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HomeMy WebLinkAbout10934 (5) ;_ :_ .- � . � �� CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT �� 21660 E.Copley Drivc Suite 190 �R��� .W (909)860-3195 Pax(909)861-3117 �'"'9M'' BUILDINGPERMITAPPLICATION FIRMLY � J08SITE ���"'cC� �d p p,�\ ��� APPLICATION PERMIT J� P/C o ADDRESS � `'L��" Y� DATE__ NUMBER! � # o� ISSUE � TYPE OCC APN LOT TRACT DATE_ � �1rCX]f� GROUP � � L'�i r� (Z,o v,i..f.Y� �r� p OWNER o ADDRESS 2 � �LGOv p.� ,��p ZONING SETBACKS w ��'� FRONT n�'T !1 0 �nnn RW ❑ o CITY ���Avw Mc1 �p.Q ZIP C1i7�S TEL.�'�161' � REAR �� Z APPI(CANT TEL. SIDE/SIDE STREET RW ❑ ¢ CONTflACTOR SIDE ❑ � ADDRESS ��, � � � CITY ZIP TEL. PROPOSED USE �--`J � oARCH/ENGI �_f�—"(_�:� 6�Z�'� ���r L'�H'`f"� W DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL._ N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � .Q- OWNER-BCILDER DECLARATION SFR/ADD/REM p� I HEflEeY AFFIqA7 UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONrpp�7pR5 LI� G91'892/C8I(JOR - W CENSELAWFORTHEFOLLOWWGREASOY(SEC.7037.58USIVESSANDPROFESSIONSCO�E:ANYCfTYOR (/) U- COUNTVNMICHPEnUIRESAPEAMITTOCONSTRUCT,ALTER,iMPROV'c,DEMOLISH,ORREPAIRANY57RUC- W P8I10/D2Ck � - Z- 7URE,PFi:OR 70 IT�ISSUANCE,ALSO PECUIRES THE APPLICANi FOR SUCH PERMIT TO FILE A SIG\ED W c� STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TD 7ME VFioVISIONS UF l HE CONTRAci(]HS Lb - � CENSE LAW(CHAPTER 9(CAMMENCING WITH SECTION.700D)OF DIVISION 3 0F THF�3USINESS AN�PRO- �'i' PD�USpd . '` PESSIONSGODE�OFTHATHcOR511EIS:J(EMPTTtiEqE:RO1dAn�THC6ASISfOftTH[ALLLG[DEXEM.'- (!j ��� TION.ANVVIOLATIONOFSECTION7W7.5BYAh'YAPPLICANTFORAPER1.11TSUBJEGTSTHEAPPLIGANTTO Z Re-Foof - , ACIVIL PENAITV OF NOT NORE THAN FNE HUNOflED DOLLAPS($500).)� - . Z ❑I;ASOWNEFOFTHEPAOPERTY,ORMYEMPLOYEES�•ATNWAGESASTHEIRSOLECAMPENSATION, � Commercial � WILI�O THE WOHK,IW�THE STRUCTURE IS NOT IMENDED OR OFFERED FOR SAIE(SEC.7044,BU51- J NESS AND PROFESSIONS CODE�THE CONTaACTORS LICFNSE l AW�OES NOT APPLY TO AN OWNER OF -� PROPERTYWHOBUILDSORIMPROVESTHEREON,AND\YHOOOESSUCHWORKHIMSELFORHERSE��OR m CL THflOUGHHI50RHEHOWNEMPIDYEES,PROV10EDTHATSJCHiMPROVEMENTSARENOTINTENDEDOfl _Q: OFFEPED FOR SALE.IF 410VJEVER,THE BIIiLDMG OR IIAPROVEMENT IS SOLD YJITHIN ONE YEAfl OF CGMPL6 - �_ TION,TH[OYlNER-BUILD'eA WILL HAVE 7HE BURDEN OF PROV!�G THAT HE OR SHE DfD NOT BNLD OR _ �. :IMPROVE FOR THE PURPOSE OF SALE). - ,_..1,AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTWG WITH LICENSED CONTRACTOflS -�-' TO CONSTRVCT THE P�JEC7(SEC.�o4n,-BUSIhESS AND PRO:ESSIONS CODE:THE CONTRACTORS LI� VdIU0li0n ADJ.AREA W: CENSELAWDOESNOTAPPIYTOANOWNEROFAPROPERiYWHOBUILDSORMAPROVESTHEflEON,ANO '�-��� WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOF(5)LICcNSEDPURSUAMTOIHECANTFiAG QUANTITY DESCRIPTION - FEE � TORS LICENSE LAW.). - CL J �_ G I AM EXEMPT U4DER SEC._ B.&P.G FOR THIS REASON �� LL + +� � DATE � t OWNER �� Z W. _�-- IICENSED CONTRACTORS DECLARATION W - �-� I HEREBY AFFIRIA UNOER PCNAITV OF PERJURY THAT i AM liCeNSED IiNDER PROVIS�OtiS 0F CiiAPTER � - -d�_ 9(WMMENCINGYdITHSECTiON7000)OFDIVISION30FTHEBUSiNESSAYOPROFESSIONSCC�E,lYD Z 'X� MY�ICENSE IS M f111 I.fORCEl��1D EFFECT. m � . 0 � � LICENSE CLASS LIC.hO. � J V-; OATE GONTRAGTOR - d W: -��` WORKEFS'COMPENSATION DECLARATION - -i -_. .. .__�_ . . . . . . _ . . . . . . ¢ .... - N U _- �; IHeREBYAFFipMUNDERPENALTYOFPERJtJRYONEOFTHEFOLLOWINGDECLARAT10N3 Z -� :—: Q . . . ... _.. -�-- I HAV'e AND WILL MA!NTAIN A C,FRTIFICATE OF CINJSENi TO SELF-WSURE FOR WORKERS' _ - � - - -- - -z-` COMPENSATIOY,pS PFOVI�E�BY SECT:ON a7a0 OF THC LA6Ofi CO�E,FOR THE PERFORMANCE U - - - Q- OF THE WORi(FOH WHICH 7HIS PEflM1T IS ISSUEO. � . �. W I HAVE ANO WILL MAINTAIN WORi(ERS'COMVtNSAIiUN INSURANCE,AS FiE�LIflE�BY SECTIOV - - - Q_. 3�ooOF THE LABOR CODE,FORTHE PERFORAAMCE OF THE WORK FOR WHICH iHIS PEaMIT IS - - � � - ��. � � - . ISSUED.MY WDRKERS'COMPENSATION INSURANCE CAFRIER AN�POLICY NUMBER ARE CONSTflUCTION J` - .j_ cnaaiEa PLAN REVIEW _ _ ��- POIiCYNUMBER ELECTRIC ' ¢� (MISSECIIONNEBNOTBECAVPLEfEDOFTHEPERNtlTISFORQtiEHl1AOR�DOLLARS(5100)ORLESS). PLUMBING - �' --- - - -W- MECHANICAL ----� Z- I GEflTIFY THAi INTHE PERFORMANCE OF THE WOflK FOfl WHICH iHIS AERM171S ISSUED,l - � . . _(�; . SHALLNOT EMPLOYANY PEPSON IN ANY.MANNER.50 AS TO BEGOME SUBJEGT TOTHE . ' - - �--�- -N'ORKERS'COMPENSATIONLAWSOFCALIFOH�IA,ANDAGFtEETNkTIFISHOULOBECCM'c - (IVSPECTIONFEE �.- . . � SUBJECTTO THE WORiCEflS'COMPENSATION PpOVU^IOYS OF 5[CTIOY alao OF TH[LABOR � � _�_- ISSUANCE 1,�L• d� CADE.I SHALL FORTHWITH C011PLY WITH THOSE PROVISIONS. �- SMIP - _ Jr� . " _p_ DATE:___ _.__— APPLICANT: -W- ENERGY P/C - '��� YdARNING:FAILURE To SEGURE WORKERS'COMPENSATION COVERAGE IS UNIAWFUL,AND SHALL BE - � J _LL: SUBJFCTANEMPLOYFRTOCRIMINALPENALTIESANDCIVIIFlNESUPTOONEHUNDREDTHOUSAN� ENERGYPERMIT- DOLLAiiS(5100.006),IN ADDITION TO THE COST OF COMPENSATION,�AMAGES AS PROVIDED FOP�N �J' SECTION37080FTHELA60ftCODE,INTEREST,AN�ATTORNEY'SFEES. FETENTIONFEE: - �; �'- CONSTRUCTION LENDING AGENCY PRE-ALT PEE: _ - - ���5� I HEREBYAFFIRM UNDER PENALTY OF PERJUfiY THAT hIEflE IS ACONSTflUCTION�ENDING AGEIJCY - �� fOR THE PERFORMANCE OF 7HE YlOHK FOR WHIGH TMIS PERMIT IS ISSUED(SEC.3097,CN.C.). - w; g9 �1��_10�;� `S: LENDEF'SNAME ��':' . . . �< ' �I_' LENDEfl'SA��RESS --�-�- ICEflTIFVTHATIHAVEREADTIIISAPPLICATIONANDSTATETHATTHEA90VEINrORMATIONISCORRECT. TOTAL FEES � �� �-�€ IAGREETOCOMP�YWITHALLCITYAN�COUNTYORDIYANGESANDSTATELAVISRELATMGTOBUf_OIVG - - _�_ CONSTRUCTION,AN�HEREBY AUTHORIZF REPaESENTAT!VES OF THIS CGUNTY TO E�TER UPON TriE _z_ ABOVE-MENTIOYED PROPEflTV Pofl INSPECTION PURPOSES. CONMENTS .$•�. ���v� ��-� 'Q'v� .. . . m� PE MITTE NAME(PRINT) n . �-[�.: �-1� :�- SIGP TUREO PERMITiEE ^DA E - - --_ - - RECPL NO. PAI�BY VALIDATION -~` WHITE—Departmen[Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO File Copy,GREEN—ApplicanPs Copy F......s_,�.m.� �. ._.� _ ,.-._..,-..��.;_.-_..._�.�.. .. .. _ l- -ry I .._ �.;. � t I � � � ' � ��~-�i �( rn�e i� � r -, � I ; -�� �� * '� � s � = _ � � ''� � s � a- �'N r �_ � ��, i ��� -� n i �, i i ��� �� i � �i . � � i I � � � � �� I *s�;� i � ` ! 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