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HomeMy WebLinkAbout13132 (14) I /'�� f J,,�_ CITY OF DIAMOND BAR �r � I DBPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � �� . 21660 B.Copley Drive Suite l90 (909)860-3195 Fax(909)861-3117 PRESS � `��'H�'��' BUILDING PERMTT APPLICATION FIRMLY i �/� � � JOBSITE %� � � l.(d1�G� APPLICATION PERMIT J�I�� P� € a ADDRESS p DATE NUMBER # � APN LOT T CT_ ISSUE r� /�/j TYPE OCC ( ¢ _ DATE_.1 � �`C�7 CONST. GROUP � p OWNER E "" ADDR SS GG(T...�� ZONING SETBACKS � w ' � FRONT RW ❑____„ gCITY ZIP TEL. �7 " , APPLICANT TEL. REAR [J_ i � SIDE/SIDE STREET RW ❑ CONTRACTOR S�DE _ LJ_.__,_,__ � � r ' o ADDRESS PROPOSED USE C:� j '. CITY ZIP TEI. ( ' a ARCWENG/ '•• DESIGNER ! � NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. uyi DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATIOIV �. ¢ OWNER-BUILDER DECLARATION SFR/ADD/REM O � Q I HEREBY AFFIRM UNOER PENAL?Y OF PE0.NflY THAT 1 Mf EXEMPT FROM THE CON7RACTORS LI- Gefe(J9/C8fF10fI f' W CENSEUWFORTHEFOLLOWINGREASON�SEC703f.6BU51NE5SAN�PROFESSIONSCODE�ANYCINOR (n '+ C.� CIXINTYWHICMREIXJIqESAPEHMRTOCANSTHIICT,ALTER,IMPHOVE,DEMOLISH.dRREPAIRANY5TNl1C- W PyIID/DBGK k'{ W NRE,PRKKi 70 ITS ISSUANCE,ALfiO REQUIi7E5 THE APPLICANT FOR SUCH PERMIT TO FILE ASIGNFD STATEMEM THAT HE OR SHE IS LICENSED PURSUANT TO THE PPOVISIONS OF THE C04TRACTORS LI. w � � CENSE LAW�CHAVTER 9(COMMENCING WITFi SECTION 7aao)OF DIVISION 30F THE BUSINE55 AN�PRO- LL PooUSpa - FESSqNS COD[)ON THAT HE OR SHE IS EXEMPT TMEREFROM AND THF BASIS FOfi THE ALLE6ED EXEMP• V TION.ANYYKKATIONOFSEC710N7aJ15BYANVAPPLI(',qNTFORAPERMITSU&IECTSTMERPPLICANTTO Z Re-Roof p � ACIVII GF�NML7V OF NO7lAORE THAN fIVE HUNORED DOLLARS(SSW)) y � QY,ASOWNEROFTHEPFOPERT',OPMYEMPLOYEESWITIIWAGESp5THE1flSOLECOMPENSATION, � COrt1fIlBfCl81 � WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDE0 OR OFFERFA fOR SAIE(SEC 7oqa,BU51- J ( y NE551WD PHOFESSIONS CODE.THE CONTFACTORS LICENSE LAW OOES NOT APPLY TO�N OWNEH OF = r PFOPERTY VhiO BUILDS OR IMPROVES 7HEREON.AND Nh10 DOES Sl1CN WORK HIMSELF OR HERSELF OR S � 7NROUGHHISDRl1EflOWNEMPIOYEES.�ROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENOEDOR m r Q OFFEREDWh`AIEIF,HOWEVERTMEBUILDIN�ORIMPqOVEMENTISSOIDWITHINONEYEAROFCOMPLE- � ? ..� . � • . . •� f �, .ti Q TOOONSTflUCT7HE PqqIECT�SEC.7aN,BU3MESSAND PROFESSIONS CODE THE CONTRACTORS LI- V81t13110f1 ADJ AREA � CENSELAWDOESNOTAPPLYTOANOWNFRbFAPROPERNWHOBUIL�SORIMIPHOVESTHEPEUN,MO , - -- — r MhIOCONTMCTSFORSUCHPROJECTSWITHA00MTRACTOR(5)LICENS'eOPURSUMTTOTHECANTRAC- ('jUANTITY DESCflIPTION FEE u 4 Y TORS LICENSE UW). - 0 q I AM E%EMPT UNDER SEC __@ 8 P C FOH THIS PEASON � i � _ U LL - [C DATE oWNE ' l � �---------- U 7 � LICENSED CONTRACTONS ECLARATION W � � IHEflEBVAFFIHMUNDERPENAL7VOFPEF7JURYTHATIAMLICENSEDUNDER�ROVI510N50FCHADT[q � 4 � 9(COMMENCINO WITN SECTIIXV 70vo)OF DIVISION 30FTHE t3U51NE5SAND PflOFE5510NS CA�E,AND X MY UCENSE IS IN FU�I FOflCEAND EFFECT m � LLI 0 LICENSE CLASS _ UC NO _ _"_____'_ � C, V DATE_ __'_ CONTRACTOR "__"'_'__ �- ' j WORKERS'COMPENSATI�N DECLARATIUN � Q � IHEHEBYAFfIRMUNDERPEFULTYOFPERJURVONEOFTHEFOLIOWINGDECLAfiATI0N5 � � � Z Q ( � __INAVEANDWILLMAINTAINACERTIfICNTECFCONSENTTOSELFINSUREFORWORKERi' Z i COMPENSATION,A3 PFOVIDEO BY SECTION 37000FTHE LABOR CODE,FOR i HE PERFORMANCE W OF hiE WbRK FOR WHICH THIS DENMIT IS ISSUEO 2 j p _ r � __I HAVE AN�WIl1 MAINTAIN WORNERS'CAMPENSATION INSURANCE,AS HEOUIREO BY SECTION � 37000FTHELA60RCO�E,FORTHEPERFORMANCEOFTHEWORKf'OflWHIC4THI5PEpMIT15 !. = I55l1E0 MY WOflKERS'COk1PEfi5ATION INSURANCF.GARRIER Air'U POIICY NUMBEfl AR'c CONSTPUCTION ,_______ ____ �y��_ �' j cnf;RieR--- -- '-----�---- PLANREVIEW -- ---- -- --�-----�— � Zaa.icvNuueea--------- —�--�----------- ELECTRIC - -- �--- ��--------�--- � d �0 (fHIeSECiIONNE�AIOT�E00MAElEDOF7/iEPEPA5TI5FORIXJE1rthYHiCDD�I.IAfL(5700)ORLEuS) PLUMBING .____,_.__ _______ ___ W �, , •---,� � � -- MECHANIGAL [[ � ' .4 \" '� ., e R s COOE,t Hh M THWITH COMPLV WITHT ',• �NSPECTION FEE � . .�___t�.i'w . . .. . .. . , t... ' . � ��•�,� �. , � � ' . .�� . . . _ �Y��•�� � ���y . . ,. , . /�i/�A .'. �...,'�5 LIFOR HOS-PROVI51_. �•4•/l"� oNs ISSUANCE _ ,__ ___ �'- • a �- �,=���---�-- � p �ATE. APPLIGANT __ __"' __ SMIP ,__'__ .____ � }�_ W ENERGY P!C ��. , x,e`F'.6�s-� � ---'-�-�— JJ � u OH'�. RTfORNE�. . . ... .. . -,... � 'h'•'. � ' �, � :. i �. • , . . . �p��-- � LL �� , :. r•. �� , .•'.,. .. .. . . . ENERGYPEflMiT �r-�.i P'.��"��`� �i S'•'.� • :J' $ J SECTION37080FiHELAB CODE,INTEFEST,ANO ' YSPEES • � �J���.1"�- � RETENTION FEE: Ft:._',_.__, oc — —�'9 "�_- — I: a CONSTRUCTION LENDINGAGENCY PRE-ALT FEE: ___ 3�'����f�`_.__,__,___.___ ._,__ fI� � IHEREBYAFFIRMUNDEHPENALTYOFPERJURVTHAT7HERf.ISACON5TRUC710NLENDINGAGENCY �i d FOR TNE PERLORAIANCE OF THE WOPK FOP WHIGH iH15 PERMIT IS ISSUEO(SEC 3oa�,CIV C) -'-- � -� �-� � ---- --- - - --- --- -------- --- ----�-/-�-.�- � LEN�ER'S NPME_____._ � .� � LEN�EFSADDflESS_."'_ _' _"__""-- w � ICERTIFVTHATIHAVEREAOTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISGORRECT TOTAL FEES S� W IAGHEETOCOMPLYWITHALLCITYANDCAUNfYOfiUINANCESANDSTAfELAWSREIATINGTOBUILDING � CON&TRUCTION,AND HEHEBY AUTHORIZE REPRESENTATIVES OF TMIS COUfJrY TO ENTER UI'ON THE ,( �y �� �?'{' Z ABOVE�MENTIIXVED Pf�OPERTY FOR INSPEG710N PURPOSES. �����J J/�I/�/ p COMMENTS___,. � � .__._ �a � � l F� f��__ - � m - - � a P H EE N l I 1 i ,. — , �` __ _—�-"� J „y�� _-' _"'— �d `�`�.����—� �, -- �s � � — /{`— — � N DATE ��! ___- !1 = a A. Mirree RECPT.NO. _ PAID BY _____ VALIDATION _`P ~ WHITE—Depahment Copy,YELI.OW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy � � w _�.`^, � �1 .� � �.� ; ,-; .. , _ ¢ :.,� � ��� . t� � :5 . � . � . +�