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HomeMy WebLinkAbout16019 (20) - �:-:::::;;.:�::��,,,�;:.::-- �� ,nl�Ye-P/1 Y�!/ '' _ _��� CITY OF DIAMOND BAR f / DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES t��3�6 �r � 21660 E.Copley Drive Suite 190 r� ,.,A�,,, (909)860-3195 Fas(909)861-3117 PRESS BUQ.DING PERMTT APPLICATION FIRMLY - .. ,,. . ...,. : .;. _ , ,.,.. . , ., ,.,� o� JOBSITE f�.�1 �"�) �� ApPLICATtON PERMIT P/C ADORESS � y � � /,p�-}� DATE 1/18/O 1 NUMBER �6 0�9 # � ISSUE TYPE OCC APN LO DATE CONST. GROUP p OWNER o ADDRESS " � ZONING SETBACKS FRONT � CITY = ZIP�,EL. � REAR � ❑ APPiICANT EL. SIDEJSIDE STREET RW O � CONTRACTOR - � SIDE ❑ ADDRESS � CITY ZIP �1'EL._ PROPOSED USE oARCH/ENG/ b � DESIGNER NO.DWEL. NO. NO. N ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HERFBY AFFIRM UNDER PENALT'OF PEPJURV TNAT I AM EXEMPT FROM THE CONTRACTORS LI� G3fflQB/C81pOlt W CENSEUWFORTNEFOLLOWINGREASON(SEC.7o31.6BUSINESSANDPROFESSIONSCODE:ANVCITYOR (n U COUKryWHICHREWIRE5A7ERMRTOCDNS7RUCT,ALTER,IMPRWE,DEMOLISH,ORREPAIRANYSTRUC• W Patio/Deck W TURE,PRIOR TO I7S ISSUANCE,AlSO REWIRES iHE APPLICANt FOR SUCH PERMIT To FILE A SIGNED w � STATEMEM THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF TME CONTRACTORS LI• � � CENSE LAW(CHAPTER D(COMMENCINO WITH SECTION 7000)OF OIVISION 3 OF 7HE BUSINE55 AND PRO� PooUSpB FESSIONSCOD�OHTHATHEORSHEISEXEMPTTHEREFFOMANDTHEBASISfORTHEALLEGEDEXEMP� (!j TION,ANYVIOLATIONOFSECilON70.71.6BVANVAPPLICANiFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � ACML PENALTY OF NOT MORE THAN FlVE HUNDRED DOLLARS(S5o01.): � OI.ASONTIEROFiHEPROPERT(OHMYEAAPLOYEESWITHWAGESASTHEIi1SO�ECAMPENSA710N, C, Commercial - ��"�� �� M11LL DO THE WORK,AND THE STRUC7URE IS NOT INTENOED OR OFFEqED FOP SALE(SEC.7044,BUSI- J � NESSAND DROFESSIONS CODE:THE CONTRACTORS UCENSE LAW OOES NOT APPLV TO AN OWNER OF � ^ PflOPERTV WHO BUIlDS OR IMPROVES 7HEREON,AND VMO DOES SUCH WORK HIMSELF OR HERSELF OR � TiFiOUGHHI50RHEROWNEMPLtlYEE3,PROVIDEDTHATSUCNIMPROVEMENTSARENOTINTENDEDOR m Q OFFEREDFORSALEIF,HOWEVEFtiHEBUILDINGORIMPROVEMENTI550tDWITHINONEYEAROFCOMPLE- Z TION,THE OWNERAUILDER WILL HAYE THE BUFDEN OF PROVING 7HA7 HE OR 5HE 010 NOT 9UIL�Ofl = IMPROVEFORTHEPURPoSEOFSAIEJ. ❑I,AS OWNEROFTHE PROPERTY,AM EXCLUSIVELYCANTRACTING WI7H LICENSED CONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.70b.BUSINESS AND PROFESSIONS bOOE:YHE COMRACTORS L6 ValUOtion ADJ.AREA W CENSEUW�OESNOTAPPLVTOANOWNEROFAPROPEFTVWHOBUILDSORIMPROVESTNEREON,AND � NM1IOCONTMCTSFORSUCHPRQIECTSWITHACONTRACTOR(S)UCENSEDPURSUANTTOTHECONfRAC- QUANTII'Y DESCRIPTION FEE � TDRS UCENSE UW.�. �1 AM EXEMPT UNDER S�C, B.8 P.C.FOR THIS PEASON Q � U LL � DATE OWNER F- � W � LICENSED CONTRACTORS DEGLARATION W OC I HEREBYAFFIRAA UNOER PENALTY OF PERJURY THAT 1 AM LICENSED UN�ER PROVISIONS OF CHAPTER � - a, Y�COMMENCNOWITHSECTION7000JOFDIVISION30FTHEBUSINESSANDPROFESSIONSCAOE,AND Z . X MV LICENSE IS IN FULL FOPCEAN EFFECT. ` m LLI �:�� � L�CENSE CLASS �'/ny LIC.NO. � ~' DATE "� Ci' CONTRACTOR d U W � WORKERS'COMPENSATION DECLARATION ¢ � 1 HEREBYAFfIRM UNDER PENQTV OF PERJURV ONE OFTNE FOLLOWIN6 DECLARATIONS: Z � IHAVEANDWILLMAINTAINACEFiTIF�CATEOFCQNSEN770SE1F-INSUREFORWORKERS' a � 2 COMP SA7tON.ASPROVIDED8V5ECTION�7ooOFTHELABORCODE.fOR7HEPERFORMANCE �U Q F_WOqK FOR WHICN THIS PFRMIT IS ISSUED. � � _I HAVE AND WILL MAINTAIN WORKERS'GOMPENSATION INSIIRANCE,AS RE�UIRED BV SECTION QQ 37000F THE LABOR CO�E,FOR THE PERf-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO.MYWORI RS'COMP iSATID INSURANCEC RIERAHDPOUCYNUMBERARE: CONSTFUCTION F �j�. CARRIER � �� �-��-... PLAN REVIEW � POLICV NUMBER_, -��� ELECTRIC �-- 0 (IHl4SECl%NJNE�NO78EWMPLEfEDOFiHEPEMMISFORONEHINOfiEDDJ1.tAfiS(E10010RLESS). PLUMBING . � W Z I CERTIFY THAT IN THE PEFFORMANCE OF THE N'ORK FOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL C7 SHALL NOT EMPLDY ANV PEFlSON IN ANV MANNER SO AS TO BECAME SUBJECT TOTNE ` � WOFKERS'COMPENSATIONLAWSOFCALIFORNIAANOAGREETHATIFISHOULOBECOME INSPECTIONFEE SU&IECTTOTHEWORKERS'COMPENSA VISIONSOFSECTION37o00FTHELABOR �/�"�� CA�E,I SH FORT�T HCOMPLV WIT THOS P ISION �-��o �SSUANCE � `� C� s.^ /O/ q p OATE:l l"� - APPLICANT. _ SMIP .1- `a��� � WMNtNGFA1LURETOSECUAEWORKERS'COMPENSATIONCOVERAGEISUNIAWFUL.ANDSHALL —R�, ���-�}���y{}��"y$i, � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILfMESIIPTOONEHUNDREDTHOl15AND ENERGYPERMIT __�TiTY�-7aThCAYiC°I'�J � DOLURS(5100,0OO�.INADDIT�ONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORIN �-is� A ��-���Z�r- J� SECTION 3708 OF THE IABOFi CO�E,INTEREST,AND ATTORNEV'S FEES FETENTION FEE: OCONSTRUCTION IENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PEFJURY THAT THERE IS A CONSTRUCTION LEN�ING AGENCV FOR THE PERFORlAANCE OF THE WORK FOR WHICH THIS 7ERMIT IS ISSUEO(SEC.3a97,CIV.C.). Z W � lENOER'S NAME F- LENDER'SADDflE55 � TOTAL FEES =�` � I CERTIFY 7NAT I HAVE READ THIS APPIICATION AND STATE THATTHEABOV NFORMATION IS CARRECT. W I AGREE TO CAMPLY WITH ALL CITY AND COIINTY OR INANCES AND STATE WS REUTMG TO BUIL�ING � CONSTRIICTqN,ANDHEREBVAUTHORI2EREPiiESE TATIVESOFTHISC NTYTOENTERUPONTHE Q�� ZABOVE�MEMIONED PROP RTV R INSPECT N PU OSf„x^. � ,� � /'�. P��a COMMENTS � �.� � QPERM�TT (PRINT� - ^� fl� 1„" � SK3NA7UR, F PEflMITTEE" D E ' " t,l' Y z RECPT.NO. 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