HomeMy WebLinkAbout12689 (14) I
_!� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT R S
�- 21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRE$$
�" BUILDING PERMTT APPLICATION FIRMLY
� JOBSITE 24 �J?� DEGBRA-N IeD �`"� �--
p APPLICATION PERMIT P/C
o ADDRESS DATE NUMBE #
� iSSUE TYPE OCC
� APN LOT TRACT DATE CONST. GROUP
p OWNER G 1�R�Ld$ A- i �IC Ll�IZO�'
ADDAESS Z.. EGd � K i ZONING SETBACKS
z CITY 6/ff/LtmN/� � Z�p 9�7(d�TE . b O D
FRONT RW ❑
o APPLICANT�}�(�Q�F�lf��pA TEL d REAR : �� ❑ _
zQ SIDE/SIQE STFEET " � W p
� CONTRACTOR SIDE ❑
AODRESS
� CITY ZIP TEL. ROPOSED USE FX7�1�/,D �XdS�'�/t/� �i4�C./JV� T
w ARCWENG/ ���� �R C"ow�VE11�T7NC� �L�G� �,
z DESIGNER S'�-�-� (l�Te�r d G d G ts��4/�*
w NO.DWEL. NO. � NO.
� ADDRESS UNITS / STORIES T�I-LEI�EZ BEDROOMS�
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
- � . . - OWNER-BUILDER DECIARATION SFR/ADD/REM
O
Q 1 HEREBY AFFI�A UNDER PENALIY OF PERNRY THQ 1 AM EXEMPT FROM THE CONTflACTOftSII� {a`g�a9B/CflfPOfi
--W CENSEUWFORTMEfOLLOWM�REASOY(SEG7031.SBU5INESSANDPROFESSIONSCODE:ANVqTYOR (f�
-U COl1NTyWHiCHREqUIRESAPERMRTOCONSTHUCT.ALTER,IMDFovE.DEMOLISH,oanEVAiRANYSTAUC -
- W� TURE,PRKKi TO Ii3 ISSUANCE,ALSO REQl11RES YHE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED - W Patio/Deck
-� STATEMENT THAT ME OR SNE IS LICENSED PURSUANT TO TIiE PROYI510.Y5 OF THE COMRACTORS-LI� � .
. .�- CENSE UW(CHAPTER 9(COIAMENCING WITN SECTI�N 7000)OF DNISIDN 3 OF 7HE 0U5MESSA.ND PP.O- POOVSPB
FESSIONSCOOE)OR7HATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALIEGE�EXEMP- �
V TION.pryYV10LAT10NOF5ECT10N7031.58YANYAPPLICANTFOflAPE(1MITSU&IEGTSTMEFPPLICANTTO Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FIVE NUNDNED�OLLARS(f5oo).):
- Q ❑I,ASOWNEqOF7NEPROPERTV,�qMVEMPLOYEESWI7HWAGESASTHEIflSOLECOMPENSATION, � COrt1rt18fCifll -
Z. VY�LL 00 Tl1E WORIC,AND THE STFiUCNRE IS NOT INTENDED Ofl OFfEflED FOR SALE(5EC.7044,BUS�� J
� NESS AND PHOFESSIONS CODE:THE COMRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER oF .� -
- PROPERiYUR{OBUIlD50RIMPROVESTHEREON,ANDWHODOESSUCHWOfiKHIMSELFORHERSELFOR
-� iHROUdHHISORHEROKTIEMPLOYEES,VROVIQE�THATSUGMIMPpOVEMEN75AqENOTINTENDEDOft m -
�! Q OFFEREDFORSALEIF,HOWEVERTMEBUN.DINGORIMPROVEMENTIS50LDWITHMONEYEAFiOFCOUPLE .
_ -TION,THE OWNER�BUILAER WILL HAVE THE BUFDEN.GF.PROVING h10.T HE OR SiiE DID NOT BUILD OA-- - - -
�� NdPROVEFORTHEPUP.P0.SEOFSALE). -
_W u1,A50WNEROFTHEPROPEHtY,MAEXCLU5IVELYCONTRACTING�NiHLICENSEDCO!fTRACTONS
� -TO CONSTRUCTTHE VRO.IECT(SEC.7016,BUSINESS AND PNOFESSIONS CODE:THE CONTRACTORS LI- - VdlUdiiOn ADJ.AREA
- -W CEN6ELAWDOESNOTAPPLYTOANOWNEflOFAPROPEtiTYWHD0UILOSOHIMPHOVESTHEFEDN,AND - ---
- -�- W11000NTMGTSFORSUCHPROJECiStNITkAGONTRACTOR(5)LICENSEDPUflSUANTTOTMECONTRAG QUANTITY DESCRIPTION � �E
� TOHSLICENSELAW.�. -
t' - 0 O IAM IXBAPTUNDER SEC. B.&P.G FORTHIS REA$ON Q - -
3 U
� ¢
DATE aWNER. - t—
Q W
Q UCENSEJ CONTRACTORS DECLARATION —i
OG
I HEHEBYAFFIRM UNOER PENRLTV OG PERIl/qV THAT�AM LICENSE�UNOER PAOVISIONS OF CHAPTER � �
- _�. 9(COMME4CiNdWITHSECTION7000)OFDIV�SION30FTHEBUSINESSAN�PROFESSION3CAOE,AN� Z
X, MY LICENSE IS IN FUIi WRCE AN6 E�ECT. �/ m
u�
� LICENSE CLASS LIC.NO. � �-
-U DATE - - CONTRACTOR - - - � d
W
` _ ___�: _ _ WORKERS'GOMPENSATION DECLARATION __ __ _ _ ¢_ _ _ _ _ _ . __ _ _
_� IHENEBYAFFlRMUNOERPENALTIOFPE0.IURYONEOFTHEFOLIOWINGDECLAM710N5: z -
:� _IHAVEANDWILLMAINTAINACERTIFICRTEOFCO�SEYTTOSEIFdN'aUflEFOftNYJRKERS' _
COlAVENSATION,ASPROVIOEDBVSECT70N3'laoOFTHEIABORCA�E,FORTNEAERFOR4IANCE U
- Q OFTME WOHK FOR WHICH lH!5 PEHMIT IS ISSUEO. �
. -� _I NAVE AND WILLMAIMAIN WORKEflS'COMP[NSAT�ON INSURANCE.AS REQUIflED BY SECTIOY - �
Q 370a Of THE 1A80R CODE.FOR7HE PERFORMANCE OF THE WOFK FOR WH:CH THIS PERMI7IS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARq1ER AND POLICV NUMBEftAPE: CONSTRUCTION
J.
j CARRIER PLAN REVIEW
Z PIX.iCV NUTABER ELECTRIC
Q
0 (fHISSECTpNNE�NOTBECOI.�LETmOFREPERNTSSF(h70NEMNDRWDOILIRS(57001IX1LESS} P 6MBIN ,�,C:
... _W_ . : . . .
Z I CERTIFYTHAT INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED.1 MECHANICA� -
_ _�!}: SHALLNOTEMPLOVANVPERSONINANYMANNERSOASTOBECOMESU&tECTTOTHE ��, "
. (q WORKERS'COMPENSATIONlAW50FCALIFOftN1A,AN�AGREETMATIF15MOl/LOBEGOME - INSPECTIONFEE - �- _ _ -
--�-. SUBJECTTO THE WOAKERS'COMPENSATION PROVISIONS Of SECTAN 3700 OF THE LABOfl
� CO�E,I SHALL FORTI-MATH COMPLY WITH TiOSE PROYI510N5. ISSUANCE � j
. _-p-- DA7E: APPLICANT: SMIP ��� � ��9�
. j WARNING:FAIWRETOSECUREVIORKERS'COMPENSAT104COVEFAGFISIINLAWNI.,AN�SHALL9E ENEflGYP/c��OFDIAMOND� -
: --LL. SUBJEC7ANEMPLOYEflTOCRIMINALPENAL7IESAN�CIVILFlNESUPTOONEHUNDREDTHO'JSAND ENERGVPE
� �- DOLLARS(51oo.00a),INAO�ITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORIN 7�� /� /�'�,ry�
- - -J- SECTION3]aeOFTHELA80RCODE,INTEfiEST,ANDATTOFNEY'SFEES. RETENTION�D11VG6'A��ll..`.-'Sa4
Q —_
- �. ;a�. CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
-0`
. -;�. I HEREBYAFFIRM U40Efl PENALTY OF PERJURY THFTiHERE�5 ACANSTRUCTION LENDING AGENCY
, - FORTHE PERFORMANCE OF THE WORK R]R WHICH THIS PERMI7IS ISSUEO(SEC.309],CIV G). .
Z
. .;W _.._..___
. `;�- lENOER'SNMiE
- -f— LENDER'SADORE55
�°
- -:_W- ICERTIFYTMAT�HAVEREADTFiISAPPLICATIONANDSTATETHATTiEABOVEWFORMRTIONISCARRECT. TOTAL FEES -,o
� IAGREETOCAMPLYWITHALLCITYAN�CAIINTYORDINANCE5AND5TATElAW5REIATINGTOBUILDING -
--��_ CONSTRUCTION,ANDHEREBVAUTHORIZENEPRESENTATNESOFTHISCOUNTVTOENTEfiUVONiHE -
E-MENTpNED PROPEflTY FOq MSPECTION PURPOSES.
�`�,l �,^�� COMMENTS - - �
�f Cf�-,Fc O�$ Ll , v��
�m PERM NAME(P �
`� r �� � \ /
- � SIG E 0/17E �_
flECPT.NO. PAID BY '� VALIDATION
~ WHIT —Departmant Copy,YELLOW—Finance Copy,PINK—Assessor Copg GOLDENROD—File Copy,GREEN—AppllcanYs Copy ..
� �� � .^s �t ._._, !..._.�_..._-,.- ..s_,. .._....,.,.�_i _.. .,. .,-�-„.�_ �m . �,T, .
c �'�sr�„at����'' "��- ; � � ? s � ( � - F,.� -. ir �I � - Y J � � 4
€ � §� ,�t ;"��,��;z'r s � � p � P , t ��. _ ,� �- I[ � �...�j°'"t 'T` -. �`V i _
��.�. -� � 1 _ f i I [ � � } � � -
� ��� ���������.��,st�a � � � t � 1 t ' s'! E ��°_ I � � � �� �;� �� ( � "^��
� xs���t;;�aa t.s-�� �`� t � i. � , , : --. � 5 .'S� y -r„ r €� ,.�� �'� � .
y� 7 � �t-�,�� �,., � � r R' 't
s 7 'a. � e" ```i r� �= - F i �,h�,
� :� , ��"����'�#� �' t � _��j- €i� � sir �! � 'c�� -�1 �'� (-I in ':`� � s � �r�_�,.... .
§ � 4�t+����P' '',�,�_"€s` � ' r"_ e'�} , = f :�1 G i i ���, '' �
} �g�¢; � t .-If � ( _P�
}
�'"�'Ye,�'a��'��`t�, ����� � � . 4 � ( j � 3 'i 1�{ , .I 3 ,�;: "i -
��, �� z a�P�4-�'�§� � - ' 3 I , �C1` ,,.
1 � ., !
� ��k d fl''s �,�� � � i"_ € � � �_� '"__ � � � 1 � � C� � �
` ' � ' "—'-�—
3 � �.a x..�....�.'�__,..�= { f �.. _
iC �` �� � { i 1 � � j � _—� -}-_-� F �. �` � i1'
€ � � � z E � � � � 3� � � i ( ' k � '�' I ' � � ..
� ; � E
t �; � � � � 3 t � � i F r: ' �.
� � � :i i j ' ' � ' � i � F �
; ; �.r E � — ; —I—. — ' - �-- � �— �--�--t---�-+--- — L �`t
i �� � t ,:- �t € i I �� � � i � i�. � ':. � � I � ,s�`
� = �"�{� I i , � ( ( i � � � � S � : �
� � 1 �. { . ' � ' I 1 � k ( 1 � � � .
� � �� 9� f ' � � � ( � � �i 3 I ' ' �t� .
; i ' i, r ` � , ' � I, �; � , � , 4 , ' � � ' I � ���
�# , � i: " 3 � i � � I � ( � I � �:�
� , i � r. , � � , f ' � � �
t 1 , � I � i '; ' : I � '; j , j ` , r �
k i
' � f P j ' � 1 � - � i � t �
� ` ` � � � � i � 3 �t � -�_..) � � � + y{� � _ � =�N __' ; � `� "�
� � 3 ( { � � � I I i--- #•, i -1.�-_d_;i .... . � €^� 9':
, . I � !. ,� � =�i T'I. �� i i�' - � :� I � `'"� � . -r.` `' � _
' � � ( � ' �3 ��� �' !-r! t � � C-C r' i � ` n �
� � s 4 � � � - �a : � � .�.�."a C .-., � .� .+� �`'. i .. k.. � � �
� . � � � � i • � z'; � �'� r-��; �, r-_r- i-',1 �t--, � ', i r� .�- � .� �' M � -
� � t i � � i � i �-.� -c � '`: � ii y i.�j i�1�,I i�` �' �� �. � "" p i � .,..� �7 �. ..�� €� .
i
j � ( � 1 .J; � f � i L t I�t -�} i I�J r? ° � �
I I � � � : i i j � � `'� � Y a-J� a . , �. -'+ �:
, � �� �i � v: � �� � Gs �
� i i ' � � �_` '� _ � � ��. t � 's .,�� r' � � �
� � ' ! ��; '` r ,> �r`�-,I�� � � i� � . �i �� � �
� i � �' � ' � � � � � ! I � ; }� � {� ' � � i � ! ( ' �I �" �'-� ��C'?; � '� � .
� � . � € ; I
�' j , i � � � � � � i € .i � C I � � .`I�-` �i �
� 7 I : 3 � � : `• �_t : I
i � � r � 1 i � i ' { I � i I � 'i � � 1 � � ; ( i ! �
{ ' � I I ' � �' •--� — -f--r---�-�� --�. �
P � � i � � I t I �� i I � i �� � � �-�- �--
� s � � i � F I � i � � 7 [ � t I i � 7 j � ��
�E � �� I � � 3 � , � I � � ; I � � { � i i _ .
5 i i � � i � � � � i !( ( � 1 � I � i � � -
�' � � �_ e i _i 1 � "�v � � 1 7 -
( � : i � j i j: �€ �-m_"�. , "'i' ' � ' i - � ,"_ ..
� .I_ f ,� � ( � � �� i i I � i i i . . .
i € � � I � t � € � � � � i i � i E i � i I �� .I ��
I� ! ' ! ! , I ' _� I I i ` ( � �� ' �
; � ( I � I I I i i ' k I i � ! ���
I ; j ' I , i ' i � � i ' ' : I � ��'
� � + I � i i ' ` i i i � ; � ' ' ; { ; , ; , i ��_"
� � � ' � � i � I � � i i i � 4 � I � i I ; ;
_�_. _4.� .L.___.=._�.s. _____.y�_._,_!a..:..a�_��A__.�_l___.,_.__�__. __ _ .,,_�._�___�� .,_.. __ C___ �.a_,z,_.F....i___.���_�__._.._.,._:__!_..,�. ar_ < < �