HomeMy WebLinkAbout13667 (14) � ��
�.� CITY OF DIAMOND BAR
DBPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
> 21660 E.Copley Drive Suite 190 PRESS
(909)860-3195 Fax(909)861-3117
��'°�' ` BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE i APPLICATION ��' �/ PERMIT 1--I�.�n P/C
o ADDRESS_� !��� ����'1^ � � DATE NUMBEIL � I_ #
� ISSUE TYPE � OCC
�- APN LOT TRACT DATE CONST. GROUP
°C OWNER � �:�
O
� ADDRES ZONING SETBACKS
� CITY ZIP�:�� TELS � FRONT RW U
APPLICANT TEL. REAR ❑
� SIDE/SIDE STREET RW ❑
� CONTRACTOR 'S► SIDE n___
� ADD SS '
� CI7Y ZI TEL. - - (^j PROPOSED USE_ �'�-""'6 "�
� ARCH/ENG/
�z DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�.
u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REIv1
O
� I HEREBY AFFIAM UNDER PENALTY OF PERNRY THFT 1 AM E%EMPT FF70M THE CONTRACTORS LI- Gdf9A0/CBfpOft
W CENSEIAWFOHiHEFOLLOWINGHEA50N(SEC.7o31.5S11SINESSANOPROFESSIONSCODE:ANYCITYOR (n
C.�� WL1NiY41MIq1HEWiRESAPERMRTOCON5TRl1CT,PLTER.IMPpOVE,OEMOLISH,ORREPAIRANVSTRUC- �j,� pyi10/DBCk
Z 7URE,PFIOR TO ITS ISGUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
w' STATEMENT TI1AT FIE Ofl SNE IS LICENSED PUflSUANT TO TME PROVISIONS OF TNE CANTRACTOR$U• W
:�. CENSE UW(CHAPTEH B(COMMENCING WRH SECTION 7000)OF OIVISION 3 OF THE BUSINESS ANO PRO- u" POOUSpB
� FES8qN4CODE�ORhIATHEOH5HEISEXEMPTTHEFEFROMPNDTHEBA3ISFORTHEALLEGFDEXEMP- � y�
.V TpN.ANYVKKATpNOFSECTqV70.s1.5BYANYAPPLICANTFORAPERMITSU&JECTSTHEAPPLICANTTO Z fle-Roat Y
� ACMLPENALT'OF N0T MORE THAN FNE HUNDRED DOLLARS(5500).):
❑I,ASOWNEROFTHEPROPERTY,OFlAIYEAiPLOVEE6WITHWAGESASTMEIFSOLECOMPENSATION, � COrtlrtlefC121 '
�g� YIILLDO THE WORK,AND THE STRUCTURE i5 NOT INTENDED OR OFFERED FOF SALE(SEC.7044,BU51- J
NE53 AND PFpFE531IXJ3 CODE:iHE CONTflACTORS LICENSE LAW OOES NOTAPPLY 70 AN OWNEN OF
�� DqOVERTYWF108UILD50RIi.9PROVESTHEREON,ANDWHO00ESSUCHWOPKHIMSELFORHERSELFOq m
i ,CC� hIHOUGHHISORHEROWNEMPLOYEES,PAOVIOEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOq
W�. OFFEREDfORSALEIF,HOWEVER111E8UIL01N60RIMPROVEMEMI550LDWITHINONEYEAROFCOMPLE-
��� '710N,hIE OWNERAl/1L�ER WILL HAVE THE BUR�EN OF PROVING THAT HE OR SHE DID NOT BUILD OR
��� �IMPROVEi'ORTHEPURPOSEOfSAIE). � �
;�y,�; ❑I,ASOWNEROFTHEPHOPERiV,AMEXCLU5IVELYCOMflACTINGWITHLICENSEDCONTRACTOR3
��� �70 CONSTRUCT THE PRD.IECT(SEG.70M,&1SINESS AN�PROFESSIONS CADE:THE CANTRACTOHS LI- VelUet1011 ADJ.AREA
'W. CENSEUWOOESNOTAPPLYTOANOWNEROFAPROPEflTYWHOBUILD50RIMPFlOVESTHEREON,AN� — ---
.� WMOCOMRACTSFORSUCHPROJECTSWiTHACONfflACTOR(S7UGENSEDPURSUANTTOTHECONTflAG QUANTITY DESCRIPTION � FEE
Y- TORS LICENSE UW.).
� L'J IAM EXEMPT 11NDER SEC. B.8 P.C.FORTHIS REASON � Q
� U
� — ----'----'-----�—�---------.'-..............'-- . � .
� DATE OKTlER � V
� LICENSED CONTRACTORS DECLARATION W
�� IHEflEBYAFFIRMUNDERPENALTYOFPE0.IURYTHATIAMLICENSE�UNOERPROVISION50FCHAPTER � I �
d•, 9(COMMENCINOWITHSECTION7000)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCADE,PND Z
�.['. MY LIGENSE IS IN FU OF EFFECT, ,+., � �
W'
0:. LICENSE CLASS LIC.NO. � " �V � ��
:UT pATE r _CONTRACTOR_ L L�f�
W4
�.[� WORKERS'COMPENSATION DECLARATION a
= U
��� IHEHE9YAFFlRM UNOER PENpLTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
:�� Z
0' �IHAVEANDWILLMRINTAINACEiifIPIGATEOFCONSENTT03ELF�INSUHFFORWORKEfIS' _
'.;�'. COMPENSATION.AS PROVI�ED BY SECTION 3700OF TME LAB�R COOE,FDH TH[PF:RfORMANCE W
OF 7HE WORK FOR WHICH YHIS PF.flMIT IS ISSUED. �
0
I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS FEOUIHED BY SECTION /
�Q.'� 37000FTHE IABOR COUE,FORTME PERFORMANCE OF 7HE WORK FOR WHICH THIS PFRMIT IS r j
`0: ISSUED.MV R�ERS'COMPENSATION INSURANCE CARRIER AN� ucv NUMu�n aaE�. CONSTRUCTION �� _____
a+ -- —
;�. CARHIER � �1 -,f PLANREVIEW ----.._._. ..-----------------
O., �icvNUMeed�x.� " ELECTRIC _._...._..--------- --------.----
��'� (fH1S5ECiqNNE�NOTBEOJMPLEfIDCFTHEPERWTISFORIXJEMNDRED�OI.LAR5�5100)OfiLE55} PWMBING
,p� —.____—_.—._____._.. _—___--
-,Z�� I CERTIFY THAT IN TME PERFORMANCE 0 E WORK FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL ______.__ __ ___ _____
���' 6HALL NO7 EMPLOY ANY PERSON IN ANNER SO AS TO 9ECA E SUBJEC7 TO TNE
�,(n'" WORKEflS'COMPENSATIONLIWSOF FOflNIA,ANDAGREET �If"ISFIOUIUDECOME INSPECTIONFEE __________ _
� SUBJECT TO THE WOfiKERS'COMPEN ION PROVISIONS OF 5 ON 37000F Tf1E Ln�6F� '
;� DE, SH IFOR WITHCOMPLY T l}WSEPROVISIONS. / j ISSUANCE _.___.______� ,_„�,__
�;:� '— .�= SMIP �
;:;`p' DAiE: � APPLIC � "'---1' '--'- .
i� ENERGY P/C
,:� WAFlNING FAIWR[TO SECl1RE WORK 5'COMPENSATION CO EPAGE IS UN UL,ANO SHAIL E ------�------���------
` SUBJECTANEMPLOYFRTOCRIMINALPENALlIESANDCIVILFINESUPTOONEHUNDREDTHOU ENERGYPERMIT �
DOLLARS(51ao.oW),IN ADDITION TO THE COSTOF CAMPENSATION,DAMAGES AS PROVIDED FOR IN ---
•�'J�: SECTION9'laeOFTHELABORCOOE.INT[REST.ANDATTORNFY'SFEES. RETENTIONFEE: �
_.Q.. -.
;'d' CONSTRUCTION LEN�ING AGENCY pNE-ALT FEE: __,._. _ �
;;O;
'��P IHERFBYAFFIRMUNDEPPENAL7YOFPERJURYTIIATTHFREISACONSTflUCTIONLENDINGAGENGV
FOF THE vERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED ISCC.3W7,CIV.C.).
Z.
':�W.. '_—""._.__—'._'_'___'—_ _
•�t LENDER'SNAME_.__.
.. _"_' "'_—
F_—� LENDER'S.ODUR[SS ________—.—______._
�' TOTAL FEES +
�` 1 CEfiTIFYTHAT 1 HAVE flEAD TNIS APPLICATIONAND STATE THATTHEABOVE INFORMATION IS CORRECT. ��
�,Q.' IAGHEETOCOMPLYWITHPLLCfiYANDCAUNTYORDINANCE5AND5TRTEUWSREUTINCTOBUIL0ING
;,Z, CONSTRUCTION,ANDHEREBYAU��7}WWW HIZEREPRESENTATIVESOFTHISCOUNTVTOENTERUPONTHE
�E-MENTIONEO PROPER OI�INsaECTwH ruAcosEs. COMMENTS ___ _
�9' �� 4 ��--- ------ --
_ --
m P ITTEE NM1E(PflINT) � �
Q _'
C!�
� NANHEO EFM E � E
,= RECPT.NO. PAID BY VALJDATION
��~ WHITE perlment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROQ—FileCopy,GHEEN—Applicant's Copy
�
._. .... .. .. �_ _. _ - -
���� �� � �ti r�� �� � � , - , , I= e �, � ` 1 '� _ � � ��� ���� �
�� � k ��1� a . i + � " � .r
��#"fq�����{�`�F � t ! ', �.. 3 M j ( j�..y f �. t �.� e��� � .
�7 a r �. 5��p pC�� �f �' , i � _ � I t " i I 4 � � ��'
��++� `"����k�^��.�� � , ' � � � � t� ���, ��� � � , i�`� 1` M�„�
� +��.xas�raa .: a� �� ; ( - j , � a � �. I � S�
y a 5'�.-��.� E �,#r e < l ` S i i : j � � � � ' � � d.�^��;.
g �������� , � �� �� b: , �� � �� „ , �
E � '`�Fh= r�3 �&�i '�r a ,`i � ' I 1 � ;�-s i i r ! 'F'x �''
� ���� �'i r'� � Y'�i r�'�3�q �� � � i i �� !
x� t � t� � ' _ . .
J��� ��.� ��. �,..�xn r . � r.^ , � � . I
��.�. ..z+< "�.�r N .; ,. �, • - ; .l --..� � � L , i _' �._..� � �V �
1 I �
.��,..�.,:� a��-i3^� . ,c � ' I ; .��, !... �. i , i ..�.._ 1 ' k '�' _ � ��. �..
� { ' 1 I
" { t , � + ��
,
. _,_ ...; , �
, _.. ,
� v i , i, i i ' � � � ����
�
I .... �,.:� ' �,,�, i '�i� �, �' 1 I ; . ! � . . ' j � I � � _,(N� _.� � � � ..{:.r�
� � � I
� - -� � �. I i �. . _ ��� ( . i_ � I : �i ., _ W',e`,"
---+- I I
i � I I � � ._j 1 � . � I ....._i _ ... } �
'; ! i � ! ' _ � _ �_ i. .
� i � � i � ,
� � I � , j � � � ; � j � � � ���
' �
I � � � , � d � � ' ���i � � � � �;
f i � ti:
� ` - r i I ' � i `. ' ' � � ' I ��s:
� ! � ' i I � �� � � i i I . i i "�€� �;e
� ,..., � � ( i � i 1 i � . j � I a a�� '"�
� �
� I I 1 � � ���
; f f _ l � �_ � ` � � . 1 � } � - � � �a
,.. I � ' I t5= .- �n �� 1... _ .. ti .
�p ' I I I I �� � f �, �� ,, I � � ', —r; � � � P t � `* �
� i
4 ( 1 x � �
p � � . : � � � ' � 'j �. �'D I I� � 'I � jyir�� t '.Y J� ��
� E 1 � � � � i � I �` ri i .i 7 � I., l .� � I.� J �'� e4„ �.c
� � i � I , � I �i ( �,�7 �' � j � ..�j_ r� I^'� � � � r .A !Ir �,; € �.. �C� ' ;� �,,�
� t i I �� r � I I ' � x � � �r� I i , , � i ��r
�
� � .�i t�� 1 3 _� � tA r � � � �;3'��a3��, � i.cn
i � � i � r�� , � � ,�;� '`, = ' , >_ � �, �`� ' , ��j ;,,� �
i � ' � � ; .� � ; �� i � ! I ; ;� ,Lt ���� �„
� � , , �£ � ,; , �<,; ��`' �> ��
.,, . I I 3 � � �!3 a � � � I I � �: �I�"� j a
I ( � 1 I
� � I � �t I I � I � � I i � � ��P { i �
t �
�
I �
i
� , � � i ' i i I � i
�
� � - - � -
e ! i
� , � � , i � I �� }
� • _ _
3 I I
!
� � I �
, 1 + ( k... � �
'
, % . � � I I � . � � i viv�
�
i
• . ��.. , � . �
� { I
'
� , i �, i = 7 t � I . 1 � I , I ' . ! .. . �
. a
; I
� . �
, i � � . � i � t I I � � I i �
, � ; � � ,
I I � ( I (
� ; � , , � � , i
.
, , ,
, i � i ` • � � � � �� '
i
, - ; - — -- ,
, I
I � I ' � � � ( I � . '..
; ; � I' � � ; I i j i t � i �
i i 4. i
, ; � . II , � � , � 1 ; ; ; � � ; � �s
i '; 'i ' � ' I i ' I i ' ; ! ; I , � � i , i i i i i ���,�,
i i ' I � �f i I ' � ( i � I I �' I , I � ��"
, ; � � j ; t j i ' � i i � � I ' ���
_ � I �, j i � ' _ � i ( '. � ` � ' f � . � ' f , #`, '
; � . j � � i � i � i j i i i � i � ' i � i I i I ; � ��.;
I
t � I � � � _ � �. ( � � � � �� i i I I
� � I e � I Y �
. f I
k
,.. _.._..._... ,� ,....._. . _ . . .__ ...----_-_. .... .. __•...�1 �_._ ..,_. .._ .. ._�,.... .. _.__���_ .._{. . .___ . _ .� _ _..__ . ....s. _._. ._.�_.. . ,_._. ... ��
�