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HomeMy WebLinkAbout10220 • CITY OF DIAMOND BAR � �; .,C� COMMUNTI'Y DEVELOPMENT DEPARTMENT -;,.,W • 21660 E.Copley Drive Suite 190 (909)86a3195 Fax(909)861•3117 PRESS """'� BUILDINGPERMITAPPLICATION;, FIRMLY o<�' JOBSITE DATECATION G� � NUMBE OR�_V-- #lC ADDRESS $ ` ISSUE TYPE OCC APN LOT RACT `� DATE CONST. GROUP p OWNER ' LL ADDRES µ ZONING SETBACKS � FRONT RW ❑___ z CITY ZI �,�'TELS " L� . REAR p SAPP4ICANT _ TEL. ;� SIDE/SIDE STREET RW O � CONTRACTOR • . . MGe � SIDE ❑ ,_o_ ADDRESS ,� � � pROPOSED USE�f�G�,�tO�c� �.�//lZS4C/Blf.� oCITY �� �1�� TEL. , ARCHIENG! � W- DESIGNER , NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS _< CITY ZIP TEL. - cn- <n: DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O., OWNER•BUILDER DECLARATION SFR/ADD/REM :,p,-: I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS li- ; Garage/Carport W: CENSELAWFORTHEFOLLOWINGREASON(SEC.T031.5BUSINESSqNDPROFESSIONSCODE:ANYCITYOR U��- �qJNTyVMICiipE�UIRESAPEflMITTOCONSiRUCT,ALTER,IMPROVE,DEMOLiSH,ORREPAIRANYSTRUC- ��� Z" TURE,PRIOR TO ITS ISSUANCE AL50 REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED � W P8�10/DBCk -:�W;� STATEMENT THA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANiRACTORS U• "W :` CENSE IAW(CHpPTEfl 9ICOMMENCING WITH SECTIDN 7000)OF OIVISION 3 OF THE BUSINE55 AN�PRO- ��� POOUSpB �� FESSIONSCODE)ORTHATHEORSNEISEXEMPTTHEflEFROMAN0THE8A515FOflTHEALLEGEDEXEMP- �-.�(� _'. TION.ANYVIOLATIONOFSECTION7631.SBVANVAPPLICRNTFORAPERMITSU&IECTSTHEAPOLICANTTO �.�Z Re-Roof �.;' A GVII PENALTY OF NOT MORE THAN FIVE HUNOREO DOLLARS(5500).): 0: CII,ASOWNEROFTHEPROPERT',ORMYEAIPLovEESWITHWAGESASTHEIRSOLECOMVENSATION, :'-�- CO(YIf118fCi91 Z:f WILL DO7HE WORK,AND 7HE 3TRUCTURE IS NOT INTENDED OR�FEPED FOR SAIE(SEC.7oM,BUSI- �:' J �_': NESS AN�PROFESSIONS CDOE:THE CANTRACTORS LICENSE LAW OOES NOT APPLY TO AN OWNER OF �� . PROPERTYNMOBUILOSOqIMPflOYESTNEREIXJ,ANDWHODOE55UCHWOflKHIMSELFOpMEHSEIFOfl �-�- THROUCNHISORHEROWNEMOLDYEESPROVIDEDTHAT3UCHIAIPROVEMENTSARENOTINTENDEDOR :'�:m :O) OFPEREDfOHSALE.IF,MOWEVERhIEBWLO�NGORIMPROVEMENTiSSOLDWI7HINONEYEAPOfCOMPIE Z; TION,THE OWNER�BUILVER WILL HAVE TNE BUFbEN OF PROVING THAT NE OR SHE DID NOT BUILD OR ._, IMPROVE FOR THE PURPOSE OF SALE). . .,W i: O I,AS OVJNEROF tHE PROPERTY,AM EXCLUSIVELYCONTRACTMG,WITH LICENSE�CONiMCTORS Q-: TO CONSTqUG7 THE PHQIECT(SEC,7oa4.BUSINE55 M1D PROFESSIONS CODE:THE CON7R0.C70R&LI- �/3�UeIiOn ADJ.AREA .. W��. CENSEIAWDOESNOTAPPIYTOANOWNEFOFAPROPEq7VWHOBURASORIMPROYESTHEREON,ANO WHO CONTRAGTS FOR SUCAi PRQIECTS WITH A CONTFiACTOR(5)LICENSEO PLIflSUAN7TO7ME CIXJiRA6 �,_ QUANTITY DESCRIPTION FEE Y. TORS LICENSE UW.�. .. . . . ��' ❑IAMEXEMPTUNOERSEC. B.aP.C.FORTHI5REA50N � J O. �. u"� DATE OWNER Z' � LICENSED CONTRACTORS DECtARATION � -- �HEPEBYAFFIRM UNDEfl PENALTY OF PEfUURV THA71 PM IICENSED UNOER PROVISIONS OF CHpPTEfl � ��� � -a,� 9SCOMMENqNGW1TH5EC710N700o)OFOIVISION30PTHEBUSINESSAN�PPOFESSIONSCODE,AND . Z �;, MY LICENSE IS IN NLl FORCE AND EFFEGT. : m . ..�� UCENSE CLASS Crr3L LIQ NO.(2�� _ ; j � � �U�: DATE CONTRACTOfi � �� �:a W -�` _�KERS'COMPENSATION DECLARATION �: � IHEREBVAFFIRMUNOER�ENALNOFPERIURYONEOFTHEFOLLOWING�FCLARATIONS: --z' _IHAVEANDWILLMA�NTAINACERTIFICATEOFCONSENTTOSELF-INSUflEFORWORNEHS' ,Q� GOMPENSATION,ASPROVIDEDBV3ECTION370oOFTHELA00R((%1L)E,fORTHEPERFORMANCE A. OF TME WORK FOR WHICH THIS PERMIT IS ISSUE�. W _IHAVEANOWILLMAINTAINWORKER&'COMPENSAT�ONINSURANCE,ASREqUIREDBYSECTION Q.: 3700 OF 7HE LABOR COOE.FOR THE PERf-0flMANCE OF THE WORK FOH WHICH THIS PERMIT IS ISSUED.MY WORKEPS'COMPEN9ATION INSIJRANCE CAflRIERAND POLICY NUMBERARE CONSTRUCTION J' ' -7: CARRIER PLAN REVIEW z POI.ICV NUMBER ELECTRIC Q d. (I'HISSEGTIONNE�NOTBEOJMPLETEOOFTMEPEM7RISFOHONEMN�pFiEDDCilARS�5�00)ORlE55}. PLUM8ING � I CERTIFV THAT INTHE PENFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL C'S SHALLNOTEMPLOYANYPERSONINANYMANNEPSOA5T08ECOMESU&IECTTOTHE � WORKERS'COMPENSATIONLAWSOFCAUFOfiNIA,ANOAGREETHAT�FISHOULDBECOME INSPECTIONFEE � SUBJECTTOTHEWORKEPS'COMPENSATIONPiiOV1810N30FSECTION37000FTHELA80F � CODE,ISHALLFORTHWITHCOMPLYWITHTH PR� �SSUANCE - � SMIP p DAT�__�� APPLIGANT:�� / �- WARNINQ:FAILURETOSECl1NEWOflNERS'COMPENSATIONCOVEPAGEISUNLAWFUL,ANOSHALLBE ENEPGYP/C LL- SUBJEGTpNEMPLOYER70CRIMINALVENALTIESANDCIVILFINE5UP700NEHl1NDREDTHOUSAND ENEPGYPERMIT P$� n:� DOLLARS(5100.000�.IN AODI7ION TO THE CDST OF COMPENSATION,�AMA�ES AS PNOVIDED FDR IN ¢ SECTION37080FTHEUBORCODE,INTEREST,ANDATTORNEI"SFEES. RETENTIONFEE: d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEREBYAFFIRMUt�EflPENP1TYOFPEWUflVTHATTHEREISACONSTflUCTIONLENDIN6AGENCY _ FOR THE PERWRMANCE Of TME WORK WR WMICH 7HI5 PEflM1T IS ISSUEO(SEC.30W,CN.C.). . � W � LENDER'S NAME . - .� � ' � 1— �LENDEfl'S'ADDRE55 /� / . � ICERTIFVTHATIHAVEHEADTNISAOPLICATIONANDSTATETNAiTNEABOVEINFORMATIONISCORRECT. TOTAL FEES O�OL I�+ ' w IAGREE TO COMPLY WITMALL CITV AND COUNTY ORDINMIGES AND STATE LAWS RELATING TO BUItAING � CONSTRUCTION,AND HEREBV AUTHORI2E REPRESENTATNES Oi 7HIS CWNTY 70 ENTERUPON THE � � ZABOVE�MENTIONED VROPERTY fOR INSPECTION PURPOSES. COMMENTS � J � m PERMITTEENAME(PHINn ./C'2 �� ���/y� . Q L0l� / � U] 'wC� � SIONATUNEOFPERMITTEE DATE � RECPT.N . PAID BY VALIDATt r WHITE—Department Copy,YELLOW—Finance Copy,PINK—Aesassa Copy,GOLDENqO�—File Copy,GREEN—Applicant's Copy . _ _ _ _ :: ; i �<p - -( �� � ' _ - ' � ,� , e , _ _ ��' r. 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