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HomeMy WebLinkAbout10329 . CITY OF DIAMQND BAR ' ��� � COMMUNITY DEVBLOPMENT I7EPARTMENT :,,� 22660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 ' �'"""� BUILDIIVG PERMITAPPLICATION FIRMLY o ADDRIESS�^ �� ��f�(���J�� DATEICATION NUMB R 1���� #C �7'�l T � ISSUE " TYPE OCC APN LOT T ACT DATE CONST. GROUF p OWNER p ADDRESS ZONING SETBACKS ����� oCITY � '/3 ZIP 9/76�TEL. FRONT RW ❑ APPLICAN7 TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ z � CONTRACTOR , SI�E ' ❑ � CITY E S ' ' ZIP TELeSj��^SObO ,PROPOSED USE � c1 :��� � w ARCWENG/ ��/ _ _ Z DESIGNER ' ���� NO.DWEL. NO. NO. a ADDRESS UNITS STORIES � BEDROOMS � CITY ZIP TEL. cr� ' ' � DESCRIPTION SQ.Ff. FACTOR PSF ApJ:AREANALUATION ! � ,O�,.. , ,OWNER-BCILDER DECLARATION SFR/ADD/REM � '� �� ' � � � ' I HEpEBY AFFIRU UNDER pENAI.TV OF PERJURY THAT 1 AM EXEMPT FNOM THE CONTRACTORS L6 G8I8lJB/COfpOA ' W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.58USINESSANDPROFESSIONSCODE:ANYCINOR .�(n � U COUNTYWHICHAEOUIRESAPEAMITTOCONSTRUCT,ALTER;IMPROVE,DEMOLISH,OflREPAIRANYSTRUC- 'W P0�i0/DBCK ��� W, �iUHE:PPIOR'TO ITS ISSUANCE,AL50 REQVIPES,THE APP�ICANT FOR SUGH PERMIT TO FILE A SIGNE� . � ' ' STA7EMENT THAT HE OR SfiE IS'LICENSED PUqSUANi TO�,'fHE PROVISIONS OF THE CIXJTRACTOflS LI- � �� CENSE LAW(CHAPTER 9(COA1M�NqNG WITH SECTIDN 7000)OF DIVISION.7 OF THE B1151NE55 ANO PfiO- � POOI/Spd ' � � � �' FESSIONSCODE)ORTHATHEOR��SHEISE%EMPT7HEREFROMANDTHEBASISFORTHEALLEOEDEXEMP- (� � 710N.ANYVIOLATIONOFSECTION7031.5BYANYAPPLICANTFORAPERMIT5UBJECTSTHEAPPLICANTTO � Z RC-ROOT ' ' A CIYIL PENpLTY OF NOT MORE TNAN FYVE HUNDqED DOLLARS(S5o0).): �� ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � CofflfflBfCiBI � ' Z WILL W THE.WOHK,ANO THE Si��iflUCTURE IS N071NTEND��OR OFFFAE�FOR SALE(SEC.7044,BU51- J '� 'NESS AND PROFESSIONS COOE:THE CONTRACTpiiS LICENSE LAW DOES NOT APPLV TO AN OWNER OF ? �$ ':PROPER'�YWHOBUILDSORIMPROVESTiEHEON,ANOWNO�OESSl1CHWORKHIMSELFORNERSELFOR i' / 1 � - � � �Q. ���:THROUGHHISORHEROWIJEMPLOYEES,PROVIDEDTWAT§UCHIMPROVEMENTSpRENOTINTENDEDOR �� " . W �'OFFEREDWRSALE.IFHOWEVERjTHEBUILDINGORIM7ROVEMENTISSOLDWITHINONEYEAROFCOMpLE- r ,��':'710N',iHE OWNER-BUILDFA WILL�,HAVE THE 9URDEN Of PROVWG THAT HE OR SNE DID NbT BUILD OR Z 'IMPROVEFORTHEPURPOSEOFSALE). '� �� ❑I.ASOWNEROFTNEPROt�ERTY.AMEXCWSIVELYCONTRACTINGWITHLICENSEDCONlRACTORS �,� :i0 k�NNSiRUCT�7HE PflOJECT(S,EC.7a44,BUSIN�&S AND PtiOFESSIONS COOE:THE COMRACTORS U V3II1d110R � ADJ.AREA 'W 'CENSE'LAWDOESNOTAPPLYTOf,NOWNERO�hPFOPERT}'WH08UILDSORfMPHOVESTHEREON,AND ' p " � '_ �'�'WHOCONTRACTSfORSUCHPROilECTSWITHpCONTRACTOR(5)LICENSEDPURSUANTTOYHECANTRAP QUANTITY DESCRIPTION � '�FEE � ,''TORS UCENSE LAW.y. � , � , � . , . J p ,�.1 . . . � � ❑I AM E7(EMPT UNDER SEC. B.8 P.C.FOR THIS REASON U �—p , �,� .''' . � , � '�, �ATE OWNER ,V . . . . . ��. Z'I ' -. � LICENSEDCONTRACTORS�ECLARATlON W �°y/ �1,�"' �� . I HEREBYAFFIRM UNOER PENALTW OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CFIAPTER '� doyd, � Pq `� . �' ���'p�9(COMMENCING WITH SECTION 7p00�OF DIVISION 3 0F THE�SrlfiE ND PROFESSIONS CADE,ANO z I � MYUCENSE IS W FULL ORCEAN�EFFECT� q?�{J � ��,m ° ' '. �`"iffi�ip' , � � , LICENSE CLASS p � LIC.NO. � �� � � ���DATE � 3�� !����I � CONTRACTOR�. � )a- W � {HEREBVAFFIRMUN�ERPENALTV � �. ��� � � � WORKE$iS'COMPENSATION DECLARATION (-s" �--� ��-� � �` a � � � OF PEHJURY ONE OF THE FOLLOWING DECLARATIONS:��F�d Z , � ¢ �'��.�,�_IHAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFOFWORKERS' _ � COMPENSATION,AS PflO1,/VOED BV SECTION 970�OF THE UBOR CODE,FORTHE PEflFOqMANCE U a �.,. OFTHE WORK FOR WHICI-ITHIS PEflMITIS ISSUED. � W ,IHAVEANDWILLMAINTpINWORKEPS'COMPEN9ATIONINSURANCE,ASREOUIREDBYSECiION ' Q 37000FTHELABORCOOE;FONTHEPERFORMPNCEOFiHEWOqKFORWHICHTHISPERMITIS '� 0" ISSUE�.MYWORKERS'CAMPENSAiIONINSLIR/WCECARqIER/WDPOLICYNUM9ERARE: CONSTRUCTION � o �P� � y-. CARqIER N flEVIF �/• • D � t �� � �� �� � , z'. POLICYNUMBER ELECTRIC Q p:�. (IWSSECTKNJNE�NOTBEOaMPLEfEDOF?IiEPEW.1f1'ISFORONEHUNDqFADOL{h9S�5700JORLESS). PLUM0ING ��� Z. �GEflTIFY THAT IN THE PEF�FOflMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL I' (,�}' ; SHALLNOTEMPLOVANYp�ASONINANVMANNERSOAS.TOBEC0AAE5UBJECTTOhIE �;/�,', WORKERS'COMPENSATIOIJlAW50FCALIFORNIA,ANDAGPEETHATIFISHOULOBECOME INSPECTIONFEE SUBJECTTO TYE WORKERS'COMPENSATION PROVISIONS Of SECTION 37000FTHE LABOR `'�g� � �,� CWE,ISHALLFORTHWITHCOMPLVWITH7HOSEPROVISIONS. ISSUANCE J�� n p�"�,,. � . . SMIP � � p TE:. APpLICANT: LL7. � JI �"' qNING FAILUqE TO SECl1RE WORKERS'COMPENSATION fAVERACaE IS 11NLAWFl1L,AN�SHALL BE ENEFGY P/C �.!' �� ;�3 BJECTANEMPLOYERTOCRIMIN'ALPENALTIESANDCIVI�FINESUPTOD4EHUNDREDTHOUSAt� ENERGYPEFMIT k ' '',�DOLLARS(f 7oD,oaO).IN ADDITION T�THE COST OF COMPENSAiION,�AMAGES AS PROV��E�FOR IN � Qj:�,,'.,SECTION3]OBOFTHELA90RCODE.INiEREST,ANDATfORNEY'SFEES. � - RETENTIONFEE: - �✓ � COMISTRUCTIONLENDINGAGENCY PRE-ALTFEE: � . �+ ��I HEREBV AFFIRM UNOER PENALTY�OF PERJURY THATTHERE�S UCTION LENDINO AOENCY a-�;''.�,FOR THE PERFORMANCE Of THF'WORK FOq WHICH T ITIS ISSLIED(SEC 3097.CIV.C.). W�'�; �, ,. � . . ��; '��LENDER'S NAME � . � �"�„��,,':'.LENDER'S ADDRE3 . � "�ICERTIFVTHATIHAVEREADTHISAPP4CATIONANDSTATETHATTHEABOVEINFORMATIONISGOqREC7 TOTAL FEES � �� � ' � w 'I AGREE TO COMPLY WITH ALL CItYAN�CDUNTY ORDINANCES AND STAT LAWS RELATING TO BUILDING � �I �;CANSTqUCIION,ANDHEREBVAUTFiOR12EREPRES�C�TAT7YESOFTHISC VNTVTOENTERUPONTHE � � ��I �,A80VE•MENTIONED PftOPEFRY FOR INSPECTIOIJ�l1FjPO5ES, �, - '. , ' . o I .� COMMENTS . A � / � � C° %%`e ��I �.P MITTEE� E�VRIN7) � � � ', 5` �2-- 9 �f �I',��SIGNATUR NMITTEE' " � DAT ' '- � .� _' RECPT.NO. / PAID BY �s' VALIDATION ~�� � . � WHITE—De artment . . . . � p Copy,YELLOW—Finance Copy,PINK—Assessor_Copy,GOLDENROD--File Copy,GFEEN—Appliqnt's� opy . -.,_ �.�,�t:.�E. .,�.,rr,.��.�.3.: , ..�.i..:. ,,:..-=�e�* ,�:,�.•^;: ,.4.:M;�";,ii e , .-�,�,r� �:i,'c e,."_r�S'+R��..:ti"-7 �.,1>sk:;'s �""'�a , � . ... ,., .. �. . - . .. � ,. , ,. . .. „,,...,.. �- a:;�: a ... �..... .-:.c:q � ....�. .. ,. -,,. � . � mxTBVr_e . 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