Loading...
HomeMy WebLinkAbout10080 , 1 , � CTI'Y OF DIAMOND BAR COMMUNTI'Y DEVELOPMENT DEPARTMENT � � �nC 21660 E.Copley Drive Sui[e 190 PRESS (909)860.3195 Fax(909)861-3117 ���'""' BUILDING PERMIT APPLICATION FIRMLY o ADDRESS��a��; ��� GSR�.�C � J DATECATION �/�t�/�� NUMBER/°Jv� #� ! � APN LOT TRACT ISSUE / TYPE OCC DATE �! ���� CONST. GROUP p OWNER � ADDRESS ZONING SETBACKS z CITY ZIP TEL. FRONT RW ❑ o APPLICANT TEL SID SIDE STREET RW ❑ � CONTRACTOR C�L�-'/�E-�?_- �l.1/�--�l-� SIDE ❑ � ADDRESS ��,C�:�b '' "-�:�-� �Cqotl C'���`�Tdt �t� C. p .= �� "' PROPOSED USE �`�� CI7Y'P�i/�.{nN�Mu�'� �s�. ZIP ' �• TEL.�,� /� ?1G�f•=,_._h4�5� w ARCH/ENG/ iz DESIGNER NO.DWEL. NO. ,NO. a ADDRESS UNITS STORIES 'BEDROOMS �- CITY ZIP TEL. � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION � OWNER-BI;ILDER DECLARATION SFFVADD/REM O p I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTOHS LI- G8�999/CdfPOK W CENSELAWFOHTHEFOLLOWINGREASON(SEC.70.9t.6BUSiNE55ANDPROFES5bN5CODE:ANYCITVOR (n U CWNTYWH�CMREQU�RESAPERM�TTOCONSTqUGT,ALTER,IMPqOVE,DEMOLISH,ORftEPAIRANYBTRUG W -,PBSIOIDeCI( -� - TURE,PRIOR TO ITS ISSUANCE.AlSO RE�UIRES THE APPLICANT FOR SUCH PEHMIT TO FILE A SIGNED W STATEMENT THAY HE OR SHE IS LICENSED PURSUPNT TO THE PROVISIONS OF THE CANTpACTOR5 LI� W � CENSE LAW(CHAPTER e�COMMENCIN6 WITH 5ECTKKJ 7000)OF�IVISION 30F THE BUSINESS AND PR0- V' POOVSPB FESSIONSCODE)ORTHAiNEOR5HE15EXEMPTTHEREFROMAND7MEBA515FOR7HEALLEGEOEXEMV- UT10N.ANYVIOLATIONOFSECTION7037.5BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLiCANTTO Z Re-Roof � A CML DENAL7Y OF NOT MORE THAN FIVE HUNDRED DOLURS(S5o0).�: O OI,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWA6E5ASTHEIRSOLECOMPENSATION, � Commercial z WILL DO TNE WORK,ANO THE STRUCTURE tS NOT INTENDED ON OFFERED WR SAIE(SEC.704�,9USI• J � NE9S AND PROFESSIONS CODE:THE CONTMCTORS IICEMSE UW DOES NOT APPLY TO AN OWNER OF ? PHOPER7Y WMO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCN WORK HIMSELF OR HERSEIFOR � THF�UGNHISORHEROWNEMGLOYEES,DROVIDEOTHATSIICHIMPROVEA7EN75ANENDTINTENDEDOH m QOFfEHEDFORSPLEiFHOWEYERTMEBUI1DINdORIMPROVEMEMI550tDWITHINONEYEAROFCAMPLE- Z TI011,THE OWNER$UILDEfl WILL HAVE TNE BURDEN OF PROVIN6 THAT HE OR SHE DID NDT BUIID OR � IMPROVE FOR THE PURPOSEOF SALE). ❑I,AS OWNER OF THE PflOPERTY,AM EXCLU&IVELY CONTRAC7ING WITH UCENSED CONTMCTORS Q TO CONSTRUCT THE PROJEC7(SEC.7ou,B1131NE5S pN�PROFESSION3 CODE:THE CDNTR4CTOHS LI- VdIU3ilIX1 ADJ.AREA W CENSELAW�OESNOTAPPLYTOANOWNEflOFAPPOPERTYWHOBUIL�SORIMPROVESiHEfiEON.AN� � WHOCONTMCTSFORSUCHPROJECTSWITHACONTRACTOR(5)IICENSEDPURSUANTTOTHECONTRAC qUANTITY DESCRIPTION FEE roRs uceNse uw.>. J .r�.;-- ( . O OIAMQfEAIPTUNOERSEC. B.BP.GFOHTHfSREASON Q "'= C.i+-.-�.�� �� � U � ' � DATE � OWNEfl �� -V �"' U Z W � ' LICENSED CONTRACTORS DECLARATION W � IMERE6Y11FfIRMUNDERPENALTYOFPERJURYTHATIAMLICENSEDUNDERPROVI510NSOFCHAMER � � 9(COAIMENCIN6WITHSEC710N7000)OFOIVISION30FTHEBUSINESSANDPROFESSIONSCODE.AND Z ' X MY LICENSE IS W FULL FORCE AND EFFECL � LLI � 0 LICENSECLA55 LIC.NO. J U DATE CONTFACTOR 0- W � WORKERS'COMPENSATION DECLARATION 4 = U � I HEREBV AFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLIOWM�DECLARATIONS: `=' a � IHAVEANDWILLMAINTAINACERTIFICATEOfCONSEMTOSELF-INSUREFORWORKERS' _ � COEIPENSATION,ASPROViDED8Y5EC710N37oaOF7HElAeORCWE,FOHTMEPERWRMANCE W � OF THE WORK FOR WHICH 7HIS PERMIT IS ISSUEO. � � W _IHAVEANDWILIMAWTAINWORKERS'COMPENSATIONINSl1RANCE,ASREOl11RE�BVSECTION Q 37000FTHElABORCODE,FOR7HEPERWRMANCEOFTHEWORKFORWHICHTHISPERMITIS - 0 ISSUED.lAVWORKERS'COMPENSATIONINSURANCECARRIERANDPIX.ICYNUMBERARE: CONSTRUCTION d � CARRIER PLAN REVIEW Z POLICVNUMBER < LECTR Q � (IHISSECTONNE�NOTBECOAiPLEfEDOFi}EPEMYfISFORIXJEMN�DREDDp.lNiS(5100)OHLESS� PL NG Z I CERTIFYTHAT IN 1HE PEPFORMANCE OF THE WORK FOR WHICH THIS PEHMIT IS ISSUED,1 MECHANICAL �j SHAL4NOTEMPLOVANYPERSONINANYMANNERSOASTOBECOMESt1&IECiTOTHE � WORKERS'COMPENSATION LAWS OF CALIFORNIANID AGREE THAT IF I SHOULD BECOME INSPECTION FEE � SU&IECTTOTHEWOflKERS'CAMPENSATIONPROVISIONSOFSECTqN37ooOFTHEtABOR e �.�� CADE,1 SHALL FORTNWITHCOMPLY WITH THOSE PROVISIONS. SSUANC �� � SMIP p DATE: APPLICANT: � ENERGY P!C WARNINO:FAIUIRETO SECURE WORKERS'COMVENSATION CAVERAGE IS UNIAWFUL,PND SHALI,BE � 6UBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINE5UPTOONEHUNDREOTNOUSANO ENERGYPERMIT DOLLARS(S7a0.oao1��NADDITiONTOTMECOSTOFCOMPEN3AT10N,DAMA�ESASPROYIDEDFORIN --------------- -------- � SECTION37080F'fHEU1BORCOOE,MTEREST.ANDATfORNE1"SfEES. � qETENTIONFEE: d CONSTFiUCT10N LENOING AGENCY PRE•AlT FEE: � I HEREBY AFFIRM UNDER PENALN OF PERJURY THAT THERE IS A CONSTRUCTION LENDINGAGENCY a- FORTHEPERWiUAANCEOFTHEWORKFORWHICHTHISPERMITISIS5UE0(SEC.3097,CN.CJ. . Z W � lENOER'SNAME F= LENDER'SADDRESS � � ICERTIFYTHATIMAVEREAUTHISAPPLICATIONANDSTATETHATTMEABOVEINFORMATIONISCARFECT, TOTAL FEES � � IAGFEETOCOMPLVWIT'HALLCINANDCOUNTYORDINANCESCNDSTATELAWSRELATINGTOBUILDING - . � CANSTRUCTION,ANDHEHEBYAU7HORIZEREPRESENTATIVESOFTHISCWNTVTOENTERUPONTHE ABOVE- ENT�ONEOPFt RTYFOHINSPECTIONVUflPO3E3. COMMENTS a 1 � � � �,���� �� m CER E NAIAE(P I - � Q 1 N � sioN EOF D I EE — D TE ! RECPT.N0. ��.���`� PAID BY �L��!�'d VALIDATION � WHITE—Oepartment Copg YEILOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplicenPs Copy �' � �'�' t"`�x„�4'_"'w'� '�"""� � -� �� i � �i '�`� �n� � � � � � ��� ';y �,�.�' ��F �' *�A� r �� � .,� � .'�� _ � �_,;�� _::� � -".��` - ' �. � �, � . '��, g . ? ;-� f e ' � �� �- �' j '` � � � � � 'I � :� � �� _ : � I 1 ( � � �j � �i b` � � � _ . �,� ;'x >� � � CT� I � ��`r � � � � ; � i ,� � � ' � � { �. :�� � t� � � ' ��_� � 3 �� ` � "��' � ��� _ ' �� � � �', t , - _ ,, ` � ' � ' � � �- � _ I�� �� f 1 � � ti � ��'� � ��; t � ; �� � � _ i ��( i I , �. � �' � x � I � � I 3 � � � `J � .y� .�t� � � � � I !I i� � 9 . . � � � ( � � � ! f � . i, '� , � �i i- �'� ���I `� �����i� � I ,� � E � � ' � �� � I � � � - . � - , -�(1"�i�'T` ' - i �� I � i f- `� I 'j �� 1 —i � � , � � , i �3 F � � " �j i �r� I � � �` E � I � �f -� ` �� �� � j; � �.; I I � _ � ' � i `:� � ' � i'_ � �J _� �' � �� � E ' _1 �; � "-, � � ; E � � � ' }� i ',I =i M1� , ( , �� � " i ' � �! � � � { � � " � � ( ;� ( C € Ir ;; s:� � i � :�� 3 . #'_'#'^ € I ! Y � i � ' '— � f� ��� F� ,�� j, g � ! _! � � � � :i ' `E I � f! , � ! � ,� �� �� ' � �_ � � ' � �� �I I �� , � {� � _i � ra � ! i � � _� f'� , , , I � � : � �: � '" � , � �� I �� � ' � G �iwj�� � 1 �� t � °i I � �� j .�� t: I � € � E . � �, � � � I .1 , � N 3 p �� � .��i� � 1�a �a I � t :1 � �) '`� '�z I � .i- � i ��� :� ' " ' ' fi � �� � �� � � , �, u�� La,�; gl j c� f l �°•_ � i � 1 �y � , � z'� ¢ w� ��. Ez �!'e�� � Icc ¢•�I k � � i , _ ; I , � � 'F�t�n�o,o u�. �I❑ � °° z'; �a�oi.� z� `.� `�` ft��cn1�. �:Ir .`�-�, fi � � � ` 4 i � � -' i � �'' j �.�3; en z �c3r I zuaj� r� a�a- i m I � � � I I. � � � �: � �s O:�{: w tL� Ca Z fl! ��`�3�� 6-�"��.�C3 ��..'� �tu� i I i : [ � � t� e —� —� ca c5'G � I c, cc � z �^� � � r. �� 1 + � � � a , � � � ¢ ¢ ¢ � p 41:G��c7t� w z �+- ��� �O � i., i .�i I l i ; i , � k, , i E ��� � $ .o � � _�'�i��mf��;?l�����iar��,lu. H- ¢ u.,��y.� ru,�,z�� '„i � ' ; r �G r } `� I ..�. Q..� i I C7 ���s J ytriltJ � . �� .� �. .. � ._..i. _i.._ : -�--� ! � i. �_1 �._...I .�.�. i,.E � � � k � ql� ��� ��w{z ��Li0i0 O u n �I� � ¢ w-u�i u�.r'�f, � i i ., s � # � �.,, � � '� � ,i�.. u.�I�ao u-.o:,m cGiu--�t�d a.-,t3 o u.��� �,� , . :. '�.� �' C '�� I � U i rn I O- � � `Iz 1�� �c� w o �a� o LL � � — ,� x ❑�ue� _ # ~~, � ' ' � � � s � �{� �, ��,` � � 4 `7 �� ' � �� �e(� � }y { �,_R� , � i ij �' '� �� 3_� � � �'� 3 I ��� if ` ' ..k� ^ � �' j � �i � � .�.. I I� �,� . Z.: p� t i � � ¢af ffi f( � �� :t � � : � I. ;. ( � ,� � I � f j . � _ +. Pj { � �1 � I i�_. � � ) � i a � �' - ( � � - �i : � �( � ��� � �� . �� � ( t t Z ' ' I _ ` � � � d; � � , I � �� �—�� � �� t � 'I',� ( i I l� f { t � �t �� ' i �� ( 3 '�1 E G,: �; E ` ( �� �� � I_ � �� � � �G _I � - . t b ` . f t r� �� � 1'�.� ,r� € ��. t � a � i. ' �( �� � - � �. � ( � ( � , il 'j - � i � � � � ; � ' �' � ? �� � I i ' � 1 � � :I i; i „ , ' � �; ;. r� � � ! I ! � ( � ' i, I - � '� � �i I '� '� � � � ��E' 1: � � � ' li � � �� � ; 1 ; � �� ��� I i ia � � � I �' i � �� � . � ' I c 3 i� i �:� I , �@, i� � � ( t � �, i a ,.��_ 3�' y � � � ' .. � �7 '..'—ir' ' � t- � I . i "�� � f i . i i � �{; � 1 ! � O �� � � , �_� ,�� , , , � j , � � ; ,; � � � � i , ��;� �''��;��!� ����,Q � � ,i � ' ; � �` E � I ; I i � �;N3 cnp � I 'c��z �-.. �zl��mF' ��...�'� �� ' t� � ' � , -� � i � � � ' � icn� �..�n � ��� ��y � z ¢.Nc��� min � — . �z >`* � z � m; �� �!�- � � ! `�:� t7 -� owd ¢ u.swa �{n �Iu> �'u> � � -' � � t= � � '� ! � � � � Y� ¢ U � ¢ � uawZ > uai.si�., � l��:z 9 q �w.z �cw � 1. 1 I ! .:� � ¢_: i • c� o a'cc � c� s o�,��a � w+ � F- � }'��o w _., w � - F-,�� � ,¢ „_ � z.� a. � mzc�_��z;sm �'" z.z. ¢ cc�c,ia � c.> x�u.+ ��i. � � s � j � %��ai m � � ��ma�uu � gus.9c�E� ��� ��� �ht=��n. ��tJ � � _, ;� t=a; F-�t, w.� � �'o a fl'�f� � i� d`� � � w w ¢�� z�z z�'; O �,1 , �'ua; , n w �- � � � w o � 4;c�Of{3xl�e � e� ocnrn' cne� � u.'s,, u.. L.9 � � ! r�ne�r> � s✓i�ta. ua c3 c. � 3 � u, ��!¢�rrc �n + !- m..�. .: a��..�_�� ._,�: .. _._..... . _ ,.. _..,..._ _. ._, �.,.,.�.