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HomeMy WebLinkAbout13235�_-� . EXPIRED � CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES MAY O 9 Z003 I � 3 21660 E.Copley Drive Saite 190 _ ";A�,+` BUII.DINGSPERMTI'APPLICATION FIRM Y I � JOBSITE APPLICATION PERMIT �2� �L��.�/C � ADDRESS � DATE NUMBERJ�./—�# � ISSUE TYPE OCC APN LOT RACT DATE y"I CONST. GROUP � � OWNER O �` ADDRESS ZONING SETBACKS � CITY � � EL. FRONT / RW ❑ APPLICANT TEL. REAR ❑ � SIDFJSIDE STREET RW ❑ CONTRACTOR SIDE ❑ Q ADDRESS — � p PROPOSED USE O� CITY ZIP TEL. � ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CfTY ZIP TEL. � N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � WNER-BUILDER DECLARATION ' SFR/ADD/REM O p I HEREBV AFFlRM UNDER PENKTY OF PERIURV THAT�AM D(EMPT FAOM THE CONTRACTORS LI- G8f9g9/C81P011 lll CEfISELAWFORTHEFOLLOWIN�HE�50N(SEC.70.71.68USINESSMIDPROFESSIONSCODEMIYCITVOR (J� , L7 �yW{��qEpUIqESAVERMRTOCONSTAUCT,ALTER.lA1PROVE.DEMOLISH,ORREPAIRANVSTRUG W Patb/Deck Z lURE,PRIOR TO 179 199UMICE,AL50 RC-0UIRES THE APPLICANT FOR SUCH PERMR TO FILE A SIONED W STATEMENT THA7 HE OR SHE IS UCENSED PURSUANT 70 THE PROVISIONS OF THE CONTRAC70RS LI- � CEN9E UW(CHAPTER Y(COMMENCWO N7TH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa FES310NS CODE)OR THAT HE OR SME IS D(EMPT 7HEREFROM AND THE BASIS FOR THE ALIEOED EXEMP- TION.ANVVIOLATIONOFSECTION70.71.68vANVAVPUCANTFOqAPEPMITSUBJECTSTNEAPPLICM17T0 Z RB-ROO} � A CML PENALTY OF NOT MORE THAN FNE HUNDRED DOIURS(i600).): � ❑4ti^ONMEROFTHEP{iOPERTV,ORMVEMVLOVEESWITHWAOESASTHEIRSOLECOMPENSATqN, O CpmmBfd91 -� . ' WN.L 00 iHE WORI(AND THE STRUCTURE IS NO7INTEN�ED OR OFFERED FOR SALE(SEC.7W1,BUSI� J � NE55 NJD PpOFES510NS COOE:THE CONiRACTOR3 LICENSE Uw DOES NOT AVPLv TO AN OWNER OF � PROPERTY Yh10 BUILD9 OR IMPROVES THEREON,M1D WFIO DOES SUCH WOqK HIMSELF OR MERSELF OR Q iNROUGH HIS OR HER ONM EAIPLOVEES,PROVIDm THAT SUCFI WPROVEMENTS ARE NOT INTENDED OR m � OFFEAmPORSALEIF,FIOWEVE0.7NEBUILD�NOORIAIPROVEMENTISSOLDN7T1nNONEYEAROFCOMPLE� , Z �'TION,THE OWNER$UpDER MIILL HAVE THE BURDEN OF PROVINO THA7 ME OR SHE DID NO7 BUIID OR � IMPHDVE FOH hIE PURPOSE OF S/�L�. w ❑I,AS OYMER OF THE PROPERTI'.AM EXCLUSNELYCONTMCTINO WRH IICENSED CONTMGTORS � TO CONaTAUCT THE FROJECT(SEC.7041.BUSINESS AND PROFESSIONS CODE:THE CONiMCTORS LI• V81U8�IOf1 ADJ.AREA CENSE UW DOES NOTAPPLY TO AN ONMER OF A PROPERTY WHO 8 S OR IMPROVES TIEREON,AND I` � NTIOCONTMCfSFORSUCHPROJECT9WIhIACONTRACTOR(S)LI� SEDPURSUMfT707HECONTRAG ouaanrv DESCAIPTION � FEE . \ `70RS LICENSE IAW.). X O I AM D(EAIVT UI�IDER SEC. B.a P.C.FOR TH Q � \1 3 �� � i � ¢ o�re � o U z � LICENSED CONT RS DEC N w � � 1 HEREBY AFFIRM UNDER PENALTY Of VE0.IURY TT1AT I AM LICENSED UNDER PROVISIONS Of CHAPTER � d Y(COMMENCWO WITH SECTION 7000)OF DMSION 3 OF THE BUSINESS AND PROFESSIONS CADE,ANO Z X W LICENSE IS BJ FU.L FOHCE M1D EFFECT. m LlJ � � IACENSE CUSS LIC.NO. � , � � J U DATE CONTRACTOR a LL � WORKERS'COMPENSATION DECLARATION Q � • �-^• -' �-- -IMenE�YM/11u1uNDen�PeNAITYOP.PERnJMONEOPTI1E�FOLLOWmaoECLA101710N9:� � . Z ... , - _ y . _ _ .. t . . n... � _IHAVEAI�WILLMAMTNNACERTIFICATEOFCONSENT70SELFaNSUREFORWORNERS' _ � ' � ' . ' ' ; ' � i Q COMPENSA7pN,AS VROVIDED BY SEC710N 370o OF iHE LABOR CaOE,FOR THE PERFORMANCE `U O OF THE WOpK FOR WHICFI THIS PERMIT IS ISSUED. • � . _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED Bv SECTION , Q ' 370o OF THE LABOH COOE,FOR THE PERFORMANCE OF THE WOH1C FOR WHICH 7HIS PERMfT IS �"')� 1'� (�� = �ISSUED.MY NORI(ERS'COMPENSATION INSURANCE CARRIER AND POLICv NUMBER ME: CONSTRUCTION v '—r/ � j caaAiea PLAN REVIEW � aa.�crriuuBER ELECTRIC � �rwsstcr�r�r+araeaoas�rIDOFn�a�rr.�rsa�aor��oou.ws�siao)oRtFss} PLUMBING w � Z I CERTIFV THAT M 7HE PERFOftMANCE OF THE MIORK FOR WHICN THIS PERMIT IS ISSUED,I MECHANICAL-,- A� � (,�} SHALL NOT EMPLOV ANY 7ERSON W ANY MANNER SO AS TO BECOME SU&IEC770 THE' �� � � WORKERS'COMPENSATIONUWSOFCALIFORNItiANDAOREETMATIFISHOUL�BECOME INSPECTIONFEE � � � SU&lECTTOTMEWORKERS'COMPENSATIONPROVISqN50FSECTpN3�ooOFTHELABOR �^� [_, COOE,I SHALLFOR7HWITHCOMPLV WITITHOSE PROVISIONS. ISSUANCE A v� - J �� � SMI.P . . -. p DATE: APPLICANT: . . . v�� �/ � ' w ENERGYP/C �P (�i\� .�['�� 71. � WARNINO:FA0.UHE TO SECURE WORKERS'COMPENSATqN COVERAOE IS UNLAWFUI.AND SHALL BE —��-^� ,,=�`.` —�y�� � � SU&IECrANEMPLOYER70CRIAIWALPENAL7lE5ANDCNILFINESUP700NEHUNDREDTHOUSANO ENERGYPERMIT '�4 �/�j-((�j J'" � DOLURS�S700.000),INADDITIONTOTHECOSTOFCOMPENSATION,DAMAOESASPROVIDEDFORIN ;v,y `,� J¢ SECTION 370E OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. ' RETENTION FEE:C�t�T� '(�G � a CONSTRUCTIONLENDINGAGENCY PRE-ALTFEE: Bv��� O � I HEREBV AFFIRM UNDER PENALTV OF PERIURV TNAT THERE IS A CONSTRUCTION LENDINO AGENCV FOR THE PERFORMANCE OF 7HE WORK FOR NM1iICN THIS PERMIT IS ISSUED(SEC,30V7,CIV.C.). . . Z W � LENDER'S NAME F— LENDERSADORE55 W ICERTIFY7HATIHAVEREADTHISAPPLICATqNAIJDSTATETMATTNEABOVEINFORMAT10NI5CORRECT. TOTAL FEES � I A6REE TO COMPLV VJfTH Nl CfTY AND COUHTY ORDINANCES M!D STATE LANS RELATIN(3 TO BULLDINO CONSTRUCTION,AND HEREBV AUT}70RI2E REPRESEN7ATIVES OF 7HIS COUNTV TO ENTER UPON THE � ABOVE-MENTIONE�PROPERTV FOR INSPECTION PURPOSES. COM TS � � � �S d. � • ' • m I N IPRI ¢ �i UJ , r.- _ � ONATURE F P DATE qECPT.NO. PAID BY VALIDATION � �WHITE�)epertmenl Copy,YELLOW—Flnance Copy,PINK—Assesaor Copy,GOLDENROD—File Copy,GREEN—AppllcanYs Copy ► `'�.���l:_'��'..���'�� ���V V� D�i"i�VCO�� �l/�VY Y �:��;; ;• f3 � �_'� BF�lS��CT806�9 �E���BfI� � "�' . . , , . , �(_l(�pC�J�� o ��� � r; g = _ . . , . p��� � � .����y� � � _� ' ��G'��,� '� ��3;�. ' o ;,,►'� D�' , -3. .�V"�5�U " s�;'f; � . _ ; . �r., SET BAGK � . 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