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HomeMy WebLinkAbout14454 (20) � � �� � CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES _ � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS � �����'� � BUII.DING PERMIT APPLICATION FIRMLY � � JOBSITE (// i `n �y,_�,_ t. APPLICA ON PERMIT `�j' /C � ¢ ADDRESS � `�J ��R� ` �� �� DATE�7 r" ��`��� NUMBE # � ISSUE TYPE OCC � APN LOT�,—�, -�"— TRACT DATE CONST. GROUP p OWNER . l�tl'1'l\II�I "" ADDRE S ZONING SETBACKS Z CITY �-V�Z P TEL. 'C� � REART RW a g APPLICA T 1'�I�P+ TEL;��� SIDE/SIDESTREET RW ❑ � � CONTRACTO ( J SIDE ❑ � � ADDRE PROPOSED USE � 0 GITY ZIP E — -- 0 ARCH/ENG/ � � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � N CITY. ZIP TEL. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION .� �. OWNEfl-BUILDERDECLARATION . SFR/ADD/REM Q p 1 HEREBY AFFlRIA 11NDER PENALTV OF PE0.NPY hUT 1 M1 EXEMPT FROM THE COMRACTORS LI- GefBgE/CeryOR �� W. CENSELAWWRiHEFOLLOWINOREA50N(SEC.7031.68USINESSANDPROFESSIONSCOOE:ANVCI7YOR (n _� U-. COUNfI'WHICHREQUIPESAPERMITTOCON57flUGT,ALTEfl,IMPROVE,�EMOUSH.OflREPAIRANYSTRUC- �[jJ patio{Deck �G- TUpE pplpp TO ITS ISSUANCE.AI.50 REQUIRES THE APPUCANT FOR SUCN PEHMIT TO PILE A SIGNED -W �: STATEMENT hUT HE OR SHE IS LICENSED PUFlSUANT TO THE PROVISIONS OF TNE CANTR4CTORS L6 CENSE LAW(CHAPTEfle(COMMENCINO WITH SECTIDN 7oDa)OF DIVISION SOF THE BUSINE55 AND PRO- � POOUSpB � FESSIONSCODE)ORTHATHEORSHEISE7(EMPTTNEREFROMAN�THEBASISFOR7HEALLEGEDEXEMP- �V,-. TION.ANVVIOLATIONOFSECTION7091.SBYANVAPPLICANTWRAPERA/ITSUBJEC75THEAPPLiCHNTTO � Z Re-Roof �_ qqYil PENRLTY OF NOT MORE THAN FIYE HUNORED UOLLARS(5500).): � ^_ ❑I,ASOWNEHOFTHEPROPERTY.ORMYEMPLO7EESWITMWAGESASIHEIRSDLECOlAPENSA7ION, . � C0t71m6fCial -' �. WILL DO THE WORK AND THE STRUCiURE IS NOT INTBJDED OR OFFFAEO FOR SALE(SEC.70d4,BU51- J � _ NE55 AND PROFESSIONS COOE:THE CONTflACTORS LICENSE LAW DDES NOT APPLY TO AN OWNER OF ��- PflOPERTYWFiOBUILOSOflIMPflOVESTHEfiEON,MIOWHO00E55UCMWORKHIMSELFOFMEflSEIFOR � � �Q'- THROUGHNISORNERONMEYPLAYEES,PqOVIDEO7HATSUCHIMPROVEMENTSARENOTMITENDEDOR � m W- pFFEqEpFpRSP1EIF,HOWEVERTMEBUIl01NGOflIMPROVEMENiISSOLDWITHINONEYEAROFCOMPLE- -� - -Q`- -'TIWi,THE OWNER�BUILIIEfl WILL F1AVE Ti1E BUROEN OF PftOY�NG TMAT HE OR SHE OID NOT BUIID OH - - - -� ��.; IMPR�VEWflTHEPUHPOSEOFSALE). - .W_ OI,AS OVMEAOFTHE Pf10PERTY,AM EXCIUSNEIYCONiRACTING WITH UCENSED CONTRACTORS �..�- TO CON5TflUCT THE PROJECT(SEC.7044,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- VHIU2ii0ft ADJ.AREA ;: CENSELAWDOESNOTAPPLY70ANOWNEROFAPflOPEtfNWHOBUILDSORIMPHQVESTHEREON,AN� - -_' WHOCON7MCTSWRSUCHPRQIEC7SW17HACONTHACTOR�S�LICENSEDPUfiSUANT70THECONTRAP QUANTITY DESCRIPTION FEE ~� TORS UCENSE UW.). �?'- - ❑IAMEXEAIPTUNOERSEC. 8.8PC.FORTHISREASON �: U - T: � - �="�- DATE OWNER ` F Z` W :�:_� UCENSE�CONTRACTORS DECUiflATION ' �j i -� -'��- IHEflEBYAFfIHtAUNDEflPENALTYOFPEflJURYTHAT1a1dLICENSEDl1N�ERPRO\1316N80PCHAPTER �. � -�- Y(COMMENCW[iWITHSECTION7000)OFUIVISION30FTNEBUSINESSANDPROFESSIONSCA�E.AND � Z . MYLICENSE IS IN FULL FORCEAND EFFECT. _ m O ¢ f � :�_ LICENSE CLA55 � v LIC.NO.�� �� - J � "w�_ DATE ^ CONTFACTOR _._____ _ _ -� �: WORKERS'COMPENSATtON DECLP.RATION ��3� ¢ �� � -� .IHEflEBYAFF7RM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOW!YG OECLARATIONS: f13 ¢ _� �.�� �INAVEANDWILLi.iN�1TFJNACERTIFiCATEOFOYlSEMTOSELF-INSUREFOPWORKEFS' 2 WMPENSATION,ASPROVIOEOBYSECTICN37a00FiHELARORCOOE,FORTHEPEFFORMANCE W � -�.- OFTHEWOflKFORWNICHTHISPERAIITISISSl1ED. � Q' � � '�.'� I HAVEAND WILL MAIMAIN WOHKERS'COMPENSRTION INSURANCE.AS REQUIREO BY SEC710N � -Q: 77000FTHE LABOfl OJDE,FORTHE PERFORMANCE OF THE WORK FOR WHICH THIS PeFMiT15 -�4,_ 6St1E�.MY W0 Rfl�'COM}EN��ON INSl1RANCE CAFRIEH ANP POLICY NUMBEftAFe: CONSTRUCTION �.'�_ ��1`��, i PLAN REVIE�V CARRIER '0`� POLICYNUMBER •? � �"�� ���� ELEC7AIC Z, —r �" ��" (fMSSEL"fpNNE�N�TBEO�MN.ETmOFTHEPERMI�ISFORONEHJhOREDD011ARS(St0%ORLESSa PLUMBING �_.0.; . . . . -.Z= I CERTIFY7NAT INTHE PERFORMANCE OF THE WORK FOR WHiCH THIS PEHMIT IS ISSUED,I MECHANICAL - -_.-Lj- - SHALLNOTEA1PlOYANYPEflSONINANYMpNNER50A5TO8ECOMESUdJECTTOTHE -_�__ WORKERS'COMPENSATIONtAWSOFCAUFORNIA,ANDAGREETHA71FI5HOULOBECOME INSPECTIDNFEE �" SUBJECTTO7HEWORKERS'COMPENSATIONPflOV�SIONSOFSECTION37o00FTHELABOR �SSUANCE �, CODE,ISHAILFOHTHWITHCOMPLYWITHTHOSEPROVISIONS. � SMIP �� �O DATE: � � APPLICANT. � �- Ty -W-� ENERGY P/C � ��`'V�'� J- WAflNINO:FPIIURETOSECt1qEWORKEflS'GOMPENSATIONCAVEHA6E19 IAWFUL.AN�SHRLLBE �J� -SUBJECTpNEMPLOYERTOCRIMINALPENALTIESANOCIVILFINESUPTOIXJEHIJN�REDTNOUSANO � -1i ENERGY PERMIT DOLLARS(5100.Oa0).IN MDITION TO THE COST OF COAIPENSATION,DPMAGES AS PROVIDE�FOR IN ._��-__ SECTIDN310BOfTHELABORCODE,MTFAEST,ANDATTORNEY'SFEES. - AE7ENTIONFEE: ��E� ��{ � �°-���� _ -�_ CONSTRUCTION LENDING AGENCY pRE-ALT FEE: ._W yyq� y� -¢�: IHEHE6YAFFIRMUNDERPENAL7YOFPERJURYTHATTHEFEISACONSTRUCTIONIENDINGAGENCY �"' �s�� �<<n�,�j���.3�t�s� d- FOR 7HE PERWRMANCEOFiHE WORK FOR WHICM TMIS PEflMiT IS ISSUED�SEC.3oe�,CIV.C.�. - - � - x._�d��aa��"Jt i.�dt'_t`� , � `s✓ z _----- w- .�_` LENDER'S NAME -F_'- LENDEFYSADDRE55 -- -..W�:_ ICERTIFYTHATIHAVEflEADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. 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