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HomeMy WebLinkAbout14516 (29) CITY OF DIAMOND BAR �� --�� ---- DEPART?:4ENT O�r COMMUWITY&DEVELOPMENT SEEtVICE5 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ���%�°� BUQ.DING 1'ERMIT APPLICATION FIRMLY - _. .. . ... ,..._ ,. --.... . � JOBSITE --� �7� DATElCATION�i ,' 11,� NUMBER� ` ./�� #/C /a . � o ADDRESS�� G'�.T, L� S- _�7t�,,i�.�kdlt / _ L7 � ISSUE TYPE OCC APN LOT �TRACT DATE _CONST. GROUP � OWNER _, ` � `' ZONING SETBACKS p ADDRESS F.•n !�- (-�Y�N �V C C� z CITY ZIP TEL(� �sG y'1.�`�t�, FRONT ._ RW ❑ �� r_n�.� � � �1f S APPLICANT TEL.� REAfS _ C SIDE/SIRE STREET RW ❑ � CONTRACTOR ���' �= SIDE J Q ADDRESS_ �' - ����'�.�.--�-- PROP�SEQ USE�li_'L�w� �`V� �GV S � CIN ZIP ��•TEL.C�� fd"Gt��`� �- � ARC ENG/ _ z DESIGNER NO.DWEL. NO. NO. oW., ADDRESS UNITS ._ STORIES BEDROOMS � CITY ZfP TEL. � DESCRIPTION SQ.FT. FACTOR PSF AD.I.AREANALUATION CA — � OWNEF-BUiLDER DECLARATION SFR/AOD/REM O — 0 I MEREBY AFFIRM UNDER PENALTV OF PERJURV THAL 1 AM IXEMPT FROM TMF CONTRACTORS LI- � Garage/Caiport W CENSEUWFORTHEFOL�OWINOAEAuDN(SEC.J031.5BUSINESSANDPROfESSIONSCODE:ANYGITYOp U COUNfVWHICHRE011F�SAPERMITTOCONSTRUCT,ALTER,IMPROYE,OEMOUSH,ORREPAIRANYSTPUC- W PatiolDeck WTURE,PRIOR TO RS ISSUANCE,ALSO REQURiES TME APPIICANT FOR SUCH PERMIT TO FILE A SIGNE� W _ � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THF CONTRACTORS LI� � CENSE LAW(CHAPTER P(COMMENCINO WfTH SEC71�N 7o0D}OF DIYISION a OF 1HE 6USWESS AN�PRO- LL' PooUSpa _ FESSIONS CDDE)ON TFUT HE OR SHE IS EXEMP7 THEREFROM AND iHE 8A515 FOR hiE ALLE6E�EXEMP� V TION.PNYVIq1TIONOFSECT10N7o31.5BVIWVAPPLICANTFORAPERMIT9UB1EC75THEAPPLICANTiD Z Re-Root _ � A CML PENAI.TY OF NOT MORE THAN FNE Hl,'NDRED DOLLARS(5500).): , � ❑I.ASONMEROFTHEPpOPEHTY.ORMVEI�LOVEESWITHWAGE5A5THEIR50LECOMPENSATION. ❑ COrtImBfCial WILL 00 hiE WORR,AND THE STRUCTURE IS NOT INTENOED OR OFFERED Fdr7 SALE(SEC.7oad,BUSI- J NESS IWO PRDFESSIONS O�DE:T11E CONTRACTORS IICENSE LAW OOES NOT APPL`!70 AN OWNER OF � PHOPER'fYNM1�OBUILD50flIiSVROVESTHEREIXJ,ANDWHODOESSUCHWORKHIMS[LFORHEFiSELFOF � � TF{qOU�HHISORHEfiONTJEMPLOYEES,PROVlDE9TW�TSUCHiMPROVEMENT6ARENOTINTEYDEOOR m O OFFEREOFORSALE.IF,HOWEYER7HEBUILDINGORIMPROVEMENiIS501DWI7HINONEYEAROFCOMPLE- Z TWN.THE OWNER-BUILDEp WILL HAVE THE BURDEN OF PAOVING THAT HE OR SHE DID NOT BUILO OR = IMPROVEFORiHEPURPO5EOF5ALE). ❑I,AS OWNER aF TME PHOPERTY.AM E%CLUSIVELYCANTRACTING WIiH LICENSED CONTRACTORS � TO CONSTRUGT THE PROJECT;SEQ 70M,BUSINESS AND PROFESSIONS COOE:THF CON7RACTORS U- ValUBCwn ADJ.AREA � GENSEUWDOESNDTAPPLYTOANOWNEROFAPROPERTIWHOBUILDSOFIUPFOVESTNEREON.AND � WFIOCOMRACTSFORSUCHPROJECT5WITHACONTRAC70R(S�LICENSEDPUiiSUANT707HECONTRAC- QUP�NTITY DESCRIPTIO�V FEE � TOp8110ENSEUW.�. J � v ❑1 AM E%EMPT UNDER 9EC. 8.S P,C.FOq THIS REASON U � � 4' DATE OWNER V Z W � UCENSED CONTRACTORS DECLARATION W � IHERE9YAFFIRMUNOERPENALTYOFPERJURY7HATIAMUCENSEDUNDERPFOVISIONSOFCHAPTER � p„ 9(COMMENCiNCi WITH SECIKNV 7000)OF DfVI510N 30F THE BUSINESS ANO PROF�SSIONS CADE,ANO Z ���t .�- }C LI NSE IS W FULL FORCEAND EFFECT. m �7��^ LLl ��(�� Q� � � CEN CLASS LIC.NO. f,�-E✓�YL_-- J +'' U � / 1Fi'a7� CONTHACTOR n- W � � � WORKERS'COMPENSATION DEC�ARATION a d��, �� �° "r:� � IHEPEBVAFFIRMUNDERPENALTYOFPERIURYONEOFTHEFOLLONANGDECLARA7ION5: � ` ,~�"'. .T .,•�'�a.' � ¢ �.. G ,�INAVEANDWILLMAINTAINACERT�FICATEOFCONSENTTOSELF-INSUREFOFYVOqKERS' S ���������.�;'• Z COMPENSATION.ASPROVI�EO9YSECTION]7o00FTMELAHOFCODE.FORTHEPEAFORMANCE U `�'-��`rr^�". "'��� Q OF 7HE WORK fOP WHICH h11S PERMIT IS ISSUEO. � 4'�.ri�F��,,:�,,,��j.� W ,IHAYEANOWILLMAINTAINWORKERS'COMPENSA710NMSURANCE.ASREOUIREDBYSECT!ON ..'>� � Q 37000F iHE LABOR CODE.60R TNE PERFORMPNCE OFTHE WORK FfiR WHICH THIS PER!AIT IS �0 7� U ISSUED.MY WOFKERS COMPENSATON INSURANCE CARPoER AND P0.ICY NUMBER ARE: CGNSTRLCTION � y CApRIEfl PLAN REVIEW --- � � po�cv Nur.eEa — ELECTRIC _. + �� Q (fHISSECTIONNE�W7BE00t.4'I.EfEDOF7NEPERMrtISFDRONE!Nh9REDDOL!MS�E100)ORLESS) PLUMBING _ Z 1 CERTFY TMAT IN THE PEflFORMANLE OF TNE WORK FOR WfiIGH TMIS PERMIT IS ISSUED.1 MECHANICAL _ (�j SHALLNOTEMPIOYANYPEflSONINANY MANNEFSOASTOBECOMESUBJECiTOTHE r/J � WORKERS'COMPENSA710NUWSOFCALIFOFNIA,ANDAGfiEE7HATIPISHOULDBECAME INSPECTIONFEE _,__ S �_ � „ �� SU&IECTTOTHEWORKERS'COMPENSATIONPFOYISIONSOFSECTiON77ooOF NELABOR ISSUANCE �� = COOE. SHALLF RTHWITHCOMPLYWIhITHOS(E'PROVISIONS , � p�` ; / e� .�s'ti��icarrr, JI�''.G��� � � SMIP W �— J WA MG FAILUflE 70 SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C J SIIBJECTANEMPLOYERTOCRIM�NALPENALTIESANDCMLFMESUPTOONEHUNDRF.�THOUSAND �y ENERGV PERMIT paLtARS(f��.�),M PD�ITION 7�THE COST OF COMPENSATION,DANAOES AS PROV WEO FOR IN � aSECTiON3708OFT1ELA90RCODE,INTEREST.ANDATTORNEYSFEES. RETENTIONFEE: _ � CONSTFUCTION LENDING AGENCY PRE-ALT FEE: O � IHEREOYAFFIHu.UNDERPENALTYOFPERiURVTHATTHEREI3ACON5TRUCTIONLEMDW6AGENCY FOR THE PERFOFMMICE OFTHE WORK FOR WHlpi THIS PERMIT IS ISSUED(SEC.30�l,CIY.C.�. Z W S LEN�ER'SNAME_ � Y LENDEWSAOARESS - 1 WICEftTItYTNATIHAVEREA�TNISAPPLICATIa1VM1DSTATETH0.TiHEf90VE1NFORMATqNISCORRECT. TOTAL FEES �. ����~ � �p � I AGREE TO COMPLY WITX Al1 CITY PNU COUNTY ORDINANCES AND STFTE UWS REIATING TO BUILDING � � � GnN57HUCTION,ANDHEREBVAUTHORIZEREPRESENTATIVESOFTHISCOUNN70ENTERUPONTHE L�W� � Z ABOYEMEN710NED PROPERTY FOR INSPcC'I/ON URP0.SF5. COMMEN7S _ � �f^./✓�� �s VQ� � - � GEFAIITTEENAME�VRIHT� Q P i" � C/) / � SKiNA1UPEOFPEflMITTEE OATE � �✓ RECPI:NO. __PAID BY VALIDAT�ON ~ WHITc—Department Copy,YELLOW—Financa Copy,PINK—Asaessor Copy,GOLAENROD—File Cnpy,GREEN—Applicant's Copy � .. : : . , , .,�, _ , � _ _ _ , ;� � .�� � : < � ,. � �r _f � .. _ � . :°. ... � f��,: � �'. '�� � € Ii.'v �� x. w�i � � a '�� A� �u�; sc �t �t��� i �d.F� a 3 :���' �. Rx �s : �.¥� � :j� �� o- xk 1 ��.� a fa���xa�a�r' ���.:k�r � .. � ,�z a .,:� i �:, y )�c:� �°`a ,:z .� s s <: s :.� ..x._.t:• m.:.:Y � , .c..:.;4 ... .f.:, ...,, a . ., r,: . . 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