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HomeMy WebLinkAbout12718 __. . _ ._.__ . , , . __ _____. .. , , _. . , , . i �- ----��`"�---- CITY OF DIAMOND BAR � � COMMUNITY DEVELOPMENT DEPARTMENT �( , :: 21660 E.Copley Drive Suite 190 PRES+S• (909)860-3195 Fax!9p9)'861�-3117 � "q�" BUILDING PERMIT APPLICATION FI R M LY ,;�:: ;, � JOBSIT.E . "` /�' �, �i� � APPLICATION � C� PERMIT /C u/h} � o ADDRESS ���� 'T"!O�f �� �� DATE' �"' r � NUMBE �� # �� o� ISSUE TYPE OCC APN L T TRACT DATE CONST. ` GROUP p OWNER "' ADDRESS = � `� ZONING SETBACKS „Z� 0 oCITY . ZIP TEL. � REART rs�e'" � RW ❑ o APPLICANT TE SIDE/51DE STRE�T' RW ❑ z ¢ CONTRACTOR �,. � ' � � SIpE ❑ � ADDRESS '"` G! � CITY ZIP EL. PROPOSED USE � � ARCH/ ' / �i'_ �+ �y _ ' '' z �ESIGNER��e�l� t.i� � : ' " :.;C' , � ADDRES � NO.DWEL. NO. NO. � CITY `ZIP F EL �, UNITS STORIES __���BEDROOMS� c�n f4 DESCRIPTION SQ.FL FACTOR PSF AD .AREANALUATION p� OWNER-BCILDER DECLARATION � � SFR/ADD/REM �' � a �i � p I HEREBV AFFIRM UNDER PENAL7V OF PERJIIRV THAT I AM EXEIAPT FROM THE CONTRACTOFS ll- G8fe98/CdfpOfi � -�� n o� W CENSELAWFORTHEFOLLOWINGREASON(SEC.7C31.6BUSINESSANDPROF'cSSIONSCODE:ANVCITYOR (f} ,,1� U COUNiYWHiCHREQUIRESAPFAMITTOCONSTRUCT,ALTER,IMPFlOVE,DEMOLISH,ORPEPAIRANYSTRUP �,jJ patio/Deck +p�y.�,r a G�✓ W TURE,PRIOR TO ITS ISSUANCE,qLSO RE�UIRES THE APPLICANT FOR SUCi PERMIT TO FILE A SIGNED W �� � �Z' STATEMENT 1H0.Y ME OR SFIE IS LICENSED PURSUhfJT Tb TFIE PRQV'SIONS OF THE CONTRACTOFS LI- � CENSE LAW(CHAPTER 9�CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa � FESSIONSCODE)ORTHATHEOfiSHEISEXENP7THEREPROMAN�THEBFSiS=ORTHEALLEGEDEXEMP� (� V TION.ANVVIOLA710NOFSECTION7a31.56'/ANYAPPLICANTFORAPERMITSlJBJECTSTHEAPPLICANTTO Z pe-Rooi A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDREC DOLLARS(E5oC).): � ❑I,ASOWNEROFTHEPROPERTv,ORMVEMP�0YEE5WITHWAGESASTHEIR50LECOMPENSATION, � COfi1fP10fCidl WILL�O THE WORK,ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SAI.E(SEC.7044,BUSI� _! � NE55 AND PRO:ESSIONS CODE:THE CONTqACTORS LICENSE LAW DOES NOT APPLV TO AN OWNE�OF � PqOPERTY WHO BUILAS OR IMPPOVES THEREON,AND WHO UOES SUCH WORK HIMSELF OR HERSELF OR CC THROUGH HIS OF HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPRQVEMENTS ARE NO7INTENDED OR � � 0 OFFEREDFORSALEIF,HOWEVER.THEBUILDINGORIMPROVEMENTIS50LDWITMINONGYEAROFCOMPLE ' TION,THE OWNER-9UIl�ER WILI HAVE 7HE BUROEN OF OROVING�HAT HE Oq SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). �/� ' �` f. ❑I,AS OWN=R Of'THE PROPERTY,AM EXCLUSNLLY CONTRACTING W ITH LICENSED CONiRACTORS � TO CONS7RUCT THE PROJECT(SEC.7044,B'JSINESS A�D PROFESSIONS CODE:THE CONTRACTORS ll� V3IU8IIOf1 ADJ.AREA r W CENSELAWCOESN0T0.PPLYTOANOWNERO?APRO?ERTYWHOBUILDSORIMPROVESYHEftEON,AN� � WHOCONTRACTSFORSUCHPROJECTSWITHACON7RACTOR(5)LICENSE�PURSVANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORSLICENSELAWJ. ¢ ❑I AM E%EMPT UNDER SEC, B.&P.C.FOR THIS REASON Q � ,� . � � U � ¢ i �. ,nQ's �ATE OWNER H � W � P'a � LICENSED CONTRACTORS DECLARATION, , W 4 � I HEREBVAFFIRM U.VDER PENA'.TV OF PERJURV THAT IAM LICENSEO UNDER PROVISIONS OF CHAPTER - - d 9(COMMENCINGWITHSECTION7o0o)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND z Lv `X MY LICENSE IS IN FULI FORC�AND EFFECT. m - '" - O � i � IICENSECIASS LIC.NO._ _ J y � I�1 e` ~ DATE � CONTRACTOR � � � 1 d � . . , s. . . . . . ...,.:. . '.,.. _. . '.iL � �/.. w / �.., � -, i � � W��RKERS'COMPENSATION DECLARXTION � '` '�V� � a � � IHEREBYAFFIRMUNDERPENA_TYOFPERJURYONEOFTHEFOLLOWINGDECLARATI�tJS:�� � z � . 0 IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' � Z — z Q COMPENSATION,ASPqOVIDEDBYSECTION37ooOFTHELABORCODE,iORTHEPERFORMAN W Q OF THE WORK POR WHICH THIS PERMIT IS ISSUED. � w _I HAVEAND WIIL MAINTAiN WORKERS'COMPENSATION INSUFANCE,�15 REOUIREO BV SECTION �?�"+ /� Q 37ooOFTHELABOfiCODE,FORTHE?ERFOFMANCEOF7HEWORKFORWHICHTHISPERMITIS �"� r '}�rt � ISSUED.MY WORKE/R�.'�oM N A710N INSURANCE CARRIER AND POLICY NUMBER ARE:��� CONSTRUCTION �. }(/� � CARRIER �---• � - --�G� PLAN REVIEW p ` � Z POLICYNUMBER r ELECTRIC 1 �l� ¢ � � � (IFiI5SEC710NNEmNOTBECOMPLEfE�OFTHEPERM ISFORONEHUNDREDOq1APS�E700)ORLE55} PLUMBING ' Z I CERTIFV THAT IN TH'e PERFORMANCE OF THE WORK FOR WHICH THiS PERMIT IS ISSLIE�,1 MECHANICAL �`'d C�S SHALL NOT EMPLOV ANY PERSON ly ANV MANNER SO AS TO BECOME SI;BJECT TO THE � WORKERS'COMPENSA'IONIAWSOFCALIFOFNIA,ANOAG ETHATIFISHOUIDBECOME INSPECTIONFEE = SUBJECTTOTHEWOaKERS'COMPENSATIONPRO SIONS = ,CTION37o00FT ELABOR CA�E,IS A�L WITHCOMPLYWITHTH E Rq�jib n. ISSUANCE O � p �ATE: � APPLICANT: . � � SMIP �( __ �J ! ~ ENERGY P/C ' � Y WHRNINGFAILURETOSECUREWORKERS'GOMPENSATIONCOVERAGEISUNLA FU'�,A SHqLLBE � � SU&IEGTANEMPLOYERTOCRIMINALPENALilESAN�CIVIIFINESJPTOONEH NJ E T OUSANO ENERGYPERMIT DOLIARS(5100.000),IN A�01110N TO THE COSTOF COMPENSA710�,DAMAGES P O I D FOR IN py ^ /,�,�y � SECTION37oeOFTHELABORCODE.INTEREST.ANDATTORNEV'SPEES. RETENTIONFEE: /'�'�C(J�` d CONSTRUCTION LENDING AGENCY PRE-ALT PEE: '� O � IHEREBYAFFIRMUNDERPENALTYOFPERJURYTHA'THEREISACIXJSTRUCTIONLEN�MGAGENCY fOR THE PEflFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3037,CIV.C.�. •;sa �,.,i: i',.,..,.,. �,d.,. a.., . W A ,� w'S"M . ..,:.�,� . . ' . .. � I.�ND�'R'S NAME � -� fff 1_- �LENDEfl'S AD�RESS .-:� �.... ....... .... .. .. ... . / /��/ ( i.A wICERTIFYTHATIHAVEREADTHISAPPLICATIONAN�STATETHATTHEA80VEINFORMATIONISCORRECT. T�TAL FEES N� l. � �� � IAGREETOCOMPLYWITHACLCITYANDCOUNTYOROINANCESANOSI'ATELAVJSRELATING'fO801L011.'G' ��--p^� t � .. + CONSTRUCTION,ANDHEREBYAUTH(SRIZEfI�PRESENTA?NESOFT}iISCOUN7VT0[NTEfiUPONTI-I[ ,�(.EL-�- � ABOVE�MENTb EDP P qNFOPiNSPECTIONPUR SES, ' ' �� -• . � x ,: : �, C Mn�E S . , � �� a' K�� m PERMITTEENAME�P T) � - � ¢ C!J � SIG VREOFPERMiT7EE � - ATE -" . - ' = RECPT.NO. PAID BY � VALIDATION��� ~ � ' VJHITE—De artment Co YELLOW—Finance Co PINI�—Assessor Co GOLDENROD—File Co GREEN—A IicanC''s Co ' �� '' ' p PY� PY� PY. PY� PP PY�.:;: �� � � 1 � ,; � , 1 ������� ��:���� � � � ' ' . � " ��''�'�� ° � � .a � � - . - �: � . :� � '� �� .�_:-: ` ������ �� � t°�""��_6r��� � � � __._d.�__�.�.� .�-�.___.� �__�_.__ _ __�__„_._.��;�.___ __ _ __ � � � � �`?';��;r:-"�'�`��-�;�` �� � � �-� ����_<�l��---- -- --- � ,.... �.� � _j_! 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