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HomeMy WebLinkAbout15230 (17) �• ��, CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � . 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ������"� BUII.DING PERMIT APPLICATION FIRMLY o D R'ESS ��I I 1.��5�,,'l�� �,{��I L(,:(�"%�� DAPEICATION G� ryUMBEA 1��=-�a� ��'''{� $ ISSUE TYPE OCC -- APN LOT TRACT DATE � � CONST. GROUP p OWNER �Z �� �� � � ADDRESS rj'�F''l,�- /3-� � ZONING SETBACKS W CITY E ZIP TEL.�,�.�.� REART RW [uj— APPLICANT IGI r! TEL. SIDE/SIDE STREET� RW CI CONTRACTOR (" U �J Z 4 ' "T.--�N�t' SIDE �7__, p� ADDRESS �("�l�� T-a��__ t LZ�..�?"✓ i�lC- �t � � CITY 7 f P 1 � ZIP TEL.qtf�l/ 1,1-7/., PROPOSED USE �' _ h�D�$l?/��c; I N Sjl�{��- �L.��'y��� w' ARCH/ENG/ r-'�'°�'T� � Nt�l,4`� l"`4L�� aL='T :—�-L � � DES{GNER / r G'-� i�. d [l�/s� c ADDRESS NO.DWEL. NO. NO. �: CITY ZIP TEL. - UNITS STORIES _ BEDROOMS � v�- DESCRIPTION SQ.FT. FACTOR PSF A�J.AREANALUATION p� OWNER-BUILDER DECLARATION SFRIADD/REM O Q I HEHEBY AFFlRM UNUER PENALTY OF PERlURY 7HA7 I AA1 EXEMP7 FROM THE CON7MCTORS LI� � G8la9B/C8f(JoR W CENSEIAWFORiNEFOLLOWINGREF50N(SEC.7031.SBUSINESSAN�PflOFES510NSCADE:ANYCITYOR U. COUNTVWHICHREWIRESAPERMRTOCONSTRUCT.ALTER,IMPpOVE,DEMOLISN,ORflEPA1RANYSiRUC- W Patio/Deck Z IURE,PRIOR TO RS ISSUANCE.ALSO R[WIflES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED �' STATEMENT THAT HE OR SHE IS LICENSEO PURSUAN7 TO iHE PROVISIONS OF THE CONTMCTOR5 LI- � LL � CENSE UW(CHpPTER 9(CDMMENCINd WITH SECTION 7000)OF OIYISION 30F TNE B1151NESS AN�PRO- POOUS{h'1 FESSK]NSCOOE�ORTHATFIEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEOFDEXEMP- (� V TION.ANYVKKATIONOFSEGTIIXV703I.6BYANYAPPLICANTFORqPEfiMITSU&IECTSTHEAPPLICANTTO Z Re-Roof F ACIVIL PENqLlV OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): � ❑I,ASOWNEFOFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, COrt11110fGlal WILI DO THE WORK,AND THE S7RlICTUFE IS NOT INTENDED OR OFFERF.O FOR SALE(SEC.7o9i,�U51� � � NE55 AND PIIOFESSKKJS COOE 7}!E CONTHAC?DRS LICENSE lAW�OES NOT APPLV TO AN OWNER OF . j PROPERTY WTiO8URD5OR IMPROVES THEREON,AND NMO WES SUCH WORK/IIMSEIF OR HERSELF OP Q TMRIXIOHNISORHEROWNEMPLOYEES,GFiOVIDEOTNATSl1CHIMPR�VFMENTSAREN�TIMEN�tiDOR : m QOFFEHEDFOflSALE1F,HOWEVER,THEBINIDINaORIMPROVEMENTI550lDWITHINONEYEMOFCOMPLE Z TION.THE OWNEH�BURDEH WILL HAVE THE BUflDEN OF PROYMa THAT HE OR SNE OID NOT BN�D OR = IMPipVEWRTHEPURPOSEOFSAL�. ❑1,A50YINEROF THE PAOPERTY.AM EXCLUSNELY CANtAACT1NG WITH LICF.NSED CONTpACTDRS � TO CONS7RUCT7HE PRQIECT(SEC.7044,BUSINESS PND PROFESSIONS CO[7E:THF.CONTRACTORS LI� VaIU0I10l1���"�� A�J.AREA.__ W. CENSEIAWDDESNOTAPPLYTOANOWNEROFAPHOPERTVWHO&IILDSDRIMPROVE5TNEREON,AryD - -- � WVIOCONTMCiSFORSUCHPRQ1EC75WITHACOMflAC70R(5)LICENSEDPUfl3UANTTOTHECONTRAP - QUAN11lY DESCRIPTION FEE �- Y TaRSlICENSELAW.). y g `__ Q ❑IAM F�(6APTIINDENSEC.� B.R P.C.FOR THIS REASON � U � -- � DA7E_' ^ '_'_oWNER` , - __ ...'___'__ U 0 W � LICENSED CON7RACTORS DECLARA710N W CL IHEREBVAFFIR4UNDERPENALTYOFPERIURYTHAI'IAAILICFNSEOUNOEflPpOVISIONSOFCHAPTER � � i(COMMENCINOWITHSECTION70W)OFDIVISION30FTN[�USINESSANDPPAFESSIONSCCDE,PND Z X IIY LICENSE IS IN KULL FORCEPND EFFECT � -'—' llJ �/ � � IiCENSE CLASS__���_LIG NO. __�` ��]��� G�'__ � ~' DATE �� l� GL,___CONTRACTOR_�{�V1�rj_ a W � � WORKERS'COMPENSA710N DEGV+RATIUN -� d � I HEREBY AFFIRIA IINDER PENALiV OF PERIIlRY IXJE�FTHE FOLLOWING DEGLARATIONS: Z � _IHAVEANDWILLMAINTAINACERTIFICATEOFCANSENT706ELF-INSUREFORWORKERS' _ CqM?[rySATIIXV.AS PRUVIDED BYSEC710N 37oa OF THE UBOR COOE,FOp THE PERFORMANCF: U Q UF THE WORK FOR WHICH THIS 7ERMIT IS ISSUED. g O Qw I MAVEAND YlILL MAINfAIN WORKERS'GOMVE45AT10N IM1SURANCE,AS fiEQU1P.E0 BV SEC710N ' 37000FTHE LACOq(%wE,FOR YHE PENFOtiMANCE OF THF.WOHK tmFl WHiCH THiS PEpM1T 15 - ISSUFO-MY WORKE(�'COMPENSATION INSURANCE CARRIER ANU POL{CY NUMBEA ARE: CONSTflUCTION ____ __ ....{{ _ � jcnaaiEa--- Li'2__✓V=�''�-----� `'�-- ---- PLANREVIEW --����.---� ---�.� -- � POLICVNUMBER Q . ---- ---.._.__ ELECTRIC — .-_-. --- ---- ---_ Q � (THSSECiKaVNc'mNDTBED00.1PLEfLUOFil�EPF(Aqi{SFiN70P1EHlMORFD00l1ARS(5700)ORLESS} PLUMBING ---.---- ----.,- --. - � ICERTIFYTHATINTNENERFORMANCEOGhIEWORKFORWHICHTHISPEFMITISIS5UE0,1 MECHANICAL _,_____ _____ ____ ,______ (!j SHAI(,NOT EMP�OYANY PERSON INANY MANN[R SOAS TO BECOME SUBJECTTOTHE N WORKERS'COMFENSATIONIAWSOFCM.IFOfiNIA,ANOAGREF.THAfIFISHWIDBECOME IN5PECTIONFEE _____ ,____ � SUBJECTTOTHEWORKERS'COMPFNSATIONPFiOV;SiONSOFSEC710N37U00FTNEtAE50R , T � CODE,ISHMIFORTHWITHCOMPIVWITHTFiOSEPROVI510NS. ISSUANGE ___, -lJ -�( _".._..'_ y_7' p DATE:_1_1_��� E7�.._.. AAPUCANT: `F� �C I ,__ SMIP ,. '$ '_--___-_' --r_Y.'� W � ENERGY P/C -� WARNINQ:FAILUflETO SECUAE WORKERS'COMPENaATION CAYERAGE IS UNLAWRIL.AND SHALL BE ---- � J SUBJEGTANEMPL01'ERTOCRIMIN/1LPENALTIE6ANDCI41LflNESUPTOONEHUNDRED?HOUSAND � �+- ENERGY PERMIT �__ OOlLAHS(f100.D00�.INADDITI0YTO7HECO5TOFCOMPEN5AT10N.UAMAGE5A5PROVI�E�FORIN ;��-� -� �- J SECTION3TaeOFTiELABORCODE,INTEREST,ANOATTORNEY'SfEES. 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