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HomeMy WebLinkAbout14305 (19) CI1'Y OF DIAMOND BAR �Q�'� —��-""1�- -- DEPARTMENT OF COMMUNITY&DEVELOP MENT SERVICES � � , 21660 E.Copley Drive Suite 190 (909)860-3195 Faz(909)861-3117 PRESS ���9�'��� BUILDING PERMIT APPLICATION FIRMLY _[,,+ ! � �_ (�.,���, APPLICATION C( PERMIT L��/�"�P!C � ADDR'ESS �\ I�.i �$ z � DATE �� v NUMBER �f�`°✓ # � ISSUE TYPE OCC APN LOT TRACT____ DATE. CONST. GROUP p OWNER �.:5'�aF7�'iy-L�'73�..� I " ADD SS��Lt' ZONING SETBACKS ' Z CITY�A�'+�'�ti3� ��.. ZI 1�I '� TEL. �`��-CyC�J'� FRONT RW ❑.- g APPLICANT TEL. REAR ❑_._____ � —��� SIDE/SIDE STREET RW ❑__..__ CONTRACTOR YCYd-'Pl..+A?-K-��''���"1%.Gl..L�Sj.._� SIDE U i Q ADDRESS :.��G-���C.dS`TVL�— � CIN C��E�urx,�U ZIP " ���L TEL.��`sS""�-f��� PROPOSEDUSE Q ARCH/ENG/ z DESIGNER �' ADDRESS NO.DWEL. NO. NO. � �; UNITS S70RIES BEDROOMS � CITY ZIP TEL. cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARAYION SFR/ADD/REM O 1 HEREBV AFFIRM UNDEH PENAIN Of PE0.NRY THRi t AM[XEMPT FROM THE CQNTRACTORS LI� G&f99B/C&(POf[ CENSEtAWWRTHEFOIIOWINGREA504(SEC.7031.58USINESSANOPROFESSIONSCO�E:lWYCITYOR (n U OOIiMYWHICHREOUIFiESAPEfiMITTOCONSTRUCT,ALTER,IMPROVE,DElA0LI5H2ORFEPAIRANYSTRUC. W PgtIOlDBCk 7URE,PHIOH TO ITS ISSU�NCE,AL50 qEOUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED � � STRTEMENT THAT ME OR SHE IS LJCENSED PURSUM7T TO THE PHOYISIONS OF THE CAPf�MCTORS LI• W 'CENSE LAW(CHAGTER 9(COMMENCINO WITH SECT!ON 7m0)OF DIVISION]OF THE OJSINESSAND PRD- � POOVSPB FESSpNSCODE)ORTHATHEOfl5HE15'c%EMPTTHEflEFROMANOTHEBA515FORTHEALLEOEDEXEMP- (� TqN.ANYVKKATIONOFSECilOiV70.91.5BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re•Roof � ACINLPENALTYOFNOTMORETHANFIYEHUNDREDDOIURS(S5ao).): OI,ASOWNEROFTHEPROPERTV,OFMVEMPIOVEESWITHWAGE5A57HEIFSOLECOMPENSA770N, C� C0171R1BfCIflI ' g� 1YILL DO THE WORK,AND TME STRUCTUPE I5 NO71NfENDED OR OFFERED FOq SALE(SEC,7oaq,BU51- J- N� NE55 ANO PfiOFES510NS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � I PROPERTVWV/OBU0.DSOFIMPROVESIHEREON,ANOWHOWESSUCHWORKHIMSELFORHERSEIFOR �..THFlOUGHHI30RHEROWNEMPLDYEE3,GflOVIDEDTFIAT3UCHIMPROVEMENTSMENOTINTENDEDOR m Q ,OfFEREDFOR5ALEIF,HOWEYEH,iHEBUILDINGORIMPROVEMEN71550LDWRHINONEYEAROFCOMPLE� ( Z '•TION,THE OWNER�UILDER WILL HAVE 7HE BURDEN OF PROVING THAT HE OR SNE DID NOT BUILD OR � IMPROVE FORTHE PURP09E OF SA�E). , ❑1,ASOWNEROFTHEPROPF.RTY,MIEXCLUSIVELYCONTRFCTINGWITMLICENSEDCANTRACTORS �• TO CONSiRUCTTHE PFOJECT(SEC.7a4,BUSINESS AND PROFESSIONS CODE:7HE CONTpACTORS LI� Valuafion ._._..,.....,..__.,_._._..______ P,DJ.AREA � W� CEHSELAWDOESNOTAPPLYTOANOWNEflOFAPROPERTVWHOBU1l0.40RIMPROVESTr1EflEON,AND -"-' -- — �' N?qGONTflACTSFORSUCHPRO.lECT5W17HACONTRRCTOR(S)UCENSEDPURSI1rWTTOTHECOPfrRAG QUANTITY DESCRIPTION FEE � � TORS 110ENSE UW.�. ____ _ J � ❑IAMEXEMPTUNOERSEC. __8.6P.C.FORTHiSREASON Q _ U LL UATE_ _OWNER_'_.'__""_.__.'—'_".__.._._._....."'_— H � Z U w � � LICENSED CONTRACTORS DECII+RATION W � . _ __...�.._- -- '� ��'I I HENEBYAFFIRM UNOER PEMALYY OF PE0.IURV TNAT 1 AM LICENSED UNDER PflUVISIONS OF CHpVTEfl f� '��.� B(COMMENCINOWITNSECTION7000�OFDIVISION30FTHEBUSMESSAN�PROF[SSIOhSCOD[,AND � Z � � MY UCENSE IS iN RILI FORCE ANt�EFFLCT. q, e � y ^ "�<��6�.-`�C�'� (L (iJ� ��.r AC�„JC+L-�%LJ�'. �.O i LICENSE CLAS}S' �" �� LIC.NO.S•�� i"""'�� _ � j J � �U'�� DA7E_.�S�L�Cl�� cONTRACTOH f��°�.1 `�.....r:- �d W ff ���� WORKF.RS'COMPENSATION DECLARATION � � Q �' IHEHEBYAFfIRMUNDERPGNALT/OFPERJURYONEOFTHEFOILOWINGDECLARATIONS: V N: d 0- ___IMAVEANDWILLMAMTAINACEHTff�CATEOFCONSENTTOSElFdNSUREFORWOflKERS' _ �. COMiEN5AT10N,A50qOViDE�9YSECT10N37ooOF?HELABOFlCODE,FORTHE7ERFOR!AANCE W OF THE WORK FOR WNICH THIS PEflMIT IS ISSUED. � O _ _I HAVE MI�WILI MAINTAIN WORKEHS'CAMPENSATIWI INSUflANCE,AS RE�l11flED BV SECTIO� Q. 3700OFTHE LABOR CODE.FORTHE PERFORMANCE OF THF WORN FOR WHICH THIS PERIAIT IS ISSUED.MYWORKERS'COMPENSATIONINSURANCECAqRIERANDAOLICVNlIMBERAflE: CONSTRUCTION ,._._______________ � _.�,' ,,..�„ � f' Y'— _-__ -..—_....'_-_'_"___"'"'__"' a CAR�tIEA__T�. ��:� �L�-z ' . PLAN REVIE�N � -------------- -----------....._-- � .. .....---------- � -- - . . w.,..,:... .Z_� PouCYNUMBEA___�7� � "' � vd . ELECTRIC + � ' °` � --`----- .. , ----'---....�_..-'•---�-------'--' , :¢ .�,.,...:........:, � — . ��0 (iHi6SECilONN[�NOTBECOAPLETEDOF7HEPEFPNTISFORONEHIN�l7EOOOIAANS(S7a0)017LES5) PLUMBING __.._..____._._......._'__._-'._ •- �. ' _ _ .._.........._ �� I CERTIFV THAT IN THE PEflFORMANCE OF THE WORK FOH WHICH THIS PEflMIT IS ISSl1EU,I MECHANICAL ______,__ ______ -�(j SHAIL NOT EMPLOV ANY PF.FSON IN ANY MANNER bOAS TO�ECOME SUBJECT TO TIIE ��°!'''� ' � :. .. Y •'' ':' . �, .:N. WOPKERS'COMPENSA710NLAWSOFCAI.IFORNIA,PNbAGRf:ETHATIFISHOUL08ECAME INSPECTIONFEE ` ' �� � � •�� � w� -ti� � SUfl1ECYTOTHEWORNERS'COMPEN JOPYPROWSI�NSOFSECTION37000FTIiELA80fl COUE,1 SHALL FORTHWITi COM ITH THOSE PROVI 5 ISSUANCE � "�'� ` �����j _ ,Y-� ' _... f L �� DATE:��_ ��r._�l� '--' _ � SMIP �+^' _ � �� . .: _.. � APPLICANT: f��."-._...._ �- .0 ..�....-�,�-.. � � -_— . _- , ... W ,.•y ..:. . . ...: .. .. . � ENERGY P1C ..,, �......::.,:.��..-�.�.... ,._.... . J WAHNING:FAILURETOSECUREWORKERS'GOMPFNSA'fIONCOVClIAGFISUNLAWNL,ANOSHALLBE --��--- �---------------- .�� SUBJECTANEMPLOVEflTOCPIMINALPENALTIESANDCIVILFINFSUPTOIXJEHUNUHF.OTHOUSANU ENERGYPERMIT � DDLLAFS(Si00.OW),INADOITIOtiTOTHECOSTOFCAMAENSATION,DAMAGESASPROVIDEDFORIN - �-��---- .. ""_'_"---_' J. SECTIDN37oeQFTHELADORCOUE,INT[REST,ANDATTOFNEV'SFEES. RETENTIONFEE: ._._,__ :Q: '_"___"..__......___"__.._..._"-_ � CONSTflUCTION LENDING AGENCY PRE-ALT FEE: �. ------�------`----...----.....------ .,Q. I HENEBV AFFIRM UNDER PENALT'OF PLFLIl1RY THAT THERE IS A CONSTRUCTIIXJ LENDING AGENCY a- FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PEPMIT IS ISSl1ED(SEC.3077,CIV.C.�. --�--`— � �� Z ..W _"—_""_--'._........_' '_"'__"'"._.._'__—'—___'__ ^.��, LENDER'SNM1E_'____"" __"_'..."---_ ___"_"'""'_— � F-� LENDEflSADDFE55 _____..____— ���. ICERTIFYTHATIHAVEREAUTMISAPPLICATIONANDSTATETHATTHEADOVEINFOflMATIONISCORREtT. TOT/'1L FEES � d IAGREETOCOMPLVWITHALLCITYANDCOUNTYORDINANCESANDSTATELAWSRELATINGTOBUILDING � CONSTflUCTION,ANDHEHE6VAUTHORIZEREPRESEN7ATIVESOFTHISCOUNTYTOENTERUPONTHE ABOVEMEIYTIONEO ROPERTY FOR INSPECTION PURPOSES ; Z �.� �j � `�,�, COMMENTS ------------------------ � �: � `"., ���!l„�-f`�.,..iC+"�C�,'"� --- � � — �----- m PEHMITTEEN (PRINq (j�"�j � .� Y �~�:�.,,,.. ���.�'J �- / —'— — � � � N SIGNATl1flEOFPEfiMITfEE,�v DATE RECPT.NO. PAID BY VALIDATION__ _ ��� WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy i ' w . � �... ..� `` i 1 1 '"i � ' '� I � � , 31'�S �. 9 d� I� � s . �� � i i 'Y� � )�r. _ �.1 m:.�� id a ; ` �t �'0d§3-r°P 2� �x.. �� �� 1 1 d ��, i L I.', � �1 �, � � t �� � � �� �'Ty 5 i d ��&Rm"� �e ��*s�3'-V t�`il i { i i f. C �t, g.. 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