Loading...
HomeMy WebLinkAbout12581 (11) CITY OF DIAMOND BAR j "-- -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ; 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3t17 PRESS �'A�" BUll.DING PERMIT APPLICATION FIRMLY I 0 DDRIESS � i �.-�a S. �IA h7i)Np IC° l�l._r____�� DATEICATION p /� q� g NUMBER I�� I #,C ` L � ISSUE TYPE OCC ; APN LOT TRACT DATE � Z CONST. GROUP p OWNER Sa�� KL� KCs�Je,� � "' � ZONING SETBACKS p ADDRESS_�I�'� S, 17jANKw�1^� F it �j # � z CITY .p(1�NnIJpq� ZIPqi��� TEL.(��a r -u7/ FRONT _ RW L�_ � g APPUCANT .r'`[�k'-- K�I K'dh1 TEL. S DEISIQE STREET_,_ RW Ll'__.____ 4 �a CONTRACTOR -- ��-L'"j"}?IC C'.�'� SIDE Il _ ADDRESS�� Cf -� �. pROPOSEDUSE I ^ 4 o CITY ZIP�([_ TEL.� --'�i�' � , � o ARCFVENGf -- j� a ADD ESS NO.DWEL. NO. NO. j. UNITS STORIES ___ BEDROOMS � N CITY ZIP_ TEL. _ — v> DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNEfl-BUILDER OECLARATION SFR/ADDIREM O p I MEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FHOM THE CONTRACTORS LI- G8fe9B/CBfPOfI � W CENSEUWFOpTNEFOLLOWINGREA50N(SEC.1o3f.5811S14E55ANDPROFE5510NSCODE:ANVf.ITVOR (J� f U �OUNTYWHICHREOUIRESAPEflMITTOGONSTfiUC7,AL7ER,IMPHUVF.,�EMOLISH,ORREPAIflANYSTRUP �jJ �: W TUqE.PRIOR TO ITS ISSUANCE,ALSO REOl11RES THE APPLICANT FOR SUCH PEPMII'TO FILE A SIGNED W PQI�����k f; � STATEMENT THAT HE OR SXE IS LICENSE�PURSUANT TO THE PROVISIONS OF THE CANTfiACTOR3 LI� LL � CENSE LAW(CH0.VTEfl B(COMIAENCING WITH SECTION 7000)OF�IVISION 3 0F 7HE BUSINESS AN�PRO� POOVSpB �' FESSpNSCODE70R7HFTHEOH5NEI5EXEMP'iT11EREFROMANDTHEBM515FORTHEFLIEGEDEXEMP� (!� !; V TION.AIJVVKKA71Q40FSECTION7031,68YANYAPVLICANTFORAPF.RiAITSU&IECTSTHEAPPLICANTTO Z Re-Roof `� RCINL PENALTY OF NOT MORE TMqN FIVE MUNDRED DOLLAqS(f5a0).): f; zC�I,ASOWNEROF7HEPROPERTY,ORMYEMVLDYEESWITHWAG[SASTHEIRSOLECOMPENSATION, ❑ COffIfi18fC19I ' � WILL DO YHE WQRK,M'�THE STRUCTURE IS NO7 Mf ENUEU OR OFFEREU FOR SALE(SF.C."1044,BUSI- J � NESS AND PqOFE5510N5 CODE:THE CANTRACTORS LICENS[LAW DOES NOT APPLY TO AN OWNER qF � PROPEHTYWHOBUILDSORIMPqOVESTMEREON.ANONRIODOESSIICMWORKHIMSELFORHERSEIFpR � � � THROUGH HIS OR HF.R OWN EFIGLOYEFS,PROVIDEO TH0.TSUCH IMPROVEMENTS ARE NOT INTENDGDOR m � W OFFEflEDFORSIILEIF,MOWEVERniEBUIL�INGORIMPROVEMEMi550LDWITHINONEYEAROFCOMP�E- '� Z TION,THE OWNER�81111DER WILL HAVE THE BUROEN OF PqOVNG THAT HF OR SHE DID NOT 6U!LD Oq ' F, = IMPROVEfOflTHEVURI'OSEOFSALE�. �• U I,ASON7JEROFTHE PROPERTV,AM EXCLUSIVELYCONTRACTI�6 WITHUCENSEDCANTRACTOHS — � Q TO CONSTflUCT THE PflQIECT(SEC.7044,BUSINE55 AND PROFESSIONS COD'c:THE CANTPACTORS LI- V8111a11011 �`�"--'-� ADJ.ARFA �• lL CENSELAWDOESNOTA7PLYTOANOWNEROFAPROPERTYWHOBUILDSDHIMPflOVESTNEREON,AND -- ---��- � ,h6 F WIIOCONTRACTSFORSUCHPR0.1EC75WITMACONTflACTOfl(S)LICENSEDPURSUANTTOTHECONTRqG QUANTITY DESCRIPTION FEE TORSLJCENSELAW.�. -� � 3 S �„� F � ❑IAM EXEMPT UNDER SEC. _____,__ B.8 P.C.FORTH!S REASON Q .� \C; � "� •" �' ��", s �� � j`�e dC0."l��- �l S S 2� r lt. DATE owNea ------- � H' � --- ------- ------ �U y o LICENSEp CQNTRACTORS DECLARATION W " Q 6 oc I HEFlEBV AFFIFlAI IINDER FENPLTV OF PFNl1RY TNAT I AA1 LICENSED UNDER PROVISIONS OF CHAPTGR � i d B(COMMENCIN(3 WITM SEGTqN 7U00)OF�IVISION 30F THE U1151NESS ANO PROFESSIONS CADE,RNU � $ X MY UCENSE I6IN FULL FORCE AND EFFECT. m LLI � LICENSE CLASS_„��"`�[Z� LIC.NO '�1-,'�] � � � "` t� _ . _�S._--___ J } WDATE���_ CONTRAGTOR_ a '�" v — �-���_�'�-�: 5 � WORKERS'COMPENSATION DECLARATION ¢ � N I HEREBYAFFIRM UNOER PENALTY OF PENIJRV ONE OF THE FOLIOWMG DECURATIONS: U � � d � l7 IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _ � � COMPENSAT:ON.ASPHOVIDEDBYSECTION37000FTHEUBORCODF.,FORTHEPERFORMANCE U _ o OF THE WORK FOR WHICH TNIS PERMIT IS ISSUED. � � W ___IHAVEAJ.IDWILLAAAINTAINWORKEW.S'COMP'eN5AT10�1175URANCE,ASRE�UIREDBYSECT:ON � T�S 3'IOOOFTMELABORCODE,FORTHEPERFOFMANCEOF'HEWOH1cFOqWHICHTHISPERMITIS Q ISSUER MV WORKEfiS'COMPENSATION INSURANCE CARRII:N AND FOLICY NUNBER ARE: CONSTRUCTION _. � ---_""'__" '____"- ' j cnaaitR---'-'- ---"'- -------'-�------= PLANflEVIEW . ----' -- - � /�0 �� � � PouCYNUMeEa______- -.._ ELECTRIC __ ,.___1,.__ � ---- -_-.'.--�----- - ¢ (iH55ECT1(.WNEmN]TBEWNPL[TCDOFiNEPENMISFORONENU•\OFiF.DDOLLAiLS�100)(MLESS). PLUMBING ri � -- ..__. ..---.......--- ---- � Z 1 GERTIFY THNT IN THE PERFORMANC[OF TI IE WORK POR WHICH THIS PEHMI7I5 ISSUED,1 MECHANICAL � (f SHALLNOT EMPLOV ANY PEFSON N ANY MANNER SO AS TO BECOME SUBJECT 10(HF � (q WORKf•,qS'COMPENSATIONLAWSOFCALIFORNIA,ANUAGfiEF'THATIFISHOULDBECOME �NSP FEE —� ___,_,_._ T SU&IECTTO7HEWORKERS'COAIPF.NSATIONPFOVISIONSOFSFCT1043�ooOfTHELAgOfl �� j / __' ',.� � CA[)E.ISHALLFORTHWIiHCOMPIYWITHTHOSEPROVISICMIS. ZS�� V � IS�UANCE �i --.. .......------- —. .. - -'--- O p UATE:_'_____— APPLICANT: ___, .__...._' ' _ � �ryryry _.._. '_..__J__d w W ENERGY P!C y y J WARNING:FAIWRE fU 6ECURE WOHKERS'CQMFENSATID4 COVEF7AG[IS UNLAWFUL,A�0 SHALL�E � � "" ��/� --- '� � � SUBJECTANEMPLOYeHTOGRIMINA�PENALTIES�NOGIVILFINESUPTOONEHUN�FEUTHOUSAND ENERGYPERMIT � DOLlARS(S1oo,00D),INADDIf10NTOTHECOSTOFCUMVFNSATI0U,0AMAGESASPROV��(DFOFiIN (� p� -- -��------��---- --- J SECTION 37a80F THE LAUOR GOUE,INTEREST.AN�A�TORNEYS FEES. RETENTION FEE: 15 d+NJJ�� _ � � g� ._A r.�n .. __ OCONSTRUCTIONLENDINGAGENCY PRE-ALTFEE: _,_ ,..,__.. _.St1l�G�'Y _ _ __._ � IHEREBYAFFIFlMUNDERPENALTYOFPCRJURYTHpT1HEREISACONSTRL'CTIONIFNUINGAGF.NCV __ _____ ________ �p FOH THE PLRFORMANCE OFiHE WDRK FOfl WHICM iH15 PERMIT IS ISSUED(SEC.3097,GIV.G). �y Z '— � � LENDER'S NAME_'_-" -_—_ '-'__'"-"' _ —'_' __ '__" ____-_—____"___' - � F- LEtJnF.H'SAD�RLSS__. .—..._ _... ......__ � wICEHTIFYTHATIHAVEflF.ADTHISAPPLICATIONANDSiATETHATTHEABUVEIkFOHMATIONISCARflECT. �OIAL FEES � 1 AGREE TO CAMPLV WITH ALl CITV AND CAUNfY OfiDMANCES AND STATE LAWS RELATING TO Bu1LDING � / � R /� + � CONSTRUCTION,ANI]HEREBYAUTNORIZEREPRESeNTAT1VE50FTHISCOUNTyTOENTERUPONTNE In / v r � ABOVE�MENTIONEOPR�PERiVFORINSPECTIONPURPO5E5. COMMENTS .,___.._-_-_ � ��__—___ � 0 t�; AJ� 7 __�1F L.�� ��.- �C—'_- -. -__ "_ '__'_"- '_'_-- m PEFMI7TEE NAME(PRINT) � Q , � n(� � S �A -r.cti T�-k St��°� . �.�. ..s- — ---- -- - � � vj SIGN OF PERMITfEE D TE ��j SO VALIDATION � = HECPT.N0.___�AID BY _ � ._ ���_ � ~ WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLOENRO�File Copy,GREEN—Applicant's Copy � .� .. .. ._ _ . -- ;� , � � - � ----, -�- _ , , i__ .._ _. _ : r- � - ���� i i I j ' l ' (. ..I. _ � ' '� _ x�° � G ' . � � I � � ` 1�.., � �:f i i � � i i ,.� . . ��� I � ' ' � i � , j , � �� " � I � � \�: . � , i \ ; .�� ! � � k � � . � : � � � . � ' I i 1 . �� . �_ _ _ _ i. ..___, � �__ __ _i 7 � . . � ; i i � . i i °� . _ �f� ' _ I ' � ' _ i , i ' . - - � . ' . , I . , , . ,�s.-� ! I ' ., � , � , . � ! ' . � � � - � ' �, , � � � . U � , �� � ' . �- : ' : � ' . , ' ' � , , � : ; , __ � _ _ r'_ ._'. _i' _ '_'__" i"""' ' '_ _"_' ' . ':�� ' � ' � i � ' i � � � � � - � , ' I . � ' . � � - ',3`�. r 'Y I_ ' � I ' � . I � ( : I '� F S , , � ; � ' ' i • "z ��� � , _ i ' I , ! � ' ' �e"��+�� � • . � . , � I i �� .� �€�j � "t�i � � � I .. . '���. - � i I � � • �< q .+. : � � . ;I , , . , : . � ' i„4; °t4 .}�rc�.�s�,, � ._ 1 . =. f ' � � ' � : &s 3��t' t�` I ;� � .� _1 = k`! . � . ' ' . � , 3, -s p_ i ...., I -:Al- .I � _ - t- . . _ � . ' . - -� �—- L i q � � ' s� � �� � � j if• I 3 � a ��� �. .sy _ .� � � . " � i � � . 7"° � � _ � .s� _ _ � . _. _ �. ,._. t,"� . ' ' , , '��, ��. � _ � -- E . .. .. . _. , _ . i ra ' � i _ -' . . ; _ M# 4' y� . ' . ' I , � � ' ' , . . . � ' , . � ' � ' 4 [ �y :c� � _ i i I . . � i i � � � ' ' ' i - . , . � x� .sx �� ' ' ' _ I . . ; � � . i � � ' � � ' I i � � , � � • � � f �i@3) ' � I . ' I '` I { , � � ' � �� C� � � [ _ �� , : , I � �i . . , . � ..._ __.. _. � , �; ,. —.� 9 ,__ p . _ � .�- i , . I r ... ;py i . i . � . , �`�o� . ' . I - _ ,+a � , . 1 � { � i � � �.: ��`�, - i.-`�� _ ,� ; : . ' � .. � -,. � , � , � - : , � ., . ��.� , , - -� � I i . . � � . - ..� 3 �c: ` � � � " � " ` S #.i . . �.. . . ' " I , , ,. S4$i- a:{.c . � 1 � I �- � j ' . , � � � _ �' ;�. } . � p � t � �, '- � . . � .., i l.:�, � C. - 3 _: ' ' j • '� ig��x•r= A K, : � ,� �f 4 - . � . _ � � ' _ ' _ �. � � 34� �_. -- f ' ' . - � ,` . . � � .� �e� ,. � . rs�,_ ___.�. ..,_.._ s._._,..�.. ..._.�.....w _.. . � . � . . . ... ... " .,_..-,...t .-.�........ .........i ... ..., e..:....-.._.. .�........_.....� ; ' � � � �g ""'..."'.. . .. . . .__.. ' _.._..._..__� .,v__.,_._ , . _..... ........ .. 4.