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HomeMy WebLinkAbout11248 CTI'Y OF DIAMOND BAR ��� � COMMUNTTY DEVELOPMENT DEPARTMENT ' � . 21660 E.Copley Drive Suite t 90 (909)860.3195 Fax(909)861-3117 PRESS '""°J BUILDING PERMITAPPLICATION FIRMLY N JOBSITE �. y {� a ADDRESS���`� ���C".��RA��.'� F{L� APPLICATION PERMIT ��Z_�� �/C p — DATE NUMBER � ISSUE l " �TypE OCC APN LOT TRACT DRTE � CONST. GROUP p OWNER ������)f..>a`�t�� o ADDRES ZONING SETBACKS Z CITY - ZI � TE�1��o��'�� FRONT RW r,) �• APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ QZ ,� �`,._._� SIDE ❑ CONTRACTOR �'�t.1��-�L"�`�5:�-�a.�=��iL�=R�..;S.�< ADD ESS-��`c�i��-a`���i��'F?'�f M1d., o � c PROPOSED USE o CIIY I� Zi� TE��- '1���'�-� o ARCH/ENG/ iz DESIGNER NO.DWEL. NO. NO. � ADDRESS = CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FC FACTOR PSF ADJ.AREANALUATION p� OWNER-BCILDER DEGLARATION - SFRIADD/REM O p I HEREBY AFPIRM UNDEft PENALN OF PERJURY THAT I AM EXEMPT FflOM THE CONTflACTORS U� GeBgB/C8�Of1 . LLf CENSELAWFORTHEFOLLOWI�GREASON(SEC.�o315Bl1SINE55ANOPROFESSIONSCODE:ANYGTYOR (n U CWNTYWHICHfiEQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,UEMOLISH,OflREPA�RANYS7RUG- W patio/Deck � TURE,PRIOF TO ITS ISSUANCE,AL50 ftEQl11HES THE APPIICANT FOR SUCH PERMIT TO FILEA SIGNEO W STATEMENT THAY HE Ofl SHE IS LICENSW PURSUANT TO THE PftDVISIONS OF THE CANTRACTORS LI- W � �: CENSE LAW(CHAPTEF 9(COMMENCIN�WITH 5ECTION 7000)OF ONISION 3 OF THE BUSMESSAND Pft0- � POOVSP2 Q FESSIONSWOE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBNSISFORTHEALLEGEDE%EMP� (� V. 710N.ANYVIOLATIONOFSECTION703L58YANYAPPLICANTFORAPERMITSUBJECTS7HEAPPLICAN770 Z Re-Roof - F ACIVILPENALTYOFNOTMOFiETHANFIVEHUNDREDDOLLARS(55no).): DI,ASOWNEROFTHEPFOPEfiN,ORMYEMPLOYEESWITHYJAGE5A5THEIRSOLECOMPENSATIOY, . � Z_- � Commercia� � - WILI DO iHE WORK.AND THE 5TRUCTURE IS NOT W7E�DED OR OFPEfiEO FOR SALE(SEC.7o4d.BU56 J �: NESS AND PROFESSIONS CAOE:THE CANTRACTORS LICENSE LAW OOES NOTAPPLY TO AN OWNER OF -- j _ PROPERTY WHD BUILOS Oq IMPROVES THEflEON,AND WHO DOES SUCH WORK HIMSELF Ofl HERSELF OR CC- THROUGHHISOHHEROWNEMPLOYEES,PHOVI�EDTHATSl1CHIMPqOVEMENTSARENOTINiENDEDOR m Q OFFEREDfOqSPLE.IF,HOWEVER,THEBUIL�INGOiiIMPPOVEMENTI550LDW1THINOUEYEAROFCOMPLE- - � T�ON,h1E OWNER-BUILAER WILL HAVE THE 6UflDEN OF PHOVIN�THAT HE Ofl 3HE�I�NOT BUILA OR � IMPROVEFOftTMEPUflPO5EOP5ILLE�. - -- - - w ❑I,ASOWNEROFiHEPROPERTY,AMEXCUISIVELYCONTRACTPIGWRHLICEN5EDCONTRACTORS � TO CONSTRUC7 THE PFOJECT(SEG 7044,BUSMESS AND PflOFESSIONS CODE:7HE CANTRACTORS L�- V2IU8IIOf1 ADJ.AREA W CENSELAW-DOESNOTAPPLYTOANOWNEROFAPflOPERT'WHOBUILDSORIMPROYESTHEflEON,AND ' - �`_ YMOCANTRACTSFORSIICHPRO.lECTSWITHACAMRACTOR(5)IICENSEDPURSUANTTOTHECONiRAG : QUANTITY DESCRIPTION - FEE Y 70RSLICENSEIAWJ. � ❑IAMEXEMPTUNDERSEC. e.BP.0 4'OHTHISREASON �`� q � V �- �ATL OWhER �'j - W � UCENSED CONTRACTORS DECLARATION -� � a �' IHEfiEBYAFFIRMUNDERPENALTYOFPERJURYTHATIAMIICEN9EDUNDERPROVIS10N30FCHAPTER � 4 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AN�PflOFE5510NS COOE.AN� z X- MYUCENSEISINFULLFORCEANDEFFECi � m �f�S -��..�1��^'�' . �S - �ir /� ry� � LICENSE CL4SS ��61 ���L.C?� � - �� �_ ? LIC.NO. �--� � V_ �ATE .?"-�-i� GONTRAGTOR - a - W. a� WORKERS'COMPENSATION DECLARATION � -� � . _; . . . . _. Q . . . � IHEREBYAFFIPMUUDERPENALNOFPERJURVONEOFTHEFOLLOWI.VGDECLAflAT10NS: ZC72 �' _IHAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' � COMPENSATION,ASPflOVIDEDBYSECT10N3�aoOFTMELA80RfADE,FORTIIEPERFORMfWCE OF TNE WORK FOR WHICH THIS PERMIT IS ISSUEO. 0. �� � _IHAVEANOWILLMAINTAINWORKEqS'COMPENSATIONINSURANCE.ASREOUIREDBYSEC710N Q 37000FTHELA80RCADE.FORTHEPERPoflMANCEOFTHEWORKFOflWHICHTHISPERMITIS ISSUED.MY WORKERS'COMPENSATION INSUqANCE CARRIERAND POLICY NUM9ERARE: CONSTRUCTION � CAqRIEH �w �l�cq���'y c PLAN REVIEW Z POLICY NUMBEP ���.)�1 �L ELECTRIC Q o fR+�ssEcraranE�rvoreEwn�r�Er�oFn��wwt�swnavEiax�onEooaudu�auoloa�ssl PLUMBING ,� � Z i CERTIFY THNT W THE PERFORMANCE OFTHE WORK FOR WHICH TNIS PEPMIT IS ISSUED,I MECHANICAL CS° SHALLNOTEMPLOYANYPEHSONINANYMANNERSOASTOBEfAMESU&IECiTOTHE �- WORKERS'COMPENSAT10NtAWSOFCALIfORNIA,ANDAGREETHATIFISHOUtDBECAME INSPECTIONFEE - SU&IECT TO THE WORKeRS'COMPENSATION FROVISIONS OF SECTIOY 3700 0F THE LABOR � CO�E,ISHALLFOflTHWITHCOMPLV . 'flOVISIDNS. ISSUANCE � � � �. " p DATE:�I�� APPLI�N�-�LJ-3 L�i SMIP JENERGY P/C WARNINa:FAILUFiE TO SECURE WORKERS'GOMPENSATION CAVERAGE IS UNU1WFUl,AND SHALI BE �y SU&IECTANEMPLOYEHTOCRIMINALPENALTIESAN�CMLFMESl1PTOONEHUNDREDTHOUSAND ENERGYPERMIT DDLLARS(5100,000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIOED FOfl IN ¢ SECTION37080FiHEUIBORCODE,MTEPEST,AN�AITOHNEY'SFEES. - RETENTIONFEE: -O CONSTRUCTIONLENDINGAGENCY PREALTFEE: � IHEFiEBYAFFIRMl1NDERPENALNOFPERJURYTHATTHEREISACANSTflUCT10NlENDINGAGENCY FOH THE PERFOflMANCE OF THE WORK FOR WHICN THIS PERMIT IS ISSUED(SEC.3097,CN.C.). Z W. — � LENOER'3 NAME F— IENDEfl'SA�OflE55 w ICERTIFYTHATIHAVEREADTHI3pPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES � G� •I�Jrs � I AGREE TO COMPLY WRH ALL CITY AND COUNTY ORDINANCES AND STA7E LAWS RELATING TO BUILDIYG � � CANSTRl1CTION,AN�HEFE6YAUTHOPIZEREPRESENiA7NESOFTHISCOUNTVTOENTEflUPONTHE Z ABOVE-MENTIIXJED PFOPEFN f-0fl INSPECTION PURPOSES. — COMMENTS _ � ___._�t�.��.�-���,� � �, m ERMITTEENAME(PflINn ^"1-.. � �.___ _� �.-��� � � SIGNATUHEOFPEFMITfEE DATE .,J�L- = RECPT.N0. PAID BY - - VALIDATION � - ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Appli nYs Copy - k. v _.� q_i...�.�..�. r� _.. � � �.. , � �. C""�("` 1 .�_ �-z+ � �. - : _ € sA -"`i-`^m._-- _.i'2 � ,E+ 7�C .r 7'I � '7 . ( s'"-} ��j : � �� ',�'�-�, � . FPl £t ! 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