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HomeMy WebLinkAbout17314 (23) � � CITI'OF DIAMOND BAR �'� �� -- DEFAR"d'1�fE�I�'OF C�MMUNITY&DEVELOPMENT SERVICES ---- I � 21825 E.Copley Drive (909)860-3195 Fac(909)861-3117 PRESS �"��� ' BUILI9Its1G1'ERMITAPPLICATION FIRMLY o DDRESS f ��� •�_ � �-�-✓ DATE CATION ��w��"��NUMBER 1��#/C � ISSUE TYPE OCC .- APN LOT TRACT DATE CONST. GROUP p OWNER .j�c-iC �L'Lf�A.��, `�` ADD SS��__=�. G��+�` _ ZONING SETBACKS Z CITY v'� l.� � ZIP ��'` TEL�/��Gf'2.�� FRONT RW ❑ o APPLICANT _ TEL. S I D E/S I D E S T R E E T R W ❑ m CONTRACTOR ��'�. �^�' 4��",����C�n' �ni C- SIDE ❑ Q ADD SS •,6�` �3 .. �+�`��aC '�'� � CITY�i k�ald� �,v�'F'L ZIP�_ TEL�peI" �L2'�''12� PROPOSED USE o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. n, ADDRESS - UNITS STORIES �" BEDROOMS � CITY ZiP TEL. cn� cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION �� OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT f AM EXEMPT FROM THE CONTRACTOPS LI- G8f892/CBfPOfI W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSMESSANDPflOFESSIONSCODE:ANYCITYOR (n U GOUNTYWFtICHFE�UIflESAPERMITTOCON57PUCT,AITER,IMPflOVE,DEMOLiSH,ORREPAiRANYSTRUC- W'. TURE,PRpR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOfl SUCH?EflMIT TO FILE A SIGNED w Patio/Deck STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONiRACTORS LI- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 ANO PAO- U' POOI/Sp2 FESSIONSCO�E)ORTHATHEDRSHEISEXEMPTTHEFEFROMAN�THEBASISFOqTHEALLEGEDEXEMP- � �� TION.ANVVIOLATIDNOFSECTION7031.5BVANVAPPLICANTFORAPERMITSUBJECTS7HEAPPLICANTTO Z Re-Roof � A CIVIL PENALTV OF NOT MORE THAN FlVE HUN�RED DOLLARS(SSoO).): � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITH]NAGESASTHEIFi30LECOMPENSATION, � COfI1fI1BfC18I -- - WILL DO THE WORK,AND THE STRUCTURc IS NOT INTENDED OR OFFERED FOR SALE(SEC.7D44,BUSI- J �' NE55 ANO PROFESSIONS CODE:THE CONTRACTORS UCENSE LAW DOES NOT APPLY TO AN OWNER OF � PFiOPERN WHO 9UILD5 OR IMPROVES THEREON,pND WHO DOES SUCH WOFiK HIMSeLF OR HERSELF OP �' THROUGHHISORHEROWNEMPLDYEES,PROVIDE�THATSUCHIMPFOVEMENTSARENOTINTENDE�OR CO Q. OFFERm WRSALE.IF,HOWEVER,THE BUIL�ING OR IMPROVEMENT IS SOLD WITHIN ONEYEPR OF COMPLE- � TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING TliAT HE OR SHE DID NOT BUILD OR � IMPROVEFORTHEPURPOSEOFSAL�. w ❑I,A30WNEROFTHEPROPEFTY,AMEXCLUSNELYCONTRACTINGWITHLICENSEDCONiRAGTORS [C TO CANSTRUCT THE PROJECT(SEC.Io40.BUSINE55 ANO PflOFE5510N5 CO�E:THE GONTRACTORS LI- VdIIJflI101t ADJ.AREA W'� CENSELAW�OESNOTAPPLYTOANOWNEROFAPfiOPEFTYWH06UILDSOflIMPFOVESTHEFEON,ANfl -- �. WHOCONTRACTSFORSUCHPROJECTSIMTHACONiRACTOR(5)LICENSE�PURSUANTT07HECONTRAP QUANTITY DESCRIPTION FEE - TORS LICENSE LAW.). Q ❑I AM EXEMP7 UNDER SEC. B.&P.C.FOR THIS REASON Q � ^"��� � � LL � ����� �� Z DATE OWNER U _�� ��e �. �, � t � LICENSED CONTRACTQRS�ECLARATION w �.� .,� ¢ � CC IHEREBVAFFIRMUNOERPENALTYOFPERJURYTHATIAMLICENSEOUN�ERPROVISIONSOFCHAPTER � g ,,,E'?� ��� �� p,; 9(COMMENCING WITN SECTION 7ooa)OF DIVISION 30FTHE BUSINE55 AND PROFCSSIONS CODE,AND Z �E�x.° 4A -� ' `X MY LICENSE IS IN FULL FOPCE AND EFFEC7. y 1 m � � � � ��,sy p.� (�j � .LICENSE CLASS �^ � 8 LIC.NO. �:�1�- { _ j � , ��TJi j 4 U DATE d�"m' �J I'^' C�I CONTRACTOR d ' ' �a t 1��� - w !�S`���.'� (� � 1 � WORKERS'COMPENSATION DECLARATION Q � IHEREBYAFFIRMUNDER?ENALTYOFPERJURYONEOFTHEFOLLOWMGDECLARATIONS: z Z _IHAVEANDWILLMAINTAINACERTIFlCATEOFCONSENTTOSELF-INSU�9EFORWORKERS' _ ¢ CAMPENSAiION,ASPflOVIDEDBYSECTION3�ooOFTHELABOflCO�E,FORTMEPERFORMANCE U Q OFiHEWORKFOaWHICHTHISPERMITISISSUEO. � W _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREQUIREDBVSECTION p $ Q 37000FTHELABORCODE,FORTMEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS 1 IY��7 ISSUED.MYWORKERS'COMPENSATIONINSt7RANCECaaa,PPP`RIERAN�PO'.IC7NUMBERARE: CONSTRUCTION I �.s ¢ cnnaiER �1��',C'� ��� PLAN REVIEW > � POLICY NUMBEH'��S—f�I V�I� ��`�1 Z.� ELECTRIC ¢ (1HISSECTIONNEmNOTBEOJMPLEfEDOFTHEPERMITISFOPONEHIhWPEDCOlLARSj$100JORLESS). PLUMBING '-^ Wp$ ��s Y t r' Z I CERTIfYTHAT IN THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUE�,I MECHANICAL - _ �� i> ^ � G� SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO HECCME SUBJECT TOTHE ' �� �� � WORKERS'COMPENSATION LAWS OF CALIFORNIA,ANO AGREE THAT IF 1 SHOUL�BECOME �NSPECTION FEE h . SUBJECTTOTHE WOflKERS'COMPEN TION P OVISIONS OFSECTIDN 3]00 ,THE LAB R � � (1 P3� � CDDE,ISHALLFORTMWITHCOMPLYW HTHO PpOV15,10 �SSUANCE ^9 ' e. �6SIa Y� � _. p DATE:�'�A"'°�, P�I �� SMIP , �� � ENERGYP/C i�� `��r ; WARNI AIWRETO WHE KERS' PENSATIONCOVEFAGEISIINLAWFUL,ANDSHALLBE r�_,. �i ' '�-F �,y_. SUBJECTANEMPLOYERTOCRIMT'ALPENALTIESANDqVILFfNEStIPTDONEHUN�REDTHOUSAN� ENERGYPERMIT� --""' '''��--�--�-��' DOLLAfiS($1oa,00�),IN AODITION TO THE COST OF COMPENSATION,DAMAGESAS PROVIDED FOR IN �� SECTION37oeOPTHELP.BORCODE,INYERESi,ANDATTORNEY'SFEES. REfENTIONFEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: ¢, IHEREBVAFFIRMUNDEPPENALTYOFPERJUHYTHATTHER�=ISACONSTRUCTIONLENDINGAGENCY FOR THE PERFOFMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). . Z LLl � LENOER'S NAME H LEN�ER'SADDflESS " � TOTAL FEES ,� ',�� -� 1 CERTIFY THAT I HAVE READ THISAPPLICA710N ANO STATE'HATTHE ABOVE INFORMATION IS COFRECT. w 1 AGflEE TO COMPLY WITH ALL CITV AN�COUNTY ORDINANCES AND S?ATE LAWS RELATING TO OUILOING d' �' CONSTRUCTION,ANDHEREBYAUTHORIZEPEPftESENTATIVE50FTHISCOUNTVTOEM'ERUPONTHE z A60VE�1AENTIONEDPROPEftTYFORINSPECTIONPURPOSES. COMMENTS � � '� � ��� � �' PERMITTEENAM PRIN7� v p�°q� C!J l 4.t'_"3 i �� � � � SIGNATUFE OF P ITTEE �ATE � RECPT.NO. PAID BY� VALIDATIO� ~ WHITE—De artment Copy,YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A IicanYs Co P PY, PY, PY. 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