Loading...
HomeMy WebLinkAbout11096 (5) ... __ _ _ _ .. _ . , .,.;.. .., -.. . <..�.._..._. ....... ,. . . .. . . , . . ,�. _ _. .. . ... . .. . .. . � . . . �..:�... , . � ,_.._. ,.._.... _.- _,. .... � �� E'XPtRED --1�1'-`'�--- CITY OF DIAMOND BAR ���""�► " � � CQMMUNITY DEVELOPMENT DEPARTI�IENT �� :;�� 21660 E.Copley Drive Suite 190 � � ��l � 3 ��Q� �R�f,�+�+ (909)860-3195 Fax(909)861-3117 4'��" BUILDING PERMIT APPLICATION FIRM LY � JOBSITE I��`y , v�� r•�1 APPLICATION "�; PERMIT P/C o ADDRESS �ATE NUMBER # o ISSUE NPE OGC � APN OT`�-- TRACT , �ATE CONSL GROUP p OWNER �l�- � o ADDRESS_!� '_�q��-' �A—�*� ZONING SETBACKS o CITY ZIP TEL.j��+�"" R£ORT _ RW ❑ z APPLICANT ___ EL. SIDE/SIDE STREET RW C _ ¢ CONTRACTOR �r" 't� SIDE ❑ �_—.— �o,�,� � ADDRESS PROPOSED USE, G.�L°�' � d�"'�� �� � CITY ZIP TE o ARCH/ENG/ � ��� � w DESIGNER -- � NO.DWEL. NO. NO. ct, ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. `n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-Bt;ILDER DECLARATION SFR/ADOlREM O [] I HEREBYAFFIRM UNDER�ENALTY OF PEFJURV THAT I AM EXEMPT FROM THE CONTqACTOHS�LI- Gdl'dQC/C3fp0/[ W CENSELAWFOflTHEFOLLOWMGftEASON(SEC.7031.SBUSINESSANDPROFESSIONSCO�E:ANYCITVOR (n U CA(1NTYWHICHFEOl11RE5APERMITTOCONSTRUCT.ALTER,IMPROVE.OEMOLISN,ORREPAIFANI'5TRUC- W Patro�Deck � TURE,PRIOR TO R8 ISSUANCE,ALSO FEQUIPES THE APPLICANT FOR SUCH?ERMIT TO FILE A SIGNED � STATEMENT iHqT HE OR SHE IS LIGENSEO PURSUANT TO�HE PROVISIONS OF THE CONTRACTORS U- � CENSELAW(CHAPTER9(COMMENCINGWITNSECTION7000)OF�IVISION30FTHEBUSINESSANO�FP,O- �'�' POOVSpd O FESSIONSCODE)ORTHATHEOFSHEISEXEMPTTHEREFFOMANDTNEBASISFORTHEALIEGE�ExEMP- � U TION.ANYVIOLATIONOFSECTION7031.58VANVAPPUCPNTFORAPEflMIT5U6JECT5THEAPPLICANT�TO z Re-Aoof r A CN'.L PENALTV OF NOT MORE THAN FIVE IiUNDRED DOC(AfiS($Sdo).): - - � � - � - Q ❑I,ASOWNE�OFTHEPflOPEFTY,ORMYEMPLOYEESWITHWAGE&ASTHEIRSD'_ECOMPENSATION, � Commercial Z W'�LL DO THE WOFll(,AND THE STRUCTURE IS NOT INTENUE�OR OFFERED�OR SALE(SEC.7044,BUSI- J NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE lAW DOES NOT APPLY TO AN OWNER OF � PROPERTYWHOBUILDSORIMPROVESTHEREON,FNDWHODOESSUCHWORHHIMSEIFORHERSELfOR m [L THROUGHHISORHEROWNEId7LOVEES,PROVI�EDTHATSUCHIMP70VEMENTSARENOTINTENDEDOR w OFFEREDFORSALE.IF,HOWEVER,hiEBUIL0INGORIMPROVEMENTSSOLDWITHINONEVEAROFCOMPLE- � 7ION,THE OWNER�BUItAER WIIL HAVE THE BUR�EN OF PRCVI�G THA7 HE OR SHE DID NOT BUILO Ofl Z IMPROVE fOR THE PURPOSE OF SALEj. � CI,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.7044,BUSINE55 FND PROFESSIONS COOE:THE COIv'TRACTORS U- V81ll3IlOf1 ADJ.AREA W CENSEL4WDOESNOiAPPLYTOANOWNEROFAPROPEpTYWHOBUILDSORIMPAOVESTHEREON,AND � VMOGO!liRACTSFORSUCHPROJECTSWITHACONTaACTOR;S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE X TORS LICENSE LAW.�. � J � [J 1 AN EXEMPT UNDER SEC. B.&P.C.FOR THIS REASON U ,��y _ —'�_— � LL' DATE OWNER � ._. Z . . . ...... ... U W � LICENSED_CONTRACTORS DECLARATION . _ �y 4 Ir IHEFEBYAFFIRMUNDEiiPENALTYOFPERJURYTHATIAMLICEN5E0UN0EftPROVI510NSOFCHAPTER � � 9(COMMENCMG WITH SECTION 7000)OF ON'�SION a oF THE Bt15MESS AND PROFESSIONS CODE,AND Z `X MY LIGENSE IS IN FULI�CFp,N��FFECT. ,y�+ m � .�Cy� r/9�y � LICENSE CLAS� � � Li4 NO. ` � � � F U DATE � �� CONTRACTOR n- W ..... � WORKERS'COMPENSATION�ECLA . ION Q � IHEFEBYAFFIRMUNDERPENALTYOFPEfiJURYONEOFTHEFOLLOWINGDECLARAiIONS: U uy Z � � _IHAVEANOWILLMA�NTAINACERTIFICATEOFCONSFNTTOSELF-INSUflEFORWORKERS' S COMPENSqTION,AS PROVIDED 8Y SECTION 37oa OF THE LABOR CODE.FOR THE PERFORMANCE C.) d OF T WORN FOR WHIGH THIS PEAMITIS ISSUEO. � � w I HAVcAND WILLAAP.IMAI�WORNERS'COMPENSATION INSIIRANCE,AS REQUIRED BYSECTION ��,,q/ d 370o OF THE lABQ�1 CODE,FOFi THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS � +� � � ISSUED.MYWOPftERS' PENSATIONINSURANCECARRI�ERAN�JPOLICYNOMBERAAEi�' ��-����� CONSTRUCTION �o '¢ �"'�! �� . M .� 7/` PLANREVIEW � CARRIER_ , Z aoucvNUMeEa ELECTRIC ¢ � (iHISSEC7qNNEmNO7BECOMPLETEDOFiHEPERMRISFORONENUN�REDDOL'J�S�S100)ORLESS). PLUMBING � w ICERTIFYTHATINiHEPERFORMANCEOFTHEWOPKFORWHICHTHISPEFMITISISSUED,I MECHANICAI � (:3 SHALLNOTEMPLOYANYPEflSONINANYMANNER50 STOBEGOMESUBJEGTTOTH� /^ � WORKERS'COMPENSATIONLAWSOFCALIFORNIA, GREETHATIFISHOU�09ECOME INSPECTIONFEE _,___ _ F �p�»[_ SUBJECT`0`HE WORKEFiS'COMPENSATION P SI NS OF SECTION 3700 Of THE LABOF �j �J lJ � � ISSUANCE C��:� ��E,I.yALL�OFj7HWITH COMPLY WITHTH R IONS. ��—��� y . � p 0�7 SS� SMIP a � p �ATE C fv APP�ICANT: _____ , ___ � WAflNING:FaLURE TO SECURE WOqKERS'COMP AT N COVERAGE IS UNL4WFUL,AND SIIALL 6E� �N E R GY P/C � SUBJECTANEMPLOVERTOCRIMINALPENALTIE APIO VI4FINESUP700NEHt1NOREDTHOUSANp ENEFGYPERMIT DOLLARS(51o0,coo).NAODITIONTOTHE COST F C PENSATION,DAMAGESA3 PqOVIDED FOR IN --- � SECTION3�o80FTHELABORCODE,iNTERES AN rroaNErsFEEs. RETENTIONFEE: _ � - � 0. CONSTRUC7 LENpING AGENGY pqE-ALT FEE: O � IHEREBYAFFIRMt1N0EPPENALTYOFPERJUPYTHATTHEFEISACON57RUCTIONLENDINGAG�NCY �- FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERN�IT�S ISSUED(SEC.309�.CIV.C.), � . .. .. .. . ' __— '_'__ — ' ` �W / LENDER'SNAME_ .,,. „ ._� . F-- LENDFR'SADDRESS .— _____ _ �� � � ICEflTIFVTHATiHAVEREA HISAPPLIC0.TIONANDSTATETHATTHEABOVE,INFORMA'IONiSCORRFC7 �OTALFEES ��� � ' w 1 AGREE TO COMPLY ' LL qTV pND COUNTY ORDINANCESAND STATE LAWS FiELAiWG i0 BU�LDING A �� /� !� � � CONS7FUCTION,A EBYAUTHORI2=REPRESENTATIVESOFTHISCOUNTYTDENTERUPONTHE �� �j� G-�-(��¢�/� ' ' Z A90VE-�AENTIO aERTYFORINSPECTIONPURPOSES. re✓ ��— q,s � COMMENTS__ d' d � C] J � - m PERlAI7TE .E(PRI ¢ � � ��;�c �i _..--- u� sSIGNATUREOF � EE � � �� �� � DATE RECPT.N0. . � _PAID BV ��VALID'A710N � ~ WHITE—Departmen[Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOL�ENROD—File Copy,GREEN—ApplicanPs Copy '�' - �������°" ' -" . . .. :.. .:. :. .. ... .,..,: . .. .... ..... �� *�: ��.;c:x�� � �s. �:t.,,;.�,n-.,M ..�»�:"�.,w� ., . ��r�', . ',,:s✓ , ,_ �. .,�:.s�t1`i a.,�',+.,`" ..,.. .,.«.� 4�'a.: i��:..;, : � �. �h� � � � � 4 �"`�,.� .,.�«�ii «r�`„ � °� � � � �' � - `�'` � ��� . ��� �� „ ,. ... � � � a �. � � � .... �� � � � . _� i � � . . ... �_ ... . .. y.. . .:.,� ::... : . . .�.+ .:. . ' ... . . : .. .. . . k�g �pr- {p'� � . . . . . . ... � 'aB��L384�t". � �.. I _ !'� �j��'`-+J�.I7�� i � ss,v .. . � � :-. _p.�.��...y...��p�+: �;+^�- ......_�.�..,_- ..._�__ ��.,g,.^, /p __r.qp�q__.�.a_...�...,__�._._....__ � ,... ...___��_ .. ���f 7'`=..33'ilYd:.3<�.3 d"�..�.�� � ! r�['"S���..?rI�'1¥a.'t � —y. � t _m. T_-«.—. F--: .____.�...._u..._.� � ����'a`���s����°�E'; , ��r��r`,'=�i i^���1� �?.�c,'�' � I �����k�C.,d E���9'4'it7�'`S`a% ._.w....._._�..... 2 ..m��[iw"J�.d'S 7-� aJ'*..F....i.�1.t1���.d4Jr 4 [ � _._"'� �__._. �._._____N 7`_ _ ................ __ ....._. { ��„�Ci s.�.�g'7P';S�P.�' j .. i � ��fl�:'�a»d'ia�✓C[ L.di.11tiLlP"i�8"J+tl .._____,�� � ..___......�.....,... <_. �..,.��..� i ���.d�° o°=���'��k=$ ' ������.�4�°,� �i����Sr''i'�e� ¢ ..... j . , _.... _ _ �_ .,..�......«......_........ � �J"?�t'"-��"�G't��i-��i,("'r� . 1 _ .,-..�,... �R�c���b �a��� ����5 ...._— ___----� !� __.._. _......._._f �C`d���a""€�a�e€�.. � i!/f/"r f/� ��� �� �3'�'���?L7�/�;�i �� . & ; ��r��.=`�_�=r����¥i�?�:?1�� �_.�.e_ i _ ' 3 �I��� ��?3�f���:��,� _ � �_ __--�_____ � �y-g�y p� q,p(.-� _{�_ ___ g-^�ry,�^q�#p�. S'SVa�d�V�V i�F'i .,__,___��.�... i � @-r��,�"'�Pld't&F�€�:iT i ...__....._' .m.....3 i F$�;�����-i�-i���{.�'� �^TI—___ _ ¢ � ���i€:k�49��� ___� ; ! �. �-� �y�?�'=�3� ��`"�.���, i ' ; ' � i � � � ( s�-�+.��,Ifa��'z[��G��9�°s� � � _.._ � ��.�� PLIsT T �'�'a �i F'�v�����ittCii�� ! ' ___ � � � F >s.`.�';�$i1t �d��� ��"'�-P' _ � :�����L�i>��$E� �: i " �E �-__--___—___ _ ._..._ _v�� � 3 __ __t— _ ._ �._.._P i �e'�';A.�e��s����4�`t�a�`a ? t��C��������0.i� �� ��.._._� �..__�_._.�. tr,7r��.�,�_����,��'��� �'C��t�_��i'�r�v �. �__._�_ �._� �;���3�������.�`�"�i�� i � � a��F S(�"E {�F`S. i _�._ t?..'°`-z�'���t�� i��a'_��'C-� ? �;m�7��,��"��hi� ��.����� � V e_ _.�__ ��_� -- ,—.______ _____—. _ ��J���� � � ���� ��9�;�,L�-��, ; ;�� , � � �`�TFt��� ( � `' j ; s ,�iv�3�����t�F�f���°a. i ; � �_-__._�. ---------__._.. �����°��'tL,�. � � E ; f��a�a'��?���'�, � �� � �,��,���Q���'______�._.� 3 ���; �:P��L��l�l�'� _ � �...�._.� �_.�;___�.�._ _�.... ���Y�9.�.��E,�.T���a�k�. � ? � ��i'�x�...2J���. �Y����.... � ;: �� �€`d�,�,.�'{���il�� � � ` FS���i 1"C ��s�"�. ���d�'a�.. � 3 �_ _�_ _.__ m._ �. �—.�..______._....�.. � .. � ____.___..� � �°��i..��.��".:a.���'�".I�. y .,... . . � ���r`'. �����r��� � �#. z W R7 € � t .r+ �__._.�.. ...._.._.��—............��-I a�x�� � � . „. - 1 ����".+�-��-a �.,?aa�bs���c.'� ) ; �d`��r"e�� --a� -7 : .... . . . «�........._._.__ �_. f "j o . �.�.,_��.�.e t j .�._...,_.._�,. � � � �l _,_ ___�__ _v ; -_-: � . . . �_____._..._____-- „ . , ',,; .,, . .,-. _ ; ,_. � t.s� ������a1 ___..�,.�. :...: �...�... . ... . i � > ., �__ __�...---- _...._._� _.___ _ -�j �.�..__ ��... __-__.�_.�..�. .�_ �. � T ,. _ ,. _.� § W W _'_� �„_.__.m�._ _----_ _____----.._.__ �: _ . _ ��^ ^W ��--- ---� n�____� __. ----- "_� ':�".tS � �r _� t .,.,-. � ., � � � S �---.___ .,�_. —. _.�._ _ _ --. . __---I ; : ��.,_._m _..__ -�- __ _.__..... ' ��������k�+!}� i��� ,.�.___.�_ , ____..__,._. ����' �,`�`�p� ���� _�_ _ ____-- ---___ ___......_._.____ _____----j � ,�� : , _.�. __.___. __; ,. _._..._�_____ ----..___ _ __._� 3 _... .�..._ , , � --� � - __� �._�__—_ _ .� z - ,::.. �. � . .:::...::. .. --.�..__ ._..�.� - ;� ��:::. --�- � . . ; : ,_ ! _ __ � . ___.__.�