HomeMy WebLinkAbout14438 (20) �� CITY OF DIAMOND BAR f—�
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES /
2]660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
�"'"', BUII,DIAiG PERMIT APPLICATION FIRMI.Y
o ADDRESS�L� �f�2,�7�� C. L�n DATECATION���� NUMBER� �-�_•��"�' li/C
� ISSUE 1YPE OCC
APN LOT . TRACT___ DATE CONST. GROUP
p OWNER _
o ADDRESS ZONING SETSACKS
W CITY ZIP TEL. FRONT RW ❑_.__
� APPLICANT TEL. _ REAR L,_ _
zd SIDE/SIQE STREET__ RW C� ,__
� CONTRACTOR L �. �f V'�'1 SIDE _ L___
ADDRESS � '
� CITY _S ZIP r3 r TEL. `f/�I'7��.� PROPOSED USE_
oARCH/ENG! --- -
DESIGNER
�ii NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS___ STORIES _ _ BEDROOMS
cn -
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADDIREM
O
Q I HEREBY AFFIRM UNDER PENALTY OF PFRJURV THAT 1 AM EXFMPT FRUM THE COMRACTORS ll- � Garage/Carport
W CENSELAWFORTHEFOLLOWINGREASON(SEC.]031..BVSINESSAN�PHOFESSIONSCODE:ANYCITVOii
U COlJN7`(WH�CHAE4UIRESAPF.RMITTOCANSTRUCT,ALTER,IMPfiOVF.,�EMOlISH,ONRF.PAIHANVSTflUC�
W 7UHE,PRIOR TO ITS ISSUANCE,pL50 REOl11RES THE APPLICANT FOR SUCN PERMIT YO FILE A SIGNE� W PetiO/08Ck
STATEI.IENT iHAT HE OR SHE IS LICENSEO PUR5UANT TO THE PROVISIONS OF THE CONTRACTORS LI-
�� CENSE LAW(CHAPTER e(COMMENCING WITH SECTION Yaoo)OF DIVISION 30F THE BUSIN[u5 AND PRO- LL' POOVSPB
FESSIONSCODF.)OR7HATHEORSMEISE%EMPTTHEflEFROMAND7HEBA5ISFORTHEALLEGEDE%EMP- (� -
V TION.ANVVIOLATIONOFSECTION7037.S8YANYAPPLICPNTFOflAGE(iMITSU&I[CTSTH[APPLICANTTO � Re-Roof
r ACML PENALTV OF NOT MORE THMI flVE HUNORED�OLLAflS(55oD).)� -
� ❑I,ASOWNEROFTNEPROPERTY,ORMYEMP�OYEESWITHW.QGESASTHEIRSOLECAMPENSATIDh, 0 CaRlrtlefCiBl
Z WILL DO THE WORK,AND TME STRUCTURE IS NDT I�lTENOED OR OfFEpED FOii SAL[(SEC.70A4.�USI� J �
N NES8AND PROFES6bN6 CADE:THE CONT(7ACTORS LICENSE LAW�DES NOT APPLV TO AN OY/NEfi OF �
PROAERTY Yh/0 BU{lC5 OFl 1�47PqOYF.S iN'cflEOii,N.0 N^.i0 DGES SUCH WORK HIM'aELF OF HEflSe:i'OF
,WiHROUGH HIS OR HEROWN EMPLOYEES,PfiOVIDEO THATStJCH IMPROVEM[NTS ARE NOT INTENDEDOF. m '
a OFFEREDfORSALEIF,V50WEVERTMEBUIIDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE
� TION.THE OWNER�BUILDER N1LL NRVE THE BUPDEN OF PNOVMG THAT HE OR SHE DI�NOT BUILO OR
� IMPROVEFORTHEPUHPOSEOFSALEJ.
W f.71,AS OWNER OF7HE PROGERTY,AM E%CI 1151VFLV COYTRACTINp VlITH LICENSED CONTRACTORS
� TO CONSTRUCT THE PR0.IECT(5EC.7044,BUSINE33 AND PAOFESSIONS Cq�[:THE GONTFqC70R5 LI- V81U2110P1_____, ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAPFOPERTYWHOBUILUSOH!lAPfiOVESTHEREON.AND -�"--� � '-"'�---'---
� WHOCQNTRACTSFORSUCHPRQI[CTSWI11iACONTflACTOR�S)LICENSEDPUP.SUANTTOTHEC04TRAF Q�)ANTITY DESCRIPTION FEE
Y TOPSUCENSEUW.).
� ❑i AM EXEIAPT UNDEHSEC. B.8 PC.FOH TNIS fi[ASON Q
� E � �
u' DATE_.__ OWNER___'_-"'___� V —
O — --_--__ —
F LICENSED CQNTRAGTORS DECLARATION W r
� IHEREBVAFFIHMUNDERPFNAI.TYOFGERJURYTMATIpMI.ICF.NS�DUNOEFlPPOVI510VSOFCHAPTER �
� B(COMMENCINO K7TH SECTION 7000)OF OIYISION 30F THE BUSIYESS AND PROFESSIONS CODE.AND z _
XL' 1.N LICENSE IS IN FULL FORCEAND EFFECT. m
LLI ff '`� _
o IICENSE CLASS (. "'/��� _LIC.NO.___,[��}�- � r �p . j..„
VDATE__ �'�.1�`� � _ CONiRACTOR_{///�q-/� �_ � _ q.��L� � a y�y� � �`�"� ��
W � " � �' � v �p '-
� WORKERS'COPRPENSA710N DECLARATION ? 4
� I HEREBYAFFIRM UNDF.R PEHAITV OF PERIl1RV ONE OFTHE FOLLOWING DECLARATIDNS:
(/� .
� IHAVEANDWILLMAINTAINACEKTIFYCATEOFCONSENTTUSFLF.145UHE�Vb(iWOFlKFR�
� �CAMPENSATION.ASPRQVI�EDBYSECTI(Nla�oaOf-THFlAl70FlGODF�;FOqTHEPEFiFOHMAkCF __
OF THE WORK FOR WHICH THIS PFRk11T I51SSL1E0. W
W �f - � � __
IHAVEANDWILIMAINTNNWORKERS'CIJMPENSATIONINSURANC,ASR[Ol11RF.D YSFCT;ON~
Q 3NOOFTHELAWHCODE,FORfHF.PFRFURMAUCEOFTHEWO FORWHICIi {�SPF.RMITIS
ISSUED.MY WORNFRS'C041PFNSR110� 11FANCF;CpRRIF.R POI.ICY NU�ARE' � N RUCTION
_—_-_""' __ _ �
— / )�� . .
? CARRIER �L!�, �` • N EVIEW ...'_-"__""' "_'_""___'.. .__ '
n POLICY NUMBEfl ' ��L? `� ELE FIC ,
Q ' � —_'__'.. ." '_ '
� (iFA55ECIl01VNE�NOTBE0.Xr4'�iFDOFTF$PERMRISWHC�EhiUNURED 'iI.L�AS( oo)ORLE55}` P MBING ` __
� I CERTIFY THAT IN THE PFFiFOqMPIrCE OF THE WORK FOR WHICH hi15 PER T IS ISSUEL�,I MECHANICAL �y}y`'.q�
�J SHALLNOTEMPLOYANYPERSONINANYMANNEP,SOASTOBECOMESUBJEC TOTHE —�'; 9`a�� �� �
y WORKFFlS'COMPENSATION LAWSOf CALIFORWA,AND AGPEf THAT IF I SHUUL� ��WreF INSPFCTION FEE _____ � '• _____ _
- SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIOkSOFSECTION37000FTHE R ' �_ .�� �L"^
~ COOE.ISHALLFORThIWITNCOMPLYWI7HT�HQSERNOVI510 s. ISSUANCE . ,_____ .� ���f�i�- �� +�-;,,,�_'�
�
0 �J1�1 �1 /� A y �T�.. T' ''a'�.""'_-rta'_'� .
� Ls�e� _._fh�C.�� '.^-��. SMIP .�e�>�� x° c'�A�-:1.'
�ATE: APPLICANT: � '- '✓�_..'_'_.__..""" I ..�.��' �:_.: _ _@�l;y�i
W Z�'� /1 �+a• �,t$`s-��:,.
J � ENERGY P/C , , �'"
WARNMG:FAILURE70SECURFWORKEHS'COMPENSA71q�COVERActISUNIAWFUL,ANDSNALLBE - - - - —
---- ----
— Sll&IECTANEMPIOVERTOCFlIMINALPENALTIESAN�CiVIlFMESUPTOONEMUNDRE�TMOUSAND ' �'�
� OOLLARS(5100,000),IN PDDITION TOTNE COST OF COMPFNSATION,DAMAGES AS PROVIDCD FOR IN ENERGY PERMIT ..____
.. .. ...... ._—____' ___ __
J SECTIONa1oeOFTHELABOflCODE,INTEREST,ANDA7TORNEI"SFEES. f1ETENTIONFEE:
2 _--- — "'_-_-_'_' __'
a CONSTRUCTION LENDING AGCNCY PRE-ALT FEE:
p --- -
QIHEREBVAFFIf1MUNDEfIPENALTVOFP[RJURYTHATTHEREISACONSTRUCTIO�LENDIKGAGENCY _ ___
FOR THE PERFORMANc:E OF THF\YOPK FOFI W HICH THIS PERMIT IS ISSUEO(SEC.3ov7,CIV.C.).
Z
W __'__'_''___'_"""'___'_'--___"'__'
� LEN�ER'S NAME
-__ '___'______-___'___''_
F� LEN�ER'SA��7RES5 J�.
� ICERTIFYTHATIHAVEREADTHISAPPLICATIOYAN�STA7E7HATTHEA90VEINFORMAP.ONISCORRECT. �UTl11�.�G�CJ 9 _, / / j
d IAOREETOCOMPIVWIh1.n�.LCITVANUCOUNTYORDINANCESANDSTATEL�WSREL4TINGT06UILDING C (,/ �
� CANSTRUCTION,AM1D HEREBYAUTF70HILE REPHESFNTATNES OF THIS GOIJNfY 70 EN7ER UPON THE
Z. ABOVE�MENTIONED PROPERTY FOR INSPLCTION VURPOSC:S.
� CObliMENTS.._._.__.. _.__..___
� y�/ /J ._�C��/V�j G'aY�I "'____-_-__'__ '__'_ '_'
� -_F_._t__'_F_
4 PERMITT PME'tPRM ✓C�� __"_ ' -'_'___' '_ �
cn /�-�--- __��":�a�----� . , __ �
� 516 REOFPEHAi1TTEE DATE
RECPT.N0. �� �PAID BY VALIDATIDN_
F � ----"---
WfiITE-Dopanment Copy.YEI10W-Finance Copy,PINK-AssRssor Copy.GOI_DENROD--Fiia Copy,GREEN-Applicanfs Copy
. _ .-- ---_ .�. ___ _ , .. .._. .. _ _ _ .
� � i
..
���� � � , i , � i i i �
t ' ! � ' ' ! : ' , . � `
' �°� � i ; j . ; i r
�.��� � ` � � � i ; i
��� I ; { i � � i � :
�� � ; : ; � ; ' ; i ,
� i ! i
E;�� ; , �
�� � ' , I ! I �
$`�� i � ; � � � � ' !
�� -_ r, _ ._. .... _ .�__ . � - - ;
� . - i I ; • � � . , , � , � � :
M ' ' ,. I , � i _ I . . , i i ; � - � �
�
ja�r= , � + ' � -, i _ - ' � � � . , � � . . i , I ' i .
..._,.... '
i
F� � � ( � . . . � , I - i j
��� � ' ' I ' � .
�
� � �
r� __ t _— — �. -- —— — rp � f � '
,
x�� i i � ; � �: � � � , �
� . � ,Y ;
:� 'y �� � i � � `�e ' ; � '
, �� � , �: , � ��x � � i
�s s.�� E �� ii ' - � , i • I ( i
� e �� �'�" r, � � 7 .x ;� I � � �
� : �� I '� L � F x . , i - � .
.�R ' J.1 i. i :, � � . - � � - � '
3 '
� `S € �� �� ..1 . I _I ' ' � � - [ � , � � ,
� I � � I
- � � ' i :A j - ' � •S. . ' I ' � � . i .
i .- .
# . - . ' - " ' _ ' �
` .��`-,. — � _� _ i _ ' � _ . � ' ' � . . ;
' _...._.. .. , _:.
�, � i � I � i —� (- . . I � �
� '` t,�" �";� . I , { i i ; • ' . ' , i" ' �d. i i i ; i , .
�� �q y� � � + � ' I �� , ' i ,
_�`' � ' � � � ° � ; ; ' i 1
�. , i : i , \ ; � +
, I ' i � i � , t � �
: �� ... . . -----� �-- -�-- I- _ I - ; -- ��..- - i ' , i _ � , 1 ' . �
.w' � - ; . � ; ; j - � � j ' � - � j � ' � '
�' ; i • j . n i � i i �
,� � � ' '-� �
g�� : . i _ ..-�. ' -. ' , - ,- . ... -, ' � � i . � - �`a�'t�'kq��.i��i � rt �
�s,
#� ' t - _ - I � ` ; , . � ; ,� q k�" .{�'F r !k Y �
! �, t k
,' � I } � I � � `'t�� .�.t Z`
�4�
..�y� �-` - � I �r . I _ � j I , . :t ��i p,`�'3,� r��i�r €.-{i i
�. .� I ' . _ � _ � _ ! � ��,��k',3y� i y'i
�� � I f }
�t - c , � �3�t,-F���s�Y`5`$$'.§�'�s+s�� .
� �� ;
_ ' ' r, � 1 , ' S I A i ����� ;��� l
„z e ; ' _ : . k A i �_b
, ' ` ,.
-t�}� t ;• � .. � ia E �'«t*', ,
,. . ___ f. � _ _. . . ._.._�.n._. ...__ , ,
� i , �