Loading...
HomeMy WebLinkAbout10067 CTI'Y OF DIAMOND BAR � COMMUNPI'Y DEVELOPIVIEIVT DEPARTMENT � 21660 E.Copley Drive Suite 190 PRESS (909)860.3195 Fax(909)861-3117 � �'A"', BUILDING PERMIT APPLICATION FIRMLY i � JOBSITE , � APPIIGATiON fL ,�� PERMIT �� P/C � ADDRESS DATE `7r � NUMBER # c� E ISSUE TYPE �• � OCC APN L T�. TR/�frL DATE CONST. '1� GROUP � OWNER � ' '° � ll�j� — ADDRESS• ZONING SETBACKS z CITY ZIP TEL. FRONT RW ❑ � APPLICANT TEL. REAR O SIDE/SIDE STREET RW � m4 CONTRACTO SIDE ❑ � AD�RESS � � pROPOSED USE � � ���- 0 CITY "���� ZIP TEL. A" � o ARCHlENG/ `1�-i� e���� W DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEI. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREAiVALUATION � OWNER-BI;ILDER DECIARATION SFR/ADDlREM O p i HEREBY AFFIRM UNDEA PENALiY OF PERJURV THAT 1 AM EXEMPT FROM THE CqNTRACTORS LI- G2f8CJB/Ce�OR W CENSEUWFORTHEfOLLOWIN6REASON�SEC.7W1.58U5ME55ANOPROFESS�ONSCODE:ANYCIT'OR (n U COUNTYWNICHREWJIRESAPERM17TOCONSTRUGT,ALTER,IMPROVE,DEMOLISH,ORREPAIflANYSTRUG � W Patio/Deck Z TURE,PRIOR TO ITS ISSUANCE,-NSO flEDU1RE6 THE APPLICANT GOR SUCH PERMIT TO FILE A SICNED - W STATEMENT THAY HE OR SHE IS LICENSE�PURSUANT TO THE PROVISIQYS OF TNE CqNTHAC70FiS LI� �- CENSE LAW(CHAPTER 9(CAMMENCWG WITH SECTION 7000)OF DIVIS:ON 3 OF THE BUSINESSAND PR0. : V" PooUSpa FESSIONSCODE)ORTHATHEORSHEISEXEAAPT7HEREFAOMAN�THEBASISFORTHEALLEGEDE%EMP- - (� V- TION,pNYVIOLATIONOFSEGTION]o31.58YANYAPPLICANTPORAPEflMITSU&IECTSTHEAPPUCANTTO - -Z fl8-ROOf �_ ACIVILPENALTVOFNOTMORETHANGiVEHUNDPED00LLARS(f5oD).): - 0- ❑LASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLEfAMPENSATION, � � CORIrt10fCidl Z- Wlll DO THE WORK,AND THE STRUCTUqE IS NOT INTENDEU OR OFFEPED FOR SALE(SEC.7044,BUS�- : J NESS AN�Pfl�FE55ION5 CADE:THE CONTRACTOFS LICENSE LAW�OES NOTAPPLY i0 AN OWNER OF " �.�� �J �- PROPERlYMRiOBU1LD30RIMPftOVESTHEREON,ANDWHODOESSUCHWOPKHIMSEIFORHERSEIfOfl . � ' ` � � �THROUGHNISORHEROWNEMPLOYEES,PflOVIDEDTHATSUCHIMPROVEMENTSARENOTINiENOEDOR C� � � d W- OFFEREOFORSALE.IFHOWEYER7MEBUILOINGOflIMPROVEM'cNTI5501DWITHINOYEYEApOFCOMPIE ' �; TION,THE OWhEPEUILDER WILL HAVE TNE BUHDEN OF PROVMG THAT HE OR SHE OID NbT BUILD OR '_ _:- IMVROYE FOR THE PURPOSE OF SALE). ❑i.AS OWNER OF THE PROPEH7Y,AM EXCLUSIVELY CONiRACTINO WITH LICENSED CONTRACTORS �., TO CONSTRUCT TNE Gq0.1ECT�SEC.7056,BUSINE55 AND PPOFE5SIONS GOOE:TNE CONTRACTOR3 LI. , V81UdIi0ft ADJ.AREA W:- CEN5ELAWDOESNOTAPPLYTOANONMEROFAPROPERTYWHOBUILDSOflIMPROVESTHEREON,ANO . �-. ��WHOCONTRACTSFOFSUCHPROJECTSWI7HACANTRACTOR(5)L'CENSEDPURSl1ANTTOTHECONTRAF : QUANfiITY DESGRIPTION � FEE 70R5 LICENSE LAW.). - Y'. g9� �' G I AM EXEAIPT UNDER SEG e.&PG FOH THIS REASON ���- Q ►K"G� �- :. � � � � � - DATE OWNER � � _j��__-_/. ' Z': � �Y W't/�`L _ �` LICENSEO CONTRACTORS DECLARATION ' —�� �Q._ w CC- IHERE6YAPFIRMUNDERPENAL7YOFPEPJURYTHATIM�UCENSEDUNDERPROVIs'IONSCFCHAPTEF � - �� 9(COMMENCMG W�TH SECiION 7000)OF DNISION 3 Of THE BUSMESSAND PROFEF510NS CODE,AND Z `X_- MYLICENSE IS IN fULL FORCEANC EfFECT. m - � s. � 0 LIGENSE C S_ - LIC.NO._ � � � . - Lf �_ J U.; �TE r' ___�__,CONTHACTOR n- _ W� - �". WORKERS'COMPENSATION OECLAFATION �- Q j �'. IHEflEOYAFFiRMUNDEflPENALNOFPEFJURYONEOFTHELOLLOWIkGDECLAMTIOYS: � C�� Q 0- IHAVfAN�WILLMAMTAINACEHTiFICATEOFCONSENTTOSEIF-iNSIJflcFORWORKEflS 2 - - CAMPENSATION,ASPHOViDEDBYSECTION37ooOFTHEIPADRCODE,FOFTHEPERFORMAkCE C) g- OFTHE WOPoC FOR WHiCH iHIS PERMIT IS I5SUE0. � � � w�: .�I HAVE ANO WILL MAMTAIN WOflKERS'COMPENSA7X;V INSUqANGE,AS RE-0UIflED BV SECTIDN � Q 37000FTHELA80NGODE,FOpTHEPERWFMANCEDFTHEWOFKFORWHICHTHISPEfiMITIS 'i � � •�.� �' ISSUED.MYYJOR 'CA PE A710N INS 'CE CRflF R AND POLiCY NUMBER APE: CONSTRUCTION ��`3 � J J' 2 j�_. CARqIEN PLAN REVIEW � Z aoucrNUMeEd �� f�" ELECTAIC 0-.. t�+�ssEcnorvNE�niora=_mra.EiEooFn�r�arott�5r�uponiEt�.vmaEooaufs(stro)aratFss} .PLUMBING -ce_:�� `� ���� w 1 CEHTIFY THAT W THE PERFOflMANCE OF THE WORK FOR WHICH 7HIS PEHMIT IS ISSUED,I MECHANICAI �:# �e w � Z. �}_ SHALL NOT EMPLOYANV PERSON IN ANY MANNER SOAS TO BECAME SU&IECT TO THE _ � �`" WORKERS'COMPENSAnONLAW50FC--IFORNIA,RN�AGR[ETiATIFiSHWIDBECQM� - �7NSPEGT�ONFEE - - _.: SUBJECTTOTHEWORKERS'COMPEN ONPROVISIONSOF CTION37000FTMEtAH�R ) CODE,ISHALLFORTHWI7HCOMPLY TNOSEPROVISIONS "��� �SSUANCE � SMIP p . OATE:.�P��.. APPLICANL � � .. �.� - � ENERGY P/C __ . � � ;WARNING FAILURE TO SEIXIRE WORKERS'GOMPENSATION CAVERAGE IS UNLAWF MALL9E LL � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNORED USAND ENERGYPEFM�T ;DOlL4qS(f��.��.INAD0ITIONTOTHECOSTOFGOMPENSATION,OAMAGESRSPROVIDEDFORIN �-��.SECTIDN37aHOFTHELABORCODE,INTEflEST,AN�ATTOflNEY5FEE5. RETENTIONFEE: �� d CONSTRUCTION LENDING AGENCY -PRE-ALT PEE: - O �- IHEREBYAFFIRMUNDERPENALTYOFPERJUqYTHpTTHEREISACONSTRUCTIONLENDINGAOENCY FORTHE PERFORM/WCE OFTHE WORK(-0R WHICH THIS PERMIT IS ISSUE�(SEC-30B7,CN.C.). Z W � LENUER'S NAME 1-- LEN�EFYSADDPE5S _— - � ICER7IFYTHATIHAVEREAOTHISAPPLICATIONANOSTATETMATTHEABOYEINFORMATIONISfARRECT. TOTAL FEES l � IAGPEETOCAMPIYWITHALLCIT'ANDGOUNTVOROINANCESANDSTATELAWSREtATWGTOBUILDING - CONSTRUCTION,AND HEREBVAUTHOfl2E REPRESENTATIVES OF THIS COUMY TO ENTEfi UPON THE qny� ��3LJ.-P I a��� � s����:-- ZABOYE-MENTIONEU PqOPERTY FOR INSPECTION PURPOSES. COMMENT$ ��•�o � 0 •�!� e �q/1��J�.� �—r — -. � // {-.lf�... � — ¢ PERAIITT (P I �� N 8 Y r— y SICNANREOFPEHMITTEE ATF. _ - RECPT.N0. � PAID 8Y � VALIDATION ~' WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,G EEN—ApplicanYs Copy _ . _ � �.,� �� .,x �_�...��,...�. � _-,- ---� (�` -�-� � ;,-___ �._z , _ �_�� � � � ��-h�riSGi�v:I�n�nic5 g m cn�Ix_�E�i�l��� -t us G` m�-r, v� � � II -tntr3{ '. � ��ZIZ�Z A rr!ftr m �7 m p 2�O,J�Ci O � �Dln 37 � -+ srt m�l � I £} ��D{�;g,la,cn�m v � {I��r-� iiC�Cic�O D O,--1 �I��c� �S.--i - '�-i i I � , � # r�r,�r r I�E'� -s t*� � �'- �f� G� 7 -n � -i,m � � c�e� U'�� � 'UI'Y I S (': j3(��n 37-D � ��� fSl S�3�Li{�! Z J J:�:�J��iZ(� 'n�D 'vt� � rl-�m � I��-i ua ro�rn�x 0 � s ca o �I� O�G� -i:-i 171 c m yz "'s � b � zc �f�lrrimC � m� ���I'�Itz �. � �D � .. � ���i—�au'�us�r-�� � usj �Icj���E� m ml�''t��� mirlG7 � _ z --� � � ��-� -� x » ��,v.'w;�.����� ��y :�i�e :n:� , �;nr ..�� r r-._ ��N Gh � � I � � � �� I, �'.� D{•� Zlti Z ''"�—"�u� I�p�---�� P�n. ���C � � , ;m;� ' }; � i � �'��Z � v�I��nj I (-�t � ^ G>I�Irm'. m � � (� :� i f i . y. � � I � {, E � � ZIE � IE ,�z� � �` " ,� � ��„ I �i ;� � � ' � . �� � , � , , ► � � �� � ;: � � , � � �� f _; '� ' ��`�, '! . �� � , i . � . � . < � i � �, i 1 ,� � E ::I �s- .,� E' � � � ` r ;. �. I . , � �� � �� ' � . ' . . ; t � ; � � ; � �� � �: �� v �� � � � � � I � i � ;'�; 4 y - � I' � ' j E; ' �i.�:`�,�I � I � � i � , � �� �-�'-' �' ' ` � 1• � �y"� �- ' � �� E , j � " � � :j , � � � � � � �� ; � i ��E , i �- 1 I �' '� i E, � ; � �� � � �� ' } I j ���� �� -1 � � � _. � �� � �; ; � i � - � � � l ' ` ' �, j `� � �e I I.: (;. � j � � � :� r ' �. � � rI=�7 ( � � � f � k � I - � �� � � � n ` _ � '� � _ � �� � � rnto�T �n � G r T.a G � s�-� �t ��m � ��� � � �� c�T+�ii � _. ��� �- - - � I ' � z m�m � zz � a_�m -nOO�O �'o,m � zl, � � z zi= r � _ r I i a l i ; . � � �-" <I� m�alm � aic -n p oio, ic;z��n v �,� �,; ;r, � a D!p � � , � , _ � �+'-� � �r o r_-.l�y �Ir r'_ = G)}f�{�y . ���5 v �u'�n rr`r�Dja �� � i �_ � � t � 7�m�ai�mlry�m ci mIp -ii�1�, ml fx�=f� w �in � "ay� i� 3 - .. � �_. �t� �.. _ I-f-m -O�_ �Y_ rnIz rsi= G)C- l� Y`O�� �i �'U"n � � �� . 1 _� . � �.Oy�Q� D 4�._m�� � �:�t� r �?' ,.. -t-I Z � � 4�i O A I.]7 fi� ti7�-��O O I�I_ -�- � � � ( � � .� I � � � ���� � ����=vjm� �-c�m " z�� r- c'�-�o y � ( � �Q �I� p�O�--�Iu; � � i ��. ���E ( 'U:�'f Z �-i �D Z �� �I . @�d . ,s� � � t) � ��' �'z � � �7 `ni�� z'r'-'��� �� �G��6�i'��T' ���Q•io � �i�i1 � � -'� � f ( 1 I� �ID � '�'n ,� .Z� I D;x� eb z:� � � . 0;1 I � � � 7: I �,�g z � � �� ,i � '��� l , jz � � ��f ; -�,� i i- ���� _�n, ( ��+�c � � �� ! ; � �- , '� � - :t � , `�' i �:D � " f � t ; ; i f I� � ��' ���I � 7D �,_. � i _- � �� � � � i '� � � � ` a �: � i I_� a � ����� C� � "' � � - q - � � � � � � _� �_ ; , z�=�! � � � :�i 'I �I " i ''I�.4*"� � ' 'i k :. � j � � � i �-__ I t : �,,a j ��.-.r. - �� . � 2�. � _� h s � J ( _y I- ` . i - 2 . � �,i � . I.- � �I . I .-�� I I'- ' t � .- [ �-I� � � �_' I .. �.�._ ',._I ae� . i ..;% � -�� i� � � _ ; � _� _ �� ��� �. _ � � I_ � -�. � _ ��6 �f� � i la ? - �':� � `��,_ s.'�S �. �� i �� _ I� ��! �� _ � I j_. I �, � �` . � :' i � `, � � . � � ' - i ,, � � � � : 3 ; I $ �� � � � � � � t _� f -� �� � ,_ ���.� � , l� , �° � � � � �3�� �3���� -�� �I �� . i _ _ =�- ;,�_ t � fi � _ � � t � �� , . ��: �,�_ _ _ ,i: ��- �� ., � � , � � ! -�� � � � ? � � � : � _,> � � ; � � .�� � �_ _,� . � _ ;; , � ' ' ;-� ,�� �� : �1 � � ; � _ : �� :;;� _ 6 ._ -. � � � � ��:� , _ �. � !� � �� � � � .�� . �_ ��. � ��� . � I .: _ � �.:� � :_ � � � �:[�L���. � � � ��!1 � � ' � � �,_ _