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HomeMy WebLinkAbout16898 C1TY()F DIAMOND BAR �"�``-- DEPARTMENT OF COMMtJN1TY&DEVELOPMENT SERVICES ---- i I 21825 E.Copley Drive � (909)860-3195 Fax(909)861-3117 PRESS ':�r�' ,,,8 DING P RhIIT P= �'ION FIRMLY � � JOBSITE (t-�' yg� APPLICATION PERMIT P/C ���� o ADDRESS.�" � � �"�`���f�`�'� ' ��%i� DATE �� NUMBER �� #��_eJ� "'� o � ISSUE �, PE OCC °� APN TRACT ���j�� DATE � ONST. GROUP p OWNE�— �� �°`"� " ADDRESS . i� t- � / �7J ZONWG SETBACKS z CITY " }��-'". .ZIP �� TEL. FRONT _ RW ❑ � APPLICANT L ' P�.Q TEL. : � n[r r REAR ❑ z SIDE/SIDE STREET .. RW ❑ � CONTFiACTOR �'C.�" ��iQ_� � .A �µ ��? (°a� SIDE ❑ Q ADDRE S " '� �: ' � " PROPOSED USE Y I ) n CI7Y ��i��^� �„�,-Q-'a..� ZIP Z" '�.TEL.� ° S.��c""�d.`I w ARCH/ENC,/ � DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEqEBV AFFIFM UNDER PENALTY OF PERJUPY THAT I A!A EXEMPT FROlA THE CONTRACTORS LI� G1f2gEIC0lpOfY W�' CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.5BU51NES5AN�PROFE5510N5CODE:ANYCITYOF (n Z' CAUMYWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSiRUC- W Patio/�eck . w. TURE,PRIOR TD 175 ISSUANCE.ALSO FEQUIflES THE APPLIGANT FOR SUCH PERMIT 70 FILE A SIGNED W ��� STATEMENT THAT HE OR SHE IS LICENSE�PURSUPNT TO THE PROVISIONS OF THE CONTRACTORS LI- . CENSE LAW(CHAPTER 9(CAMMENGING:WIiH SECTION 7000)OF�IVISION 9 OF THE BUSINESS ANO PRO- � POOUSPa FES910N9COOE�ORTHATHEORSHEISEXE�MPiTHEREFflDMAND7HEBASISFORTHEALLEGE]EX[MP- (� .�,� TION.ANYVIOLATIONOFSECTION�7097.SBYANVAPPLICA,UTFORAPERMITSUBJECTSTHEAPPLICANTTO z R8-FOOf ��'A CIVIL PENALTY OF NOT MORE T!{AN FIVE HUNDRE�DOLLAftS(5500).): '�, 0 ❑I,ASOWNEROFTHEPROPERN.OFMtlEMPLOVEESWITHINAGESASTHEiR50lECOMPENSATION, � Commercia� – '�, Z. WILL DO iHe WORK,AND THE STRUCTURE IS NOT M'ENDED OR OFFERED FOR SALE(SEC.7044,BU51- _! ��,�., NESSAN�PROFESSIDN6 CODE;THE CANTPAC70RS LICENSE LAN!�OES NOT APPLV TO AN OWNER OF � �'PROPERTY WHD 6UILDSOF IMPROVES THEFEON,ANO WHO DOES SUCH WORK HIMSELF OR HcRSELF OR (C'�.'THROUQHHI509HEROWNEMPLOYEES,PROVIOEDTHATSUCHIMPROVEMENTSARENOTINTEN�EUOR � � Q�,'OFFEREOF�RSALE.IF,HOWEVER,��hIE9UIL01NGOPIMPROVEMENTI550LDYVITHINONEYEAROFCOMPLE- �.�, TION,THE OWNEH-BUILDER WILL�HAVE 11-IE BUflDEN OF PROVINO iHAT HE OR SHE DID NOT BUILD OR ��',IMPROVEFOFTHEPURPOSEOFS,ALEf.'. . W, ❑I,ASOWNEROFTHEPROPERTV,AMEXCWSIVELVCONTRACTINGWITHLICENSEDCONTRAC70R5 (Z.;',',TO CANSTRUCTTHE PROJECT(SEC.�00.4,BUSWESS AND pqOFESSIONS CODE�THE CONTRAC70R5 LI- VHIU211011 ADJ.AREA � W'���'CENSEIAW�OESNOTAPPLYTOANOWNEROFAPROPERiYWHOBUILD50RIMPROYESTHEREDN,AND ���,4VNOCANiRACTSFORSUCHPFOJECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE � Y� �TORS UCENSE LAW.). ��� �71AMEXEMPTl1N�ER5EC.' B.6P.C.FORTHISREASON U � � . � DATE �OWNEH U W �, � LICEN$ED CONTRACTORS DECLARATION w ¢ Cr" IHEREBYAFFIflMUNDERPENALTYOFPERJURYTHATIAlALICENSEDUNDERPROVISIONSOFCHAPTER � . ��. p_., e(COMMENCING WITH SECTION 7000)OF DIVISION 30FTHE BUSINESS AND PROFESSIONS CODE,AN0 Z �, 9G' MY LICENSE IS IN FULL FORCEAN�EFFECT. �' LICENSECLASSy�l���-? � IIC.NO. ��` � � :f ° j V' DATE� (,� � � CANTRACTOR C'°- � ��f � W � WORKERS'COMPENSATION DECLAHATION Q � IHER�YAFFIftMUNDERPENALTYOFPEqJl1RYONEOFTHEfOLLOWMGDECLARATIDNS: U . � Z � _IHAVEANDWILLMAINiAIN��,pCEFliIFICATEDFCONSENTTOSELFINSUREFOPWORKERS' _ COMPENSATION,ASPROVIDEDBYSECTION37ooOFTHELA90RCODE,FORTHEPERFORMANCE U � OFTHEWORKFORWHICHTHISPERMITISISSUED, � d w ----¢¢IHAVEAN�WILLMAINTAIN',WORKERS'COMPENSATIONINSURANCE,ASREQUIP,EDBYSECTION $_ �+ � � Q �37GOOFTHELABORQODE;,FORTHEPERFORMANCEOFTHEWORKFORWi-ACH7HISPERMITIS �j ISSUE�.MV WORK SATION INSkl�ANCE.rCuARRI R AND POLICY NUMBEPARE: CONSTRUCTION j cnaaiEa � '��. ��� � �r�� PLAN REVIEW `! Z POLICYNUMBER I . "��.� . ELECTAIC Q 0 (iWSSECTKKJNEmNOTBE�COMPLEfEDOFhiEPERMRISFORON[HUPDRE��OIJ.ARS($100JORLESS). PLUMBING Z ICERTIFVTHHTMTHEPEf3FORMANCEOFTHEWORKFORWHICHTiiISPERMiTI5155UE�,l MECHANICAL (,.3' SHALL NOT EMPLOYANY P�RSOCJ IN ANV MANNER 50 AS TO BECOME SUBJECT 70 THE � WORKERS'COMPENSA7IONLAWSOFCALIFORNIA,AN AGREETHATIFISHOULOBECOME INSPECTIONFEE , F- SUBJECTTOTHEWORKERS'COMPENSATIO PROVI ONSOFSECTIQN 3a0oOF71 i.ABOR QCODE,ISHALLFORTHWITFICOMPLYWITH OSEP VISIONS. p ( � ISSUANCE _._ `�� p OATE: ''.�� APPLICdNT: .-'Z�'- �"�id �` SMIP W � ` ENERGY P/C � WARNING:FAILURETOSECUREW�ilRKEFS'COMPENSATIONCOVERAGEISUNL4WFUL,ANDSHALLBE � SUdJECTANEMPLOYEftTOCRIMINALPENALTIESANDCNILFMESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT �OLLARS(5100.oao),IN AD�ITION Tp THE�COST OF COMPENSATION,DAMAGES AS PqOVI�E�FOR IN � SECTION37oBOFTHELABORCODE,INTEREST,AM1'DATTORNEI"SFEES. REfENTIONFEE: d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYpFFIqMUN�ERPENALNOFPERJURVTHATTHEREISACON&TRUCTIONLENDWGAGENCV .s � d FORTHEPERF-0RMANCEOF�HE4yORKFORWHICHTHISPERM1iI5155UED�5EG.309],C�V.G.). � W � LENDER'S NAME ._ F_- LENDER'SADORE55 � � I CERTIFV THAT 1 HAVE REA�THIS APPLICATION ANO STATE THAT TNE ABOVE INFORMATION IS CORRECT. TOTAL FE ES ���J � W IAGftCETOCOMPLVWITHALLCINANDCAUNiVORDINANCESANOSTAiELAWSRELATINGTOBUIL0ING � � CONSTRl1C710N,AN�HEflEBYAUTHOft1YEREPRESENTATIVESOFTHISCOUNiYTOENTERU?ONTHE � ABOVEMENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � ' �l -�� `�� ' � Q r�' �� z� � � PERMITTEENAME(PRIN') ' ' � � " UJ �fj SIGNATUFEOFPERM EE � �ATE _, � RECPL NO. 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