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HomeMy WebLinkAbout10662 . — CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E.Copley Drive Suite 190 PRESS � (909)860-3195 Fax(909)861-3117 '""'� BUILDING PERMIT APPLICATION FIRMLY a' AODDR'ESS �"IL.�-�+ �/���F�E`1 P�.o APpLICATION PERMIT %�/ /,/_Y"P/C � p DA7E NUMBER� �' # � ISSUE 7YPE OCC r APN LOT TRACT DATE CON8T. GROUP k p OWNER CIS►R�/' L�-���J�iR-�—K1^�e1�i�� � p ADDRESS �L'� - VCTt=.� �� �r ZONING SETBACKS ���'RED � z CITY ���� 3d ZIP�TEL. ��� FRONT RW ❑ � o APPLICANT ^'C ' ' !V1 TEL. y t SI�SIDE STREET RW ❑ � � CONTRACTOR SIDE T____T ❑...___ � ADDRESS PROPOSEDUSE I�t��='�d �-P��2.�'C`��' i.C�'�'T �' o CITY ZtP TEL. ,,� - F � w ARCH/ENG/ � z' DESIGNER W NO.DWEL. N . NO. ' � � � ADDRES5 UNITS STORIES BE�ROOMS�7 � � CITY ZtP TEL._ � � u� DESGRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNEF-BI;ILDER DECLARATION SFRlA�D/REM ��,`yC�,�r ^ � r p I NEREBY AFfIRM UNOEH PENALTY OF PERJURY 7HqT I qM E%EMPT FROM THE CONTRACTOqS LI- � GaragelCarport W CENSEUWFORTHEFOLLOWINGREASON(SEC.�03159USINESSANDPROFESSbNSCO�E.ANVCIT'OR , U COt1NNWHICNNEWIflESAPERMITTOCON5TRUCT.ALTER.IMVROVE,DEMOLISH,ORREPAIflANYSTRUC- W patio/Deck Z TURE,PRIOR TOITS ISSUANCE,A150 flEOUIHES TNE APP�IC/NT FOq SUCH PERMITTO FILEASIONEO � STATEMENT THAi HE OR SHE IS LICENSEO Pl1RSl1ANT TO THE PROVISIONS OF TNE CONTRACTORS LI• W � GENSE LAW(GHAPTER e(COMMENCING WITM SEGTION 7000)OF DIVISION 3 OF TXE BUSINE33 qND PRO- � PooVSpe , FESSIONS CODE)OR THAT HE OR SHE IS E7(EMPT THEREFROM AND THE BASIS FOF THE ALLEGED EXEMP- VTION.ANVVIOLRTIONOFSECTION1031GBYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPUCANTTO Z RB-ROOI Y A CIVIL PENAITV OF NOT MORE THAN FIVE HUNDRED DOLLARS�i500)) ' ~ ❑I.ASOWNEROFTHEPROPERTY,OflMVEMPLOYEESWITMWAGESA5THEIR50LECOMPENSATION, Q R O Commercial s Z WILL DO THE WOFK,AN�iHE STNUCTl1flE IS NOT INTENDEU OR OFFERED FO�SALE(SEC.7044,BU51- J � NESS AND 7ROFESSIONS(Y�DE THE CANTRACTORS LIC[NSE LAW DOES NOT APPLY TO AN OWNER OF � � PROPERTY WHO BUILDS OR IMPROVES THEREON,AND N710 DOES SUCH WOPK MIMSELF OR HERSELF Op ; Q iHROUGHHISORHEROWNEMPLOYEES.OROVIDEDhIATSUCHIMPROVEAIENTSARFNOTINTENOEDOR m � � OFFEREDFORSPLE IF,MOWEVERlHEBUILDINGORIMPflOVEMENTI550LDWfrMM10NEYEAROFCOMPLE� ? TION,THE OWNER BUILOER WiLL HAVE THE BURDEN OF PROVING THAT HE OR 6HE DID NOT BUIID OR F � IMPROVE FOR THE PURPOSE OF SALE) j W ❑I,ASOVMEHOFTHEPROPEHN,AME%CLUSNELV�pNTRACTINQWITNLICENSE�CONTMCTOflS 4 � i0 CONSTpUCT THE Pp0.1ECT(SEC 70d<,BUSINE55 ANU PROFESSIONS CO�E�THE CONTRACTOFlS LI� VaIUB�iOf1 ADJ.AREA I W CENSELAWDOESNOTAPPLVTOANONRJEfiOFAPROPERTYWHOBUILD30flIMPROVESTHEREDN,AND f F WHOCANTRACTSFORSUCHGqQ1ECTSWITHqCONTPACTOR(S�UCENSEDPURSUpNTTOTHECONTRAG qUANTITY DESCRIPTION FEE � Y TORSLICENSELAW) /} {� � I I I AM EXEMPT UN�ER SEC B&P.0 FOR THIS REASON Q ' 1�����6� e 1� ����' � � �--,�— W- � � �-{ ��L�i`�'�w� "s�t�,E-�'�� � � OATE OWNER U � LICENSED CONTRACT 5 oECLARATION � � ¢ W f � 1 HEREBY AFFIRM UN�ER PENpITY OF PFNUqY THAT I AM UCENSED UNDER PfiOVI510NS OF CHAPTER p. 9�COAIMENCINGWITHSECTION7000)OFDIVISION30FTHEBUSINESSANOPR�FESSION5CO�E,AN� Z {:. � � �X MY LICENSE IS IN FULI FORCE ANO EFFECT m � W • Q � � LICEN3ECLA33__ _____LIC NO __ J UDATE__ CONTRACTOR ____ a W �� � WORKERS'COMPENSATION DECLARATION a E � I HEREBY AFFIRM UNOER PENALTV OF PENURY ONEOF THE FOLLOWING DECLARATKKJS Z � a � _IMAVEANDWI��MAWTAINACERTIFICpTEOFCONSENTTOSELF-0NSUREFOPWOfli(ERS' = i Z CAMPENSAiION,A6 PROVIDED BY SECTION 37000F THE LA60R CODE,FOR THE PERFORMANC6 W a OF 7HE WORK FOR WHICH TNIS PERMIT IS ISSUEO � O � W _.iHAVEANDWI��MAINTAINWORKERS'CAMPENSATIONINSURANCE,ASREWIREDBYSECTION � Q 370o OF THE LABOR CODE,FOF THE PERFORMANCE OFTHE WOPK FOR WHICH THIS PEFMIi IS ISSUED.MY WORKEIiS'COMPENSATION INSURANCE CPflRIER ANU POLICY NUMBERARE' CONSTRUCTION �' J 3 j cqqqiea__ _____ ___ — PLAN REVIEW ' Z PW.ICYNUM6En . -.- ELECTRIC � Q 0 (1}iISSECTK7NNE�MJTBE00MFLEfEDOFTHEPERMIfISFORONEHINDRmO0.LAR5(SI00)OfiLESS} PLUMBING Z I CER7IFY TMNT IN THE PEqFOHMANCE OF THE WOflK FOfl WFiICH THIS PEFMIT IS ISSUEO,I MECHANICAL . (,�j SNALLNOTEMPLOVANVPERSONINANYMANNEqSOASTOBECOMESUBJECTTO7HE Uj WORKERS'COMPENSATIONLAWSOFCALIFORNIA.AN�AGREETHATIFISHOULOOECOME INSPECTIONFEE _ _ j SU&IECTTOTY.EWORKERS'COMPF.NSATIONPROVISIONSOFSECTION37000FTHEUBOF - — CADE,1 SFULI FORTHWITH COMPLV WITH THOSE PROVISIONS ISSUANCE � SMIP p DATE:__ . ._�.. .- APPLICANT _' _ - — J „ ., . • .. • • . E ENERGY P/C �+. . ti '' : ' ' '' ENERGYPERMIT � + � RETEN710N FEE: _ a CONSTRUCTION LENDING AGENCY PRE-ALT FEE. O � IHEREBYAFFIRMUNDERPENALNOFPERJUqYTHATTHEREISACONSTRUCTIONLENDINGAGENCY _ FOR TH[pERFOflMANCE aF THE WORK FOR WHICH THIS PERMIT IS ISSUE�(SEC 3097,CIV C,) Z W � LEN�Efl'SNAME__ __ ..._ _ ►— LENDER'SADDRESS _ _ � ICERTIFYTHATIHAVEFEADTHISAPPLICATIONPNDSTATETHATTHEABOVEINFOHMATIONISCqRRECT. TOTAL FEES E W 1 AGflEE TO COMPLY WITri ALLCITYAND COUNTV ORDINANCES PND STATE LAWS RELA7�NG TO BUIIDING ` � CANSTR4CTION,ANOHEREBVAUfHORRERfPFESENTATIVE50FTHI5GOUNTYTOENTERUPONTHE 1 ZABOVE�MENTIONED PROPERTY FOR IN9PECTION PUHPOSCS yi COMMENTS____ _ � :�G f7,�'��CC� �'. �i!�l�a t,.�. '� PE MIREE NAME DRI f N _ �` �.t� �.. � �.� ��7 _ ' � y SIG EOFP MI E �ATE ;d = RECPT.N0. PAID BY VALIDATION � ~ WHITE-Departmant Copy,YELLOW-Finance Copy.PINK-Assessu Copy,GOLDENRO�-File Copy,GREEN-ApplicanYs Copy � ._�o_,_ --� - . . � . . . . . ... .._ . _.. i ; , . . , . _........ . � , i i � i � � . i i. . � al� � , I � , ! : , � . . � � � � � . ��� �� � ��� �� : � . , , ' - � , � { I = �� ; � � � � � : � ' . i � -1 ' � :� i , �; , � , {. . � � . , � �, , ,� � �- �� - � . � � . � _ -;� .- , .i: i ,�: , � � � . ;t � , • . , • .. � _ �: :� `r� .� � �� _ _ - � - •, �{�+�t . . ' ' ' . � . ( � _�' .� � , � � ' - ��.' „f• .. . � . ' ' I ',� -� ��. I � �}, - " . ' � : . . . : . 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