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HomeMy WebLinkAbout13923 (14) J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ���',y�", BUILDING PERMIT APPLICATION FIRMLY � JOBSITE J�•�� ��r. � e���� APPLICATION�: PERMIT ' "�;�x P/C o ADDRESS� DATE � NUMBER � l q � APN LOT RACT, ISSUE TYPE OCC °C OWNE�� ,�,,��,, DATE CONST. GROUP O o ADDRES � �l .riS� „ L„� ZONING SETBACKS W CITY � �+ EL. �` FRONT RW ❑__ � APPLICANT C REAR ❑ �. � SIDE/SIDE STREET RW ❑___ CONTRACI"O ' SIDE u Q CIT`( ES � ' "ZIP� TEL. a • �� PROPOSED USE �r � � �'�° Q � w ARCH/E G/ ��_ ` ''*� � z DESIGNER " �" � '�' � ADDRESS NO.DWEL. NO. � d-. NO. � CITY ZiP TEL. UNITS____ STORIES BEDROOMS r � v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.ARErWALUATION � OWNER-SUILDER DECLARATION SFR/ADD/REM O p t HEREBY AFFlRM UNDER PENALT/OF PE0.IURY 1HA71 AM EXEMPT FHOM 7HE CONTRAC70R5 u� pafage/CafpOrt W CENSELAWFORiHEFOLLOWINGREA50N�5EC.7037.56USINESSANDPROFES510NSCODE:ANYCINOfl (� COUNf'!WHICH HEOUIRESAPERMRTO CONSTRUCT,FLl'ER,IMAflOVE,DEMULISH,OR PEPAIR ANV STRUG W TURE,PRpR TO ITS ISSUANCE,ALSO 0.EOUIfiES THE APPLICANT FOR SUCH PERMIT TO FI�E A SIGNED W P�tiO/DBCk � STATEMENT THAT HE OR SHF.IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE UW(pWPTEH B(CAlAMENCINO N7TH SECTION 7aoo)OF DIVISION 3 OF THF.BUSI�E55 AND Pfl0- POOUSpfi FESSIONSCO�E)ORTMATHEORSHEISEXEMPTTHEREFROM�NOTHEBASISFOR7HEALLEOEDEXEMP- (� p�'{ V TION.ANYVIOLATIONOFSECTION7031,5BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z He-Root Y lr' � ACIVILPENALTVOFNOTMORE7HANFIVENUN�REDDOLLARS(55Da)): � ❑I,ASOWNEROFTHEPROPEFIY.ORMYEMPLOYF.ESWITHWqGE5A5THEIR50LECOMAEN5ATION. 0 COttIf110fCIIII WILL DO THE WORK,AN�THE STRUCTl1RE IS NOT INTENOED OR OFFF.RED FOq SALF.(SFC.%Oaa,BUSI- J � NESS M!D PI?OFESSIONS CODE:THE WNTRACTORS LICEkSE LAW DOES NOT APPLV TO AN OWNER CF � PROPERTY MRiO BUILDS OR IMPROVES TMEHEON,AND WMO DOES SUCN WORK HIMSELFOR HERSELF OF Q THROU(3HHIS ORHEfi OMM EMDLOVEES,PROVIOED THAT SIICN IMGROVEMENiS ApE NOT INTEN�ED OR m QOFfEREDFOR6ALE.IF,HOWEVERTIIEBUIL�INGORIMPROVEMEN'fI550lDW1THINONEYFAHOFCOMPLE• Z TION,THE OWNEH�BULLDEfl WILL HAVE THE BURDEN OF PROVING TTi/aT HE OR SHE DI�NOT BUILO OR � IMPROVEFORTHEPURPQSEOFSALF.). %\ W ❑I.ASOYlNER OFTHE PilOPEPTV,AM E%CUISIVFA.Y CONTRACTING Wi7H IICENSED CONTRAC70R5 .' ,' � 70 CONSTRUC7 THE Pq0.1EC7(SEC.7oaa,BUSINESS AND PROFESSIONS CODE.TME CONTRAC70N5 LI- V81118t1011 _. �`� AD,1,- 11�_____.,,. W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUS.DSORIA1PriOVESTHEH[ON,AN� '-- � WFiOCONTRACTS(ORSUCHPROJECTSWITHACCNiRACTOR(S)LICE45E�PURSUANTTOTHECONTRRG QUANTIN DESCRIPTION FEE Y TORS LICENSE UWJ. _'_ _.. � ❑I AM EXEMPT UNDER SEC. 8.8 P.C.FOR THIS REASON Q ( � U ----' LL - - DATE __..._ OWNER'______._._'_.'___'_"'_"'_..._.- U � __ - W � LICENSED CONTRACTORS DECLARATION W � I HEREBYiIFFIflM UNUER PE�ALI'Y OF YERJUHY THAT IAM LICF.NS[D UNUER PROV151045 OF CN�P7EH � d O�COAIAIENCIN(3 WRH SECfKKJ 7oao�OF DIVISION 3 0F THE 6U51hESS AND PRCFESSIONS CODE,NVD � ___ __ _ X MY LICENS[IS IN FULL f0: E AND EFFEC: � � LICENSEC �_�� LIQ NO.__� �,._�,_ j ~ DATE_ CDNTHACTOR• � a ��� � w _ _'_— . � � WONKERS':OMPFNSATIJN D[CI.ARHT'ICN ° �^ Q � °t N I R BY�FFIRMUNDERPENAI.NOfPEHJURVCNEOFTHEFOLLOIti�NGDECLARAiIONS: Z .,f'"•.,. ' .i7 ., % � � � .. `:6 � �IHAVEA4DWILLMAINTAINACER71FICd'fF.OFCONSENTTOSELF�INSUREFORWORKERS' 2 ,)x�I »�� =-3%�.'Y.@,i{F. � COMPENSATION.ASPROViO[DBYSECTION37WOFT1IELAEOflCpDE,FORTH[PER�Oi1MANCE U �_�i •��"„ � ' � OF THE WORK FOR WHiCH THIS FERMI7'IS ISaUEO. W �,��?'�'e � � "' V IHAlFAMOWIII.MAIHTAINW�RKEHS(:OMPENSAYiD.�'INSURANCE.ASREOl/iRED9V5eCTIDN " � f Qs7000FTHEUBOACOD,FOHTII'PERFOHMANCEOFTHEKOFlKFORVJH�CHTHISPERMITIS ( ''f l� �� R � ISSUEU.MY WOHKE "' MPF.N IDN MS � WRRIEft POLI . RARE: CONSTRUCTION __ - -- __���(.__L___�-4"_ pp _ .- " � CARRIEFl_ "" _�'� �"-- --..._...�_��V4.Y_� PLAN REVIEW ..__ � ----------._...._. . ..----- � � P(H.ICYNUM6EH ' � � � ELEGTflIC � " - ___ ...'_--'—'___"""'- Q Q (IFGSSEC�pNNtiE�NO?SE�M°I.EfEDOFTiEP:F7�.�TISF(MMEI0.MSMEDWLLAFlS(blao)IXitESS�. PLUM6ING _ —_._........_—__—.—__'_'__.'___ w Z i CEHTIFI'THAT IN THE PERFOHMANCE UF TH'c Y/ORK FOR WHICH THIS P[ftMiT IS ISSl1F.D,1 MECHANICAL .___.__. "_'-_"_"__"_'_ C7 SHALLNOTEMPIDYANYPEFSONINANYMl�YNER50HSTUHFGOMC:SU�JEGTinlflL (q WORKERS'AMPENSATIOYLAWSUFCPLIfORNIA,AIvDAGfiEETNATIFISHOULDBECOME INSPECTION�EE ._______,_,__________,__.,___. ._ - SUBJECTTOTHEWORKERS'�MPtKSAf�ONPHOVISIONSOFSE(:IION]]QOUFiHELA80f7 - � CODE,I SHALL FORTHIYITN COMPLY WITH TMUSF.PPOVISICNS. ISSUANCE ___,_,,,_..__,.___________�,�,Sr�l��_ O '. p OATE: APPLIGANT. _"""___."_--__-- SMIP --_'..._.__.—..�"-s-�¢-__ ` � ENERGY P/C WAflNINC:FAILURETO SECUNE WORKERS'COMPENSA710N COVERAdE IS UNLAWFUL,PND SHALL BE � SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES M1�CNIL FINES UP To oNE IiUN�FlEo T�fOUSAn� ENERGY PERMIT UOLLARS(5100.0OO�,INADDITIONTOTHECOSTOFCOMPENSATION.DAMIIGESASPAOVIDEOFORIN - -���-- --���— J SECTION3�oPOFTHELAl30FCODE,INTERESLANDNTTOflNGY'SFEES. RETENTIONFEE: .__ � ......'_ _""_...._ _'- '__'__._.... d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O — � iHEREBVAFFIRMUN�FRPENAI.NOFPERJURV7HATTHERE4CACONSTRUCTIONLEN0INGACFNCY � FOR TME PF.qFOfiN�ANGE Of 7 HE WOfiK FOFi WI IICH THIS PLi7MIT IS ISSUF.D(SFC.9097,CIV.C.). -- �--'�------"— W � LENDER'3NAIAE_ .__-""-___' ' _..__.._""_'_ _'" ""'_-__'-'_"'____ _ F_ LFNDEN'SAO�PE55__,. _ _- � ICERTIFYTHATIHAVEREADTFIISAI'GUCATIONAN�STATETHATTH[A60V[INFORlAATIONISCAPREC2 � � `� � IA(3FIEETOCONPI.YWITHALLCITYMIDCOUNTYORDINANCESANDSTATELAWSRFLATIN(;TO�UILDING TOTAL FEES �� t,� � � CONSTRUCTION,AND HFREBY AU7kORIZE flEPRESENTATNES OFTNIS LOUNTY TO ENTER UPON THE 7 A90VE�MENTIOdJED PflOPERTV FOH INSPECTIO VUHPOSES. COMMENTS n y P-�.. � _��. � 'e_ ----- — �- -- — - --�--- .. m PFRMITTE NAME(PRINTI . . •.- 9 � ,�y •/` "'--'--- _"___"""""_'__ - Q �___'_'-W�+,� &"t ` r-5 ! � Uj IGNATU :OFPERMITTF.E �-"�'— '— - - -'---�'-- -----'-------- --- _ , „� _ RECPY.NO.----- PAID BY ---------.,.,VALIDATION------,— ~' -• WHITE—Department Copy,YELLOW—Finance Co ,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy I . / i � . � . . � i � , . _ � � ' : i i .. _ _ _. 1 f , ! , ' ; i i � ' ; ; ,=u' ' . • , � _ .- � ,i • � , i � ' . � , , , � . , . . . • , . � .. , i . — , - , I _ ' . ' . , _ , '_. � . . . . _s . . . _ - _ � _ . '_ ' - � � . . �� � �a; ' , � - - .� - — - � ,.. .. . - _ �a - � � . . . - . . . _ _ �' . . �' , � - , _ _ , ' , " - - -_ .' � i• �_. - . �� . . ,. .- . . '; : , . , . . � . � • � ��� . � - � . . . . .. x,i._..-_ . -�..- .� _ , _ � .. .., - . .... ._._ ..,. . ; , � . . ' . + � �. . - ._ .. .. . ._ _.._ , ... 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