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HomeMy WebLinkAbout17247 „�,..� �..--�.._,._,..�.. ...n_ __._.�.. . .._..._..,� �..e.,.. ,,,.,_ e... s' '� ' _!� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&c DEVELOPMENT SERVICES ,wa 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS �”, . BUII.DING P�ERMTT APPL�CATION '.. FIRMLY . , _. } JOBSITE ���r /!��G�G'�� �! APPLICATION PERMIT • P/C o ADDRESS l0 �� ��� DATE_1� I� �� NUMBER�Z # $ ISSUE TYPE OCC APN LOT • TRACT DATE CONST. GROUP p OWNER � I p ADD S ZONING SETBACKS Z CITY Y ZiP �_�TEL. ( RE�ART RW 0 g APPLICANT TEL. SIOE/SIQE STREET RW ❑ � CONTRACTO 0 � S SIDE ❑ ADDFt L� � CITY ZIP TEL PROPOSED USE ��l��L1L S�/ %�i�'c..� � ARCH/ENG/ ��,, DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS = CITY ZIP TEL. � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM � Q I HEREBV AFFIRM UN�ER PENALTY OF PERJURV THAT I MI EXEMPT FROA1 THE CONTRACTORS LI- G3f8JB/C8fp01'I W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITVOfl (f� COUMVWHICHRE9UIflESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOUSH,ORREPA�RANYSTAUG W pati0/OBCk w TURE,PRpR TO ITS�SSUANCE,AL50 REQUIRES THE APPLICM7T FOR Sllpi PERMIT TO FILE A SIGNEO W � STATEMENT TiAT ME OR SHE IS UCENSED PUflSUANT TO THE PROVISIIXJS OF THE CONTRACTORS LI� CENSE UW(CHAPTEFI9(COMMENCINO NATH SECTION 7W0)OF DIYISION 3 OF THE BUSINESS AND PRO- LL" POoVSpB FESSIONSCADEJORTHATHEORSHEISEXEMPTTHEREFRqMANOTHEBA5ISFORTHEALLEGEDE%EMP- (� TION.ANYVIOUTIONOFSECTION7031.6BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z RB-ROOf � ACMLPENM.TY OF NOT MOHE THAN FME HUNORED�OLURS(l5ao).): � ❑I,ASOWNEqOFTHEPROPERN,ORMVEMPLOYEESWITHWAGESASTHEIRSOIECAMPENSATION, � CORIRIBICIHI � WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEND6b OR OFFERE�FOR SALE(SEC.70l1,BUSF J � NESS MID PROFESSIONS CODE:7NE CONTRACTORS UCENSE UW DOES NOT APPLV 70 AN OWNEfi OF � PROPERTY YYFIO BU%.DS OR IMPROVES hiEREON.AND WHO�OES SUCH WORK HIMSELF OR HERSELF OR � THROUl3HHISORHEHOWNEMPLOYEES,PROVIDEDTMATSUCHIMPROVEMENTSARENOTINTENDEOOR m QOFFEREDFORSALEIi,HOWEYER,THEBUILDINGORIMPROYEMEMISSOLOWITHINONEYEAROFCOMPIE Z TqN,THE OWNER$UILOER WILL NAVE THE BUfl�EN OF PROVING THAT HE OR SNE�IO NOT BUILD Ofl = IMPfpYEFORTHEPURPOSEOFSALE). �y,� ❑I,AS OVMEH OF THE PROPERTV,AM E%CLUSIVELY CANTFlACTING WITH UCENSEO CANTRACTORS � TO CONSTRUCT THE PROJECT(SEC.7044,BUS�NESS AND PROFESSIONS CODE:THE CONTRACTORS L4 ValuOtion ADJ.AREA W CENSELAWDOESNOTAPPLYTOANONMEROFAPROPERTYWH08UILOSORIMPROVESTNEHEON,ANO — � VAIOOpNTRACTSFORSl1CHPR0.IECTSWITHACONTRACTOR(SjLICENSEDPUqSUANTTOTHECQNTRAG QUANTITY DESCRIPTION FEE � TORSUCENSEUW.). ❑1 AM EXEMPTUNDER SEC. B.8 P.C.FOR THIS REASON Q U � � OATE OWNER U Z W Q LICENSED GONTRACTORS DECLARATION W � 1 HEREBV AFFIRAI UNDEP PENALTY OF PEPJURV THAT I AM LICENSED UN�ER PROVISIONS OF CHAPTER � p. 9(COMMENCINGWITHSECT10N7oo0)OiDIVI5lON30FTHE8U51NE5SAN�PFOF'e5S10 OE,AND Z X MV LICENSE IS 7N FU FORCEAND E FECT. m y/ / � R � (! `� LICENSE C'L�AS`�, � LIC.NO.� V�� ,_ � , V DATE�LL��–, O� COMqACTOR d W T- � WORKERS'COMPENSATiON DECLARATI ¢ � I HEHEBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOILOWING DECURATIONS: Z � _IHAVEANOWILLMAMTAINACEFiTIFICATEOFCONSENTTOSELF-INSUqEFORWORKEFS' _ COMPENSA110N.ASPROVIDEDBYSEC710N370oOFTHEIABORCO�E.FORTHEPERFORMANCE W O OF THE WORK FOR WHICH THIS PERMIT�S ISSl1ED. � W I HAVEANO WILLMAIMAIN WORNERS'COMPENSATION INSUfiANCE.AS REal11RED BY SECTIDN Q 370o OF THE LABOR COAE,FQR THE PERFORMPNCE OFTHE WORK F R WHICH THIS PERMI715 ISSUED.MY WOR 5A MPENS UjriANCE IERAND ICY NUMBERARE: CONSTRUCTION � W��VIQ� t PJ U• PLAN REVIEW ] CAHRIER ^ Z POLICV NUMBER_ �7 + ELECTflIC Q Q � (IHIS3ECTqNNE�NOTBECAAPLEfEbOFT-IEPEL�qTSFORONEHUI�DREDDOILUlS�5100)ORLESS} PLUMBING Z I CEHTIFY THAT IN THE PERFORMANCE OFTHE WORK FOR WHICH T 5 P RM IS ISSUED,I MECHANICAL C.� SHAL�NOTEMPLOVANYPERSONINANYMANNF.RSOASTOBECO S JE TOTHE �� t+" � WORKEkS'COMPENSATION V WS OF CALIFORNIA.AND AGREE T I SN LD BECOME INSPECTION F E-. - . SU&IECT TOTHE WORKERS'COMPENSATION PROVISIONS OF S I 37 Of THE LABOR �� "] / \ "� � �`"�� OCO�E, HA FO WITHCAMPLYWIIHTHOSEPROVISIO . ISSUANCE �P •.,. � i f_w p DATE: �D `� �� qppLICANT. SMIP J WARNING:FAILURE TO SECURE WORKEflS'COMPENSATION COVERA WFUL,AND SHALL BE ENERGY P/C �y SLIBJECTANEMPLOYERTOCRIMINALPENALTIESANDqVILFMESl1P EHUNORE�THOUSAN� ENERGYPERM OOLLARS(5100,000),IN ADDITION TO THE COST OF CAMPENSATION,OAMAGES AS PftOV10E0 FOR IN J SECTbN37a80FTHELABORCODE,INTEREST,ANDATTORNEY'SFEES. RETENTIONFE ?���. ��— � 3. �A w_�_..� • ow., CONSTRUCTION LENDING AGENCY PRE-ALT FEE: " ""��""����� ::�:-�-�"' �""" O � I HERE9Y AFFIRM UNOER PENALTV OF PEflJURV THAT THERE IS ACONSTRUCTION IENDING AGENCY FOR THE PERFORMANCE OF THE WOPK FOP W HICH THIS PEFMIT IS ISSUED(SEC.30 W.CN.C.). . . Z W � LENDER'SNAME_ H LENDEF'SIIDORESS � / �� W ICERTIFViHATIHAVEREADTHISAPPLICATKNJANOS7ATE7HATTHEABOVEINFORMATIONISCOHRECL TOTAL FEES (� T d I AGREE TO CAMPLY W1TH ALL CITV AND COUNTY OROINANCES AND STATE IAWS RELATING TO BUILDING .. � CONSTRUCTIDN,AN�HEREBY AUTHORIZE REPRESENTATIVES OFTNIS COUNTV TO ENTEfl UPON THE Z ABOVE-MENTIONmPpOGERTVFORINSPECTION�UR Es. COMMENTS � o S� �'�6 � m PEFMITTEE NAME(PRINT� 7� v¢i U f 6� � � SIGNATUREOFPERMITTEE DAT = RECPT.NO. 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