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HomeMy WebLinkAbout12686 (14) _, � / : . _ _�,` CITY OF DIAMOND BAR � � DEPAI2TMENT OF COMMUNITY&DEVELOPMENT SERVICES � , 21660 E.Copley Drive Suite 190 � (909)860-3195 Pa�c(909)861-3117 PRESS ����"� BUQ,DING PERMTT APPLICATION ���j� FIRMLY � JOBSITE +g�J �,^ '� APPLICATI N PER / � � ADDRESS ( �(� S� �� /\ 1���,CY(-:�L(� '� DATE NUMBHXi "' q C � o ISSt1E TYPE •• OCC :-° APN�, LOT TRACT_ /�" � DATE k CONST.�� GROUP p OWNER —_�s_�� f�----- f'T��� �— � ADDRESS � ' +'- � N ZONING SETBACKS � g CITY ZIP�I r� TEI.�C�.� :- FRONT RW_ ❑_ APPLICANT TEL. REAR 17_`__,_ � �-• SIDElSIDE STREET RW ❑ a CONTRACTOR r��'___.� _L , '� �} SIDE ❑____ 'S� � lk�fi.��--(I�Cr' -- o ADDRESS s0_r.�rJ�,� �C ' � �� , � �.( r o CITY_�,��� ZIP�(� TEL. �Ct�/ �'� PROPOSED USE_ � w ARCH/ENGI � DESIGNER � a ADDRESS NO.DWEL. NO. NO. UNITS STORIES _ BEDROOMS � � CITY ZIP TEL. y - DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION L � OWNER-BUILDER DECLARATION SFR/ADD/REM i O � Q I HEflEBY AFFlRM UNDER PENALN Of PEiWiiY THAT 1 AM EXF.MPT FROM 7HE CONTRACTORS LL � � Garege/Ca�port W CENSEIAWFOqTHEFOLLOWINGREASON(SEC.703f.5AUSINE55ANDPROFES510N5CADE:ANYGITYOR U CWNTYWHICHpEWIRE3APERMRTOCONSTflUCY.ALTER.IMPflOYE,DEMOLISH,OflHEPAIRANYSTRUG - W PatiolDeck � 7URE,PRIOR TO IT8 ISSUMICE,ALSO RE�UIRES THE APPLICAN7 FOR Sl1CH PERMIT TO FILE A SIGNED W F � STATEMENT THAT HE Oq SHE IS LICENEED PURSUANT TO THE PRONSIONS OF THE OONTRACTORS ll- CENSE LAW(CMAPTER 9(COMMENCING WITH SECTION 7000)OF�IVISION e OF THE BUSINESS AND PR0-. ` �' POOUSp2 ' FESSION50]DE)OflTHATHEORSHEISEXEMPTTHEREFpOMAN�TNEBASISFDRTHEALIEG[�F%EMP. .' C7 U TqN.ANYVIOLATIONOFSECTION7031.5BVANYpPPUCRN7FORAPEflMITSUEilECTSTHEAPPLICANTTO • z Re-Foof � flCIViLPENALiYOFNOTMORETHANFNEHIINDREDDOLLARS(5500�.�: t � ❑I.ASOWNEfiOFTMEPFIOPERTY.ORMYEMPLOYEE5W17HWAGESASTHEIRSOLECOMPENSATION, � COrcIRIBfCIaI : WILI.DO THE WORK,AND THE 9TFiUCTURL IS NOT INTEN�ED OR OFFEREO FOH SALE(SEC.7044,BU51- J N' NESS M1D PROFESSIONS CWE�.THE CCNTRACTOAS tICENSE LAW DOES NO7 AP?lY TO PN OWNEP OF . ? � PROPEqiY WF10Bl11LD60R IAIPROVES THEREON,AND WHO DOES SUCH WORK NIMSELF OR HEHSEIf ON Q TH{IOUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT$UCH IMPFOVEMENTSARE NOT INTENOEOOR � R oOFFEHEOFORSALEIF,NOWEVER,7HEBUItDINGONIMPROVEMENT550LDWITNINONEYEkROFCOMVLE � Z TION,TriE OWNEF-BWLOER WILL HAYE TME BUROEN OF PROVING THAT HE OR SHE DID NOT BURD OR � IMPROVEFORTNEPUPPOSEOFSALE). ❑I,ASOWNEfl OF THE PROPERN.AM EXCLUSNELY CONTMCTING WITH LICENSE�CONTHACTORS ; � TO CONSTRUCT THE PROJECT(SEC,7aH,BUSINESS ANU PHOFE6SIONS COOE:THE CONTRACTOflS U- V8IU8IIOf1 ADJ.AREA____ R� W CENSELAWDOESNOTAPPLYTOANOWNEFOFpPpOPER7YWMOBUILD50R11APROVESTHEREON,ANO � � NMOCON7PACTSFORSUCMPRQIECTSWIIY.ACONTRACTOR(S�LCENSE�PURSUANTTOTNF.CONTRAG QUANTIN DESCRIPTION FEE � TORS UCENSE UW.). � �{ / j ' � fl 1 AM EXEMPT UNDER 5EC._ _ - __B,8 P.C.FOR THIS REASON • � ("` j'^��'~( � � t_ � OATE' __OWNEfl__ _ _ U O � IICENSED CONTAACTORS DECLARATION -'w� G � w (! I HEflEBY AFfIpM UNDER PENN.TYOF PER1Uf7Y THAT IAM LICENSED UN�[R PROVISIONS OF CHAPTER � " CL, B(COAIMENCINOWITHSECTION7000)OF�IVISION30FTHE9USINESSANUPHOFESSIONSCODE,ANU z � X IAV LICENSE IS IN FULL FOHCE M1D EFFECT. tiJ m � p UCENSE CLASS_,��_LIC.NO. �. � � � 9 7��.____- V �ATE_,__ _ CONTRACTOR_. _... ._ d W C� WOFKERS'COMPENSA710N DECLARATION J - — 4 = d Y N 1 HEREBY AFFIRM UNDER PENALTV OF PEPJURY ONEOF 7HF FOLLOWING D[CLARATIDNS: U - � z ¢ � _., IHRV6ANDVlILLMAINTAINACEFifIFICATEOFCONSENTTOSELF-INSURFFOPWORKERS' = y Z COMPENSATION.ASPqOVIDEDBVSEC.T10N370oOFTHELA80RCODE,FpRTHEPERFOR4IANCE U � 4 OF TNE WORK FOR WHICHTFiIS PF.RMIT IS ISSUED. � k e"i w _1 HAVEMD WILL MAINTAIN WORKEftS'CAAIPENSATiOY INSURANCf.AS RE0.'�IRED�Y SbCTIU� Q 37000FTHELABORCOOE,FORTHFPF.PFORMANCEOFTHEWORKFORWH:CHTHISPERMITIS ` ISSUEO.MYWORKERS'GOMPENSATIONINSURANCECARRIERAIJU7ULICVNUMBEHARG� CONSTRUC7ION . ._ _-_... ..-.._. __..-- { � ._._, PLAN REVIEW _ } CAHRIER_._ __-._' -'__-" '___ _ _�-'-- a ..-_._., y � POLICYNUMBER__. - .— -'--"— '�L�ECTRIC ' y ! � � Q � _- '_ _"_-_ ' _''—" ___'�__�.�'_. �, � (IHSSECiK�NNEC-0NOTBEOY.�IEfIDOFTHEPE(tN1iI5FOPaM1'EMJ�.OFtEDDOItARS(61Wi0RLES5) <PCIIFdBiNG _....-... --'-- '- -'--- '-- � w MECHANICAL t Z I CERTIFYTNAT IN THE PEflFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSU'cD.1 ..�----.� .----.-� -...-.-- (.'} SHAlLNOT EMPIOY ANY PER59N IN ANY MANNEH SOAS TO OECOME SUOJECT TO THE � [/) WORKEflS'COMPENSAT�ON LAWS OF CALIFORNIA,�NU ACREE THAT IF I SHOULO BECOME INSPECTION FEE _.__,_. .____. ,___.__,. .__. . '"'...�.-.. � SU&IECTTOTHEWORNEHS'COIAPENSATIONPqOVISIONSOFSECTION3]ooOFjHELA00R �.-�" -�---. f� � / � f:ODE,I SHRLL FORTHWITH COMPLY WITH OSE P.P ISIaNS. t IS�UANCE � _ _., _-..__ ...._ . �(.�-'fl 3 � O ����(^ p /� � ,-Q , '__ - ' , .`- '— �`__�_i_[SL.1ltAPPLiCANT. J._�_(,s.,�1eL/�.�_—�+��-- p DATE:._. ..._.._ _--_... "__ .._ _.___.–_�-- t „� ,. �« ENERGYPlC ------- ...-----� �------ 4 �� WARNING:FAILURETO SECURF.WrRKERS'COMPENSA710N CDVERA6E IS 11NlAWFI1L,AN�SHALI.BE �y SU&lEC(ANEMPLOVERTOCRIMINALVErvALTIESANDCIVILFINESUATOONENUN�flF.OTHOU9AND ENERGYPERMIT . ._ _._— DOLL4RS(41oo.oao�,INAO��TIONTOTNEGOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORIN -- -'-- "- '- � J SECTION37080F1HEL�90(iCODE.INTERESLAN�ATTORNEY'SF[ES RETENTIONFEE: � "'" '_"'_ ""'_'" __" __ OCONSTRUCTION LEN�ING AGENCY PRE-ALT FEE: ____ .-,__—_ ; � I HEREBY AFFIRAA UNDER PENALTY OF P[RJUpYTHAT TH[RE IS A CONSTRUCTION LENDING AGENCY __ �' FOqTHE PERFORMANCE OF THE WORK FOF WIIICH 7 HIS PEflMIT IS ISSUEO(SEC 3097,CIV.C.). -- � LENOER'SNAME______-" _' --' '__"__ __�f('�/(1�'���0�— __ .."--_ _,__ 4 �-��'��' 6 F- LENOER'SAOORE55___ __- _._. -._. -..._ � ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEq80VEINFOPMATIONISCORRECT. TOTAL FE "'r ! 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