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HomeMy WebLinkAbout14816 (20) CITY OF DIAMOND BAR r -�---1� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �w 21660 E.Copley Drive Suite 190 (909)86a3195 Fax(909)861-3117 PRESS �'^�° BUQ.DING PERMIT APPLICATION FIRMLY � JOBSITE ���,,$)�7 �O�S�' , l PL DATE CATIO l� � NUMBER� #/C o ADDRESS �'y' / N � ISSUE TYPE OCC APN LOT RACT � DATE CONST. GROUP °C OWNER � O ADDRE 4 .l L ZONING SETBACKS � a � FRONT RW_ G_ CITY � ZIP TEL. REAR ❑ APPLICANT C, f TEL. SIDE/SIDE STREET RW G_ � 6 SIDE — ❑---- � CONTRACTOR C� �' g AODRESS ��' PROPOSED USE �( S -_���l�j- ^� o CITY ZIP_ TEL. � w ARCH/ENG/ �- z DESIGNER w NO.DWEL. NO. NO. a ADDRESS UNITS!�____ STORIES BEDROOMS � CITY ZIP TEL. cn y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNEfl-BUILDER DECLARATION SFR/ADD/REM O � I HEREBY AFFIHM UNDEH PENqLTY OF PERJURV THAT I Mi FXEMPT FROM THE CON(RACTOHS LI- G8f89B/C8R70fI W CENSELAWFORTHEFOLLOWIN6RE4SON(SEC70315BUSINE55ANDPROFESSIONSCO�EANVCITYOR (n U COl1NTVWFiICHREQUIRESAPERMITTOCONSTRl1CT,ALTER,IMPRUVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck W NRE,PHIOR TO ITS ISSUIWCE,ILL50 REQUIRES 7HE APPLICMIT fOli SUCM PERMIT To FILE A SIGNED W � STATEMENT TFNT HE OR 9HE IS IICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� CENSE UW(CHAP7ER e(COMMENCINO WITH SECTION�000)oF DIVISION a oF THE BUSINESS AND PRO- � POoUSP2 FESSIONS CODE�OR7}1AT HE OP SNE IS EX�7PT THEREFHOM AND iHE BASIS FOfl THE ALIEGE�EXEMP� TION.ANYVIOLATIONOFSECT�DN70315BVANYAPPLICANTFORAPERMITSU&IECTS7HEAPPLICANTTO Z R8-R00� � ACML PEN�LTY OF NOT MOflE TNAN FNE HUNORED DOLURS(S+�)) � ❑t,ASOYYNEflOFTHEPROPERTY,ORMYEMPLOYEESWITNWAGESASTHEIR50lECOMPENSATION, � COmmefCldl WILL 00 7HE WOAK,AND THE STRI1CTl1RE IS NOT INTEN�ED OR OFF[REO FOR SALE(SEC 7044,Bl1Sl- J � � NES6 AND PROFESSIONS CQDE THE CANTPACTORS LICEN&E LAW DOES N07 APPLV TO AN OWNER OF ' PROPERiYWtiOBURDSOflIMPROVESTHERE-0N,ANDWHODOESSUCHWORKHIM50.FOriHERSELFOR m � THHOUGHHISORNERONMEMPLOYEES.VHOVI�EDTHATSUCHIMPROVEMENTSARFNOTINTENDEDOR QOFFEREOWRSKEIF,NOWEVE0.TIIEBUILOINGORIMPROVEMENTISSOLDWITHINONFYEAROFCOMPLE- � TIOp,THE OWNEH�BUILDER WILL NAVE YNE BUflDEN 6F PROYMG THAT HE OR SHE DID NOT BUILD OR � IMPROYEFORTHEPUflPOSEOFSAIE� ❑1,AS OWNER OF hIE PROPERTY,AM EXClUSNELY COMIiACTINQ WITH LICENSEO CANTRACTORS � TO CANS7pL1CT THE PRQIECT(SEC�a4,6USINESS AND PROFE3SIONS CADE THE CONTMCTOAS LI Valuation __ ' PDJ AREA_.___ _. 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B&PCFOR7HISREASON Q � � � DATE OWNER___' __"' "_ f" - U w �@ LICENSED CONTRACTORS DECLARATION W S IHEREBVAFFIAMUNDERPENALiYOFPERJURYTHATiAMLICENSEDUNDEAPROVISIONSOFCHAPTER � Q„ B(CQAIMENCINQWI7HSECTIONiOW)OFONISION30FTHEBUSINESSANDPROFESSIONSCADE,AND Z MY LICE45E IS IN FULI FORCEAND EFFECT m / � UCENSE CLASS_�__LIC NO ������ � V �ATE _ CONTRACTOR d W a�i WORKERS'COMPEPISATION DECLARA710N -� � U � I HEREBY AFFlAM UNDEFl PENALTY OF PERIURV ONF.OF THE FOLLOWING DECLARATIDNS � Z Q 0 IHAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSELFINSUREFORWORKERS' _ � CAMPENSATION,ASPROVIDEDBYSEGTION3�ooOF7HEUBORCODE,FOflTHEPERFORMANCE �U OF THE WORK FOR WHICH THIS PFRMIT IS�SSUED � � W _I HAVEAND WILL MAINfAIN WORKERS'COMPENSAT:ON INSURANCE,AS REOUIRED BV SECTION Q 3�o00FTHELA80RCODE,FORiHEPERFORlAANCEOFiHEWOflKFORVJHICHTHISPERMITIS �. 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O aI NEREBV AFFIPM UNDER PENALTV OF PERIURV THAT THERE IS ACONSTFUCTION LEN�ING AGENCV _ _____ _ FOR THE PERF(?RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 308�,CIV C J W ____"_— _— � LENDER'S NM1E_....__" '_— _'_""_ F- LENDER'SADDflESS __- ___-_-__— ----- � ICERTIFVTHIITIHAVEREADTHISAPPLICRTIONAN�STATETHATTHEABOVEINFORMATKKJISCARRECT TOTAL FEES W I AGREETO COMPLY WITH ALL CITV AN�COUNTV ORDINANCESAND STATE fAWS PEIATING TO BUILOING � �I � CONSTPUCTION,AND HEflEBY AllrFiOHIZE REPRESEN7ATIYES OF THIS COUNTV 70 ENTER UPON 7HE ��/ ��s/��7� ZABOVE�MEMIONEDPROPERTYFORINSPEC_7j�PUf7PO5E5 COMMEN -` � �~����� `� � � jt!/�� '�—' "' � C�� �- � "_'_'._..__ m PE ITTEE NAIAE(PRINT) c'r` l y.� __ -- 4 11 „/ . L++a Q'� ") Cn ) _ Vy SIONATUREOFP R1ARtEE DATE = RECPT.N0. _PAID BY VALIDATION _. 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