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HomeMy WebLinkAbout12309 (11) CTI'Y OF DIAMOND BAR �r �/ ' COMMUNITY DEVELOP1vIENT DEPARTIvIBNT � ..,,.,� 21660 E.Copley Drive Sutte 190 _ , ;, , PRESS (909)860-3195 Fax{904)$6l-31`17 �'°"' BUILDING PERMIT APPLICATION FIRMLV . -_ � ; ;.� , _ � __ . .::. o DDR�ESS� .24005 HIG�T I)T��CVE., .. � .... DATE CATION��-Z�_ C NU BER ��� �/C c� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER PTFRC'F CYINSTRTi(:Ti(1N ADDRESS ZONING SETBACKS w �Te���4� FRONT RW ❑ Z CITY mo+mT r r+Tmcs n,ZIP�_ TEL.�i�ry/��.�(� REAR ❑ g APPLICANT ' TEL. SIDEJSIDE STREET RW ❑ � CONTRACTOR �NK 1�iAR1X1N1F. �i S(]NS, lTY'- SIDE ❑ � ADDRESS -� PROPOSED USE � CITY 917��. TEI.6=���F �4r �— o ARCWE�� z DESIGNER NO.DWEL, NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cn � OWNER-BULDER DECLARATION SFRlAD�lFiEM O p I NEREB�AFFipM UNDER PENALN OF PERJURV TNAT I AM E%EMPT FROM THE C6NTRACTORS L4 � Garage/Carport W CENSEUWFORTHEFOLLOWINGAEASOY(SEC.7a37.68UsiNE55ANDPftCFE5510NSCODE:ANYCITYOR U COUNTYWHICHREQUIRESAPEFMITTOCONSTRUCT,AITER,IMPPOVE,OEMOL�SH,OPREPAIRANYSTRUC- W pg[i0/DBCk wTURE.PRIOR 70 RS ISSUANCE,ALSO HEQUIRES iHE APPUCANT FOR SUCH PEFMIT TO FILE A SIGNE� � STATEMENT THAY HE OR SHE IS LICENSEO PUqSUANT TO THE PROVISIONS OF�THE CON7HACTOR6 LI• � CENSE LAW(CHAPTER B(COMMENCWG WITN SECTION 7000)OF 61VISbN 9 0F THE 9USINESSA1J6pHO- � Po0USp8 � FESSIONSCADE)OHTHATHEORSHEISEI(EMPTTHF.REFROMANOTHEBASISFOATHEALLEGFDE%EMP� (� V TION.ANYVIOIATIONOfSECTION7031.58YANYAP7LICANTFORAPERMIT&U&IECTSTHEAPPLICMITTO Z Re-Roof � A CIVIL�ENAIN OF NOT MORE THAN FIVE HUNDRED DOLtAR5I350o}J:� �- - � O QI,ASOWNEROFTHEPROPERTV,ORMVEMPIOVEESW�TNWAQE5A5THEIR50lECAMPENSATION, � Commercial Z WILL DO THE WORF(,Ahb THE S7RUCTURE IS NOT INTENOED OR OFFEFIED FOR SALE(SEC.70A4,BU51- J NESS AND PROFE5510N5 CODE:THE CONTFACTORS LICENSE LAW OOES NOTAPPLY TO AN OWNER OF � vqGPEflTY WMO eUIIDS Oft IMPROVES THEREON,AN�WHO D0E5 SUCH WORKHIMSELFOR HER56LP OR = � THfiOUGHHI50RHEFONT1EMPlOVEES,PROV10EQTHATSUCHIMPROVEMEN7SApENO71NTENDEDOR m QOFFERE�FORSPIE.IF.HOWEVER.THEBWLDINGORIIAPROVElAENTISSOLDWRHINONEYEARdFCOM11PLE- � TKKJ.THE ONMER-BWLDER WILL HAVE THE BUROEN OF PROVING THAT HE OR�6HF.DID NOT BUILD OR = IMPROVE FOR TNE CURPOSE OF SALE). ❑I,AS OWNER OF THL PROPERTV,AM EXCLUSIVELY CONTRACTNG WiTM LICENSEO CANTHAC7OqS � TO(:ONSTRUCT THE PROJECT(SEC.70u.BUSINE55 PND PROFESSIONS CaDE:TNE CONTRACT�iS ll� V81U81iq1 ADJ.AREA W CENSELAWDOE3IYJT,4PPlYTOANONTJEROFAPfiOPERTYWH09UI1DSORIMPROVESI'HEREDN.AND � WhqcoYTPACTSFORSUCHPROJECTSWITHACONTRACT�Fi(S)lICE4SEDPllF50ANTTOTHECONTRAG QUANTPTY DESCAIPTION - FEE TORS LICENSE LAW.�. f� /� � G I AM eXE�APT liNOER SEC. 8.6 P.C.fOR TH4S REASON Q v� � 4� � (� � � !�' .'�' zDATI: _ OWNER W ���� �Q UCENSED CONTRACTORS DECLARATION �y �C'�J^ 2 1 HEPEBY AFFIR/A UN�EH PENALTV OF 7ERlUPY THAT I AM LICENSEO UNDER PROVISIONS OF bHAPTER� �� � 9(COMMENCING WITi SECTION 7000)Of DIVISION 30F THE BUSINESS AND PROFES31ONS CODE,AND X AIY LICENSE IS IN FULI FORCEAND EFFEC7. :2' � eSe � � UCENSE CLASS C/36 C/16 �,�.No. 397884 � � r�� ►— oare 12/31��1$ coNrr��r _ � -G� ' � � ' . ¢� WORKERS'COMPENSATION DECLARATION� '27.�.i�-� ¢ � � �°'„� �' � J � � I HEREBY AFFIRM UNDER PENALTV OF PERJURY ONE OFhIE FOLLOWING DECLARA710N5: Z J � � C1J a .�;, yy� � __IFiAVEANDW1�lMA1NTAINACERT1FlCATEOFCANSEw'TTOSFLF-INSUREFORWpRKERS' S ;f 6 �..� "f���✓° Q COMPENSATION,A6 PROVIDEO BV SEC71oN 3�0o OFTHE LABOR CODE,FOR THE PERiORMANCE W OF THE WORK FOR WF11CH THIS PERMI7IS I5SUE0. � 0 W __I HAVE AND WILL MAINTAIN WORKERS'COMPENSAriON INSURANCE,AS REOUIRED 8Y SECTION Q 37ao oF THE LABOR COOE.FOR:HE PERFORMANCE Qf THE VfORK fOR WH��CH THIS PERMR 15 ISSUED.MVWORKERS'COMPENSATIONINSURANCECARRIERANDPOLICVNUMBEPAflE: CONSTRUCTION J j GAflFIER FR�F��M,y��p3'f' �Y�VIPFNCdTTf1Tf _ PLAN REVIEW � POLICYNUMBER_,fyl]L,�[p-7�9�7-n� � ^� ELECTFIC Z ,J ��^"•. `,. ¢ (ttilSSEc7aNNE�NOTBE�IXd'IErEooF7FlePEanMilSwao�vEHUNDf+EODouARs(s1wloRt,c'SS). P MBI O Z I CERnFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEq I MECHANICAL (!7 SHALI NOT ENPLOV ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJE(:TTO THE � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANOAGREETHATIGISHOULDBECOME iNSPECTIONFEE SU&IECT TO THE WOqNERS'COMPENSATION PFOVISIONS OF SECTION 37ao OF 7HE UBOR � = CODE,I SHALL FORTHWITH COMPLV WITM THOSE PROVIS70N5. ISSUANCE � SMIP p DATE: APPLICANL -- w ENERGY P/C � WARNWG FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS I/NLAWFUL,ANO SHpLL BE � SUBJECTANEMPLOVERTOCRIMINALPENAIT�ESANDCIVILFINESUPTOONEMUNDAEDTMOU5AN0 ENERGYPEAMIT DOLLARS(S1a0.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 37oeOF iHE LA80R CODE,IN7EREST,AN�ATfoRNEYS FEES. � RETENTION FEE: __ � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � I HEREBV AFFWM UNOER PENALTY OF GER.1UqY THRT h1ERE IS A CONSTRUCTION LENOING AGENCV � FOR THE PERWRMANCE OF THE WORK FOR WHICH THIS PERM�71S IS3UED(SEC.3097,CIV,C.). .. , . . Z � . W I � LENDEH'6NAME �' �- . ..,....� . . .,.._:,. ,...<. . .. F— LENDER'SADORESS � .• � �CERTIFY TMA71 HAVE RERD THISAPPLICATION ANO STATE THAT THE ABOVE MFORMATION IS CARpECT. TOTAL FE ES . � , W ; d IAGREE7000MPLYWITHALLCITYANDCOUNTYOROINANCESANOSTAYEV.VfSRElA71NGTO�BUILDiNG �. CONSTRUCSION,AND H^�REBV AUTHORIZf REPHESEtiTAT1VES OFTFIIS COUN7Y TO ENTER UOON THE Z ABOVE•ME TIONED PROPER7Y F INSPECTqN OUPPOSES. COMMENTS � �� �l� �`�� � Q � m PERMITTEE .���j•5� �;�� � —/ -- i. � S�ONA7 E OF P RMI E DATE � ' = RECPt NO. PAID BY VAC�DATION'_ ~ WHITE-DepatlmeM Copy.YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENRO[)-FOa Copy,GREEN-ApplicanYs Copy�� � � � � � � :�,«.�w��� .. . .. _ ---�_..-_ . _.. . . .. . . . . . .. r„ ..t:;: ) .�,i,.:.,<:4r.�...u.�.:.,:�. .�,:;?y si �..nt,.`.11i a+i,.v'. r4,.a,'$i{j^w.� '+`�.�,.'m4 J+{,w-��� 'pt. ti . r ,. . � . .,.<. . ,e . . , . . . �'N`!^°��,1 .�:;:.by. .'+'�+p�� ts�f'(.,'7i;�'4.�:a«��- xi^.:,"SY�,=,ax, � n��Ne rrv . .. ;�- , n��`..'�.5'� . . .�i'%}�4 ,.."�".ss �"kto-;�,3?R�... u. :b'; . . .,..:,�-.., 6s9� '6J�,_6J1d17Y{.�1 9V..-���.: . ..;; �. . �. ;,a� ' I1�����B 9�� �������:r.,"�. . ...„ ,: . ,i;x ��,v�° ,�a+.A" . . ,.� .�....... ,. .. .�..., ,.r',�a:,.;,. �: • � , � .�,.. . �.�.r .; ,.:. n, , o _.. .:..,_..�,�� , . � � 0 � � :_:. - :,...:.�._.,�.._...:�._, ,�� SET BACK . _ __._ FLOO�i JOiST_. - -- -- �=T�S/F�RIVfS/STEE� _. 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