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HomeMy WebLinkAbout10156 _ ,.� ,�-, t' GiTY OF DIAMOND BAR � COMMUNITY DEVELOPMENT DEPARTMENT .:,sC 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 �''"' BUILDTNGPERMITAPPLICATION FIRMLY oy JOBSITE �^7 �'Z �� DATECATIQN PERMIT P/C ADDRESS y��S I �RNJ�ICJ�' 'S " Z"�7 NUMBER �_� # � APN LOT 1�� TRACT �� ��� DATE ONST. GROUP p. OWNER �1�/" H�t�C.. � cJ�i�--.��tc:1 t�� ADDRESS ���j r 5 1 f.� 1J Z ` ZONING SEfBACKS o� t c' b FRONT RW ❑ CITY ��Ul����T' ZIP TEL. �ZG�' REAR ❑ p APPLICASJT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE ❑ o CDDRESS Z�p � TE� � pROPOSED USE � ��"� W ARCWENG/ �z DESIGNER ND.DWEL NO. NO. a ADDRESS ' UNITS STORIES BEDROOMS � CITY ZIP TEL. y DESCRIPTIDN SQ.Ff: FACTOR PSF ADJ.AREANAUlATION � p� OWNER•BCILDER DECLARATION SFR/ADD/REM O Q 1 HEREBY AFG�HM UN�ER PENALTV OF PEflJUNY 1HAT 1 AM EXEMPT FROM THE CONTMCiORS LI�; G8fSQ8ICd�OR W CEN9EUWFPRTHEFOLLOWINGflEA54N(SEC.7o31,68U3ME35ANOPROFESSION5CO0E:ANYCITYOA ;(n Z. COUNiYNRIICHREWIRE6APERMIT7000NSTqUCT,ALTEqIMPpOVE,DEAfOUSN,ORREPAIRANYSTBUG' .W p8tf0lD0Ck - � W TUqE,PRIOR TO ITS ISSUANCE,AL50 REW IRES THE APPLICANT FOR SUCH PEfiM1T TO FlLE A SIONED ?W �-, &TATEMENT THAT HE,OR SNE IS LICENSED PURSUANT 7o THE PROVIsiONS OF TNE coNTRA�TOpS U- FE$SI�O SWCODE)qA THAT�HE�OR 5HE IB EXEMPT H REFRdA AND TH 8ASI5 FOR TNEALLE6�EM �� �'bOVSpa V TI�I.ANVVKKAibNOFSECTION7037.38YANVAPPLICMRFORqPERMITS1�iECTS7HEMPUGWiTO _:'Z- R8-ROOf � A CNIL PENAL7V OF NOT MOFE 7NAN FNE MINOREO DOLlARS(55o0)J: - . ❑I,ASOWNEHOFTHEPROPER7Y,ORMYEMPLOYEESWITHWAOESASTHEIRSOLEc�MPENSATION, ��,� C01TImBfCie1 � Z: WILL DO THE WORK.AND 7HE SiRUCTURE IS NOT INTENDEO OR OFfEHED FOR SN.E(SEC.7o4d,BU84 �_,I NESS AND PROFESSION5 CODE:THE CONTMCTORS LICENSE LAw OOES NOi APPLY To AN OWNER oF - - � PROPEqTYWFiOBUILD50qIMPROVESTMEHEON,ANDWHO00ES5UqiMlORKM�MSELFORHERSELFOR � � THROUGN.HISORHEHOWNEMOLOYEE9.PROVIDEDTHATSUCHIMVROVEMENiSMENOTINTEN�EDOR . m � �� OFfEREOFORSALEIF,FpWEVEq,THEBUILDINGOAIMPROVEMENTISSOLDWITN�NONEYEAROFGOMPLE� � TqN,7HE OWNER-WILDER WILL.HAVE THE BURDEN OF PqOVINO 7HA7 NE OR SHE�io NOT BUILD oN � IMPROVEFORTHEPURPOSEOFSALE�. _ ❑I,AS OWNEROF THE PROPERTI:AM EXCLUSIVELYCANTMCTM�WRN LICENSED CONTRACTORS a� 70 CON37HUCT iHE PqQ1EC7(SEG.7od4.BUSME&S AND PflOFES8IQYS CODE:THE CONiMCTORS LI� V21U3tiOt1 ADJ.AREA W CENSEUWOOESNDTAPPLYTOANOWNEROFppROPERiYWHOBUILD50RIMPHOVESTHEREON,AND �. �_ WHOCONTRACTSFORSUCHPtiQ1ECTSWiiMACONTRAC70R(S)tICENSEOPUflSUANTTOiHECONTMG QUANTITY DESCRIPTION FEE �- TORSLICENSELAW.). �J �' ❑IAMEXEMPTUNDERSEC. B.BP.QWRTHISREASON �- Q � U ¢ �- onre �- �— i I owriea V �Q LICENSED CONTRACTOHS DECLARATION W CC INEREBVAFFIRMUNDERPENAITI'OfPENURY7HA71AMLICENSEDUNDERPROVISKKJSOFCHAPTEp ��; - � (y,. 9(COMMENCINGWITNSECTION700o)OFDIVISION30FTHEBUSMES5AN�PROFESSIONSCO�E,ANO z X MY UCENSE IS M FULI FORCE AN�FFFEC7. � � LLI � � LICENSE CLASS LIC.NO. -. J V� DATE CONTflACTOR "� a W . �� WORKERS'COMPENSATION DEGLARATfON �- Q . � IHEREBYAfFiRMUNpERPENALTYOfPERIUfiYONEOFTHEFOLLOWINGDECLAMTIONS � C� Q � �_IHAVEANDWILI.MAINTqINACERTIFICATEOFCONSEMTOSELF•INSUREFORWOFKERS' S .� COMPENSATIIXJ,ASPROVWEDBYSECTION37000FTHELABORCOOE,FOfliHEPENFORMMGE W . OF THE WOpK FOR WHICH THIS PERNIT IS ISSUED. � O W' �IHAVEANDWILLMA�HTAINWORKERS'COMPENSATIONINSURANGE.ASREIX/1REDBYSECTION /'� Q� 37ooOFTHEU19oRmDE,FOPTHEPERFORMNNCEOFTMEKbRKWHWHICHiHISPERM1Tl9 (.vl�f'--- ISSUEO.MYWORKERS'COMPENSATIONINSURNtYCECARRIERANDPOLICYNUMBERARE: CONSTRUCTION / a J e'� j CAFRIER PLAN REVfEW � Z_ POLICVNUMBEfl . ELECTRIC Q .0 (f}A9sEcnoNNE�taiBECOMREfEDOF7HEPERA4T16Poti0NEMx�DaED00uARSR�ta�IORLESsb PLUMBING W 1 CER7IFY THAT W THE PERFORMANCE OF 7HE WDRK fOR WHICN THIS vENMIT b IS5UED,i MECHANICAL �'� - 2 (}-, SHAIINOTEMPLAYANYPER50NINANVMANNER50ASTOBECOMESUBJECT70THE � � WORKEtiS'WMPENSATIONLAWSOFCALIFORNIA.ANDA�REETHATIFISHOULDBECOME iNSPECTIONFEE � . SU&IECTTOTMEWOFNCEHS'COMPENSATIONPqOVI510NSOFSECipN37000FTHElABOP �, OODE,1 SHAIL fORTHWITH COMPLY N7TH THOSE PROVISIONS. ISSUANCE � SMIP � /�� p. �A E: . APPLICANT: F� �� �`�--_ W ENERGY P!C J, WARNINQ:FAIIUflETOSECUREW�DRKERS'COMPENSATKINCAVERAGEISUNUWFUL,ANDSNAlLBE WD �� SUBJECTANEMPLAYEHTOCNIMINALPENAL7IESANOCIYILFINESUPTOONEMUNf7REbTF10USANp ENERGYPERMIT . OptLARS(5��.�).IN FD�ITION TO THE C0.ST OF COMPENSATION.DAMAOES I1S PROYIDEO fOR IN �� -SECTION370aOFTHELABORCWE,INTERE9T,ANDATfOflNEN5FEE6. RETEN710NFEE: ��,� � CONS7RUCTION LENDING AGENCY PRE-ALT PEE: O ` � IHEREBYAFF�RMUNDERPENAL7YOFPEFLIUFYTHATTHEREISACONSTRUCTIONLENDINGAGENCY Z FOR THE PER WAMANCE OF THE W�RK FOR MINICH TXIS PEfiM1T IS ISSUEO(SEC.3097.GV.C.). W � LENDER'S NAME � LENDER'SRWRE35 . � �� TOTAL FEES 1 CERTIFY THAT I HAVE HEAD TFIIS APPLICATION ANO STATE THA7 THEABOVE INFOflMATION IS GORHECT. - - � . . �y IAGREETOCOMPLYWITNALLG7YANDWUMYOflDINANCESANDS7ATEUWSREU7INGTO6UIL�IN� . STHUGTION.PNDMEREBYAUTHONREREPHESENTATIVESOFTHISCWN7YTOENTEfiUPONTHE . . - � NTIONEDVROPERNFORIN&PEC7KKJPUHPOSES. COMMEN7S . � � �f� ESf� � ��� f� m PEfU11TTEE ( NT} uQi y'YI e�ze-s�-�-� ��`�� Uj SIONANREOFPERM�iTEE DATE � RECP7:N0. PAID BY VAI,IDATION � ����� WHI7E—Department Copy,YELLOW—Finance Copy.PINK—Assessa Copy,GO. 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