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HomeMy WebLinkAbout15424 (22) . r- � YJ . � �: CITY OF DIAMOND BAR -- DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES � �,w 21660 E.Copley Drive 5uite 190 (909)860-3195 Fax(909)861-3117 PRESS �' 'A�'� BUILDING PERMIT APPLICATION FIRMLY OJOBSITE y}.y � DATEICATION�,� ^ 1 _� NUMB R�{'" C/�� #/C Q ADDRESS_��+�0 D��J!./ L( �r �,�D�D �� �� � c`�i ISSUE TYPE OCC APN �.�L,O,,T���,, TR CT DATE � `�I "� CONST. � '/''( GROUP�' i p OWNER --5��' ✓a p ADDRESS F�! v ZONING SETBACKS Z CITY ZIP TEL. FRONT _ RW ❑__. � APPLICANT _^ t TEL. REAR ❑_ SIDE/SIDE STREET RW ❑ � CONTRACTOR�(��''l�p Q7 lc�fCjQ�'(/�__ SIDE v � ADDRESS� '?��_����,/ �O � � � � � � CITY_(�t7a _ ZIP TEL.�� PROPOSED USE w ARCH/ENG/ � ���""�' � Z DESIGNER �py��R�� eQ Y NO. � ADDRESS • � UNITS STORIES BEDROOMS � CITY ZIP TEL. .- � DESCR ON .Sp.FT. FACTOR PSF ADJ.AR�EA'7PA p� OWNER-BUILDER DECI�IRATION p SFR/ADD/REM � - 0 I HEREBY AFFlFUA UNDER PENAL7Y OF PERJURY THAT t AM EXEMPT FROM THE COYTHACTORS LI- GHfOgB/C3(POfI �� W CENSEIAWFOqTHEFOILOWIN6REASON(SEC.IIXi1.53U51NE55ANDPflOFESSiONSCO�E:ANVCITVOfl (n _ - ZCOUNTYWHICNRE�l11RE5APERMITTOCONSTHUCT,AL7'ER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W PglIOJD6Ck e W TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANi fOR SUCH PEflM1T TO FILE A SIGNED W � STATEMENT THAT HE Oq SHE IS LICENSEU PURSUANT TO THE PROVISIONS OF THE CONTRACTOHS LI� � CENSE UW(CHAPTER 9(COMMENCING WITH SECTION 7o00)OF DIVISION 3 OF THE BUSINESS AND Pq0- � PooUSpa FE3310NSODDE)ORiHATHEOR5HE18EXEMPTTHEFlEFROMAN0THE8A51SFORTHEALLEGEUEXF.MP� (r] TqN..WYVIOLATIONOFSECTION7o3/.SBYRNYAPP�ICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � ACIVIL FENALTY oF NOT MOqE THAN FIVE HUNDRED DOLLAHS(Ssao).)� � ❑I,ASONMEROFTHgppppERTY,ORA1VEAlPLOVEESWITHYlAGESASTHEIRSOLECOMPENSATION, 0 Commercial WILL DO THE WOHIf,AND THE SYRUCTURE IS NOT INTENOED OR OFFEHED FOfl SALE�SEC.7041,BUSI- J � NESS ANO PROFESSIONS CODE:TNE CANTRACTORS LICENSE LAW�OES NOT APPLY TO AN OWNER OF � PR�EPTY NM1iO BURDS OR IMPROVES THEREON,M1D WHO DOES SUCH WORH HIMSEtF OR HERSELF OR � 7HROVGHHISORHEROWNEMPLOYEES,PfiOVIDEDTHATSUCHIMPROVEMENTSARENOTINTENOE�OFl m Q OFFEREDFORS1ILE.IF,HOWEVEF{THEBUIIDINGORIIAPROVEMEMI550LDWI7HINONEVEAROFfAA1PLE- Z TKKJ,TME OWNER�9UIIDER WILL HAVE THE BURDEN OF PROVING THAT NE OR SHE OID NOT BUILD OR � IMPROVE FORTHE PURPOSE OF SALE). w ❑I,ASONTlEROFTHEPROPEHII',4AIEXCLlI51VELYCON7RACTINOWITHLICENSEDCONTRAC70RS � TO CONSTRUCT THE PRQIECT(SEC.7o�e,BUSINl55 AND PROFESSIONS CO�[.THE COYTRACTOqS LI- VdIU8110(1 6,� ADJ.AREA W CENSELAWDOESNO�APPLVTOANOWtJEROFAPflOPERTYWHOBU!1.�50NIMPqOVESTHEREON,AND - --- -- � WFNICONTMC75FORSUCHPFQJECTSWITHACANTqpCTOR(5)LICENSEDPURSUPNTTOTH[CONTHAG QUANTITY DESCRIPTION FEE Y TOHS LICENSE LAW.). 0 ❑IAM E%EMPT UNDER SEC.___ _ 8.&P.C.FOF THIS REASON Q � 3 U ..W` ------- ---------'--- — . � DATE oWNEF F� Z __.'---._"'_— U OQ LICENSED CONTRACTORS DECLARATION W 2 - 1 HEHEBYflFFIqM UNOER PENALTY OF PERJl1RV THAT I AA1 LiC[NSCD UNUER PROVIS'ONS OF CHAPTEFl � p�, B(COMMENCINfi Wlhi SECTION Iom)OF DIVISION i OF THE BUSINESSAND PROFESSIONS CODF.,AND Z _ _ �X� MY UCENSE IS IN FULL FORGEAND EFFECT. m � LICENSE CLASS � �� LIC.NO. ,__�_� ��2 � , � DATE__ _ __ CONTRACTOR�__,,__�,l�!�_. d W / � °� � WURKERS'COM�'ENSATION DECLARATfON � 1 HERFBY AFFIRM UNUER PENALTY OF PEH,)UHY ONE Or THe FOLLOWiNG DECLAqk"FO/N�� � �� U - � _IIIAVEMJDWILLMAINTAINAGERTiFICATEUFCANSENTTOSELF-IN RErFOF�'WORICF ¢ ,� C.dAPEN5A71ON,A5PROV!DE�BVS[CTION:i7o00FTNEl.ABOqC OE,FOfifHEP�EKTS E U O OF THE VlORK(OR WHICH TNIS CFRMIT IS ISSUF.D. � .��-'� � �w _IHAVEANDWILLMAINTAINWURKERS'CCMPENSAfIONINSURANCE,ASRE�UNEU9YSFCTI a�oo OF TME U19OR CWE,FOR rHE PERWHASANCE OF THE WORK FOR WHICH 1HI IT IS � �� ISSUfD.MY WORNERS'COMVENSATION INSURANCE C.4RRIER h4D POLICY NU : AflE� ' �'CONSTRUCTION . /7 ___"_' � , ...__ _-'_"'_"' j caRa,ien -���_.----G'�-.___ . . %� .. ^ LAN REVIENJ .._�i x. �, � Z POLICYNUMBEH �.l� ELCCTRIC ' —___--"._ -' . � ' Q ""—'_'_ '—_"' ---'_ = � (IHlSSECPKYJNE�N�I'BECO�AAL_RFDOFhIEPER�.9TISFORONF [otrx If�ao�pq�Es a PLUMBING ..----.. . -_..__.. �------ Z I CERTIFYTHAT IN THE PERFOAMANCE OF THE WOFH FCR WHIC THIS�VEii �SSUF,I � MECHANICAL ___,.,,.____._._ � (� SNALLNOTEMPLOYMIVPEFYSCNINANYMANNERSOASTOE7[CC. � JSTJ�ECTTOTIIE � (j� WORKF:RS'COMPENSATIGNl�W50FC�LIFORNI4,AND�GREETMATIFISHOULDeECOM S INSPECTIONFEE � SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF S[CTION 370u bF TfiE LAF3OR w�, 1y � .q ��� __.. � CADE,I SHALL FORI"HWITH COMPLY WITk Tl�{OSE:=ROVISION6. ISSUANCE 'g� #.j� �r ., � � c� —�,:.-.'�� s-.,�--------- � p DATE: APPLICpNT: a ' w ��--------- SMIP ----- ---...----...--=.._ S� � ENERGY P/C c.- � WARNING FAILUflE TO SEC'JRE WOHKERS'COMPENSATION COVERAGE IS UNLfiWFl1L,AN�SHALL BE -- �-�-��- } SUBJECTANEMPLUVERTOCRIMINALPENALTIESAIJDCIVILFINESUP7oONEHUNDFlF:OTHOUSANU ��� ��1 � ENERGYPERMIT t,._I . �� ' DOLLARS(S�oo,000),IN AODITION TO TME COST OF GOMNENSATION,DAMFGES RS PFOVIUE�FOR IN -��}e�-- , �'� "� � J $ECTION37080FTHGLABORCODE,INTC-ftESLANDATTORNEY'SFEES. ' ���� 0[ RETENTION FEE: qT �- ! O CONSTRUCTION LENDING AGENCY .<.1.3.� �-����r��y�t�;'-- W � r � PFE-ALT FEE: y)T '{� � a� � IHC-REDYAFFIf1MUNDEFlP[NA�TYOI�P[fiJURYTHRT7HER[ISAGONSTRUCTIONIEN�INGAGENCY $J7„�.tCJ����^ � FOF THE P[RFONMANCE Of TH[WOFlK FDR WHICH THI.S PE(iMI71S ISSUED(SEC.7oe7.CIV.C.]. --'---"--' ----------- �---- Z UA -- -_._.-_ � LENDER'S NAME ____„ .._.'"____.."'___ -___'_ '___- ' H- L,ENUEH'SAOORESS.._.."_'_"'__"_"'""'__".,._'_'....-__"""..._-""_-_ W I CERTIFY THAT I HAVE flEAD THISAPPLICA710NAND STATE THAT THEABOVE INFOflMATION IS CORRECT. TOTAL FE ES i,,,�`� '���••���'� � I AGR[E TO COMPLY WITH Al.l.CITY RNO CA�INTY OfiDINANCESANO STATE LAWS R[LATING l0�UILOING � CON57Rl1CTION,ANDH[REdYAUT}IOPoLCRF:PRESLNTA'(NESCFIHISCOUNTYTOENTERUPONTHE z ABOVE-MENTIONEDPROPEflNFORINSPECTIONPURPO5E5. � COMMENTS__.,.,_._.______ ---- — � �4�l 1 l� � —�_. ---------- -- -- ---------- -------------._...----- --- -�-- m PERMIi E /�i [(PfiINT) . f � �i — � �.�----�— -- -- � ---. - �_:-- � s - -- � SIG A7 OF M EE DATE 4 �`�` --�_- �}M1 � RECP7.NO._ �✓ Y�PAID BY __,._�. VALIDATION_.��_� � WFIITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GRE N—Applicant's Copy s _. . _ , _ .. . . __._. . - _ , , � . � � ,, > . ' ' � i ; � � , , I ' , ' ` � , , � - . ; , .. � j • . , I , ; , ! ` ' , ' I � , ... - ' -- - _.__ . .. .. , . . : . - , , . -= � , � � � • i , , •...... , _ _ -, - ' ' � t I � , i � ' ' i ; , ! . , , _ ` � . . _ i � ��r�' _ . _. . . � S.. ,. . ' � i i i , ' . . � � - . ' ; � � ,. `� " ' - . . � . � ,... 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