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��..�_�� ._,�: .. _._..... . _ ,.. _..,..._ _. ._, �.,.,.�.