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HomeMy WebLinkAbout12998 .. , ��� ��� CITY OF DIl�MOND BAR - DEPARTMENT OF CQMMUrTITY,&DEVELOPIVIENT SERVICES . w . 216G0 E.Copley Drive Suite 19i1 � °."'' �k""� � ;.; (909)860-3195 Fax(909)861-311? PRESS .". BUILD�IG P��214i�1'APi'�.IC.�`Y`f!ON ` ' " `;;�, �," FI,RM4Y .�: . , vM .. .. .,,n-., �r . a '.: -, �:� . � .:.; .w, .e...�. . r s, . .:�.. ,,... .:, . �s,,;a, �..� � �n �,n'��.� ,a 4 PERMIT P/C y�. JO�SITE` ��,��� HI GHC�E'`�.r�'T DRy APPLICA710N �,� � NUMBER � � # a A6DRESS DATE _ -r � ISSUE TYPE OCC �- APN LOT,.,�� TRACT DATE GONST. GRQUP � OWNER j .� � AQDRESS���-�-�� • _��- ZONING SETBACKS W CITY �1�_ ZIP "�� TEL '� °-;��- -� FRONT RW ❑ � A�PLICANT TEL<,,,�7� REAR C1 � � , _: , SIDE/SIDE STREET RW ❑ CONTRACTOR �a � SIDE ❑ � ACDRE$S_.��I:�hi� :i ��� ..,, ; t ��� �� r,,,Q: a� PROPCSSED USE Q CI7Y C ol mnv�-l-o ZIP E �d„py,y,A__� .. oAF4CWrNG/ ^ . ---- _ �z DESIGNER — NO.OWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS = CITY ZIP TEL. � `' " " DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION . � SFR/ADp/qEM [] I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT F50M THE CONTNACTORS Li� G8298(CBfpOPt -' �'�" � ��--� �� W CENSELAWfORTHEFOI�dWINGREASON(SEC.7037SBU$INE55ANDPPAFE5510NSCODE:ANYCII`'%6p (J) . � GOUNTYWHICIiREWIRESAPERMYfTOCANSTRUCT,AL7Efl,IMPROVE,DEMOLISH,ORREPAIRAN`/STRUG tW patio/Deck w TURE,PRIOfl TO ITS ISSl1ANCE,ALSO REf]UIRES THE APP�ICANT FDH SOCH PERMR TD PILEA SIGNEO 1J ., . � S7ATEMENT 7'HAT HE OR SNE IS LICENSED PUR6UANT TO�THE PNONSIONS OF 7HE CONTRACTOAS Lb � GENSE LAW(CHAPTER e(OOMMENCINO WIiH SECTION 7000)OF�NISION 3 OF THE BUSINESS AND�PFiO� �' POO�Spa FESSpNS CDDE)OR TH.�T HE OR SHE IS EXEMPT THEREfROM ANO 7HE BASIS FOR THE AIIEGEti EXEMP• TION.ANVYIOLATIONOFSECTION703t.58YANYAPPLICANTfORkPERMITSUeJECTSiHEAPPLICAA770 � p@-ROoP � AdNI PENALTY OF NOT MORE THAN FlVE HUNDRED DOLiARS(S5o0).): � ❑I,ASOWNEROfTHEPHOPERTV,ORMVEMPLOYEESWITHWAGESAS'HEIRSOLECOIAPENSA7ION, � COmflle�cial W1LL 00 hiE WORK�D THE STRUCTURE IS NOT IMENDEC/OR OFFERED FOR SALE�SEC.)o4d,�US6 J NE55 AND PROFESSbNS CODE:THE CANTRAC70RS LICENSE I�U,V DOES NOT APPLY TO AN�NER OF � PROPEPTYWHOBUILASOFIMPROVESTHEREON.ANDWHODOESSUCHWORKHIMSELFORHEq EIfOR � Cr. THROUGHHISORHERONMEMPLOVEES.PROVIDEDTHATSUCHIMpROVEMEMSARFNOTIN7ENDEl�OR m � ,OFP'ERWFOFSALEIF,HOWEVER,7NEBUILDINGOpIMPRDVEMENT1550LDWITHINONEVEAROFFOAlPLE- . z TION,THE OWNER•BUMER WILL HAYE THE BUftDEN Oi PRDVMG THAT�HE Ofl SHC DID NOT B111L0 aR = IMPAOVEFORTHEPURPOSEOfSALE). ` ❑I,AS ONMEH O�'THE PROPEliTY,AN EXCLUSIVELY CAN7RP,CTING WIiN 4�CENSED CANTRACTORS � TO^WN$TpUCT THE PRbJECt(SEC.70M,BUSINESS ANO PROFESSIbN5 COOE:TN�CDNTRACTOA$LI- VelUeii0f7 � �� ADJ.AREA - � W CEMSELAWDOESNOTAPPLYTOANOWNEROFAPROPEPTYWHOBtIILOSORIMPROVES7MEfiEON,ANO . ', S• N'HOCONTRAGTSFOR3UCHPROJECTSWI7HACONTRACTOR(S)L!CENSEDPURSUANTT07HECONTRAC- QUANTITY DESCRIF''f'ION ' � �. _, FEE �' TORS IJCENSE LAWJ. '� '... � . � � _{.. .. . ..,.. . �f �/ � ❑IMIEXEMPTUNbEflSEC. B.&P.C.FpRTHIS�PEASON U 4O�.�E� � ��..s.� d, ° / � cr �"Jc�.t',Z �U� r � DA7E ONRJER � W 1 � shower � o LICENSEp CONTRACTORS DEGLAAATION , -' �j �„ '�r�,-�Or - �° � C�� —i �r-{ � IHEREBYAFFIRMUNDERPENALttOFPERJURYTiAT1AMLICEN5E0UNDERPROVISIONSOFCHAPTER """ g i.".� �p d 0(COMMENCINCi WITH SECTION 7ao0)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS COD'c,AtJD Z "T �_�� ..__� T X MYUCENSEISRdFULLFO AN EFFE T. 7� m �,'S Q� E�y�..'�ra�v���Ia _�Y_��'J 4ia /,�v�.+�y' -4. L:-� o LICENSE CI.ASS �IC.NO. �os"C^".�"" �•^' j . � � w ter h�ate� f � VDA CONTPACTOR_ �� �- w '�'L'rCl � C.1.1"���'� � � WORK RS'COMPENSA'�ION DECIARATION Q �y T � �+ � .. uN+ � � U � IHEREBYAFFIRMUNDERPENALTYOFPERJURYONEOFTHEFOLLtlWING�=CLARATIONS: ;' � Z `�+� p ..�..5�+�*- �'�� f� �' d � 0 IHAYEANDWILLMAl13TAiNACERTIF�CATEOFCONSENTTOSELF-INSUpEfOPWORKERS' =I _ � CAMPENSATION.ASPROVI�EDBVSECTION37oo6FTHE'LABORCODE,FORTHEPEfiFORMANCE �J'� , OFTHEWORI<FOpWNICHTHISPERMITISI5SU60. W�i ! ; r p' �' m � � _IHAVEANDWILLMAINTAINWOqKERS'COMPENSATIONINSURANCE,ASREQUIREDBVSECTION � Q37000FTHEI.ABORCODE.FORTHEPERFORMANCEOFTHEMKIRK OROYHICHy�ISPEPMITIS � ' ISSUEO.MVWORKER '�� IONIN�^U�ANCECARRIER POLICVNUMe�anaE: CONSTRUCTION /,,��.y�..� . . . _.......... ._._..._....__..,........._... __.....__.____�. ? CARRIER _ +' "�-�� PLAN REVIEW � POUCYNUMDEA `� � E��� � � (IHI55ECTpNNE�NOTBE00P.�lEfEDCF7HEPEi�WTSWRCNEHUM1ORED00t.LAFS{StCo)ORLESS4 I PLIJ,P,�1NCr "�' Z ICERTIFYTHATMThIEPEflFORMANCEOFTHEWORKFOftWHICHTHiSPERMITISISSUCO,I `MECHANICl4L ��$� � SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE � WORNERS'COMP[NSA:ION IAWS OF CALIFOPNIA,AND AGREE 7HAT IF I SHOULO BE07ME INSPECTION FEE . � SV&1ECTTOTH ORKERS'COMPEN54TIONPROVISIONSOFSECTION37000FTNELA@OR �� - � � �yCO"DE, AW. iNCOMPIYW/ITHT, �AOVISIONS. ISSUANCE �� i � DA'Tj�,!_�', �ApPLiCAPf.7��� SMIP . .� � 0 J ENEFIGY P/C WARNING FAILURE TO SECURE WORKEFS'COMPENSATION COVERAGE IS IINiAWFUL,AND A1LOE �` � SU&IECTANEMPLOYERTOCRIAA1NAlPENALTIESANOCIVILFINESUPTOONEHUNDREDT USAND ENEiiGYPERMI7 � � pOlLARS(5��.�),INADOITONTOTHECOSTOFCOMPENSATION.DAMAGES OFORIN � SECTION37080FTriE4ABOFICODE,INTE(iEST,ANDATTORNEI^SfEES. RETENTIONFEE: ___�_ � �.� � � CONSTRUCTION LENOING AGENCY PRE-ALT FEE: O � IHEREBYAfFIRMl1NDERPENAINOFPERJURVTHATTHEREISACONSTRUCTIONLENDINGAGENCV , FOR THE PERFPRMANGE OFTHE WORK FOR WHICH h115 PERMIT IS ISSUED�SEC.3097,CIV.C.). Z W � 4EN�ER'SNAME F F— LEN�ER'SADDRE55 c � � I CERTIFYTHAT I HAVE ilEAD THISAPPUCATION AND STATE TrlATTrIE ABOVE INFORMATION IS CORRECT. TOTAL�E GS � � IAGREETOCAMPLYNATHAL�CfiYANDCOUNTYORDINANCESANUSTATELAWSREIATMGTOBUIt,DING , � , , CDNSTRUCTIOµAND HEREBYAUTHORIZE HEPRESENTAiIVES OF THIS COU TO ENTER UPON�THE Z ABOYE-MEN7'IONE PftOPERTY FOR INSPECTION PURPOSES. 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