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HomeMy WebLinkAbout12352 �� CITY OF DIAMOND BAR !� DEPARTMENT OF COMMUNITY 8z DEVELOPMENT SERVTCES �� 21660 E.Copley Drive Suite 190 PRESS ���9�^�� BUII,DING PERMIT APPLICATION FIRMLY � JOBSITE � r APPLICATION i� ._ �`,,.�� NUMB R ��#/C o ADDRESS � � ��� � OATE L c� ISSUE rs M TYPE OCC APN L T T�i CT_ DATE_�V `� ��J�' CONST. GROUP °C OWNER OO ADDRESS ZONING SETBACKS Z ��n, ,C FRONT RW ❑__..._. APPLICA T TEL. REAR ❑ o ,� SIDEISIDE STREET RW f7 ,._ � CONTRACTOR � a j'�j,� �'j��° SIDE L7.___._._ � ADDRESS ��--�,� �1 . � CITY '� IZ P / TEL._ � PROPOSED USE o ARC G/ � DESIGNER� � ' NO.DWEL. NO. NO. ADDRESS � �p�-- UNITS STORIES BEDROOMS � CITY ZI� j�� ���� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION �n - � OWNER-BUILDER DECLARATION SFR/ADD/REM O 0 I HEREBY AFFlRM UNDER PENALTY OF PERtt1HY THAi i AA1 EXEMPT FROM 7HE CONTRACTORS LI- � GafdgB/COfpOft li! CENSELAWFOXiNEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCADE:ANYCITYOR EJ COUNNYh11CHRF:OUIRESAPERMITTOCONSTPUCT,ALTEP,IlAPROVF.,DEMOLISH.ORREPAIRANVSTRUP W pyti0/DBCk ZTURE.PRIOR TO ITS ISSUANCE,ALSO RE�l11HE5 THE APPLICANT I�OR SUGH PERMIT TO FILE A SIGNED � STATEMENT TNAT HE OR 3HE IS LICENSED PUflSUANT TO THE PROVISIONS OF THE CONTflACTORS LI- � CENSE LAW(CHAPTEH B(OOMMENCINO WITH SECTION 7Do0)O��DIVISION 3 OF THE Bl1SINE55 AND VRO� LL POOUSpd FESSqNSCODE)ORTHATHEORSHEISE%F.MPT7HEREFflOMANDTHE8A515FORTrIEALLEGF:DEXEMP- (�J TION.ANYYIOi.ATIONOfSECT10N709/SBYANVAPPLICANiFORAPERMITSUBJEC'fSTHEA77UCANiTO Z Re-Roof � ACINLPENALTYOFNOTI�FETHANFNEHUN�REDUOLUFS(5500).�: � f]I,A50WNEROFTHEPflOPERTY.OHMYEMPLOYEESWITHWAGESA5iHE1flSOLECOMP[NSATIDN, � COffIrt78fC10I Z K7LL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OF OFfERED FOFI5ALE(SEC.704C,B1151� _1 NE55 ANO PROFE55lONS CODE:THE CANTqACTORS LICENSE LAW DOES NOT APPLV YO AN OWNEfl OF � PRDPERTVWF108UXASORIMPROVESTHEHEIXJ.ANDWHODDES&UCHWORKHIMSELFORHERSEI.FON m � TNROUaH HIS OR HER ONM EMP�OYEES,PROVIDEO THAT SUCH IMPPOVEMENTSAriE f�TINTENDED OR QOFFEflEDfORSAIE.IF,HOWEVER,THEBUIL[11NGORIMPROVEMENTISSOLDWITH�NONEVEAROFCOMPLE- Z TqN.THE OWNER-BUIlOER W�LL HAVE THE BUROEN OF PHOVMG 7HAT HF OR SH[UIO NOT BUILD OR � IMPFiOYE FOR THE PURF'OSE OF SALE). L7 i,AS OWNER OF THE PROPERT/.AM EXCLUSIVELV CONTRACTING W7TH LICENSED CONTMCT�RS � TO CANSTRUCT THE PH0.IECT(SEC.IOM,BU9INESS AND PPOFf.55�ON5 GO�E:THE CONTRACTOqS LI- VdI11allOfl ADJ.AREA W CEN5ELAWOOE5NOTAPPLYTOANOWNEROFAPROPERTVWFIODIIILOSORIMPROVES7HEREON,AND � WFiOCANTRACTSFORSUCHPROJECTSWITkACOPJTqACTOR�S)LICENSE�PURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TOqSLICENSEIhW.1. � J o O�AM EXEMPT IINOER SEC. _0.8 P.C.FOR THIS HEA50N U � � ___�'__'�_'—____._..__'_-_- ¢ �i" DATE__ OWNER._"__- - U W 0 LICENSED CONTRACTORS DECLAPATION W � I NEREBY AFFIRM UNDER PENA�TY OF PERJURY 7HAT IAM LICENSED Uh'DER PPOVISiONS OFCHAPTER � r`��'� �"�C�1 �O� _ V� y 8(COMMENCINQ WITH SECTION 70ooj OF DIYISION 3 OF THE B1151NE55 AND PROFESSIONS GUOE,ANO Z MY LICENSE IS IN FULL FOflCE A�D EFFEGT. m � � LICENSE CLASS LIC.N0. � � �ATE_�r"� _" CONTRACTOFI�.y,.�c�A�?3%�� a' W � WORKER9'COMPENSATI04 DECLARATION Q N U � IHERF.BYAFFIRMUNDERPENALiYOfPERIURVOYEOFTHFFOLLQWNGOFCLAfiAT10N5: z Q � _INpyEANDWILLMAINTRINACEflTIFICATEOFCONSENTTOSELF-INSIIRFFOHWORKERS' 2 COMPENSATION,AS PROVIDED BY SECTION a]oo OF THE IAeOR COOE,TOR THE GEHFOHMANCE �U OF THE WORK FOR WHICH TN�S 7ERMIT�S ICSUED- � � � _INAVFANOWILLMAINTNINWOflKEflS'GOMPENSA710NINSUHANCF,ASRF.OUIFlE�UVSECTION Q37000FhIEN90RCO�E,FORTHEPERFO(iMANCEOFTHGWORKFOFWHICHfF115VERMIT�S _, ISSUED.�7Y K'OR RS'fAMPENSATION�NSURANCE CANPIEft AN�/VO,I�ICY NUMOEA AFlE: CONSTRUCTION ____ ._..___..,.._ _ � CAflRI[R ����/��.� �_�L���vc r PLAN REVIEW ---.._,.- ----.._----.--- C] POLICVNl1M�E�J_.�.92JS'C-_ ���'�7�J�7/i/A:s`i__"_�f.''� _ ELEC _ _ __'__ - ___-_- Z° v/V •�'6f' f � - _,}_ _er.x a ' •/ �` 0 (IHISSECI%7NRE�NJiBEO7AIPLETmOFTHEPERMRISFOROAEHUW9EDDOLWIS(5100)ORlE56} � PLUMDING .___"--_'."_ __. _-'_.._..._._—r�- w I CEHTIFY THAT IN THE PERFORMANCE OF THE WORK FOH WHIGM TH!5 PEFM.IT IS�SSUED,I MECHANICAL _.._ __.___._._ -. --.-- Z _'_ ' ` (�J SHALLNOTEMPLO�PddYPEflSONINANYMANNERSOASTOBECOMESUBJECfTOTHE NFEE � WOqNERS'COMPENSATIUNLAW50f CALI , 7EETHA(IFISVIOII f3fCOML — -�-�----�----- --��-�-�--------- � -------- SU&IECiTOTHCWORKER5'COMP'cNSAT10NP VISIONS FSECTION37C0 THE R �% � CODE,1 SHALL FORTHWITH COMPLY WI7 ANS. .: ��G; ISSUANC�/' .._.__-._. _..___ .._—.,�j-� �7 .. _ SMIP ---- v DATE: APPLICANT: � _, _ ---- �—�- J ENERGY P!C ._._ _—.,.-- —_ --, -- J WAflNING:FAILURETOSECUREWOflKFfiS' MP ATI NCOVERAGEISUNLAWFUL,ANUSf{q��BF � Sl10JECTANEMPLOYEPTOCRIMINALFENALTI MDC ILFINESUPTOONEHUNDRE�THWSAND FNERGYPERMIT _.._. DOLLARS(51(IDp00),IN ADUITION T07H[ OF CO ENSATICN,DAMAGES AS PHOVI�EO FOH IN '-"" --- -' —"--" '-"-'----' � J SECTION 3�oa Of TI IE LABOfi CODE,INTER i AN oaNers Fees. RETENTION FEE . ___ _. � ..,_. ---...._.__...---'--�— pw_, CONSTR ION LENDING AGENCY PRE-ALT FEE: _ ,_ ...__.___......_ ------- � IHEREBVAFFIRMUNDEHPENALTYOFPFRJURVTHATTHEREISACONSTflUCTIONL[N�INGAGENCY __._....___..____ --- d FOR THE PERFOFMANCE OF THE WORK FOfl WHlqi THIS PERMIT IS ISSUEU(SEC.]OW,CIV.C.). L '--___"___— _ I.LI � LENDER'SNAME __-_--------"-'""'- —"-"'-- F- LENDEF'SFDDRE55____._ - C � I CEHTIFY THA7 I MAVE HEAD THIS APPLICATION AND STATE THATTHE A90VE INFORMATtON IS CORRECT. TOTAL FE CS � � p �� � I AGREE TO COM�LY WITHALL D COUNN OPDINANCESAND 3TATE lAriS REUTING TO BUILDING / � CONSTRUCTION,ANDHE YRUTHOHI �PRESEN TIVF.SOFiHISCOUNTYTUENTERt1P�NTHE — Iib _ ABOVE�MENTIONED PROFER POR INSPEC N VUH E5. � � COMMENTS F•�F � ��� � � --- j , - - -�-- _ � m PERMITTEENAME(F y / ____—".-- -'�—'____-"-" '-__—____ fh y>�'�L-� � — ' -.. �/f�j7� � SIGNA7UREOFPERMITT °A7� RECPT.NO.._ PAIDBY� <_J,s/�VALIDATION � H � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy _....___.. ._. _....._. .._ --- -.__._ .. ... _a..,..._ ... . ,- - . _ . _ _ . .. __ — - .._. . . ; _ o.;.<;,: ; , ; , < <, . . � - �-. - . --. — _ . � � ' ; � . � � � � i � . � i � � � �. ( , - , �, I � ; i i ' � ' ' I i ! ; , ' ; J �, I' i i ' i � ; ' � � , i i i �`��� �� -- ---� � �- ' � __ � _ � � I ' � � ; ' � , xr � � ' ¢ � i i i ' i ' I . � I , ' i ' ; 1 -� ,-:e � � ' - - _ � - . ' . 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