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HomeMy WebLinkAbout10666 � � CITY OF DiAMOND BAR COMMUNITY DEVELOPMENT DEPARfM 21660E.Copley DriveSuite l9D PRESS � (909)860-3195�ax(909}861-3117 '""' BUILDING PERMIT APPLICATION FI RMLY � J08SITE �la�rS�T� ���%`l�d��, . DATEICATjQN NUMB R ����� #/C I /''�"�� • o ADDRESS ZS t' ' ' ISSUE TYPE OCC � APN LOT TRACT DATE CONS7. GROUP � p OWNER �" �C9�G��("��r/SSG;iIZ " ADDRESS ZONING SETF3ACKS OCITY 21P TEL.7� •� . •�� FRONT RW Ll _ APPLICANT TEL. REAR --7TI T�-- f7�__ z SIDElS1DE STREET_____�RW Lsl ¢ CONTRACTOR�T���a ri - rG' S ." /> SIDE � n_ ADDRES�S�,+,� fv ' S t OPOSED USE �' e'�"`� �'''�� �� hx.� � CITY�. .,�'/ /YD.0 i.� 71P��EL.l�'LG•� - i o ARCWENG/ _ �z DESIGNER NO.DWEL. NO. NO. a ADDRESS_���L - UNITS STORIES BEDROOMS � CITY / ZfP ^ TEL. -- � - y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BI:ILDEF DECLARATION SFR/ADD/REM O p I HERE6Y AFFIRM UND£H PENALTV OF PERJURY 7NA1 1 AM EXEMPi FROM THE CONTRACTORS LI� GafBgB/CBfpOR L1J CENSELAWFORTMEFOILOWINGREASON(SEC.7031.SBUSINE33ANOVNOFESSqN9CODE.ANYCITYOR (n C� CDUMYWHICHt7EWIRESADERMI7TOCONSTRUCT,ALTER.IMPROYE,DEMOLI6H2ORpEPA1RANVSTRUC-� _ w pat10IDBCIC . . . -W� •RURE,PAIOA TO ITS 135UA#ICE AL50 RE�UIRES-THPkPPLICAMT FOR SUCFF PEPMIT TO FILE A SIONEO ' ' SiATEMEN7 THAT HE OR SHE IS UCENSED PUFSUAM TO THE VROVISIONS OF TNE CONTRACTORS LI• � GENSE LAW(RiFPTEH 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F TME BUSINESSAND PRO- � � PooUSpa FESSIONS CODE)OR TNAT HE OR SHE IS EXEMPT THEHEFROM AND TIiE�ASIS FOR THE ALLEGED EXEMP- � 710N.ANYVIOUTIONOFSECTION703t,5BVANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO � Z Re-Roaf � R CIVIL PENALN OF NOT�IORE THAN FIVE HUNUflED UOLLARS(f500�.}. • 0 fII,ASOWNEROFTHEPROPEflTY,ORMYEMPLOY[ESWITHWqGE5A5THEIR50LEfAMVENSATIDN, : � COTlI1BfCIBI Z WILL 00 7HE WOFK,AND TNE STRUCTURE IS NOT INTENDED OR OFFEflED FOA SALE(SEC.7044,BUSI- • J � NESSAND PROFESSIONS CODE:THE CONTRACiORSIICENS[LAW UOES NOT APPLY TO ANOWNER OF � PROPERiY WHO BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIM6ELF OR NERSELF OR � THRW(iHHISORHEHOWNEMPLOYEES,PROVIDEDTHATSUCHIMPFOVFIUENTSARENOTINTENDEDOq 'm QOFFEREDFOHSALE.IF,HOWEVER7HEBUILOINGORIMPROVEMENTISSOIDWITHINONEYEAFOFCAMPLE- Z TION,TH[OWNER�Bl11LDER WILL HAYE THE 9URDEN OF PflOVMG THAT ME OR SME DID NOT 9UIL0 OR � IMPROVEFOflTH[PURPOSEOFSALE). w Cl1,ASOWNEFOFTHEPROPENT',AMEXCLUSNELYCANTRACTINGWIfHLICENSEDCANTiiACTOHS � TO CONSTRUCT THE PRQIECT(SEC.704q BUSME55 ANO VqOFE5510N5 COOE�THE L'ONTRqCTORS LI- V01U8110f1 ADJ.AREA W CENSELAW�OESNOTAPPLYTOANOWNEROFAPR07EFTYWHOBUILDSORIMPFlOVESTHEflEON,AND � WHOCONTRACTSFORSUCHPROJECTSWITMACONTflACTOq�3)UCEtJSEDPURSUANTTOTHECONTFAP QUANTITY DESCRIPTION FEE TORS UCENSE LAW.). � O�AM EXEAIPT 11NDEN SEC.__ B.&V C.FOR THIS FEASON Q G � '- '_" ^ _"' '__-' . Q Z� � JC C �- fJ J � DATE_____. __ OWNEH �' ~ Z '_ __'�' ___- W � LICENSED CONTRACTORS DECLARATION � W � IHEflEBVAFFIRMUNDERPENALTYOFPERJURYTHATIAMLICENSE�UN�ERPROVISIONSOFCHAPTER � � d� 9(COMMENCINGWITHSECTION7000�OFDIVISION30F7HE9USINESSANOPROFESS!ONSCOOE,AND Z �X: MY LICENSE IS IN NLL FORCEAN�EFFECT. m � LICENSE CLA55�(�� L1C.NO._ T"�I��'�y j V DATE�t�Ft�__ CONTRACTOR��N�'� �{¢j,�j__ �d W � WORKERS'COMPENSATION DECIARATION � � a N IHEREBYAFFIRMUNDF.RPENALTYOiPERJURYONEOFTHEFOLLOWINGOEIXARATIONS: U � Z O _�IHAVEANDWILLMAiNTA1NACERTIFICATEOFCONSEN7TOSElF�INSUREFORWORKERS' _ COMPENSATION,AS PHOVIDED 6Y SECTION 31000F TNE LABOR CO�E,FOR THE P[RFORMpNCE U ¢ OF THE WOqK FOR WHICH 7HI5 PERMIT IS ISSUED. � O W _IHAVEANOW�LLMA�NTAINWORKERS'COMPENSPTIONINSl1AANCE,ASPE�lJiREDF3Y5ECT10N Q3]aoOFTHE LPHOR CODE,FOR THE PEPFOHMMICE OFTHE WORK FOR WHIGH 7HI5 PERMIT IS ,-.g���,/5, ISSUED.IAVWO�RK'E�Pp$'�CA1.MPENSpTIONINSuqpNC�EC��nR}R�IERANOPOLICYNUMBERARE: CONSTRUCTION ��'•'� j cnqqieA- _�--;I—!-2" .�r^ �'7 -- PLAN REVIEW �s•U� —.-- --- �0 POttCYNUMOER '� �� ._—. ELECTRIC � ���` Z — -- Q � (IHlSSECTIONNEmNOTBEOJMPLEfEDOFTHEPEN�IRISfOR�NEF4F�Df7EO00l1AFi4(E1a��R1E55). PIUMBING __'_ '_'_. „" _ Z I CEHTIFY TMAT IN THE PEFFOFMANCE OF THE WONK fOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL ___ ._ _,. ('j St1AlL NOT EMPIOY ANY PERSON IN ANY MANNER SO AS TO BECOME SU&1FC7 TO THE � WORKERS'COMPENSATIONLAWSOFCALIFORNIF,ANDAGHEF:THATIFISHOULDBECOME INSPECTIONFEE ___ ___ _—_ _ SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECT10Y37aoOFThIF.LHBOH �� . (�/� � CODE,1541ALLFORTHWITHCOMPLY T EPROVI51(NiS. ISSUANCE _._ ._ ._._, �Q /g' 1 � DATE: �r r��J^/�APPLICANT. .���__��� SMIP —_'_ '-" _'_ I e��- W ENERGY P/C J WARNING:FAILURE TO SECURE WOflKEfl3'LOMPENSATION COVEFiAGE IS UNLAWFUL M1D SHALL BE -'----" - '- LL SU&IECTANEMPLOYERTOCRIMINAIPENALTIESPNOCIVILFINESUPTOONEHUNOREDTNOl1SAND ENERGYPERMIT _.__ DOLLAflS�5100,000).W ADDITION TO THE COST OF COMPFNSATION,DAMAGES AS PROVIDED FOR IN -"-"'- J SECTION 3]OB OF THE U60R CODE.INTEREST,ANDATfORNEY'S FEES. RETENTION FEE: CC _'_—' _ '—_ a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: __._ __ _ Q I HEREBV AFFIflM UNDEH PENALTV OF GER1UqY THAT THERE IS ACONSTRUCT�ON LENDINO AGENCY ---�---� � FOR THE PERFORMANCE OFTHE WOflK FOR WHIGHTHIS PEHMIT IS ISSUED(SEC.�087,CIV.C.). � �Z _ _' '_ 2 LENOEHS NAME __-_._ --.---..-- '} '_— '_'"'_—' '_— __ F- LENDER5A�DPE55______�_ � TOTAL FEES �°�°j � ICERTIFYTHATIHAVEREI.DTHfSAPPLiCATfONANDSTAtETHATTMEABOYEMFOqMAT10NI5CORRECT. W IAGREETOCOMPlYW1THALLCITYANDCOUMYORDINANCE5AND5TATELAWSREIATINGTOBUILUINO � CANSTRUCTION.ANDHEREBYAU7HORIZEREPflESENTATIVESOFTHISCOUNTYTOENTEFUPONTHE N00VE•MENTIQYEDPROPEATY FOR INSPECT�ON PURPOSES. z (` COMMENTS-----.---------- —.— — — � /���/ `�/f' "P E r �J — --- --- _' �-�9 • 4�--- � - m PtF.RMiTiEE NAME(PflINT) _ . __ � �.� ��``�� --- - � � TUR OF PERMITTEE DATE �jJ�� _ / RECPT.NO. �'�_.`PAID B� __ VALIDATfON ~ WHITE—Departmenl Copy,YELLOW�inance Copy,PINK—Acsaeaor Copy,GOLOENROD—Flle Copy.GREEN—ApplicanCs Copy � i` _..,�_a �y__.�._i__.r. . ��_ � __ �_.. _ � �._ i ��_ _ �__ �._. _.I .�.__...__ _.' - I i � I , =_�.._._ I i I � i 1 � � � .. � �.. I I i I � �___i � I i . � � � j 1 i , � . j l � � ' � i , � � .� : � ( r. � �. 1 ,�= . 1-= � ; ' i = GI i. � = .I � - - � :I. I � � � . I � .. . � :f::_ - �f �. , ,I� ; ;i � . . ' �; i - I I ' � . I i ' r_: I ^ 1 . ! '".�. I_ t ' . , ": � � `, I � f .,, _ � � � � !. �I II _ '.I i � " � . . � �. . __. . 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