Loading...
HomeMy WebLinkAbout15280 � _!� CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �,w 21660 E.Copiey Drive Suite 190 PRESS ` (909)860-3195 Faa(909)861-3117 '9�' BUII.DING PERMIT APPLICATION FIRMLY � JOBSITE r �s APPLICATION� �� PERMIT l P/C � ADDRESS � ^(.✓..� '����i�= G.-P'�•� DATE N �� NUMBERI� .,Z # � ISSUE 1YPE OCC APN LOT TRACT DATE CONST. GROUP � _,"'�. �r �� . _ — p OWNER f.._� . % � t. t. p ADDR�S:i . . �+,. ,�.. - %,i_, ZONING SETBACKS Z CITY��'.� . i�• , :I�� _ .� .� :,'• •S .i�,,.•'. FRONT RW ❑ APPLICANT ? • , �.b�t,�- � � . TEL. .��, REAR ❑ � � �'� SIDE/SIDE STREET RW L] � � CONTRACTOR _ SIDE C] E g ADDRESS - PROPOSED USE �'�f�'f�//�S_C�J/iF '(/f.:_"'G.I�- ; o CITY ZIP TEL. �f���'/���_��� � w ARCH/ENG/ z DESIGNER NO.DWEL. NO. NO. �� pW„ ADDRESS _ --�— UNITS STORIES _ BEDROOMS � � CITY ZIP TEL. i � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATfON c f � OWNER-BUILDER DECLARATION � 0 SFR/ADD/REM � i MEflEBY AFFIRM UN�Efl PEN0.L7Y OF PEMIRY THAT I AM EXEMPT FFOM THE CONrRACTORS LI- G8f8gB/CBfPOfI W CENSELAWfORTHEFOILOWINGHEASON(SEC7031.SBUSINESSANDPROFESSIONSCADEANVCITYOR (n i COUNTVWMICHREWIRESAPERMITTOCONSTRIICT,ALTER,IMPROVE,DEMOLISH,ORHEPAIqANYSTFLIC. W pgll0/DBCk TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES 7HE APPLICRN7 FOFl SUCH PEftM1T TO FILE A SIQNED �. W STATEA/ENT THAT HE OR SME IS LICENSED PUFSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� W � � CENSE UW(qiAPTEFi 9(COMMENCIN�WITM SECTION 7aoa)9F DIVISION 30F THE OUSINE55 AND PRO- U' POOUSP3 y FESSIONSCODE)ORTIIATHEORSHEI3EXEMPTiHEREFFOMANpTNERA5ISFOPTH'cALLEGeDE%EMP- (� . TION,ANYVIOUTIONOFSECTIDP170376BVpNYAPPLICANTFOFAPERMITSU&1ECTSTHEAPPLICANTTO z RB-R00� � ACIVIL PENALT/OF NDT MOflE THAN FIVE HUNDRED�OLLAFS�5500)j � ^ ❑I,ASONTIEROFTMcPROPEflTY.ORMYEMPLOYEE5WITHWAGESASTfiEIR50LECAMPENSATlO\, ❑ COfIIRIBfCIflI � j WILL 00 THE WORK,AND THE STRUCTURE IS NOT INTENOED OFi OFFEREO FOR SALE(SEC.7046,Bl1Sl- J r � NESS AND PROFF65IONS CODE�THE CONTRACTORS LICENSE LAW DOES NOTAPPLY 70 AN OWNER OF � g PROPEflTV NMO BUILDS OR IMPHOVES THEREON,l�YO WHO DOES SUCM WORK HIMSELF Ofl HEflSELF OR Q[ THROUONHISORHEHOWNEAIPLOYEESPROVIDEOTHATSUCHIMPROVEMEkTSARENOTINTENDEDOq m ��• 0 OFFEREDFORSALEIFHOWEVER.THEBUILOINGORIMPROYEMENTISSOLDWITMINONEYEAROFCOMPLE- e TqN,THE OWNER�BUILDER WILL HRVE TXE BUROfN OF PAOVING THA7 HF.OH SHE�IU NOT BUILD OR � IMVROVE FOR7HC PUflPOSE OF SALE} F W [71,ASOWNEROFTHEPROPERTY,AMEXCWSNELYCAMMCTINGWITHI.ICLNSEDCOYTMCTORS [[ TO CONSTRUCT THE PRDJECT(5EC.70d6,B1151N[3S AN�PROFESSIONS COD[THF CONTRACTOHS ll- V8IU8I1011___ __ ADJ AREA W CENSEIAWDOESNOiAPPLYTOANOLNJEROFAPROPERTYWHOBUILDSORIMPROVE5THCREON,AND -�-� — ----- � - — �: L W{p�pNTRACTSFORSUGiPR0.1ECT5WITHACONTR4CTOR(S�LICFNSEDPIINSUMItTOTHECONTPAC- QUANTI DESCRIPTION FEE �� TORSLICENSEL�W) �g �' � ❑I AM EXEMP�UNOEfl SEC _�&PC FOR THIS REASON U l.G+ �� i � 3 ----- aC � I � u' OATE t�'_�'Y" J iJ OWNER���` .��%S� _ U F W � LICENSED CONTRACTOHS DECLARATION W zg � IHEflEBVAFKIRAll1NDERPENALTVOFPF.Fl1URVTHATIAMLICENSEDUN�ERPROVI510N50FCHAVfER � � _ f, �,j��� '7 � J g d 9(COMiAENCIN(:WITFISECTION70W70FDIVISKJNaOFiHEBUSINESSANDVFOfES510NSCADE,AN�J z '�`-Y" ��� ��J +✓����''K IL � t; I E � MY UCENSE IS IN FULL FORCE AND EfFECT m � 0 LICENSE CIASS_ _LIC.NO _ .__ � UDATE_._� CONTRACTOR._ .___.._� Q W � � WORKERS'COMPENSATION DECLARATION Q � U � 1 HEREBY AFFIRIR UNOEfl PENALTV OF PERIURY ONE OF THE FO�LOWING DECLARA710N5 � Z . ' O __IHRVEANOWII.LMAINTAINACEHTIFICATEOFCANSENTTOSELF-INSUREFOHWOqKLRS' _ — ¢ COAIPENSATION,ASPROVIDE�BYSECTIONJ7000FTNElP.BOflCWE.fORTHEPEHFORMANCE U 4 OF TME WOflK FOR WHIGH THIS PERMIT IS ISSUED W � d � . - r� w I HRVE AND Wllt MAINTAIN WORKER5'CAMPENSATION INSUPANCE,AS HF.QUIfiED BY SECTION � n 370o OF TNE LABOR CODE.FOR THE PERFORMANGE OF THE WORK FOR WticCN THIS PERMIT IS CI ISSUED MYWORKEflS'COMPENSATIONINSURAtiCFCARRIERANDPOLICYNUMOERARE CONSTRUCTION ___ , _____ , ___,_ 4 f: �, cnAqieR __..__ PLANREVtEW � � —'-- —_..— - Z PCLICV NLIAIBER______"�_ '. . ..._ ' '_'_"__'_ _""" __-_ F ---- - FLE01`RIO ----` - -- — �+ ,d } . � � (IFiI35ECIlONNEEIR9T0E00NIP�EIED�F'MEPEPlJnISFOF70tJEHINCFEDIX%lARS(51ooIOFlLESSj. PLUMBING _ _____ ___.....____"'t- ' W ICEq11FYTHATINTHEPERFORMANCEOFTHEWORKFOiiWHICHTNIS�ERMIlISISSt1fU,l MECHANICAL _____ __ � � Z - '____——__ _ (,�} SMALL NOT EMPLOY IWY PEft50N IN ANY MANNFR 50l5 TD BECOMF.SUBJECT TO THE ' � WORNERS'C4MPENSATIONLAWSOFCALIFORNIA,ANDAGF.EETNATIFISHDULOBfCOME INSPECTIONFEE .___ __ _,_____, � SUBJECTTOTHEWORKERS'C�MPENSATIOYPROVISIONSOFSECTION37COOFTHF.�ABOf7 '��,!, j� � GODE.I SHALI FOHTHWIT}i CVMPLY WIhiTHOSE PROVI510NS ISSUANCE __ ___ _______ _ __ J ��. ____ r � p DATE: _ AYPLICANT ,._ SMIP `� ' _______— � � „ . . . - ---. ENERGY P/C �P'�7+Wi,Y ' 1�bY'r+ta���'�P�1�� � . • •• � �: � •'�•.•J • ' � ENERGY PERMIT w rxv vr+ a av'r1 6.`f�°"� � '.,,� . , , . ,,, • .. . . ��f1�AII°�d�'a�.�a�-� � RETENTION FEE� - --- — - ----------- -- ,—— OGONSTRUCTION LENDING AGENCY pRE-ALT FEE: _ ____. __..____ —_—_ � � IHEREBYAFFlRMUNDERPENALTYOFPERJURVTHHTTH[flEISACONSTqUCTIONLENDiNGAGENf,Y � FOR THE PfRFOfiMhNCE OF THE WORK FOR WlIIC41 THIS PERMIT IS ISSUED(SEC 3oe7,CIV C� � � � Z LL ___ "__'"" '-""'_ '_'___ - � LENDER'SNAME_"__'-_ __'_ ___. _ .,_._ __-"_ '__-_ '___' __ F- LENDEFSAUDRESS__._ ___._ . ---__- ---- w . � . . , . . . . . .. ` „ �- TOTAL.FEEB r, a .. . ,.v . .. . •. . . ,..,� . . � . . . . . Z ��•.' °, •, � ,. . •, . ' COMMENTS_ —'- - � _�1.�'�'�_.��-, !�"�''� --- - ------ — — � m ------ — � Q PEflMITTEE NM7E(PflINT)'� _ __. —'_"_' '_ __ cn C r-'"1 1 jj�.� � � SIONATURF.O�� DATE � I,aJ � �� s FlECPT.NO.,_ _ PAID BY w_,_ _VALIDATION_____ ~ WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREE pplica Copy � �'lnj X . r.t . ,i A�.. � . � �},t �' L^� . �1 �