Loading...
HomeMy WebLinkAbout11476 T��� C]TY OF DIAMOND BAR � COMMUNITY DEVELOPMEN'I'DEPARTMENT 21660 E.Copley Drive Suite 190 PR�S+S (909)860-3195 Fax(909)861-3117 ' "''""'" BLTILDINGPERMITAPPLICATION FIRMLY o' ADDRESS ��o�Ccz-rD12Y CQ A?PLICATION PERMIT P/G � �f�� �� DATE �NUMBER� # � ISSUE TYPE OCC ' APN LOT TRACT DATE CONST. GROUP � p OWNER � r ZONING SETBACKS �; o ADDRESS d �y z CITY�Q 1���� ZIP� TEL �a FRONT _._._____—. RW ❑ I o APPUCANT �C1��, TEL. SIDE/SIDESTREET RW ❑ z � m CONTRACTOR SIDE ❑ ¢ ADDRESS � PROPOSFD USE p CITY ZIP TEL. w ARCH/ENG/ ZDESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � C{TY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BCILDER DECLARATION SFR/ADD/flEM � O 1 HEREBV AFFlFM UN�ER 7ENALTY OF PERJURY THAT I AM EXEMPT FFOM THE COMFACTORS LI- � G8f899/CBfpOfl �W CENSELAWFOHTHEFOLLOWINOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCO�E:ANYCINOR ((� V COUNTYYdNICHHEqUIHESAPERlAI7TOCONSTRUCT,ALTER,IMPROVe,DEMOlISH,OHHEPAINANY51qUC- W Patio/Deck W TURE,PRIOR TO ITS I55UANCE.AlSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A 51GNE0 W STATEMENT TI IAT HL 0I1 SHE I$LICENSe�Pll(iSUANT TO THE P(lOVISIONS Of TH[CONTllACTORS LJ- � CENSE LAW(CHAPTEfl 9(COMMENCING WITH SECTION 7aa0)OF OIVISION 3 OF THE BIJSINE55 AN�PRO- �'1"- POOUSPd FESSIONSCODE)ORTHATHEOFSHEISEXEMPTTHEREFPOMANDTHE6ASISFORTHEALLEGEDEXEMP- (�, � TION.ANYVIOLATiON0�6[CTION7031.SOYANYAPPLICANTf017APEfIMIT5U8JCCTSTH[APPI.ICANTTO Z Re-Raof A CIVII PENALTY OF NOT MORE THAN FlVE HUNDRE�OOLLARS(35a0).7: o ❑I,ASOWNEROFTHEPflOPERTY,OPMVEMPLOVEFSWITHWAGESASTHEIRSOLECOMPENSATION, � COfi11110fC181 ' Z WILL DO THE WOAK,AND iHE STf1UCTURE IS NOT INTENOED OR OfFERE�FOR SALE(SEC.70a4,BUSI- J � NESS AND PRDFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTY WHO RUIL�S OR IMDflOVES THEREON,AND WHO OOES SUCH WORK HIMSELF 017 HERSELF OP - � THFOUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENOEDOR � - Q� OfFEREDFORSAIE.IF,HOWEVER7HEBUIL�WGORiMPROYEMENTISSOLDWiTHiNONEYEAROFCOMPLE- - Z 710N,THE OWNEFi-BUILOEfl WILL HAVE THE BORDEN OF PROVING THAT HE ORSHE DI�NOT OUILD OR- = IMPRO FORTHEPURPOSEOFSALE). AS ONMER OF THE PflOPERTY,AM EXCLUSIVEIY CONTFlACTING WITH LICENSED CONTflACTORS � TO CO STRUCT THE PROJECT(SEC.�044.BUSINE55 Alr'D PROFESSIONS CODE 7HE CONTFWC70F5 U- V81U3fiOn ADJ.AREA W CENSELAW�OESNOTAPPLYTOANOWNEROFAPflOPERNWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTFACTSFORSUCHPROJECTSWITHACONTRACTDR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE IAW.y. I L� ¢ ❑I AM EXEMPT UNDER SEC. 0.&P.C.FOR 7HI5 REASON Q ` � �I� (c�{ � '� LL � ° `� 6 — DATE __.__.. OWNER_. _ V �. LICENSED CONTRACTORS DECLARATION , � W ¢ 2 I HERE6V AFFIRM UN F PENALTY OF PERJURY THAT IAM LICENSED UNDEft PROVISIONS OF CHAPTER ' . p� 9(COMMENCINGWITHSECTION]000jOFDIVIS:ON30FTHE8USINESSANDPROFESSIONSCADE,AND ' X MY LICENSE IS IN FUII FOFCE AND EFFECT. - W � LICENSECLASS LIC.NO. � U DATE GONTFACTOfi W n�i� WORKERS'COMPENSA710N DECLARATION ' � � I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FO�LOWING�ECLARATIONS: � � 1 HAVE AND WILL MAINTAIN A CERiiFICATE OF CONSENTTO SELf-INSURE FOR WORKERS' Z CAMPENSATION,ASVROVIDEDBYSECTIDN37oaOFTHELABORCODE,FOfiTHEPERFORMANCE � a OF THE WOFK FOft WHiGH THIS PERMIT IS ISSUED. � O � _IHAVEANDWILLMAINTAINWORK[f1S'COMPENSATIONINSURANCE,ASHE�UIRE�BYSECTION O 37000FTHELABORCODE.FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSUED.MYWORKERS'COMPENSATIONINSURANCECARRIERANOPOLICYNUMBERARE: CONSTRUCTION � j CARRIER PLAN REVIEW . z POGCYNUMBER ELECTRIC � Q � (iHIS5EC7I0NNE�NOTBECOMPI.EfEDOFiHEPERMfTISFORONEHUM19REDOCALAAS(5107)ORLFSS). PLUMBING Z i CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSIIED.I MECHANICAL (`3. SHALLNOTEMPLOYANYPEfi50NINANYMANN[RSOASTOBECOMESUBJECTTOTHE (n WDRKERS'COMPENSATIONLAWSOFCALIFORNIA.ANDAGflEE�HATIFISHOUL�eECAME (NSPECTIONFEE SUBJEC7 TO THE WORKERS'COMPFNSATION PROVISIONS Of SECTION 3700 OF THE LABOR / � CODE,ISHALLFORTHWITHCOMPLYWITHTHOSEPROVISIONS. ISSUANCE / � Y f0�"'b� � p �ATE: APPLICANP. SMIP ...__ ___-_ A!� W � 1 J WAPNWGFAILURETOSECUREWORKERS'CAIAPENSATIONCOVEFAGEISUNLAWFUL.ANDSHALLBE ENERGYP/C ��. r J � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCNILFINESUPTOONEfIUNDREDTHOUSAND ENERGYPERMIT OOLLARS(5700.000),IN AD�ITION TO THE COST OF COMPENSATION,DAMAGES AS NHUVIDEO FtiN IN J SECTION37060FTHELA60RCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: _ Ct �y 7g _" _'__ _' � CONSTRUCTION LEN�ING AGENCY PRE-AlT FEE: �M�� �� '7i � O . . —_�F_ . . � {HEREBV AFFIRM UN�ER PENALTY OF PERJUPV THAT THEPE IS A CONS7RUCTION LENDING ACaENCY n-- FOR TFIE P[RFOtiMANCE OF THE W�RK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z W _ —. __.. ___--_. _____ ._...'_-.__- , . _ � LENDEfl'S NAME ... � C LENDER'SADDRE55_ p � ICERTIFVTHATIHAVEPEADTHISAPPLICATIONANUSTATETHATTHEABOVEINFORMATIONISCORRECL TOTAL FEES - w a. �� w I AGREE TO COMPLY WIFH�LL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATMG TO BUIL�ING ' � CONSiRUCTION,ANDHEflEBYAUTHORI2EREPPESENTATNESOFTHISCOUNTVTOENTERUPONTHE � � ZA80VE-MENTIONE�PPOPERTY FOR INSPECTION PURPOSES. COMMENTS___._._._ —_._._<___ .- � J ^'�U aa. � m PE� EENAME(P ' - 4 � ._ __....__ ___-... _ • � .F Uj SI�NAT EO RMTTEE T � /����� � - � �� = RECPT.NO.� PAID BY t�i"'O VALIOATION- �� - ~ � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy � � _ _. : �� � I I � I i , � � ; � ' � �� i I ���� � [ I i i ' � �__�� I ' i I � � f � � ' ' I � � � � � � € � 'i � 1 i i �� � � � ' , i��" I � � � ' I , i I � � � � � , = � � , i ! ] ' .�. ; ' � � i I E ° ', 3 � � 3 i E � ' � i ; i � I, i � G � j i I � . � i ( .. } � ' � t ' �i I f - � � 1 � I � i . !y : i � ��'..�!, i t � }� � I � i —� € � � � i t f � � � � � I � € ; � � � � � � � ' � ` ; ( � � E i ' ' i i � � I � ' i ' � � 'uy � , � � '" } � � � � ; � � � � _ � � > .. i � � �, � E � � ( . � i i a I � � �� � ; ' ' � ± � � i � � � � _� � � � ��� � �� ; � i j i ' � � � ! I , � � j � �p� � �� � � ��wi� � � ' � +� � ' ( � .. � @w9 ��,�j��{���� l��f�]I('� �� � '.� �� (U} � {,�j�� �.�•��. � � � � � ( .,E �I � r- e,� � �r.s m�� � z ,,� G �n � � I , � �� eP t-a � 1� � �3,�4 +� �i=- ,,,,a E �' Li� a. 2 �'-�0.. �+.. �� ! - � �� �4�±.u�s.�, � � 4 ca UI.,�1� �- � � . � E � �� �} � rj�'����� U�t��m ����d�� U,� J w��3�, �:� � '��� c�.�cs�,`-�"� i � G � � � � � s � � � (d ¢, i '.C'3 � . -a3�✓"I � s - � .�.i �,� �(,...� }� � tA �:'-r S w�t�I�^f�,-t� w U w ry w�z r�.i �`� � � � � i � i • � # °��,`^ '.p��= w u�i cr�a�� � .��� � rn;� � I_a�v: c.7 � s�� b �� �.,�,F-1� { � ; - � � ��.� CS C1 ���i� ��di.�J �f��� QiC3 Cltx.€� � -�a��I� ,`d1�_�� t'l�a� � ' t I ' t � � � � ' � U � _,�— z�z rt u � OiCj � ���a�_ ( iu� aa,�r € } i I � � � � � �. r����� u. � �;ca u.�a m���uW a c� ae��`C1 u_ �.C3 � u�;� �,u! ¢ € � � �- � i �:� - - -- ( _ "�.._ ._ � _--�-Jr_-,��_a�; ! � � j ; i � � I �� � , � � � � � � � � � II ; � ; i � � � � � �q ; � � � � ` � i � � i� � ; a ' � � '- ' : ; � � � � ' � . E ' � i � t ; � ; � i � � ; �; � , I � � I � ; � , � I j � , 1 ' � ' , 1 � ' �� � i j_ + i � i ;�`�n i � j � r,t � � ��j� � �� j� I � l �� ',.� � �� � I { � 3 � I ' I. � — - j ; � � � � � ; � ; �f + � � `• �' m � � � , � _ � _ �� � T� � �� , '--;��— { � � � I ` ;���� I� �� �, :� � i� °i��� � � � " � ' ' � I E � �w � F-I�1 C,�� kll'.� `i fJ � L3 'C5 k--�r � 1 i i i � ! �G'� �.� {`a'� E- ���>t �- � ..�.s- � c5�� � Js` € i zra rd �i� � � >,�- z� r�� �, ��m � �-s ` s--�=- ��� �: � � i�ua �iv.--' �, v- x�Q � w�¢ us.� � c,�l�tua�� }� -'i� M�r� r.�.> � � ' ���°"� �E�ica,�� � S �a,��- � =ry -�''-'�� ''I i�c i ��� 1 ( �-t� �� E� I� � C7 n,� s� G� � a � u, � � .�7 ,at �; .��a '� � - e- � �a.{cc.�' r����,x.rt� � t3 � ����uu i�!'��' �I Sx C7 �., �l e.7�� ua c a � i � l � C.�ti � . ����� ��� a3��-�� � �_�� a ���' '-� r cn, �L�� � � �- j = � � �M-�i, �t� ItJ »� ,� r' O 1�L�fJ � .� � t��€- .� --'i?-'S e..�t a�3-�i Q K'L eC, i � ; `t7a U! u� (� �" � � Oi� C) �) � � sX � W � wW �.�; <%�� � � � i � W€a! ua i� w t� �ra r- c� ci. rx €C x � r,y�au > v � rre c�s c c:�i�? u,�c���.,� � Cm: j `u°s G� . ......._,�... _.... . _ ...._.__... ._,�...� a