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HomeMy WebLinkAbout11743 (5) s CITY OF DIAMOND BAR -- DEPARTMENT OF COMMUNITY&DEVELOP - 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(9p9)861-3117 PRESS '""°- BUILDING PERMIT APPLICATION _ FIRMLY -.-- � JOBSITE APPLICATI N PERMIT P/C i/ � o ADDRESS 23Gz 9 Ot-c�Ar� �/� DATE �k —S � NUMBER �� p � APN LOT TRACT ISSUE TYPE aCC o �ATE CONST. GROUP OWNER �/l�f`1 p ADDRESS �7 leCd rLI ZONING SETBACKS z CITY O4/D ZIP TE�6 '��-'� FRONT F�P���j�_ �j g- APPLICANTG��.lFOhr//��Oo/S TE16ZG-�3Z.SDH� REAR J � SIDEJSIDE STREET ❑ � CONTRACTOR G.�G,�o�-�A 1JOd�S "+F.�R S' SIDE _ ����— � � ADDRESS 3/06 G GA/SVEy.4y� p• /1 � CITY(A/. G r�Vi�.A Z��j'I�4/ 7EGZ,G-�*�;� -ymY+f PROPOSED USE �L `�^ SY 8 ARCHlENG! `F_R�Cc`�-` z` � a ADDRESS NO.DWEL. NO. NO. � UNITS STORIES BEDRDOMS � C�TY ZIP TEL. , N DESCRIPTION SQ.FT. FACTOR PSF ADJ:AREANALUATION ' ' O OWNER•BUILDER DECLARAT�ON - - SFR/ADD/REM -- Q I HEflEBY AfPRM UNDER PENAL7Y OF VERIURV THAT 1 AM EXEMPi FPOM THE COMflAC70RS L�� �� GBfdgB/C8(POfI - ' W CENSELAWFOHTHEFOLIOWINGqEASpry(SEC.7a31.561191NES5ANOPHOFE5510NSCO�E:ANYCITYOR �.(f� - C� COUMYXRi1CMREQUIRESRPERMITTOCIXJSTAUC7,ALTER.�M,PPOVE,DEMOLISH.OqREPAIRANYSTtiUo - -�J pati0lDeCk �� TURE.PNIOR TO ITS 75St1ANCE,ALSO R[pU1HE5 THE APPLICANT FOR SUCH PERMR TO FILE A SIQNEO - W �• ST�TEMENT THATliE OR SHE IS LICEN&ED PURSUANT TO THE PqOVi$IONS OF THE CON(flACTOpS LI• - - .s_ CENBELAW(CHAVTERe(COMMENCMGN7THSECTION700D)OFDNISION30FTHEBUSINESSANDPqO- �� POOUS(38 /.� 5 VfES5pN5WD�ORiHATHEORSHEISEXEMPTTHEREFROMANDTHE6A5i5FORTHEALLEGEDEXEMP- ' � TION.ANVVIOLATIONOFSECTION7031.SBYANVAPPIICANTFORAPERMIT3U&lECTSTHEpPPUCANiTO -- �Z REROOf � ACIVIL PENALiY pF NpT MORE THAN PNE MUNDfl W DOLLARS(ESaO).): - �- OI,ASOWNENOFTHEPpOPEHiY.OBMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPEN5A710N, � ColntflBlCidl .- YJILL 00 THE WORIC,AND THE S7RUCTUqE IS NOT IN7ENDED OH OFFERED FOfl SAI.E(SEC.7oM,BUSI� ` � - �- NESS ANU PpOFES910N3 CODE h1E CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF , P(iOPERTYWl10BUILDSORIMVROVESTHEflEON,ANONMO00E5Sl1CHWORNHIMSELFOflHERSEIGOR ' � � �-- hIROUGHNiSORHEROVlNEMPLAVEES,PROVIOEUTHATSUCHIMPROVEMENTSAFENOTINTENDEDOR -� 'm� = O_ ,OFFEREDWRSALEIF,HOYVEVERTNE&11LDINGORM/PROVEMENTISSOLpWfJ1{�NONEYEAROFCQNP�E- - - TION,THE OWNER�UILOER WILL HAVE THE 9URDEN OF PROVMG THAT HE OR SHE DID NOT BUILA OR - �T _ ... ��' �IMPROI/EPoHTHEPURPOSEOFSALEJ.- - . . - - - . r� . . . . W: ❑I.ASON7IEROFhIEPqOPERN,AM-EXCLU9NELYCOMRqCTihGWITHLICENSEDCONTRACTORS � - � TO CONSTRUCTTHE PROJECT�SEC.70fI,BUSINESSANO PpOFE5510NS CODE:THE CANTflACTORS LI- - gIUBt� - ADJ.AREA - W_ CENSELAWDOESNOTAPPLYTOFNOWNEROFAPROPERTVWHOBUII.OSONIIAPpOVE5h1EPEON,AND . - �1.r y�p�pp(�q�CTSFOF3UCHPROJECTSWITHACONTRACTOR(S)LICEMSEDPUqSUANTTOTHECONTflAG '. QUANTITY DESCR�PTION FEE � � TOR9 tJCBlSE LAW.). - Y - Q_ OIAMIXEMPTUNDEHSEC. B.AP.C.FORTMISflEA50N - Q t 3, c.� ! � DATE oWNER - � � IICENSFp CONTRACTORS DECLARATION J �� ~ W .� �HEflEBY AFFIflM UNDEfl PENALTY OF PEflJuqY THAT I AM LICENSED UNDER PHOVISIONS OF CHAPTER- � � - �; B{COMMENCINO N77H SECTIJN 7000)DF DIVISION 3 Of THE BUS W ESS AND PROFESSIONS CADE,AY� . Z � - - x MY LICENSE IS IN GULI WqCE AND EFFECT. m - W: Z �C��,,� �_ UCENSE/CLASS C G��y/ UC.NO.���^ � � - ~`- OATE 7—1`,� / D �J ; w= p corrrrucroa GA�k/�D�y/►� � ` a .- _ � WORKERS COMPENSATION DECLARATION ��J,�.'I� � Q . 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ICERTIF'!T�-IATINTHEPERFOflMANCEOFTHEWORKFOAWHICHTNISPERMITi5155UED,l - MECHANICA� -� .��� �,(� - . � ..__ .CJ_.. .SHNLLNOTEMPLOYM1YPEflSONINANYMANNEPSOASTO8EC0lAESU&IECTTOTHE . .. ¢* . . ` .. ;:-� - (/�-. - WOPo(ERS'COAIPENSATIONLAWSDFCAI.!FORtdtqMDA6REETHATiFISHOULOBEWME INSPECT�ONFEE - - - - - �--- -- - SU&IECT TOTHE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE 1A80P � �� - COUE,ISHALLFyO^fiTHWITHCOMPLYWITHTHOSEPROVISIONS. ISSUANCE � �;- � `p.`.�ATE: �� � ( APPLIGANT.Ci'rL�� Y mG r/— SM�P � � �' - �- WARNMG FAILUHE TO SECURE WORKERS'COMPENSATION COYERAGE IS UNLAWFUL,AND SMALL BE ENERGY P/C � �� � - �"- SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT � � '. OOLLAflS(5100.000],INADDITIONTOTHECOSTOFC01.1VENSATION,DAMAGESASPROVIDEDFOqM - �-- SECTION87oBOFiHELABORCODE,INTEHEST,ANDATfOP,NE1^SFEES. ��Y r ¢�- RETENTION FEE: f�- - I � -O- CONSTRUCTIONLENDINGAGENCY PREALTFEE: �� a " ��� ° �- IHEREBVAFFIRMUNDERPENALTYOFPERJURVTHATTHEREISACONSiRUCT10NLEN�INGAOENCY [ `- � FORTHEPERFORMANCEOFTHEWORKFORWHICM7HI5PEFM1T15i55UE0(SEC.3o87,CIV.C.). ---- W. �,� -�� LENOEWSNAME � . �- -- F—_ LENOEFMSADDRESS Y. �: . �� ��� .ICEPTIFYTHATIHAVEREA�THISAPPLICATIONANDSTATETiATTHEABOVEINFORMATpNISCARRECL TOTAL FEES /, ' � � �� - - i-_ - .IA6REETOCOMPLVWITHALLCITYPNDCOUNTVORDINANCESANDSTA7ELAWSHEUTINGTOBUILOMG '�-'- ::QONSTRUCTION,ANDNEREBYAUTMOflIZEREPflE5EN7ATIVE50FTHISCOUNTYTOENTEHUPONTHE - - �' -��ABOVE•MENTIONEOPPOPERTY-FORINSPECTIONPURPOSES. Z- .- -n - -. COMMENTS � J J�ryt c� �� � � o - ¢ -_PEHAII E N�(PRIN� . . � S� ^ .- (n- � REOFPERAIITfEE - - - - DATE - �_ RECPT.N0. 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