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HomeMy WebLinkAbout15300 � -� �� � ``� CITY OF DIAMOND BAR � ' � L-- �'�- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ,% � 21660 E,Copley Drive Suite 190 � . (909)8603195 Fax(909)861-3117 PRESS ��9�^, BUILDING PERMIT APPLICATION FIRMLY ; � JOBSITE U . /� qPPLICRTION PERMIT �\y P/C �, . n ADDRESS ����7 D�.L�12 i �lJ-� 'tr � °�7` DATE �e�NUMBER ���'�d # � ' ISSUE TYPE OCC � APN � LOT TFiACT �� � DATE CONST. GROUP p OWNER _ T) `� ADDRESS � f3 f��E.-'1�i� S7. ZONING SETBACKS � CITY—�-��- ZIP��fT��"TEL_06'�'� FRONT RW ❑ APPLICANT L�Yt9Ad ��_ T I���/Z��-�17 r4 REAR ❑ T— SIDEISIDE STREET RW L� � CONTRACTOR SIDE ❑ � ADDRESS PROPOSED USE � � ���L �` � CITY ZIP TEL. w ARCWENG/ � , , z DESIGNER `?�'�i'/�J (��'�4'�°� NO.DWEL. NO, N0. a. ADDRESS �J 2d, a) L`.i�!7-?'(�,IF� r�. �-'*�, UNITS STORIES BEDROOMS N cirv�/_,��Tv��,r,T��� ziP���� rE�f.�� — -- y DESCRIPTION Sq.FT. FAC70R PSF ADJ.AREANALUATION . OOWNEfl-BUILDER DECLARATION SFR/ADD/REM Q I HEHEBY AFFIRM UNDER PENALN OF PERJUftY THAT 1/�M EXEMP7 FROM THE CONTRAC7'ORS LI. G8f9 2/C8 OfS • IJ,I CENSELAWFORTHEFOLIOWIM1GREA90NISEC.7031.5BUSINESSANDPROFE55lONSCOOE:ANYC1TYOR (n 9 � p CZ7 COUNTYWHICMflEQU1pESAPERMITTOWNSTql1CT,AlTEH,IMPHOYE,OEMOLISH,ORFEPAIRANYSiRUF (jJ pyj10/DBCk W TUqE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PFNIAIT TO FILE A SIGNEU W � �' STATEMENT iHAT H6 ON SNE IS 4CENSED PURSUAN7 TO TME PqOVISIONS OF THE CANTRACTORS LI� � CENSE LAW�CHAPTER 9(COMMENCING WITN SECTION 7000)OF DIVISION 3 OFTHE BUSINESS ANO PR0- LL PooUSpa FESSIONS CODE)OH THA7 HE OR 9HE IS EXEMPT THEFEFflOM AND THE BASIS FOR THE ALLEGED EXEMP� y 710N.ANYVIOLATIONOFSECTIDN7c31.5BVANYAPPLICANiFORAPERMITSU&IECTSTHEAPP�ICANTTO Z Re-Raoi � ACINLPENALTVOFN07MORETHANFNFHUNOREDDOWAS(i5o0)J: � � IJ�.�ONTlEHOFTNEPqaPERTY,ORMYEMPLOYEESWITHWAGE5A5THEIRSCL`.COMPENSATION. � COR11f10fCi8I i WILL 00 THE WORK,AND THE 57RUCTURE IS NOT IMENOED DA OFFEflED FOR SALE(SEG 7Da4,BUSI. J N NESS AND PROFESSIONS COOE:THE CANTRACTORS UCLNSE UW DOES NOT APPLY TO AN OWNER OF n PFqPERTVVh100U1LDSOHIMPROVESTHEHEON,ANOWHO�OESSUCHWORKHIA15ElKOPHERSELFOR � �. � 7Hpq1OHHI50RHEROWNEMPLOYEES.PHOVIOFATHATSUCHIMPROVEMENTSARENOiIN7EN0EODA m � OFFEREOFORSALEIF,FIOWEVER.7HEBUILOVNGORIMPROVEMENTI550L�WIPHIryONEYEqROFCAMPLF.- �' TION.7ME OWNEH�6UIIDER YfiLl HAVE THE BURDEN OF PROVINO THAT HE OR SNE VI�NO7 BUIID OR �' W IMPflOVEFORTHEPUR�'OSEOFSALE), t CI1,AS ONMER OF TME PfiOPEPTV,NA EXCLUSIVEIV C04TPACTINO W�TH LICENSEO CONTRAC70RS -- � Q TO CONSTRUCT THE PflOJEC'f�SEC.�D�O,BUSINE55 qND PROFESSI045 CAUE'TME CONTRACTORS Lb V81U8G011 __ .__ __ ADJ.AREA_. �___ W CENSELJIWDOESNOTAPPLYTOMIOVYNEROFAPPOPEflTYYYMOBUILD50RIMPROVESTHEREON,AN� Z NryipGONTRACTSFOR3UCNPRQIECTSWITHACONTRACTOR(S�UCcNSEDPUfISUANTTOTHECONTRRC- QUANTITY DESCFIPTION FEE � TOA9IJCENSEUW.). �, Q J Q ❑IAM EX[MPT UNOER SEC.,____. .�,_ B.d P.G FOR THIS REASON � _ ,� S 3 _. __.'_��—'"'—'.. —"'- � �, LL DATE oWNER_ .____— _—-. ~ Z W � � LICENSED CONTRACTORS DECLAFiATION � � W t' IHEREBYAFFIqMUNDERPENN"fVOFPERJURY7HATIAMIICENSEDU4D[RVROVI5loN50FCMnPTEH � Cp � Y(CQUMENCiNGWITHSECTION700�)OFONISION30FTl1EBL151NE.SSANDPNOfeS510NSGODE.ANU z C X AIY UGENSE IS IN FULL FOflCEMO EFFECT m LiJ / � LICENSE CL7ASS� Llc.No.��,p��_�____.. � VDATE '�.Cy a�• (2 d __CONTRACTOR.."____" o- € w � 6•� � � WOFlI(ERS'COMPENSAT�ION DECLARATION �' ¢ � � U [ � I HEREBV AFFIRM UNDER PENALT'OF PERIUFlV ONEOFTF�E FqLLOW:NG DECLAI2ATIONS� z F d j O _._IMAVEANDWILLMAINTAINACERI'IFICATEOFCONSENTTOSELF�INSUHEFORWORKERS' S S Q COMPENSATION.FS PfiOVIDEO 9Y SECTION 37000F THE LABOR COOE.F�R TNE PERFORMANCE W_ & OF THE WORK FOR WHICH iN15 PEf�MR fS IS5UE0. � Q f w _�I HAVEAND WILLMAINTAIN WOR%EH�COMPE�SPTION INSl1flANCE,AS HF.al11RED BY SECTION /�/� ,Jp s � 37000FTHEL4BORCWE,FOATMEPERFORMANCEOFTHEWORKFORWHICHiNISPERMlifS � �j�{/� � ` _ ISSUED.MVWORKEoc,rnMPENSpfIONINSURANCECARRIEAluNDPOLICYNUMBERARE: CONSTRUCTION _„_,.., �._______..�=_�`�` j CpRRIJi�^,G�� -�_��'- --'---- --- PLANPEVIEW ------- . ----- zra�cvnumeea_ ' _ ' .-�-- �------ ELECTRIC __...-------��pr}_r ¢ � �„ ( � ��J�— Q (IHI65ECIlONNF.�MJ7BEQ'7F�LEfEDOFhEPERIMISFORONEI�AN�DPEDOq.lARS;�W)OALESS). PLUMB�NG __.._ . f _ ' u, N�, l.^vD. . _ ,_�(/� Z I CEH11fY THAT INTHE PEflFORMANCE OF iHE WORK FOR WHiCH THIS PERMIT IS ISSUEU,1 MECHANICAL ___._�F�y R � 1 y ��v���j1 _ C� __ � � SHALLNOTEMPLOYANYPERSONINPNYMRNNEHSOA5T09EC�MESIJBJECTiOfHf_ �y�7 I�'ry�, �j WORKEHS'CAMPENSATIONLAWSOFCALIFORNIA.AN�AGFlEETHFTIFISHOULDBECOME INSPEC710NFEE -.--.---�'89Y���.�I'1t"���"'�'��•:•'—y � SIIBIECT T07H[WORNlRS'CAMPENSRI ION PftOVbIONS OF SECTION 37oDOF THE LA90R _�� � CADE,I SHAL(.FOHTHWRtiCOMPLY W17H THO3E PROY15lONS ISSUANCE ,_... __....—____. — � SMIP . - ---- ---- p OATE'._. APPLICANT _'_ '_"_ .'.___..- . _—_.' ' . J ENERGYP/C —'---- . ._'-----... .--�----- J WARNING:FAIIURETO5ECUREWORKEHS'COMPENSATIONCOVF.RAGEISUNLANKUL,ANbSHALIBE � SUBJECTANEMPLOYEflTOCflIMINALPENALTIESAN�CIVILFMESUPTOOMEHUNORE�THOUSAND ENERGYPERMIT _ ____ ._____ ,__...— DOLLAqS(S1W,0oo),IN���TION TOTHE COSTOF GOMPENSATION,DPMPGES AS PROYIDED FOR IN - � SECTION9]oeOFhIELAeURCODF.,INTEREST.ANDATTOfiN[YSFEES. RETENTIONFEE: _.,._. _ —__",.—... ...__' w CONSTAUCTION LENDING AGENCY pRE-ALT FEE: a ------ ---- --- ---- O � IHEFlE9YnFFIRMUN�ERPENALNOFPEHJUflYTHAT7HF:FlEISACONSTRUCTIONLEN0INGAGF.NCY _'_"' _'_—'__ "_"'.,. ._'—_ _—_ FORTNE PERFORMANCE�FTHE WORK FOR WHIGN TtIIS PERMITIS ISSUF.D(SEC.3097,CIV.C.). Z _'" '_—"_ —'_ _.____„—'—'--`_ � LENDER'SNAME_ _'______"__ "—_'_ "_'_- _ H LENDEH'SADDRESS_ .__... ,___ ._—__ ______ wICEATIFI7HATIHAVEREPUT1iISAPPUCATIOYANDSTATETHAf'fHEABOVEMFORIAATIOHISCOqHECT. TOTAL FEES � IApREEfOCOMPLYWITHALLCIIYANDCOUNTYORUINANCESANoSTI.TELAWSRELATINCTO�NLDWG ^ CONSTAl1CTION,ANpNEHEBVAUTHOFl2F.REFFiESENiAfIVE50FTHI5GUUNTVTOENTERUPONTHE �J�y y y�,� ZpgOVE�MENTIONED PROPEHTY FOR INSPECTIpN PURPOSES. COMMENTS "-'""''���t� �� —__ � D � J �.�.-�-�,�_�,r-���.� _- -- -��-� -- - - _ -- ) � PERMlTE�ENA..Mf�',qPRifiT) G*( �•�C, __"_ _—_' '—' `— ' V Cn iU�__1� � � � t — ..—_ ' _' n�J��— _.—'_ � SIGNA `�E'�B��F�4f� ' �ATE —— _ � � RECPT.NO.. PAID SY_. 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