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HomeMy WebLinkAbout16823 (42) . .___—- _ ____- .._ ._.. .._ i .._ . CITY OF DIAMOND BAR —��'�`"-- DEPAR"I"MENT OF COMMUNNTIY&DEVELOPMENT SERVICES � I - 21825 E.Copley Drive - (909)860.3195 Fax(909)861•3117 PRESS '%»�..: BiTILDING PERMIT APPLICATION FIR Y ¢ ADDRIESS�(rJJO S, (1'X� �ar�P�r`� APPLICATION � PERMIT � �� P/C a — DATE NUMBER # � ISSUE TYPE OCC APN LO TRACT DATE � CONST. GROUP p OWNER ��(.'� ' P-pGr � o ADDRESS V . n"� ZONING SETBACKS Z CITY ZIP TEL„�,3y" .?•�Q� FRONT HW ❑ � APPLICANT TEL. REAR ❑ Z SIDE/SIDE STREET RW ❑ ¢ CONTRACTO ��GJeQFC SIDE ❑ ADDRESS � �g��� PROPOSED USE � CIN ZIP4'�O�'o` TEL. o ARCH/ENG/ � z DESIGNER w NO.DWEL. NO. NO. d ADDRESS = CITY_ ZIP TEL. UNITS STORIES __Z___BEDRDOMS � m DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECtARATION SFR/A��/REM O p I HEREBV AFFIRM UNDEFi P�NALTY OF PERJURY THAT 1 Al,1 EXEMPT FROM THE CONTRACTORS LI- G2f8 JEJC2fpOfl W CENSEIAWFORTHEFOLLOWWGREASON(SEC.�o31.5BUSINESSAN�PROFESSIONSCODE:ANYqTYOR (f� U CDUNTYWHICHREQUIRESAPERt�ITTDCONSTflUCT,ALTER,IMPROVE,�EMOLISH,ORREPAIRANYSTRUC- w TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNE� W Patio/Deck � STATEMENT THAT HE OR SHE I5�.ICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � � CENSE LAW(CHAPTER 9(CAMME CING WITH SECTION 7000)OF�IVISION 30�THE BUSINESS AN�PFO� POOUSp2 Q FESSIONSCODE)ORTHATHEOR�HEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGE�EXEMP� (� V TION.ANYVIOLATIONOFSECTIO 7o31.5BYANYAPPLICANTFOqAPERMITSUBJECTSTHEAPPLICANTTO Z RE-ROOf ACIVIL PENALTV OF NOT MOF�THAN FIVE HUNDRED DOLLARS(S5o0).�: � ❑I,ASOWNEROFTHEPROP�RN,ORlAYEMPLOYEESWIiHSNA6ESASTHEIRSOLECOMP'cNSATICN, � COfilfllEfC12I - Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INiEN�ED OR OFFERED FOR SALE(SEC.7044,6US6 J � NE55 AND PAOFESSIONS CDOE:THE CONTRAGTORS LICENSE LAW DOES NDT APPLV TO AN OWNER OF � PFOPEHT'WHO BUILDS OR IMPROVES THEREON,AND WHO�OES SUCH WORK HIMSELF OR HERSELF OR wTHROUGHHISORHEflOWNEMPL�0YEE5,PROVIDEDTHA7SUCHIMPFOVEMEN7SARENOTM7EN�E�oR m � OFFEREDFOFISALE.IF,HOWEVERJTHE9UILDMGORIMPROVEMENTIS50LOWITHINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE�I�NOT BUILD OR � IMPROVE FOR THE PURPOSE OF�ALE). W ❑I,ASOWNEROFTHEPROPEq'TY,AMEXCLUSIVELYCONTRAC7INGWITHLICENSEDCONTRqCTOFS � TO CONSiRUCT THE�PROJECT(S�C.7044,BUS!NESSAN�PROFESSIONS CODE:THE CONTRACTORS LI� VBIUdtI0f1 ADJ.AREA W CENSELAWDOESNOTAPPLYTO NOWNEROFAPROPERTYWH08UIL�SORIMPROVESTHEREON,ANO � WHOCONTRACiSFORSUCHPROJECTSWITHACOMRACTORIS)LIC'eNSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE � Y TORS LICENSE LAWJ. � � ❑I AM EXEMPT UNDER SEC., B.8 P.C.FOR THIS REASON Q � .��. U Z �ATE_ � OWNER U OG O � LICEN,�ED CONTRACTORS DECLARATION W �l� Q �v � I HEREBYAFFIRM UNDER PENA�T OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF ChIAPTER � � 9(COMMENCINGWI7HSECTION7�o�)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z � QG OO 1X MY LICENSE IS IN FULL FOflC N EFFECT. m a LICENSE S �� LIC.NO. ��� � V DATE � CONTRACTOR G� � d W � WORKERS'COMPENSAT�ON DECLARATION Q � I HEREBY AFFIRM UNDER PENALTy OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z Z _IHA�/EANDWILLMAINTAI ACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' ¢ 2 ¢ COMPENSATION,AS PRO�IDED BV SECTION 370o OF THE LABOR CODE,FOR TME PERFORMANCE U Q OFTHEWORKFOR�WHICMTHISPEflMITI5ISSUEO. � . QW �HAVE AND WILL MAINTAI�'�I WOFKEPS'WMPENSpTION INSURANCE,AS REQUIflED BY SECTION 37000FiHELABORCODE,FOFTHEPERFOFMANCEOFTHEW KFORWHICHTHISPEflMIT15 ���� ISSUED.hiY WOflKEAs'C� PEN iION INSUFANCE CARRIE ND POLICY NUMBERAFiE'. CONSTRUCTION � caqaiEa_.. S � PLANREVIEW Z POLICYNUMBER �. L.� ELECTRIC 4 � � (1HISSEGTKKJNEmNOTBELOMFLEfEDOFhiEPERMITISPJRIXVEHUNDFEDOOLLARS(StOCJORLE55). PLUMBING Z ICERTIFYTHATINTHEPERFORMANCEOFTHEWORKFORWHICH7HISPERMITISISSUED,1 MECHANICAL C� SHALL NOT EMPLOY ANY PERSON IN ANV 6AANNER SO AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSATIdNLAWSOFCAUFORNIA,A OAGREETHATIFISHOULOBECOME WSPECTIONFEE � SLIBJECT OTHE RKEE15'COMPENSATIONPROV IONSOF CTION37000 HELABO � C I RTH THGOMPLYWITHTHOS OVISIO ISSUANCE e�'"" 0 p DATE: � AbPLICANT. SMIP - ...,�,._.,m.,,. _ � ENERGYP/C ..i�:-�?-�`�.ti, ..� f. ._-�,,,,,;.....�- . WARNINQ AILU -TO SECUFE RKER3'COMPENSATION COVERAGE IS UNLAWFUL,AN�SHALL BE � SVBJEGTANEMPLOYERTOCRIMIJALPENALTIESANDCNILFINESU?TOONEHUNDHEDTHOUSAN� � DOLLARS(§10o,OCo),IN A��ITION O THE COST OF COMPENSATIDN,DAMAGES AS PFOVIDED FOR IN ENERGY PERMIT � J SECTION 37oe OFTHE LABOR C0 E,INTERES7.AND ATTORNEY'S FEES. � RETENTION FEE: � � � CO STRUCTION LENDINGAGENCY PRE-ALT FEE: o � � I HEREBYAFFIRM UNDER PENALT�OF PER RV THATTHEflE IS A CONSTRUCTION LEN�INCa AGENCY 1 k..`��r. � � FOR THE PEFFORMANCE OF THE O K F i IICH THIS PEflMIT IS ISSUED(SEC.3097.CIV.C.�. E.TM�,x. Z ..+..�«"�„"""°'....�'�,'..'J�"";.r __._—._—} L1J � LEN�EF'SNAME � __ I-� LENDER'SADDqESS � g� � TOTAL FEES /� W ICERTIFYTHATIHAVEREA�THISIAPPLICATIONANDSTATETHATTHEABOVElNFORMATIONISCOFiRECT. (� p'�� I AGREE TO COMFLY W1TH ALl CiTYANLI COUNTY ORDINANCES AND STATF LAWS RELATING TO BUILDING ' � / �,J�� � CDNSTRL�CTION,AhDHEREBYAUTHORIZEREPAESENTATIVESOFTHISCOUNTViOENTERU?ONTHE . Z A60VE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS - Q �'C' - r�j 7-- � --� m PERMITTEEN (PRINT) C� �� � _ Uj SIGNAT F EE ❑ E = RECPT.NO. PAID BY VALIDATION ~ WHITE—De artmentCo YELLOW—FinanceCo PINK—AssessorCo GOLDENRO FiieCo GREEN—A IicanYs o P PY, PY, PY� PY. PP PY .. .. . �.. , ;., ,.... ,...,, ,,.. . . �, ��,� ,�,-�� � _ _ ` y � � ` ' ;�: ;� � = w �� !`� .'` .�� , E`w '�. �� � n 4ans* 4 �^^ 'z t � ��. "��.:. a F �.s �.�s' r'.� x d"+ d�� x o- .�.x a �,�,, a t y 4 r , � P ' ¥ �'a"",� � a r"� 'i��� �„ � � a �C . P � ��. � ti� ,a r ,.� ?: r 9 � ¢ :. � � , y � i �a�'# '«x '�� a - r °�a " s�^p ��' ¥ <�:,.� € ;� 't, �'� �ve �g r � '.§ � � q� g .. �; � 4 �' e � a 1��5 ���:� �'}A.. �re�.......w..-..�..," .9� . _ d « ��,'r ..:� s 5�. :t. '.&,,:'�:�a �;x w"�,���. 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