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HomeMy WebLinkAbout15430 (20) f t< \.�.. lj �' CITY OF DIAMOND BAR � . _?•• � --� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 4' 21660 E.Copley Drive Suite 190 (909)860.3195 Fax(909)861-3117 �' PRE`S$ ''A^"� BUII.DING PERMIT APPLICATION FIRMLY a DDRIESS ��� ��C;�2� IN I L L��" � � APPUCATION �7'� PERMIT C`" �. P/C p DATE �' � NUMBER �-��•�� # c� ISSUE � y� f/ TYPE OCC APN LOT TRACT_,_ DATE_ � V'� CONST, GROUP p OWNER �I_� _L.� AODRESS /��� ,� ONING SETBACKS W CITY e�r� ZIP TEL. ' FRONT ___ RW ;l_._ � APPLICANT lL lC,`-1 TEL. REAR ❑____ ` SI�E/SIQE STREET______ RW LJ_____ CONTRACTOR � 7'i�I � _ SIDE (-; ADDRESS�_ .� p ��.n, --� 1 t �� PROPOSED USE e�I'� /IJ � � �, ZIP TEL-aizY��-/ t /J '% �" . r w ARCWENG/ Z DESIGNER � � W NO.DWEL. NO. ��---- a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP 7EL. N v� DESCRIPTION S(�.FT. FACTOF PSF ADJ.ARErWALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O 1 HEREOV AFFIRM UNDER PENqLTV OF PENJURV THAT I A!A EXF.MPT FNOM THF WNTRACTOFl6 LL GdfdQ0�C8f(10R W CBiSEUWFORTHEFO!LOWINOREASON(SEC.7031.SBUSINESSNJOPROFESSIONSGODE:RNVGITYOR (n ZCIXINTVWHICHREIXIIRESAPEHMITTOCONSTRUCT,ALTER��PRnvE,DEMOLISH,ORREPAIRANYSTFLIC� W Patio/Deck W TURE.PRIOR TO ITS ISSUANCE,ALSO HEQUIRES TNE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO W STRTEIAENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTFlAC70R5 LI� � CENSE LAW(qiAPTEN 6(COMMENCINO WITH SECTION 7WU)OF UIVISION 3 0F THE BUSINESS AND PRO� � PooUSpa _ FESSIONSCODE)ORTHATHEORSHEISEXEMPTTNEREFROMANDTHEOASISFORTHEAlLEOEDEXEMP� � — TION.ANYVIOLATIONOf3ECTION7o31.56YANYAPPIICANTFORAPERMITSUBJECTSTHEAPPLiCANTTO Z Re-Root Z � ACIVIL PENALTY OF NOT MOqE TFiPN FIVE I1UNDflED�OLLARS(E500�.): Q — � ❑I,ASOWNEROFTHEPI?CPEHTV,ORAIYEMPLOVEESWITH4VAGESASTHEIRSOLECOM?ENSATION, COInfnBfClal ' _ WILl00 THE WOHK,AND THE STRUCTUR[IS NOY INTENDE�OR OFFFRED FOR SALE(SEC 7044,(3U51- � NESS AND PROFESSIONS CODE:THE CONTRACTORS IICENSE LAW�OES N07 APPLY TO Ai{OWNER OF � `,s� � PRODERTYW110BUILDSORIIAPROVESTHEREON,ANOWHODOESSUCHWORKHIAISELFORNERSELFOR , d THHOUGHHISORHEHOWNEMPLOYEES,PROVI[1EDTHATSIICHIMPRUVEMENTSARENOTINTENDFDOR m _ ' QOFFEREDFORSFLE.IF,HOWEVEf�iHE6UIl�INOORIMPFOVEMENTI550lDWITMINONEYENROFCOMPLE � TION,THE OWNER$111LDER WILL HAVE THE BURDEN OF PROYMG TH4T HE OF SHE�I�NOT BUItD OR �� � IMPROVE FOqTHE PURPOSE OF SALE). � ❑1,AS OWNER OF THE PROPF.RIY,AM EXCLUSIVELY CONTRACTING WI7H LICENSED GON?RACTORS p� Q TO CONSTRUCT TH[PHQIECT(SEC_7oM,8l1SINESS AND PROFESSI�NS WOE:THE CCNi flACTORS LI� VdIUdPi0f1 ___ .._ �_.{/______,.__ADJ.AREA__.____ y W CENSEUWOOESNOTAPPLVTOANOYMEROFAPROPERTYYMO[iU1LDSORIN�PROVESTNEREON,AND — ---- �{ � NRIOCONTRACTSFORSUCHPflQIECTSWIiNACONiRACTOR(SjLICENSEDPURSUANTTOTHEWNTRAG �UANTITY �DESCRIPTION FEE Y TORS LICENSE LAW.j. � � J CJ IAM E%EMPT UNDEfl SEC.,_________ B.&F.C.FOR THIS P,EASON Q � J ---�------ --------------------------- ' IL ' LL" DATE OWNER_ r V � LICENSED CONTRACTORS DECLARATION W � I HEREBV AFFIHAI UNOER PENALN OF PERIURY THAT IAlA LICENSEO UNDER PROVISI�NS UF CHAVTEN � d 9(COMMENCINOWITHSEC710NNoo)OFUIVISION30FTHEBUSWESSARDPFOFE561CVSCODE,AND z MY tICENSE IS IN FULL FORCE AND EFFECT. o � � q ��r��� � ----- � IICENSE CLASS LIC.NO. _ __ J U DA7E __ CONTMCTOR.___ a -- W _ � � WORKER�COMPENSATIOPJ�ECLARATION � ¢ N t HEREBV AFFIRM UNDEfi PENALTY DF PERJURY ONk c]F iHt FOILOWING�ECLARATIOYS: U � Z � Q O _IMRVEANDWILLMAINTAINACEFTIFIGATEOF['ANSf:NTT05[LF-IN9UREFORN'ORHERS' Y � CaAFENSATION,ASPROV�DEDBVS[C'ICNa'InooFTHELA60FCODE,FOH7HEPERfORAIANCE W _ OF hiE WOflK�OR WHiCM TH!5 PERMII'IS ISSUEU. � Ld _'__'__ —_'_—'"_ '—_"__-- __I HAVE AN�WILL MAINTAIN WORNERS'COMPENSAlION INSURANCE,AS RFQUIRED BV SECTION �y �// y n37fA OF h1E LA90R CODE.FOH THE PERFORMAFGE OF Tt1E WOHK FOR WtIICM THIS FEflMIT IS ��u GJ I J � ISSUED.MYYlORKERS'COMPfENSATIONMSIIFANCECAPRIE/R/9NDPOLICYNUMBERARE: CONSTRUCTION ____ _____ ..... ........�.�,��1.,_C � � cnaRiEA-- --1 � "�L�.-------�--- PLANREVIFW _,._�?5,.� ZPouCV NUMBER� ----._-------_-- ELECTRIC _______ ' ¢ o frwssEcr�NCEoueTaEa�ooFn��wm��SwNcxv[tanvxat�oaiar�sry�ool�n�r.ssl. PLUMBING _ _ W MECHANICAL W Z I CERTiFY THAT IN 7HE PERFOR�AANCE OF THF YlORK FOR WHICH THIS PERMIT IS ISSUEU,I (r} SHALLNOTEMPLOYANYPERSUN:NANYMANNEHSOA570F7ECOMESU�JE�:fi0711C (p WORKERS'COMPF.NSATIONLAWSOFC/LL.iFORNIA,ANDAGiiFE?HATIFI�HOU�DBECAME INSPECT�ONFEE ________ ,_ F_ Su&IECTTO7HEWORK&RS'COMPENSA7IONYHOVISIONSOFSEC�lON3�ooOFTMELABOR ., � - — C ISH�, FORTHWI'NCOMPLVWITHTHOSE ROVISIONS. IJ'SUANCE .__ '���� ��_��.__�� :��'G"�� � n ra_ � [�1 SMIP qy /�� p UATE: � APPLICAN7: ."'_ ~ _ S.__�_"_— . .._..'.'..'_.'..._—�z��-�r�,S.�_...__ .'___ .�'�L— W _._.. �----- FNERGYP/C :.�.. ��1�.!�,(J�a�ill;. � SU&IECTAN EMPLO EFl TO CRIMINAL�PENALTOIES AND CNIL F NES U TO ONE HI NF�'7C[^l T�FIOU54N[)E ����T- �+1 r , � � DOLLAFlS(5100,aao�,INADDITIONTOTIIFGOSTO�COMPENSATION,OAMAQESASPROVI�EUFOflIN ENERGYPERMIT .t�rs �r'ro�'�O.Tf.� _ J SEC710N37o80f7HEL�9oHCO�E,INTERESLANDATTORNEY'SFEES. FiETENTIONFEE: ¢ __-- � CONSTRUCTIONLENDINGAGC-NCY PRE-ALTFEE: _.._.—.___...___.........—_.._....._..—_._..._..__.._..___—. � O Q IHLREOYAFFIRMUNDERPENALTYOFPC�iJUf7YTHATTMEflEISACONSTRUCTIONLEN�iNGAGENC7 FbRTHEP[RFORAIANCEOFTHFWORKFOFlWHICHTHISPEFiMITISISSUED(SEC.30W,CIV.C.). � � � ��� � � L�LI ......_...__--'__._.,......' __--..—' � LENDEF1'SNPME__'_"'_ _'______.._.._"_—'— F— LENDEN'SA(bit[9S___._.'"_—_'_'__" _..,_"'—'_—'_""_'_ /� yy. , W ICERTIFYiHq7�HAVERCPDTHISAPPLICATIONANDSTATEi11AfTHGABWEMfORMATIONISCORPECL TOTAL FE�S �.n Q i,�� � I AGR[E TO CAMPLV WITN ALL GITY AN�COIIYTY OflDIYFNCES ANO STPTE LAWS HELATI�G TO BUILDING (N� � CONSTRUCTION,ANDHEREBYAUIHORV.E17EPfilS[NTATIVCSOFTHISCOUYTVTOENTEflUPONTHE � ABOVE�MENTIONED PROVERTY FOfl IhSPECTION PURPOSES.� _ o ` , COMMENTS_._.,____._ � • ..�.4-�-T� _ �� v., v ----------- ...— -- - m PFHMiTfEENAME RINT . 1, — ¢ ] '___'__ —_—_' � / � � _ ' '_ _'_ �_/.____"_' ____— SICNA7UHE0 PE I D E � � (A �'�--'______ = RECPT.NO. 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