HomeMy WebLinkAbout11401 (5) - - CITY OF DIAMOND BAR
rc � COMMUNITY DEVELOPMENT DEPARTMENT
-,,,,t; 21660 E.Copley Drive Suite 190 PRE�+g+
(909)860-3195 Fax(909)861-3117
�'"""' BUILDING PERMiTAPPLICATION FIRMLY
� JOBSITE '%��*1���%'�i����fJ APPLICAT�I J—�j� �J PERMIT P/C
>-:
o� ADDRESS<<.>« b K_-" DATE :J �+G� 6C'J NUMBER #
o ISSUE TYPE OCC
°�° APN ` ��T� TRACT DATE CONST. GROUP
°C OWNER
O
� ADD S ZONING SETBACKS
Z CITY TE� �� FRONT RW ❑
o APPLICANT TEL. REAR ❑
z SIDFJSIDE STREE RW ❑
a CONTRACT R � � 6" SIDE � ❑
� ADD S PROPOSED USE
Q CI� / � Z _.. �
pARCH/ENG/
W DESIGNER NO.DWEL. NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION
�
p OWNER-BCILDER DECLARATION - SFR/ADD/REM
p. I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTOFS LI- � Garage/Carport
W CENSELAWfORTHEFOLLOWINGREASON(SEG7031.68USINESSANDPROFESSIONSCODE:ANYCINOR
C.�- GOUNTYWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTHUG � W :P2f10/DQCK
W-�' TURE,PRIOR TO 175 ISSUANCE,AL50 REQUIRES THE APPL�CANT FOR SUCH PERMIT TO FILE A SIGNEO
STATEMEM THAY HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRAC70f7S Lb
� CENSEIAW(CHAPTER9(COMNENCINGWITNSECTION�000)OFDIVISION30FTHEBUSINESSANDPRO- ' V' Poo��Spa
FESSIONS COD�OR THAT HE OR SHE IS EXEMP7 THEREFROM AND 1 HE 6A515 FOR THE ALLEGEo EXEMR
� iION.�NVVfOLATIONOFSECTION�o31.5BYANYAPPLICANTfORAPERMITSUBJECTSTHEAPPLICAMTO , z RB-ROO(
� AqVILPENALTYOFNOTMOflETHANFNEHUNDREDDOLLAPS(ESoo).):
�� ❑I,ASOWNEROFTHEPflOPERTY,ORMYEMPLOYEESWITHWAGESFSTMEIflSOLECOMPENSATION, - � Commercial
Z� WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDEO OR OFFERED FOR SALE(SEC.i044,BUS6 J _
� NESS AND PROFESSIONS CO�E:THE CANTRACTORS LICEN3E tAW 00[S NOT APCLY TO AN OYMER OF =
PROPERTY WHO BUIL�S OR IMPROVES THEHEON,AND WHO DOES SUCH WOftK HIMSELF OR HERSELF OR
� iHROUGHHISORHEROWNEMPLOVEES,PROVI�F�THATSIJCHIMPROVEMENTSARENOTINTENDEDOR �
W OFFEREDFORSALE.IF,HOWEVER,TH[BUILDINGORIMPROVEMENTISSOIDWITHINONEVEhROFCOMPIE-
��� TION,THE OWNER-6UIWEH Y/ILL HAVE THE BURDEN OF PPOVING THPT HE OR SHE DID NOT BUILA OR �
Z IMPROVEFOATHEPUROOSEOFSALE}. - -
_ ❑I,ASOWNEROFTN[PftOP[fYTV,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS .
�. TO CONSTRUCT THE PFOJECT(SEC,7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- - V31U8fi0f1 ADJ.AflEA
W CFNSFIAWDOESNOTAPPLYTOANOWNEROFAPflOPERTYWHOBUIL�SORIMPROVESTHEREON,AN�
� WHOWNTRACTSFORSUCHPROJECTSWITHACONTRAC70R(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY OESCRIPTION FEE
Y TURSLICENSELAW.�.
� ❑IAM EXEMPT UNDER SEC. 8.8 P.C.FOR 7HIS REASON �.
�
�
LL' DATE OWNER �
Z W
� , LICENSED CONTRACTORS DECLARATION W
a � f�Y� i
� � I HEREBY AFFIRM UNOER PENALTY OF PERJUHY IHAT I AM LICENSE�UNDER PROYISIONS OF CNAPTEH �
d- '9(COMMENCING VJITH SECTION]000)OF DIVISION 30F TNE 0LISINESSAND PROFESSIONS CODE:AND Z
X MY L�CENSE I51N FULL FORCE AND EfF�T�.�J - ' "
W �-'�j� �°�7��/ m
o �
� UCENSE CLAS ���`� �LIC.NO. J�
U DATE CONTRACTO �' � � a
W
� WORKERS'COMPENSATION DECLARATION Q
� U
� I HEHE(iY AFFIRM UNOER PENALTY OF PERJURY ONEOF THE FOLLOWMG DECLARATIONS: ' .
� Z
Q
C1 I HAVEAND WILLMAINTAIN A CERiIFICATE OF CANS[NT TO SELF-INSURE FOR WORKEfiS' _
COMPENSATION,AS PROVIDED BY SECTION 37000F THE Ll+BOH GOUE,FOR THE PERFOflMANCE U
- ¢ Of THE WORK FOfl WHICH THIS PERMIT IS ISSUED. �
� .
W �IHAVEANDWILLMAIMAINWORKEFS'COMPENSATIONINSURANCE,ASqFQUIpE�RVSFCTION
Q 37000FTHELABORCODE.FORTHEPERFORMANCEOFTHEWOFKFOflWHICHTHISPERMITIS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER ANO POLICY NUMBERAftE: GONSTRIICTION
J
j CARRIER PLAN REVIEW
Z POLICYNUMBER _....._-_ °^�'_ -
ELECT
¢ �—� �iHISSECTIONNEmNOT8ECI�MPLEfEDOFTHEPEMMISPoRONEHUWREDD01.lAfiS(St00IORLESS). ..LUMBING �-
Z �CERTIFYTHAT W THE PERFORMANCE OF THE WOFK FOH WHIGH THIS IT IS ISSUE�,1 MECHAN�CAL
� SHAII NOT EMPLOY ANY PERSON IN ANY MANNER TO B SUB CT TO THE
[n WORKERS'COMPENSATIONLAWSOFCALIFOR ,AND T HOULDBECOME INSPECTIONFEE
� Sl1fllECTTOTHEWORKERS'COMPENSATIO ROVI N ONa�ooOFTHEUBOR
� `C DE,I SH O� ITN COMPLY WITH ISSUANCE P
� �� SMIP
p DA = APPLICANT.
w �� ENERGY P!C
—� WAflNING.FAILURE TO SECUflE WORKERS'COMPENSATIDN COVERAGE I� NLp L,AN�SHALL BE
J
� SU&IECTANEMPLOYERTOCRIMINALPENA�TIESANOqVILFINESUPT .ONEHUN EDTHOUSAN� ENERGYPERMIT
DOIURS($700,000),INA�OITIONTOTHECOSTOFCOMPENSATION.DA GESASP OVIDEDFORIN
J SECTION37o80FTHELA60RCADE,INTEREST,AN�ATTORNEY'SfEES. RETENTIONFEE:
�
� CONSTRUCTION LENDING AGENCY PRE-ALT PEE:
Q IHEREBYAFFIRMl1NDEflPENALTYOFPERJURVTHATTHEftEISACONSTRUCTiONLENOINGAGENCY
� FOR THE PERFOLiMANCE OF iHE WORk-'FOR WHICH THIS PEflMIT IS ISSUED(SEC.3097,CIV.C.). -�� --��-�� ��� -- ��
Z
W
� I.ENDEfl'S NAME
F- LENDER'SADOflE55
� ICERTIFY7HATIHAVEREADTHISAPPLICATIONANDSTA7ETHATTHEA80VEINFORMATIONISCORRECT. TOTAL FEES . d ��
w I AGREE TO COMPLV WRii ALL CITV AND COUNTY ORDINANCES ANO STATE IAWS flELATING TO BUILDING � �
� CONSTRUCTION EflEBV AUTHORIZE REPPESENTATNES OF THIS COUNTV TO ENTER UPON THE �
ZABOVE�MENTI EO P PEflTY FOR I TION PURPO�65. COMMENTS �
� �����
J
�
,Q PERMITT�A H .... .
�� _ __ ..._— _._.
�
� SIG 7UR O DATE � � �
= RECPT.NO. PAID BY VALIDATIO
~ ITE—Department Copy.YELLOW—Finance Copy,FINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicanfs Copy �
€ € �� � ( � I � � � � � � � � � I ' �� �
.�m � ( � � � � � + ;
' � � � I , i � i �
� ' € � � C � � � � i � i I . 4 3 i � i � i �
� � � : i � �� i �� ` i ( i � � �� i
� � � i t i ' : ' ( I s � C ` � '
€ �
€ � i � � i t i I i-.. f � i � �
� E � i E � , � ( � 7 { I I I � I � I � �
-, .. � j i � � i � � ! i € i j ; � i � � �
! : � � � i I � I I 1
�, k i � � i �
- � � I � __�i , � f � � � ( t E � � � I S
� i � , i , � � ; (
� �.� i � � , � � i � i � � �� I � � � 1 � . s � � ... I i '
� ! ' � ' % � I , � � t f � , � , � � � � E �
... .�.�....��' I ._3 f ���. ; i f i � 4 � S
I � �
G '�� �i i � � 1 i 7 � (
= �)� � � i j � � � � � � � }1
� � i, � N �� ' � i � � I ' ; ; , � }
'� � � �tJ � � �! �;� . i � I � Isy i i i ' i ! (
- � � �� in � � �'td�li"��`,.�'�� ��'�� ' ( I � '��� ' . i i � � � ('
� � � �; � .��¢�cu i�lz �'�td� Iv� � �,z`1, �''� E ; � ! � ; ,
� �-- ��� � � � �:�,m,� � i�, t� �i, ,� c, _ u; �^._� 3� � r ( E € i 1 '
� � z� ��� .,�i... t— i� z _ i:.i ci � '-I 3�- i � � i E E � i 1
� c7�r� .t"�,'�t� !.� s�.a � (. �— �& c.7 v i �=° w i
� g� �p � ���, �•�i,z�r c�3 ����' ua ��'��`�E� c, �- � ��o-����r r i , � � ( � � ,
-,�r� �:i� � � m€ iC>�� � U� �, .� w � �,tw�� `� Pc� a� �.�: �; � � i � � � I i
� � �� � � -C71�i's7� a�. 3.0 u.'�.�.. `-€d�.� C� u� y U3; �u.l �
� � CC!Lt l�� � ,�� � � C`3 � t i�7 ...,,! v3 E� i o-•� h 1� +� 3�- u. � i i ' i a i
� � � e u: w[c.�� , i �' � i.r. ; I � �„ i� r�� � � 1 � + 3 �
� :3 �€w �u � � �'�l � Q °� € i<C,� � icC �� I � ( j
� '� `_�_l ? �€��'� ���f `'� tC k.S- �=J 1 � -..'"} Cn7 i C3 u.�La.�c"i.g��k?_j C4'L.�t � :�� , � 1 � E I :� ( � j i �
u.. a. �.a � ,.L u. �'w r u r� cr,x,t� a. W i� � r� a.�.i.�r�� �r�.;� i�� � � I ? � � {{:
" �0 �" --;--j �......_--�-- - _� --- _ . �{--�-- + �`' � ( � � { �
�. �.9 —r`_ � � �--� 3 �' > ` : � i , ; � i ` �
� � i E 3 ! � ' ' ; � � � � � � '. E � � � � ' , ' i
� � °� i € � � � i ! � ' i � i ' � � € ' i i � f !
� � i � � � i i ( � E f ; i � 3 k � � ;
� i i � � 3 : ' + i i ; ' j i
� i � i
.. i i i i ' E � ( i � ' ' ! i i 3 € .
� � i
I ' ' ' ' � ' � ; : i �' � 1
, � ,
; � 6
� ._..__, j I ���. i i � . + _ � � � � { '
k � p
,�
u.. - —� _ .._ _ _._•._
' �—�—r i r � � E , � f � 'I � � i �
.. I � � j 1 , ; � �� � � I i � � , � . � { i i ' s i I � �E
Q `
. ` ' 3j � � �
� � ; i � i � 3 a ,
� � ; � , ; � ' M` �
� , � ; ; , � � ; � ,
� � F
� � �- � ��--�- ( ' ` � � - � �--�- � � I
� , ' , €
i� ��� � �` � �i � � 3 � j 3 �""�
� `� �`a � :ui� �� ��5�`"" � � �'� j r-i�� C:� ' i 'u:r��
<" �' --� � 1`��.��� ���l,��E—I� � � � � � .�{�.� � I tr� � � �F�y
� � �+.� b, F,,,,, L� � �����T.f €�! c' ��a: �.*�w` 1 ?'"` � a� i $"'° I �
� G ' -�1 L'C ^� �I`� 1.Y � � tn --s u; � --'1� 'J;1 r--''�-- �
� ! � �
rj �� E� ��(?�� .a. +'a rJ'� ����`� � +.7 :°w .,.�I �t�� j�°� .�at�a4� � �+ � � ( '��—F�
� � �;��� c �- �I� ,�,� z �-.� ca � ,�3c� ¢ � � �.e�'u ,��� �� : °� " , ! � ��
. ��r �" �� i�.,i::y ti �t�. t� C.+ C.,�'� ..z! � � 1�s� �¢ � � �., � . °� j E am tL
�I r� � i � �� i k- G., t � � _ I
—,U ���!J s �-- vl�l� � a.C�i�--� � �i �i� a. cu�f� �o� � � � � � , �tu
iu €--(� cc � u.*':i G�x�C � C7�C.� e... x �'--�,a e���.x� ut �.�, .� l � �'� � � ' ; .E:;ua
c+� �. �;�^ n �.�i�- u_i� ���,r� �7 _a .�-�, r., c�i u en � �.'u_ a��u- �� C� � � � ' � cn sr� �
� _�_L_��_.__ � 4..._,.... _ _._ .a.e_ ! v.��