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HomeMy WebLinkAbout16368 (37) _1�� CITY OF DIAMOND BAR ' /r�': DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � " ,5� w '• 21660 E.Copley Drive Suite 190 " .,,,., . (909)860-3195 Fax(909)861-3ll'7 PRESS ,�". .. . BUILDINGI'EItMITAPPLICATiON } . ,Y�` FIRMLY : ,_. � JOBSITE _ _;,.: .�,;,,. � ;,:,,.A , ,�.;., : o AODRESS I�J�'� � -�IL.1.• �7�, APPUCATION � �t � PERMIT QP/C � Y DATE � NUMBER "S# � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER �� �7� �_�f�'T�c... p ADDRESS_��I ���� �� ZONING SETBACKS �W CITY ZIP � TEL � � REART RW o APPLICAN'f TEL�— SIDEISIDESTREET RW ❑ � CONTRACTO r'1Wk�ZA/�U���/' �n. ^_ SiDE ❑ ADDRE S ��-L,��,_��/�. � CITY 21P�.�� TEL.4��P�'�CY"j PROPOSED USE 0 ARCWENG/ � �� z DESIGNER w NO.DWEL. N . Np. a ADDRESSA u� UNITS_ � STORIES ( BEDROOMS � � CITY ZIP TEL. tn cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION �.. �- SFR/ADOlREM � O 1 HEREBY AFFIRAI UNDER PENALTV OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- G2fdgBJCflfpOR W CENSEUWFORTHEFOLLOWINGREASON(SEG7o31.58U51NESSANOPROFE5510N5CODE:ANYbiTYOF (n C.� GOUNTYWHICHflEQtiIRESAPEHMRTOCON57'RUCT,ALTER,IMPROVE,DEMOUSH,ORREPqIRANVS?HUC- W patiolDeck Z TUHE.VRIOR TO IiS{SSUANCE,AL54 RE�UIRES THE APPUCANT FOR SUCH PERMIT TD FlCE A 516NED W STATEMENT THAT HE Ofl SHE IS LICENSE�WRSUANT TO THE PROVIS�ONS OF THE CONTRAC70RS�L4 W �. CENSE LAW(diAP7EH e(COMMENCING WIiH SECTION 7000)OP OIVISION 3 OP THE BUSINESS AND PRO: LL POOUSpB FESSqNSCODE)ORTHATHEORSHEISEXEMMTHEREFROMANDTHEBASISFOR7HEAlLEGED'EXEMP- (� TION.ANYVKKATIONOKSECTION7o37.5BYANVAPPLICANTFORAPERMITSUBJECTSTNEAPPLiCA1JTT0 �� R8-ROO� � ACIVILPENAIttOF�:OTMORETFIANFNEHUNDRED�OLLAiiS(S5oaj.): � � -'�^������ � ❑I.ASOWNEROF7HEPROPEH7Y,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATqN, O COItlf118fC121 -- WILL DO THE WOFIIC,AND THE STRUCTURE IS NOT INTENOED OR OFFERED POR SAI.E(SEC.�7d44,BUSI- _„! � NESS AND PROFESSIONS CODE:THE CANTRACTORS IICENSE LAW�OES NOTAPPIV TO AN 01NNEF OF � PROPER'TY WFiO BUIIOS OR IMPFOVES THEREON,AND WHO OOES SUCH WOqKHIMSELF OR H�RSELF OR � THROUCUiHISaiHEROWNEIUPLOYEES,PROVIDEOTHATSUCH0.IPNOVEMENT5ARENOTMTENDEDOR m - - "-- QOFFEREDFORSILLEIF,HOWEVER,TiEBUILDINGORIMPROVEMENTISSOtDWITHINONEVEAROF'C,Ob1PLE- Z TION,THE OWNEP-BUItDER WILL HAVE THE BVRDEN OF PROVING THAT HE OR SHE DII7 NO'f yU1LD OR _. IMPROVE FORTHE PURPOSE OF SALE). ' ' �'... '��.:'' O t,ASOMMEROFTHE PROPERfY,AM EXCLUSIVELYCONTRACTWG WITH LICENSED CONTRACTORS � TO CONSTRUCT THE PflQIECT(SEC.7044,BUSINESS AND PROFESSIONS CODE:TNE CQNTRAG�YOfiS LI- VaIUBS10f1 A�J.AREA W CENSELAWDOESNDTAPPLYTOANOWNEHOfAPROPEFTYWHOBU1L�50RIMPROVE57HEREAN,liND � F WHOCONTRRCTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEOPUPSVANTTOTHE�CONiRAG QUANTITY DESCRIPTION FEE Y . TORS LICENSE UW.�. , ¢ ❑IAMEXFMPTUNDERSEC. 0.8P.C.FORTHISREASON Q '� � . � U ' ... . � . . u' DATE ONMER � � �@� LICENSED CONTRACTORS DECLARATION � CC I HEREBV AFFIpM UNDER PENALTY OF PERJURY THAT i AM LICENSE'�UNOER PROVISIONS OF CHAPTER �.. � �� � B(COMMENCIN�3WITHSECTION7D00)OFDIVISION30FTHEBUSINES;ANOPROF[SSIONSCODE,AND Z ��� MY iICENSE IS IN FULL FORCE ANO EFFECT, J�{ m � LICENSE C�LA-SS_'Jt�-G 3��LIC.NU._ j � DATE�—'T�=1�1_"'I7T_ CONTRACT � a � � 6C � WORKERS'COMPENSA710N D CL RATION —� Q � I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: Z C] _IHAVEANDWILIMAINTAINACERTIFYCATEOFCONSENTTOSELF�INSUPEFORWORKEPS' � tY CAMPENSATION,ASPROVIDEDBYSECTION37000FTHEUBORCODE,FORTNEPERFORMANCE W Q � OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. � W _I NAVE AND WILL MAINiAIN WORIQERS'COMPENSATION INSURANCE,AS REQUIREb BV SEC710N JJJ��� B � p Q 37oD OF THE LABOR CO�E,FOR THE PERFORMANCE OF TI�IE WORK FOR WNICH THIS PEPMIT IS �/�{..�.�'�� p � ISSUED.MY WOFKERS'COMPENSA710N INSU(RANCE�CA�RRyIE(fl�AND�POLICY NUMBER A/RE�: CONSTRUCTION "f l liB,,,J j CARRIER����,RL�����J�6yTN� ��. /�i/'I PLAN FIEVIEW 0 POLICYNUMBER ����2?��.�[!�'1"�IT' E�ECTRI Q '_---�`_'—� �_. 'I , . --.-... — � �n-iss[cnoNr�mworsEco�mc�cooFlr�PErr�ur�swr�auE�Eo�.i,v,ws�S�ao�oa�Ess�. PLUMBIN ...-, .. Z I CERTIfV 7HAT IN THE PERFOPMANCE OF THE VJOHK FOFi WHICH THIS PERMIT 151SSUED,l- MECHANI L p� CS SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS 70 OECOME SUB.iECT TO THE �{=� ' � WORKERS'COMPFNSATIONLA6VSOFCALIFORNIA,AND ,REETHATI�ISHOl1Lp8ECDIUF INSPECTI FEE" � SU&IECTTO THE WORKERS'CONPENSATION PROVIS OF CT�ON 37ao OF 7HE LABOR CODE,I SHALL FORTHWITHCOMP4V WITH SE Pfl SIO . ISSUANCE � �p p DATE: �����(,_/►_ APPLICANT: SMIP ��• ._------ � WARNING:FAILURETO SECURE WORKERS'C P SATION COVERAGE IS UNLAWFUL,AN�SHALL BE ENERGY P! � SU&IECTAN EMPIOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE MUNOREO THOVSAND ENERGY PERMIT DOIURS($to0,oaa),IN ADOITION TO TNE COSTOF COMPENSATION,DAMAQES AS PROVIDED FOR IN � SECTION37oeOFTHEIABOFiCO�E,MTEReST,ANOATTORNEY'SFEES. RETEN7IONFEE: a CONSTRUC710N LENDING AGENCY PRE-AL7 FEE: G7 � 1 HEREBYAFFIflM UNDF.P PENALiV OF PERJURY THATTHERE IS A CONSTRUCTION LENDING A6ENCY FOR THE PERFORMANCE OF 7HE WORK FOF WHICH THIS PEflMIT IS ISSUED(SEC.�097,qV.C.). � � - Z W � LENDER'S NAME � - � I— LEN�Efl'SADDFlE55 � TOTAL FEES '�,� � �� I CERTIFY THAT 1 HAVE READ THIS APPUCA710N AND STATE THATTHE ABOVE INFORMATION IS CARRECT. �y I AGREE TO CAMPLY WITVi ALL CITY AN�COUNTV OROINANCES ANO STATE LAWS RELATING 70 BUILOING � CONS7RUCilON,ANDHEREBVAUTHOR2EREPRESENTATIVESOFTHISCOUN7YTOENTEFIUPONTHE � -� � ', Z A80VE-MENTIONED PROPERTV FOFl INSPECTION PURPOSES. COMMENTS ��'°�'�` '' o �6� _ i - � � PEHMITfE E �y d� (/ � sic q o e �� RECPT.NO. � PAID BY ��VALIDATI�N����_. _ 2 ~ Wt#ITE—Department Copy,YELLOW—Finance Copy,PtNK:—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy �`�`� 1 ,� , . :. . : ,. _� .. ..,, .:, ; . ;, ,.� �,�.��,,� � � ��'�� - _ ��.. ,� :>; - . _ _ _: s , = . - . 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