HomeMy WebLinkAbout11672 i • -
��° � •�+ CITY OF DIAMOND BAR
�----��--- DEPARTMENT OF COMMUNITY&DEV E
21660 E.Copley Drive Suitc 190
(909)860-3195 Fax(909)861-3117 PRESS
���9N°� � BUILD[NG PERMTi'APPLICATION FIRMLY
oN JOBSITE APPLICATION l ��- PERMIT 1��7 P/C
ADDRESS O�'°��y s°'E��✓.St-��.�s DATE x`�/S'� S�'. NUMBER �- a
c� ISSUE ,., TYPE OCC
APN LOT TRAC7_ DATE � CONST. GRDUP
p OWNER �°'�i c cr.sxsry C�� �r�91•'"'-<••�'�'2�
" ADDRESS �/� ZONING SETBACKS
i sl/ G�d'-�e° c'.+>
W � a���- ZIP ;�l.�'K eL TEL.�7F�L'•/ff'lS"" FRONT RW fl__
Z CITY d/v.;.e•:� _ —
g APPLICANT .5:�'��" TEL. REAR �Tn; CJ
� SI�E/SIDE STREET � f7
CONTRACTOR SIDE _ U
� ADDRESS
PROPOSED USE��s�ir•:�E" G'.c✓ri+��s/'r.r,-s�'c�
s
� C1TY ZIP TEL.� � �������,�,' �
0 .E'f�t�r r....s c'• .` r:r s �.
wo ARCH/ENG! , y, y,��.y.
W DESIGNER NO.DWEL. ' NO. NO.
a ADDRESS UNITS STORIES _ BEDROOMS
� CITY ZIP TEL. —
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION .�
¢ OWNER-BUILDER DECLARATION , SFR/ADD/REM
O
Q 1 HEREBY AFFIRM UNDER PEN/LLTY OF PERJURV THAT�AN E%EMPT FROM THE COMRACTORS ll� ' G9fd98/CBl�Oft
W CENSELAWFORTHEFOLLOWINGREASON(SEG7031.58USINESSANOPFOFESSIONSCODE:ANYCIT'OH � (n
� WUNfYYYHICFiHEWINESAPERMITTOCON3TRUCi,ALTER,IMPROYE,OEMOLISH,ORREPAIRANYSTRUG !1,I pali0/D6Ck
TURE,PRIOR TO 1T5 ISSUANCE,PL50 FiC-0UIRES TNE APPLICANT F�R Sl1CH PEPMIT TO FILE A SIGNED � W
� STATEMEYI�TMAY HE OR SHE 19 LICENSE�PUftSUANT 70 7HE PROVISIONS OF TME CONTRAC70R5 LI�
� CFNSE LAW(CHAPTER9(COMMENCINO N7TH SECTION 7uoo�OF DIVISbN 30F THE BUSINESS AND PRO� V' POOI/Spd
FESSpNSCODE�OflTHATMEORSHEI3E%EMPTTHEREFRqAANOTHEBASI9FOFTHEALLEGEUf%EMP� �
7bN,�UJYVIOL4Ti0NOFSECT�ON7o91.5BYANYAPPLICANTFOHAPERlAITSl1fl1ECTSTHEAPPLICANTTO y Re-Roof a' �,�!��
A CML PENALTV pF NOT MOflE 1HPN PIVE HUNORED DOLLARS(5500).): � {
^ ❑I,ASOWNEHOF7HEPROPERTY,ORAAYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � 0 �mmerciai - '
� WILL�O THE WORK AND TNE STRUCTURE I5 NO7INTENDEO Ofl OFFERED FOR SALE(SEC.7044,BUSI- ' _J
� NESS qN�PROFES510N8 CODE�.iHE CONTRACTORS LICENSE LAW OOE5 NOTAPPLV TO AN OWNER OF �
PROPERfYWFIOBUILD50RIMPROYE3THEREON,ANOWHODOES5UCHWORKHIMSELFORHERSELFOR �
� THHIXIGHHISORHERONTIEMPLAVEES,PROVIOED7HATS�CHIMPROVEMENTSAFiENOTINTENDE00R m -��
QOFFEREDFORSALEIF,HONEVERTMEBUII�INGOFIMPROVEMENTI550lDWRHINONEVEAROFCOMPIE� %
Z iqN,hIE ONRJERAIIILDER WILL HAVE THE BUR�EN OF PROVWG THAT HE OR SHE�I�t�T BUILD OR '.
� IMPROVE FOR THE PURPoSE OF SAIE}.
❑I,ASOWNEROFTHEPHOPEiifl;AIAEXCW51VE4YCONTRACTINOWITHLICENSEDCANTRACTORS �' o
� TO CONSTRUCTTME PROJECT(SEG.70�4,9USINE93 AND PROFESSIONS CODE:THE CONTNACTORS LI- � V8I1JeilOfl DJ.AFiEA_,___,...
W CENSEtAWDOESNOTAPPLVTOANOWNEROFAPflOPERTYWF109tlILO50HIA�PROVESTHEFEON,AND
� WMOCONTMCTSFORSUCHPROJECTSWITMACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAC-� � QUANTITY DESCRIPTION FEE
TORSIlCENSELAW.).
Q, �%1M EXEMPTUN�ER SEC.� ._ B.B P.0 FOR THIS REASON � U
� �"" 14r.s'�' ',s'�.,,�c ���s�/�'s� , �
ll' DATE�/���� - �� � r»-ww�..._ I- 't
oWNEA:�.�.'�,1��..G= - �7-� . U
� J [
�� � � LICENSED CON7RACTORS DECLARATION W
9 � IHEREBYAFFIRMUNDERPENALT'OFPER1UqYTHATIAMLICENSEUUNOERPROVISIONSOGCHAVTER �
� a; p(COMMENCINOWITMSECT�ON7000)OFDIVISION30FTHE�USINESSANDPHOFESSIONSC�DE,AND Z
]C MY LICENSE IS IN FULL FORCE AND EFFECT. � `
11J m =
� UCENSE CLASS LIC.NO. __._.___ �� � (,
V _ CONTflACTOq__ _'."_ t d t
DATE____
W `
� WORKERS'COMPENSATION DECLARATION Q s�
� V �.
� IHEREdVAFFIqMUNDERPENALTYOKPERIURYONEOFTHEFOLIOW�NGOCCLAFlATIONS: z
O �IHAVEANDWILLMAINTAINACEfiTIFICATEOFCONSENTTOSELF-INSUHGFORWOpKERS' 2 �>,
� COMPENSATION,ASPROVIDE09YSECTION37000F1HELAWRCOOE,FORTHEPERFORMANCE 'U 1':
OF THE WORK FOFl WHICFI TMIS PERMIT IS ISSUED. �
� �:
w _I HAVE AND WILL MAIMAIN WOFNERS'COMPENSATION INSURANCE,AS REQUIRED 8Y SECTION i
Q 37�OFTHELABORCODE,iORiHEPERF-0RMRNCEOFTHEWORKFORWHICHTHISPERMI715 - �
ISSUED.MYWORNERS'COMPEN5Af1ONINCURANCECAqRIENANUPOLICYNUMBERFRE: CONSTRUCTION �`�,�+�, �
�y cnaaiea.---- ------ PLAN P,EVIEW _-.- -.---. _�7��s 4! }�.
£.
Z acxicrnurneeR __--.--.-- ��. ELECTRIC ______ __—_ ___— y.
_....-----
a (IFiLSSECf10NNEH)NO78EOOMCLEfEDOFhIEPF(UN�ISFORONEMh10REDDOLLMS.15100)ORLE55�. PLUMBING �
_ uxr —... _--------- — °,
0
Z I CERTIFY THAT W THE PEflFORMANCE OF THE WOHN FOP WHiCH THIS PERMIT IS ISSUED,I � MECHANICAL _______ __.,__ _...__ _- y�..
LJ � SNALL NOT EMPLOYANY PEHSON IN ANY MANNER SOAS TO BECOME SUBJECTTOTt1E �'J U
(/] WORKEflS'COAIPENSATIUNtAWSOFCPLIFORNIA,ANUAGREETHATIFISHOULDBECOME INSPECTIONFEE __._..__._ __.______ _,__�i
F SUBJECT TO THE WOfiKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE 1A80R �SSUANCE ��'
� CAOE,ISHALLFOFTHWITHCOMPLVWITHTNOSEPROVISIONS. -------�- -�--�-- -�--�- �����y
� SMIP _., . �V f.
p OATE:� . APPLICANT. "'__ .._— - --�—� -- .
t
W ENERGY P/C
J WARNING:FAILUR[TO SECUfiE R'ORKERS'CAMPF.NSA710N COVFRAG[IS UNLAWFUL,AND SHALL BE -""--'-- -'-"' --"-'-'--
� SUHJECTANEMPL9YEHTOCqIMINALPENALilESANDGVILFINESUPTOONEHUNDRCDTHOUSANU ENERGYPEFaMIT _., __ _, _ _.___
OOLLhRS(5100,000�,IN ADDI1lON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR IN "-' -'- -" " ��
� SECTION37080FTHELABORCOOE.INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: __„_._ ��
O CONSTRUCTION LENDING AGENCY PHE-ALT FEE: ..._____._ _._._... `
_-�"'�—� ;.
�. IHEREBYAFFlFlMUNDERPENALTVOFPERJURYTHATTNEi1EISACON51'RIICTIONLENDMGAOEhCY ___ ___ __
F-0R 7HE PER W FMANCE OF iHE WORK FOfi WHICH THIS PERMIT IS ISSUE�(SEC.3�97,CIV.C.).
Z ___ _ ,
W
� LENDEN'SNM1E___---"""""-.- ""-" '_" '___' _ --_
!- LENDER'6.4DDRESS .._.-_._.-_-_
WICERTIFYTHATIMAVEREADTHISAPPLiCA710NAND57ATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES .�� � t����
� IAGREETOCOM.PIVWIhIALLCRVANDCAUNTYORDINANCESANOSTATELAWSPELATINOT09UA.DING �
CONSTRUCTtON,AN�HEREBY AUTIWRIZE REPRESF.NTATIVF.S OF THIS COUNN TO ENTER UPON THE
� ABOVE�MEMKKJED PROPERTY FOR INSPECTqN PURPOSES. _ -
� COMMENTS
� � ��....yy-�..�,.r..,+_..�._�..��'", 4..'
m ''�-�-�,�
¢ PEflMITTEENAME(PflINTJ f ---.---.
uJ CC/��•e/IyH � /L/-'-'..+.d?9/t�.F� _ Z/✓S" f'� __'
� SIONATUREOFPERMITTEE UATE
� • RECPL NO. _PAID BY C � VALIDATIDN
WHITE-0epartment Copy,YELLOW—Finance Copy,PINK—Assassor Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy
� .# . _. .� _f.,.,.. � i � �y _� ! i� } �� 1, � .-; .i � � . .
�a 3 C ,r��d j � E � I � � £ I ��
�.F X°E s y�.tq s r� � , .t l �I '� ,, f, r �t . .
� 4„{ '#Al�d` F''�% j A s � r � � M
��`� ��.,". . . .�.���� �. . . ' ' ' �.I I � I ` 5� ��ft .
F ( �� � �
��,� . f �". E � i 1 r - � 3 Y M�
f s r'� d . ; . � i ' i ,, ¢ �: � � e F k �+
5 � � � �'�� �• • , , i � a�,. i � € ( 1 ' "� �e
� ��� t� �� � i � i I . �� � ;'� I - I � �� g
I s ,.j � : � r „r
�,� �i a £'�. M � � � � { { ,: I � � j' r i� ; � ' I r`�j �,� �
P� p*�� � ���' ( � � . � � ' � ,. �� I ,� ; � i �� � �+ � i .
,
� � �r� � � � € I i I i ' I
:
� , i
�� � E� � i i � � � L_ � -- — }. 1 _
� i � i s �
�.4 ' i ' :.... I ... ��_ l... �� '
1'— I
��r"n`' �... .... . � .h� � ( � E ` � � � � i � i � ��i : � � �� � , �
�., 1 i . � I ; j ' ' �;� ' ' ��'
i �i. � . I ; ' �' � � i i ' � -1 I I i , , k � I v�1. ( _ �, � s ti s�.� � ,
., � , + ' I �� I,
� � � i I � ; .--- G - - -- � .
.
•
� F + � . p {� —
� '� � � I ; I tl -� .
f �. , i . , , � � � ; � �.
': � , , � ; ( ', .
, , �
; , ; ,, i I , ; i 1 i '_ � , ' . ; � _ � � ' I... $ .
I i � 1 �*
� ! ; , � � { f � \ ��.
+ i � I i � , '�� � i, � E �. I � '� ,, � �. I � � , -�-l"' � i �� `�$'
i �. ' �! ��� ' : ' I I i � I i ( � i\}A•i I � �: rS:x -F ^" .
� � i k � � I 1 I � � � I ; 1 ` � �,( I � �' �����"' �1
� ' ` � ' � ' � � 1
,
i ; ; � ' � , ' ' � I ' � � ,. '
� � 1 � � I � I 1 � ( —r i k � _ I I k _i I _ Q� �d
' � ,{ i i i — i.:r r ;r -- lJ r��_�I �� x3� i _( a � ��_ — r � �� i �'� � .
f i € I ! � � ' ` I �� ' � I ,�i �`S `, �` I �,� ' Ir y f' '�-' .
a I i � .,, � � .I ,, �� i j -✓ i t r t r i�.� � T .
� � � � � � ' �-F rl ' �r � ., 7 -.!�t �� � �� , r� �
� I �I �
� � '�� � i � � � � ' I �_ t�� � t I ';,� �C � I Li ( C r'; !{ i� j ��.:.� � 8�d 3'",
E I I i ' i I i �a� c:, tl I g E i�I z I c'I �. �� � I i I� tf�� � 's�A
� t j ' t
, I �. �
I ' , i � �
i � '� � � � I� � i I I � ( t�� i ,�+� � [ z � i I-. � ��� I � . h�� � �
� � � , i j . I _ r� � � ( E � i �� 7 �� � � a� r# ��
E � � � � I � � � � i �'�� � � , ! � � 1 � i� � `r ( � �
� � I � 1 � i � ( �'�N � I � � ` ' : � � � i � � , �
� . � ' �� � . j i , ' � �'�� t .._ ��;. ._. - t i _'.._p �....._.�_. I � �__� I } — .i...
' • i ' I ' �'' ' �-- '..
k I I I ; � ,...._' �, I I f ��.
E � , � , � ; � � ' i ; t j �, �
, , , , � � , � �
�� , ; i '' � ' . i l_ ,. I ' � � ` ' ' , �
; , ! , , , I :, , i r- - r � I - �- --- -� - t �,-
� � ; . � � , � , ; � ; ; I, I i I i i � :
i , � I I ( i
r �� i � i {- � 1 ., � : ' '� I � � x a�
i � i I I I : ( , , I � 1 ';� i . � � � � � �A��
� � � � � � i i � ( � I I 3: �i ' � � � � ; � ..
� ' , ( I I �� 'i i I ( i I � i ; -i �s''
'� i
� � � � , . �
� � �� i � � � � , ���
�
'�i i
� , � i
, � , i ' ' � � � � � '� � i ' ( � ; I : I � � ; ( � ' �'`�
�' , ' � i ' ' � I '
i � i � . C � , � ' sp
., � ! k . I . , � ,.. _... _2
.. ....—.�..._.._. __._......,..�F...- .._,.. _....:.....,.._. ...:....,...�_..,_........: ._. ...._:....._...k .._.,,.._._ L...._.1....... .....�:_.. .,<._ ...�" '__:._"_... ._..� ...... _.,..��.._...... .._ __..�..: ...�_.r..�, _�. ,