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HomeMy WebLinkAbout12454 (11) 4�,�s.� f� �--� � CITY OF DIAMOND BAR � � ^-�� DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES ,�; 21660E.CopleyDriveSuiteT90 � ��)ado-si9sF��s6i-3ii� PRESS %�� BUII.DING�'E A�'PLICATI�S�1, . „ � . . ,.., _.. . . . _.. .w ..,. .�. , .. ... ., . ;:; ., ... FIRMt.Y , � .. .; ..,.:. .�.�.< � ' ,�I'�".� �. ,�::'�.:�f i .�t.,,;:�`�� ,.:��lk3F +.���� .� - ' /� Q ADDRESS ��1 �.1���W�`'i�'@, pC' , APPUCA'1�iO1V {`� !� PERMI'C � � /C � DATE k•� NUMBER # � ISSUE TYPE OCC -- APN LOT TRACT DATE CONST. GROUP p OWNER ��Q''�� S\1 Q ADp E5S 4�'a.�(, �d �, p��G7�►J �\h'Q,.. ZONING SETBACKS QCITY�\Qr"O`�C� �11r ZIP al�a TEL.�qV-o�]_"��_ FRONT RW ❑ � APPLICANT TEL. REAR ❑ SIDEISIQE STREET RW ❑ CONTRACTOR �'� ��4�� SIDE [' O AODRESS ��o�,��.1�.'�V�r l.� � PROPOSED USE CITY�`l'��� C� ZIP 3.�t SZb TEL.'�10-l��„_ w ARCH/ENG/ z DESIGNER ��R NO.pWEL NO. NO. � ADDRESS �ln�rg l y�_�Q,_ UNITS � a�TORIES "' BEDROOMS y CiTY �`�„�` h"�'`n CG. ZIP aa$'�C�TEL.'13_��_ cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-EtUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFlRM UNDER 7ENALTY OF PERJURV TNA7I AM EXEMPi FROM THE CON?RACTORS LL Gefd90/COfpOtt W GENSEUWFOR7HEFOLL0ININGREASON'(SEC.7o51.5BU51NE55ANOPROFE55roNSCODEiANVCI7VOR (n CIX1MfV WHICH NEOUIqESA PERMRTO CONSTRUC7 ALTER.IMPROVE,OEMOLISH.OR REPAIR ANV STRUG w 7URE.PRWf7 TO ITS ISSUANCE.ALSO REQUIqES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED W P8t10/DeCk $UTEIAENT-THAT FIE�OR$RE fS UCENS�PURSUANT TO fiHE`pRONSION$OF THE CONTRACTOp5 LI� � CENSE LAW(CHAPTER 9(COMMENCIN6 WITH SECTION 7nob)CK'DIVISION'3�OP THE BUSINESSAND'PRO- �'�' POOUSpd fESSpN3 COOE)OR TH.4T FiE OR 3HE IS EX�2MPT 7HEREFROM ANO TNE BASIS FOR THE AIL:"-OED EXEMP� �� TION.ANYVKKATIONOFSECTION7099.6BYANYAPPLICANTFORAPERMITSU&IEC757FIEMPPLII:ANTTO R8-ROOf � A CML PENAITY OF NO7 MORf THAN FlVE HUNDRED DOLUIRS(Ssoo).): � �- � ❑I,ASONRIEROFTHEPqOPERTY,ORI�AYEMPIOYEESWITHWAGE5A5THEIR50lECqMPENSATION, COfI1fIlBfCi81 - WILL DO THE WOFIK,AND THE STR�CTURE IS NOT INTEND6D OP OFiEiiE�FOR SALE(SEC.7ob4,BUS6 Jn � NESS AND PflOFESSIONS CODE:THE CANTRACTORS LICENSE LAW pOES NOT APPLV TO'AN OWN�R OF � PFi�PERtt VrtiO BU0.D5 OR IMPFOVES TMEI3EON,AN�WHO pOEs SUCH WORK HIA45ELF OR HERSELF OR � 1HFOUaHHIS�OR�HEHOWNEMPL6VEES,pIiOVIDEDTHATSUCHIFAVpOVEIAENTSARENOT!NTENDEOOR � � OFFEHEDFORSALEIF,HOWEVEIi,7MEBU1LbMGORIMPROVEMEMI550LPW17HINONEYEAftOFCAMP�E� � TIQN.TNE ONMEp�8U1tAER 1VIL1 HAVE THf BUR�EN oF PROVING THAT HE OR�SHE 01��'N�T Bl11LD OR IMPROYE WRTHE PURPOSE OF SALE7. ❑I.AS OWNER OFTME PROPERTY,AM EXCLUSIVEL7 COMflACTIN6 WITN IICENSED CONrPACYORS � 70 WNSTRUCT THE PqO.IECT�SEC.7oA4,13USINESS ANO PROFESSIONS CODEi THE bONTRACTORS LI� VelUation ADJ.AREA W GENSEUWDOESNOTAPPLVTOANOWNEROFAPROPEP7VWHO8UILD30RIMPROVES7HEREpN,AND � VhiOCONTRACTSFOPSUCHPR0.IECTSN7TNACONTRACTOR(S)LICENSEDPUHSUANT70TV1ECONTRAG QUANT{lY DESCRIPTION FEE � Y TOFiS LICENSE UW.). � O I AM EXEMPTUNDER SEC. B.&P.C.FpR'(HIS REASON Q 3 � � '� � � y�,,,y�,,�� y� � DATE O�NhER - -----.-- U �"R."�V h�. �C.�, � W o LICENSED COIJTRAC70FS DECLARATION -w t � I HEREBV AFFIRM UNDEA PENALTV OF PERJURYTHAT IAM IICENSED UN�ER PROVISIONS OF CHAPTEH � e(COMM£NqNOWITH5ECT10N7oaa)OFDp/I510NaOFTNEeU5INE55hNPPROFE5510N5CODE,AN� Z - �+ ,n' XL� MY LlCENSE IS IN FULL fORCEAN�EFFECT m � �C` � U� U Y LLI � UCENSE ClASS C'� �LIC.NO. O qqq � v DATE ``�`��� _..,CONTRACTOR j„ � d W � � WORKERS'COMPENSATION DECLARATIQN �''�(-'r"��� p -� „ .�... . ...... .. .-.. � G.�c�- �a ...;w,:�:, � � .�,.�:� :�� a";'- �� �;w^:-: .. U ='. ., , � IHEREBYAFFIRMUNDERPENALTYOFVERJUqYONEOFTHEFolt.OiiVINGDECL./i�RATtONS: � �� � � '�� � �� � � � _I HAVE AND WILL MAINTAIN ACERi1FICATE OF CONSENTiQ SELF-INSUPE FOR WORKEflS' _ . COMPENSA710N,AS PAOVIDED BV SEC710N s7oo pF7HE 1A80R CO�E,FOR7HE PEfiFORMANCE �� OF THE WORH FOR WNICH THIS PERMIr IS ISSUE�. � � 'J I HAVE AN�WILL UAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION )^�7 Q 37o60FTHELABORCO�E,FOR7HEPERFORMANCEOFTHEWORKFOR�dHICHTMBPERMI7IS �}g - /p ISSUED.MY WORKE CO PENSATI NSIIa,q,`�CE CARRIEF AN�POLICY Nl1MBER ARE CONSTFlUCTION Y/ E N j CAqRIER____�S���vh�-'���'�j���� 1 4� �, PLAN REVIEW � POLICYNLMIBEP�^`Q�, �1_SZ(„L.1.47__ 4 �� EI.ECTRIC Q (IHISSEC110NNE�NOTBEOOT.Y`LFfE:DDFTHEPERFMI6FORONEHU�ORED001.1NiS(S°N)ORLESS) PLUMBING W � ICELiTiFYTHATINTHEPERFORMANCEOFTHEWORKFOP,WHICHTHISPERMITI5155UED,l MECHANICAL C7 SMHLLNOTEMPLOYANYPERSONINANYMqNNER50AS'U6ECpMESUBJECTTOTHE � � WORKERS'COMPENSATION LAWS 01-CALIFORNIA,AND AGREE THAT IF I SHOLLD 6ECOME INSPECTION FEE /1 �'_� � SUBJECTT07HEWORKERS'COMPENSATIONPROVISIONSOFSECTiON37ooOFTHELA80q ) � CODE 1 SH FORTHWITH COA�PLY WITHTHOSE PROVISIDNS. ISSUANCE _ ✓ f � Q� SMIP T p DATE:__\4�,���'��--`�- APPLICANT:���1 �,�„�j �a• J WARNlNG:FpILUflE TO 5ECURE YlORKERS'COMPENSATION COVEFIA�E IS lJ tJL,AN�SHALL 8E ENERGY P/C � � � SU&IECT/u4EMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSANO ENERGYPERMIT - OOLIARS(51 W,ODO).IN AODITIONTD THE COST OF COMPENSATION.DAMAGES AS PftOVI�ED FOR IN J £ECTION37o80FTHELABORCO�E,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: /y�v�J �+T p7�,(/� �p n � 1 HEREBV AFFIRM UNDEF PENALTY OF PERJURY THAT THEAE IS A CONSTRUCTION I.ENOWG AGENCV Lj j j Oy'I,pTd'11Y1VND L?A10, ZFOPh1EPERFORMANCEOFTNEWORKFORWHICHTHISPEFMITISI55UEp(SEC.3097,CIV.C.). 'Aj�D����r��p�TY-- ' W A � LENDER'S NAA1E � - ' F- 'LENDER'SADDFlESS ���-t� � ICERTIF1'THATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFOqMATtONISCORRECT. TOTAL �FCEJ 4 � I AGREE TO COMPLY N11TH ALL CI7Y AN�CAUNTY OR'JINANCES AND STATE lAVJS PELATING TO 9UIL�ING - ,,, ., � CONSTRUCTION,ANDHEREBVAUTHORIZEREPHESENTATIVESOFTH15COVNTVTOENTERUnONTHE , � � nBOVE�MENTIONEDPROPERttFORINSPECTIONPUflPOSES. �C,..� i COMMENTS -:. O U���� �`� �j,y' a;' t � QPERMITTEENAM P IN'� ���'''"""``` 1^ - - $s � � \V � : ('� I�� °I'�. . {/j SIGNATUREOFPERMITTEE DTE -'�=1-t`-i-i � � � = RECPT.NO. E� � PAID BY . VALIDATION ~ � WM17E—Dapartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy.GREEN—Applicani's Copy ,...,<..�.,:; � . . .�.;-;,� r ;.u>�:�:� 4,�:r�,�,f - ,.� . , . . . �, . . .... m( ����.-� � �. ��''��i r' hr,�:,��.� 9 .z::P: :. a..... .......: �:,�sr ... . . . .. ���� �� � �� � �� � °�°� �� , : : e.; .-,,.-_ � _�,a , , .. . _ S�..t..-� ,. .. � .... .:.. � $ �. ...� ..., � � . � � . ' . � 4 � . . �....,, �' -.: ,� ' . :. �� . � �, a;. a. '-�xi::. .. .: .. _.. ..:. 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