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HomeMy WebLinkAbout11149 '� CITY OF DIAMOND BAR � ' COMMUNITY DEVELOPMENT DEYAIZi'MENT �` �'=�' 21660 E.Copley Dm�e Suite 190 (909)860-3195 Cax(909)861-3117 PR��� ,'"°``� BUILDINGPERMITAPPLICATION � ��� FIRMLY � o� JOBSITE /���� �������� APPLICATION ����R NUMBE� f #/C ADDRESS � DATE w ISSUE TYPE � OCC r APN LOT TRACT DATE CONST. GROUP p OWNER ��;��L��s�C51��� o ADDRESS c-� 1_ ZONING SETBACKS � z CITY ZIP_����i� TEL.���d'�tY�� FRONT RW ❑ � APPLICANT TEL. REAR ❑ Z / SIDE/SIDE STREET RW ❑ � a CONTRACTO ��,[6�i('C3 ' —���� SIDE ` ❑ � ADDRESS � , f _ � � CIN �, �.= ZIP f TEL.__� - PROPOSED USE 1�, oARCHlENG/ ' f W DESIGNER NO.DWEL. NO. NO. a ADDRESS � � UNITS STORIES ___BEDROOMS � CITY ZIP TEL. cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION b. O OWNER-BCILDER DECLARATION - SFR/ADD/flEM 0 1 HENEBY AFFIRM UN�ER PENALIY OF PEFJUHV THAT 1 Ald EXEMPT FROlA THE CONTRACTORS L- -�-G3fd(JB�C8fp0�I � W. CENSELAVlFORT4{EFOLIOWMGflEASON(SEC.7G31.S6USMESSA�1'�PPOFESSiONSCADE:FNYCITYOR (n - � U COWTVWHICHREQU:RESA7EFiMITTOCONSTFUCT,ALTcR,IMPROVe,OEMOLISH,ORFEPAIRAtvYSTRJC- - W TURE,PRIOR 70 IT¢ISSUANCE,AL50 RE�UIRES TN.E APPLICAIJT FOfl SUGi PERMIT TO FILE A SIGNE� .W Pdt10/D2CK STATEMENT THAY HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTOflS LI- �: GENSE LAW(CHAPTER 9(COMMENGMG Ydl IH SECTION 7000)OF DIYISION 30F THE dU5ME55 AN�PPO- � � PODUSPB - FESSIONSCOD'e)ORTfIATH[OftSHEISEXEMPTTIIEREFROMANOTHEBASISFORTHEALLEGEDEXEMP- :-(� � �-_ TION.ANVVALAiIONOFSFCTlO\7n31.5HYANYAPPLICANTFORAPEFMITSUHJECTSTHEAopiICANT70 --z` Re-Roof �: A CIVIL PENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS(5500).): 0_ ❑I,ASOWNEqOFiH'ePROPERN,OqMYEMPLOY'cESWITHWAGESASTHEIFSOIECOMPENSAT104, : � Cemm2fCidl Z- WILL DD THE WORK,AND THE STRUCTURE IS NOT R�TENOED OR OFFEflED FOR SALE(SEG.774a,BUSI- --J � �. NESS AND PROFESSIO�S COD[:THE COKTRACTORS LICENSE LAW�OES�OT APPLY 70 AN OWNER OF- - PROPERTYWHOBUILDSORIMPROVESTHFRF�4,ANDWHODDESSUCNWORKHIMSFLFORHERSgFOR -� .[L-- THHOU(#HHISORHEROWNEMPLOYEES,PROV:DEOTHATSt1CF11MPROVEMENTSARENOTIMENOEDOH m -� W- OFFEFEOFORSALE.ISHOWEVER,THEBUILOINGORIMPROVEb7ENT15SOlDW17HINONEYEAROFC041PLE- � -�' TION,TNE OVINEP-BUILDER WILL HAVE THE 6URDEN OF PROVMG TMAT N.�OR SIiE DiD NOT B111L0 OR --%- --Z' �IMPROVEFORTHEPURPOSEOFSAIE). - - - -� -�j± !iI,ASOWYEROFIHEPROPERTV.AMEXCLUSNELYGONIRACTINGWITHLICENSEDCANTRACTORS _� �.: TO CQNSTRUCT THE PROJECT(SEC.704C,BUSINESS AND PFlOFESSIONS CODE:THE CONTRACTORS LI- VBIUeS10f1 ADJ.AREA -W- CENSELAWDOESNOTAPPLYTOANOWNEROFAPNOFERNWHOBUI�DSORISiPROVESTHERE04,AND -�_ WHOCONTRACTSFORSUCHPpOJECTSY�RHACONTRACTOR(S)LIGE45EDPURSUpNTTOTMECONiRAG QUANTITY DESCRIPTION FEE � Y_ TORS LICENSE LAV�.). -�-: C I AM[X[MPT UNDLR SEC. B.H P.C_FOR THIS REA30N � Q �' U �; ¢ - DATE OWNEfl -- F Z W -�__ LICENSED CONTRACTORS DEGLARATION -; W d- CL- IHEfiEOYAFFIR�lUVDeRPENA�7YOFAERJU�';THATIAMLiCE�SECUNDERPF20VIS104SOFCHAP?EA q ,.y i� $ -p_,= 9(CONME�CW3WITHSECT�ONTCaojOFDIVISION30FTHE9U51nESSANDPP,OFE5510N5CODE.AND ;, Z I ,�7p ti =g- �� � � _ �XY MY LICENSE IS W FULL FORCE AND EFFECT. ._ m ��- LICENSE CLASS ����� UC.NO. �`�' �`� "i - j `~�- DAiE F� ' � "�� CONTRACTOR� = OJ. `U.- W;: (� �- WORKERS'COMPENSATION DECLARATION `r��`"/ F � �: Vf ¢ -�_�- IHEFEBVAFFIe7MUNDFR7ENAITYOFPERJURYONEOFTHEFOLI.OWI�IGDE(IARATIONS: � . Z -0�- _IHAVEANDWILLMAINTAI4ACERTIFICATEOFCONSENTTOSRFINSUREFORWORKERS' �� _ �-¢- CAMPENSnTION.ASPROVIDEDBYSECT:ON37a�OFTHELABOFCODE,FORTHEPERFORMA4CE U Q_ OFTHE WORK FUR WHIGH THIS PERMIT IS ISSUED. -,_ � �k`- -F-_ ANDWILLMAWTAINWORKERS'COMPENSAT:ONIIvSURANCE,ASREQUIREDBYSECTION �'. 4 3�DOOFTHELAHOFlCODE,FORTH'cPERf-0RMANCEOFTHEWORKFORWHICHTHISPERMITIS �= ISSUE�.MYWORKERS'COMPENSATIONINSURANCECAFRIEFiANDPOLIGYNl1M13ERARE: CONSTRUCTION A'^ - �-_�f caaRiEA___�_��- qC� � pLANREVIEW -0 POIICYNUMBER ` EL� _� � z Qi _ . �.t ��;: (nissEcrror�NEonero[oon+a�.�r��n+e�awriswnauEHuanr+Eo s�oo>oat.[ss} UMBING ' - r 1f _W._ � __----. - g-� �Z-. IGEFITIFYTHAT;NTHEPENFOFMAhCEOFTHEYlORKFpRWHIGMlHiSPERMITISI55UED.l MECHANICAL ___ �--C�S= SHALLNOTEMPLOYANYPERSONINANVMANNERSOASTOOECOMESUOJ[CTTOTHE - --(n' � WOAKERS'COMPENSATIONIAWSO�CALIFOR�IA.ANDAGRFETHATIF�SHDULDBECOPAE INSPECTIONFEE - _�' SU&IECTTO7HEWORKERS'COMPENSATIONPflOV IONSOFSECTION3]ooOFTHELA80R p p�+ //�� -.�' CO�E.I SHAI,L FORTHWITH COUPLY WITHTHOS VI510 ISSUANCE f I�M d �� --:0 /p Esp•�T -p: DATE:�+—��'��APPLICANT. _G-�� SMIP _ _ _ J-�- WARNING:FAILURETOSECUREWORKERSCOMPENSATIONCOVEfiAGEISUNLAWFUL,AN�SHAlLBE ENERGVP/C _ �_ SUBJeCTANEMPLOYERTOGRIM�NAIPENAlTIESAN�GIVI�FI�ESUPTOONEHUNOREDiHOUSAHD ENERGYPERMIT }; DOiLARS(51CO.00G),INADDITIONTOTH[COSTOFCOMPENSATION,DAMAG[SASPflOVIDEDFOqIN J' SECTION 37080L THE LABOR CODE,INTEflEST,AND ATTORNEY'S FEES_ RETENTION FEE: �- "-d• CONSTflUCTION LENDWG AGENCY - pR6ALT FEE: `O` �_�_ �HEREBVAFFIPUUNOERPENALT'OFPERJURYTHATTHEREISACANSTRUCTIONLENDINGAGENCY _ _ FOR THE PERFORMANCE OF THE YIORK FOfl WHICH THIS PEflMIT IS ISSUED(SEC.3097,CIV.C.). ,Z'. 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