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HomeMy WebLinkAbout12872 (13) < __�� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES __� . � 21660 E.Copley Drive Suite 190 ��>s6a-3i9sF���)s6i-3ii, �� '�� PRESS '"" BUILDING PERMIT APPLICATION FIRMLY a A�D RIESS �lfA�' � . ��• ' APPUCATION ��� � PERMIT ���P/C o DATE NUMBER�_ # � APN LOT TRACT ISSUE TYPE OCC -�,- , � DATE CONST. GROUP p OWNER � � ADORES • ' ZONING SETBACKS z C�TY ` ZIP TEL.���G�(.�iy.�,�( FRONT RW ❑ 0 -b'"'��-F REAR ❑ p APPLICANT TEL. SI�E/SIQE STREET RW O � CONTRACTO SIDE r � ADDRESS O C�-�y Z�P T • G f _ PROPOSED USE Q ARCFUENG/ z DESIGNER a ADDRESS NO.DWEL. NO. NO. ar ' UNITS STORIES BEDAOOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFWADD/REM O Q 1 HEAEBY AFFIiW UNOER PENALT!OF PERJUqY THAT I PM EXEAlPT FROM THE COMRAC70R5 LI- Gdf8jBIC2Ip0f1 tll CENSELAWfORPiEfOLLOWItiOREA50N(SEC.]W1.5BUSI4ESSA�YDPP,OFESSIOY5CODE:ANYCfTYOR (J� C� CIXINTYYYHICHflEIX11RESAPERMITTOCONSTRUCT,ALTER,IAiPROVE,DEMOLISH,ORREPAIRANVSTRUC- - -W iURE,PpiOq TO ITS ISSUANCE,ALSO qEWIRES THE APPLICANT fOR SUCH PERMIT TO FIIEA SIGNED W Patio/Deck - � STATEMENT THAT HE OR SHE IS LIGENSED PURSUANT TO THE PROYISIONS OF THE CONTflACTORS.LI• - . . ' - � GENSELAW(CHAPTEfl9(COMMENC�NGWITHSECTION700�)OFDIVISION30FTHE6l1SMESSANOPRO� �� POOVSP2 F�SIONSCODE)ORTHATHECASHEISEXEMMTHEREFROMMDTHEBASISPoRTHEALIEGEDEXEMP- (� ' V TWN.ANYVqLATIOtiOF9ECTION7031.5BYANYAPP�ICANTFORqPEFMITSU&IECTSTHEAPPLICANTTO Z Re-ROOf A CML PENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS(SSOD).): � 0 ❑I.ASOWNEROFTHEPRCPERTY,OHAIYEM7lOVEESWITHWAGE5A5THEIflSOLECOMPENSATION, �� COI11If18fCid1 - � Z Yl�LL 00 THE WOpK,AkD THE STR�CTUflE IS NOT INTENDED OR OFiEflED FOR SALE(SEC.7044,BU51�. J N NESS AN�PROFESSIONS CoOE TME CONTFACTORS LICENSE LAW DOES NOTAPPLY 70 AN OWNER OF � P��ERNNhiO0UMD50RIMPROVESiHEHEON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR - -OC THtiOUGHHISORHEflOWNEMPtAYEES,PROVIDEDTHATSUCHIAIPROVEMENT3ARENOTMTENDE00R � .Q OFFEREDFOpSALEiF,HOWEYERT}{EBUILAINGORIMPROVEMENTISSOtDWI7HINONEYfAROFCOMPLE . -_Z. :Tp�J,THE OWNER�BUILDER-WILL MAVE THE 9URDEN OF PROVING THAT HE Oii SHE DID NOT 9UIlD OR -- - -- - - - - - - � IMPROVE FORTHE PURPOSE OF SALE). - - . � . �,y,� ❑I,ASONTiEROFTHEPROPERTY,PMEXCLUSIYELYCONTRACTIYGWITMUCENSEDCONTflACTORS p[ ro cONs'rRucrTHE PHaEci(sEc.7oea.6us�NEss,wo cnocEssioNs caoE:n�E coNraacroas u: - Valuation - ADJ.AREA - W CENSEIAWDOESNOTAPPLVTOANOWNEHOFAPROPERTYNM1iOBUROSORIMPROY[STHEflEON.AND - --- � WHOCONTRRCTSFORSUCMPROJECTSWITF!ACONTfUC70R(5)LILENSEOPIIRSUAMTOTHECOMflAG QUANTITY DESCRIPTION- �E � TORS IJCR.SE LAW.?. 0 OIAbiIXEMPTUNDER9EC. B.&P.C..FORTHISREASOIV _ Q� y U � � OATE _ OWNER F� � W Q ! :.ICENSED CONTfiACTORS DECLAH11TI0*! W ! [L IHEflEBYRFFIHMUNDEflPENALTYOFPERiUHYTHATiAMLICENSEDUN�ERPPOVI510NS�FCHAPTEfl Z � p„ B(COMMENCiN(iWITHSECTICN7000JOFDIVISION30FTHE8U51NESSANDPROFE5510NSCODE,AYD � . _X MYLIGENS£�SINfULLFORGEAND FECT. m LL ,fy` `� - 0 LICENSE C 5 LIC.NO. {f e� �✓ - j - V DATE CONTRACTOP - d W _ -� WORKERS'COMPENSATION DECIARATION ¢ _ _ _ NIHEflEBYAFFlRMUN�ENPENALTYOFPERIURYDNEOFTHEWLLOY7NG0ECLARATIONS: Z - - � _IHAYEANDW�LLMAINTAIfiACERfIFICATEOFGON5ENT705ELF-0NSUREFOflWORKERS' g COASPENSATION.AS PRO`JIOED 8Y SEC710N 37W OF THE LABOfl C6DE,FOR THE PERPoPMANCE iU - � �OF 7Hc'WOflK FOR WHICH TMIS PEflM171S�SSUED. � � � V i NAVEAND WILLMAIMAItJ WORKEtiS'COMPENSATION INSURANCE;AS REQUItiED BY SECTION Q 37o00FTHELA80RCODE,FORTHEPERWRMANCEOFTHEWORKFOqWHIC!iTHISPEAM1T15 _� ISSUED.MV WORK S'CO PE�� ATION INSUrg A�NCE CAPRIE��/n�r�,D POLICY Nt1MBER ARE: CONSTRUCTION . j- caaRiEn�–J���� . C-��w1� PLAN REVIEW - . Z PouCYNUMBEa .�C:� ELECTRIC ¢ Q (fHiSSECiIONNE�NDTBECQ�LEfE00FTFEPEFUATiSFY7RONEf#1M)REDOq1AAS(Si00)OqLESS� PLUMBING ' { Z iC`eflTIFYTHA7INTHEPEfiFORMA1vCEDFTHEWOflKFORWHICHTHISPERMITI5I55UED.l MECHANICAL -(°j- SHALLNOTEMPLOYANVPERSON�NANYMANNEfl50ASTO8ECOMeSU9JECTTOTHE - - - - --� WORKER5 COMPENSATION LAWS OF CALIFORNIA,ANDAGflEE TNAT IF i SMOL'LD BECAME INSPECTION FEE - " r SL�&IECTTO7HEWORKERS'COlAPENSATIONPPOVISIONSOFSECTION370o0PTHELA80R ' -�- � CADE,ISHALLFO THWITHCOMPLVWITH��TH��OSEff��R9VISIONS. ISSUANCE �� O . j/// - p DATE: APPLICAN7: ///.✓��� _. SMIP . T�T J WAfL41NG FAILURE TO SECURE WOFKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHAII BE ENERGY P/C ___ _ -LL SUBJECTM!EMP�OYEHTO CPIMINAL PENALTIES ANO CIVILFINES UPTOONE HUNDRED THOUSAND ENERGY PER /� ,��q .� DOLLl�RS(S1oo,000),IN ADDITION TOTHE GOSTOF GOMPENSATIOY,DAMA6E5 AS PROVIDED FOR IN �IT�E/���y Y}F/t�1I�-�-�-� SECTION37080FTHELA9ORCOOE,INTEflEST,ANDATfORNEY5FEE5- RETENTION F�U���,{��1�T�T�+(��j_�'[^.T'(J d CONSTRUCTION LENDING AGENCY v t1�71��,L L - 0 PRE-ALT FEE: - - � IHEREBYAFFIRMUNDERPENW.TYOFPERJURYTHATTHEREISACONSTftUCTIONLENDINGAGENCY PORTHE PEHfORMANCE OFiHE WORK FOR WHICH THIS PEFMIT IS ISSUED(SEC.3o97,CIV.C.). Z W. .� LENOERS NAME F— LENPEflSADDRESS � TOTAL FEES �'vj-�(� � ICENTIFYTHATIHAVEREADTMISAPPLICATIONANOSTATETHAiTMEABOVEWFORMATIONISCARflECT. W IAGNEETOCOMPLVN7THALLCITVANDCOUN7YOROINANCESANOSTATELAWSRELATWGTOBUILDING - � CONSTRUCTION,AND HEREBV AUTHOFIZE REPRESENTATIVES OF THIS COUNTV TO EN7ER UPON THE - - � ABOYEMENTIONED PROPEHN FOR INSPECTION PUqPOSES. Z COMMENTS � -��� - J � — ¢ PERMITTEE�AM - � � � � SIGlVnSUFiEO PEHlA1 EE �A -- � :: -= RECPT.NO. PAID BY VALIDATION ~ WHITE—Depatlment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,QOLDENROD—File Copy,GREEN—Applicant's Copy -. 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