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HomeMy WebLinkAbout13879 CITY OF DIAMOND BAR ---- " — DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �w . 21660 E.Copley Drive Suite 190 PR�` (909)860-3195 Fax(9U9)861-3117 ���'9�",� BUILDING PERMIT APPLICATION FIRM1 � JOBSITE f APPLICATION PERMIT �(� P!C y"-�cy s� � ADDRESS /���/ /Yli� .2 fJ7ll,1� � � � /�CJ � I / '"��"��' �� �' DATE � � NUMBER=� q � ISSUE � TYPE OCC APN LOT TRACT_ DATE CONST. GROUP p OWNER G"�l�'�C[.) �dl./p S�'���Gc'S" p ADDRESS�• �1��J6t%? i�`v.� ZONING SETBACKS W CITY � P->j� "� ZIP y� TEL.Cl� 6���'D FRONT RW U � APPLICANT�ff„j�� sA'�".s��.oh:z'`i�,..� TEL. -"' '� REAR ❑ � � SIDE/SIDE STREET RW f_] CONTRACTOR � i'•�✓ �.�/S� SIDE ❑ Q ADDRESS ��f `" /N ' E �. �� � CITY ��r.�"?�"��a' ZIP �,7�'G 7EL.,^1'D� S/.f%'aa PROPOSED USE_ r�'. _ • • � _ w ARCH/ENG!,�7 — ' � DESIGNER !/-L ��C�/�v'�� � � ADDRESS ' i c> "�/ NO.DWEL. NO. NO. � CITY % /�'JG 7 ZIP�� 7EL.�ls�_�34°�/rj'66 UNITS STORIES ___.__,_,____�BEDROOMS__ k u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION � Q OWNER-BUILDEH DECLARATION SFRlADD/REM C 0 I HERE9V AFFIRM t1NDER DENALTY OF PEftNNY THAT I AA1 F%[MPT FROM THE CANTRACTOHS LI- QyfBQB/C9fPOf[ W CEN6EUWWRTiEFOLIOWINGREASON(&EC.7037.SBUSINESSANDPROFESSIONSCODE:ANYCITVOfl (n � U COUNTYYhIICHRC-0UIRESAPERMITTOCONSTRl1C7,ALTER,IMPROVE,�EMOLISH,ORHEPAIRANY57Rl1C- � W TURE,PRqR 70 ITS ISSUANCE,AL50 HEOUIRES TNE AVPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Pa�io/Deck 8TATEMENT THAT HE OR SHE IS LJCENSED PURSUANT TO"fHE FpOVISIONS OF THE CONTRAC70FlS LI- � GENSE LAW(LMAP7ER 9(COMMENqNO WITN SECTION 7aoo)O(UIVISION 3 OF THE BUSINE55 AND PRO- u' POOUSpa � FESSpN5CODE)ORTHATHEORSHEISEXEMPTTHEREFROMANOiHEBASISFORTHEALLEGEDEXEMP- p¢ TKKJ.ANVVKKATIONOFSECTION7W7,SBVANVAPPLICANTFOFlAPERMITSUAJ[CTSTHEAPPLICANTTO Z Re-Roof § � ACINLPENRLTYOPNOTMORETHANFIVEliUNDRE000L1AR5(i500).J' 6 � ❑I.ASOWNEROFTHEPROPERN.ORMYEMPLOVEESY/ITFiWAGESASTNEIRSOLECOMPENSATION. � COmm9fCi21 ��l/a � Will DO THE WORN,M!D THE STRUCTUIiF IS NOT INTENDED OR OFFFREO FOq SAII'ISEC.7ond,BU51- J � NE99 ANO PRDPE93:ON3 CODE:THE CONTR�CTORS LICENSE L1W DOES NOT APALY TO AN OWNER OF � PROPEFirY WIiO 9UItD3 OR IMPROVE57HEfiEON,AND WHO DDES SUCH WORK HIM3ELF OR HFRSELF OR � TMfqU(iHHI50RHERONRJEMP�OYEES,PROVIDEDTHATSUCHIAIPROVFMENTSARENO'fMTENDE�OR m QOFFERE�FORSALE.IF,HOW[VEF47HEBUIlDIN00RIMPROVEMENTI550lDWITHINONEYEAROFCOMPLE� Z TION,THE OWNER-BUILOER WILL HAVE 7NE BURDEN OF f�ROYING THAT NE OR SHE filD NOT BUILD 9R � IM7ROVE FOR THE VU{iPOSEOF SALE). _ ❑I,A60WNER OFTFiE PROPERfV,AM EX�.UGNELY CANTflACTING WITH LIC{N6c0 CONTHACTOR6 ¢ TO LOhJ5TRUCT TiE PRQIEC?(SEC.7oM,BUSINE55 PNO PROFESSIOYu COUE:THE COiVTflACTORS LI- V�7�1J2410f1 1 ADJ.AREA W CENSflAW00F5NdTAPPLYTOANOWNEROFAPROPERTYWHO&lILD50RIMPROVESTH[HEON,AN� I H7{OCONfRACTSWRSUCNPRQIEC7SWITNACONTRpC7UR(6)UCENSEOpJRSUANTT07HECONTFAF OUANTITY DESCRIPTION EE TORS LICENSE UW). �°� ,�.(� � IJ I AM EXElAPT UNLIER SEC._ 8.8 P.C.FOF THIS REASON Q O �v�� �����' "� '^�✓+� �S`CV V � U I� L�7/� J JYJv.G4S� ' -� —' _'—_"__—_.'_""___".'_"'._"_ � ' k �'1' DATE_ OWNErI � f� Z w ✓CS L7�/L�'/�� - L� ' G � LICENSED CON'fRACTORS�ECLARATION W � 1 HEREBV hFFlRM UNDER PENALN OF PERJURY THA71 AM LICeN5E0 UNDER PROVISIONS OF CHqPTEfl � ;,^"�..� ^��.�� `'��,,�Y'� (� D(COMMENCINO WITH SECTK;N�o0a)OF DiVISIQV 3 OF THE Bl1SMESS M1D PHOFESSY�4S COOE,AN� Z _ �� J �' � `X MY LFCENSE IS IN Fl/LL FORCE N�D F.FFECT. m ����C s_ J � IICENSE CLA55_1�G LIC.NO. �� G-��� j ` r UDATE �_.S� .�7 __' CUNTRACTOR��`�"C/btl C•~ !Y d / �e• `• �S ��� w ' / s'Ii� 5..:.r�� � WOHKEfiS'COMPENSATIONDECLAqAT16N '�. +� , � � � IHEREBYAFFIR EFiPENALfYOFGL0./URYONF.O�THE�OLLOWINGDECLA�lATIONS: ! (� —i— � ♦ d G HA4EAND�h'ILLMAINTAMACER�IFICATEDfCAaS'eNTTOSEIF�INSUREFORWORY,ERS' ! �'j`'� � ���y�_ � � COMPENSATICN.AS PROVIDEO BY SECTIOIJ 3]co OF THE LSBOfl CA�E,FOFl rME PEflFORMANCE �d 1 OFTHE WORK FOR WHICH THIS��RMI?IS ISSl1ED. �'� � G7 � _I HAVE AND VlILL MAI�TAIN W.ORKERS'COPAPENSATION INSURANCE,AS REOUiPED BY SECTION ' � 970o OF TFIF LABOR CODE,FOR THL 9E.FiFOAMANCE OF THE WORK FOR WHICHTHIS PERMIT IS �] : J ISSUFD.MYWOP.KERS'WUFENS:.�;ONINSUBANCECARHIEFt.UtDPOLiC7NUMBEFARE: CONSTRUCTION . _____,.,__�� __ �"` .. .. � j CRRRIER�'Y�_f.�_��l'e. ..61+<S_._..L`Gd���'---� ---- PLANREVIEW • ----..._.._.i .— -_ --- � Pa�cr nuMeeri��L.`��2'G����""�-� ------- ELECTRIC _ � f`�— ¢ _ �' p fnuss[cnonir��taoi�o�MtEre�oFni�r+��rxr�swriorreta�wnfoocxunslb�w)oH�ess} PLUMBING w f� Z 1 CERTIFY TMI1T IN TNE PERFORMANCE OF THE WORK FOFl WHICH 1'HIS PEHM�T IS ISSIJ[D,I MECHANICAL -g;y'•'-�'ti�� ___ (!3 SHALL NOT fMPIUY hNY PERSON IN ANY MANNER SOAS TO C+ECOME SUBJLCT i0 i IiF A�?;'.�==� �n WORKERS'COMPi:N9ATiON UWS UF CALIFORNIA,AND AGPEE THAT IF I SHOULD BECAME INSPECTION FEE'" � = SUQ)[GTlqfll[WORKFRS'COMPENSATIOMP(tOVI51UNSOFSECTlqY3]ooOFTHEIABOR — - � R COLE,ISHAILFORTHWITHCOMPLYWI7HTH e OVISION . ISSUANCE ' _�y�''�, ._ _.. .. ..._. p DATE:��IJ'•�`f'_ APPLIGAN7� _._ `_� '` .v SMIP S•`� ._:^...L:'_,����_ _ __� _... '� -{� w ` � ENERGY P!C�`•e;"� � -� �� �Z "+J -- � WARNING:FAILUR[705ECUREWORKF.RS'COMPENSATIONCOVEflAOEIS NLAWFUL,ANDSHF!LOE y,. � . '--- — � S1161FCTANFMPIOYERTOCRIMINALPENALTIESANOCIVILFINESUPTOONE�+.UNORCDTHOUSANU E��•-•T -'r�';/��;,%�;"^>'-'• __ -� •'SY �'� ... DOLLANS(5/00.OD0).�Nl�DITIONTOTHFCOSTOFCOMPENSATI04,DAMAGF.SASPROVIUE�WFiIN ' '� �-x �"; � --J'___ ..: � � SECTION37060F'MELABORf.ODE,INTEREST,ANDATTORNEY'SfF.ES ' ' " ' � ' �'� �� � ;. N'��E"'� � ---------- ...— � _.._.— � CONS7RUCTYON LENDING AGENCY PRE- "aSa, � I HER[BV AFFIRM UNDER PEhA1.TV OF PEFlJURY THATTHEFE IS ACANSTRUCTION LENDING AGENCV n- FORTHEPERFORMMILEOFThIEWOHKFOHWH!CHTHISPERMITISISSIiE�(SEC,3o9�,GV.C.). ��-�- ��--- ��� �� � � —�� �� � Z W . ______"_.'__—_--.'_---__ .. a LENDFR'S NAMF,._,._ ... -- ' _ """"'__—..._ ! _._..._"_' F_ LENDER'SADORESS_.___ _ ------ • ¢ ICERTIFVThiA'fIF1AVEREADTHISRPPLICAiIONANDSTAT[THATTHEABOVEINFORMATIONISCORRECT. �T�FEES� l� �« � � n QI ACREE TO COMPLY WITH ALLCITY AND COUNTY ORD�4ANCF.S AND STATE LAWS REL4TING TO BUILDINC (bNSTRUCTION,ANDHEREB�AUTHORIZEREPftESENTATIVESQFTHISCOUNTVfOENTERUPONTHE � ZABOVE�MF.NTIONEOPf10PEFTYFORINSP[CfIONPURPOSES. COMM$NTS Q V7� � _"_—_"""" "_""' —"'_"--'_'_""'__ % m PERMITTEE NAME(PRINT) _._.....""'___"_" "_ __ " � .'" ' � 'i _'""_ — � i � �' � � —___'____-_" ___— -_'_"""'__ :'yr,�'�.�.'�-.c-'_' G / ,, SIGNATURE OF PERMITTEF C�ATE = RECPT.NO._.�`_f_��PAIDBY VALIDATION_ � � %L.-�,. ~ NJHITE—Oepartment Copy,YELLOW—Finance Copy,PINK—Assessor CoDy�GOLDENRO�-File Copy,GREEN—Applicant's Copy , __. _ — ,. � . � � � � ' �� � — � �� . � � � . ; � ' ; , ; - . : , . . ; � , ; � ; . � � � � � � ; _ i � . � ; � , . : . . . _.._.. —— s __ _ — — � , , ; � ; , ; , � . � , , . . : , , � , , . , ; , ,: ; � ; . . , , — — --- -— — � . � ; , _ — � � , � � � — _. _ _ , , � � � _ k.� � � � _ '.i . _ . .., � -- _.. ... .. . _ . . . ' C- .. .. . .._ . I _ ,.. ��` i .��\ I .'. , . , .. . ;_ :. � � � . � �� � . � � � : ' � � : . . .. � � � � � . . � . ;�, � . 5 . . , � ; � , - , . . . . . . "�, ' ' . .""' ;�_ . �-. _ . - ; . . , . . . ` � � i . \ . _ 'y- � �--- �— , , a � - � � ' � . - �� - - - . � - ;. f . , -. ,_ , - . � _ . i.. � . . � � ' � , . . . ..: • . .. ; -------''''`,