Loading...
HomeMy WebLinkAbout14334 (19) � CITY OF DIAMOND BAR v--��-' � '----��-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 �'" PRESS (909)860-3195 F�(909)861-3117 �'9M'~ BUILDING PERMIT APPLICATYON FIRMLY � JOBSITE � ,{'�i���� ��, ia,��.! DATECI��10 i�`g� NUMBER � ��� #/ � �"" o ADDRESS �I� IL IJ CX { � ISSUE TYPE ��.-. OCC APN LOT_ TRACT DATE CONST. 6 GROUP � p OWNER �� " ADDRESS "� � ---�"�•� ZONING SETBACKS Z CITY � Zip� TE .. t • J FRONT RW _ ❑ g APPLICA� l•�,,�,{(��(�f,�� T L. "1� REAR ❑ �d„ _��� SIDE/SIQE STREET_ RW CI___ ca CONTRACTOR r°.� SIDE ❑ ADDRESS ` `` � CfTY ZIP `Z � TEL. PROPOSED USE 8 ARCH/ENG/ T'� y 1��V.[.(�1.P�YL -.YCV✓L � Z DESIGNER ���D�fl � ADDRESS '2t�ljfL �Ilb'v1vt(�dd - �`�y NO.�WEL NO. NO. � aTv i�rvi vt.� ZIP")l� TEL.�y�`1�G+J'��A UNITS STORIES �BEDROOMS rn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADDlREM O � I HEREBY AFFIRM UNDER PENAL7V OF PER1UfiY THAT I N.1 EXEMPT FROM THE CONTRAC70R5 L4 Gef&(JB/COfpOR W CENSEUWFORTHEFOL�OWINGREASON(SEC.70.91.68USINESSANDPROFESSpNSCODE:�NYCITYOR (n C7 COUNfVWHICHREWIRESAPERMITTOCONSTRUC7,ALTER,IMPROVE,DEMbLISH,ORREPAIRANYSTRUG W Patio/Deck � W NNE.PRIOH TO I75 ISSUANCE.ALSO REW IRES THE RPPLICANT FON SUCH PERMIT TO FILE A SIGNED W STATEIAENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF h1E CANTRAC70RS LI� � CENSE LAW(CHAPTER 6(COMMENCIVO WITH SECTION 7000)OF�IVISION 3 OF THE 9USINESSAND PPO� u' POOVS�B FESSIONSCODE)ORTHATHEORSNEISEXEMPTTHEREFFiOMANDTHEBASIbFORTHEAI:EGE�IXEMP� (� TKKJ.ANVVIOLATIONOFSECTION7D31.5BVANYAPPLICANTFORAPEHMITSU(fJ[CTSTH[APPLICANTTO Z Re-Raot � ACIVIL PENALTY Of NOT MORE THAN FNE HUNDRED D011ARS(5500�.): � � ❑I,ASOYMEROFTHEPHOFERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COfIlrt10fC18I �? f� E�C,^' WILI DO THE WORK,AND THE STRUCTURE IS NOT INTENDF.D OR OFFERED f OFl SALE(SEC io�4,BU51� .J N NESS RND PflOFESSIONS CODE:THE CONTRACTOP,S LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTY 1VFi0 BUILDS OR IMPROVES TiiEFlEON,ANO WHO W'e5 5UCFI WOflK HIMSELF OR HERSEI�Ofl Q TNq01)GHHISORHEROWNEMPLOVEES,VROVIDE�THATSUCHIMVROVEMENTSARENOTINTEN�E�Ofl m 0 OFFEREDFORSALEIP,HOWEVER7MEBUIIDINGORIMPROVEMENTIS80LDWITHINONEVFAFOFCqMPLE� Z TION,THE OWNEfl�BUIL�ER WILL HAVE THE BUF�EN OF PPOVING THAT NE OR SHE DID NOT BUiLD OR = IMPROVE FOR THE PURPoSE OF SALE). W ❑I,ASOWNEROFTHEPROPEHfV,AMEXCLUSIVELVCONTRACTIN6WITHLICENSEDCON7RACTORS � TO CONSTRUCT h1E PqOJECT(SEC.7o�4,BUSINE55 AND PROFESSIONS CO�E,7F1F.CONTFACTURS LI� V8I118IIDfl ADJ.AREA � CENSEUWDDESNOTAPPLYTOANOWNEROFAPflOPERTYMM06UILD50R!MPfiOVESTHEpEON.AND � NM1IOCOMMCTSFORSUCHPRQIECTSWIiHACONTRACTOR(S�LiCENSE�PURSUNITTOTHECONTRAG QUANTITY D SCRIPTION FEE � TOpS UCENSE UW.). � U T AM EXEAIPT UNDER SEC._` B.&P.0 FOR TNIS REASON Q I ,�� � DATE _ONTJEfl -____"_'_"'_-_'_"_"� U� f i Z W � LICENSED CONTRACTORS DECLARATION �j 1 HEREBY�FFIRM UNDER PENALTV OF PFRJUFY THAT IAM LICENSED UNDEfl PPOVISIONS OF CHAPTEfl �/� /� � 9�COMMENCIN(3 WITX SECTION 7090J OF�IVISION 3 OF THE BUSINESSAND PROFFSSIONS CAUF.AIiD Z ���N 6� ' M 1 �� MY UCENSE IS M FULL FORCE MD EFFECi. / [��/� .�) m 0 UCENSE CIASS� �� _V'_��LIC.NO. �� lJ v/ v j . a ` � 'y'� • � J V DATE ����J�rL; CONTRACTO� _��___.�^�1�_�,�.1�%�'�_ ° d r o�� ��� •' 3�,�.�`a9 w ��✓'�V��-�'' __. ` � WORKERS'COMPFNSATION D[CLARATICN /� � J�''-Jr � IHEREBYAFFIRMIJNDERPENALT'OFPERJURVONEO�THEFOLLOWINGOC:CLARATIOfJS:'�']�- ��Agj"'i��yxi�' � , .' � ' , f /� l S�,'� � _IHAVEANDWILLAIAINTAINACERTIFICATEOiCaNSENTTOSELF-INSUH ORWORNERS'J �1-is;iq;,�>r.C"�+ ' ' - — 41�MP["ISATION,XSPROYIDEDBVSECTION37000FTMELABORGODE OR7MEPERFORMANCE U t OF THE WORK FOFl WHICM TNIS PERAIIT IS ISSUEO. W 6 , � W _I HAVE ANO WILL MAINTAIN WONKERS'CAIAPENSATION iNSURANCE,AS . lL3FJ)Ay.SLGAON"" � Q370o OF THE LPBOR GY)Oc,FOR THE PERFOPMANCE O�THF WORK FOH W111CH THIS PEqMIT IS , (/�J � IS3UE0.MY WOHKERS'l:(MiPEN5ATI0N INSURANCF.CANfiICFi AND P9LICV NUMBF,RARF: f CONSTRUCTION ..... ' "v _ - - �-....-'- -'-`---�----'-----------� ---'-------- �' � CARRIER____"__—_"""_"___ ' PI.AN REVIEW ���,���.._�-.__..."'_' .... ..'_'..._—_._._.,_..._._.....j-n,,.1 � d poucrNUMeeR______.__._____--.__ ELECTRIC /•� �'9 CJ d P/ � (IHtSAECiK�lN:F�ND7PE(SJM6'LF�E09FiHEPEF7NiI5WRIX��HIF�OREDOCLLAP.S(E�w)OXLE�S� PLUMBING ��t d W � 1 CERTIFY THAT IN fME PERFOfiMANCF OF THE WORK FOA WHICH i HIS PFRMIT IS ISSUE�,1 MECHANICAL C:f SHALLNOTLMPLOVANVPER50N'NANYMANNtiH50A5TUEECOME:UBJ:CTTOTHE � WOFKERS'COMVENSATIONLAWSOFCALiFOFiNIA,ANpAGREETH0.TI�ISHOULOBECOME INSPECTIONFEE = SU&IFCTTOTHEWORKERS'C[>MPFNSATIO\PFtOY1SIONfiOFSECTION37000FTHElABUR � 5�1 CAOE.I HALLFONTMWI7HCOMPLYWITH7f EPSIOVISICN��+� ISSUANCE ___._______._________ -�,5,� . p.;,,� � �,(,, , � p DATE:`� Yr7L APPIICA r� -S�.b_��"4��.N-�— SMIP __ .� . .__..'.'.___...._._____.'_..—___—_'._ w ��" -/ �7� - - ENERGY P/C ��-��------- LLWARfi1NG iNLURE TO uFCURE WOAKERS'COMPENSATION COVEFlAGE 19 UNLAWfUL,ANU SHALL DE . � S1131ECTAN EMPLOYEH TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDREO THOUSAN[] ENERGY PERMIT y OOLLAflS(S�OO,aao�.INADDITIONTOTHECOSTOFCOMPENSATIOY,DAUAGCSASPROVIDEDFORIN ^ �------�- -��----��----- -� � _1 SECTION3]oaOF7HELABORCOOE,INTER[ST,ANDATTORNEY'SFEES. RETENTIONFEE: % ¢ __ d CpNSTRUCTION LENDING RGENCY PRE-ALT FEE: __ _______— � � IHf:HERYAFFIRMUNDEflPENALTVOFPEHJUHYTHATTHEREISACONSTRUCTIONLEN0INGAG[NCY FOR THF.PERFORMANCE OFTHE WORK FOFl WI IICH 7ryIS P[RMIT IS ISSUED(SEC.3o97,CIV.G). --�-����-- -������-�--����- Z w "'__.'_.__ � LENDEIi'S NAME____"__ _—'_'—__""_ _"_—_"—'_ '—' F- LENDEH'SADURE55__.__..—_. .-...._...— h , W ICERTIFYTHATIHAVEREADTHISAPPLICATiONM'DSTATETHATTNEABOVEINFORMAiIONISCORFiECi TOTAL �.y' � j "���, �� � 1 AGREE TO CAMPLY WITH ALL CITY ANU COUNYV ORDINANCES AND STATE lAWS REIATING TO BIIILDING s�' � A l � � fANSTRUCTION,ANDHEREBYAUTHORIZEHEPR[SF:NTATIVFSOFTHISCOUNTVTOENTEFUPONTHE �Y) � � ��.e..��- f�� � ABOVE�MENTqNEO PF07ERTV FOli INSPECTION PURPOSES. � � 7_ COM ENTS_ ___ . -�-�T-�-�-�..- - � ��. � � .�-�-�_ '-'`'` — --- ---�� c i-!�I�1�------- m PERM EE NAMF:IPRINT)� J � / '— ,� � q �„i �'_ __' ---' — � a � � ��J — — � � SIGNATUHE OF PEftMITTEE �AT� � RECPT.NO. ___PAID BY __ !.__, __ VALIDATION ______ � WHITE—Depariment Copy.YELLOW—Finflnce Copy,PINK—Assessor CoDY.GOLDENRO�File Copy,GREEN— plicanYs Copy � � � � , � - _ . . , � . _� _ ' . .. � � :r , .. . .. . .: . . . ' ' .. , , . '• ' ' v � , _ ' . . ... : C.._ .. , . . . � . . , . . , . . . , . - ; ' ' � .... - �' . . � � . . , . r � . ; �'.. : �' , . � . : . � . , �I ' � . . . . _ .. ' . . . . . _' . " ' S. � � , . .� . ' � � � . . !.. _ . , , .. -_ .... . - _.. . � . � , � � � , � r . V �- , . ..� .., � � . ' . . � , � . � _�� � , . � . . . . - . � �_ . ._ � ' . . . '" , . �. � � �-' � . . � . � ' � � . . . " . -_ ' . " _ . . , . . . . �. � ' � � . . ' ' . ' - . . .. , . .. ' .. � 'y .� . . . � �. . \ i� " . ���- , .. : : , .� . ,i ... . . . � ,.. - � ,n . . r � . . . . t ` ^\ � _ _ '�,� . , . � � , �P � : _ . • � � ( J ; � s 3 ' � a � � J � � � � , , , _...._ _ . ,� . , -' , .� . '� � _ � � . . ;�� ; � . � . . .... � -.�` ; � � : h ' . . - . . . -.. . . '\ � . cR ' _ _�. . �...� . � .� - .� i � . . . _. ) \ � � . � ._ - � . � � ._ { � t . . . . '�'�} ����� . �.. . . . �\. ' � . � . . . i.y: w��.a � �,;, . , . . . . . ^*� . .. . . . ' . . . - ... _ r� ,. „�'�'�Tyg ,•` 5.,:� , . _ ... � . � � � � ' . � ., . ., . - . . - . • . ' , '-.. . ' - . . V1 . , -'fsn�'��;t., � � ...,�, . � ' � .. � ' . - ' ' � "u � �'.�c^Q"vz«a�'i_} .. � � . . , . .. ' . � . . . � . . - � ��,t,,,.n�. ��� �,Y,��,� �4 .