Loading...
HomeMy WebLinkAbout11372 (5) , _.,t___ _ -- - ---�__T_ _ _ - - --- -_ _ . ---� � ---�T»�'``"F---• CITY OF DIAMOND BAR � � � COMMUNITY DEVELOPMENT DEPARTMENT __ 21860 E.Copley Drive Suite 190 PR�SS (909)_860-3195 rax(909)861-3117 �"���' BUILDINGPERMITAPPLICATION / F ' �t-^,��,f�J FIRMLY � JOBSITE ARPLICATION „ (� � PERMIT �/C o ADDRESS 2 ?t DATE `� � NUMBER�`�# o ISSUE TYPE OCC . °r° APN LOT TRACT DATE CONST. GROUP ' p OWNER .t�n�`�n;..,,n �����Li� � ��� ZONING . SETBACKS p ADDRESS_,�r.�:,s .� Z CITY ZIP TEL. FRQNT RW ❑ ZAPPLICANT TEL. REAR ❑ SIDE/SIDE STREET RW I� ¢ CONTRACTOR SIDE ❑ � ADDRESS PROPOSED USE � � CITY ZIP TEL. . ..,,. . ,... w ARCH/ENG/ w DESIGNER N0.DWEL. � NO. NO. a AQDRESS UNITS STORIES BEDROOMS . �' CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUAT[ON cn �, �� � . OWNER-BCILDER DECLARATION - SFR/ADDlREM � ��� - �� � � �� , �, p I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS L6 � GaragelCarport � � � W CENSELAWFOFlTHEFOLLOWMGflEASON(SEC.7031.SBUSMESSAN�PROFESSIONSCO�E:ANYCITYOR � U COUNTYWHICHREQUIRESAPERMITTOCO�'SiRUCT,ALTER,IMPROVE,DEMOLISH,OflREPAiRA.YYSTRUG W Patio/De � '� z TVflE,PRIOR TO ITS ISSUANCE,ALSO HEDUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNE� . � � W �STATEMENT THAT HE OR SHE IS LICENSED PUFSIIANT TO THE PROVISIONS OF THE CONTRACTORS LI� � �. � � �CENSE LAW(CHAPTER s(COMMENCING WITH SECTION 7oDo)OF DIVISION 30�=THE BUSINESS AND PRO- � � Poo a- � , �� � � FESSIONSCODE)oRTHATHEOFSHEISEXEMPiTHEREFROMANDTHEBASISFORTHEALIEGEDEXEMP- (!S � �'�TION.ANVVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTiO Z RB-ROOf � �� � � � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDFiED DOLLARS j8600).�: , ❑I,ASOWNEROFTHEPROPERTY,OFMYEM2LDYEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 Commerclal o WILL DO THE'WOR.K,AND THE STaUCTURE�IS NOi IN7ENDED OR OFFERED FOR SALE-(SEC.7044,BU51� J � � Z NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW�OES NOT APPLV TO AN OWNER OF ' �. PROPERTYWH09UILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR . m ' � '�, �. THROUGHHISORHEFOWNEMPLOYEES,PROVIDEDTHATSUCHIMPRDVEMcNTSARENOTINTEN�E�OR ' , � W� OFFERE�FORSALE.IF,HdWEVEF,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE� � '�' TION,THE'OWNER-BUILDER WILI HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NOT 9UILD OR � . � �Z IMPflOVEFORTHEPURPOSEOFSALE). ' ' _ . ❑.I,ASONTIEROFTHEPROPE(iTY,AMEXCLUSNELYCONTRACTINGWITHLICENSEDCONTRACTOfiS , �.,� TO CONSTRUCT THE PFOJECT(SEC,1a44,BUSINESS AND PROFESSIONS GODE:THE CONTRACTORS LI- V0IO8tI0f1 ADJ.AREA � �, W"� CENSELAWDOESNOTAPPLYTOANOWNEROFAPflOPERiVWHOHUIL�50RIMPROVESTNEREON,ANO '� WHOCONTRACi5FOR5UCHPFOJEQiSWITHACONTRACTOR�S�LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION � � ' �� � '��FEE . Y TORSLICENSELAWJ. ', � ❑I AM IXEMPT UNDER SEC. B.&P.C.FOR THIS REASON � , I �" ' .�, . � . . �. � ,.,,. � DATE 3�-12.-�� owNEa�� � �/_2t�,:� U w '. ,� . . LICENSED CONTRACTORS DECLARATION W ��, � , � '� IHEFeBYAFFIRMUNDERPENALTYOF�PERJURYTHATIAMLICENSEDUNDERPROVI510NSOFCHAPTER � '� ';Q„- 9(COMMENpNGWIiHSECTION7oa0)OFDIVISION30FTHEBUSINESSANDPROFESSpNSCODE,AND 4X MY LICENSE IS IN FULL FORCE AND EFFECT, , � �J� I�� '�, Q LICENSECLASS LIC.NO. � j � � � .� J � ��;U DATE GONTRAGTOR d , � �, � '.W �� . . , � . , �� ��� WORKERS'COMPENSATION DECLARATION Q � � � � ' � IHEREBVAFFIPMUNDERPENALTYOFPERJUflVONEOFTHEFOLLOWINGDECLARATIONS� ' Z �'� �Q:. ; , '�, � IHAVEANDWILLMAWTAINACER?IFlCAiEOFCONSENTTOSELF-INSUREFORWORKEflS' _ � ' � COMPENSATION.AS PROVIDE�BY SECTION 3700 OF 7HE LABOR CADE.FORTHE PERFORMANCE U ', ¢ OF THE WORK FOR WHICH THIS PERMI71515SUED. � � W _I HAVE ANO WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION �e/ �P"'"� � �O 370o OP THE LABOR CODE.FOR THE PEfiFORMANCE OF THE WORK WR WHlqi iH15 PERMIT IS �O�� �9 � ISSUED.MVWORKEPS'COMPENSATIONMSURANCECARRIERANOPOUCYNLIMBERARE CONSTRUCTION 1 �F ° �'° J �'. �j CAftRtER PLANAEVIEW ZPOLICV NUMBER ELECTRIC " i Q / 0 (il-IlSSEC'.IDNNEmNOTeECOMPLElEDOFTHEPERMITISWRONEHUNDREDDOLLARS(5700)ORLESS). PLUMBING . �dls��[�` �� LLI ' �Z 1 CERTIFVTHAT M THE PERFOPMANCE OF THE WOflK FOfl WHICH THIS PERMIT IS ISSUE�,I MECHANICAL � E��� �I C,J" SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO TH'c , ��. � WORKERS'C6MPENSATIONLAWSOFCALIFORNIA,ANDAGFEETHATIFISHOUL�BECOME INSPECTIONFEE ' �, = SU&IECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37oD Of THE IABOR �' � CODE,I SHALL FORTHWITH COMPLV WITH iHOSE PROVISIONS_ ISSUANCE o SMIP . —.— ,L. i p DATE: APPLICANT: /q , ;J� WARNINGFAILURETOSECUflEWORKERS'COMPENSA710NCOVERAGEISUNUIWFUL,ANDSHALLBE ENERGYP/C � ���. � ,$ .>� s '', .�� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDqVILFINESUPTOONEHUNORE�THOl15AN0 ENERGYPERMIT �OLLARS(57 oo,ao0).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN �p '�. -'� SECTION37080FTHELABORCADE,INTEREST,ANDATTORNEY'SFEES, flETENTIONFEE: � � ��P �/' +� ' '. -� CONSTRUCTION LENDING AGENCY PRE-ALT FEE ' ' � � O . '� � IHEREBYAFFIRMUNDERPENALiYOFPERJURYTHATTHEREISACONSTqUCTiONLENOINaAOENCY � � FORTHEPERFORMANGEOFTHEWORKFORWHIGHTHISPERMITISISSUED(SEG.3oW,qV.G). z u, __ '� f' j LENDER'S NAME � � H LENDER'SAD�FESS - � �� ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIDNISCORRECT. TOTAL FEES �' II � '�� w I �� �i � IAGREETOCOMPLYWITHALLCITYANDCOUN7YORDINANCESANDSTA7ELAWSRELATINGiO6UILD�NG , I;,�', � CANSTRUCTION.ANDHEREBYAUTHOR2EFEPRESENTF7!VESOFTHISCOUN7Y70ENTERUPON iHE �f'�� z ABOVE-MENTIQVE�PROPERTV FOR INSPECTION PURPOSES. COMMENTS � �'��i�f Il Pzl` i�`> f�-1'G-�f�.�'tT��`l m j i , Q PERMITTEE NAM1E(PRINT) I '. , a? �iGZ.h.G�r�.�q��I��--� ^ i �� SIGNATU� FPER EE DATE q � ' . � — 3`I�` 1 RECPT.NO. PAID BY �UALIqATIpN�� 4 I S � ~ � - WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GFEEN—ApplicanPs Copy '�. . �� �. i'���� ; , -:,:.._. ... . .': .'- .,:., . -: F } e>,.v - - �- �- . ����. � ���, � „ � � � ��� ������ � �., � , � ��!, ,.; ., �. � � , � � �.. �,,.� �� � � , '��_ �'' ���,�' �-� �'� I � �� ,. : � , _ _.. __;._. . �����.�€a 3 , 3 � �F^?�i � � __ �_ }.,__. �..._____.._._�.:.�,. �3�i e�`�4 _ E � _ _ �"" � � ���1�"�Jr�f���'',�"�-�i � � E�������lT;� � � '�����T'�(���v�'�� ; � 4.?�'(��'� t=���� ��3,.�Ci � � �-. _.._ _ .____�,_.�,.�...�_.___ __..� g ��t�J���?��.'.��rr�€�°��9 � ;. �����,�� .=��+.�,����d�?�Ei` __ --- � - � ---- _ � � ��l�u���:s�P� ; � , _�.:_ i € �;,3����.�€.��- :�,rJl1i���0.T6�.7i� � ,____.� _ _ �F�%��.��.���Pt���> . � �� �I���'�.a:����(���7��.��.� ; ���� � �� � �, n� ,� � _ = E�¢:€�3��. ��!°�@�}?��r�� � , r����9��ll°J���`���',.��1^ � ° ' l �;�T �(��5�?�r�a�".� E � > ,- , __...�. ..��- -- ____._.__. l � � � ( s-€�€�_c��a��,���% � !�,�it�i��=�:����� � ; i��=t�-�;��i�I��ta � $ (.��t-~�i��i"��v� F ���?�".�("��`a � � N ���� �?c� �i€+:� ���" : r�t�s.1;a��F"t�i�l�� �-- �. � �_�._ ���� ; �v�������,.������?�;� ; �� - �=��I��i��?�aL3I1�� �— � c,g��:�<�`T'���s T��a"' � �j' . . f r t3C�� �',.���T:�9�� � r ,�.'a��`�"�4=�1�;�7t�C�; � € ' F'a�v,g�.���ui�� ` ; --�--� � ��1_.'l�.a `������.����� __ ___� �_i�Cs+�..= F���f�L. _..,_._ .._," w -� , ��;��aa L.�f���J�.r��"?Cl�� 1 ' � ______��__ E � , °�.. �� ; ��=��!:E i�,t3?>: � ����a����`�'��4�'L P'� � � ��'��I��T1��:i �v_�.��_{__.W._._ � � 4( x� i3�"w�U"Pr-,�S , � , P'9!V�2#..a$ �,Y'��' . . � � �� -. , � � ����� :o�t�t�%m � �� j � 1 �..,�s�¢�.��'a's��'�� xi��ia. ��� � a _._...._ H.. — . . �}�a�,9,.a:=.6{�'�!?u.� :�_._..,_.".._::....�...�....�..,T_____. ._.:_....._. � ����a"�E d�{�.�,.. �. . j . , j. . . ' �t���4;�?'��7' '. ���� . . .o� �(��;L��s�����1� : ��� _____..�. -------�-�- � ������.��}t�� ,, � '� /3 �� " i Fi����'��,�" �;�'���_ —�_____� — � � ', s�:� � - . � i F���a � ���� �:R!�... , -- ; ��- �as�r.�.�^�.r�t"��aCa A.._�___�. �� ..� � �� � �� __� ____ ____3 � F=�,`�L��.�����pCF z . � ' j ��°�. �-�����,�i� , ��� �'§�i��L FL.��="t�a��� -` ; � �.��°��'�` 'a���z � : � , � E----�- � �. � , , —_I_�___ ' � �'� � . � _ � � .--.�.�— � — � � �������������`� . _ ^ ;, , 6 � � �� . ��. , . ' . . . . ., � ry x ., . . :', '. � ... .... ... . . .. . , .. , .. . ' � . . „�'_ . .�......................��.e.�..�. . _ _ . . . ' �_ .., �_ . __ ' . _ .� .w...�...�- " _._._. .�_ � . . ._ ._ ._..... _...,_ .......... .....� . . .. . . . . . . . . . . . , . ,-, � € ,. ' . .. , .�.._._�_�_ '.. �. .. . ..� . . . . . � . . ... -�� . .. . . . . - �« . "--� �� �:�y��� �4� ��� " "' . . . . ... T.. . ' . _ . , . ' ��� 4^�b S��.�4 ,i li� J ..'. . _. ._ . � . . ___.____....—.,—.,� .... . . . . . .:.,�� . '_�• ��-� . .. . . ... . . . . . .... . . . .. .. _..r a , . . . ... " �.� . '�._._......�. ���'s���'����m �i�� .�,..��s 3 ���� ��i 1!: ���r- �-� . , � �; �: � � _�.�, �.� ___. , . ;: ._ _ � ' —. __— µ --- ._... _�_�� � _._ _.� � ,' � ,;€ . � __.�:� _.___�.�_._.�:_�__�.T _.�. � ��� � , I � � , �,..��.. _, �