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HomeMy WebLinkAbout18566 � �,� CITY OF DIAMOND BAR � DEPARTME'e'T OF COMMUMTY&DEVELOP1v�NT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS `�%�� BUILDING PERMIT APPL[CATiON FIRMLY QJOBSITE �� � APPLICATION � /` PERMIT -�� p/C ¢ ADDRESS � 'F � Q-t IZ j1i./�C� L A1 DATE �� D I� NUMBER u W — ISSUE TYPE OCC APN LGT •7 �=___ TRACT . DATE � C� CONST. GROUP °C OWNER _.��.' :L�/a X.A p� ZONING SETBACKS ADDRESS��2��7� �LL��!� E IC� o CITY �y�L'�}'�IP ,�,.'`�EL.�'11 � J3 � FRONT RW ❑ _ =t� ' T'9 �' � � REAR _ ❑ o APPUCAN9` " " ___ TEL.� SIDEJSIDE STREET RW ❑ ¢Z SIDE ❑ CONTRACTOR — Q ADDRESS — PROPOSED USE ��'���� R'�fa JM�C`�1 Z ."j�4�GV O � CITY ZIP TEL. _- �� �N'7_T'! �u!�_ l.7'S . o ARCH/ENG/ iz DESIGNER --- NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TFL._ _ � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUII.DER DECLARATION SFRrAODlREM O I HEREBY AFFIRM UNDER.PENAL7V OF PERJURV THAT I AM EXEMPT FROM THE CONTRAGTOqS LI- G2fd9�/CBfPOfI W CENSEUWFORTHEFOLLOWINGREASON(SEC.]031.SP.USINESSANDPROFES51ONSf.ODE�.ANYCITYOR (� Z COUNTVWHICHREOUIRESAPE'.RMITTOCONSTRUCT,ALTER,IMOROVE.DEMDLISH,GRREVAIRANYiTRUC- W Patio/Deck TURE,PRIOR TO ITS ISSUANCL.AL50 RE�UIqE5 THE APPLIGANT FUP SUCH PERMIT TO FlLE A SIGNED W ST4TEMENT THI.T NE OH SHE IS LICENSE➢v�q5UAt1T TO THE PftOY15!ONS OF TME CONTRA�TOPS 1�� w � CENSE LAW;CHAPTEfl 9(LOMI�fENGING WITH SECTION 7000�OF DIVI$10Y 3(�F THE BUSINESSAN�PRO- LL PDOUSP2 fESSIONSCADE�ORTMATHEI)RSHEISE%EM�TTHFqEFROMANDTHEBA515FOFTHEALLEGEDE%EM�- � � itON.ANVYWIAIIO�OFSECTIDN�OJi.SBYAM1YAPPLiCANi FORAPFRMITSiJgJEC�51H"r.APPLICANTTO Z qe-Roof � A CIYILPENPLTV OF NOT MORF THAN fIVE HUNDRE�OOlLARS(5500).)�. - Q ❑I,ASOWNEROFTHEPGUJPER�Y.OF�.IVEMGLOYEESW�THWAGESA�iHE19SOLECOMoENSATiON, � COI7IRIBICI21 Z WI�L DO TNE WORK,AN�THE STRUCTURE IS NOT IN�ENDLD ON OFFERED FOH SALE;iEC.7U44,BU�I- J � NE55 AN�PROFESSIONS CO�I=:THE CONTRACTORS IICENSE LAW OOES NO'APPiV TO AN OWNER OF J PROPERTVWHOBUILDSORINf'ROVESTHEREO�,ANOWHODOESSl1G'+WpRKH'.MSELFORNEflSELFOF � C� � THROUGN HIS OR HEROWN EMPI.OVEES,PROVIDED THAT�UGH IMPNOVcMENTSARE NOT INTENDEDOR m j�f�l� i QOFFERED�ORSQEJF,MOWEVEiR,THEBUILDINGORIMPHOVEMENTISSOLDWITHINONEVEAROFCOM7LE� -r1�ci� Z TION.THE OWNEfi-BVIL�ER WILL MAVE TME BURDEN OF PROVING'.HAT HE OR SHE�ill NOT dUIID OR � IMPROVE FOR iME PURPOSE OF SALE�. w �I,ASOWNEROFTHEPFOPEFTY.AME%ClU51VElYCC1NiRACTINGWITHLICEN5E000NTRACTpRS ¢ TO CANSTRUCT TME PFOJECT(SEC.�060.BIJSINE55 AND PRUFESSIONS CODE:TNE CONTq�C�ORS LI- V81U8110f1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOdU11D50RIMPPOVESTHEREON,AND — -- � WIqCONTRACTSFORSl1CNGFIOJECTSWITHACONTRACTOR(`1LICEhSCOPURSVANiTOTH��CANTRRG- QUANTIN DESCRiPTION FEE Y TORS LICENSF LAW.). � !J i AM EXEMPT JNDER SFC. B.i PC.FOR THI$REASON Q � U � -- Q DATE _ _ _ OWNEF , __,__ U Z w � LICENSED CONTRACTORS DECLARATION W � I HEREBVAFFIRM UNDEi1 PENAITY OF PER�URY TNAT I Al.i�ICENSED JNDER GRO'JiSION50F CMAPTEN � R��� '� d 9�COMMENCING WITH SECTION]oa0)OF DIVISION 3 Uf THE BUSINE55 AND PP.OfE55iJN5 CODE,AND Z L% `X MV LICENSE IS M FULL FORCE AND EFFECT. m ���;^ � LICENSE CLASS ..�_�L i 2 _ ���.N�. 1 N ��l� a � 1� '- 'n�k- � � U DATE__.._ CONTRACTOR___ _ n. � W a� WORH:EFS'COMPENSATION DECLARATION Q � � I HEPEB�AFFlRM UNDEA PENALTY pF PERJURY ONE OF TNE FOLIOWING DECUMTIONS: Z Q 0 IHAVEANDWILIMAINTAINACERTIFICATEOFCON5EN7TO5ELF-INSUREFORWORKERS' _ Z CAAIPENSAT�ON.ASPROVIOE�BVSECTION]]UOOFTNELABORCOD[,FORTHEPERFORMANLE U Q OF TNE WORK FOR WHICH THIS PERMIT IS ISSUEO. � � w I HAVE PND WILL MAINTAIN WOHKERS'COlAPENSATION INSURANCE,AS RE�UIRED BV SECTION < 3�oa OF THE LABOR COGE,FOR THE PEPFORMANCE OFTHE WORK FOR WNICH THIS PERMIT i5 � ISSUEJ.MV WORKERS'COMPENSATION INSUfi4NCE CARRIER ANC POLICv NUMBER ARE. CONSTRUCTION I��� j CARRIER f G JIJI�+"� PLAN REVIEW � PO4�CVNUMBE � 1���..�J � '-'f� ___ ELECTRIC 4 ��� 0 (1}1I5SECTIONNEmNOrBECOMREfEDOFIHEPEHhY7ISFOFIXJEHUrDREDD7llAfLIE10010RLE55) PLUMBING � � . J� w MECHANICAL Z I CERTIFV TMAT M THE Pf_RFOFMANCE OF THE WORK FOR WHICH TNIS PEHMIT IS ISSUED,I .. _ (,`} SHALLNOTEMPLOVANVPERSONINANVMANNERSOASTOBECONESl18JE.^.TTOTHE � WORKERS'COMPENSATION�AWS OF CPLIFOHNIA,ANO AGREE THAT If I ShOULOBECOME INS�ECTIQN FEE _ __ � Sl1PJEC'TOTHEWORNE'.RS'COMPENSATIONPRDY IONSOFSECTION3]CUOFTNELABOR � CODE.I SHALLFORTtIWI'fH COMPLV W OS ROVISIONS. ISSUANCE ___ � � �c SM�P _ � .Oa p DATE�.�/�/ 7GAPPLICANT: _ J WARNING:FAILl1RE TO SECURE VVORKERS'COMPENSATION COVEFlAGE IS UNLAWFUL,AND SHFLL BE ENERGY P/C _ __ � SUB.IECT AN EMPLOVER TO CPIMINAL PENALTIES ANO CI'!IL FINES UP TOONE HUNORE�THOUSANp ENERGV PERMIT OOIIARS(S�OC,oW).IN ADDITION TO TNE COST CF COMPENSATION.DAM.4GE5 PS PROVIOED FOfl IN -�- — J SECTION 3)OB OF THE LABOft CO�E,INTEREST AND ATTURNEY'S FEES. RETENTION FEE: t • C� � - — d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O Q I HEREBV AFFIRM UNDEA�ENALIV OF PERJUFY THAT TN_RE IS ACONSTP,'JCTION LENDING AGENCY � FOq THE PFRFORMANCE OF THE WOFK FOR WHIGH THIS PERMIT IS ISSUED�SEG.309),CIV C.) �'� — Z W � LEN'JEF'S NAME __ — _ _ _ F-- LENOE4YSA�D'1CSS ___ _ _ � TOTAL FEES �3 ,� � I CERTIFV THAT I HAVE READ THIS AGPI.ICATIONANO ST4TETHAT TFEABOVE INFOi11AATiON i5 CORREGT w I AGREE TO COM7LY WITH ALl fI1�V AND COl1NTV ORDINANCESANO STATE UWS RELATING TO 9UILDING d � CONSTRUCTION.AN�HEREBY AUTHORIZE REPRESENTATIVES OF THIS COI.NTV TO ENTER UPUN THt Z ABOVF�MENTIONeO GROPERTV F!JR INSPECTION VURPOSES. GOMMENTS __ O " — � , � l . �M_�e�r� �-�A �.�-� - PER E NAME�9�1iN7) A � � J//V'�-'L�L. — V � SiG . . VtHMITTEE � OATE � �� � ;, 'I = RECPT��[ PAIU BY VALIDATION ~ WHITE—Department Copy,VELI.OW—F�nance Copy,pINK—Assessor Copy:GOLDENROD—File Gopy,GREEN—Applicanl's Copy ,. � � _ � • ��'�� ' ���,�� � � ,�«,���'� �, .., "�+ � �� � � � � •a s� ��` � � _ .����� �. ������z�. �"�E•��� �°'��p3 vr �,� ��.� �fl �� ,.� _ _ .� .��,�� �� � _ _ _ _ _ _ _—_._ __ ° _ , _ _ _ _ _; _ _ __ _ _ __ _ _ _ ; __ _ _ _ _ _ . _ _ � �� � �� � �,.,,� _. ������ �� �� " � � _ _. �� �a� � ,,, �� 3� � _._ _. , �' '� v 1Y ,�y � 3ey. r . .. . . . .. .. ... ._ . ._.. ..... . .. . .. � �, .�� .,`v., - —. .. _.... ,_ k.i � {' t' j `. � � � �. �k�, . "� a �� . . . ... . . . .. . .... . .. ... . .. . . .. .. � .� �< ^� .t� ��, . . 4 �" � �� t� _. . . .... ... . . . ... ... ... ... . . .. .. _. . .. . . �,��� � �..'�4��. . ... .. . .. ....... ....... .. .... . ... . . . . .. .. .. ... .. .. ... _ ...... ._... .. ... . .... � CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy