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HomeMy WebLinkAbout17122 (39) _�� CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �` r� 21825 E.Copley Drive (909)860-3195 Far(909)861-3117 PRESS �`-�� BUILDING PERMIT APPLICATION FIRMLY o DDRIESS � r � �� DATEICATION Q �f��.G 1 NU BERI r� ri� J � ISSUE TYPE OCC .- APN LOT TRACT DATE CONST. GROUP °C OWNER r: �TEZ/f�- _ 0 o ADDRESS �q�� t?DU ' ZONING SETBACKS z CITY �IP TEL. FRONT RW ❑ � APPLICANT ��_ "'' TEL.�_-^-�_�"�-�s,r� REAR ❑ �"�' SIOFJSIDE STREET RW p � CONTRACTOR 1 SIDE ❑ ADDRES o CIN ' ZIP ! TEL�� � 'fQ,F).5_- PROPOSED USE P ` wo ARCH/ENG/ � z DESIGNER ' W NO.DWEL. NO. I.G.�j+e.�[ ) NO. � CITY �SS ZIP TEL UNITS STORIES �BEDROOMS � cn DESCRIPTION S0.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFWADD/REM O 1 NEREBY AFFIRM UNDER PENA�TY OF PER/JNY THAT 1 AM EXEMPT fROM TNE CONTRACTORS U� G2f290I(�'dfP01S W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.6BUSINESSAN07ROFESSiONSLOOE:ANYCIriOR (n U COI,NTVWHICHREWIqESAPERAIITTOCONSTRUC7,ALTER,IMPROVE,OENOLISM.ORFEPAIRAIIYSTR'JC- W patio/Dack Z IURE,PRIOR TO ITS ISSUANCE,A150 REW IRES THE APPIICANT FOR SIKH PERI.IIT TO FILE A SIGN[0 W SUTE�ENT TNAT HE OR SHE IS UCENSED VURSUWT 70 TME PROYISIONS OF THE CONTRACTORS Lb W � CENSE LAW(CHAPTEfl Y(COMMENCING YATH SECTqN IWO)OF OIVIS�ON]Of TH�BUSINE55 ANO PRO u- PooVSpa fE5510N5CO0E)ORiMATHEOR5ME15EXEMPT7HEFEFFOMANDiME8A515FORTHEALECEDE7(EMP• (� V 710N.ANYVKKATqNOFSECTION70.17.S8YMIVAPPUCANTFORAPE0.MITSV&IECTSTHEAPPLICAN7i0 Z Re�Root � A CML CENALTY OF NOT MORE iNFN fIVE MUNOFED DOlURS(1500).): O I,AS ONMER OF TNE DROPERN,OR AIY EIAGLOVEES W'�TM WAGES AS hIEIR SOIE C0�7ENSATION, Z � Commercial W�LL 00 THE WORKµD THE STFUCTUFE IS NOT INTEN�EO OR OFFERE�FOR SALE�SEC.70�1,BU51� J N NE55 AND�ROFESSIONS COOE:THE CONTRACTORS IICENSE LAW DOES NOT AVPLY TO AN OWNER OF ' FROPERTYN�108UILDSORIAAOqOVFSTHEREON,MIDWHODOE55UCNWORKNiMSCLFOfiHERSELLOR � � TMiiOUGHMI50RNEROWNEMVIOYEE3.PROYIDEDTHATSUCHIMPROV[MENTSMLI:OTWTENOEDOR m . � OFFEREDFORSALE.IFIIOWEVEil.7HEBUtLDINGORIMCROYEMfMIS50lDWiTH'NONEYEAROFCOAIPIE• Z TION,THE OWNER�BUILDER WILL MAVE TME BUHDEN OF PqOVWC THAT ME OR SHE DID NOT BUItD OR = IMGROVEFORTMEPURPOSEOFSALE). O l�S OWNER OF TME 7ROPERTY,AU E%ClUSNEIV CONTRACTIN�WitH UCENSED CONTMCTORS � TO CONSTRU�T 7HE V(iWECT(SEC.7G1,BUSMCSS ANO VROFESSIOHS CODE:THE CONTMCTORS L4 V01p0I100 AGC� ADJ.AREA W CENSEUWDOESNOTMPLYTOANOWNEROF�PqOVERTYWHOBU1LD50RU.'VROY[STHEfl[ON.ANO � N11000N7MCTSFOFSUq/VRQIECTSWITNACpNTMCTOR(5)LICEYSEDPUR,UANTTOTHECONTMG QUANTITY DESCRIPTION FEE Y TORSUCENSELAW.). ; ¢ OIlJAEREMPTUNDERSEC. B.LP.C.FORTHISR[ASON Q � U L� � DATE OK7JER U Z W F UCENSED CONTRACTORS D[CLARATION W � IHEREBVAFFIMIUNDERGENALTVOFFER1URVTMAT1AA1lICENSEDUNDGRFPOVI510N50FCWloTER �r p„ 9(LOMMENCINpWITM5ECT1ON7D0o�OF0�VI5qN70F1MEBU5ME5SAN�VROFE55qN50WE,M70 z X W�ICENSE IS M FULL FORCE.WD EFFECT. . m � IICENSE CLA55 IIC.N0. � --,yn7y.+�' j V OATE CONTRACTOR,� (���f_-�`���!` d W � WORKERS'COMPENSATION DECLARATION ' ¢ NIHEREBYAFFIRMUNOER�ENAITYOFPERJViiYONEOFT/1EFOLLOW:NGDECUAATqNS�. z � �IHAVEANDWILLMAMTAIN�CERTIFICATEOFCONSENTTOSELFd45UREFORN'ORKEFS' 2 LOIIPENSA710N,A$PflOVIDED BY SECTO4 7]00 Of THE LABOR CODE,FOq TME PERFORMANCE W OF iME WOfU(FOR WNICH THIS CERMIT IS ISSUED. � � O _IHAVEANDWILLMNNTAINWORKERS'CAMPEYSATqNINSURANCE.ASFEOUtpEDBYSECTION i0�`�O 4 97000FTHELA80RCOOE,FORTH[PERFORMANCEOFTHEWORNFOf1WHICHTHISPERMITIS ISSUE�.AIYWORKERS' OMGENSATIONINSURANC R/riEfffRA�)'N''']]]DPOIICYNUMCERARE: CONSTRUCTION j CARRIER ' �� � � PLAN FiEVIEW Z DOLICVNUMBER �.�� s^ � ELECTRIC Q � (fHISSECIqNNEmNOTBE001.F'LEfEDOFT1E7EiAtt6i�iChEHMt%i[:DDCLLs1iSR��)�LE551 PLUMBING Z I CERTIFY THAT N THE VERCORIAANCE OF THE WORK iOR WHICH TNIS PERMIT IS ISSUE�,i MECHANICAL C,'} SNAILNOTEMP�OYANYPER50NINIWYMAkNEH50A5708ECAM[SUBJECTTOTNE � N/ORRERS'fAA1vEN5A710NLAWSOFGIIFOR9IAANDAGREETNQIFISMOULDBECOME INSPECTIONFEE S SV&lCCTTOTHEWOHNERS'COMPENSATIONPROVISIONSOFSECTION77000FTHElA00R —� ` COUE.I HILLLF RTMV�IlHGOMPLYWITM SEPRO�A;IONS. 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TOTAL FEES d IAGFEETOCAMPLYWITFIhLLCRYANOCOUNTYORDINhNCE5MIDSTATEUWSREUTWGTOBU0.DIN6 ��14 � CON57RUCilON.ANDHEREBYAUTrqR12EREPRESEVTATNE50FTHI5COUNTYTOENTERUPONTHE Z I�BOV tqNEDPROPERTYiORINSPELTIONPU aosEs. COMMENTS � � �� � �° rE NunE�vwr�r� ¢ � � � SiGNATUREOFVERAlI1TEE f� DATE � . • , RECPT.N0. PAID BY VALIDATION HITE—Department Copy.YELLOW—Finance Copy.PINK—Assessor Copy.GOLDENROD--File Copy.GREEN—AOOlicanCs Copy . , _ . , ._ , ,. , . . „ . ,. . . �.r; , . � -•. ,.,.,. , . , _.. _ . .. _ ;—, ��^r� ,z E--� h...�J � ��� �,��' �,i{�:i i,... . .�.. I�..,�'.."� �i'i_.�, y:4.. . t�.�'i�,! C'.i_,.. :�:�.�1 ---.__.� _. _ --. _. __.. . .- ._ . _ - - - -�.._..__. . _. _ ._. ............__ - __._., . -_ -- ..v�_.._----�._. ���Ei+�:4 "f��,Ct�� f,. �� �4�R�.�e=��, ���!�, �1`�.�i. ,. _ .�dF�ti��. 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