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HomeMy WebLinkAbout15426 (22) ,�. � CITY OF DIAMOND BAR � �' ----�'� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � ., ` , � . 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 �'�'�� � BUILDING PERMIT APPLICATIQN FIRMLY, y�, JOBSITE ,,- � ,� ,�n : �. , APPLICATION f PERMI'f ' /C o ADDRE55 �� L� DATE�r NUMBEF� # ISSUE TYPE OCC � APN LO TRACT DATE CONST. GROUP p OWNER �����.,�9�`�_�`�` - LL ADDRESS � ''"C�� ZONING SEfBACKS 0 �i CITY ` ZIP TEL. REART RW ❑❑ APPLICANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR� �%, „�': �' 'C-�,;� .�. SIDE ❑ �' ADDRESS 't�i'"Ft �2`'�t?6;� J#1/+� � o `�'� PROPOSED USE ''��� � �✓ �u CITY�,} `F?J�JT� : ZIP TEL.`�j > } � , o;; ARCH/ENG/ z' DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES I BEDROOMS � CITY ZIP TEL. �. �` DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q��- -. - - OWNER•BUILDER OECLARATION SPRIADDlREM 0 0- . I HEREBY AFFlRM UNDEH PENl�LTY OF PEFJURV THAT I AM IXEMPT FROIA h1E COMRACTORS L6 (�j8fdQ6/C8(P011 W; -CENSEUWFOflTNEFOLIOWINGREASON(SEC.70Ji.5BU91NE85ANDPROFE55IONSCAOE:ANYCITYOR , (n C.7 :COUNTYNHICHREIXIIRESA�EHMtTTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTAUC- � W PetIO/DeCk W �TURE.PPIOR TO ITS 133UANCE,/1S0 REW IRES THE APPLICANT FOR SUCH VERMIT TO FILE A SI�NED W �. STATEMENf THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 � CENSE LAW(CHAPTER 9(COMMENCINO WITH SECTION 7000)oF t71VISION a oF THE BUSINESSAND PRO� u' PooUSpO FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM ANDTHE BA515 FOR THE ALLEGFD F.XEMP- , -TION.ANYVIOUTlONOf9ECTiON7031.6BYANYAPPUCANTFORAPEPoAITSU&lECTSTHEAPPUCANT70 Z Re-Roof �; .A CMl VENFLTY OF NOT MOPE THJW FNE HUNDRED DOLLARS(S5o0)J: . � �I,ASOWNEHOFTHEPROPERTV,ORAIVEMPLOVEESWITHY�AQESASTHEIRSOLECOMPENSATION, � Commercial Y11LL 00 THE WOflI(,AND TNE S7RUCTUflE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7044,8U51� �I NESS ANO VROFESSIONS CODE:iHE CONTHACTORS LICENSE lAW DOES No7AYPLY TO AN OWNER OF �-- PROPERTYNM06UILDSORIMPROVESTHEREON.ANDN?fO�OESSUCHWORKHIMSEIFDRHERSELPOR m �- THROU(3MHISORHEROWNEMPLOYEE6,PROVI�EDTHATSUCHIMPpoVEMENTSAFENOTINTENDEDOR W� OFFp1ED(ORSALEIF,IIOWEVER,7HEBUILDINGORIMPROVEMENTi550tDWITHINONEYEAROFCOMPLE - Z�_ TIOtd,7HE OWNER•BUILDf(i WILL HAVE 7HE BURDEN OF PROVING THAT HE OFi SNE DID NOT BUIIA OR � IMPFWVE FORhIE PURPOSE OF SALE). ' W ❑I,ASOYMEROFTHEPROPERTY,AMIE7CClUSIVELYCAYTRACTINAWiTI-ILICENSE�CONTRACTORS . , . ✓ � TO CONSTRUCT THE PRO.IECT(SEC.704d.BUSINESS AN�PROFESSIONS COOE:THE CANTRAC70RS Lb .VBIUfltI01i "� �'w� �__._._____.._ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPFOPEFTYWNOBUILDStlR11APROVE3THEREON,AND �- �� N7pCON7RAC75WR5UC:HPROlEGT3WITHACONTflACTOR(S)IICENSEDPURSUANTTOTHECONTMQ � QUANTITY DESCRIPTION - - FEE . - � TORS UCENSE LAW.}. � p ❑i AM EXEMPT UNDER SEC. 8.S P.C.FOR THIS REASON � 3 DATE __ON7JEft U � W � LICENSED CONTRACTORS LIECLARATION W � �HEREBYRFFIRM UNOFR PENALTV OF PEPJURY THAT IAM LICENSEO UN�Efl PflOV�510NS DF CHAPTER � d 9 MENCINO WIiH SECTKKJ 7000�OFDIViSION 3 OF 7HE BUSINESS AND PROFESSIONS CADE.M7D Z LICENSE IS IN FULL FORCEAND EFPECT. m 0 LICENSECLASSi�� ���O _s�_ . � -. . DATE ���/� a s CONTRACTOR W � WORKERS'COMPENSATIONDECLARATION �' � �� U � IHEHEBYAFFIRMUN�ERPENAL7YOFPEFLJURYONEOFTHEFOLIOWINGDECLARATIONS: Z Q Ll _IHhYEANDWILlMA1NiAItiACERTIFICATEOFCONSEM70SELF-IN6UREFORWOFKEflS' 2 -' L fAMAENSATION.ASPROVIDEOBYSECTION37000FTHELABOflWDE,FORTHEPERFORMANCE U �� OFTHEWORKFORWHICHiHISVERMITiSI5SUE0. � d W IHAVEANDWILLMAMTAINWORKERS'COMPENSATIONINSURANCF,ASREQUIRE06YSECTIDN / j Q 370UOFTHELFBORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS �(/4 I� ISSIIE�.MYWOPKEiiS'COMPENSA7iONIN5l1RANCECARRIERANDPOLICYNUMBERARE: CONSTRUCTION ici i�.� jc�qR�ER � PLAN REVIEW Q POIICYNUMBER ELECTRIC . G �C Q (IFNSSECPIOPJNE�NJTBECO�/PLETEDOF7HEPEI�NTi$fORONEI1lHJJFiED00LLPA5(S7C0)ORLESS� PLUMBING w MECHANICAL z- ICERTIFYTHATINTFiEPERFOflMANCEOFTHEWORI(FORWHICMTHISPERMITISISSUED,1 '(3' SHALLNOTEMPLOYANYPERSONINANVMANNEPSOASTOBECAMESUBJECTTOTHE � WURKERS'COMPENSATpNLAWSOFCALIFORNIA,ANDRGREETHATIFISHOULDBECDME INSPECTIONFEE _ SU&IECTTOTHEWORKEFS'COMPENSAT�JPftOVI510N50F5ECTION3To00FTHELABOR � � � CODE,ISHALLFORTHWITHCOMPLYWITH OSEPROVISION� ISSUANCE � DATE:.S2�S�,L APPLICAM: � � �t C�� _� SMIP � � `.. �� ENERGY P/C WARNING FAIUIRE TO SECURE WOFKEFiS'COMPENSAiION CAYERAGE IS UNLAWFUL,AND SHAIL BE � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCMLFINESl1PTOONENUNDREDTHOUSAND ENEFGYPEAMIT pOLLAflS({100,000).IN ADD�TION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION37o80FhiELABOflCODE.INTEREST,ANDATTORNE7'SFEES. RETENTIONFEE: � ��� CONSTRUCTION LENDING ACaENCY pqE-ALT FEE: ��"Y"`i1'.nr r'iz A�xflYaftl�� — O LR7t7"S7� � INEREBYAFFIflMUN�ERPENALTYOFPERJURYTHATTHEREI3ACONSTRUCTIONLENDINGAGENCY FOR THE PERFORMANCE OF hiE WORK f-0H WNICH THIS PERMIT IS ISSUED(SEC.309�,CIV.C.). Z __—_ _ W � LENDFA'S NAME F— IENDER'3ADDRE55 ' WICERTIFYTHATIHAVEREADYHISAPPLICATIONANDSTATETHATTHEABOVEWFORMATIONiSCARRECT. TOTAL FEES � � ' � IAGREETOCOMPLYWITHALLCfi7FNOGOUNTYORDINANCESANO3TATELAWSREIATINGTDBU1l01NG � CONSTfiUCTION.ANDHEREBYAl/THORREHEPRESENTATNE50FTHISCOUNTYTOENiEflUPONTHE Z ABOYE-MENTIONEUPROPERTYFORINSPECTIONPURPOSES. COMMENTS ___ . � �f��� ��� �'�tt"���� m p�GAMMPPEE E P �r ./ Q � d 3 � P UJ SIG TUREOFPERMITTEE ' ATE �, � � � RECPT.NO. 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