Loading...
HomeMy WebLinkAbout10809 (5) � , - CITY OF DIAMOND BAR � � � 'T � COMMUNITY DEVELOPMENT DEPARTMENT �' ?,_� . 21660 E.Copley Drive Suite 190 PRE�J+S (909)860-3195 Fax(909)861-3117 """" BUILDING PERMIT APPLICATION FI RM LY o�r JOBSITE ��� ����ICEGt`��- I�� - /J�/J DATEICATION/O � �/ NUMBER/V(/�/ #/C � ADDRESS o ISSUE �J �y TYPE OCC °� APN�,_ LOT TRACT DATE /'" � "� � CONST. GROUP p OWNER �r f..�• �A��F'�� � � ADDRESS ZONING SETBACKS ZCITY�n�P r�� ZIP TEL FRONT RW ❑ � APPLICANT TEL. REAR ❑ o SIDE/SIDE STREET RW ❑ m CONTRACTOR /�@.KJ �✓-� �� �/�C.� . SIDE O �: ADDflESS � �.� F s pROPOSED USE ��`''�� '���"�' � � CITY tid lt��s ZIP�� TEl � /"S � _ w ARCH/�G/ �- W DESIGNER NO.DWEL. ' NO. NO. n., ADDRESS. UNITS STORIES BEDROOMS _� CITY ZIP TEL._ � '. _ � �ESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION � � - O OWNEP-BCILDER DECLARATION . � - SFR/ADD/REM � � � .. � . I HER�Y AFFIRM UNDEFi PENALiY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- �- ��_ ..G0fa9B/CBfpOfl � � - � - W CENSEL4WFOPTHEFOLLOWINOREASON�SEC.7037.SBUSINESSANDPROFESSIONSCODE:ANYCIiYOIi �- . U COUNTYWHICHREQUIRESAPERMITTOCONSTflUCT,FLTEF,IMPflOVE,�EMOLISH,ORflEPAIRANYSTftUC- ' W Pafio/Deck � � '� z- TURE,OPIOR TO I7S ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W W STATEMENT THAY HE OR Sf{E IS LICENSEO PURSUANT TO THE f'flOV!SIONS OF THE CANTflACTORS LI� � '� CENSE LAW(CHFPTER e(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSMESS AND PRO- ' u' POOUSpB � FESSIONSCODE)ORTHATHEOFSHEISEXEMPTTHEREFROMANOTHEBASISFORTHEALLEGEDEXEMP- - - .�' TION.ANYVIOLATIONOFSECTION7o31.58YANYAPPUCANiFORAPERMITSUBJECT&THEAPPLICANTTO � Z� R2-ROO� - �� � � ACIVILPENALTYOFNOTMOflETHANFIYEHUNDREDDOLlARS(55o0).): , � ❑I,ASOWNEROFTHEPROPERT',OPMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSAT�ON: �� �� COmmeroiel - . � WIIL DO THE WORK,AND THE-STflUCTURE IS NOT INTENDED OR OFFERED FOR SAI.E(SEC,7044,BL1SI- - J � NE55 PND PHOFESSIONS CODE:THE GONTFqCTOflS LICENSE LAW DOES NOT APPLY TO AN OWNER OF ! _ � PROPEPTYWHOBUIL�SORIMPROVFSTHEREON,AN�WHODOESSUCHWORKHIMSELfORHERSELFOR � �- THROUGHHISORHEROV7NEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSAPENOTINTENDEDOR'� .� m ' _}_-__ .._�_.Q_-AFFERFAFORSl�LEIF,HOWEVER,iHEBUIIDiNGQRIMPROYEMENTISSO�,DWITHIIJONEYEAROF,_COMPLE �.,_ ': __. ._..._ . _. .. .. .__. . ..__..__ . .-. . .. -._ Z TION,THE OWNEFl-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � q � � IMPROVEFORTHEPURPOSEOFSALE). ❑I,ASOWNEHOFTHEPROPERTY,AMEXCLUSIVEIYCONTRACTING.W�THLICENSEDCONTRACTOFS.� ., , � TO CANSTRl1C7 THE PflQ1ECT(SEC.7044.BUSINE55 AND PROFESSIONs CODE:THE GONTqACTOflS LI-� • ValuatiOfl AOJ.AREA W CENSEtAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILOSORIMPROVESTHEREON,AND ; . � � WMOCONTRACTSFOflSUCHPROJEC75WITHACONTRACTOR{S)LICENSEDPURSUANTTOTHECANTRAC- `- QUANTITY DESCRIPTION - FEE , _ Y TORSLICENSELAWJ. /}f/+�/� �— �� OIAMEXEMPTUNOEflSEC. B.&P.C,FORTHISilEASON. � Q. C/ ✓ � �rl � � � Sl��//�G-�S LL oarE owNEa_ F z w . .. � LICENSED CONTRACTORS OECLARATION W - � 1 HEREBY AFFIRM UNOER PFNALTY OF PERJUFIY THAT IAM IICENSED UNDER PROVISIONSOF CHAPTER � / � /� - d 9(COMMENqN6 WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AN� � Z, � �J - X -MY LICENSE IS W FULL FORCE AND EFFEGT. fy m ' �� S�T S f�.7� - - � �LICENSE CLASS LIC.NO. ��� J �9l� V s�� � /1 , U^/�'+n/J���+S /(7-�JV U , DATE � � CONTRACTOR-�-��-�`�°�'L`-�'y � -a: �'� _. LiJ . � .: . � � . ;" � � . WORKERS'CQMPENSATION DECLARATION Q �/� . �' �� = U � � I HEREBV AFFIRM UNDER PENALT'OF PERJUFY ONE OF THE FOLLOWMG DECLARATIONS: � Z Q O IHAVEANDWILLMAINTRINACERTIFICATEOFCANSENTTOSELF-INSUREFORWORKERS' _' - COMPENSATION,ASPPOVIDEDBYSECTION37�OOFTHEIAeORCODE,FORTHEPERFORMANCE U , Q OF THE WOFiK FOR WHICH THIS PERMIT IS ISSUED. , _ � � W I HAVE AND WILI MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION /J/J Q 3�0o OF THE LPBOfl CODE.FOR iHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS- '' ' � h}� ISSUED.MY WOFKERS'COMPE SATION INSURANCqCAARIERAND POLICI'NUMBERARE: ONSTRLJCTION � /✓�./ ����D � +�,¢. CARRIER �"w ��'�E� �� C'�- PLAN REVIEW / / ��� �, z POLICVNUMBER V � �� � "'� Y ELECTRI , • ���,..— -- - ¢ (MISSECTKKJNE�NOTBE�APLEfEDOFTHEPEW�tITISWRONEHUnDREDDIX.IAfiS(S10D)ONLESS} LUMBI v � ` � ���` � Z �CERTIFYTHAT IN THE PERFOflMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I ECHANIC L �� f (� SHALLNOTEMpLOYANYPERSONINANYMANNERSOASTOBECAMESU8JEC7TOTHE , ' WORKERS'CAMPENSA710N LAWS OF CALIFORNIA,AND AGREE TMPT IF 1 SHOULD BECOME INSPECTION FEE f � SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELA80Fi �/ �•✓^ � ~� CADE,ISHALLFOftTHWITMCOMPLYWITHTH�` PROVISIONS. " '� � ISSUANC �� O.. y - ,�/O I J . � �. ..� /. �O � � p DATE: - 2 �` APPUCANT: T[ �fa�+..�. �hO..� SMIP I s" ,�`4 � ENERGY P/C �T J- WARNING:FAILURETO SECURE WORKERS'COMPEN5ATION COVERAGE IS UNLAWFUL,ANO SHa.I.BE �- SUBJECT f N EMPLOYEP TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNORE�THOUSAND ENERGY PERMIT _ �OLLARS(E1tln,000).IN AD�ITION TO TNE COST OF COMPENSATIDN,�AMAGES AS PflOVIDED FOR IN � ' �'. SECTION3�o80FTHELABORCODE,INTEREST,ANDATTORNEY'SFEES. - r "�'T.� RETENTIONFEE: �_��`^`�' �, w s� � �� � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: `` �� IHEREBYAFFIRMUNDEFiPENALTYOFPERIURVTHATTHEREISACONSTRUCTIONLEN0INGAGENCY g � � FOR THE PERFOFMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z. 8 W Y LEN�ER'S NAME _.- � � - � F_- LENDER'SADDFE55__._.. - . - � ICERTIFYTHATIHAVERFADTHISAPPLICATIONANDSTATETNATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES ' ,��/����� �� -Y � I AGREE TO COMPLY WITH AlL CITY AND COUNTY ORDINANCESAND STATE LAWS REIATING TO 9lllf DMG . . - - . � � CONSTRUCTION,AN�HEflEBYAUTHORIZEREPFESENTAT!VESOFTHISCOUNTYTOENTERUPONTHE �j ��� � /i/A f�_ Z A80VE-MENTIONEDPROPERTYFORINSPECTIONPURPOSES. COMMENTS. ����S�r �� K� � /°�fi�� t �e�t<'7"e�� ST�G t C/4L .G�j��/Lo�.K= i";G � /�/J � m' PERM EENAME(PAINT) � �IQ��'j�Sy ' — � ��..� � �� f��2,1�� „ � S�f t•TATUflEOF RMI7TEE �� � �AT '- - _ . RECPT.NO. PAID B I VALIDATION � ~ � � - WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy.GREEN—ApplisanPs Copy�. . � . � . i _; ; _" i ; �j ; � �"'"i�.. _._.�� t � ' i 1 � i �� { d31 � � �' t ; t i i I � i � I i ' � i� � k. . � � � ; � � ! .� I N I � t � � } � t j i i � i ,,, { � i i � E .�� ' � � � � i � � � I 1 i q � � � a '�_ , ,! �. . � . ;.. .. � ! � � ��. �� E � � � j � i � � � � � ; � � � � I i + j i _ � � � � ! � � � Q � �� � � � «� � � � � � � � � a � � � J � . � = � m w ? � U c� � au� � cc � oo ,� wmc� r� z � z � cn � ,�fc'� Z � Q � � o � o o � � � � � nc� � � wz � � Oc.� w � z }= cy � w I a us � C} #� � �'� � �k� J � � m° � � z � w � � r��-�� u�� � � � � rs- �w �� � t� iu wau = � Uc� � � � v� _ � ..� 3S- �^ � � � z a � � � � z � w O � O O O LL � 2 � � �z � � � �� � � � u. � � � � � mu. a. m�t� cian. aC9au, ..� OaicT. 2ow �. IX, L$ - � -`r-�;� - � � Y `� � � � � /� i L�d � � 3 :^ .�� .:'/ :^.' .` _ t � � � • i ` ,, � � . � �: u . v� � ` .�^... � �� � � � � � � � � � � �, . . O � ��6 � �� � Z ��C7 � i-- �) N i— �'� tti � — �`," � O �� U � i LA N ��7 i: �i U — F-- Z=E�.- �-- � E,,, � =t! c!5�— �, . U� � � G��J��-L. i.1.3 '�r �luill.�QftJ�� � f� � 4/? �� .�,—�.� USP— (,3��`--, � . ", � �� �,� ���. q � � :za�c > � J � e � � �1 � -'� � �: ys3� fl,:,9 � � 1�-s� t�Io r� � t� cn :;. c� 4z �ua.. � �tcn J }-- . C> usJ � - � • ¢ �9� zlc.� 4- c�. v5 � c.� z � aw (� � a � vci � z3 � w�ca. � � t�fi co ini� aima �i,uo � u. t� t.� c� � ��� � � �.u � a � � � as}_: � ; � j t=a. c7�w � ¢ � }-- � ¢ C>;� � � of= -' --' >- � uwen <ca ¢ v: �, �. w _ r�n � w �lu'"'�^� � � � � � � ��� � wt� cwa � c°�n � v�ac�.�3t�`iu ��� � � � � ��