Loading...
HomeMy WebLinkAbout12821 (11) � __�� CITY OF DIAMOND BAR _,,. DEPARTMENT OF COMMUNITY&DEVELO 2166Q E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ���'�"� BUILDING PERMIT APPLICATION FIRMLY y JOBSITE {� o ADDRESS ���''a� 's�4��-�#�2��i. d�� DATE CATION��_�Gl �!�8 NUMB R � #'0 q 8"-3�3 -� � APN LOT TRACT �SSUE TYPE OCC � ,� DATE CONST. GROUP p. OWNER �'.€�ay,�set ' �•`7`"C'f4;t�:;3� o ADDRESS'L - � _ — )�z,�— ZONING SETBACKS �W CITY ��1:r�::-3�� _;,^, ZIP; e ��i TEL� E�6,f'�';,�.. /' FRONT ` RW ❑ APPLICAN'f 'r� � �z�� ��kri"4 L jt�'� TEL. � �i'��_� REAR � � "' SIDE/SIQESTREET RW n � CONTRACTOR SIDE � � AD�RESS / i D S� �T �D I��b� � C�TY ZIP TEL. PROPOSED USE__ o ARCH/ENG/ Z DESIGNER a ADDRESS NO.DWEL. NO. NO. � UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION .O OWiVER-BUILOER DEQLARATION - SF DD EM 'p . p- 1 HEA�Y AFFIRM UNDER PENALT/OF PER.RIRY THAT I AM EXEMPT FROM THE CONTpqCTOqS LI�� G8fd9B/C9tpofl W. CENSEUWFOR7HEf-0LLOWINGREASON(SEC.7031.58USINESSANDPftOFESSIDNSCODE:ANYCITYOR� (n WCOUNTYWMCFIHC-0UIRESAPEflMITTOCONSTRUC7,ALTER!MPqOYE,OEMOLISH,ORREPAIRANYSTRUC-: � W P8t10lDBCk TURE,PRIDq TO ITS ISSUANCE.AL50 REQLIIRES THE APPLICANT FOR SUC#i PEi7M1TT0 FlLEASIGNED - W � STATEMENT THAT HE OA SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE COMRACTORS LI•.:� � CENSE UW(CHMTER 9(COMMENCING WITH SECTION 7oao)OF�IVISION 3 OF THE BUSINESSAND PRP, ' V"' PooUSpa - - FESSpNSCODE)ORiHATHEOR5HE13EXEMPTTHEREFpOMANDTHEBASISFORTHEALlEOEDEXEMP (� - _ TI�N.ANYVYJUTIONOFSECT�qV7o31.66YANYAPPLICANTFORAP[RMITSU&IECTSTHEAPPLICANTTO -- Z R8-RDOf - - - - � A CIVIL PENALN OF NOT MORE THAf!FNE HUNDREU DOL(ARS(5500).): - - - - Q 06ASOWNEHOFTHEPROPER7Y,OpMYEMPLOYEESWITHWAGESASTHEIRSOLECpMPENSA710N;_. C, Commerclai � - Z. WLLl DO THE V10A1(,AND THE STRUCNRE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC..7o44,BUSI�.-- J - - �• NESS AND PROFESSIONS CODE:hIE CONTRACTONS LICENSE LAW DOES NOT AGPLY TO AN OWNEfl Of--�- j PROPERTY HR10 9UIlD50R IMPROYES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR - - �: i}iROUGHHISORHEROWNEMPLOYEES,PROVIDE�7HATSUCHIMPROVEMENTSAflEhOTINTENDE�OR::�" m: -- - - . ` Q OFFEREDPoRSALEIFHOWEVERTMEBUILDINGORIMPROVEMENTIS50LDWITHINONEYEAROFCOMPLE- - _ �_ TION,TME OWPIER�BUILDER WILL HAVE THE BUfiDEN OF PROYI�G.7HAT HE OR SHE DID�OT 9UIL0 OR:. . ._ . .._ ..... . . . - ... _. - - �--- 9�iPROVEFORTHEPUHPO5EOF5ALEj. - �y,�, ❑I,ASONMEROFTHEPROPERN,AMEXCLUSIVEIY�NTRACTINGWITHLiGENSEDCONTRACTOflS Q: TO CONSTRUCTTHE PflOJECT(SEC.7044,BUSINE55 AND PROFESSIONS CODE:THE COMRACTORS LI� - Valuation ADJ.AREA W CENSEUWDOESNOTAPPLYTOM'OKTiEROFAPPOPER7VKRfOBUl1ASORIMPROVE3THEREON,ANO � -- ` ��- WNOCONiMCTSFORSUCHPRQIECTSN77HACONTRACTOR(5)LICENSEDPURSUAMiOTNECONTqqp - QUANTITY DESCFIPTION Y �p�,y� rau uc�se wwy FEE - 0-. �AM IXEMPTUNDER SEC. j �'8 P.C.FORTHIS REASON -__ U- O LJ�.s/�S ��✓��/]�"� � �i._ � � �� L� � � 7� � �� � �� .. � DATE 1':.% `h .�,r, OWNER- a:�r 1�n.�:J � .s>v� . p— P �= � " cU gY: � e�is? ��f�O �_ UCENSED CONTRACTORS DECIARATiON � ' W -.�__ �- . . � . �� � . IHEREBYAFFIRMUNDERPENlLLTYOFPEflJURVTHATIAMIICENSEDUNDERPROVISIONSOFCHAPTEq � � �y a.ji.� - �Of�� �_ 8(COMMENCVH3WITHSECT�ON7000)OFUIVISION30FTNEAUSINESSANDPFOFESSIONSCADE,A,YD _. Z - /7 /J X� MY IiCENSE IS�N FULL FORCE AND EFFECT. m �y � �� � �� O� UCENSECLASS UC.NO. - '�II .T�-. j S ' •��VR�� �C.(J ��"rl��i Gl��v��- j- �AT�''��'� CONTRAG . ' l! 2 y� >� � � ur /�Gf�i!/`d /g'�E°G[�'t'-f�t�� -��: WORKERS'COMPENSATION C�ECLARATlON . � g � �`� _ �� �p� �. V i( �__ IHER�ByAFFIRMUNOERAENALTYOFPEqJURVONEOFTHEFOLLOWIN6DECUIRATIONS: Z �- �i/�+jL • � �� v� , Q. /s-o� �- ��'IHAVEANDWILLAIAINTAIN.{CERTIFlCATEOFCONSENTTOSELF-INEUPEFORWORKER5 A � � � � �' COAIPENSATION,ASPROYIDEDBYSECTION37000FTNEIAeOHCODE,FORTHEPERWRMANCE U �'1�� OFTHE WORK FOR WHICH THIS PERIAITIS ISSUED. - � �p O � W -_IHAVEANDWILLMAINTAINWORKERS'COMPENSATIDYINSl1RANCE,ASPEQUIliEDeYSECTIQV o- 3]aoOFTHELABOflCO�E.FORTHEPEP.FORMANCEOFTHEWORKFORWMICHTHISPERMRIS ^ ���0 J ISSUEU.MY WORKEAS'COMPENSATION INSURANCE CARfl1ER AND POLICY NUMB£R ARE: CONSTRUCTION O � �- c^rtqiER - PLAN REVIEW Z D � Z: POLiCYNUMBER ELECTRIC � Q �. 0_ . (ItussECRJNIVE�Norse�lEfIDOFit�aERnailSfOAorvEliurvqimpq.W?fi(Ete�ORLESs} PWMBING A � - .._ :. - Z ICERTIFYTHATINTHEPERFORMANCEOFTHEWORKFORWNIGHTHISPEHMITISISSUEO,I - MECHANICAL 4 r�� CS SHALLNOTEMPLOYANYPEflSCNINANYMANNERSOA5TO8ECOMESUBJECTTOTHE '-_� - .(�- WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOUL�BECOME - INSPECTIONFE�Z���i���T���ATs - SUBJECTTOTHEWORKERS'COMPENSATIONPROVIS!ONSOFSECTI�Y37000FTHELA90R �y �'kx�- � - � GOOE,iSHALLFOHTHWITHCOMPLYWIh1THOSEPROVISIONS. ISSUANCE K �_: p � ��-��`-��-���"�'�' /�U�C9C7 . �- �`p_ DATE: - APPLICANT: -SMIP � _ ENERGY P/C Z J WARNIN6:FAIWRETOSECUf7EWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE �y,_ SU&IECTANEMPLOYERTOCRIMINALPENqLTIESANDCIVILFMESUPTOONEHl1NOREDTHOUSAND ENERGYPERM�T - � - OOLLAF78(fiW.0o0).iNPDDITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIOEDPoqiN �� �'� .r_I SECTION 31oe OF THE LABOft CODE,INTEREST,ANDATTORNEY'S FEES. —'� / t p�O � ` OC -RETENTION FEE: �.� u ' I , O- CONSTRUCTIONLENDINGAGENCY . PRE-ALTFEE: �, �- IHEREBYAFFIPMUNDEflPENALTYOFPERJUAYTHATiHERE1SACANSTflUCTIONtENDINGAGENCY d �: FOR TME PEflFOflMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3a9�,GIV.C.). i�: Z � , W �. LENDER'SNAME F= LENDER'SA�DRE55 W- ICERTIFYTHATIHAVERE4DTi13APPLICATIONANOSTATETHATTHEA60VEMFORMATIONISCORRECL TOTAL FEES //�� .�) _�-- I AGREE TO COMPLV N7TH ALL CIN AND COUNTY ORDINANCESANO STATE LAWS RELATING TO BUILDINO � _-//'�� � f " -.�,-� CONS7HUC710N,ANDHEREBYAUTHOHIZEREPflESENTA7IV,�5oFTHISCOUNTV70ENTERUPONTHE x � ;: - -Zs : ABOVE�MENTIONEDPROGER7yFOflINSPECTIONPURVOSES. `� � COMMENTS �: a�T �`m� �PERM� �E NAMEIPRIPfi) �. . ;c_¢n; .,-' j 4� yi S OF P ITTEE D �s RECPT.NO. PAID BY � � VAUDATION WHITE—Department Copy,YELLOW�inence Copy,PIIdK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy 4'`_ F ��� 3- � ' v 1 i. ,' -7-,_<.�... a.=«a..,... �.-�_1� � � � �_Y i '.' ��Ry.{ w � ', ' t�� ,'���� , � ,�.' i 1 � j � � f, j •�` � i �'� �i ? =� � ' �- � ] � � '�=.�`����� s 2 ( � � ' - { a� ��� � _.�� 1 �r� � � � -t r� � ���� t� i ( � t � "� 7� - � 3 a _ 3 . � �€ _,��,#��� �"'�� E � � € € � � - I ! '� 6� 1 .� � � _. �' 3 �% I < �'� . � ���,�s�--�'������i � E j : ! ,. €:- � �� � W�.�` .= i� r- i 3, � �1,.� „y � .-� r�� . . �° f : ' I T i � �'�..���'-w'� ��`�. ��� . � � � � ' � �€ i ` r - 'r -"`�( i � r � � � �a^.�, -— _ - �`g, �e'-:��`�2�. � ,�i 1 � � _ � )f � � 7 t � �C,z i C3 _. i �� 1 a r'9 1 3 F `�> 3 s::�� �"�'�E ��''.� '� »a � ' E I � � 1 � . _� � .Y; _ ,�����3�� ��'� � { ; I ��- � i � � : � �: � �-I a � , i � t � S i`� -„ � i '.�a � ���� � � i � � � . � � � ' '�'� �sz���� �a�?"��`e�''���a��, j . ( 3 � � (�.-; ] � � � ( �- j �-�'�j �—� �i. : i'_� � s` _ � m����,�=�,��'...�t=�a_���_ �`r�i � , f ��I [ �� �, =�-� € �"�N•1 i I j I � E. ( y.�—s�^cry ,w'�yll i � i !� r � ��' � �� a E � � c� f�'�' E.,, ' W ��� � i �'_ ; i � y I � 1 i.�s. �9� ! �� � � � �� :� �.,=� � � ; _ � �� � ; t—� �-- � -�� =---1— ;�. , f� i —4 ' _ , ��_ � ' § � € �.� � ' � � t f� E i 3__, i._ I :i '.: ��',, � { � �. i I �' .. ( � tv�, � � �� I i f � ;. I I + ( � � ; I I , \� _. � ,� E i .t> � � �� � i �' �' ' I � ' 1 I , � i � � � � , E'_ I i���. � , i � ' I rt j Y i � I �t;� � i i � k I � � � ' � : � I � � � � I f ' � � �x �� 's ` 3 � i ,�, i �� i ' v E ' 3 � � a � ', i { F ` l I f � � �� � i I i � ( ; � ( �,'�i � : :. ' � , , , , , � , ; � � . ; � i � � �'. ' ` � _. �_—i– ` � `�i y �+1� � � � , } i —�– `—'–_�" �1.._�.= � ?�_ �'� :'. � `� ' ' ` ' , �= � � � r i � i � E t i ��� �� � .�-, � .� �� i �- i�e'i _ � `-5t � � ' i � �� � � �"� � r ( -,s�� s.-' 3 ( � 1 1� .p ,� �' g's � 4 ` :� � ? � € ( 3 ( I �� ��'� r I � f !�I£ � ,. ...� c��� '�_' � � i J.� �V � � � I I � i � �� '� � ' � � � � � � I � � 3 i i � � ';. �}�� �f �� 7�- �,�a-I �k� �� .-5�� -: 1�i� _�� ;� ��,� ��"-' � � I 1 ( i � � ��i � .G ;j (" t S. G( '� 7� i� j.....� � �� � ' �; � ` i • ; �� � '" � ( �' �� � _ j :I I �� j[ ��cr �� �� � � , � 3 � , j �� :_,� ; E-,� '� �� � �—� � � ' '�� �i i � i i i � � C �� a'.3 I i-__��I � '' �� � t �. � - �'� , � I �� � 't �: � - � � � , � ; I 1 : I � ,. � � � Y` � I - � .��. '+�.. i � : � � � � I l � a ; I � ;! � � ; � �I� ( i , E i ��� k�;i �''�a ` i ' ;, I � �� ' ' � I � `_ � �' � { ' ; i ? � i ���_: s , � � � 1 � �� � � � � I " , I E i � i � � �� -G� j i � i k � , i � I E I I ' � ,, i ( ; � �� �� i ; ( I ' ' I � � i � � f I i � 4 ;- . ( � I I � � i i `� € Gj { ' � ( i �.. ; ; 3 a 4 � I � ' i ' I E : `�._.J�.�—� �—�- � € � I , I , � ; E i t--� i _...�_ . I i —;_ � a-- . - E , 1 f i I � � , � ' � k � i � I f ' S 1 � ^� i ' ( I I I ` I I Y.'�¢; � � ( � I I � � � ' � i � I � � � � � i 7 � ' , i I � � �''; � � � ' ' ' ' ' I 7 � ! � � � � f � � � � � � � � � � � ( � � I 1 � � � � � � � i i ; � i i � 4 � � i , � �� � � � � � ! I i � i � � ' I 1 � ' � � I � i � � �,� �. � '..,. : j �' a- i . � � ( � G i � • � -� , ; � �`�.� � .9. _ j ; . - I s i � , ` � � ` 3..�,.�� ,� ._._ a_.�_ i �:..._- . -. .. q.; : ' d___ ` .