Loading...
HomeMy WebLinkAbout15634 (22) J� CITY OF DIAMOND BAR , DEPARTMENT OF COMMiJNITY 8c DEVELOPMENT SERVICES �� � " 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS � ; �"'9�' � BUILDINGPERMITAPPLICATION __ FIRMLY � JOBSITE APPLICATION i PERMIT P/C � ADDRESS����13�a a�' C c��G� �C;o• DATE �O�+�1�'� NUMBER ���' # $ ISSUE ^I TYPE OCC APN LOT TRACT DATE � � �9� CONST. GROUP p OWNER�In�C?S+ �t)f3"Ri�ti� t�@I<.. Q ADDRESS,��j� G� J,��(t4 2Ce�11 ��. ZONING SETBACKS Z CITYa.��- ZIP 1�(� TEL.:��' /Q� FRONT RW ❑ g APPUCANT TEL. REAR CI � SIDFJSIDE STREET RW ❑ d� CONTRACTOR SIDE ❑ � ADDRESS _ � CITY ZIP TEL PROPOSED USE � ARCWENG/ W DESIGNER NO.DWEL. NO. NO. � a ADDRESS � UNITS STORIES BEDROOMS � CITY ZIP TEL. � u� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION -� OWNER-BUILDER DECLARATION SFR/ADO/REM � O � -�. I HEPEBY AFFlRM UNDER GENAITY OF PEMIRY THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gdldge�C2fpOlt -1tJ' CENSELAWFORiHEFOLLOW�NGREASON(SEC.7031.58USINESSAN�PpOFESSIONSCODE:ANYCiTYOR {n COUN7YWFIIqiflEqUIflESAPEflM1TTOCOtJSTPUCT.ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Pd110/DBCk - TURE,PRIOR TO ITS ISSUANCE,ALSO REQL11HE5 THE APPLICANT FOR SUCH PEFMIT TO FILE A SIGNED f �_ STATEIAENT THAT HE OR SHE�3 IJCENSEO PURSUANT TO TNE PROVISIONS OF THE COUTRACTOflS LI- � . � CENSEUW(CHAiTERe(GORIMENCING WITH SECTION 7000)OF DIYISION 30F THE BUSINESS AND PR0- PooUSpa � �- FESSIONSCODE)ORTHATHEORSHEISEXEMPTlHEREFHOMAN07HEBA5ISPOPTHEALLEGEOEXEMP- � 1 v TION.AN`/VIOLATKKJOFSECTION703t.5BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPUCANTTO Z Re-Roof � - AC�VILPENAL7YOFNOTMORETHANFIVEHUNDFiEDDOLU1H5�5500).): r~i` ❑I,ASOWNEROFTHEPHOPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION. ❑ COmmBrCial � WILL DO THE WOAIC,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BUSI- .J tJE55 AND PROFESSIONS COOE:THE CONTFlACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � i � PROPERiVNhiOBIlILD3DNAdPROVESTHEREON,AN�Vh10DOESSUCHWORKHIMSELFORHERSEI.FOR CL�- THRIXIGNHISORHEROWNEMPLOVEES,PROVIDE�7HATSUCHIMPROVEMENTSARENOTINTENDEDOR m _Q___ _OFF6iE�FOflS/VLEIF,HOWEVERT�'�EBUILDIN(iDR�MPROVEMEMTiSSOLDWITHINONEYEAROFCAMPIE- � TION,TME OWNER�9UiLDEH NflLL HAVE TXE BUROEN OF PPOYING iXAT HE OR SHE OIO NOT OUILD OR .�. IMVl�VE FOA THE PURPOSE OF SILLE�. �.W- ❑I,ASOWNEROFTHEPROPEHTV,AMEXCWSNELY�NTRACiINGWiYHLICCNSEDCANTMCTORS �_ TO CONSTflUCT iME PRQIECT(SEG 7044,BUSINESS AND PROiESSIONS CODE:TNE CAYiRAGTOflS ll- - V81t18tltlil ADJ.AREA - CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPEAttWFiOBUfLD50R161PROVESTNEREOtd.AND - �' WHOCOMMCT8FORSUCHPRQIECTSWITiACONTRACTOR(S)LICENSEDPUR6UANTTOTHECONTFAO QUANTITY DESCRIPTION FEE -. TORS IiCENSE UW.).- . -��� O I AM EXEIAPT UNOEA SEC. B.d P.0 FOR THIS REASON Q - � U �- � �: OATE �-``� ,�OWNER f' Z` . W � �_�- UCENSE�CQNTRACTORS�ECLARATIO W . IHEREBYAFFlflMUNDERPeNALTYOFPERJURYiHAiIAAiLICeNSEDUNDEHPRCVISlOiJSCFCHAPTER •� j i _ ,��J,�� -;.d_. 9(COMMENCINGWIiNSECTION7ao0)OFCIVISIOtJ30FTHEEl1SINESSANOPROFESSIONSCOOF,AN� � l - Y� TC ��:_X-._ MYLICENSE IS ItJ NLL FOFCEAND EFFECT. - m - 11.{ - �o.f UCENSECLA55 LIQNO. -:'j U:, J UA7E CONTRACTOR �- w= � -�� WOFKc'RS'CnMPENSATIONDECLARATION Q _' U .�' 7HEREBYAFflRMUNDERPENALTYOFPERJURYOYEOfiHEfOILOWWGOECLARATIONS: Z � -�; IHRVEANDVALLMAINiRINACERIIFlCA7'cOFCOYSENTTOSE�F-INSURSFOFWORKEFS � _ -_� WA/PENSFTIOtJ,ASPROViDEOHYSEClIOM3'IooOF1MELABOflGODE,FORTHEPEqtORh1ANCE �U - OFTHEWOFKFORWHICHTHISPEflM1TI5155UED. � �,. W- i HAVEAND WILLMAIMAIN WQRKEflS'COM?ENSATIDN INSUflANCE.AS PEQUIR'c�BY SECTIO� 1.—: — _Q`� 37000FTtiELRBGflWOE,fORYHEPERFORMANCEOFiHEWORKPoRWHICH7HV5PERMiTiS ISSl1ED.MY V10FiKEHS'COAIPENSATION INSUBANCE CARHIER AND POLICY NUMBEN ARE: CONSTRUCTION ___ .�-j�� . c�Rniea_ PLANREVIEW �_z� POLICYNUMBER ELECTRIC ��a` (fHlSSECiqNNE�NOT8E00A'PLETIDOFTHEPEF�Y.4l45FORONES,'IkAREDDIX.LARS(£iW)ORLESS} PLUMBING � �� W-. .,Z„ iCEflTtFYTHNTINTHEPEHfOPMAIJCEOFTNEWOflKFQflWHICHTHISPERMITI5155UE0.1 MECHANICAL -(�}:. SHALLNOTEMPLOYI.`UYPERSONINANYF6RNNERSORST08ECOMESIIBJECTTOTHE _ . . --��- WORKEflS'COMPENSATIONLAWSOFCALIFORNIA,ANDAPREETHATIFISHOULD6ECOME INSPECTIONFEE � -- --_- SUB1cCTTO7MEWORKENS'COMPENSATIMPROVISIONSOPSECTION37000F7HELNBOfl , � / - CO�E,ISHALIFORTHWITHCOMPLYWITHTHOSEPROVISIONS. �SSUANCE C. �' SMIP -'p- DATE: APPLICANT: _._ _ ' " .. . -W- ENERGY P/C � --J' WARNING:FAILUflETOSEWREWORKER3'CAMPENSATIONCOYERAGEISUNIAWFUI,ANDSMNLLBE -J' -Sll&IECTANEMPLOYERTQCRIMINALPENALTIESANOCIVILFINESUPTDONEHUNDREDTHOUSAND � ��� UOLLAflS(5100.000),IN ADDI'f10N TO THE COST OF COMPENSATION,OAAAAGES AS PROVIDED FOR M ENERGY PERMIT _ .J. SECTION37080FTHELA60flCODE,IYTEREST,IWOATTORNEY5FEE5. RETENTIONFEE: # ` �- � -:�-��- CONSTRUCTION LENDING AGENCY PRE-ALT PEE: �"�`�'- �` � ---'- � ` .O; '-�-� IMEflEBYAFFIRMt1N0ERPENALTYOFPERJURYTHATTHEREISACONSTRUCTIDNLEH0INGAGENCY ' -�--` FORTNE PEflFORMANCE OF THE WORK FOR WHIGH 7MI5 PEflM1T IS ISSUE�(SEC.309�,CIV.G.). . Z� ,.W i LENDER'S NAME ;1—; IENDEP'SA�DRESS .�__�- ICEflTIFYTHAiIHAJEREADTHISAPPUCATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. �. TOTAL FEES 4 t� ::::�;; IACiREETOCOMPLYWITMPLLCIT'ANOCOUNNOflDINANCE5ANO5TATElAWSflEtATINGTOBUILDING _�' CONSTRUCTION.ANDHEREBYAUTHORIZEREPftESENTATIVE50FTHI5COUNTYTOENTERUPONTHE __Z_ ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS �� C��i.���- �', e i�a�� -m- RMITTEENAME(PflINT �� �Q1����45�4�'��C��- i o 1 s)� ��-. S T OFPERMITtEE DATE _= RECPT.NO. � PAID BY VALIDATION `~- WHITE—D artment Co YELLOW--Finance Co PINK—Assessor Co GOLAENROQ—File Co GREEN— . BP PY� PY. PY. PY. ApPlicanYs CoPY _ �.t�_ �� �� �� � � � �'` . , i , � + !� � ,�3�+�����k'"�.� �s.��:,�.. i t � �,A. � � ����� 3���[k � � l I- _ ` i ��-`� � ����a ��� `��� � � a #�'��- � �'s , � ;� : , , ���'�5����'�k s*�,���'�€� �� �... ._ ,_; ; '' ' � - _ — ��'.... � ., � ��'� '� sr � ' � � - � � � � � �. � E � � � � -�{�� �� �'s � � ` � � I � ; ( ' _ Ex. � � I � +��s P I ; � " i - : �� � ����� � � i t �� ; a� �� t � �� �� � � � � � � �� � � j � � '����--�"����#'� ��� �� �� � � I ; T _LL� - �' ! I 1 �� �s � ��.. .�. 3- � �,�.� �.'s.� i ! _ � .�. _ ' _ _ _ .n � �. �`��� , ._ __ . : i . i j I I �� � i ���� . , 3 � i ��' + ; � i �� ' i ' � . ' � 3 � � r � > � 3 � i 3 r 3 n = = , = I � � ' , ,., 4 � } � f I . i i' '___ ��- i-` � - � _ � - _ ��-� , �. : i _ ' . + . . : .: I ' ' ', ' . ' , . 1 . (, , . ; � ; , . , � i i ( � € . 3 '� i '. i i ; i ; . ' ,,. , i '�'� ' . ! � i � �� � � . � I i � ( � � ' j � � ',� j I � � '.. � � . €� �i I '��. � � _ � � � � E ; � i { � ' � 3 I ; � j € � -' _ i, ' � � � ` � � � i I I i ��� � i I E � � I I I _ � � g ..�„ �-r, i � � _' -!_� _ > — ��' ��� � p � � � , ; I �� �'. ; . yt I i - y � , , e., .,�r _ � ! � ' ' � 3 rN € - � y"� ':. i � �• ' � ' � ' � N .� . � . , :[ . ��'"qi . 'i ���,��.� '( - � � ���.� �� �_ ' , —( ti � I �_ : .^,� - .:3 C I i I"`'��w� -3 ; � j I � ! I i � i - i �� � �s � € � ; ' E � ; : � ; ; , i ��� ... t , � , � � 1 � � � , j � � �� ` � � 3 �� � i k i ' � I ' � �� • I j ' i € - . � '"'� f 1 : I I ' ^. �. ; � , � �_ ' j l � � i � _� _ � i l - - -� , - — -;� - - . � , i � �� $ ' I t `� t ; i I , 3: � :� � f ;� _ ��! . � , . � , i� � - � ' � I _� ���.� _'�....�.._ l _,_ _ � i _ ��'. , - ( � � i �, � i � I � �.- I I � � r � � ��>' � - ; I i i '�- 1 1 I i � �; - '� � � ; � � I -_e i " ; f _ ; ( � . :� f i � ��� , � '� E � ; I � f i k I � .i ; � � ;�� . � ; : ; , : i , � � ' ' � - �- ' .� I �-� � -:� ! �� R ' ' I j € ' � I � I ( � � � , ; ; ; ; ,.._—' --_ —_ ._ _.�_ � .--. _.!�. _._ e. �K _.. . ___ _. ;_._ _.. ,.,. _i_ __. 1, _ .. :__ e____y_ .. _ ._..� _. __ --- . ��_u