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HomeMy WebLinkAbout16650 (35) .. . . ---------,---- ---. -__�_-___..._.. , CITY OF DIAMOND BAR � � -�`---- DEP.�RTMENT OF COMMITrTI'TY&DEVELOPMENT SERVICES � I � �---` 21825 E.Copley Drive � � ��w (909)860-3195 Fax(909)861-3117 PRE$$ ''"%»��'� BUIL'DINGPERMITAPPLICATION FIRMLY � JOBSITE �/�� � /� w. / '�j �1 qppLICATION� �� �� PERMIT ��/C � a ADDRESS L!� • !r!!!4�'�O �fa�� l� p . ' �;r+t DATE NUMBER # � ISSUE 9 TYPE OCC APN LOT TRACT DATE � CONST. GROUP °C OWNER O o ADDRESS t' �v , ZONING SETBACKS Z CITY ZIP TEL,r'`1���•Z�� FRONT RW ❑ p APPLICANT TEL. SDE/SIDESTREET RW ❑ z Q CONTRACTOR L SIDE C o C�RESS Z�P� TE� PROPOSED USE � ARCH/ENG/ � z DESIGNER_� w NO.DWEL NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS ui DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O O�+VNER-BUILDER DECLARATION SFR/ADD/REM p I HEREBY AFFIRM UNDER P NALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACiORS LI- G2f8JB{CflfPOfl W CENSELAWFORTHEFOLLOWINO EASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITYOR (n U COUNTYWHICHREQUIRESAPEH ITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTFUC- � W TURE,PRIOR To ITS ISSUANCE, L50 RE�UIRES THE APPLICAN7 FDR SUCH PERMIT TO FILE A SIGNED w PatiO/DeCk � STATEMENT 1HAT HE OR SHE IS ICENSED PURSUANT TO iHE PROVISIqNS OF THE CONiRACTORS LI- � CENSE LAW(CHAPTER 9(COMMENCING WITN SECTION 7aoo)OF DIVISION a DF THE BUSWESS AND PRD- PO�USpa 0 ', FESSIONSCODE)DRTHA7HEOR$HEISIXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� , V TION.ANYVIOLATIONOFSECTION7o31.6BVANVAPPLICANYFORAPERMITSUBJECTSTHEAPPLICANiTO Z Re-Roof � ACNIL PENALTY OF NOT MORE THI�AN FlVE HUNDRED DOLLARS(E5oo).): � ❑�,A30WNEROFTHEPROPEHTY,ORMYEMPLOYEESWITHYJAGESASTHEIFSOLECOMPENSATION, 0 Commarcial -� WILL DO THE WORK,AND THE ST(iUCTURE IS NOi INTENOE�OR OFFEFED FOfl SALE(SEC.7044,BU51� J � � NESSAND PROFESSIONS CODE:tHE CONiRACiORS LICENSE LAW�OES NOT APPLY TO AN OWNER OF � ' PHOPERTYWHOBUILDSORIMPR�VESTHEREON,AN�WHODOESSUCHWORKHIMSELFORHERSELFOq CC ' THROUGH HIS OR HER OWN EMP YEES,PflOVIDE�THAT SUCH IMPROVEME�'TS ARE NOT INTENDEO OR m Q :'OFFEREDFORSILLE.IF,HOWEVER,THEBUILDINGOqIMPROVEMEN'ISSOLDWITHINONEVEAROFCOMPLE- z ,�TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVMG iHAT HE OR SHE DID NOT BUIL�OR IMPROVE FOq THE PUFiPOSE OF ALE). ' W ❑I,ASOWNEROFTHEPROP�ERTV,AMEXCLUSIVELYCONTRAGTINGWITHLICENSEOCONiRFCTOHS [L 'TO CONSTRUCT THE PROJECT(SEC.7044,BUSINE55 AND PROFESSIONS CODE:THE CONTRACiORS LI- VAlllatlOfl � ADJ.AREA W CENSELAWDOESNOiAPPLYTOANOWNEROFAPflOPERTYWHO6UILDSORIMPROVESTHEREON.AND � ��WHOCOMfiACTSFORSUCHPRO�ECTSWITHACONiRACTOR�SJLICENSEDPIJtiSl1ANTTO7HECOMRAC- ~ 'TORSLICENSELAW.). QUANTITY DESCRIPTION FEE - Y 0 ❑I AM E%EMPT UNDER SEC.�� B.&P.C.FOR THIS REASON Q � U W ¢ DATE OWNER E'- � Z W I � LICEN�ED CONTRACTORS DECLARATION -� ¢ W � � I HEREOYAFFlRM UNDER PENALT'''OF PERJUflV THAT I AM LICENSED UNDER PFOVISIONS OF CHAPTER � ' d 9(COMMENCING WITH SECTION 7 oD)OF DNISION 30F THE BUSINE55 AND PROFESSIONS CO�E,AND Z X MY LICENSE IS IN FULL FORCEAN�EFFECT. � LICENSE C S LIC.NO._I��// � U DATE � CONTRACTOR d W � WORK�AS'COMPENSATION DECLARATION a � � ' IHEREOYAFFIRMl1NDERPENALT�/OFPERJURVONEOFTHEFOLLOWING�ECLARATIONS: z 0 _IHAVEpN�WILLMAINTAI AGERTIFICATEOFCONSENTTOSELF-INSUREFORWOHKERS' a ¢ CAMPENSAiION,AS PRO�IDED BY SECTION 37o00F THE LABOR CODE,FOR THE PERFORMANCE U Q OF iHE WOfiK FOR WHICH THIS PEPMIT IS ISSUE�. � Qw IHAVEAN�WILIMAINTAI WORKERS'CAMPENSA710NINSUFANCE,ASRE�UIREDBYSECTION '� 37ao oF THE LABOR COD�„FORTHE PERFORMANCE O,7./�'HE WORK FOR WHICH THIS P'cRMIT 15 � ISSUED.MYWORKEAS' OMP SATIONJj�,aURANCEC�IRIERAN�POiJCYNLIMBEFARE CONSTRUCTION � �� ' ¢ CARRIER !%r/U' > PLAN REVIEW Z POLICVNUMBER ELECTRIC Q '�'j i ( (iHISSECiIONNEmNOTBEO�MPLEfEDOFhI_PERMtTISFJ1iONEHI.NDPEDDOLLARS�$70�ORLESS). PLUMBING ��� I I I ,_ _,..iJ� W � ___� Z ICEF7TIFVTHATINTHEPE�iFORMANCEOFTHEWORKFORWHiCHTHISPERMITI51S51/ED,I MECHANICAL � (3 SHAIL NOT EMPIOY ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE � !i �f Vj WORKERS'COMPESATIf,NLAW50FGALIFORNI ,ANDAGR=ETNATIFISHOULOBECOME INSPECTIONFEE ___:,�U� �d ` Le SUBJECTTOTHE ORKE�iS'COMPENSATIONP VI510 SOFSECTION3700 HELAB � = CODE,I RTHWIT�iCON.iPLYWITHTH PR IONS. ISSUANCE ___ F � /� L v SMIP sy M p DATE: V AI+PLICANT: J WARNING FAILURE TO SECVflE WOflK�RS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � _____ -- --'-'"— � � LL, SUBJECTANEMPLOYERTOCRIMI ALPENALTIESANDCIVILFINESU?TOONE'r1UNOREDTHOUSAND ENERGYPERMIT DOLLARS(5700,DC0),IN AD�ITION�O THE COST OF COMPENSATI�N,DAMAGES AS PPOV@E�FOR IN � SECTION3�o80FTHELABORCODE,INTEREST,ANDATTOflNEY'SFEES. RETENTIONFEE: OCO�JSTFtUCTION LENDINGAGENCY PRE-ALT FEE: � I HER=6V AFFIRM UNDER PENALT}'OF PERJl1RV THATTHERE IS A CONSTRUCTION LENDING AGENCY ' FOR THE PEFFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.308],CIV.C.J. Z W � / ' � LEN�ER'S NAME ��� I // F— LENDEF7'SADDRE55 � � ICERTIFYTNATIHAVEREA�THISI�,APPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECi TOTALFEES �� �" W IAGRcETOCOMPLYWITHALLCI'Ti1'AND'COUNTVORDINANCESANDSTATELAWSRELATINGTOOUILDING � CDNSTRUCTION,ANDHEREBYAUTHOR�ZEREPRESEMATIVESOFTHISCOUNTYiOENTERUPON7HE ZABOVE-MENTIONEDPROPERTYFORINSPECTIONPUqPO5E5. o � COMMENTS � _ --- m PERMITT NH P INT �� Q /� cn / v -� � 51 ATUREOF RMI EE ' �A i� _ � RECPT.NO. 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