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HomeMy WebLinkAbout10863 CTTY OF DIAMOND BAR • COMMUNITY DEVELOPMENT DEPARTMENT �,.� 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-311� '�"'"'` BUILDINGPERMITAPPLICATIaN FIRMLY � JOBSITE � � APPUCATION I h'I, /�GL-� NUMBER / ��� #1C 4� o ADDRESS���� ��C-��a � DATE f/ "4— f ! $ APN CJ� LOT �d� TRACT �3 iJ�L_ iSSUE TYPE OCC � � DATE �V GROUP p OWNER � - t' p ADDRESS`Z- ZONING SETBACKS Z CITY ZIP TEL.� 0't6 FRONT_�q��� RW O o APPLICAN h � TEL.�i�w�� REAR v U Ll1U SIDE/SIDE STREET RW O �� CONTRAGTQR �'�Q.-I�4'�f7'r' �' ��' � .�.. SIDE p � ADDRESS 1�.,{ t7� E��c„ !�a/�- � � e � p. .� PROPOSED USE CITY ,J;r�-.9Tr°l ZIP� TEL� ��t`9 a�:�� Q; --�` w: ARCHlENG/ z DESIGNER W NO.DWEL. _ NO. NO. a; ADDRESS UNITS STORIES BEDROpMS �' CITY ZIP TEL. u�i'" DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION a: OWNER-BI;ILDEA DECLARA710N SPR/ADD/REM O I HEflEBY AFFIRM UNOER PENALTY OF PERJURY TIiAT i AM EXEMPT FflOM THE CONfMCTORS LI- ` Ga�g�(��Ort W-- CENSELAWFORTHEFOLLOWINGPFASON(SEG7031.59USINESSANDPHOFESSIONSCODE:ANYCITYOq (n . U' COUfdTyWHICHRE�l11RESAPEflMiTTOCONSTRUCT,ALTER,IMPROVE.DEMOUSH,ORqEPNRANYSTRUC- ` W patio/Oedc �' .Tl1qE,PpiOR TO ITS ISSt1ANCE,AL50 flEOUIRES THE APPI.ICANT FOR SUCH PEflMIT TO FILE A SIGNEO W - : STATEMENT THAYHE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE WtJTMCTOflS LI- - `�� CEt�E LAW(CHAPTFA 9(COMMENCINO WRH SECTION 7000}OF DIVISION 3 Of 7HE Bl1SINE55 ANO PHO. LL' POOUSpff . -�<�. FE9310NSCOOE�OflTHATHEORSHEISEXEMPT7HEREFROMANDTHEBASISFOflTHEALLEOEDEXEMP _C7 TION.pNYVIOLATiDNOFSECTION7o31.5BYANVAPPLICANTFORAPERMITSU&IECTSiHEAPPUCANTTO * Z RaRoof - - AdYILPENAL7YOF NOT MOqE TMAN FtYE HUNURED DOLLARS(f5a0)J: EQ: OI.ASOWNEflOFTHEPPOPERTY.ORMYEMPLOYEESWITHWAGE5A5THEIR50LECOMPENSATION �0- C�tflff�B�CIdI -Z:.-Will DOTHE WOHK,AND THE STRUC7URE IS NOT INiENDEU OR OFfEflED FOR SALE�SEC.70d6,BU31 - J ' NESS AN�PqOFES510N5 CO�E:THE CONTRACTORS LiCENSE LAW DOES NOT APPLV TO AN OWNER OF-} - N�. PROVERTYriHO�11lDSORIMPROVESTHEFEIX�I,ANDIYHD00ES5UCHWORKH�M3ELFOflNEflSELFOR�' � �-`. THHOU6NHISORHEROWNEMPLOYEES,GROVIOEOTHATSUCHIMPROVEMEMSARENOTIMENDEUOR m W' OFFEREDFORSAtE.IFFIDWEVERTMEBUILDINGOpIMPflOVEMENTIS50LDWITHINONEYEAROFWMPLE-. �- 0=. TqN,THH OWNER�6UILDER WILL HAVE THE BURDEN OF PROVIl1G THAT HE OR SHE DIO NOT BUIID OR � ` . Z� IMPROVEWRTHEPUflP0.5EOf5ALEt. � - -� OI,ASOWNEROFTNEPpOPERTV,AAIEXCLUSIVEIYCANTRACTINGWRHL�CENSEDCONTHACTOqS � �j�, TO CONSTflUCi THE PR0.IECT(SEC.7044,9USINE55 ANO PROFESSIONS CODE:THE CONTMCTOflS LI- - V81118i1Of1 A�J.AREA W,;- CENSELAWOOESNOTAPPLYTOANOWNEROFADROPERTVWHOBUILDSORIMPROVESTHEREON,AND - � - _�-:WHOCONTqACTSFORSUCHPHQIEGTSWITNAWNTRACTOR(5)LICENSEDPURSUANTTOTHEWNTRAG _ 'eUANT1TY DESCRIPTION FEE -~"_ T00.SltCENSEUW.). - CL` ' - �_�: ❑1lUA EXEMPT�NDEH SEC. - 8.d P.C.FOR THIS qEA50N � Q � � U ta. � -- �ATE OWNER _-U O = w Q£: UCENSEO CONTRACTORS DECLARATION ' W _ �, IHEREBVAPFlRMUNDEflPENALTVOFPERJUR�THpTiAMLICENSEDUNDERPROVI510NSCFCHAPTER , � d- 8(COMMENCINGWITMSECTION7000)OFDIVISION30FTHE8USINESSANDPROFESSIONSCODE.AN� '_ Z X_ IAY IICENSE IS IN FULL WRCEAND EFFECL - - - Q'�� UCENSE CLA55 � LIC:NO. ����� _ j - - t—'. F—` � J U, oa� coniraacraa r`ti. " s a w: � �� WORKERS'COMPENSATION DECLARATION `-' � � . �-.. . ���� V - � �;- INENEBYAFFIqMUN�ERPEN�ILTYOFPERJURYONEOFTHEWLLOWINGDECUMTION& _' Z �'- ,IHAVEANDWILLMAMTAINACERTIFICATEOFCANSENTTOSEIFdNSUflEFOPNiORKERS' -- _ - Z' CAMPENSATION,ASPROVIDEDBVSECTION37a00FTHElABOROODE,FORTHEPEHi'ORMANCE ._ `U ¢� /f OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �- j(/ � W ^IHAVEANDWIILMA�NTAINWORKERS'COMPENSATIONINSURANCE,ASREWIREDBVSECTION �- Q31o00iTHELA80RCODE,FORTHEPERFOHMANCEOFTHEWOFKFOflWNICHTHISPERM1T15 7 - ISSUEO.MY WOHNERS'C�OMP,�EN9A_T INSURANCE CARRIEfl AN POIICY NUMBERAHE: CONSTAUCTION J �-r T� j, caaaien z rci�� PLAN REVIEW �•� Z-� POLICV NUMBER�Z . ELECTRIC 4 � A . - �: (IH6SECT)JNNE�N0T8EOONFLETWOFTFiEPEFWlf�SPof1aNEHlXJDfimW � (510D)ORLESSE PLUMBING Z � ICERTIFYTHATiNTHEPERFOPMANCEOFiHEWORKFORWHICHTHISPERMITI5I55llED.l MECHANICAL �,?. C�S� SHAIL NOT EMPLOY ANY PERSON IN ANY MANNER SDAS TO BECAME SU&IECT TO THE - - -' -- �(n-�-- WORKERS'fAMPENSATIONtAW50FCALIFORN10.ANDAGREETHATIFISHOULD9ECOME � INSPECTIONFEE � - - - �" -St1BJECT TO T1:E WORKEflS'CDMPENSATION PROV�SIONSOf SECTION 370o OFTHE LA80fl - � COOE,I SHAIL FOqTNW1TH COMPLY WITH THOSE PROVIS�ONS. 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