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HomeMy WebLinkAbout13550 i - ��`'� CITY OF DIAMOND BAR ;}" ^-w '--��' DEPARTMENT OF COMMUNITY&DEV�LOPMENT SERVICES �`---�'"`y _ . a 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 pRESS � 'g�� BUII.DING PERMIT APPLICAI'ION FIRMLY , __ � ADDRESS`���Xa�� ��+111�f���`� DATE CATION�'"`I�� (T� NU BER" ` '#/C / l � ISSUE TYPE OCC APN L07 TRACT DATE CaNST. GROUP �p OWNER � ADDRESS� yt'' "�'��• �7�'�'� �Aa`�'�Z ZONING SETBACKS w � � �� t�•�� . FRONT RW ❑ � CIT`!_,� �� dYri. ZIP TEL. APPLICANY TEL. REAR ❑ � SIDE/SIQE STREET RW ❑ a� CONTRACTOR�� I �+ ' '��.�i��!'`��3 ` SIDE p � ADDRESS .r+�'`' �p.��� � Y� � �- PROPOSEP USE m�G'l�i,��'�1� ���" C� I» f c^'" M O CITY ���I'"_AO'SJ ��A�L�_ ZIP f 7EL. ti � P'`�"` ', � ARCH/EIVG/ � — ,�•Y �+ 'T f�d z DESIGNER NO.DWEL. N0. NO. � CITY ES� ZIP TEL. vNITS S'TORIES � BEDROOMS I � DESCRIPTiON SQ.FT. FACTOR PSF ADJ.ARE.1/VALUATION �'�., � � OWNER-SUILDER DECLARATION SFRIADD/AEM ' O ' p� I HEREBY AFFlRM UNDER PENALIY OF PEHJURY THAT I AM EXEMPT FROM THE CONTRACTORS ll- G8f29@/CBPPOR � ��� �, �7 , CENSELAWFOR7HEFOLLOWINGREASON(SEC7031.58USINESSAiJ�PRDFE5S10N5CO0E:ANYGTYdR (J� . �, C.�.��..:COUNT'YVHICHflEpUIflESAPERMIT;TOWNSTNUCT,ALTeR,iMPROVE,DEMOLISH,DRfiEPAIflANYSTRUC- W patiolDeck � '�, � �TURE,PRIOH TO ITS ISSUANCE,AL50 REBUIRES iHE APPLICANT FOR SUCH PERMIT i0 FILE A SIGNED W STATEMENT THAT HE Ofl SHE IS LICENSED Pl1R3UANT TO THE PROV9510NS OF THE CONTRACTOP3 LI- � '', g ,CENSE lAW(CHAATER 9(COMMENCM�WI1H SECTbN�000)OF DIVISION 3 OF THE BUSINESS AND Pfl0- u' POOVSpe V�...FESSIONSCODE)ORTHATHEOR5HEISEXEMPTh1EREFFA'JMAN�THE9ASISFORTHEAL�EGEDE%EMP- {� V� .TIQd,ANYVIOLATIONOFSECT10iY7037.58tlANtlAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z RE-ROOf �A CM6 PENAI.TY OF NOT MORE THAN FlVE HUN�RED DOLLARS(SSo�.J: ' �' ❑�,ASOWNEROFTHEPROPER7V,ORMYEMPIDYEESWiTHWAGE5A5THEIRSOLECOMPEPISATION, ❑ COI11111BfG�8I - � . ' '' Z �WILL DO THE WOHK,AND THE SPAUCTURE 15 NO7 INiENDED OR OFFER'cD FOR Sf LE(SEC.7044,BU51- J ', , � NESS.WDPROFESSIONSCODE:THECQJTRAC7�RSLIC6NSELAWDOESNOTAFPLYTOANOWNEROF = ' � '� ���.PROpEflTYVYFiO8UI1D50RIMPROVESTHEREON,A1VDYdHODOESSUCHWORKHIMSELFORHERSELFOR '� 2' 'THROUGHHI&ORHERONMEMPLOYEES,PROS'��EDTNA75UCHIMPROVEMEMSARENOTINTEN�EDOR m �I, �..'OFFEflE�PoR&ALEIFHOWEVE0.R1EBl1IL01NGOAMPROVEMEN7155oLDWITHINONEYEAflOFCAMPLE- ' � , Z� ��TION,THE OWNER-BUILOER WILL HAVE THE BUR�EN OF PROVING THAT HE OR SHE DID MOT BU!LD OR � �� IMPROVEWRTHEPURPaSEOFSALk). � '�1,0.50NRdEqOFTHEPROPERTY,AIAEXCLU5IVELYCON4AACTINGYlITHLICENSEDCONTRqCTOP.S ��. �� TO CONSTflUCT 7He PP.OJECT(SEC..7066,91151NE55 AN�PROFES510N5 C6�E:THE COkTFAGTORS L�� V'c11U�210ft � ADJ.AREA '� N�� :�CENSEIAWDOESNO7APPLYTOAN064NER',OFAPROPEfl7YY�PoiOBUil�50AlMPROVESTHEFEIXd,AND �� F' �wriocorrrwccTSFaasuct+vwo.iEcrswirwqca�rrancroa�s�iicErdsEcauasuuvrrorHEcowsaao qUANTI'fl' DESGRIP710N FEE � � TOAS LICENSE LAW.). '�� o p i AM EXEMPT UNOEfl SE6. 8.8 P.C.FOR THIS REASON Q � U lt.: ¢ ��, DA7E � OWNER .0 � Z W �' LiCENSED CONTR4CTORS DECLARATlON � li, �� 1 HEREBYAFFIRM UN�Eq PENTLTY OF PER,IURY iHAT I AM L�CENSED UNDER FROVISIONS OF CHA?7EF � I �,, 9(COAIMENCINOWITHSEC?ION700D)OFDIVIS!ON30F7HEBUSINESSANCPROFESSIONSCOOE,ANO Z MY LtCENSE IS IN NLL FOfiC'c AND EFFECT. I OdJ ____����� �� ., LICENSE C S �"'.�LIC.NO. � �_ , V'�� 6ATE �CONTRACTOR fA c 1 � �CG '� W„ Y VC �I ���' � WORKERS'COMPENSATION DECLARATION -� _„ � �I � 1 HEREBYAFFIRAA i1NDER PEFdALTY OF PERJl1RY ONE DFTHE WLLOWWG DECUAA710N5: � �' ¢ '�il �'�,, ��IHAYEANDWILLAAAINTAINACERTIFICATEOFCONSENTTOSELF•INSI�REFORWORKERS' =[ COAAPENSATION,pSPROY��EDBYSECTiON3790QFTHEIABORCODF.,FORTHEPERFORMANCE gU OFYHE WORK FORI'+/HIGf?HIS PERMIT IS ISSUID. � �.. w' _I HpVEAND Wltl MAINiAON FVOF�iKERS'CAMPENSATION IWSURANCE,AS R'cQUiREO BY SECTION � � �� 37W OFYHE UBOR CODE,FORYHE PFpFORMANCE OF THE WORK FOP WHICH TNIS PERMITI'a ��� . ISStJED.MYVlORKERS'COP,f�ENSATIONINSURANC CARRIEFANDPOLICYNUMBEflARE: CONSTRUCTION � � ��"�.d�°"� ��:� , I y, cnciaieR _ PLAN REVIEW ��� � �aicrr�UMaEn ���'9�S� ELECTRIC =, .. c"c'� . . .. — I�i ¢ T n_,... , � Q�, �, (PNISSE�.E�TiONNE�NJSBE�API..EfFDOF1FEPERWI'16WRavEF0.11�AE�DaLARS(S1aa)ORLESS). PLUMBlNG 'K... "�I�..; .. 5 � '� Z 9 CERTdFY THhT INTI'.E PEfiFORPAANCE OFTHE WORK FCR WHICH THIS PERMIP IS ISSUED,I MECYIANICAL � - - � � ('4., . SHALLNOTEMPLOYIWYPEHSQNINRNYMANNERSDA5T08ECO�NESUBJECTTOTME ��`;] � � ' � ! '�, �y. VJORKERS'COM,PENSATIONLAWSOFCAL'�,FOFrNiA,ANDAGREETHATIFISHOUL�BECOME INSPECTIONFEE _ ��"�'d' �g''"y" - f IeAI SIHJECTT07HE WOflKERS'GDMPENSATIOIVPRO'dI510N5OFSECTIO�Y37000FTNEL180fl . 'I �� COOE,I9HALLFOFlT'�iWIT}iCOMPLYWIhiTHOSEPRQVI510N5. �SSUANCE � � . , O .; � Yfl �� " SMBP �� I ^�y �DATE: __ APPLICAN7: ����7L__t_. �" �i ��'�..,WARNINGFAILUHeTOSECUREWORKERS'COMPENSATIONCOVERAGEISUNIAWFUL,ANDSHALLBE EPJERGYP/C � - . �':'". SU&IECTANEMPLOYERTOGRIMINAI,PENALTIESANDGNILFlNESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT ' '�DOLLARS(Sia0,o00y,IN AbDITION iDTHE COST OF COMPENSATION,DA�AAGES AS PROVID�FOR IN I�i J�� �.SECTION 37080f Tl-IE L4BOf7 CODE;INTERESi,AND ATTORNEYS FEES. ' RETENTION FEE: , II �.�,��, ���.,;, CONS7RUCTION LENDING AGENCY pRE-ALT FEE: ' II, �.',�'',IHEREBYAFFIRly1UN�ERP6NALTYOFPERJUflVhIA7THEREISACONSTRUCTIONLENDMGAGENCY ' ' �, ':FOq THE PERWRMANGEOFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.309],GV.C.�. , , I Z ',: jl 19L1 :" , � �,'�,�LENDER'S NAME ' '� I I—' ��LEN�eR'SA�DR5S5 , I �,�, ';,ICER7fF1'YHATIHAVEREADTW9APPLICATIONANDSTATEiHATTHEABOVEiNFORMATIIX�IISCOqRECT. �'OTAL FEES � , r �. 4,'.�",IAGREETOCOMPLVWIiHALLCITVANOCOUNTYOR�INAPICESANDSTATELAWSREUITINGTOBUILDING ' ��.�,'�;CONSTRUCTION.ANOHEREBVRUTHORIZEREPRESENTATIVESOF7HISCOUNTtlTOENTEpUPONTHE � � i Z,';',ABOVE�AIEPf�IOPJE�PRDPERTV FOR INSPECTION PURPOSES. COMMENTS - . C1�'� .�'�' �" . �. I � �' � ',PEPMI (PRINn � e . � I � ' ! 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