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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. 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