Loading...
HomeMy WebLinkAbout15615 (22) w _�� CITY OF DIAMOND BAR H DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 '� � (909)860-3195 Fax(909)861-3117 PRESS �����'� BUII,DING PERMIT APPLICATION FIRMLY y JOBSITE � ' APPLICATIO �,._ PERMIT P/C o, ADDRESS D � � DATE NUMBER # c� ; ISSUE TYPE OGC APN LOT TRACT � DATE � CONST. GF10UP g OWNER 1-f��} �v t�S � � ADDRESS 1L C�e��" 7 ` ZONING SETBACKS W CITY/��-ty(C„c,Sj� ZI / - TEt�1�' .3��/>Z//G FRONT RW ❑ � APPLICANT TEL REAR ❑ � SIDE/SIDE S7REET RW ❑ _ CONTRACTOR SIDE CI O: CDDRESS ZIP TEL. PROPOSEO USE � � � � c � � ARCHIENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS l STORIES � BEDROOMS�_ �' CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION �- OWNER-BUILAER DECLAFiATION - - • SPR/ADD/REM O � 1 HEREBY�FFlflM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS Li� G8f89BIC0fpOfl W CENSEUWFORTNEFOLLOWINGREASON(SEC.70.97.58USINESSANDPROFESSIONSCODE:ANYCINOR ;(n . G7 COUNfYYYHICHREOUIRE6APENMRTOCONSTfiUCT,ALTERIMPROVE,DEMOUSH,ORREPAIRANYS7RUC. �.W� P2t10/D@Ck W TURE,PRIOfl TO ITS ISSUANCE,AL50 REQUIflES THE APPLICANi FOR SUCH PEflMITTO FlLEA SIGNED _W STATEMENT THAT HE OR SHE IS LICENSBD PURSUANT 70 hIE PROVISIONS OF THE CON7RACTORS LI- �-. CENSE UW(CHAPTER 9�COMMENCINa WITH SECTION 7000)Of 01VI510N 30F THE BUSMESSAND PF0- � POOUSPd FESSqNSCOOE)ORTHA7HEDFSHEISEXEMPTTHEflEFROMANDTHEBASISfORTNEALLEGEOEXEMP- -� TqN.ANYVIIXATIONOFSECT10N7031.6BYANYAPPLICANTF�RAPERIA1TStl&IECTSTHEAPPLICANTTO Z Re-4ioof � � A CIVIL PENALTY OF NOT MORE THAN FNE Ht1NDPED DOLLARS(5500�.): � ❑I,ASONMEROfTHEPROPERTY,ORMVEMVLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial - WILL DO THE WOAK.AND iHE STRUCTURE IS NO7INTENDED OR OFFERED FOR SFLE(SEC.7o4a,BU51� J � NESS ANU PFpJF�S510NS CODE:THE CONTtiACTORS UCENSE LAW DOES NOT APPLY TO AN OWNEF OF . _ PqOPERTY WFiO HUILDS OR IMPFOVES THEREON,ANO WHO DOES SUCH WORK HIMSELF Op HERSELF OR Q THF#�UOIIHISOpHEROWNEMPIOYEEB,PROVIDEDhIATSUCHIMPROVEMEMSARENOTINTENDEDOR �m - Q ,OFFEREpFORSPLE1f,HOWEVER,7HEBUIIDINGOH�MPROVBAENTI55CLDWITHINONEVEAROFCOM�LE� - z TION,THE ON7JER-8UIl0ER WILL HAVE THE OURDEN OF PROVINR THAT HE OP SHE�ID NOT BUIID OR � IMPI�VE FOR THE PURPOSE OF SALE}. ❑i.l15OWNEROF7NEPF�PENTV.AM EXCLUSIVEIYCOIVTPACTING WIhiLICENSE�COMRACTORS - � TO CONSTRUCT THE PROJECT(SE0.7ad,BUSINESS AND PROFES&IONS CODE:iHE CONTpACTOHS LI� VelUetiol1 ADJ.AREA � W� CENSEIAWDOESNDTAPPLYTOANOWNEROFAPROPF.RTYWHOBU1LD50RIMPROVE9THEflEON.AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRAC70R(SILICENSEDPUASUANTTO7HECONTMG QUANTITY DESCRIPTION FEE � Y 70RSLICENSEUW.). J � ❑i AM IXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q - f': � U � � � OATE � � OWNER ' V - � �a IICENSED CONTRACTORS DECLARATION W - ¢ IHEREBYAFFIRlAUNDERPENAL7YOFPER1UflYTHATtAMLICENSEDUNOERPROVISIONSOFCHAPTER � . � 9(COMMENpNOW1THSECTlON7000)OFOIVISION30FTHEBUSINESSANDFfiOFESSIONSCO�B,AND Z MY IiCENSE IS IN FULL f-0RCE AND EfFEC'L m 0 UCENSE CLA55 IIC.NO. _� �V- DA7E CANTAAGTOfl. _ a ui � WORKERS'COMPENSATION�ECLARATION Q � 1 MEREBY AFFlfiM UNDER PENALTY OF PERIURV ONE OFTHE FOLIOWING OECURATIONS: U Vj Z 0 _.IHMEANDWIlL1A.41td7AINACERTIFICATEOKCONSENTTOSELFdNSUREWRWORKERS' 2 � COWPENSA7ION,ASPFiOVIOE-0BYSECTION37ooOFTMEU80RCODE,FORTHEPERFORMANCE WU OP THE WOflK FOH WHICH THI3 PERMIT 1313SUED. � � _I HAVEAND WILLMAIN7AIN WORKER3'CCMVENSATION INSUHANCE.AS REQUIRED BY SECTION Q 37090F THE UBOH CODE.FOft TNE PERFORMANCE OF THE WOflK FOR WHICNTHIS PERMIT IS �� F43UED.MY WORKERS'C��IPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: . CONSTRUCTION �� ( J j c�qqiEp � PLAN REVIEW � POLICV NUMBER ELECTRIC Q (n�ssEcrqnir�nnraEmuwiErEooFn�a�anar�sr�orvEr,urnAEooalnresisim)oa�ess� PWMBING z iCERTiFYTHATINTHEPERFORMANCEOFTHEWORKF017WHICHTHISPERMITISISSUED.i MECHANICAL '" �' ��_3�~�`� . (,rJ SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESU&!EC?TO7HE Y`;-7�r�'��.}.-�� � � WORKERS'COt�1PENSATIONLAW30FCALIFOFIN�A,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE �� � SU&IECTTOTNEWORKERS'C061PENSATIONGROVISIONSOFSECTION37000FTHELA80R � r _- CO�E,I SHALLFOR'(N4YITM COMPLY WI7NTHOSE PROYISIONS. ISSUANCE .� p DATE: � APPLICANT: .SMIP �"'° �sk��� � Q � s��:s:, ENEAGY P/C "'�� � WARNINGFAILURETOSECUREWORKEHS'COMPEN9ATIONCAVERAGEISUNUWNL,ANOSHALLBE . .c i�'�'�'— ,,�; . � SU&lEC7ANEMP�OYERTOCRIMPIALPENALTIESAN�CNILFINESUPTOONEHUNDREDTHOUSAN� ENERGYPERMIT - ��� �' DOLLARS(5700,0oo),INAD�ITIONTOTHECOSTOFCOMPENSATION,�AMAQESASPflOVIDEDFORIN --^�^ �� � � SECTION37080FTriELABORCODE,INTEflEST,ANDATTORNEI"&FEES. ' RETENTIONFEE: 6 � � --- d CONSTRUCTION LENDING AGENCY pRE-ALT FEE: � IHEREBYAFFIRMUNDERPENALTVOFPERJURYTHATTHEFEISACONSTRUC710NLENDINGAGENCY - n- FORTHEPERf-0RMANCEOF7HEWOPo(FORWHICHTHISPERMiTI5155UE�(SEC.3os7,CIY.C.). W - � LENDER'S NAME F- LENDER'SA�DRE55 WICERTIFY'fHAT�HAVEREAD7H�SAPP�ICATIONANDSTATETHAYTHEABOVEINFORMATIONISCARHECT. TOTAL FEES - � � /�'� � I AGREE TO COMPLV WITH ALLCITY AND COUNTY ORDINANCESANO STATE LAWS RELATING TO BUILDING Y CONSTflUCTION,ANDMEREBYAUT1iORREREPflESENTATIVESOFTNISCOUNNTOENTERUPONTHE G . Z � E-MENTIONEDPROVERTYFORiNSGECTIONP RPOSES. COMMENTS _._. _____ = t ' \ �-(` C .9 m PEflMITTEE�' (PRI � ) R N !� � VCi � SIG TU PE ITTEE � D E RECPT.N0. PAI�BY VALIDATION � � WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDEN OD—File Copy,GREEN—AppiicanYs Copy . _ �. ..� ...,.. _._.�.,-...._ ,- _i._ _..,_ _ �_.� _€ � � �� ._� ( � _ �. � � � . ' � � � _,.��. .� _- _ ° � , �,� ; I � , � � ° 3 � � ; � • I� � � i � � '� t ; ,.. �< i m � , �.� i i. > f: l 1 �; i � 4 ' i � S 1 E � �, r I � � � � 1 � ( € � ' � � � 1 � � i i i � E (- .E. � �'. � ( .-i � (�. � �� � � � � ��- i � '� � � � � i � " -� ( � � F� ' � ( � � f � � �'9�` a�- � t �. i 3 � . 1 1 - I . k I `, ( i � � .� �`� .� � � � . � � I ( � 3. �� ���- � - � � ' _..1 ' i� � � -"�f i I E I -i � I i-. � � � � �� .. I� E i ' � � . . �-� k . .:j i F� � � �_ � � � i ' i , � � , � ; �� � I � �� �� 1 � ' � . . , ;, . ,.. � � � �, � I . � � � � � � � �. i � 1 _ 4 � j �?- 4- � . i r ; �. � .. - L_J � ...__' -�—� .__ {._3. -E-.�._� .i ! : - ( � � � � � I �` � � ' �� � � � � � � — ' � �' � � ; � � ; t ��� � ��� � � i � � ��� �� . !- � � � ( � '� � � � '�� . ����. � �� � ; �� � . � � � .�� � � � i . � � � i I i, .. � � ( ..��. � � � , c" I � ; '. �� � ` i , I,� � i � � � � � � { �� �� j � '�,i - l i- � � t � �_. � _.� � � , � � � � ( E � I � �. i � � �( � � �� � � � � � € i � ' f � ; ' � � 3 ` ; � � ' "— ��. � l� E ��' ' i � } i � , � �E � ,� � —� 3 ( j I � i . ( E i � i � i �� € : I � ! ; ��� � � i : � � ! ' � E I � ( .— � i, I E-� � i � � I� ��3 ; � ' � � � �' � � � � � � i �" � j l � �� � �.�� > ' �� ���s � � 1 � � � � � � � � �`�� ' l� � ` � � `` ( � � � � �� � � �_� � � i � � � � �� , � � � , f . � �." �' � C? �" `� �"i �''1` i � ( �^^ � I �� � � �� ;� �. � � � „�,�c�, � t a � e �; i i -�..� � � I �-. � � � �� � i r � �? �'i�� �� rt , i^I`- i � � �� 3 I � E � '�. r r,r a7 CJ ' �di�° i u � �I ,.,� '"l I � ,� �• i �i � :7,_ 'a� t � �. � � � . � � �,,: � � e ? F-E ,_.� � C i C.. �..$ t � � � a: � � � � �y�`�� �� ��`�,�3 � �z ��r� � ��) ;� rs r� �r � � � ° ��� � ; � �� � ° � `�� �'� �� � '`� � �) ��L.a � �� �+.3 t�! a�� j � ��� �� ( ���� � �� ( I, � � i � `� � � �' �� � ,� L� -� .i��!� �"- �i � C� �.. � i = i � U.. I �..- k F� C 1 E I -I � � � �.. r�.� a € �.-�a-�.�i� '�� �q �i i .�€� e. �c) �s� i�-, � € , � �, � € i r i i i �. �i,� au. t,R� .� E � �� � � � .., .� � , <i < 1 � t � �, � � �_�C.i "��,j� i � - � � . 1�� i�i""j� � €-� � � �.t� � r � . .. f ' 1 � � . �..:� '� i � -��� "� � � „� � s� L.i r�`� V C` 7 { i E:, ,T (f �� � _ .zi..l...4 ��.��� ��.:41L 2_�.L'.�IF t .L G. 4. i� 3 '. � i � ' _ E � � i ,:. � � � � ',y ! �......__ �... �. a--, � ��.a....: I _.:.��_�....��_� _ ��� � + ' '.E' 1 �{ � G � I:�:.. _ f � � � � ; � �� � � '� �� � � I � � � (( ' ? ' i I � � � � � � i � � € � � ! � , �i `�� � � �..0� � .I I _ I i � , E � � ,,� j f� i � � 3 '� t �: i f I � � �- � ' E j i �.. � � ���� I � � � I � � �� �� � � .L i�� � � � � � i . ! �� . � i � � � i ? � ` � j �..� . _ � � � � � 7 � � � � ' �. ( . � � � � i � � - � t € I : 3 �. � ' � � ; ���.F � _ � ( � � _ 1 � C E � 3 — � s � i� � � � � � �: �, �� ' a � — � �' a ? �' I .j ��, � , ' i i� ' ' ' � � � � tF j G , � � 1. � �� s i � � � E i � � :4 � �. _ ` t �k � 3 � , i EE p�I� � 1 � � �� f k �I � I_.. �..�.. ,�.. .�'��._��:..�.... �.�.i.��;��_�.� �'ij,� � S � E . � I ! � i� � � . , . � I 7 � �I jI ` � � � i � ,� � � t � i _� ( ' � ft . . ,. ���. t f� 4 �. y � �'� � � .. � I �I � � _� i I�.j # 1 j � � � �.� '€. i � i.� { t � �. � k; `..,�i �i� i � 1 � � . ' € . 1 i ; -� i _ �{ . ' � � i._ �-f--=. �._' t � I - � � -P-,-�'i-...__i_..�..1._....�� � ' � �� . . . � � ( � �' �. �'�� � � ��- ; � F�� I �_��! E ; �� � I ��.� � � , � i � � � i ; i� � � � ._ � , ' � �� � ' � i ,;I°�i � �� ���,�� ����( � I i � ,� ; j i � ; � i I j�.� .� � �'� '3- i ! i [.,.. I (C�•. � i, m,I � j . �.y �. �,e;' E . ,� . I t� °a - E �� I _„�� �, as��` ��� ( ..� �€� � � � � �€ � F� . � - �:,�, � -a. ��`� �3��.���u��,�-_� � �,�,€� �P�����si i�' k�ay �.i �. =�i� � ` '� � � , i i� t � It � � � E � iC t �a t ^�. (3 �+ t _ (C' � 1 � � �-r�-r w� � � .�.� � ... I �_.-�i a � �� . " � �,; � I� �_ � e � , v�� �1 ,, a� .��� °� � i .a "� � x u � � � � � � ' �� � { � �,� , R � i ,� � �' � � �� 3 _ � .�s.�n_�___ ' ,C 1 i i�I�.�'��F- �-,.I t�i .�.�-........���..���.:-���. 3:�.._�TM�...�,._..._,w.,.....�...-...._.t.....�.�_m .,.......�._ ..:�.��........,...�....._..�....f�.--'��.:�. � �' "�.a . ,"` �. ,� — � `^ s`f��-i� � �I E �E 1 J �r� i i -�g r � 3 t ,r^ n `�I I k k � ..:,'.3 , :� � _..!,.m.�__���a!_�_....:�;......a.� . .�..............,_..�__..6 v'