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HomeMy WebLinkAbout10359 � ' . I � , � � CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT � ;,,. 2I660 E.Copley Drive Suite I90 PRESS � (909)860-3195 Fax(9O9)R61-3117 �'"", BUILDINGPERMITAPPLICATION FIRMLY 0� JOBS�TE � /�dl��n,,,/ 62�I� APPLiCATION � ��. NUMB R ��" #/C ADDRESS � '��� DATE - : c� ISSUE � TYPE OCC � APN LOT T T DATE CONST. GROUP °C OWNER O o ADDR ZONING SETBACKS gCITY ZIPL�,/= TEL. � FRONT RW ❑ APPUCANT TEL. REAR ❑ Z SIDE/SIDE STREET RW ❑ m CONTRACTOR R. .�. nC. S�DE ❑ � � ADDRESS ' � QITY I � TEL � PROPOSED USE -� 4 0 ARCWENG/ �n�>���— � W DESIGNER NO.DWEL NO. NO. i a ADDRESS UNITS STORIES BEDROOMS ' � CITY ZIP TEL. I � DESCRIPTION SQ.F? FACTOR PSF ADJ.AREANAIUATION p� OWNER•BI:ILDER DECLARATION SFWADD/REM O p I HEREBY AFFIRM UNOEH PENALTY OF PEFJURY THAT I AM E%EMPT FqOM 7HE CONTRACTORS U- Gdlfl98/C8tP0lI W CENSELAWFORiHEFOLLOWINGREASON(SEC.7031SBUSINESSAN�PROFESSKKJSCOOE:ANYCITYOR (f� U COUryTyWHICHREWIRESAPERMITTOCONSTRUCT,ALTEli,IMPROVE,OEMOLISFI,ORREPAIRANYSTRUG W Patio/Deck -Z TUflE,PHIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCM PERMIT TO FILE A SIGNEO W STpTEMENT TNAT HE Ofl SHE IS LICENSED PI/RSIIANT TO THE PROVISIONS OF THE CAMRACTORS L6 W � � CENSE tAW(CNAPTEfl 9(CQMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSWESSAND PAO � PooUSpa FESSi6N5CODE�OflTHATHEOftSHEISEXEMPTTMEflEFROMANDTHEBA515FORTMEALLE6EDE%EMP- (� � TION.ANYVIOLAiIONOFSECTION7031.58YANVAPPLICANTPoHAPERMITSU&IECTSTHEAPPLiCANTTO Z Ra-Roof A CML PENALN OF NOT MORE THAN FIVE NUNDREU�OLURS(5500).): � 0 ❑I,ASOWNEFiOF7MEPHOPEFi7Y,�RMYEMPLOYEESWI7HWAGESASTHEIR50LECOMPENSATION, . 0 COffIrt18fC181 Z WILl00 THE WORK,AND THE STHUCTURE IS NOT INTENDED OH OFfERED FOR SALE(SEC.7uaa,8�54 J � NESS AND PROFESSIONS CODE THE�NTRACTORS LICENSE UW DOES NOTAPPLY TO AN OWNEH OF � PROPERTY N7i0 BUILDS OR IMPROYES THEREIXd,AND WMO DOES Sl1CH WOflK HIMSELF Ofl NERSELf Oq � � THHOUGHHISORHEROWNEMPLAYEES.PROVIDEUTHATSUCHIMPROVEMENTSAFENOTINTEN�EDOR m _ Q- oFFEPEDf-0RSALEIF,HOWEVERTMEBUILdNGORIMPROVEMEMISSOLDWRHINONEYEAIiOFt�MPLE• - _ �- TqIV.THE OWNER-BUILDEH W�LL HAVE THE Bt1flDEN OF PiiOVING THAT HE OR SHE DID NOT BUIID OR IAiPROVEFORTHEPURPOSEOPSALE). �- - - - - - � W.- OI,ASOWNEROFTHEPHOPERTY,AMEXCLUSIVELYCONTR4CTIN6WITHLICENSEDCONTRACTORS (t TO CONS7RUCT THE PPPJECT(SEC.7a44,BUSWE55 AND PflOFESSIONS fADE:7HE CONTMCTORS LI- V81U8110f1 ADJ.AREA W CENSEtAWDOE3NOTAPPLYTOANOWNEROFAPROPERTYWNOBUItD50RIMPROVESTHEflEQY,RND � �- NM1iOCAMTRACTSFORSUCHGROJECTSWITHACOMRACTOR(S)LICENSEDPURSUANTTOTHEOONTIiAG QUANTIN DESCRIPTION FEE Y TORS UCENSE IAW.). � � �IAME7fEMPTUNDERSEC. B-EP.C.FORTHISREASON � LL DATE OWNEfl � O �_ LICENSED CONTRACTORS DECLARATION ( � 1 HER�Y AFFIRM UNDER PENALTY OF PERJUHY TMAT 1 AM UCENSEO UNDER PftOVI310N3 OF CHAPTEfl � d 9(COMMENCINGWITHSECT�ON7000�OFDNISION30FTHEBUSINESSAN�PflOFE5510N5CODE,AND z `X MV LICENSE IS IN FULI FORCE AND EFFECi. m O LICEN5E C S LIC.NO. o j V DATE �� CONTRACTOR - d- W � .� � �_ WORKERS'COMPENSATION DECLARATION j � � IHEfl�YAFFIRMUNDERPENALNOFPERJURYONEOFTHEFOLIOWINGDECLAMT16N5: � . � O _IHAVEANDWILLMAMTAINACERTiFICA7EOFCONSENTTOSEtFdNSUREFONWORKERS' � CAMPENSATION,ASPROYI�EDHYSECTION37000FTHElABORCOOE.FORTHEPEflFORMANCE OF THE WOFlK FOR WHICH THIS PERMIT IS ISSUED. _� � W _ t HAVE AN�WILL IAAINTAIN WORKERS'COMPENSATION INSUHANCE,AS REW IRED BY SECTION � Q 37000FTHELABORCODE.FORTHEPEflFORMANCEOFTHEWORKWRWHICHTHISPEflMITIS ISSUEU.MY WORKERS'CAMPENSATfON INSURANCE CARRIEfl AND POLICYNUMBEHARE: CONSTRUCTION Q > CARRIEfl PLAN REVIEW Zaoucr NurnsEN - ELECTRI - r'""�• � (IHLSSECTIONNE�NOTBECOA�LETm�THEPEPo�YlISFORONEFRN�ARED�OIlAA51610010fiLE55}. P��U BIN i _ Z 1 CEflTIFY Tf1qT W TXE PERFORMANCE OF 7HE NlORK FOfl WHICH THIS PERM�T IS ISSUED,I MECHANICAL' (�} SFiALLNOTEMPLOYANYPEfiSONINANYlAANNERSOAST06ECAMESUBJECTTOTHE -r� -,n �si=1� - �- -WORKEflS'COMPENSATKKJI.AWSOFCAUFORNIAANDAGREETHATIFISHOULDBECOME INSPECTIONFEE - �_ SUBJECT 70 TME NroPKEHS'CAMPENSATION PROVISIONS OF SECTION 370o OP THE LABOH --- � ' � �k,_ �3� , . COOE,I SHALL FORTHWITN COA.IPLV WITHT�P V� ISSUANCE ry' � SMIP p DATE:� APPLICAM: , W WARNINGFAIWRETOSECUREWORKERS'COMPENSA7IONCOVEflAGEISUNLAWFUL,/WDSHALLBE ENERGYP/C - '�- -. e-. 'A�°`� � &U&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTODNEHUNDRE�THOUSAND sa�3� -� ! -� - � DOLLARS(S70D,000),INADDITIONTOTHECOSTOF�MPENSATION,OAMA�ESASPHOVIDWFORIN ENERGYPERMIT � SECTION3)aBOFTHELA80RCO�E.INTENEST,ANDATfORNEV'SFEES. RETENTIONFEE: a CONSTRUCTION LENDING AGENCY pRE-ALT FEE: O � IHEREBYAFFIRMUNOENPENALTYOFPERJURYTHATTHEREISAGONSTRUCTIONLENDINGAGENCY Z iOq THE PERFORMANCE OFTHE WORK WN WHICN 1NIS PERMITIS ISSUEU(SEC.3077.CIV.C.). W � IENDER'S NAME - - - -- � F- LENDER'SADDRE5S � ICEflTIFYiMATIMqVEREADTHISAPPUCATIONRNDSTATETHATTNEABOVEINFORMAT10NI5CORflECT. TOTAL FEES - - a3�i�-- �- IAGHEETOCOMPLVWITHALLCI7YANOCOUNTYOHOINANCESAN�STATEIAWSRELATINGTOBUILDING . � - - � CONSTRUCTION,ANDHEREBVAUTHORIZEREPFlESENTATIVESOFTHISCOUMVTOENTERUPONTHE - Z ABOVE-MENTIONED PHOPERTY fOR INSPEGTION PURPOSES. COMMENTS - - � J � m PERMITfEENAME(PRItiT) /J / _ ���w /,+'' tn /�C�l��itLf� � A ��..Y�K�. uj SIGNpTUPEOfPERAIITTEE DATE - - � _- = RECPT.NO. PAID 8Y VALIDATION ~ WHITE—Department Copy.YELLOW�inance Copy,PINK—Assessor Capy,GOLDENROD—Fi�e Copy,GREEN—App�icanl's Copy - � V.� . , � ,� � , _ _.. . .., ____II . ` �'T-�"T�'T �IIII :67fn1 , . 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