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HomeMy WebLinkAbout17344 (25) _ . _ _ ----- - . .. _.._._ _ . _ . . , � � �` CITY OF DIAMOND BAR DEPARTMENT OF COIvIIvfUNTTY&DEVELOPMENT SERVICES 21825 E.Copley Drive EX P I R E D (909)860-3195 Fax(909)861-3117 PRESS `���� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE / � APPLICATIO PERMIT P/C o ADDRESSI.3Sl5 �__�� �_.�,.. C:G DATE �l/�G / NUMBER� M � ISSUE TYPE pC� APN LOT� TRACT DATE ��^ I^d I CONST. GROUP p OWNER � p ADDRESS ZONING SEiBACKS z CITY ZIP TEL. � o FRONT RW ❑ g APPLICANT � " �, REAR ❑ � SIDE/SIDE STREET RW ❑ a� CONTRACTOR SIDE ❑ OC'D�D�RESS ZIP � TEL.f0�'9�'S.SyS PROPOSED USE wo ARCH/EN DESIGNER �i7 NO.DWEL O. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEOROOMS � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECLARATION SFWADDlREM O I HEREBY AFFIRM UNDEH iEN/�LTY OF iEiWRY THAT I AM EXEMPT iHOM ME CON7MCTORS L4 Garage/Carport W CENSEUWFOHiHEFOLLOWINOREA50N(SEC.70.lt.5BU51NE5SANDFROFE55lON5CODE:IINYCITYOF (n U COl1NTyWHICHRE0UIRESAPERMITTOCONSTRUCf,ILLTE0.�PNOVEDEMOLISH,ORREPAIqANYSTRUG W patio/Deck � NRE,PRIOR TO RS ISSUANCE,ALSO REWIRES THE APVUCANT FOR SUCM PERMiT TO FILE A SIGNE� W STATEMENT THAT HE OH SHE IS LICENSED PURSUANf TO iHE VROVISIONS OF THE CON7MCT00.5 L6 � CENSEUW�fHAPTERY�CdAAAENCwONATNSECTIDN70o0�OF01VI510N70FTMEBUSINE55ANDVR0. � POOUSp8 FESSIONS COOE�OH THAT HE OR SHE IS E%E4PT THEREFPOAI ANO TME BASiS FOR THE ALLE6E0 EXEMP� 710N.AN'/VKKATIONOFSECTKKJIO]1.6BYANYAPPLICANTFOFAPERMITSUBJECTSTHEAPPLICANfTO Z Re-Raat Q� A GVIL GENALTV OF!qT MORE iHAN i1VE HUNORED DOLURS(f5oo).�: Z ❑I,I�SOYMEROFTMEYROPERTY,ORMYEMGLOYEESWITHWAGESAS?MEIRSOLECOIAPENS�TION, � Commarcial - WILL OO 7HE WORK,AND TME STRUCIURE IS NOT INTENDED OR OFFEREO FOR SILLE(SEG 7W�,BU51• J � NE55 AND PROFFSSIONS COOE:THE CONTRACTORS LICENSE UW DOES NOT A7PLY TO AN OWNER OF j PROPERTYVAIO BUILDS OR M7ROVES TMEHEON,AND WHO DOES SUCH WORN HIMSELF OR HERSELF OR (L THFiOUfiMMI50RHEROWNEAIPLOYEES.PFOVIDEDiHATSUCMIMPROVEAAENTSARENOTMTENDEDOR m � OFFEREDFOfl5/�LEIF,HOWEVER7ME9UILDINCOHIMFROVEMFNTI55OlDNrtTHINONEVEAROfCAMPIE- Z 710N,TNE OWNER�BUIIDER WILL NAVE THE BUROEN OF FROVIN6 TNAT HE OR SHE DID NOT BUttD O!7 � WDROVEFORTMEPURPOSEOFSALE} O 4A`+�WNER OF THE PROPEHT'/,M1 E%CLUSIVELY COMRACTMO VrtTN LICENSEO CONTRACTORS � TO CONS7i1UCT TNE MIWECT(SEC.7aa,BUSINESS 1W�VROFESSIONS CODE:T/E CONTRACTORS Lb VBIUeU0f1 /1DJ.AREA W CENSELAWDOESNOTAPPIYTOANOYMEROFAPftOPERTY1NfOBULLD50RNIPROVESTHEflEON,ANO ` � W/pCOMMGT5iOR5Uq1PR0.1ECT5WITMACONTMCTOR(S)IILENSEDVURSUANTTOTMECONTFLtG QUANTITY DESCFiIPTION �E Y TORSLICENSEUW.). � ❑IMIE%E4PTUNDERSEC. B.LP.C.FORTHISREASON a � U 1�.. � OATE OwNER V Z W � LICENSED CONTFiACTORS DECUIRATION w � IMEREBYAFFIRMUNDERPENALTYOFPEfLNRYTHATIAMLICENSEDUNDERPROV15tONSOFCMAPTEfl � � Y(COMMENCINON7iH SECTION 7000)OF DMSION�OF THE BUSINESS AND PROFESSiONS CODE,AND Z ��� IAYtICENSEISNiII.LFORCEANDEFFECT. m ' /' .S� � � LICENSE CLA55 �/// �-� LIC.NO. � V DATE��CONTMC70R d W � WORKERS'COMPENSATION DECLARATIO a � IHERE9YAFFIMIUNOERGENALTYOFVERtt1RVONEOFMEiOLLOWINGDECLAfUTIONS: Z � _IIUVEANOMALLAWNTNNALERTIFIGATEOFC0IYEMTOSELF�INSUREFORWOflKERS' = i CAMPENSATION,ASPROVIOEDB�SECTIONS7000FTMEU80RCODE,FOR7HE�ERFpRMANCE W OFTHE WORK FOR WHIp1TM15 PERMIT 13155UE0. � � O � O �I/4NEMID YALLhWNfAIN WORKERS'COMPENSATION INSURANCE,AS REOUIREDBV SECTION / �1ooOFiMELABORCODE,fORiHEPERFORMANCEOfTHEWOWCFORWMIp1THI5PERMITIS ' ]OG �QOj � ISSUED.MY WORKER5 COMPENSATION INSURANCE CA . ER AND iOLIGY NUMBERARE: CONSTRUCTION l ! r � ] CARRIER PLAN REVIEW � � POLICYNUMBER ELECTRIC � (M1USSECIfONNEmN0T8[OObTiEfIDOFTEDEib.R6FORONEM.rDREDDQ.LULS�itOo)OqLESS} PLUMBING Z ICERTIFYTHATINTHEPERfORMMlCEOFTHEWORKFORYMId1THi5VERA11TI5155UED,1 MECHANICAL C7 SwLLLNOTEMPLOYANYPER50NPlANYMANNERSOASTOBECOMESUBJEC7TOTHE N WORKE0.5'LOMPENSATIONUN50FCALIFORNIAANDA(iREE7FUTIFISHOULOBECOME INSPECTIONFEE � _ S SUBJECTiOTHEWORKERS'COMPENSATqNPROVISIONSOFSECT N�7DOOFTHEUBOR COOE,ISHALLfOHil1WITHCOAIPIYWIiMTH�SEPROVISIONS. ISSUANCE � � �–� �' SMIP D p DATE:��PPLICANT. � ENERGY P/C _ WARNINO;FALURE TO SELURE WORKE(15 COMPENSATION COVER .,E IS UNUWFUL,AND SHALLBE � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCMLFINES PTOONEHUNDREOTHOUSANO ENERGYPERMI� '� �'�� I f � I ) : DOLLARS(f 100.000),!!►D�ITION TO THE COST OF CAMPENSATqN.DAMAGES AS PROVIOEO FOR IN � SECTqN7�0lOFTHEUBORCOOE,INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: n q OCONSTRUCTIONLENDINGAGENCY pqE-ALTFEE: ���J � � 71101 � IHEREBYAFFIRMUNOERPENALTVOFPEiWRVTHATTHEREIS�CONSTPUCTION�ENDIN6�GENCY FORTNE 7ERFORMANCE OF THE WOFK FOR WHICH MIS VERMIT IS ISSUED(SEC.7ov7,CIV.C,). I � LENDERSNAME -��?, � �._��_ _ ___ � lENOER'S/�D�RE55 w� TOTAL FEES 3 . v v I CERTIFY THAT I HAVE PEAD THIS A7PLICATION M!D STATE TYUT THE A00YE MFORMATON IS COftRECT. � IAGREETOCOMPLVWITHALLCRYANDCOUNTYORDINANCESANOSTATEUWSREUTWGTOBUILOING � CONSTRUCiION.AND HEREBV AUTHORIZE REPRESEN7A7IVE5 Of THIS CWNTYTO EMER UFON THE Z 11BOVE�MENTqNEDVROVERTYFORINSPECTIONPURPOSES. COMMENTS � v c - � � 5 re.� m GERMITTEE N ' iNn � `/�G � 6NINA t F V IT7EE DATE � RECPT.NO. PfUD BY YALIDATION WMITE—Depariment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOIDENROD—File Copy,�REEN—ApplicanPs Copy .1�. 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LATH/SIDING POOL FENCING INALL INSULATION POOL FINAL CEILING WSULATION OFF SITE IMPS. ; DRYV'JALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK � LANDSCAPE/IRRIG. � SEEP PITlLL. I ON SITE IMPS. GAS AIR TEST FI�JAL ZONING FIN,4L CONSL � FIRE D�PT. FIP�A! FINAL HEATING HEALTH DEPT. FIN.AL FIN,4L ELECTRIC DEV. FEES PAID FIPJAL PLUMBING ENERGY t;�1�'`r.�:sd,_`._c;ieia--_-_�__�__� � � cor�nr�nENTs SEPTIC TANK SIZE SEEP PIT/U SIZE ------------, '►�� ; ( � i�r� 'd`� - � �� , ,