYWNOBUIlO50RIMPROVESTHER[ON.AND �. p � WHOCONTMCTSFORSUCMPROJECT55YITFfACONTRACTOP.(S�LICENSEDPtJRSIlANT707ryFC(NTRAO QUANTITY DESCF9IPTION FEE � �" TORSLICENSELAWJ. � � /��] ' ❑IAM EXFMPT UNDEF S�C. D.8 P.C.FDR TH:S REASON Q � !f"G'' /'9 J � L���. I O ---...--_ U ''i _� �-'-----'-- -- � "R" ts '�� ��'""�'t- � DATE ___._OYMER - w ` ' 7 °yt� .0 P..,a.-- oz � LICENSED CONTRAC70RS DECLARATION �y f�,�,,.rr � K7�G r����S' � 1 HEREBY AFFIRM UNOER PENALTY OF PEKIURV'fHq'f I AM LICENSEO UNDER Pi70V15�ON5 Of CHAVTEH � � D(COMMENCINGWITHSECTION7C�IOFDINSION3OFTHEBu51NE55ANDPftofE551CT�5CODE.MID Z X MY 4�CENSE IS IN FULL FORCFA4P EFFECT. / 413 ! d Z t~f � � � LICENSE CLAgSS__ ��A LIC.NO.�yL _._r_!______ � V DATE ✓ �I�^ �� rL_. CONTRACTOR/T°L� �GS'1E�°'� __'..._.__ � a u.i � WORKEHS'COMPENSATION DECLARATION a � IHEf1EBYAfFIRMUNDEflPENALTYOFPERIl1RYONEOFTHF.FOLLOWI�G0ECIARATIONS U CA Q O _�i NAVEMID WILI MAINTAIN ACERTIFICATE OF GONSENT TO SELF�IYSURE FOR WORKERS' _ Z COMPENSATION,ASPROVIOEDBYSECilON37aoOF'RiELABOflCODE,FDRTHEPERfORMANCE U � OF TH:WORK FDR WFIICH THI6 PERMIT IS ISSUED. � � w _IHAVEANDWILLMAINTAINWORKERS'CAMPENSATIONINSUHqNGE.ASHECUIqEDSYSECTlO� Q3�a00F7HELHBORCODE.FORTHEPERFORMANCEOFIHEWORRFOHWHICHTHISPERMlT15 _ ISSUED.MY WOr7KER5'COMPENSATION INSUf7ANCE CAqR1Ef7 ANO POUCV NUMBEFARE CONSTRUCTION ____ _ � . - _'.._ ..._—_""'_ a � 7 , r . GARRIER d"��G'Olt i�� � '�•'^•--���'_'_-.'.-.-.-.--__...__ PLAN REVIEW > ` t �p �-- �----..._ .......�- -----'- --�--....._..---`-'- � POLIC�NUMBER v L? D�[f �/� - __�'�` J_.� ELECTHIC ___...._—_..__ � � —" ..._.._...... _— d 0 (IFY&SECipNNEEDNJTOEWh�LEfE00F7HEPEFiMfTISFOROYEMN�OR5D�011.PA5(EIa01(N�ILESSA PLUMBING ----.........-----. _........--- --.--..._. W � I CERTIFY THAT 14 THE PERFOFMANCE OF 7HE WOFK FOR WHICH THIS PERAl1T IS ISSUE�.I MECHANICAL .,...__—__� ,._�..__ ._.._.— SHALL NOT EMDLAY AN'(PERSON IN ANV MANNER SO AS TO BECCM�SlJ&EGT TO TI if � WORKERS'COMPENSA710NLAWSOFCNLIFOflNIA.�NU�CR'eETHATIFISHOULDBECOME iNSPECYIONFEE � ' " __—'�,..,�__ SU&IECTTOTHEWORKERS'COMPENSATIONPAOVISIONSOFSECTI0Y37oaOFTMELAeDR � "fi � COOE,�SNALLFORTHWITHCOMPLYWITHTHO vwioNs.�ry � �SSUANCF ._...___._ � ' - .. . � _' -"..._ p DATE '� �'�r` APPLICANT.__����11/7 4/`^-�='-` SMIP �.'__.._.. . "'..... .........._ J � � WARNINGFAIWHF.TOSECUN[WORKERS'GOMPCNSHTIONCOVEIINGEISUNLAWFUL,ANOSHA�LBE ENERGYP/C ____..._ ` J _—_...�_....._ '"' �y SU9JECTPNEMPLOYERTOCRIMINAIPENALTIESANDCIVILFINESUPTOONEHUNDR[UTHOUSAND �' {� "� DOIIARS(S1W,OOD),INA�DITIONTOTHECOSTOFCOMPFNSA7!D4,�AMAGF.SASPROVIOE�FOflIN ENERGYPERMIT ___ ,.._. _ __.�.__ ' �`� �"'-" ''— � SECTION370BOFTH[LABORCODE,INTEREST,ANDATTORNENSFEES. RETENTIONFEE: ,._... �� 1,�'�r~ ......_—..___"�"..\';. W f� CONSTRUCTION LENDING AGENCY PpE-AL7 FEE: .�-L+`a7�' ^'�'� � _...,._—..._.—' - .. ;;,s..,._..----` - p Y � <�,i � I HEREBVAFFIRM UNOEFl PENALTY OF PERJURY THAT TH[PE IS A CONSTRIICTION LEN�ING AGENCV �-��__"' _,_._,_,__,_..._ FOHTHE PERFORMANCE OF TNE WORK FOR WHICH 7HIS PERMIT IS ISSUED(SEC.3oA7.CIV.C.�. ��� �__ ____�4��.'�'� � LENPER'SNM1E __'"__""_" �.� � ___.._•.a�es��"' . , H- LEN�ER'SADDHESS.__ ------�-- --��--- . � I CERTIFV THA1�HAVE READ THIS�PPUCATION ANU STATE TMAT THEA90VE INFORMATION IS CORR[CT. TOTA�FEES �4 � I AGfi[E TO CqMPI.V WITH PLL CIN M!D CAUNTY ORDINANCES ANO STATE LAWS FF.LATING TO BUILOING i. � CONSTRUCTION,ANDHGREBYAUTHORI2EFiEFRESENTATIVE50FTHISCOUNTYTOENTEflUPONTHE /¢'} y� • //// //�� •/y nQ � A90VE•MENTIONW PROPERTY FOR INSPECTION PURPOSES, COMMENTS_�y/�a./� �•'' � �—�LL.�� ���•�°_:._ � ' � — � . . �.G -/,trS ��G�.� -- J �R;� �`�v,�-��,�- _ �r��n�- � , � -__ ..... �- '� ¢ PEFMITTEE N9�P 'T}� �7�'�� f • _"____—__ —'__ cn %is(:"/L '� '�� �'/�-`/� � —. -- --��— ------ � - ' ---- N SIGNA7UREOFPERMI7TEE �ATE . 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