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HomeMy WebLinkAbout13407 (16) � _�� CITY OF DIAMOND BAR DEPARTMENT OF COMMUrTITY&DBVELO N S 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ' ro�°� � BUILDING PERMIT APPLICATION FIRMLY o DDRIESS �-1 ��J ��F Iti�0.` ��� DATECATION NUMBER�� 6`�� #C � ISSUE ! �_�'^� TYPE OCC APN LOT-7-- TRAC7 DATE ll� `� � CONST. GROUP p OWNER ��,i'v�c..�e� 1+�..+L tri� "�bUi'Nil' ADDRESS ?1�.b`S C'_^hdLo. S�^ ZONING SETBACKS � cirr 0�...�.���..d� �c°+.r ZIP — TEL.�rf"C��S`� FRONT ,�i W Cl _ APPLICANT TEL. REAR `I.J ❑ � SIDEJSIDE STREET RW Ll __ CONTRACTOR R.,In Sc1.� .f�IpC_• v�� SCr�J1tC S��E n ct ADDRESS �'� �' c,, cv� oit- o CITY l ti)^ �ca��, ZIP�TEL. 5 �-� �L i�1 PROPOSED IJSE .� t�. ��.� �i � ARCHlENG/ t+ � DESIGNER — NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROaMS � CITY ZIP TEL. � y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AFIEANALUATION p� OWNER-BUILDER DECLAflATION SFR/ADD/REM O QQQ I HEREBY AFFIRM UNDER PENAITY OF PEHJURV THAT 1 AM EXEAIPT FHOM THE GbNiRACTORS L6 GBfaJB/Cd�Ol1 � '�'ti9•..�w�iF+ ••I�IM :YY\:�:..�.,i,Y...��:,; ,..... ��tii!''....,�.��: . ,: .;�'.•.'��. ' , , (n lrY!•�"'W 1 h�:i}�� y •• )�.��•� . \.' . M• V, �•:•ti� W Patio/Deck "' ' F�(7i ' ' ��I\� �!•'�� •.•: �:ti • ' •4' '\; W STATFMEM TNAT HE Ofl SHE IS LICENSED PURSUAN7 70 THE PROYISIONS OF 7HE CAMRACTORB LI- � CENSE LAW(Gi�PTER 9(COMMENCINQ Wf�H SECTION 70DD)OF DIVISION 3 OF THE BUSINE55 AND PFO- V" POOUSPB FESSbNSCODE)OH7HA7HEOHSHEISF�(EMPTTHEREFROMANDTHEBASISFOR7HEALLEOEDEXEMP- � V 710N.11NYVIOLATIONOFSECTION70315BYANYAPPLICANTFORAPERMITSUBJECTSTHEAVPLICANTTO Z qe-Roof � A GIViI PENKTY OF NOT MORE TMM7 FIVE IiUNDRm OOLlAR3(35o0J� � ❑I.ASOWNEHOFIHEPROP6RTY,ORI.IYEMPLOYEESWTHWAGESASTHEIRSOLECAMPENSATIOY, � COlI1RIBfC181 WILL DO TME WORK,AND THE STRUGTURE IS NOT INTENDE�Ofl OFFERED FOR SAIE(SEC.70a,8U51• J � NE$6ANU PqOFES510N5 CODE THE CANTRACTORS LICENSE LAW�OES NO7 APPLY TO AN OWNEfl OF � PFqPEH7Y WHO BU�S OR MIPflOVES THEREON,AND NM1i000E5 SUCH WORK HIMSELF OH HEflSELF OR � THROUGH HISOR HEROWN EAIPLOYEES,PROVIDED TNATSUCH IMPROVEAIENTS ARE NOT INTEN�ED OH m L�1 OFFERED(ORSALE IF.l10WEVEF�THE BUILDIN60R IMPflOVEMEM IS SOID WI7NINONEYEAq OF COMPLE• � 710N,THE OWNERbUILDER WILL HAVE TME BUHDEN OF PROVINO 7HAT HE OR SHE DID NOT BUIID OR '.�j IAIPHOVEFORTHEWNPOSEOFS�LEJ. ❑I,AS OYMEP OF THE PROPERTV,MI ENCLUSIVELY COHTRACTINO NA7M LICENSE�CONTflACTOH6 � :+ � • ti' �• � "- ' � ' ----� -- ----- Valuation ADJ.AREA � � M~ ,'�tiV,^. 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B6PC.FOHTHISHEASON � � � C�� ` � S 3 __ ___'_""'__ � � DATE OWNER ___ � � W LICENSED CONTRACTORS DECLARATION J � W 1 HEREBY AfF�RM UNDER PENALTY OF PERIUHV THAT I AIA LICENSED UNDER PROVISIONS OF GHAPTER e� � e(COMMENCINO WITM SECTqN 70o0�OF DIVISION 3 OF THE BUSINE55 RND PROFESSIONS COOE,AND Z _ _ � MY UCENSE IS IN FULL FORCEAND EFFECT. m � LICENSECpU-55 C�q1C� __ LIC NO �-_((J__I_�S.Z�—�/��� � � DATE ?��� ` CONTRACTOP 2w' ���'d�v�� �- i W ��v i � WORKERS'COMPENSATION DECL4RATI�/3 Q � 1 HEREBY AFFIRAI UNDEH PENILN OF PERIURY ONE OFTHE FOLLOWING DECL4RATIONS U G) a C _IHAVEANDWILLMAINTAINACEHTIFlCATEOFCONSENTT09ElF�INBUFEFORWOFKEflS' _ � COMPEHSATION,ASPROVIDEDBVSECT10N37o00FTHElA80RCODE,FORTHEPEqFORMMCE U Q OFTHE WORN FOR WHICH THIS PERMIT I5155UED � � W �_1 HAVE N7D M/iLL MWNTNN WORKERS'COMPENSATION INSURANCE,AS RE�UIflED BV SECTION 4 37000FTHELPBOROODE.FORTHEVERFORMANCEOFTHEWORKFORWHICHTMISPERMITIS � ISSl1E0.YVWORKEHS'COMPEN5ATIONINSURPNCECRRHIERPNOPOLICYNUMBEflARE CONSTFiUCTION _._____,___ ____..__,_ j cu�RiEq _ PLAN REVIEW -- -------.- � — ------------ ^— ZPa�cvnuMeea__ ------ - EIECTRIC ----- ---- ------------�-` — Q — � (iH6SECfKXJNE�NO7BEOqJPLEfEDOFTHEPEA,NiISFIXiONEHUf�DFEDWLLAR5Bfo0)OFiLESS) PLUMBING ----.._...-- ----------------- z � , , , ;.ti. .. .,..r.. . .x .. •h - - „-� � - MECHANICAL — .. + � , , . (� �. .4 . i\ .. .,.I.\n\•4'ti•�• ' . . , �: � , .. .. :,a . +�,.a.�,� ,R . .. � INSPECTION PEE _----- :i GOOE.�,.� . ,� . . . . . ' ISMALIF(RTHWITH� ..",V.. �e. '�,. . ' �. , r,. S ,e.... " . Q ; r' . "_'�_ ._._ � COMPLY 4 RO1VIS'IONS ISSUANCE ., __ : J _���`_ � � /�L� L7✓��� SMIP — . . . ��`'------' — � DATE•. �v�0_ +. J wyrrrose��.,. , .,.,, �,� . ENERGV P/C ------ ' .: � . . __.. — n APPLICANT J •. Y�, S, ' , � „' . . . ""_ . � . . • 4.�.� ♦:.� . .. , ti, • , , ,•, ' � "�, y . , . , . . ,.„ ,. ,�,�'ti ENERGY PERMIT ----.. . — .,..". . . ; .,�. . 1,,. . r .. -� • •• � � ' ' ' RE7ENTION FEE: � -- ^' ------ � CONSTRUCTION LEN�ING AGENCY PpE-ALT FEE . ,'. ' .... .___ _._.. .. � IHEHEBVAFFIRMlJNOERPENALNOFPEFUURYTNA7THEREISACONSTflUCTIONLENDINGAC3ENCY FORTHEPERFORMRNCEOFIHEWORKFORWHICH7HISDERMITISISSUED(SEC309'I,CIV.C) � � � �� � �� � �� Z '_ —_—'—_'_"_' "_'_'_'_' W � LENDER'SNAME__._— __,__ r __ _ F— LENDER'SAODFES5 __'_'----'---"__-""—'---- � , . . . . , . . . . �. . . TOTAL FEES a .. . . . ,:,, . . . :"' ,. ;' ., Z ^..•'.`�,". . . • ' . " . " � COMMENTS _ � ��,r.�sr i c�. �C. � r S��— - ------ -- m PERMITTEE NAME(PRINT) '-------'— — ¢ ' � . _ — Uj SIO OF PE N s ���� RECPT.N0. PAID BY VALIDA710 � WHITE—Deparlment Capy,YELL04J�inence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApphcanYs Copy 3 y"_ . } �. . � s i $ �, 1, ....�...� ` ;� i� � ' �y `J M1 � 's , ^..,,,, • � .r'"a4� ; �.�;� � Pc,,,�`� � ► �."� . � �=- � � � �_ � � g. � . e+�"�� „��,.:M "� .