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HomeMy WebLinkAbout13005 (14) ��_ CITY OF DIAMOND BAR � DEPARTMENT OF COMIVIUNTTY&DEVELOPMENT SERVICES �. � 2165o E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 .' •••`� BUILDING PERMIT APPLYCATIOI�T ; -_ . ,<w ` k, FIRMLY """ ._ ..t,,.,e. _, .. . , . , . ;,� ...... ,.; . �, _. ...:.. .. �. �. ,. . _.. ... . . : �t „� : �,. � �.�•. � JOB517E' � ��� ��/�� APPLIC�71OF1' ' � ee �` F���f�I1T� '7/p� P/C � ADDRESS �v DATE NUMBER J�� # ISSUE TYPE OCC � APN LOT�� TRACT �� DATE CONST. GROUP p OWNER ZONING SETBACKS o ADDRESS �i � .� • � CITY � C ZIP fa�~ TEL. 2 FRONT RW ❑ APPLICANT �� 7��. REAR ❑ SIDE/S�QE STREET RW ❑ � CONTRACTOR t7 ' (J `e�° '�_ S1DE � � AODRESS " "' � CC7Y ~ � /L' ZI ��TEL. L- '^ � ��AOPOSED USE o AflCH/ENG/ � � DESIGNER -- NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROQMS � CITY 21P TE4. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ca� � OWNER-BUILDER DECLAFATION SFR/ADD/REM O � 1 HEREBY AFFIFW UNDER PENALTY OF PERJ�RY hiAT I AA1 E%E/APT FROM THE CONTRACTORS L4 � G�rage/Carport LIJ CEHSELAWFORTHEFOLLOWING�RF.ASON�SEC.7D3i.58USINE55ANDPROFESSbNSC,00E:ANYCITYOR U COUNTVWHICHREdARESAPERMiTTOGONS7RUCT.PLTEA.IMPROVE,DEMOI.ISH,ORREPAIRANVS7RUC- W py1i0/Deck WNRE,PRIOR TO ITS 168UANCE,AlSO REOUIRES THE AFPLICAN7�FOR SOCH PERIUIT76 FYLE'A SIGNE� W $7PoTEMENT iHAT HE Ofl SHE IS LICENSED PUPSUANT TO THE PROVISIONS oF TFIE CONTRACTORS LI- � CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF pIVISION 30F TME 9U51NE�S AND PRO� � PODUSpa � FESSIONSCODE)ORTHATHEORSHEISEXEMPiYHEREFROMANDTHEBASISFOf37HEALLEGEDEKEMP� � TION,ANVVIOIATIONOFSECTION7a31.6BVANVAPPLICANTFORAPERMITSUeJECT57HEAPPIICAN7T0 z R2•ROOf F ACIVILPENAL7VOFNO7MORETHANFiVEHUNDRE000LLAR5(55o0)_)� � ❑I,ASOWNEROFTHEPROPERTY.ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, O Comfiterdal � MALL 00 TH£WORK,AND T1iE STRUCTURE IS NOT INTENOED OP OFFERED FOR SALE(SEC.7b44,BU51� �I NESS AND PROFESStONS OODE:THE CON7RACTORS LICENSE LAW bOES NOT APPLY TO AN OWNF_R OF � PROPERfYWHOBUILD50RIMPROVESTHEREON,ANDWHODOESSUCHWOFIKHIM$ELFOFHEI'{SELFOR m pC TNNOLIOH HIS OR HER OY1M EMPLOVEES,RROVIDED THAT SUCH IMPROVEMENTSARE NDT IN7�'tdpED OR . � ,OFFEREDFOqSN.EIFt10WEVER.TNEBUILDINGORIMPPOVEMENTISSOIDWITHINONE�F�lROFCAWOLE� 'i�- Z TION,THE OWNER-BUII.DER WILL HAVE THE 6URDEN OF PROVING THAT HE OR 5HE DI�NOT EUIID OR . = IMPR�VEFORTFIEPURPOSEOFSALE). ❑I,AS OWNEH OF 7HE PROPEFlT�',AM EXCLUSIYELY CONTRAC7ING WITI�I LICENSED CON7RACTORS FlT � T(1 CONSTRUCT THE PROJECT(SEC.7040,BUSINESS AND PMOFESSIONS CACIE:TFiE C0�7RACTORS U- V21U8t1011 ___ ____ __ADJ.AREA_.____. W CENSELAWDDESNOTAP9LYTOANOWNEROFAPROPERTYWHOBUILDSORIMPAOVF5THEREON,ANO � YMOCONTRACTSFORSUCMPflQ1ECTSWITF!ACONTRACTOp(S)LICENSEDPUqSUANTI'OTFIECONTFiAG QUANTITY DESCRIPTION FEE � TORSUCENSEUW.J. � O ❑I AM EXEMPT UNDER S�C. B.8 P.C.FOR THIS REASON Q � — C) CC � �ATE OVdNER V W �+c( LICENSED CONTRACTORS�ECLARATION W IL 1 HFflE9YAFFIRM UNDER PENALiY OF PERJURY THAT 1 AM LICENSED UN�ER PROb'ISIONS OF CHAPTER � � � 9(CqMMENCINraWRHSECTiON7000)OFDIVISION30FTHEBL151NESSANPPROFESSIONSCOOE,AND � X MY UCENSE IS IN FULI fORCE AND EFFECT. m r ��M1 lL. p f � laL ? � . ,�/ � �2 --- �J'✓�,i� � � � I..ICENSE CLASS UC.NO.�j e- "�._ J �j OA(E °� "�' � CIN�ITRACTOR �' �� , n- . W � WORKERS'COMPENSATIO�DECLARATION � � U � I NEREBV AFFIRM UNDER PENAL7V OF PERIl1RV ONE OFTHE iOLLOWING DEClAR4TIONS:� Z Q � _IHAVEANDWILLMAWTAINACERiIFiCATEOFCONSENTTOSELf-INSUPEFOPWORKERS' � � COMPENSATION�,ASPpOV10Ed8Y5EC710N37000FTHELABORCODE:FORTNEPERFORMANCE W OFTHE WORK FOR WHICH THIS PERMIT IS I,SSUED. � � W �_I HAVE AN�WILL IAAINTAIN WORKERS'COMPENSATION INSURANCE,AS REIXJ'�RED BV SEC710N S 3700 OF THE LABOR CO ,FOR THE PERFORMANCE OF T'rIE WOPH FOR WHICH THIS PERMIT IS Q ISSUED.MYtlJORK ' PE TIONINSW%111HECARR1EqAN POLICYNUMBERARE: CONSTRUCTION — __ ._ _. .,_........'_"'_. �___._'__ _.._"�._..._—..—_...._... j cnnaieR �'`,�"� ,t.•°..,e3 _ PLAN REVIEW ��� Z aoucvNuinoesi_ � " " • • EL,E�T-RtC � � � (TH55ECTkXJNE�PIOTBE�PLEfE00FTNEPEPMTISFCRONEHUl�RED�4.lAR5(SiCO)ORLE551. PL�G 1 _ Z I CERIIFY THAT M THE PERFORMANCE OFTNE WORK FOR WHICH THIS PER�AIT IS ISSUED.I `MECHANICAL ��� L$' SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJEC7 TO THE y WORNERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREE?HATIFISHOULOBECOME INSPECTIONFEE �� � SUB.IECT TO THE WOAKERS'COAAPENSATION PROVISI�NS OF SECTION 3700 0F TNE LABOP ' � CO�E,ISHALLFOqj7HWITHCOMPLYWI TH S�PROVIStONS. P ESSUANCE � � /' r! ) � ,��t-e...�(� SMIP _�. p OATE: '� APPUCANT: ��4c---+� ug,��,t , . w ENERGY PIC J WARNING:FAILURETOSECUPEMOFKERS'CDMPENSAT�OYCOVEFiAGEISUNLAWFUI�,"l�NDSHALLBE � 1 �y SUf3JECTANEMPLOYERTOCR�MINALPENALTIESANOCIVILFINE5UP700NEHUNOFEOTHOUSAND ENERGYPERMIT DOILARS151oo,00n),INPDDITIONTOTHECOSTOGCOMPENSATION,�AMAGESASPROVIOF_�FORIN 1 � � � SECTION37080FTHELA60RCODE,INTEREST,ANOATTORNEY'SFEES. RETENTIONFEE: d CONSTRVCTION LENDING AGENCY pRE-ALT FEE: O � INEREBYAFFIRMUN�ERPENAL7YOFPERJURVTHATTHEREISACONSTRUCTIONI,ENDINGAGENCY FOR?HE PERFORMANCE OFTHE WORK FORYJHIGH THIS 7EflMlT IS ISSUED(SEC.3697,CIV.CJ. � W � �ENOER'S NAME '' 1'_' LENOER'SAD�ftE55 C - � W ICEPTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETMATTHEABOVEINFOPMfATIONISCORRECT. TOTAL FGG� �� � � w � I AGREETO COMPLV W1TH ALL CITV AN�CAl1NTV OflDINANCESP7J�STATE�NWS RELATMG TO BUILOING , H CONSTRUCTIDN,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTYTO ENTER UPON iHE � ABOVE�MENTIONEDPflOPEFlTYFORMSPEGTIONPURP05 . � ' COMMENTS � � C�-'�L:-�.' � ?�l /�s R�Z� aPERMITTE\NAAAEfPRIM'} �. - �• ! .— . � �,:� . � • _ •+..�... _ . ^ICNATU E OF IiMI EE �dTE ��� ' = 4 RECPT.NO. 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