HomeMy WebLinkAbout11364 �
--��'�`�"`�-1 CTI'Y OF DIAMOND BAR
! COMMUNITY DEVELOFMENT 7�EPARTMENT � � ���
-.e. 21660 E.Copley Drive Suite 190 PRESS
(909)860-3195 Fax(909)861-3117
�"%"' BUILDING PERMIT APPLICATION FI RM LY
o A DRiESS� `�� 'V : C�� DATE'CATION ,� NUMB R �� #/C
ISSUE TYPE OCC
� � APN L T TRACT DATE CONST. GROUP
� OWNEA ��Q_ ��
� ADD SS � °�C � ZONING SETBACKS
i z CITY _�- Ct.� ZIP TEL. FRONT RW ❑
o APPLICANT � ` � . ' TEL.y�— A� REAR ❑
SIDE/SIDE STREET RW �
Q CONTRACTC� �� SIDE G
� Q ADDRESS � �� �-
� CITY �_ ZIP ^ � TEL.��...F�-#�cG�S�{, PROPOSED USE
� � ARCH/ENG/
i z DESIGNER NO.DWEL. NO. NO.
� a_ ADDRESS UNITS STORIES BEDROOMS
NCITY ZIP TEL.
� � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION '
�O- OWNER-BCILDER�ECLARATION SFR/ADD/REM
1 p- I HEHEBY AFFIHM UN�ER PENALTY OF PERJURV TMAT 1 A.M EXEMPT FROM THE CON7RACTOHS LI- G2f8Q2/CBIpOfi
� 'W CENSEL4WFORTHEFOLLOI'dMGPEASON(SEC.�a315Bl1SWESSAN�PFOFESS10N5CA�E:ANYCITVOR (n
3 � CAUNTYWI{ICIiREQUIRESAPCFIMITTOCONSTRUCT,AITER,IMPROVE,DEM.O�ISH,ORREPAIRANYSTRUC- W Pa[io/Deck
� .W. TUHE,PRIOR TO ITS ISSUANCE.PL50 RE�UIRES THE APPLICANT FOfl SL'CH PEftMIT TO FILE A SIGNED W
�� STATFMENT THAT HF OR SHE IS LICENSED PURSUANT TO THE PflOVI510YS OF THE CONTRACTORS ll-
j - CLNSE LAW(CHAPTER 9(COMMENCING VlITH SEC7104 7000)OF DIVISION 30F THE BUSMESS AND PR0- � Pool/Spa
; �- FESSIONSCADE)OFTNATHEORSHEISE%EMPTTHEREFROIdANDTHE6ASISFOPTHEALLEGEDEXE�dP-
� 0 710N.AtdvVIOLAT70NOFSECTION7o37.50YANYAPPLICANTFORAPERMITSU&1EC757HEAPPLICANTTO Z� RE-RoOf
F ACIVIL PENALTY OF NOT MOflE THAN FNE HUNDRED DOLLARS(5500).):
_O. ❑I,ASOWYEROFTHEPROPERN,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATIOY, Q COffIrtlOfClfll
� -_Z WILL DO THE WORK,ANO THE STfiUCTURE IS NOT INTENDED OR OFFERED FOR SALE ISEC.7044,9USI- J .
NESSAND PPOFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES hOT APPLY TO AN OWNER OF
� PROPEflNWHOeUILD50ftIMPflOVESTHEREON.ANOWHODOE55UCNV/OAKHIMSELFORHERSELFOR �
:[L THROUGHHISOqHEROWNEMPLOYEES,PFlOVIDE�THATSUCHIMPPOVEMENTSARENOTINTENDEDOR m
-W-. OFFEREDFORSALE.IF,HOWEVER,THEBUILDWGORIAAPROVEMENTISSOLOWITHINONEYEAROFCOMPLE- -
4 '�' TION,THE OWNEFi�BU1LDER WILL HAVE THE BURDEN OF PROVING THAT HE OR 51{E DID NbT OUILD OR
--Z- IMPROVEFORTHEPURPOSEOFSALE). - --
� GI,ASOWNEROFTHEPROPERTV,AMEXCLUSNEIYCONTpACTINGWITHIICENSE�CONTPACTORS
�-� TO CANSTRUCT THE PROJECT(SEC.�oa4,BUSIN[SS AND PPOFESSIONS CODE:THE CANTRACTORS LI- VdI11d11011 ADJ.AREA
�W CENSEUlW00E5NOTAPPLYTOANOWNEROFAPflOPERTYWHOBUILD50RIMPROVESTHEREON,AND
-�_ WHOCANTflACTSFORSUCHPPOJECTSWITHACANTRAC70R(S)UCENSE�PURSUANTTOTHECONTf7AC QUANTITY DESCRIPTION FEE
_Y_ TOFSLICENSEIAW.).
� J
,�. CIAMEXEMPTUNDERSEG B.&P.C,FORTHISREASON Q
� V
� LL F�-
- DATE OWNER U
W
--,�, __ LICENSED CONTRACTORS DECIARATION - W
:�- I HEREBYAFFIRhA UN�ER PEYALTV OF PEP.JURV THAT I AM LICENSED UN�ER PROVISIONS OF CHAPTEfl � F � '� � ��n , f I
:d.: 9(CJMMENCW�WiTHSECTION70bJ)OFDIViSION30F1HEBUSINE55ANDPROFESSiONSCADE,AND z - ���
-X--- MY LICENSE IS M Fl1LL FORCE AND EFFECT. m
W.: — � �
-�� LICENSE C SS i�c UC.NO. � �
� � J
-j �•V< DATE� CONTRAG70R�! y - d
W,
-.�- � WORKERS'COMPENSATION DECLARATION Q
;= U
�-�- I HEREBYAFFIflM UNDER PENALTY OF PERJUFlY ONE OFTHE FOLLOWING DECLARATIONS:
� Q
�� I HAVE AND WILL MAINTAIN ACERiIFICATE Of CONSENTTO SELF-INSURE FOR WORKERS' _ - � -
� -Z- COMPENSATION,ASPflOVIDE06YSEGTION3]OOOFTHEIABORGODE,FORTH'cPEHFORMANCE U - �
�¢- OF THE WORK FOR WHICH THIS PERAAIT IS ISSUEO. �
j O:
W- I HAVF AND WILL MAINTAIN WOfiKERS'COMPENSATION INSURANCE.AS RE�SIIRED BY SECTION
�- ,Q_ - 3�ooOFTHELABORCODE,FOflTHEPERFORMANCEOFTHEWORKFORWHiCHTHISPE[iM1TIS
ISSUEO.MYW�C ERS' DMP SATIONINSURANCECAflFIERANUPOL'GYNUMdEHAHE: CONSTRUCTION
Q: ( �
-.� CARRIER `�-- �—`�P%�1'��� �7 PLANREVIEW
� -Z_. POLICY NUMBER__ ����2 �y��C�1 i ELECTRIC
Q,
( ;�� (IHISSECTK)NNEmNOTBECOMPLETEDOFiHEVtNhYTISFORIXJEHU�REOD�f.IARS(57C0)ORLESS4 PLUMBING f.y _
.-� -W. . . . .
.z IGEflTIFYTHATMTHEPERFORMANGEOFTHEWORKPoflWHICHTHISPERMITISISSUE�,I MECHANICAL
-�;�- SHALLNOTEMP�OVANVPERSONINANYMANNERSDASTOBECANESUBJECTTOTHE
-_� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGReETHATiFISHOL'LDBECOlAE INSPECTIONFEE . -
- SU9JECiTOTHEWORKERS'CA!APENSATIONPROVISIONSOFSECTiON3 OOFTH LABOR ' �
,�, CO�E.ISHA FORT�HW/ITHCQ`.1PLYWITHTHO PROVISIONS ISSUANCE r .�.��'
�p. DATE:��U APPLICANT: - � ._ . SMIP . �, .
W- -� ---�-�--�--�� ENERGYP/C
.J_. WAFNINQ:FAIL RE SECURE WOFKERS'COMPENSATION CO4ERAGE IS UNLAWFUL,AND SMPLL BE
..� SU&IECTAN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL F1NES 11P TOONE HUNORED THOUSAND ENERGY PERMIT
DOLLARS(5700.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PflOVIDED FOF IN �p� -�--�--- -
�J SECTION37080FTHELA60RCODE,INTEREST,ANDATTOFNEY'SFEES. RETENTIONFEE: __�VF�
� .�
-;� CONSTFIUCTION LENDING AGENCY PRE-ALT FEE
0
��- IHEREBYAFFlflMUNDERPENALTYOfPERJURVTMATTHEREISACONSTRUCTIONLENDINGAGENCY
��� FOR THE PERFOflMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED{SEC.3097,CIV.C.). � �---
>Z-
W:.
.��_ LENOER'S NAME
1_' LENDER'S A�DiiE55
���. IGEHTIFYTHATIHAVEREADTHISAPPUGATIONANDSTATETHATTHEABOVEINFOflMATIONISCOflRECT. TOTAL FEES �� �'��
W I AGREE TO CAMPLY WITH ALL CIN AND COUNTY OFDINAYCES AND STATE lAWS RELATING T0 OUILDING
� CONSTRUCTION,AND HERE6VAUTHORIZE REVFESENTATIVES OFTHIS COUNTV TO ENTEp UPO4 THE
_,Z-._ ABOVE�MENTIONEDPROPER.VFORINSPEC O�l'PURPO�Es. COMMENTS
�-
J �
_. �' ti
_- ___�__ '_..______._
-m:. PEflMI M.E(PRINTI __ ...
I ¢� _ � _ _._ '
�:
�-�- IG PERMITfEE E RECPT.NO. � ��`'� PAIDBY VAUDATION
i = ,
_i ._~_� WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy -
f
_ __ _ --- _ ___----- --- -�._.______-� �-,
r ---'-----�— —i. ?. y .�.�.,. E'.� �c P ' � 5 . �t 7 '��,t3 � � I �� �
� "� �i=� . ��t �,- �i . I � � ! ��'?j 3a �, i �.� }��„ � � x � .-
? :`r � � � � E ' � ' � i ( , i � .. � � �
e i ; � � `P � t � ? --5� � } -ja ; �
1 �� � ! "f I {' i€ i T 1 -1 }� T '� �S
I — ' I i �ti r�� 3��1 � r i � ���
I b�r � y !'� I � ' : � E �I� I � � �� t � p�`��'� ' `'i �,' I i � '�
; ' �, ' � ; ` � j � . �. C � ; I r5 : , �,� �:E� t �% f �-� � (. � $
� �, � ; � � t � � ; �� � ; I I ,�,�� 't �' I ' � I� , �
, .
�
� �� �• 3�'` �.� � ' i i i � j i � t , I . �
i i
� � a e ' 1 � � � t __� t ( � . , �
y . .. .- _�._.� .,u � 3 ,�i}� ` i i � � ,—j-�-� -; � i i�l—�—�-..—} {=--F—� .
� � � , � � ( � f I � �
� � � �:� � '' � � i ' � � I � � � ( ' a'
� `{-.� � � a - . � � % € ' `
� '', I � � t # . t ( i I �_ ' _ _� { '__ i : i � , �
;
. ,
I � � I � , i. � i ±- i € .� � -j�-, i �M�
, � � �
; ; , . �
� 7 , : '� ( i � � �
i . � : � i ' : ' i , , ' ' � i� � j ~
! i � � 3 ! � E � i i � ; ( i � � { I � I I �x}.
9 � � !, I ! I E � � � � I � i � � ( I ; � I � ����
� , ' � ; � ' ' ' ' ' I : ( ' ' ' �
` j r � � ` ! � � , ` � . � � � � i � i � �
, ; , � � ; � , � E ���: � �
,
� � , � � E � � , ' � �
� ' `_ ` j � ` ' �� �__.� — ���r_ �� _ �' °
�� I { � �
� I ; ' � � — — .
I � ' "� r � -� -� I r ' I � r -� ' � � �' -� �
9 � . i � � ; � ; i'�� � " ..v 'C"i i ��. : '-,
� � � � i �: y .� � �� !Q i c � -I �-�,; , �
� � ; �* �� � , � v- � c� '�(T � .� � _��—"' � -�. �.� � �
� ; i ; ' � i � ! . I �' �� - rr �- -' C` �� �; �I�, ��^ S � .' L�''j� z �I .,.���� ^r° ''� -_
,'a ! � i i � I : � � _-� r" a ��,'. � c � � � � i i i .S i�I f��'� � wp
�� � i '.� � i I • � � , � C ., � 3 Y: e' ; '¢-;�� =q
i j � y f r
� t ` � k i ' � : � � �'�" �y _ i i Z i � t� r �. � I : ,�i.r�' �;
- � ' � � ! � I ', I I i I € I � a � j i. � j �1 � 9� �� ��-`- .
- ' � i i . ��'.� ; '� .3> Y .gs
� 4 ' � � i ' I I � i i -i
= i ; � , i ! � I i ; i � , �':� .
;
�j ` � � � � � ;
E i ' i
� ; � : I
� ; � i .
,� � � � ; � : -- ---� - — -'
, . , ,
i
� � , � . , � - : ; ; ;-�1- � � �
: , i �
, , , . , , i ��
, , ; , , , � , : i � ��
, 4
, , �
„ ;
� � � ' � � � i i ' � E i , (
� I i I � ; ` 1 � I � I i I � i � i ; i I , � �
E �
�
� t `, : � : i � � � j � 1 i �
I `
i
i I 3
£ � � ' ' ' � � I . � E '-__ � -_1 I ' � .
� �
r � I ` � E ; ; � I � i f � � � ( "
; ( ; �
� ,
, ; ; ; � ,
� i I
( , ; , , �- � � i � �
� : : i ' f � ; i ( i ; � , ', . i '. ( i
€
: �
i (
I �
. , 1 - � . � : � . � � . � � i
� . � j E � ( � ` I � ' i f �. ! I ( , � � � �f _
� � � � � i � I f{ i 4 I , i ; � ' e
€ I � . ; i ��� � � � .) r
€ � I � ' � f '�� � f ��- � � �
€ �. .'ii � �i � _� ' � I t
j � i ; � i 1 � ` � ', ..i ; � { ; �� f � ��
� � i I � � � � I � � ! I I I �- i I I ( !� ( �I i .
�:
� :�
� , I
�
t � . . ' ` . �L.__._.
I ; , �._ !_�.___n�., '_..x._.,..J.�_�.____..�--_i ; � ._. _,__._.�_�__._.�__ _,.I__.._._.�__ �