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HomeMy WebLinkAbout14612 (8) �. � ^ �� CITY OF DIAMOND BAR � DEPARTMENT OF COMMiJNITY&DEVELOPMENT SBRVICBS „ 21660 E.Copley Drive Suite 190 w (909)860-3195 Fax(909)861-3117 PRESS ; :{ "��^�,, BUII.DING PERMIT APPLICATION FIRMLY ;�� JOBSITE �L r APPLICATIO t �'j �, ERMIT p " " o ADDRESS �� l �� �$C��"Y' �� DATE NUMBER � #i = ISSUE TYPE OCC `�` APN�OT TRACT DATE CONST. GROUP p.i OWNER �QY �2S Cr ADDRE t SI��� @E' ca! ZONING SEBACKS "' C1TY w+•-� �i�"ZIP TEL. REART RW C❑ �s APPLICANT TEL._ SIDElSIDE STREET RW O �` CONTRACTOR ✓�i .$ r"'l���� SIDE LI ��` ADDR S . J � • �''`'` .' PROPOSED USE �": CiIY i�_� � '� ZIP Y TELC,L...�> �� f'�13� �.w.� ARCH7ENG1 ;;w' DESIGNER NO.DWEL. NO. NO. ;�{ ADDRESS ' UNITS STORIES BEDROOMS _- CIIY ZIP TEL. '� DESCRIPTION SQ.FT. PACTOR PSF ADJ.AREANALUATIaN _�_: ;Q_ OWNER-BUILDER DECLARATION ,. � SFAlADDtREM O< p 1 HEREBY AFFIflM UNDEfl PENAI.TY OF PEfLR/RY THA7�AIA EXEMP7 FROM THE CONTRACTORS U� G8�d9B/CBfpOfl ��1J' CENSEUWF�RTFIEF-0110WINGR6A50N(SEC.T031.58USINESShtlOPPAFESS10N5CADE:ANYCITYOF ;�(n ,CJ� CIXINTYWHICFiRC-0UIpESAPER.NITTOCONSTRUCT,ALTkR.IMPROVE,OEMOUSH.ORREPAIRA.WSTRUC 'W Paiio/Dack 'Z:: -TURE,PRIOFS TO IT5155UM'CE,ALSO REOUIRES THE pPPLiCANT FOH SUCH PERMIT TO FILE A SIGNED -���� �,�g �STATEMENT THAT HE OR SNE IS IiCENSED PURSUAN7 TO THE PROVISIONS OF 7ME CONTMCTORS L4 - 9ENSE IAW(CHMTEP a(COMMENqNC3 WI7N SECTION 7000)OF DIVISION 3 0F7HE 6USINESS AND PR6 �� POOUSpB ��� FESSfONSCODE�ORTFUTHEORSHEISEXEMPTiHEAEFROlAANOTHEBASISFOR7HEALlEGEOEXEMP ,.�� :V� TpN.ANYVKKATIONOFSECTION703t.5BVANYAPPIICANTFORAPERMITSUB.lECTSTHEAPPLIGANTTO .�_ Z RE-ROOI QC1 � ACPlILPENALTVOFNO7MORElHM7FlYEHUNDREDDOlURS(SSoo).): - . ❑I,ASO'MNEROFTHEPPOP£RTY.ORMYEMPIOYEESWITNWAGESASTHEIRSOLECAM9ENSRTtON. � '�� CCTI(P.8fCl8i ' � :�j .YALL QD THE WOAK.AKD TNE STRUCiURE IS ta�T iiJTENDEO OH OfFERED FOR SALE(SEC.7oa4,BU51- . .J - NEA:AND PP.OFE&&IONS CODE:THE CCtdTFACTOR3 LICENSE I.RW OOES NOT A?FLY TO AN OWNEfl OF ��.- PqOPEqTYVht08UiLD50RIMPHOVESTMEREDN,ANDYM1IODOESSUCHWORKHVMSELFORHERSELFOR ��� - :,�; TMFpUOFIHiSORHEROWNEAIPLUYEES,PROViDEOTHATSUCHIMPROVEMENTSARENOTINTENUE00R m ��. ,OFFFAm FORSPLE IF,FIOWEVER,TME BUILDINQ OR IMPFOVEMENT IS SOID WITHI�N ONEYFAR OFGOMPIE� ,.L' �-TION.TME OWNEA$UtLDER WILL HAVE THE BUPDEN OF PROVIN6 THAT HE OR SHE�I�NO7 BUIID OR �.= IMPROVEFORiHEPURPDSEOFSALE�. - � _ ❑1,AS OWNER OF THE PROPEFm'.M7IXCLUSlVEIV COMMCTINA WITH IICENSED GQMRACTOqS �Q�_ TO CONS7RUCT 7HE PROJECT(SEC.)004,BU5WE55 AND PROFESSI045 CODE:THE CANTRACTORS LI- Vfllu0ti0n ADJ.AREA - W: CENSELAW60ESNOTAPPLYTOANOWNEROFAPROPERNWHOfiU!LOSORIAiGROVESTHEREON,AN� .���. KYtOCONTRACTSiORSllCHvfiO.IECTSWRHACONTRACTOA�S)LICERSEDPURSUPMIOTNECONTRRG QUANTITY DESCRIPTION FEE - ' TORSUCENSELAW.). - o� � I ❑I A�d IXEIA?T L11.DER EFC. 6.a P.C.FOR TN�S PEASON Q 'f�"10�-'' ��� �'v. � ¢ Cce' `1��'1 7 O S �u': DATE OWNEH ~ - -- � � � tir' .F_. LICENSED CONTRACTORS DECIARATION -� - � � - �� � �_ W r E� � � F �j iHEREBYAfFIRMUNDERPENAL7YOFPER7URYTHATIAAILICENSE�UN6EHPROVISIONSOFCHAPTER U. c.,,� Q- D(COMMENCMOWITHSECTION7000�OFDIVISIONaOFTHEBUSINE55ANDPROFESSioNSCOOE,au� Z � ' AIY UCENSE IS IN FULL FORCE AND EFFECT. m � ��: LICENSEC(L�f�S[����r�+1 UC.NO.-- � Z�`''��� --- � � � ('� j,. .. �_�' DATE.�S�Y . J e KJ �� CDNTRACTOR 2� W ��- WORKERS'COMPENSATION DECLARATIOM ry��i� � [, 1 � IHEREBYAFFlRMUNDERPENALNOFPEPJURI'ONEOFTHEWLIOWINGDECLARAT10N5: Y � Z � Q O _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSEMTOSELF-1NSL7FlEFORWOANERS' 2 � COMPENSATION,ASPROVIDEDBYSECT70N37000FTHElA80RC00E,FOflTHEPERFORlAlvUCE ��. W OF THE WORK FOR WHICHTHIS PERMIT IS ISSUW. � � r _I NRVE AND WILL MA�NTAM WORKERS'COMPENSAT:DY INSURANCE,AS RE�UIRED BY SECTION y / { Q 57000Fh1ELABORCO�E.FOfl7NEPERFORMNICEOFiHEW09KFORWMICHTMISPERMI715 / i� � I� • ISSUED.MY WONK 'CAMPENSAT�ON 1�J$URANCE CARRIER AND POLICY NUMBEAARE `�� CONSTRUCT�ON � .> CARRIER����������� ��^j� � 1 _ PLANREVIEW � POLICYNUM6ER /"'~� � � � � � ELECTRIC Q � (IHISSECfIOr�NE�NDTBE�RkiFDOF7!£PERIMISFCRONEF•.lNOfiEDCOLIAPS(5100IORLESS} PLUMBING �.� ....� . w MECHANICAL �`� Z i CERTIfYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSL1E0.1 �f° SHAI.LNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMF.SUBJECTTOTHE INSPECTIONFEE �/j WORKERS'COMPENSA710NV.WSOFCALIFORN10.M1DAGREETHATIFISHOUI.OBECOME �} � St18lECTTOTHEWOPKERS'COMPENSATIONPROVISIONSOFSECTION3�o00FTHELABOfl �SSUANCE ��{� � � ��� CODE,I SHFLL FORTHWI7M COMPLV W ITH THUSE PROYISHJNS. O SMIP . _�W - � ' p DATE: APPLICANT. —_____— �.. . �� +? ,e� � J ENERGY P/C WApN�NO:FpIIURE TO SECURE WORKERS'CAMPENSATION COVERAGE IS UNLAWFIJL,ANO SHqLL BE � --- �� J SU&IECTANEMPLOYERTOCRIMINAIPENALTIESANDCNILFIhESUPTOONFHt1N�RFDTHOUSAND -� �- - � �•`T'"'"�3''�'rty����� � DOLLARS(£100,000),INA�DITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVID[DFORIN ENERGVPERMIT J SECTION37080FTHELABORCODE,INTEREST,AN�ATTORNEYSFEES. RETENTIONFEE: _.. � Q W- CONSTRUCTION LENDING AGENCY PRE-ALT FEE: a � IHEREBYAFFIRMUNDERPENALTYOFPERJURVTHATTHEFlEISACANSTRUCTIONLENDINGAGENCY FORTHE PEFlFORMANCE OFTHE WORK FOil WHICH THIS PENMIT IS ISSUEp(SEC.:097,CIY.C.), Z W � LENUER'SNAME I— LENDER'SADDRESS � ICEN7IFYTMATINAVEREADTHISAPPIICATIIXJANDSTAiETHATTHEABOVEINFOPMATIONISCORRECT. TOTAL FEES - L - W IAGREETOCAMALYWITHALLCIiVANDCOl1NTYORDINANCESAN�STATElAW3FELAT�NGTOBU��OING {� �� �' - � - � COI+STRUCTION,ANDHEREBYAUTMORIZEflEPRESENTRTIVE50FTMISCOUNTYTOEMEFUPONTHE ���'�ji'1 ��� - ZA90VE-MENTIONEO PflOPERTY FOR INSPEC au aosEs. 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