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HomeMy WebLinkAbout17272 (25) CITY OF DIAMOND BAR - -J�`" DEPARTMENT OF CO1��vIUNTi'Y&DEVELOPMENT SERVICES I 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRE$$ '�%vK^ BUILDING PERMTT APPLICATION FIRMLY y JOBSITE o ADDRESS� ���� APPLICATION �� rO� �y� PERMIT �/�f P/C / DATE NUMBER' ! (...�� # ✓ � •.r ISSUE I NPE OCC APN LO T CT � _ DATE `� r��i'�I CONST. GROUP p OWNER I r y a�w ' .�Ci o ADDRESS -���� ZONING SETBACKS ' FRONT R1/� ❑ z CITY IP TEL. � APPLICANT -.. J' � TEL. 1 REAR ❑ Z � SIDE/SIDE STREET RW ❑ � CONTRACTOR ' � ^ � SIDE ❑ ADDRE S ' a,,, �' �`� � PROPOSED USE o CITY ZIP`�y��-��,'� TEL.- G � w ARCH/E G/ z DESIGNER �) a ADDRESS '� _ / ° � NO.DWEL. NO. NO. cn �d� Z�P�� T.E4ff' UNITS STORIES BEDROOMS � CITY�'� cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION � OWNER-BUiLDER DECLARATION SFR/ADD/REM O p 1 HEREBY AFFIFM UNDER PENALTV OF PEPJURY THAT I AM EMEMPT FROM THE CON7RACTORS LI� Gflf&Q8/CBfPOIi W CENSELAWFOR7HEFOLLOWINGREA30N�SEC.7031.5BUSINESSAN�PROFESSIONSCODE:ANVCIT'OR (f� U CWNTYWHICHREQUIRESAPERMIT5000NSTRUCt,ALTER,IMPROVE,�EMOLISH,ORREPAIRHNYSTRUC- w TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRcS THE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED W Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF T4E CONTRACTORS LI- LL � CENSE LAW(CHAPTER 9 ICOMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRD- POOUSpe 0 FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHER=FROMANOTHEBASISFORTHEALLE6EDEXEMP- (� V TION.ANYVIOLATIONOFSECTION7o31.5HYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICAN7T0 Z Re-Roaf A CIVIL PENALT'OF NOT h10RE THAN FIVE HUNORED�OLL4R5(ESoo�.�: � ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAOESASTHEIRSOIECOMPENSATION, 0 Commercial Z WILL DO THE WORN,AND THE S7RUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SECJo44,BUSI- J � NE55 ANO PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF � PROPERTY WFIO BUILDS OF IMPROVES THEREON,ANO WHO�OES SUCH WORK HIMSELF OR HERSE�F OR � THROUGHHISORHEFOWNEMPLOYEES,PROVIDED7HATSUCHIMPROVEMENTSARENOTINTENDEDOR m 0 OFFEREDFORSALE.IF,HOWEVER,THEBUILDMGORIMPROVEMENTISSOIDW'THINONEYEAROFCOMPLE- Z TION.THE OWNER-BUILDEF WILL HAVE TH'c 9URDEN OF PROVING TI�IAT HE OR SHE OID NOT BUIL�OR = IMPROVEFORTHEPURPOSEOFSALE). W ❑I,ASOWNEROFTHEPROPERTV,AMEXClU51VELVCONTRACTMGWITN`_ICENSEDCDNTRACTORS � TO CONSTRUCT THE PROJECT(SEC.7044,BUSMESS AND PROFESSIONS CODE:THE CONTRACTORS ll- ValU8f10f7 ADJ.AREA W CENSELAWOOESNOTAPPLYTOANOWNEROFAFROPERiYWHOBUILD50RIMPROVESTHEflEON,AND � WHOCONTRACTSPORSUCHPROJECTSWITHACONTRACTOR(S)UCENSEDPURSUANTTOTHECONTRAC� QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW). � ❑I AM IXEMPT UNDER SEC. B.&P.C.FOR THIS REASON Q � U LL � DATE OW'NER U Z W � LICENSED CONTRACTOFS DECLARATION W ¢ � I XEREBYAFFlRM UNDER PENALTY OF PERJURY THAf I AM LICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMMENCING WITH SECTION 7000)OFDIVISION 30F 7HE BUSINESSAND PROFESSIONS CODE,AND Z `X MY LICENSE IS IN FULL FORCE AND EFFECT. � � '� � +� { � LIGENSE C� � LIC.NO.__.�!��,� l"" � U DATE '�' CONTRACTORy�_�� a W � WORKERS'COMPENSATION DECLARATION a � I HEREBY AFFlqM UNDER PENALN OF PERJURY ONE OF THE FOLLOWMG DECLARATIONS: z � _IHAVEANDWILLMAINTAINACEFTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' a S ¢ COMPENSATION,AS PROVIDEO BY SECTION 37000F THE LA60F CO�E,FOR THE PEFFORMANCE U Q OFTHE WORK FOi7 WHICH THIS PERMIT IS ISSUED. � � _I HAVE ANO WILL MAINTAIN WORNERS'COMPE�'SATION INSURANCE,AS RE�UIRED BV SECTION Q 9l0o OF THE LABOR CODE,FOR THE PERFOflMANCE OF THE WORK FOR'NHICH THIS PERMIT IS ISSUED.MY WORKERS'COMPENSATION INSUFANCE CARRIER AND POLICYNUM6EflARE: CONSTRUCTION J j cnaaiEa---,----.--.__.._...__.._.__.___.__.—__ PLANREVIEW z aoucVNUMeER ELECTRIC ¢ � (IFIISSECTKKJNEmN0T6ECOMPLEfEDOFh1EP[RMfTISFORONEHUnpREDDOLLMS(5100)ORLESS� PLUMBING Z 1 CER7IFYTHAT IN THE PERFORMANCE OF THE WORK POFi WHICH THIS PERNdT IS ISSUED,I MECHAnICAL (3' SHAILNOTEMPLOYANYPERSONINANYMANNER50AS70BECOMESUBJECTTOTHE � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGf7EETHATIFISHOULDBECAME INSPECTIONFEE � Sl18JECTTO THE WORNERS'COFAPENSA��Q,[J PROVISIOy B6 ECTION 3TGOOFTHE UBOR /'� CODE,IS LLFORTHWITHCOMPLYWffHTH�EPROGI510 S. ISSUANCE � 0 p DATE: � G � APPUCANTy" �� +. SMIP J WARNING F iWRE O SECURF WORKE�CO ENSATIO OV AGE IS UNLAWFUL,AN�SHAIL BE ENERGY P/C � SU&IECTAN EMPLOVERTO CRIMINAL P�N ES ANO CN FI S UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLLAR5151o0,000�,IN ADDITION TO OSTOF COMP TION,DAMAGES AS PROVIDEO FOR IN J SECTION 370e OFTHE LABOF CO�E,INTEREST,AND ATTO NEY'S FEES. � p� RETENTION FEE: oCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBVAFFIRM UNDER PENALTV OF PERJURV THATTHERE IS ACONSTRUCTION LENDING AGENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH TMS PERMIT IS ISSVED�SEC.�097,CIV.C.). Z W � LENDER'S NAME _ H LENDER'SADDflE55 �+^p-,� wICERTIFYTNATIHAVEREADTHISAPPLICATIONANDS7ATETHATTHEABOVEINFORA4ATIONISCORREC7. TOTAL FEES y/�r /1 ,/ � I AGREE TO COMPLV WITH ALL CITV ANO COUN�V OR�INANCESANO STATE LAWS REIATING TO BU�LDING r ✓V CANSTRUCTION,ANO HEREBY AUTHOPI2E REPRESENTATI4E5 OF THIS COUNT'f TO[NTER UPON THE ABOVE� TIONE�PROPERTV FOFi INS�ON/}ppN��RPOSES. � � �'_,�e.-^i�� . r�✓/ /B1�'�rL'3f COMMENTS � � V QR NAME(PRIN _ 4J ,� �. . '� ��� � NA MITT E :. DATE �� � RECPT.�O. PAID BY VALIDATION �, f WHITE—De artmentCo YELLOW—FinanceCo PWK—AssessorCo GOLDENROD—FileCo GREEN—A licant'sCo 1 p pY. PY, PY� PY� PP PY ���� � £� °��� �.��,�����::��� '�� �«��� z �..,� �,�...,�'°� ��._'�� ��� `���$ m��-�@.� < �5,,:��"a ��g ����� ��a f�." �g �"�� ���".�," e�� �� -.��`�� �a�: �a :`�:'� �„�,� .��� �" �q`�,�,���.: � �� ���:�a�a� �swa����._... �`�„��� � � ��.� � :# �� �`" � � �. : t �x � d'� � ' �� � � � �; �^,���:�������:�w�m �������t�� .�"�«������ ���� ; ��"���'��,�� �� � �� � �e� ��� "� � ' ,. �a#:. � ,�� .�___ ���� �,�,�„���� �..�t, �� ��.��,x��.� �����'_a a � � � �. 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