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HomeMy WebLinkAbout16659 (35) . . .. _ ' __-._-___.__. . _ . ___L..__ __- _- _ —_. _ . . _ �,�_ CITI'OF I)IAMOND BAR j�� --- � � DEPAR'TMENT OF COMIv1UNPI'Y&DEVELOPMENT SERVICES �,�'r 21825 E.Copley Drive (909)860-3195 Fax(909}861-3I17 PRESS ""��»i' ' BUILDING PERMIT APPLICATION FIRM Y r } JOBSITE / �J APPLICATION i PERMIT 6� P!C o AODRESS � O �• �" �"'� �� �, � ��� DATE NUMBER # T° APN LO TRACT �SSUE � TYPE OCC DATE � � CONST. GROUP p OWNE� 4�� p ADDRE S r �1'� �(1 • ZONING SETBACKS Z CITY ZIP TEL�Nr=.Z�G� FRONT RW ❑ p APPLICANT TEL.� � S DE/SIDE STREET. RW ❑ ¢Z SIDE ❑ CONTRRCT Q ADDRESS ✓JYn � CITY • ZIP TEL. �� PROPOSED USE 0 w ARCH/ENG/ �� ���v ""- z DESIGNER W � NO.DWEL. NO. � NO. � ADdRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS c�_n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLAAATION SFR(ADD/REM O p I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- G8f2.JB/CBfpOfl W CENSELAWFOR7HEFOLLOWINGbEASON(SEC.�o31.5BUSMESSAN�PROFESSIONSCODE:ANYqTYOF (n U COUNNWHICHFE�UIflESAPEFt�ITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIftANYSiRUC- W patio/Deck w TUP,E,PflIOR TO fT5 ISSUANCE,AL50 REQUIRES THE APPLICAN7 FOR Sl1CH PERMITTO FILEASICaNED W �� STATEMENT THAT HE OR SHE IS LICENSED PURSUAM TO 7HE PROVISIONS OP THE CONTRACTORS LI- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BL151NESS AND PRO- POOVS[Jd � FESSIONSCODE)OflTHATHEOR$HEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� - V TION.ANVVIOLA710NOFSECTION,7o37.56VANVAPPLICANTFORAPERMITSUBJEC76THEAPP'��_ICANTTO Z Re-Raof ACIVIL PENALTY OF NOT MORE iFYAN FlVE HUNOFiED DOLLARS($500).): Z~ ❑I,ASOWNEROFTHEPHOPERN,OflMYEMPLAYEE54YITHYVAGE5A5?HElRSOLECOMPENSATIqV, , WILL DO THE WORK,ANO THE STpUCiWFE IS NOi INiEN�E�OR OFFERED FOR SALE(SEC.7044,8U51- � COfPIfYlelCle� -- � NESS AND PROFESSIONS CODE:"{HE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNEFi OF � PROPERTY WHO BUILDS OR IMPRQVES THEREON.AN�WHO DOES SUCH WORH HIMSELF OR HERSELF OR CC THqOt1GH HIS OR HER OWN EMPI�DVEE$,PflOVI�ED THATSUCH IMPFiOVEMENTS ARE NOT INTEN�ED OR m QOFFEREDFORSALE.IF,HOWEVER,i7HEB,UIL01NGOftIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z , TION,THE OWNEF-6UIL�ER WIIL'HAVE THE BUflDEN OF PROVING iHAT HE OR SNE DID NOT BUIL�OR � ' IMPROVE FOR THE PURP03E OF 3ALE). W ❑I,ASOWNEROFTHEPROFlERTY,AMEXCWSIVELYCOMRqCTiNGWITHLICENSE�CONTRACTORS � , TO CONSTRUCT THE PROJECT(S�C.7049,6USINE55 AND PROFESSIONS CODE�.THE COMRACTORS LI- VBIllfftl011 ADJ.AREA LCI CENSELAWDOESNOiAPPLYTOANOYyNEflOFAPflOPERTYWHOBUILDSORIMPROVESTHEREON.AND � WHOCOMRACTSFOp5UCHPRO.�ECTSWIiHACONTHACTOR�S)LICENSE�PURSUANTTO7HECONTRAG QUANTITY DESCRIPTION FEE � Y ' TORSLICENSELAW.). �� ❑I AM EXEMPT UNDEfl SEC.�� 8.&P.C.FOR THIS FEASON Q U � � �ATE OWNER U O 0 W � LICEN$ED CONTRACTORS DECLARATION � W ¢ � IHEREBYAFFlRMUNDERPENALTYOFPERJURYTHATIAML!CENSEDUNDEPPROVISIONSOFCHAPTER � � 9(COMMENCINGWITHSECTION7poDjOFDIVI510N30FTHEBU51NES5ANDPROFE5510N5CODE,AN� Z ! � - X MY LICENSE IS M FULI.FaRCEAN�EFFECT. � � LICENSE C 4� •_�LIC.NO. � � �� � � J V � DATE CONTRACTOR_ L � n. LLI � WORKERS'COMPENSATION DECLARATION Q � IHEFEBYAFFIRMUNDEFPENALTj'OFPERJl1RVONEOFTHEFOLLOWINGDE(lARATIONS: Z � _IHAVEAN�WILLMAINTAII!IACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ ¢ COMPENSATION,ASPR0I�I�EDBYSECTION37o00FTHELABORCODE,FOPTHEPERFORMANCE U Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�. � � �I HAVEAt�ID WILL MAINTAI'�WORKERS'COMPENSATION INSURANCE,AS REQUIflED 8Y SECTION Q 37000F THE LABOR CODE,FOqTHE PEHFORMANCE OFTH WORK FOR WHICHTHIS PERMITIS ISSUED.MY WORKER'CQM ATION INSyU�pNCE CARR R AND POLICV NUMBER ARE�, CONSTRUCTION �.� g � CARRIER �� 7 UYL PLAN REVIEW z POLICVNUMBER � � L:I� �� ELECTRIC d 0 (�HISSECTIONNEmNOTBEWMPLEfE00FiHEPERMITISPJRONEHIJNDREDDCJ.lARS($100)ORLESS�. PLUMBING _____ Z ICERiIFYTHATINTHEPE'�iFORMANCEOFIHEWORKFOFWHICHTHISPERMITISISSUED,I MECHANICAL (3 SHAILNOTEMPLOYANVQERSONINANV MANNERSOASTOBECOMESUBJECTTOTHE �pj WORKERS'COMPENSATIONLAWSOFCALIFORNIqAN AGREETHATIFISHOULOBECOME INSPECTIONFEE � � SUBJECTTO TH WORKE�S'COMPENSATION PROV DNS OF SECTIDN 9700 THE LAB COD,I AL ORTHWITHCOMPLYWITHTHOS OVIS ��/ ISSUANCE � p DATE:_!� ACPLICANT: Y�t SMIP �.� _m '�P�'=�.\ _.. _ fl •� g J WARNING FAILURETO SECUflE WORKEflS'GOMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C ��5� /��� �' Sl10JECTANEMPLOYERTOCRIMWALPENALTIESAN�CIVILFINESUPT00NEHUNDREDTHOUSAN� +. Lu � DOLLAFS(E700,000),IN ADDITION'fOTHc COS7 OF COMPENSATION,DAMAGESAS PROVIOED FOR IN ENERGY PERM� J SECTIIXJ 3]oe OF THE LABOR CODE,WTERE57,ANOATTOPNEV'S FEES. � : RETENTION FE : � CO,NSTAUCTION LENDING AGENCY z 0 PRE-ALT FEE: ��" - -�` .�.,.w.-,�.----- 4 I HEREBYAFFIRM UN�ER PENALTN OF PERJURV THATTHERE ISACONSTRUCTION LENDING AGENCY FORTHEPERFORAAANCEOFTHEINORKF R HICHTHISPERMITISISSl1E�(SEG309],CIV.C.). , Z ��f W �� LEN�ER'S NAME !-�- LEN�ER'SADDRE55 ,�+'q, W ICERTIFVTHATIHAVERE4DTHI&'APPLICATIONANOSTATETHAT7HEABOVEINFORMATIONISCOFiRECT. TOTAL FEES -/���� d I AGREE TO COMPLV WI7H ALL CIIIY ANO COUNTV DRDINANCES ANO S?ATE L4W5 RELAiING TO BUIL�ING � �Y �,�/ � CONSTRUCiION,ANDHEREBYAU�THORIZEflEPRESENTATIVESOFTHISCOUNTYTOEMERUPONTHE Z ABOVE�MENTIONEO PROPERTYFbR INSPECTION PURPOSES. COMMENTS - o � � T-- .� _ m PEflMI E ��// L CIJ I� � �' I � r ,¢� \ 2 tR' 1 N 5 GNAll1RE OF PERMITTEE ' ATE � � RECPT.NO. PAID B . 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