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HomeMy WebLinkAbout16521 � CITY OF DIAMOND BAR � ----�� DEPARTMENT OF COIVIIvIU1VITY&17EVET.C.1P1G1�NT SERVICES ,�°""�r� W y 216b0 E.Copley Drive Suite 190 ' (909)86Q3195Fa�c(909)561-311') � r''`'� PRE$$ "�° .BUII.D$NG PE�1T APPLICA7'ION.. . � , <, . FIRMLY . . ¢ ADDRIESS ��� ��5,5' ]f- APPLICATION � ( � �� 1 PERMIT r '��C.r-,`��� PJC o DATE_ � NUMBERe ✓ # c� ISSUE TYPE OCC APN LOT TFIACT DATE C�NST. GROUP p OWNEFi�'�lL' REvc,�;,�ca{' �` ADDRESS " � f �� ZONING SETBACKS w CITI'�t� ZIP�'�7�' TEL. � �✓"S5' " FRONT RW ❑ � APPL�CANT + �ct���e�. TEL Z. S p SIRE STREE'f RW ❑ � CONTRACTOR �B-�� _�^�cvC':'�1.__ S�pE _ n ADDRESS / - Yyd� +� ����� � CIT( <'�c�. ZIP`�/�,�TEL.r`��'2.3' 7E'w� PROPOSED USE r �'� n c.�.-=-���L•.�c.�— w ARCWENG/ ���— � DESIGNER_ NO.DWEL. � � � NO. - NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP _ TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION p� OWNER•BUILDER DECLARATION SFRlA�D)FiEM O p I HEREBY AFFlRM UN�ER PENALTY OK PERIURV TFNT I AM EXEMPT FROM THE CON7RACTORS ll- G2fa B/C8 Dlt � CENSELAWWNTHEFq.LOWMGNEA30N(SEC.7031.SBUSINESSANbPROFESSIONSCODE:ANYCI7YOR (n 9 � COUNTYWHICHREOWRESAPERMITTOCONS7'RUC7,ALTER,IMPpOVE,DEMOLISH,ORREPAIRANY57%UC- W patioNeck Tl1RE,�RIOR TO(TS ISSUANCE,Al.�RE���S THE APp[I(;pNT FOp SIJCH PFRbi1T TO FILE A SI(CNEn w STATEMENT 7HAT HE OP SHE IS UCEN9ED PURSUANT TO THE�PFIOVISIOMS OF'Pi1E CONTRAC70RS LI- w � CENSE UW(CHAPTER 9(COMMENCINO WI7N SECTION 7000)OF�IVISION 9-QF THE PUSINE55 AND PRO- LL Pool/Spa FESSqNS ODDE�OR THA7 HE OR SHE IS EKEMPT THEREFROM ANO THE BASIS FOP THE ALLEOEO EXEA7P• TION.ANVVKK.ATIONOFSECTION7o31.58YANVAPPI.ICANiFORAPERM�TSUBJECTSTHEAPPGCANTTO � RB-R001 '� � ACIVII PENALTY OF NOT MORE THAN fIVE HUN�flED DqLLAqS 155DD�.7: � 04�+^OWNEROFTHEPROPERTY,ORMVEIAPLOYEESWItHWA0E5ASTNEIRSOLECOMPEHSA710N, � CofI7tT10fCidl , ' WILL DO THE WOAIC MID THE STRUCTUFE IS NOT INTENDED OR OFFEAED fOR SALE�(SEC.79�a,6U51- J � NE&S M10 PROFESSIONS CODE:THE CONTRACTORS LICEN$E LA4d�DOES NOT APPIV TO AN OWMER OF �_ PHOPERTY WFIO BUILDSORIMPpOVESTHEREON./WD WHO DOE$SUCH WORK HIMSELFOR HEPSELF OR � THRIXIGH HIS OP HEN OWN EMPIOVEES,PROVI�ED THAT 5UCH IMpqOVEMENTSARE NOT INTEN'JED OR � QOFFEREDWRSALEIF,HOWEVERTMEBUILOIN60RIMPfiOVETAENY'I$SOLDWIThANONEYEARbF'C6AAPLE'- Z TION,THE OWNER�BU�LDER WILL HAYE THE BUH�EN OF PROVING THAT HE OF SHE�ID NOT 9U�LP OR IMPROVEFORTHEPURPOSEOFSALE} � ❑I.A30WNEROFYHEPROPEFiTV,AMIEXCLUSIVELYCONTRACTINGY/ITHLICEN5'cOCONTRAC70R5 W (x; TO CONSTRUCT THE P0.QIECT(SEC.7041,9USINESS AND PROFESSIONS COOE�THE CONTRACTORS lJ- V3I11811011 � ��� ADJ.AREA W CENSEUWOOESt�qTAPPLYTOANOWNEROFAPROPER7VWF106UILDSOLIIMPROVEShIEflEON,AND � WI9000NTRACTSFORSUCHPAQIECTSWITNACONTRACTOR(S)LICENSEDPURSUANTT0IHECONTRAC- QUANT�'Y DESCRIPTION FEE � � 70R5 LICENSE LAW.). Q ❑i NM EXEMPT UNDER SEC. @.&P.C.FOATNIS REASON Q � U � a OATE�_, DYYNER_ � � � LICENSED CONTRAC70RS DECIARATION W � 1 HEREBY AFFIRki UNDER PENALTY OF PERJUFYTHA71 AM LICEN5,E�UNDER PflOVI510N5 CF GHAPTER � � 9(COMMENClNG WITH SECii4N 7oP0�of DNISION a O�7HE BUS WESB AN�PROFES61ONS COOE,ANO Z X YY UCENSE IS IN FVLL FORCE AND EFFECT. m o LICENSE CLASS�, ��` LIC.NO._ �t�'�1�/�^'.� �.d��� ��� � � DRTE � "� ��� &-� ._ CONTRACTORTy;,,.y.����"����- �- W � WOAi(ERS'GOMPENSATION DECLAAATION � � ¢ � I HEREB�AFFlqA9 UNDER PENALTV OF PERJUFY ONE OF THE FOLLOWING DECL4R0.T�ONS: Z � _ IHAVEANOW11LlMAINTAINACEfl71FICATEOFCANSENTTOSE�F-INSWREFORWORNEF9' $ �C6MPENSATIOPI,AS PRONOFD BY SECTIOW 370o OFTNE LA80q CO�E,FORTHE PERFORMANCF. U OF THE WORK fOR WHICM THiS PERMIT I5 155UED. . � G � _IHAVEANDWILLMAIMAIPdWORKERS'COMPENSATIONINSt1qANCE,ASREQU(REDOYSr'CTION /^p Q 370DOFTHE:.ABORCAbE,FORTMEPERFORMANGEOFTHEWORKFORWHICHTHISPERMiT15 / / ISSUED.MVWOHKERS'WMPENSA7pNINSURANCECARpIERANDPOLICVNUM6F.RAP.F_: CONSTRUCTIUN ��1,��V � canaisrt_ S}�.�s� �- ��-*•"�- �(' PLAN REVIEW Z POLICY NUMBER... .__�R..✓��"�.a.- �.°���.1.�.:J-� . --........�.. ELECTRIC � (ni�sEcr.on�n�raoraeoa��tereooFn�aEauar�swaavErnxaoaEocaU.as�S+co)oA�Ess). PLUMBING � ICERTiFVTHA-ilNl}1EPERFORMANCEOFTNE'eVOfiKFORWHICHTHISPEFM1T1515SUED.1 MECNANICAL R^- -..._:�"� !«�_,_,_'1 ('$ SHAILNOTEMPLOVANYPEpSOkINMlYMANNEqSOASTOBEWMESUBJECTTOTHE � WORKERS'CaNPENSATIONlAW50FCALIFORNIA.AN�AGREETHA71FI5HOUL�6EOJME INSPECTIONFEE SU&JECTTO THE WORISERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR j (� ~ CO�D^E^,I SHALI FOR7HWITH COMPLY WITH THOSE P VI 11N. ISSUANCE �1�f!� � � OATE: J�'�Z�"G� APPLICANT: ��n����� � SMIP ��— � W ENERGY P/C ,��= y"_ WARNING FAllUF1E TO SECUFiE WORKERS'COMPENSATION COVERAGE 15 UNLAWFUL,AND SHpLL BE � SUBJECTANEMPLOVFRTOCRIMINALPENALTIESAN�CIVILFINESUPTOONEHl1NDRebTHOUSAND ENERGYPERM�T �----- ---� DOLLARS(5100,OW),IN ADOITION TO THE COST OF Ca.APENSATION.DqMAGES AS PROVIOEO FOR IN � SECTIONJ)UBOFTHEIABORCODE,�NTEREST,AN�A7TORNEY'SFEES. RETENTIONFEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEREBVAFFIRNUNDERPENALTVOFPERJURYTHATTHEREISACONSTRUCTIONLENDINGAGENCY _ FOR THE PERFORMANCE OFTHE WORK FOR WHIC4THIS PERMIT IS ISSUED(SEC.3097,CIY.C.), . . Z li l � LENOER'S NAME F= LENOER'SADDRESS.__ w ICE(iTIFYTHATIHAVEREAOTHISAPPLICqTIONANDS7ATETHA7THEABO�EINFOR�ATIONISCORRECT. TOTAL FEES , y�� � IAGREETOCOMPLYWITHAIICIiYANOCOUNTYORDINANCESANDSTATEIAWSREIATINGTOBU4DING � CONSTFUCTION,AN�HEREBY AUTFIORIZE REPRESENTATIVES OF THIS CWNTV 1'O ENiER UPoN TNE� ABOVE•MENTIONED PHOPERTY FOR INSPECTION PUFPOSES. 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