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HomeMy WebLinkAbout10537 (5) - - CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT .,,.� . 21660E.CopleyDriveSuite190 PRESS (909)860-3195 Fax(909)861-3117 "�%�'� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE � ;..� APPLICATION� �l �"s� PERMIT ''�!C Q ADDRESS -�-G � �/��/V �� DATE / , r NUMBER���� �# ! $ T ISSUE TYPE OCC ; APN LOT TRACT DATE CONST. GROUP g OWNER 7�olVE��f LZ/�s /-'Z�CiI,� � o ADDRESS. ��.a� l-«(,(�sTT /� ZONING FRONT KS RW ❑ � z CITY Tli�3awa��� i�/.4/t ZIP 4'/:7�5(�'iEL.�t�5��',�E+•_�-�3 I APPLICANT fa.rz.,.n is�-�>:i'�n L. Cto 4��[,._3zi. REAR ❑ � g �-- °Ji� r—�rz- SIDE/SIDE STREET RW ❑ E m CONTRACTOR SIDE I 7_ f O ADDRESS PROPOSED USE �/.•� � Z �` `��� ���`� ! CITY ZIP TEL. g � ARCH/ENG/ �1 (?--;1��,•� z DESIGNER �'��'�% �`SSoC-�A'�x .y � � W ADDRESS "�i� i+�;� ,` '�S: .i � NO.OWEL. NO. NO. o- � '�j 2� �r� ' `�� UNITS STORIES BEDROOMS � � CITY L�� .d1�dx'LX�ZIP�. TE�x���36.("--Y�ra � � DESCRIPTION SQ.FT FACTOR PSF ADJ.AREANALUATION � OWNER-BL'IL�ER DECLARATION SFR/ADD/REM O p I HEREBV AFFIp1A UNDEN PENALN OF PERIURV THAT I AM EXEMPT FROA1 T!{E CONTRACTORS LI� G8�896/Ceryali � W CEN9EUWFORTHEFO�LOWINCREASON(SEC.�o31.5BU51NES6AN�PROFESSIONSCODE:PNYCITVOR (A � U COUNTYWHICHREDUIqESAPEHMITTOCONSTflUCT,ALTER.IMPROVE,OEMOL15M,ORREPAIRANY5TRl1G w patio/Deck . TUHE,PRIOR TO ITS I5SUANCE.ALSO REQUIRES THE APPLICANT FOH SUCH PERMIT TO FILE A SIGNED � � STATEMENT THAY HE OR SHE IS LICENSED PURSUANT TO TNE PROVISIONS OF THE CONTRACTORS LI- GENSE lAW(CHAPTER B�GOMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PRO- � PooUSpa +� � FESSIONSCODEJOH7HA7HEORSHEISEXEMPT7HEREFAOMANDTHEBASISFOHTHEALLE6EDEXEMP- (3 _;� � TI�l.ANYVIOLAibNOFSECTION7037.58VANVAPPUCANTFORAGERIAITSUBJECTSTHEAPPIICANTTO Z pe-poaf A qVIL PENALTY OF NOT�.WRE 7HrW FIVE HUN�RED DOLLARS(SSODj.): ; � L11,ASOWNEHOFTNEPROPERTY.ORMVEMP�OVEESWITMWAGE5ASTNEIRSOLECOMPENSA7IDN, 0 CommefCi21 Y Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDE�OR OFFERED FOR SALE(SEC.7oaa,BUSI- J � NESS AND PflOFE5510N5 UJDE:THE CANTRAGTORS I.ICENSE LAW DOES NOT APPLY TO AN OWNER OF ,� � OFODERTVNMOBl11LOSOFiIMPROVESTHEREON.ANONhiODOESSUCHWORKHIMSELFORHEHSELFOH � I � THflWGHHISORHEROWNEMPLOYEES,VFiOVI�E�THATSUCHIMPROYEA�ENTSARENOTINTENOEDOR m p W pFFERE0FOfl5PLE.IF,HOWEVEfl.T11EBUILDINROflIMPROVEMENTIS50LDWITHINONEVEAqOFCOMPLE- � TICM'.7HE OWNER�9UILDER WILL HAYE THE 6UP.OEN OF PROVING THAT NE OR SHE DI�NOi BUII.D OR z IMPROVEFOHTHEPURPOSEOFSN.E). 3 =�J f71,RSOVdtJEROFTHEPROPER7Y,AME%CLUSIVELYCONTRACTINGWITHLICENSEDCONTMCTORS j ('t� TO CONSTRUCT THE VR0.1EC7(SEC.7014,BUSINE55 AND PROFESSIONS CODE:7HE CONTMC70R5 LI- V81U0�1Of1 ADJ.AREA W CENSELAWDOESNOTAPVLYTOANOWNEROFAPROPERNWHDBUILOSORIMPROYESTHEREON.AND � _' Y/FIOCONTMCTSFOHSUCHPRQIECTSWITHACONTHACTOR�S�LICENSEDPUfiSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE � ~ TORSLICENSELAW.). � ¢ __—_— O ❑i AM EXEMPT 11NDER SEC. _B.&P.G FOR THIS REASON � � OATE � °7s! OWNER, �y '��' 3 ,__ � c � Q LICENSED CONTRAC t�{iS DECLARATION t. i �.— I � i HEREBY AFFIflM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNOER PHOVISIONS OFCHAPTEfl j d 9(COMMENCING WI7H SEC710N 7000)OF DIVISION 30F THE B1151NE55 ANO PROFESSIONS CO�E,PND z � � X. MYLICENSE IS IN FULL FOflCEAND EFFECT. m ��„ t1J � � � LICENSE ClASS __LIC.NO._ ._ J # W DATE_ ._ CONTRACTOR_ �- � r � WORKERS'COMPENSATION DECLARATION -� j �. j � I HEREBY AFFIflM UN[]F.R 7ENALTY OF PERIURY IXJE OP THE FOLLOWING DECIAfiATIDNS: � .� Z _IHPVEANOWILLMAWTAINACEflTIFICATEOFCONSENTTOSEIF-INSIIREFOFWORKEPS' a COAAPENSATION,ASPROVI�EDBYSECTION37000F7HELAflONCWE,FORTMEPERFOPMANCE € OF THE WORK FOH WHICH THIS PERMIT I5 155UE0. � i w _INAVEANDWILLMAINTAINWOAKERS'COMPENSATIONIN5URANCE,ASREOUIRED9YSECTION ;A O 37000F THE LABOH CADE,FOFl THE PERFORMANCE OF THE WORK FOfl WHICH THIS PERMITIS -- S� ISSUED.A1Y WORKEflS'COMPENSATION INSl1NANCE CARHIER AND POLICY NUMBER ARE: CONSTRUCTION � ----- �— PLAN REVIEW --- r` ' �v,:,-.,,�,:: CARHIER �------- z� OOLICV Nl1MBER___ ELECTRIC r�+ , ����x, � a �1 / � (IHISSEGTqNNE�NOTBECOMPLEfIDOFTHEFEHfMTLSfORONEMR�OREDDOl1ARS(51001��`} PLUMBIN Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOH WHICH THIS PERMIT IS ISSUE�,I MECHANICAL ._ � � `� "�4��F ()' SHAI.I.NOTEMPLOYANYPER50NINANYIAANNERSOAST06ECOMESUBJECTTOTNE �.i�.'+, ��� � Uj WORKERS'COMPENSATIONLAWSOFCALIFOFNIA,MlDAGflEETHATIFISHDULDBECOME INSPECTIONFEE _ ? SU&IECTTOTHEWORKEflS'fAMPENSATIONPROVI5lON50F5EGTI0Y3i0oOFTHELABOfl � ---- N++' CO�E,1 SHALL FORTHWITH COMPLV W I7H THOSE PROVISIONS. SSUAN ��' � 0 -- --- SMIP .-- -- p DATE:_ APPLICANT: _ W ENERGY P/C J' WARNING:FAILURE 70 SECl1RE WORNERS'COMPENSATION COVERA6E IS UNLAWFl1L,AND SHAL�9E � �� SU&IECTANEMPLOYEHTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDHED7HOUSAND ENERGYPERMIT _ DOLLAHS(5100.W0).IN ADDITION TO THE GOST OF WMPENSATION,�AMAGES AS PROVIDED FOFl IN i �� SECTION31a80FTHELA80RCADE,INTEREST,AN�ATTORNEV5FEE5. RETENTIONFEE: { W' CONSTRUCTION LENDING AGENCY a,, PRE-ALT FEE: � IHEPEBYAFFIRMIIN�ERDENALNOFPERJURYTHATTHEREISACANSTflUCTIONLEN0INGAGENCY FOHTHE PERFORMANCF OF THE WORK FOR WHICH THIS PERAAITIS ISSUED(SEC.3097.CIY.CJ. Z W, �� IENUEH'SNAME F–� LENDER'SA��RESS W10EHTIFVTHATIHAVEHEADTHISAPPUCATIONPN�ST�TETMATTHEABOVEINFORMNTIONISCOFflECT. TOTALFEES �/�• �� ��. I A6HEE 70 COAIPLV WITH ALL CIN AN�COUN7V OROINANCES AN�S7ATE U1WS RELATING TO BUILDING CONSiRUCTION,AND HEREBY AUTHORIZE flEPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z�, A60VE-MENTIONED PROPERTY FOfl INSPECTION PURPOSES. COMMENTS 0 � �, ' :.c t✓ a�aJ - m PERAIITTEE 1AME(PRINT) � N , �_. � �l�.�l� - - � � � sioN O PERIAI E ^ DA7E RECPT.NO. J PAID BV VALIDA 2 � ~ WHITE—Depanment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENHOD--Fila Capy,OHEEN—AppllcanYs Copy �._.,�....� �_�__ _ ..._ .r___. - �-- �- . ...I _ m�i I � �9:���. �; 'rv��n �i�tr, ;Cn U, a c? ���t Vi�:A7 i 27�3H-75��n � ��-1 G����m �i t° �. , z �iz z�"s m m; a� ��o�a'oI � n � i m�al i ( C? R�y, ��y.i;s,lm -v'� y-� r,l ��O�c e cl0`� o -t �ImI� � �`.'� '� +Ii � � � �+���'yi�`ID � � � D �;�����IL7 CT7f�I9]�'S_ TI m� � ,� � � ��� T!�7`' I -T' rn ��zy;- � �,x. ' � ?' iI t � � z�. 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