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Home My WebLink About13691 (16) rr CITY OF DIAMOND BAR �~� �---��--- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Gopley Drive Suite 19i1 ` �„a�`" (��s6o-�i�s F��ebi-3i i� PRESS , sun.Dnvc r . „ ..... - .. ... ...,. FIRMLY �. ,, ...ERMIT APPLICATtON. �. ,.. , . ...:- �. .-. o DDR'ESS ��C� I7 Il.�r-/T�� .� ,,/. =, DATE CATlpN �%/�"�� NUMB R� y� #/C �� $ ISSUE TYPE OCC APN LOT T T DATE CONST. GROUP O OWNER L- YJI�.� Q ADDRESS E Z,- ZONING SETBACKS �W CI'!Y �� ZIP 5�,� T L ��+,`� REART RW O APPLICA T _,_f�_ _ TEI�i-�s�+�+j�C SIDE/SIDE STREET RW ❑ � CONTRACTOR�"��S i �' �C�.^__��/�� SI�E ❑ p� ADDR S .- - f Q CITY . ZIP � L. `L�- . -�.,j PROPOSED USE �r:✓T�%/�� 'l.-�. o ARC N / , � DEStGNER Np.DWEL. NO. NO, ADDRESS � ' UNITS STORIES BEOROOMS � CITY� ZIP�EL., cn DESCRIPTION SQ.FT. FACTOR PSF ApJ.AREfWALUATION � OYN�fER-BE11tDER DECLARAT�ON SFR/ACDD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAi 1 AA9 E%EMPT FROM 7HE CONTHAC7oRS LI- Ggr�gBlClfport W CENSELAWFORTHEFOLLOWINGREASON(SEC.703t.58U5ME5SANOPRDFESSION$CODE:ANYCINOR (� G7 COUNT'/WHIqiREIXARESAPERMITTOCON5TA11CT,ALTER,IMPR0VE,0EMOlISN,ORREPAiRANYSTflUC- W Patio/Deck TIJRE,PRIOR TO ITS ISSUANCE,�1LS0 REOUIRES THE APPLICANT FOR SUCH�PERAAIT TO Fl�E A StGNEO W STATEMENT THAT HE OR SHE IS UCENSED PUiiSUANT 70 THE P�OVISIONS OF THE CONTPACTORS U- W � CENSE LAW(��TER 9�COMMENCINO WITII SEGTION 7oo0J OF DIVISION J OF THE BUSINESSRNp PRO- V' p006�SpB FESSqNS CW E�OR THAT HE OR SHE IS EXEMPT THEREFROM AN�THE BASIS FOR 7HE ALLEGED EXEMV- � TION.ANVVIOt.ATIONOFSEC710N7031.5BYANVAPPLICANTFORAPERMITSU&lEC7STHEAPPLICANTTO Z Re-Roof � ACMLPENALT'OFfdO7MORETHANFIVEFiUN�RE�00LLAAS(SSoo).j: � � ❑I.ASOVMEROFTHEPROPERTY,ORMVEMPLOYEESWITNWAGESASiHEIRSOLECOMPEN5ATi0N, O Commercial '.M � NIILL DO THE WORK,AND THE STRUCTURE IS NO7 INTENOEO OR OFFERED FOR SALE(SEC.7044,BUSI- .,J � NESSAND PROFESSIONS COOE:THE CANTFACTORS LICENSE LAW DOES NOT APPLY'fD AN OWNER OF = ' � PROPERTYY/HO BUIL0.5 OR IAIPflOVES THEREON,0.Nb MMb pOES SUCH WORN HIM3EI:F OR HERSELF OR WTHROUGHHISORHEROWPdEAOPLOVEE3,PROVIDEDTHATSUCHIMPROVEMEPITSAkENOTINTENpEDOR � � OFFEREDFOHSALE,IF,NOWEVEi1,TFiEBUILDINGORIMPROVEMENI'ISSOIDWITHINONEYEA�90FCOMPLE� Z �TIOPI,THE OWNEF�BUILDEP WILL HAYE 7HE Bl1RDEN oF 7ROVING THhT NE OR SHE DID NOT BUII.D OR � IMPpOV£FORTHEPURPOSEOFSAIE). w ❑I„�SOWNEROFTHEPROPERN,AMEXCLUSNF,IYCAN?RRCTIKGWI7l-GCEN6EDCON7RACT�RS /y�y — � TO CONSTRUCT THE PROJECT(SEC.1040,BUSINE55 AND PROFESSIONS CODE:TI1E CONiRACTORS�I- V31113tiCn t,�s('V ADJ.ARcA lJ.I CENSELAWDOESNOTAPPLYTOANOWNFAOFAPROPERNNRiOBU1LOSQRIMPROYESTHEREON,AND � WFqCON'TRACTSFORSUCHPROJSCTS\VITHACONTiiRC70R(S)I:ICENSEDPUi15UAPlTTOTHECA�TRAG QU�,f4TIT' bESCRIPTION FEE Y TORSUCENSEIAW.). � O I AM EXEMPT UNOER S�C. B.&P.C.FORTHIS REASON � ' � U � -- � OATE OWNER U (�� LICENSED CONTRACTOHS DECLARATION � W � � . �:'.L'5�..�.�"� 1 H�EBY AFFIRM UNDER PENALTY OF PERJURY THAT i AM LICENSED UNDER PROVI510NS OF CHAPTEft � � 9(CDMMENCINQ WITH SECTIDN 70001 OF DIV�SION 3 qFTHE BUSINESS ANO PROFESSIONS GODE.AND Z _ �� MYIiCENSE IS IN FULL FORCEAND EFF�CT, m ]� ��p° r�� UCENSE CLASS � UC.NO. 7 ' ti-1 �� " .. . .�.. `�' .i�'�';e.,,„, � �ATE �.1,Z=�r� CONTRACTOR _ 0. .,.r y. �y; . . . ..,.. � �: �'r?� W � WQRKFRS'COMPENSATION DECLARATiON 4 '�� I Fl1-R:8y@ AFFIRM UNDER PEN.LLN OF PERJURY 011E OFTHE FOLLOWING DECLARATIONS: Z d �7•��' �HAVEANDWIl.LMAINTAINACERTIFICATEOFCONSENTTOSELFINSLIREfORVJOFKERS' _ Q CAAIPENSATION,AS PflOVIDED BV SECTION 37900FTHE V BOR CODE,FOR THE PERFCIRMANCE UW OF 7HE WORK FOR WXICH THIS VEHPAIT IS ISSUED. � � � IHRVEAND'MLLMAIPRAINWOANERS'COMPENSA7ItlNINSUAANCE,FSRE�UIRF_DBYSEC7ION Q 37o00FTHELR^HORCODE,FOR7HEPERFORMA�'CE06TH�WOR#FORWHICN?HISPERMITIg - ��+ ISSUED.MY WOPoCEFSS'COMPENSAT!ON I%SURANCE CqRRIER AND POUGY t�UMeER ARE CONSTRUCTION �_.�].��,.y� s.l g� µ, y�,�/� � CARRIER � ._._ _, LAN IEW ,�J � ,(�G��^,�{{{ F�� . � POLICY NUMSER _ � ` Q Q <rw�ssEcnc�r�Memr�rseaauti�rEa�triEa�wm�sFoaor�eru,��c;xi.tsu�spirn�ofliEssa PLUMBiNG Z ICEATIFYTHAT SNTFtE PERFORMANCE OFTHE WORK�OA WHICH TNIS PERASITIS:SSUEO,I MECHANICAL ('} SHALLNOTEMPLOYANYPERSO4INANYMANNERSOA5708ECOMESUBJECTTOTHE � WORKERS'COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOUTA BECOME EG E _ �y�q--� � SUBJECT TO TNE WOflKERS'CqMPENSATION PROVISIONS OF SECTION 37po OF THE LABOF "� �7�, �+� CADE,ISHALLFOR7NWITHCOMPLYWITHhIOSEPRpVl510N. SUANCE 4yY �'-.1 .�V ✓ p DATE: ��_,(�� APPLICANT: _ ��.�.�,.��'�' _ �!Q �1+' J WARNING:FAILURFTO S[CUqE WORKERS'COMPENSATIfJN COVERAGE I�i1.NlAWNI,AND&HALL 9E P�C -- � SU&IECTANEMPLOVEflTOCRIMINAIPENAlTIESANDpVILFINE$,UPTOONEHUNORE�THOUSAND ENERGYPERMIT � DOLLARS(5100.000J.IN A�DITION TO THE COST OF COMPENSATISN;bAMAGE$AS PROVIOED F-0R IN J SECTION3]o80FTiELABORCO�E,MTEREST,ANDATTORNEI"'�FEES._,� RETENTIONFEE: � '- �...�.. . �., � ;�.✓O CONSTqUCT4fl,;�LENDINU�A�iENCY�� PRE-A{L7�FE�:�� IHEREBYAFFIRMUNDERPENALTYOFpERJU�AT7HEREISACON$'�'HUCTIONLENDINGAGENCY jM'� : FbR THE PERW RMANCE Of TFiE WORK FOi�R4H CH?HIS PF�fyM1T IS 145UE0(SEC.3087,CIV.C,�. �-T Z �� W _—_ —'__—'._ � LENOER'S NAME '" � .ef F— LENOER'SADOFE35 /� ICERTIF/THATIHAVEFEAOTHISAPPLICATIONANDSiATETFiATTFiEAeOVEINFpqpApTtONISCORRECT. TOT L FEES � , j/ � IAGREETOCOMPLVWITHALLCINANDCOUNTYORQINANCESANDSTATELAWSREtATINGTOBUILDING � .. . � CONSTRUCTION,ANOHEREBVAI.iTHORIZEREPRESENTATIVE5Y1CTF71SCAUNTV70ENTERUpONTNE i Z ABOYE-MEIYf10NEDPROPEflTYFORINSPECTIONPURPOS�S. �� ENTS��J�� ck� � ��._,qL �� m ¢ PERMITT E(PRIYT) . . . . � � ,�2�._ .Z"(�-��_ � SIGNATUREOFPERMITTEE OATE �. Z RECPt NO. 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