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HomeMy WebLinkAbout10949 � � ---�``�- CITY OF DIAMOND BAR : � � � COMMUNITY DEVELOPMENT DEPARTMENT � �� �-„.;;; 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 � ,"°"" BUILDING PERMIT APPLICATION FIRMLY � � JOBSITE �� I /7-----��� '" ��� � NUMBER � # APPLICATIDN & PERMIT PIC o ADDRESS � �� ^C.� ������G! DATE____ � ISSUE TYPE OCC r APN LOT TRACT DATE CONST. GROUP p OWNER �. �,��I1F. ADDRESS _� I� ZONING SETBACKS ��y s w e` FRONT RW C Z CITY�' 1't 1�s__ ZIP �. TEL. ��1��, -�h'�'i� o APPLICANT �� TEL. SIDE/SIDE STREET RW ❑ z Q CONTRACTOR SIDE ;_ o CDDRESS ZIP TEL. PROPOSED USE ��� `'����' �'�J��� � o ARCH/ENG/ � �� �� � �� w DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS__ � CITY ZIP TEL. — cn cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANA�UATION - � OWNER-BCILAER DECLARATION SFR/ADD/REM - O — p I HEREBY AFFIFM UNDER PENALTV OF PERJUftY THAT I AM EXEUPT FROM THE CONTI7ACTORS LI- GdfflgB/C8f{70it � W CcNSELAWFORTHEFOLLOWINGREA50N(SEC.�031.SBUSINESSAN�PROiE5510\SCODE:ANYC:TYOR (n - U- CCUNTVVJHiCHFECUIRESAPERMITTOCONSTRIICT,ALTER,IMPROVE,�EMOLISH,OFREPAIRANYSTR�G W TURE,PRIOFi TO IT3 ISSUANCE,ALSO ftEQU1RES THE APPLICAhT FOA SUCH PERMIS TO fllC A SlGNED W Patio!Deck - -f STATEMENT THAY I:E OR SHE IS LIGENSED PUflSUANT TO THE PflOVI510N5 OF THE COYTFACTOflS ll- _ �- CENSE LAW(CHAPTER9(COMMENCMG WITH SECTIDN.70oa)OF DIVISION 30F THE BUS!NESS AN�PFO- u' POOVSpO FESSIONSCO�E)ORTHATHEOPSHEISEXEMPTTHER'cFRCMnNDTNE9ASI5FOflTHE�L.EGEDEXEMP- (� � TION.ANYVIOLATIO�OFSECTION7031.5BYANYAP?4CANTFORhPERMIT5U8JECT5THEAPPLICANTTO � R-R ACIVIL PENALTV OF NOT MORE THAN FIVE HUNOFED DOLLARS(5500)): - Fy,��AS OWYER OFTHE PF07ERTY,OR!AY E61PlOYEES:'lITH WAGES AS THEIR SOLE COMPENSATION, O 0 Commeroial � WILL90 THE Y�OPK,AND THE STflUCTIiRE IS NOT INTENDED OR OFFERE�FOA SALE(SEC.7oaa,BU51- - J � NESSAN�PROFESSIONS CODE:THE CO4TRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF :- � PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DO'cS SUCH WORK HiMSELF OR HERSELF OR . � THflOIJGHHISORHEROWNEMPLOYEES,PflOVI�ED7HATSUCHISI2ROVEMENTSAfl'cNOTINTENDEDOR .m W OFfEREOWR5A�EIF,HOWEVcR,THEOUILOINGORIMPROVEMENTI550LDYYliHMONEYEAROFCOMPLE- Z TION,THE OWNER-BUILOER WILL HAVE THE BUHOEN OF PAOVING THA7 HE OR SHE DID UOT BUIID OR . . � IMPROVEPoRTtIEPURPOSEOFSALE). . �yj CI,ASOWYtHOF7HEPHOPEH7Y,AMEXCLU5IVELYGOMfiAGTINGWIIHLICENSEDCANTFACTORS . [C TO CONSTRL'CT THE PPOJECT(SEC_]04a,Bl1SlNESS ANO PROFESSIONS CODE:THF(bNTRACTDFS LI- V8IUa�lOt1 ADJ.AREA W CE4SELAWDOEShOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSOflIMPROVESTHEREON,AND - ' �� WHOCCNTftACTSFOrlSUCHPROJECTSY/ITHACONTRACTOR�57LICENSEDPURSUANTTOTHECONTflAC- QUANTITY DESCRIPTION FEE � TO�S LICE:45E LA�V.). � ❑1 AU EXEMPTUNDER SEC. B.&P.C.FOR THIS REASON � J O U - � ---- - �y - -._. ...___.- ---- -- -- S �3� � DATE��'I"/�'�_OVlNEfi �� �_� ���y �� - F— § Z U � � W , .� LICENSED CONTRACTORS DECLARATION W � CL 1 HEFlc'BYFFFIPM UNDER PENALTV OF PERJURY TriAi I AM LICENSED U�'D'cR PROVISIOIrS OF CHAPTER � - d 9(COMMENCING WITH SECTIO�7000)CF DIVISION 3 0F TNE OUSINESS AND PRO�ESSIONS COOE,AND Z XW MY LICENSE IS M FULL FORCEAND EFFEGT. m 0 LICENSECLASS �IC.NO. �I H J U DATE CONTRACTOR � a . IJJ � WORKERS'COMPENSATION DECLARATION - ¢ � IHEREBYAFFIR:AWDERPENALiYOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS: Z � IHAV[ANDW�LLMAINiAINACERTIFICATEOFCONSENTTOSE�F-INSUREFORN'ORKERS' _ - -� - - -- Q WMPENSATION.ASPROIIDEDBY5ECT1043�C00FTHELA80RCODE,FORTHEPERGORMANCE IU - 6 OF THE WORK FOR WHIGH TMIS PERMIT IS ISSUE�. � - W I NAVE AND WiLL�.1AiN'AIN WORK`eR5'GOMPENSATION INSUFANCE.AS ReQUIR'cD BY SECTION J v � Q 37000F THE LABOR CODE,FOR THE PEFFORMA�CE OFTHE VlORK FOR WHICH THIS PERMIT IS �3 �. � ISSUED.MY WORKERS'COLIPENSATION INSURANCE CARR�ERAND POLICY NUMBERARE: - STRUC N � J � CARRIER PLAN REVIEW � POLICVNUMBER ELECTRIC Z 4 d �ss`cnauNEmnoreEcaaci.Er[owni[a[a+nrr�sroaau[i+�voacoocunas�sim�oa�Ess�. - PLUMBING . w Z 1 CER7IFV THA'f IY THE PERFORAMNCE Or'THE WORK FOR WHICH THIS PERMIT IS�SSUED.I ti1ECHANICAL � SHALLNOTEMPLOYANYPEflSONINANYMANNERSOASTOBECOMESUBJECTTOTHE �i. _ WORKERS'CONPENSATION�AWSOFCAL:FOANIA,ANDAGReETHATIFISHOUI�°ECOME � INSPECTIONFEE ���r _- ? SU&IECTTO THE WORKEfiS'COMPENSATIOV PFOVISIONS OF SECTION s70o OFTHE LABOR _ CADE,I SHALL FOflTHW1TH CONPLY WITH THOSE PftOVI5:ON5. UAN � t.:. � 5 . p DATE: APPLICANT. �'t�� p . - J- WAflNWGFA1LUflETOSECUflEWORKERS'CAHPENSATIONCqVERAGEISUNtAWFUi,ANDSHALLBE - ENERGYP�C � ` � SU9JECT qN EMPLOYER i0 GRIMINAL PENALTIES At�D GVIL FINES UP TOONE HUNDRE�THOUSAtvD [NERGY PERMIT � - DOLLAPS(E1oo.o0o7,INAD0ITIONTOTHECOSTOFCOMPEN5AT10N,�AUAGESASPflOVI�F�FORIN - - J- SECTiON 37oe OFTHE LABOR CODE,INTEREST,ANDATTORNEY'S FEES. RETENTION FEE: � . a CONSTRUCT�ON LENDING AGENCY PRE-AlT FEE: O � IHEftE6VAFFlRMUNDERPENALTVOFPERJURVTHATTHERE!SACONSTRUCTIONLEN�INGAGEYCY n- FOR THE PER�ORMANGE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3o97,CIV.C.). ------- Z- W � � LEN�ER'SNAME F— LENDER'SADDFE55 � TOTAL FEES � /� � � I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFOR47ATION IS CORRECT � I AGREE TO COSIPLY WITH AlL CITYAND CO:INTYORDI4ANCES AND STATE LAWS RELATING TO 6UILDING , - � CONSTRUCTION.ANDHEREOYAUTHORIZERtPHtS`tNTATNESOFTHISCOIINIYIOENTEHU{'O\THE . . z A80VE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS - 0 A ' �� � � ` m P R TT NAME !NT) � � � i�aT eo PERMITTE oaie flECPT NO. � � PAID BY � �� VALIDATION 2 ~ WHITE—De artment Co YEILOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN— p py. py, py, py, Applicant's Copy �` ( �-r--r----._ �----�---;--j`�`�Y' � 1_ ..�.' 1� 1`_`f_`_j— . � . `y ~ � ' CnCt�° � E � , �� i ' -� � `r'c � �� ( i.�� � f�i ��;i��l� � zn �� i� iry ; , � ' �— i a l � , E —s �� —�,�<, —� � z� Efl � � � � � � z � � � � � -'��"E`f4i3 i� i .� � �- l�-�' ��. 3. ���< �� � �G. 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