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HomeMy WebLinkAbout13786 (16) � ( ��_ CITY OF DIAMOND BAR � j DEPARTMENT OF COMMUNITY d�DEVELOPMENT SERVICES � 21660 E.Copley Drive Suitc 190 (909)860-3195 Fax(909)861-3117 PRESS �'�9�'�� BUILDING PERMTT APPLICATION FIRMLY � � JOBSITE �.j 9�y� APPLICATION PERMIT ? o ADDRESS��J ��Q�UI'� ��ar �J� � DATE � � NUMBER .� �✓�-^- � c� �SSUE TYPE CC APN LOT TRACT DATE__ CONST. GROUP � � OWNER �017P�/h0.t'i�?r-' o ADDRESS �f�' �L'�'C �T��9 ZONING SETBACKS �'r —'-- FRONT RW C7 � z CITY ��n � lf'-��_ ZIP �-,� i�-. TE —' S APPUCANT �� �_vy'?' T�L3 7 {, 04 REAR _ ❑_ SIDEJSIDE STREET RW ❑__�_ � � CONTRACTOR (ti' aGJ k°`� G U� L ' SIDE ❑ � ADDRESS � �'� �` . �� L� "" ' � ROPOSED USE�_,j'��. ��'s��% � :� '�'�� G�n�/1 o CITY > �t?t��� ZIP 6c,t�` T 5L� c,. -> � � w ApCHlENG/ ""` z DESIGNER � -F , ' I�f�� '�" � NO.DWEL. NO. NO. � d ADDRESS `i a s� � e�=1 �rl�• �` ; UNITS,________,__.� STORIES BEDROOMS � � CITY )'. Zl�t:'�'''�' �' Z'�D� --•- � N DESCRIPTION SQ.FT. FACTOR PSF ADJ.ARErWALUATION r OOWNER-BUILDER DECLARATION SFR/ADD/RFM (� I HEi7EBV AFFlRM UNOER PENAL7V OF PERJURY THAT I AM EXEMPT FqOM THE CONTPACTORS LI- � Garage/Carport � W CENSELAWFOR7HEFOLLOWINGREASON�SEG.7031-HUSINF:SSFNDPFlOF[SSIOYSCODE�.ANYqTYOfl ;, U Cp(1NTYWMlCHREWNIESAPERM17TOCONS7AUCT,ALiER.lMPAO`JE,D[MUUSH,DflAEPA1RANY57AUC- W PatiolDeck 4 w iURE.PRIOR 70 ITS ISSUNJCE./U.SU REQUIqES THF.APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED W F STA7&1AEM THAT HE OR SHE IS UCENSEO PURSUAN�TO TNE PqOVISIa4S OF THE CANTMC70RS LI� � CENSE LAW(CHAPTER B(COMMENCIYG WITH SECTIOIv 7000)OF�IYISION 3 OF THE BUSINESS ANp FRO- � POOUSPa � FESSIONS CODE)OR 71ihT HE GH SryE IS EXEMP7 THF.flf FflOM AND 7HE BASIS FOR THE A!LEGED EXEMP� : V 7pN,ANYVKKATIONOFSECTION7037.5BYANVAPPUCANTFORAP4RM17SU&IF:l:TS7HEAPFLiCANtTO Z Re-Roof y � A C7VIL PENAL7Y OF HOT A10RE THAN FIVE HUNDRED UOLlAfiS(SSCoI). � CII,ASOWNEROFTHEPH07ERTV.OfiMVEMPLOYEfSWITHWAGE5AS7HEIH50lECOMPEN5ATKIN, � Commercial _ � WILL 00 THE WORK,AND iHE STRl1GTURE IS NOT INTENDED OR OFFERED FOR SALE(uEC�Ona,fiUSl- J - ' � NE93AND VROFESSIONS CODE:THE CONTPACTOI75 JCENSE lAW COES NOi APPLV TO AM OWNEA OF � � PROPERTVVhiOBUILDSORIMPROVESTHEFlEON,ANUWFiODOESSUCHWOqKHIMSEIFORHERSELFOfl � 9 � n{qpUGFINISORNEFOWNE►1Pl.OYEES,PHOVI�E�T}iATSUCkIIMPftOVEMEN75AFlENOTM7EN�EDUR t W OFFEREDFORSALEIF,HOWEVERiHEBUN.bINGORIMPROVC-MENTISSOIDWITHINONEYEAROFCOM�LE� + � TION,YHE OWNEfl�8UIL0ER WILL HAVE THE BUR�EN OF PflOYING fHAI'Hf OR SHF fJ10 NOT OUII�OR � IMPROVEFORTHEPURPbSEOFS/dE). (, W Il1,ASOWNEROFTHEPs10PE.7�Y,A4EXCLUSIVELYCONTPACTINGWi7HlICEN5E0WNTPqCTOPoS � � To CONSTRUCT TMF PftQIECT(SEC.l0I<.BUSINFSS AI�D PROFESSIONS COnE:7Nt CONTFACTURS LI- 21t13ti0fi r ADJ.AREA � W LENSEU4VDOESNOTAPPLYTOANOKHEROFAPflOPEPNWHO�UIIUSOR:MPFOVFSTHEREON,Ah� - -� WFIOCONTflACTSFOHSUCHPROJ6CT5WITHACCNiFACTOR(S)LICiYSF_DPURS�b.U7TOTYECGNTRAC- UANTITY DESCRIPTION FEE g� F- TORS LICENSE LAW.). - ------ - ---'— £ � L]1 AM EXEMi�T�hDEFl SEC. _.__9.8 P.C.FOR TH!5 RE.hSON � Z O ----------- ca� E' 3 � ---- --�---- �� - - � LL DA7E ^_-- OWNEH_"____ -_.__.......... 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ELECTRIC .__ � � � —�-- --- � I PLUMBING � � (7FLLSSECfpNNEFDNOTBEOWa'L[TEDOF7/2FPERiJ1TISFOHCNEIf'r1NaE�00iUvt5� iL5 :' _"__"".. ..'_'_ -'-___"__ W MECHP.NIGAL � � I C[RTIFV THAT INlHE PEAFOHMNNCE OF THE 1VORK FOH WHICM 7Hi5 PFRMII'IS ISSUFD,I ----�-•-� .. , -""'------'--- '(}' SNALL NOT EMPLOY RNY PERSON IN ANY MANNCF SOAS TO BECOME SUWE:�1(?TH[ . . ' {, � WORKERS'COMPENSATIONIAWSOFCALIFOP.NIA,A��ACHLF1�i0.TIFISHOULDBECOME INSPECTIONFE[ _ � � SU&IECTTOTHEWOflKEP.S'COAIPFNSATIONPROVISIONSOFSECTION3'/CnO��H�LAHON � � GOUE,ISHAlLFOR7HWIT1{(;OMPLYWI7H7 ° FOVISIONS. � ISSUANCG -���� _ / --------------... ._....._ � ; �.� O j (79(�� L p + ✓ SMIP . ' F� � pw DAYE:_�.__£.__ 1 1 APP�ICANT. _ �'^ �-FF'-l. l _____ ._-__---__--_-___ J WARNING FAILl1RET09ECUHE WOflK[R9'COMPENSAI'ION COVERAGE IS VNIAW�U.,AND£HALLBE �NERGY?/C .. . __ � � __. ._-._._— � `'•k__-' � SUSJECTANF.MPLOYEFlTOCRIMiNA4P'cNAI.TIESAN�CIVILFINESUPTOONE4iUNUNFOTHOUSAND ENERGYPERMIT'"'�___ _____ pOL(ARS(LI00,000),INADD�TIONTOlHECOSTOFCDMPENSATION,�AMAGESASPF041UEDFOrlIN - �� r� � SECTION370B OG THF.LAOOR CODE,INTEFEST,ANo ATTORNEYS FEES. _.-- FlETENTION FEE:'�'�_ I�•__� a CONSTRUCTION LEN�ING AGENCY pRE ALT FE���� �� d .� -----------------�- - � � I HLREBV AFFIRM UNDEFl PCNALTY OF PEfUURV TI IAi THF.RE IS A CONSTRUCTION LEN�ING AG�NCV F' FOFTHE PERFORMMICF OF SHE WUflK FUF W41fCH iHl$PEFfd1T IS ISSUED(SEC,30`�7.CN C.). � � Z �,.� /' � ii LLI 1����-__ C� ��"-"'--__'_ -___"-"' ___._'"— � � LENDER'SNAAIE_ ] '_... .. ._'_ - . '_'_ "—'_"_'_'. ._...—__ � LENDER'SADDPE55____" ___"" ---"'----' (�'y' , /'''�') /(�,{�y� C � I CERTIFY THAT I HAVE REAO TI IIS A{'VI.ICATION ANC STATE THATIHC-q9OVF INFOHMATION IS CORRECT. �V 1 AL F EES � (£,// � C / 1 � IACREETOCDMPLVWITh1ALLCITYMDCOUNTYOfiUINANCESANDSTATELAWSREL�TINCTOOUILDING r � « CANSTRUCTION.AP10 hlf:fiEDY AUiMORIZE FEPRESENTATIVES nF THIS COUNTY TO ENTER UPON THF. )/y� Z qBOVE�MF.NTIONEO PROPEFIY FU1i INSPECTION PUAPOSES. lJ ___ _ _____ � P COMMENTS� ! .-_ . O J � . C.. __._____— _ •: _"'.__'__'_'"' ______—_____-"'____"_ ___'__-_"- �_'__"___� m PERMI EE t1AME�PFlINT) � ----- - a �_ ��(� �'� _._.. -.--'...._'___ E I �'i .�- ' I^"�� F- i � � '-' - fi 3 �`- � •- PAID 8Y -• -'----- /° i- - ' = SICaN tl EO PEAMiTlEE DATE •� .,. VALIDATION_ a__ FECPT.NO... . �'t_--�----_------- - ~ WHITE-Department Cnpy,YELLOYY-Finance Copy.PINK-Assessw Copy,GOIDENROP-File Copy,GREEN-ApplicanPs Copy � , i � ' ; .. 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