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HomeMy WebLinkAbout12996 ----_�� CITY OF DIAMOND BAR ' ' � DEPARTMENT_OF COMMUNITY&DEVBLOPMENT SERVICES ' �� 21660 E.Copley Drive Suite 190 � ' � PRESS \,,�.,,.. (904}860-3195 Faac(909)861-3117 sUII.nnvG r��1[�r Arr�.tcATi�r� . � ° � k�.,r FIRMLY . .. ,.:,: ..�,..�..�,.�. .� ,n.. . r ,, . .., � , .,�, , _,,,._ . , , ,., �_:.�,..h � JOBSITE •'a�� ,��-z,nr i'::st .,., ,a i 4.<;�+,. ^-� (''� , DATEICATION�-t-4��- NU BER, P/C ¢ ADDRESS �, rQ9� Hl�aF7.Ci�'L�:��' i�I�. , . C.-, �{ # � ` ISSUE TYPE OCC � APN LOT� TRACT �/�� �� - � pATE CONST. GROUP � OWNER � ` o ADDRESS '"` ,,�,, Z�NING SETBACKS � CITY _ ZIP���� EL -=�' REART RW O__�_ APPiICANT t�� SIDFJSIDE STREET RW ❑ � CONTRACTOR z+l ti� �: z a�� a tx ,. � 51DE ❑ � ADDRESS .%� �-t-����� �`� � ' � i PROPOSED USE o CITY'a-. „c-.� n�t�"'� ZIP�%iT�"y�'��'; o ARCH/ENG! x D�SIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDRO�MS a CITY ZIP _ TEL. � DESCRIPTION SQ.Fi. FACTOR PSF ADJ.AREANALUATION cn �� . OWNER-LUILD.Eft DECLARATION„ , ,� . . SFRlADDIREM � � O LL�8 CENSIE UW FORTFIE FIX.LOVYNG REASON(SEC.�7 3R 5 811$(NESBANP Pp0�OM THE CONTflACTORS LI� � Garage/Carport �' � � � � S510NSCod�E:ANVCIfYOH C.S CIXIN7YWHICHREIX116iESAPERMt7TOWNSTRUCT.ALTER.IMPROYE,DEh�LISH,ORfiEPAIRANYS7RUG W Pgi�O/DBCI( wNpE,PRIOR TO f�3 ISSUANCE,ALSO REQU�FIES THE APPCICANT FOR SIIbFY PERM�i TO FILE A SIGNED W STA7EMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PHOVISIONS OF THE CONTRACTORS LI� � CENSE tM!11CHAPTEq e(COMMENCNO WItH SECTION 7000)OF DIVISbN 9 OF THE BUS�NESS ANq PRO� � PooVSpa � FE&SIONSWOE70RTHATHEORSHEISE%EMpThIEREFROMANbTHE0A515FORTHEALLEGED,E%EMP- TION.ANVVIOLATIONOFSECTION7037.58VANVAPPLICANTFORAPERMITS�BJECT57HEAPPI.ICANT70 � Ae-qoof � ACML PENALTV OF NOT MORE THAN FIVE MUNDRED DOLLARS(E5ao).). � � OI,ASOWNEROFTHEPqoPERN,ONMVEMPLOYEESWITHINAGESASTHEiRSOLEpOMPEN5ATI0N. C1 CommerCial WILL DO iNE WOHK,MID THE STRUCNRE IS NOT INTEND50 OR OFFERED FOR SALE(SEC.7044,BUSb J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW ObES NdT APPLV TO AN OWN�R OF � PflOPERTY WHO BUII.D3 OR IMPROVE57HEREON,AND WHO DOEG SUCH WORK HIAASEIF OR HERSELF Op - [L� THFiq1QVIHISORNEHOVJkEMPLOYEES.PROVIDE�THATSUCHIpAPROVEMEPITSARENOTiNTENDED'OR � ' ' � Ll] OhFEREOFORSALEIF,HOWEVERTMEBU1�pINGORN�ROVEMENTISSOtAWITHINONE�EAROFCOMPLE- � �TICN,THE OWNER-BUIIAEfl WILL NAVE THE BURDEN OF PqOVING 7HAY,F�E�OR SNE OID NOT HllllA OP , IMPROVEFORTHEPUFlPOSEOFSALE�. - ' i� ���" O I.AS OWNER OF TF1£PROPERIY.AM ERCLUSIVELY CONTRAC7ING WITFI LICEN��D CONTRACTORS � TO CONSTRUCT TrfE PPQIECT(SEC.704f,BUSINESS AND PROFESSIONS C('l�E:TH£�Cb�NTFACTOPS L,I- VHIU8f10t1 ADJ.AREA ' � CEo�SEL+�WDOESNOTAAPIYTOANOWNEROFAPROPERNWHOBUILDSORIMPROVESTHEqEON,AND WMpC6NTRACTSFORSUCHPRQIECTSWITHACONTRACTOR�S�LiCENSEDP[IRSUANT70TNECONTRAG qUANTf'IY OESCRIPT�ON FEEI y T03i5 UCENSE tAW.). '{' o ❑i AR4 EXEMPT UNDEFi S�C, B.8 P.C.FOR THIS REASON Q ..� 'V��`�� " ' " ' - L � — — c b�.`[;'h t U.b � u" DA7E OWNER . . . U 4 � ��+�'V11�.G � o LICENSED CONTRAC70RS DECLARATION � -� ''�� �� � ua lc�Vc"��;0�'t" ' C� IH�REBYAFFIFiMUNDERPENALTYOfPERIURY7HATIAMLICENSEDUNDERPROVISION50FCHAPTER � -'�i � ,�ry� i�; � �;;' i ,�,,,qy,�M` ^�7�y � 9�COMMENCINQ WITM 3 TION 7o00J OF DIVISION 30F THE BU51NE5SAN�PROFESSIONS COD[ ND .•4. 11 4 ... Z�V 4YLICENSEISINFUL CE CT. m •g � �y f�..�.1,.�y�,� ��.��-.'G��j�.. i .PI LLt .1. ..4:. t9 � UGENSE CIASS�'��c LIC.NO. �� _ q . B� f .� � �^ d. �i��L J', i��.'Ga cY��.'a� �j DAT CONTRACTOR- "g� ' 0- u, �. d� �����Biis �' �L."�.�.E:'� 7 � C��f WORKE S'CAMPENSATlON DECLARATION J� 4 �� . .j � � � I HEREBYAFFIiiM UPIDER PENALTY OF PERJURY ONE OF THE FOIIOWING DECLAR0.TIONy�r. t!� � ' �a� � a � L7 IMAVEANDWILIMAINTPINACERTIFICA'fEOFCONSENTTOSELF-IN6UREFORWOPK'cRS' 2 � CAMPENSATION.AS PROVI�Ep BV SECTIDN 37000F THE LA80R CA�E,FORTHE PERFORMANCE 'U OF THE WORK FOFt WMICH 1HIS PBRMIT IS 158UE0. � O -- w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATIDN INSURANCE,AS REQUIRED BY SECTION Q 370a OFTHE LABOR CODE,FOR THC-PE�9FORMANCE OF THE WORK F R WH�CFF�HIS PERMIT IS p . ISSUEO.IAY WORKE ' NS I N INS CE CARflIERA LICtl NUMb'EH ARE: CONSTFIUCTION ? CAaRIER ''7 r . .-. PlANREVIEW �. , , . ., .... .--....,. .:... . .,_ . ... � .. z POLICYNUMBEH , � �� _ . � ELECTfj(C� - �� - � Q l� �4 Q (iHI55EC(%AVNE�PlOTBE �OFTHEPER�WT{SFOAONEHUMREDpOl1MSl�7oo) IFSS� PIUMB'�,NG ) � � z I CEFTIFY THAT IN THE PERFORMANCE OF TNE WORH FOR WHICH THIS PEflMiT IS ISSUEO.I 'MECHANICAL � (;}' SHALL NOT EMPLOYANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECTTOTHE � WORKERS'CAMPENSATIONLAWSQFCAUFOPNIA,ANDAGqEETHATiFISHOULDBECOME INSPECtIONFEE �/ � SU&IECT TO THE WOFKERS'COMPENSATION PROVISIONS OF SECTION 3]00 OF THE LA90P CODE,1 SHALL F TH M COMPIY WITH THOSE PqOVI NS. ISSUANCE o � `,�A 0 DA�',y_��PPLIGANT: �.----�.v�ir '�� - SMIP � ENERGY P/C _ WAHNING:FAILUFE TO SEC E WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE '�--- � St)BJECTAIdEMPLOVERT CHIMWALPENALTIESPNDCIVILFINESUPTOONEHUNDiiED O ENERGYPERMST DOLLARS(S1 W,aooj,IN ADOITION TO THE COST OF COMPENSATION,DAMAGES AS PriOVI0E0 FOR IN -- � SECTION37o80FTNELABORCODE,INTERE5i;ANDATTORNE`/'SFEES. RETENTIONFEE: oCONSTRUCTION LENDING AGENCY � PRE-ALT FEE: _��=�z � I HERE6V AFFIftM UN�EF PEN0.LN OF PERJURY TMA7THERE IS A CONSTRUC710N�.ENDING ApENCY � FORTHE PERFORMANCE OF TNE WORK fOR WHI(%a THIS PERMI7IS ISSUED(SEC.3097,CIV,CJ, 9 L i'4 � 9w gg�'y 7A�'�3✓ p ,.... ..,„. � LENOER'SNAPAE di.aA.f.[lei Ly..L F— LENDER'S ADDRESS_. 'p' � ICERTIF'/THATIHAVEREAOhiISAPP4ICATIONANDSTATETHATTHEABOVEINFORMATIONISCARPECT. 1 OTAL FEES � � I AGREE TO COMPLY W1TH ALL CITY AND COUNTV ORD�NANCES AND STATE LAWS flE�ATING TO BUIICWG . . - . . . CONSTflUCT10N,ANOHEREBYAUTHORIZEREPRESENTATIVESO�THISCOU TOENTERUPONTHE ' Z ABOVE�MEM�/IONEDPRJPERTYFOFINSP/ECTIpNPURPOSES. ,y 9 ! COMMENTS � % , .�y..,",�+ t'/6/AY. . �-�L"�✓'✓^„2. . ... ., � PEiiMITTEE NAME(PRIN'T) f y r '' � (.�q ..c.�,—.�m+.+'�r"..^__ . . , . _, {/� S ATUR�RMITTEE •DA�� . = RECPT.NO. 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