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HomeMy WebLinkAbout12673 (13) • ^ _.`�_ CITY OF DIAMOND BAR DEPARTMENT OF GOMMUNITY&DEVELOP � 21660 E.Copley Drive Suite 190 (9Q9)860-3195 Fax(909)861-3117 PRESS 9�°�V' BUQ.DING PERMTl'APPLICATION FIRM�Y v5 JOBSITE J� '�v'1� � APPLICATION C� . PERMIT � P/C o ADDRESS 4.� �� DATE (�� �,J NUMBE �# �° APN- ISSUE TYPE OCC ¢ OWNER ILa�'``R��'n 1-„� -,r�RACT DATE CONST.�p o .�.�r �'` ADDRESS � �-''' ZONING SETBACKS z CITY ZIP 7EL REART �"' �� LU� g APPLICAN7 TE . SIDE/SIDE STREET RW ❑ � CONTRACTO .'t � � ' � ✓ SIDE O ' ADDRESS � �,�' - � PROPOSED USE�� �5 ('�_" ��� e-' ���9� � CITY • J• � ZIP TE . �� � - . ��> QARCH/ENG/ � W DESIGNER NO.DWEL. ' O. NO. a: ADDRESS UN{TS ST�RIES BEDRO�MS = CITY ZIP TEL. cn � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VAIUATION � OWNER-BUILDEft DECLARATION , SFRlADD/REM O � 1 HEREBY AFFlRM UNDER PENALTY OF PERJURY THAT I NA EXQAPT FROM THE CONTRACTORS LI- � G8f8QB(CBfPOR W CENSEIAWPoflTHEFOIIOWINGREA50N(SEC.7o31.5BUSINESSAN�PROFE5510N5CO0E:PNYCI7YOFi (n G�- COUNTVWHIGHREQUIRESAPERMITTOCONSIAUCT,AITER,IMPHOVE,�EMOLISH,ORREPP.IRANYSTRUC- 'W PgtI0/UBCk � NHE,PRIOR TO ITS ISSl/ANCE.A150 HC-0UIRES 7HE APPLICANT FOR SUCH PEflMIT TO FILE A SIGNED � � SiATEMENT THAT HE OR SHE�5 LICENSED PURSUANT 70 THE PflOVI510N5 OF THE CON7MCTORS L�- c. CENSE lAW(CHAPTER 9(COMMENCINO WITH SECTION 7�j OF DIYISION S OF THE 6USINESS AND Pq0- u' POOVSpB T FESSpNSCORE)ORTHATHEORSHEISEXEMP7THEREFROMAN�THEBhSISFOflYHEALLEQEOEXEMP• (� V TION.ANVVIOLATIONOFSEC710N703f.5BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � � � ACMLPEWLLTYOPNOTMOPETHANFIVEHUNDREDOOLlARS{5500).): - � OI,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � COf111flefC121 ' - WILL 00 THE WOFlt(,AND THE STRUCTURE IS NOT INTENDED OH OFFEfiEO FOR SW.E(SEC.7044,BU51- �1 NESS ANU PPOFE651INJS CObE:THE CONTRACTORS LICENSE LAW DOES NOT AAPLY TO AN OWNER OF � Pf�PERTYWHOBUILDSORIMPflOVESTHEREON,qN�WHOU0ES5UCHWORKHIMSEIFOflHERSELFOR-�- m OC- TNRODUHHI90RNERONMEMPLOYEES,PfiOVIDE�THRTSUCHIMPROVEMENTSAflENOTMiENDE00R � - QOFFERmFOR5ALEIF,HOWEVERTNEBUIL�M60RIMPROVEMEMiS50lDWRMINONEYEAflOFCOMPLE- Z TION.THE OWNEfl�9UILDER WILL HAVE THE 6URDEN OF PflDYIN4 THAT HE OR SHE DID NOT BUILD OR � IMPFiOVEFORTHEPURPOSEOFSALE). OI,ASOWNEROF7HEPROPERT;AME%CLUSIVELYCONiRACTIN�WfTHLICENSEOCOMRACTOqS- � TO CONSTRUCTTHE PROJECT(SEC.7ou,9USINESS AND PROFESSIONS CODE:7H@ CONTRACTORS LI- V8111fl110l1 �r� ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEflOFAPROPERTYWHOBUILD50RIMPPOVESTHEREON.AND � N'FiOCONTRACTSFORSUCHPROJECTSWiTkACONTRAGTOR(S)LICENSEDPUpSUAMTOTHECONTRAG QUANT�TY DESCRIPTION FEE - . Y 70R5 LICENSE UW.). - � J � 0 ❑I AM EJ(EMPT UNDER SEC. B.&P.G FOR fH15 REA50N � � � LL' OATE OYJNER F" - � � W. � UCENSED CONTRACTORS DECLARAfiON w � �HEREBVAFFlRMUNDERPENALTVOFPERJURYTHATIAMLICENSEDLINDERPROVISIONSOFCHAPTEP � . d. 9(COMMENCINOWITHSECTION7000)OFOIVISION30FTHEBUSINESSANDPROFESS�ONSCODE,PND z ?C MY 410ENSE IS�N FULL KORCE AND EFFECT. ��� � �y m LLI "� � � UCENSE CLASS -'"� LIC.NO. - � Y—' _ -- j U pq7E C CONTRACTOR -�_. �a - � � ��a � WORKERS'COMPENSATION DEC ATION ¢ � IHEREBYAFFIRMUNDERPENALTYOFPERJURYONEOFTHEFOLLOWIN60ECLqFATIONS U � Z Q � INAVE DWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUFEWRWORKEFS' 2 �' g�SATION.ASPfiOVIDEDBYSEGTION37000FTHELA80RCODE,FORTHEPERFORMANCE W THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � W IHAVEAN�WILLMAINTAINWOHKERS'COMPENSATiONI SURpNCE,ASRE�UIRED8Y5ECTION �/ ( Q 37o00FTHELABORG E,WRTHEPE MANCE EYJORKFOR'MHIqITHISPERMITiS '" 1I/'j� � � ISSUED.MY WO��COMP�NSATIO.IN RANC RIER AND POLICV Nl1M8EP AFE: CONSTRUCTION � � � CARRIER �� �� �'LAN REVIEW JT � � �- __ __. _t_._..___._- __— Z coucvNUMeER_,.� �' ELECTR�C � Q (fHISSEGTqNNE�NDiBE�A4LETmOFT1-�PEFiMfTiSFU7�NEHU�Of1E�00LLARS�Siao) LESS} PLUMBING ���� - z- ICERTIFYiHATINTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED,i MECHANICAL (,'j SHALL NOT EMPLOY ANY PERSON IN ANY MANNER AS TO BECOME SUBJECTTOTHE � WORKERS'COMPENSATIONlAWSOfCALIFORNIA DAqREETHATIFISHOUIDBECOME INSP6CTIONFEE SU&IEGTTOTHEWORKERS'COMPENSATIONP �SI NSOF6ECTION37ooOFTHELA00P � CO�E ISH O WITHCOMPLYWITHTH0.S PP lISIONS. ISSUANCE �'� o SMiP `p DATE:__� APPLICANT. � . � F DI � ENERGY P/C WANNING FAILUHE TO SECURE WOHKEHS'GOMPENSFTIOI VEFAGE IS UNLAWFUL.AND SHALL 8E �Y � SU&IECT AN EMPIOYEfl TO CflIMINAL PEMALTIES AN�qV MES UP TO ONE HUNDRED THOUSAN� ENERGY PERMIT ��_�yj���� _ DOLLARS(5100,000),INADDIT�ONTOTHECOSTOFCOMP SATION.DAMAGESASPflOVIDEOFORIN � SEGTION37080FTHELABORCODE,INTEREST,ANDATT NEY'SfG[S. ' RETENTIONFEE' � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEflEBYAPFIRMUN�ERPENAITYOFPENURVTHATTHEFEISACONSTRUCTIONI.ENDINGAGENCV , FORTHE PERF4RMpNCE OFTHE WOHK FOR WHICH THIS PERMI7IS 155UED(SEC.3o9�,qV.C.i. W � � LENDER'SNAME � 1— LENDER'SADDRESS W ICEflTIFVTHATINAVEREA0IHISAPP�ICATtONANDSTATETHATTHEABOVEMFORMATIONISCORflECT. TOTA�FEES � � IAOREETOCOMPIYWITHALICITYANDCdUNTYOflDINANCESANDSTATELAWSREIAT�NGTOBUILDING . - CANSTRUCTION, DHERE6YAUTHONIZEREPRESENTA7IVESOFTHISCDUNttTOEMERl1PONTHE - . . - . ZABOVE-MENTION�PROPERTI'WRINSPECTIO PunPoses. COMMENTS - � ��/, `a.'�� � — . . . �� l�� m �� _ ¢ PEflMITTE E(P . � y SIONATU O PEfiMI7rEE + �TE RECPT.NO. � PAID BY VALIDATION � WHITE—DepaAment Copy,YELLOW�inance Copy,PINK—Assessor Copy.GOLDENRO�File Copy.GREEN—ApplicanPs Copy - - � ; �----,— � ;�--�----- , �-----�--�e__._r_____.____,. ,�.��_�.__ , � 4 �'^���I � I i �- � � � ' � � 1 l � [ ; � � ' � , � i I� � � � 1 ; ; , + . ; , � , jj ; i � � � � ; � � � � � , � � . i i ( i j 1 ; - � � . i � � i i � � � a I I � I i I � � � i � � � � ' � ( �� � � � i � _ ' �� C �{ ; + �� � ' � � j � �� f � ' �� � 1 � � � �� � � � � i� � € � �i � � � � i �.. � 1 - �, �; I,. , i , ; � , � , � , � � i � � i i � ':; � ; ; � � ; � � � � ? , � ;. i i ; , j j � _ _ � _ { � � � � � , f I' > �S ( � ' ' ��—��I I � ` � � I 3 ( � � ;_ , �: �,�. � � { � � j � i I � � ' � � 1 t ' � i i i j � � � ' I ; � i � � � > � � � � J � � � � : ; � � ! � ; ; � , — ; , �" � � �-_ � , ' ? 1 � �.."I' I �—p i ' �ll � ._; 1 = E � � I � � � � � �. _�{ --t ' i �..�.,, - i � � } i ��� € � ( i ��V! i � I_^I � � 7 � � � F l � � ,� I � i � k � ; ( �-�� � ( ! � C � . i �� i ��� � �C.�:� `�`3 GG���Y,� � � I ..�.. � � � .� � �`3I � � � � � I � � � I 'i .��- .. � � � � � � .�� � �;��, i : �i f ' 1 r � � � ! � i _ �" .� � G�IIC�.yi� � 1.�U w �� iG� - ; � � � � � - � �� cc :��cg � °� u`s.�� �( ��z. � �a; ( '� �., � `� �I = i �� s � � � i I €— c�+ C� o � �� � m � � u u� �v. 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