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HomeMy WebLinkAbout13229 (17) � �r�_ CITY OF DIAMOND BAR r �l� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ` ; 21660 E.Copley Drive Suite 190 ` (909)860-3195 Fax(909)861-3117 PRE$$ "9t".� BUII,DIIVG PERMIT APPLICATION FIRML o ADDR'ES�r,�N��� ` �-�� /�� DATEICATION •- ���-�� NUMB R�i�,���#!C _/'}� � ISSUE TYPE OCC `J APN LOT TRACT_ DATE CONST, GROUP p OWNER � � rp p ADDRESS ZONING SETBACKS Z CITY ` ZIP��,= TELQ� �� �' FRONT RW LJ____ � � I.I------ � APPLICAN7 TEL. REAR Z '— SIDE/SIDE STREET RW i7 � CONTRACTOR ` E SIDE �; _ _ p� ADDNESS -� � C��Y ZIP TEL. ROPOSED US � � � � � �' ° � � o ARCH/'cNG/ _ �z DESIGNEFi NO.DWEL. NO. NO. a ADDRESS � CI7Y ZIP 7EL. UNITS_ STORIES BEDROOMS � rn — DESCRIPTION Q.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECIARATION SFRlAD�/REM O � 1 HEREBY AFFIRM UNDER PENM1LTY OF PEHJURY THAT I AM EXFMPT FqOM THE CO�TRAC70H5 LI� G7fB JB/Ce(POfI � CENSELAWFORhIEFOLLOWINGfiEASON(SEC.7031.SBUSINESSPNOPPAFES510YSCODE:ANYCITYOfl (f� � CIXINTYWHICHREOIlIRESAPERMITTOCONSTFUCT,ALTER,IMPROVE,DEAIOLISH,ORREPAIPANYSTPUG W PdIiO/OaCk w TURE,PRIOR TO ITS ISSUNVCE,PLSO REfli11flES THE APPIICANT FOR SUCH PERMIT TO FIIE A SIONED � � STATEMENT THAT HE Ofl SNE IS LICENSED PURSU0.NT TO THE PROVISIONS OF THE CANTRACTORS ll� �. � CENSE LAW(CHAPTEH 8(COMMENCINO WITH SECTION 7000)OF OIVISION�OF THE BUSINESSAND PRO� POOUSpB FESSIONSCOD�ORTH.OTHEORSHEISEXEMPTTHEREFROMANUYHEBASISFURTHEALIEGEDExEMP• � TION.ANYVpLATIONOF5EC710N7o31.5BYANYAPPUCAMFOqpPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � ACIV��ILp ENALTYOFNOTMOHETHANFIVEHUNDRE��OLLARS(55oo).J: 0 �I,ASOWtdEqOFTHFPROPERN,OAMYEMPLOYEESWITHWAGE5A5THEIR50LECOMPENSATION, L� Commercial � � z WILL Ob THE WORK,AND THE STflUGTURE IS NO7INTEND°D OR OFFERED FOR SALL(SEG.7oaa,BU51� .J � NESS AND PROFESSIONS CODE:THE CANTRACTORS I.ICENSE LAW OOES NO7APPLY 70 AN OWNER OF � PROPERTY WHO BUILDS OR IUIPROVES THERECXJ,AND WNO�OES SUCH WORK HIMSELF OR HERSELF OR ,� � THRq1GHNI50RHcflOHT2EMPlOYEES,PFlOVIDEDTHRT3UCHIMPFlOYEMENTSAfiENOTINTEN�E00R m pOFFEflFAFORSALEIF,HOWEVERTHEBUIL0INGORIMPROVEMENTI550LDWITHiNONEYEAROfCOMPLE� � TION,THE OWNER-BUILDEfi WILL HAVE TNE BUROEN OF PROVINO THAY IiE OR SHE D1D NOT Bt11L0 OR IMPROVE FOR 7NE PURWSE oF SALEa. � W ❑I,ASOWNEHOFTMEPROPERT;AMEXCLUSNEIV[:ONTR/1CTINGWiTNLICENSEDCONTRACTORS Q TO CANSTRUCT THE VROJECT(SEC.70ld,B1151NF55 AN�PROFESSIQ4S CODE:THE COYTHACTORS LI. V9IU8110f1 ADJ.AREA______..___.._ LLI CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERNWHOBUILDSORIMPROVESh/EREON,ANO � "--- � � NRIOCONfRAGTSFOflSUCHPR0.IECTSN7TMACOYTRACTOR(5)LICEMSEDPUqSl1ANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TOqSLICENSf.lAW.�. 0 ❑IAM EXFMPT UNDER SEC._______,_,____,____p.h P,C.FOFiTHIS REASON Q L. Q U - '� � � ' ' __""'-__ U . lL � UATE OWNER � f � z — w � LICENSED CONTRACTORS DECLARATION W I I � '� IHEflE6YAFFIPMl1N�EHPENALTYOFPERIl1RYTHATIAMLICENSEDUNDERPROVISION50FCHAPTER � d 9(COlAAIENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE ElU5MF.5S ANO PROfE5510N5 CODE,AND Z. �., MY LICENSC IS IN FUIL FOFCE N1D EFFECT. � p LICENSE CLASS__ _ LIC.N0.__..___ ..._.___._.— � � —__'._...._ J DATE CONTRACTOR_ f1 W .� WORKERS'COMPENSATION D'c.CLARATIUN Q — `� ` �� � — �.G •'' 1 �a NIHEREBYAFFIRMUNOERPENAITYOFPF.RIURYONEUFTHF.FOLLOWINGIJEGLARAT10Y5: Z t. C] IHAtlEANDWILlMMN7AINACEHf�FICATEOiCONSENTTOSFLf-INSUflEFORWORKERS' � �'d- � COMPENSATION.AS PROVIOEO dY SF_L`TION 37a00G THE LABOR CODE,FOR THE P'cRFORMANCE w _ _ Q OF TH�WOflK FOR WHICH THIS PF.FlMIT IS ISuUED. � � 'W __I HAVE NJD Wlll MNMAIN WORKERS'COMPENSATiON INSVRANCe,AS REQUIRED BV&ECTION � ' ' - ' �y Q97DOOFTHELABORCADE,FORTHEPEflFOqMANCEOFTHEWORKFORWHICHTHISPEflM1T15 •. . °J � .z• �T. — ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRI'eR AND POIICV NUMBER ARE: CONSTRUCTION . �•.v� ,� _ ---- j cneRieR-------- ----._.._.._....--- PLANHEVIEW .�� �t'����.----.. , � POLICY NUMBER_____---__-_.__-__--_...._-_-__-___-__".__ ELF_CTRIC __._.....__- _..._._--...._ P � � . (fF11SS[CTIONNE�N0T8EO7N�FLEfEDOFTNEPEMqflSFIX1IXJEMINDREDDOLLPAS(510o�ORLESSA PLUMBING . r�' ---------�,�.�ry �--p-___----..._ �.-=--�- Z ICEHLFVTHFTINTHEPEAFOFlMANCEOF?HEWOFKFORWHICHTHISPEfIMITISISSIIF.D.I � MECHANICAL �-��"S -`� (� E��`A_...__,_._ �� ' �C� SHALLNOT[MPLOYANYPERSONINANYIAANN[RSOASTUOECOMESUBJECTTUTHC ��� � � �� '. - -A .�r...,�i• :".'.' ... � WORKEflS'COMPENSA710NLAWSOFCALIFORNIA,ANDAGREETHATIFISHOUL�BECOME INSPECTIONFEE ���. � �1,�����h� �,,,,{ � �.� � SUBJECTTO THG WORKEflS'COMPENSATION PfiOVISIONS OF SECTAN 37ao OF THE UBOR k r W"+'i f � �J� '� � CO�E,1 SHALL FORTHWITi COMPLY WITH THOSE PROVISIONS. �SSUANCE ,�d i_,�.4. ��i � _/ ,____ I � SMIP � .,... .. ..':+..r:;... .:<S�k �J '�7 j� . .,• ...fr. (_L__ :. 'p DATE:__—'__'_"' APPLICANP. _- ��. . -_..... - ...-_ 1.f_. JENERGY P/C 0�,���� _.....---- WARNING:FAILURE TO SECUFE WORKERS'COMPENSA710N COVERAGE I&UNLAWFUL.AND SHALL 8'c .�. SUBIECTAYEMPLOYF.RTPCRIAIINALPENALTILSANDCIVILFINESUPTUONEHUNUR[�THOUSAN� ENERGYPERMIT � � � DOLLARS(5100,000),IN q001TION TO7HE COST Of COMPENSATIOY,DAMAGES AS PFlOVIDEO FOR IN --�-�-��------��-�-- �J� 3ECTION37oBOFTtIELA�ORCODE.INTEfiEST.ANDATTORN[Y'SFEES. RETENTIONFEE: _____ _ �� CONSTRUCTION LENDING AGENCY PRE-AlT FE .. . . .. __.____________ O ,: � I HEREBY AFFIflM UNOER PENALTY OF PERJURY TMqT THEflE IS ACONSTRUCTIDN LEN�ING AGENCY � i� -- -------- .� d FORTHE PEHFORMANCE OF THE WORK FOR WHICH THIS PERMIIT IS ISSUED(SEC.�097.CIV.CJ. '-"" '"""'""-'-""'------'---" . -- � Z '_._--_.__._— _—' __ --.--_____ W :��. '� LENUER'SNAME__"___"""___"'___ _' "_-' �. I- LENDER'SADDFESS_"_'_'_""" "_"""--_ "'—'—"— �� W ICERTIfYTHATIHAV[AEADTHISAPPLICATIONANDSTATF.THATTHfABOVEINFORMATIONISCqRRECT. TOTAL FEES � � C L � }� � I AGREETO CAMPLY WITHALI CIiY ANO COUNTY ORDINANCESAND S7A7E U1W5 HELATING 70�UIL�ING �� CONSTRUCTION,ANO H[REBY AUTHORIZE REPRESEN7ATIVES OF THIS COUNTV TO ENTER UPONTHE � ABOVE-MENTIONED PROPERTY FOR INSPECTION PUHPOSES. COMMENTS Q "'_"__"'_"---_"_'_"_"' '— 3� m PER AM PH ) . "'__" ___'_' � �`� ---��Z�3':�� --- --- ------ �� SI Ufl P ITTE� - DATE -^7 /i� � .�= RECPT NO. 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