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HomeMy WebLinkAbout16813 . . . ......... .... .. .. ... _ I.. . ... ._. ._ _ _ .. . � I . . . CITY OF DIAMOND BAR :�"�,� --�,- DEPAR'TA�NT OF COMMiJNITY&DEVELOPMENT SERVICES f� ,� � � � _ 21825 E.Copley Drive q (909)860-3195 Fax(909)861-3117 �'`� PRESS '"''<vwy''�w BUILDIIVG PERMIT APPLICATION �'� FIRMLY o DDRESS_ ����� �����°���P'3� C"�': APPLICATION , PERMIT P/C DATE��I� "�I NUMBER /���� # �o ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER ---���C�1'1�t�,d ����ie1i LL ADDRESS � �t 1 n�"� I �f7! €°i'I�fY1� ��. ZONING SETBACKS W CITY '�.��6"Y1041t� �R�'ZIP�.TEL.���'S�a3r C� FRONT RW ❑ � APPLICANT ' TEL. REAR ❑ � �- SIDE/SIDE STREET RW ❑ � CONIRACTOR CS� �1` P' SIDE ❑ o ADDRESS � ��� ' PROPOSED USE � I�P ��� ��'!, � l ciTv �.n� �s ziP `7��TEL.7I°J-rJ.��J-�1f��3 . „� I �w ARCH/ENG/. , �z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS = CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ' p�� � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HERE6Y AFFIRM UNOER P�NALN OF PERJL'RY iHAT I AM EXEMPT FflOM THE CONTRACTOqS LI- � GaragelCarport � W CENSEL4WFORTHEF-0LLOWING'�,REASON(SEC.7037.5BUSINESSANDPROFESSIONSCODEANYCITYOR �, U .COUNNWHICryREQUIRESFPERMI7TOCONSTRUGi,ALTER.�MPROVE,DEMOUSH,ORREPAIRANYSTRUG W PatioiDeck � W' TURE,PRIOR TO I7S ISSUANCE,�ALSO REdUIRES THE APPLICANT FOR SUCH PERMIiTO FILE A SIGNED w ' �� STATEMENT THAT HE OR SHE IS LICENSED PURSUAIJi TO THE PROVISIONS OF THE CONTRACTOFS LI- � �CEN3E LAW(CHAPTER 9�COMMENCING WITH SECTION 7ouoj OF DIVISION 30F THE BUSINESS AND PRO- U' POOVSP2 FESSIONSCODE)ORiHATHEOR5HEI5EXEAAPTTHEREFROMANOTHEBASISFORiHEAIIEG'eDEXEMP- (� yy V' TION.ANYVIOLATIONOFSECTI0I�7o31.5BYANYAGPLICANiFORAPERMIT5UeJECiSTHEAPPLICANTTO Z Re-Root ��'"/ ��. A CIVIL PENALTY OF NOT MORE 1HAN FIVE HUNDREO DOLIARS($Soo)J: Z�. . ❑I.ASOWNEROFTHEPROPERIY.OPMVEMPLOYEESWITH-WAGESASh1EIR50LECOMPEN5AT10N, ❑ CORiR1B�C18I -' WILL DO THE WORK,AN�THE STRUCTURE IS NOY INTENDED OR OFFERED FOR SAIE(SEC.7044.6U51- J NESSAN�PROFESSIDNS CAOE:'�'HE CONTF7ACTORS LICENSE LAW�OES NOT APPLY 70 AN OWNER OF � '�PflOPFATYWNOBUIlD50RIMPRaVESTHEAEON,ANDWHODOESSUCHWORKHIMSELFOpHERSELFOR = � ��THqOUGHHISORHEROWNEMPl;0YEE5,PROVIDE�THAT5l1CHIMPPOVEMENTSARENOiINTENDEDOR LY� � OFFEREDFOFSALE.IF,HOWEVER,!,THEBUILOINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- � Z� '.TION,THE OWNER-BUIL�ER WILL'iHAVE.THE BUR�EN OF PROVING THAT HE OR SHE DID NOT BUILD OR _ 'IMPROYE FORTHE PURPDSE DF SA�E). ' ]I,AS OWNEROFhIE PflOf7ERTY.AM EXCLUSIYELV CON7RACiING W1TH LICENSED CONTRACTORS e� ''�. �' ''.TO CONSTRUCT TFE PROJECT(S�C.7od4,6USME55 AND PROFESSIONS CODE THE CONiRACTORS LI- VflIU8U0l1 �rf y�� p A�J.AREA LLI. �CENSELAWDOESNOiAPPLYTOpNON[NEROFAPROPERTYWHOOUILDSORIMPROVESTHEREON,ANO ' �' ,WHOCONTRACTSFORSUCHPRO;IECTSWITHACONTRACTOR(S)LICENSEDPUpSUANTTOTHECONTRAP QUANTITY DESCRIPTION FEE TORS LICENSE LAWJ. � J � G I AM EXEMPT 11N�ER SEC.�, __8.&P.C.FORTHIS flEASON Q �, U LL � DATE OWNER U W ', � LICENSED CONTRACTORS DECLARATION W � � I HEREBYAFFIRM UN�Efl PENAL7V OF VERJURY THAT I AM LICENSED UNDER PROVI510N5 0F CHAPTER � �, �9(COMMENCING WITH SECTION 7000)OF DiVISION 30FTHE 6USINE55 AN�PPOFE5510N5 COOE,AN� z X MY LICENSE IS IN FULL FORCE AND EFFECT. m . W /'� }� � LIGENSE CLASS �m�� LIC.NO. ���[te`'�{�' � _ H ,�rp p� � � V DATE � � GONTRACTOR 31E�R'LAG"it� �E���Y� d W � WORKERS'COMPENSATION DECLARATION a = U � IHEREBVAFFIRMUNDERPENALTVOFPERJURVONEOFTHEFOLLOWINGDECLARATIONS: � Q � �IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENiTOSELF-INSUF1'cFORWORNERS' 2 COMPENSATION,ASPROVIDEOBYSECTION3�oaOF7HELABORCODE,FORTHEPERFORMANCE U ¢ F1HE WORN FOR WHICH THIS PERMIT IS ISSl1E�. � � W �HAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE.ASREQUIREDBVSECTION �j Q 37000FTHELABOPCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ��q�,s�� ISSLIEO.MYWORNEASCOMPENSA/T�IONIrypSURANCECARRIER�BANDPOLICYNUM9EflARE: CONSTRUCTION t a.e ¢ - _�TCC i'C ��`"IL7 PLANREVIEW � CARqIER �p p� e,}. Z POLICYNUMBER �'Y W7 � �PJ �� ELECTRIC Q 0 (iHISSECiIONA�mNOTBEO�MPCEfEDOfhIEPERIMISFORONEHUNDRmDdJ WS(5100�ORLESSJ PLUMBING � ICEPTIFYTHATINTFiEPERFOFMANCEOF7HEWORKFORWHICHTHISPERMITI515511'c�.l MECHANICAL �j' SFIALL NOT EMPLOY ANY piEfl50N IN ANY MANNER SOAS TO BECOME SU9JEC7 TO THE � WORKERS'COMPENSpTIONLAWSOFCALIFORNIAANDAGflEETHATIFISHOUL�BECON.E INSPECTIONFEE SUBJECTTOiHEWORKERS'COMPENSATIDNPROVISIONSOFSECTION3looOFTHELABOR ^'TAd"`"` lQ�� � COOE,ISHALIFORTHWITHCOMPLYWITHTH05 P�NS. '/� ISSUANCE L � @�� � .y f gry SMIP ""'"`�"�^' R 7� p OATE: S�f�y�I APPLICANT. �� � p+• � g �� / .!y { ' W ENERGY P/C �.�'. � ./r�`"`""~w / 4 �i._. �„�' � WARNING�FAIWRETOSECl1pEWOflKERSCOMPENSATIOnCOVERAGEISUNLAWFUL,AND5HAL46E - - ' � SUBJECTANEMPLOYERTOGRIMINALPENALTIESANOCIVILFlNESIJPTOONEHUNORE�THOUSAND u- ENERGY PERMIT � OOLLARS(E70Q000).IN A��ITION TOTHECOSTOF COMPENSAiION.OAMAGES AS PROVIDE�FOR IN E J SECTION37080FTHE LABOft CODE.INTEftEST,ANDATTORNEY'S FEES. �ETENTION FEE: E � �� ���� � � .:, .�. ' ,� Q CONSTRUCTION LENDING AGENCY ` � PRE-ALT FEE: f: � IHEREBVAFFIRMUNDERPENALTYOFPEflJURYTHAiiHEFEISACOhSTRUCTiONLEN0INOAGENCY ���'��K i 0^ FORTHEPERf-0RMANCEOFTHEWORNFORWHICHTHI5PERMIT151SSUE�(SEC.309�,CIV.C.). ��� ;r���r„�°.�.„_ – � . ,.,_...,_....-.`._"'.:"._�:"�"..�'__-,:"e'e".' . W —" � LEN�ER'SNAME - F^ LEN�ER'SADORE55 ' /��,r� � ICEqTIFYTHATIHAV6READTHISAPPLICATIONAN�5TA7ETHAiTHEABOVEMFORMATIONISCOflRECT. TOTAL FEES f��eqy • W I AGREE TO CON�PLY WITH ALlC1TY AND COUNTY ORDINANCES AN�STATE tA'rV5 RELATING T06UILDING 0. CONSTflUCiION,ANDHERE�VAUTHOPIZEREPRESEN7A71VE50FTHiSCDIJNTVTOENTERUPONTHE Z ' ABOVE�MENTIONEDPROPERNFORINS�EC710NPURPOSES. COMMENTS Q i_. m �Z�"�ixts�t� ��'�r�r ���i�ee� � . �e�xrc' Q PERMI'7E NAME RINT� �' , �; ����1�� � SIG ATUREOFPERMITTEE '�, �ATE _ . R[CPL NO. PAID BY VALIDATION ~ V✓HITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,G DENROD—File Copy,GREEN—Applicant's Copy . . . . , .,_, ,. - .. . �.r.� ....� . �.�-�:: :_ iM.��n�«+�L?h,....ii�.,: 'd1.wa=,a �flhn"a � , , . . .,. , . . _,.. , ...., � ... . . . ' � y ='d . . � ,� ' ^'��. € ? .:. ., 1^ ... , . _ , . . � & ��� . .� �1,,.. .. ri #.. �, ,V � �'�u�#",!��,*�''� �-� r $�., �"� �. �^a � a -,. d '� » �. � ��� f � � � ts € , r� � � � u s � � � � �;ws � 7 � � r �s9 � ,s =� � t, a� � '�'.�la�� aa, f 6�t�� ka�� ��q § ; ka� 3� � v �. '.�: a5� # A��,� Y {a, -ry� � �:x � ���� k � a i a �� d r'� � ? 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