Loading...
HomeMy WebLinkAbout12674 (14) �,\ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNTTY&DEVELOPMEN'I'SERVICES '"� '° a , 21660 E.Capley Drive Suite 190 � (909)860-3195 Fazc(909)861-3117 PR ESS ...���°'`' BUII,DING PERIVIIT APPLI�A`TION _ � � ,. , . �` , . ., ,, . FIRMLY . . . � JOBSITE i �p ��1� �/p� APPUCATION4 J +4 �p�+ PERMIT Z� P/C o ADDRESS �� 1 I��I�IV ���� N��.` DATE 1 1 � 1 / /C1 NUMBER� ! # c� ISSUE a(� � Q TYPE OCC APN LOT TRACT pATE ` �^�C� CONST. GROUP p OWNER ' 9:F� p ADDRESS =37 a � � � ZONING SETBACKS W CITY'��Ar1�L'hti'A t�L��' ZIP�f_��t�' TEL.ac�'9��� • FRONT RW ❑ � APPLICANT TEL. REAR ❑ SIDE/SIDE STREE7 RW ❑ � CONTRACTOR �' I•�°��-`C,�,. �,� SIDE ❑ ADDRESS pROPO5ED USE � CITY. ZIP C TEL. ��' r � ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS = CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF AOJ.AREANALUATION � Q OWNER-Bl11LDER DECLARATION SFRIADD/REM O p I HEPEBV AFFIRM UNDER PENALTY Of PERJURv THA71 AM EXEMPT FROM THE COMRACiOpS U� � GB�dgB/CBrpOf1 lJa CENSEUWFORTHEFOLIOWINGflEASON(SEC.7o31.58USINESSANDPROFE5510N5CADE:ANVq7YOR CJ COUNTYWHICHREWIRESACERMYfTOCANSiRUCT,ALTER,IMPROVE.�EIAOLISH,ORREPAIRANVSTRUC- W PaSiO/DBCK � NHE,PRIOFl TO ITS ISSUANCE,ALSO RE�UIPES THE APPUCANT FOH SUCH PERMIT TO fILE A SIGNED � SiATEIAENT THAT HE OFl SHE IS LICENSED PURSUANT 70 THE PqOVISIONS OF TME CONTRACTORS ll- � CENSE LAW(CHAPTER 9(COMMENCINO WITH SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND PRO- LL' POOVSp2 FESSIONS CODE)OR 7HAT NE OR SHE IS E%EMP7 THEREFiiOM AND THE BMSIS FON THE ALLEDED E%EMP- TION.ANVVIOLAiIONOFSECTION7031.5BVANYFPPLICANTFOqqPERMITSU&lECTSTHEAPPLICANTTO z RB-ROOf � ACdNI PENALTY OF NO'f MORE THAN FlVE HUNDRED�OLIARS(f5oo).�: � ❑I.ASOWNEROFTHEPHOPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 Commercial - WILL 00 THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.7044,BUSI- _) NESS AND PROFESSIONS CODE:THE COHTRACTORS LICENSE LAW�DES NOT A7PLV TO AN OWNER OF N PROPEIiTVWHOBt11l�SOPINPROVESTHEREON,ANUWHO00E55UCHWORKHIMSEIFORHEHSELFOR � � THflOUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCNIMPROVEMEMSARENOTINiEN0E00R m WO pFFEq�FORSALEIF,FIOMlEVERTMEBUILOINGORIMPROYEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE ONMER-BUILDER WILL HAVE THE BUR�B1 OF PROVING THAT HE OR SHE OID NOT BUILD OP � IMPROVEFORTFiEPUHPOSEOFSALE). ❑I,AS OMMEfl OF iHE PROPER7Y,AM E%CLUSIVELY CONTPACTINO WI7H LICENSED CONTRAC70R3 � TO CONSTRUCT THE PROJECT(SEC.70{4.BUSINESS AND PROFESSIONS CODE THE COMRACTORS U� VflIU8Y�011 ADJ.AREA W GENSELAWUOESNOTAPPLYTOANOWNEROFAPROPEFTVWHOBUILDSORIMPqOVESTHEqEON,ANO � WFiOCONTMCTSFORSUCHPROJECTSWITHACONTRACTOR(S�LICENSEDPUFSUANTTOTHEGONTRAG QUANTIIY DESCRIPTION FEE OTOHS IJCENSE UWJ. sy� ❑I AM EXFIIPT IINDER SEC. ,9.&P.C.FOfl THIS pEA50N � ' �V�'� ��� � ¢ � -!�. Q o LL' DATE OWNER �' � �9 � ( E' ?� �� �. w � LICENSED CONTRACTORS DECLAFATION �j � IHEflEBYAFFIRMUNDERPENALNOFPERJURYTHATIAMLICENSEDUNOEFPROVI510NSOFCHAPTER � p� e(COMMENCINO WITH SECTION 700�)OF DNISION 3 OF 7HE BUSINESS AND PROFESSIONS CODE.AN� Z X MY IICENSE IS IN FULL FORCE AND EFFECT. m lll 'j� y('� o LICENSE CLq4SS p,�} �+'�.d LIC.NO. '�f 4/'��,-�u ����q�' � V DATE L 1 � l"i I�7 _ CONTRACTOR P �- �� a W � WORKERS'COMPENSATION DECLARA7IDN � � U � iHEREBYAFFIRMUNOERPENALTYOFPERJURVONEOFTHEFOLLOWINGDECLARATIONS� , Z � � �IHAVEANDWILLMAMTAIN'ACER7IFlCA��F��C(7NSEyTTOSELF-INSI�REFORWORKERS'' . _ ,�sr" �`'-���. x_q"�„R�y' COMPENSATION.ASPROJIYIEDBY�EG�a'73"1ooOFTNEE%i6Y>RCODE,FORTHEPEfiF`URMANCE � W OFTHE WORK FOR WHICH THIS VEiiM1T IS ISSUEO. � 0 W _I HAVE AND NALL MAINTAIN WORKERS'COMPENSAT'�ON INSUFiANCE,AS REQUIRED BY SECTION O 37000FTHELABOFiCODE,FOR'MEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSUED.MY WORKERS'COMPENSATION INSUPANCE CARPIER ANO POLICY NUMBER ARE: CONSTRUCTION � CARRIER PLAN EW ZPOLICY NUMBEfi ELECT Q � (iHSSEC(IONNE�NOTBEOa+1PLERD�FTHEPERMRISFORONEFA�NDREDDOLL.AFiS15100)Of7LE551 PLUMBING — W Z I CERTIFV THAT IN THE PERFOAMANCE OF THE WPRK FOR WNICH THIS PERMI7IS ISSUEO,I MECHANICAL (!J' SHALLNOTEMPLOYANYPERSONINANVMANNERSOAS70BECOMESUBJECTTOTHE INSPECTIONFEE � WOFKERS'COMPENSATION IAWS oF CAUfOFNIA.AND AGREE THAT IF I SHOULD BECOME S SU&IECTTOTHEWORKERS'COMPENSATIONPPOVISIONSOFSECTION37000FTHE�BOR SSUANCE CODE.I SHALL FORTHWITH COMPLV WITH THOSE PROVISiONS. � p DA7E �� � APPUGANT: SMIP J ENERGY P/C WARNING:FAILURE TO SECURE WORKERS'COMPEN ATION COVERAGE IS UNLAWFUL,AND SHALL BE �y SUBJECTANEMPLOYERTOCRIMINALPENALTIESAN�qVILFWESUPTOONEHUNDRE�THOUSAND ENERGYPERMIT ��� DOLLARS(S1 Do,00D).IN PDDIl10N TO THE COSTOF COMPENSATION,DAMAGES A5 PROVIpEO FOR IN � SECTION 37aP OF THE LA60R CODE,INTERESi AN�ATTORNEV'S FEES. RETENTION FEE: � CONSTRUCTION LEN�ING AGENCY PRE-ALT FEE: Q I HEREBYAFFlRM UNDER PENALTY OF PERJURV THAT THEftE IS ACONSTRUGTION IENDING AGENCV ��Y � � ���$ � FORTHE PERFORMANCE OF THE WORK FOR WHICHTHIS PEflMIT IS ISSUED(SEC.3�97,CiY.CJ. , . Z � 4ENDER'S NAME CITY OF DIAMOND B _ � LENDER'S AODRESS /� � - ¢ ICEPTIFYTNATIHAVEFEADTHLSAPPLICA710NANDSTRTETHATTHEABOVEINFORMATIONISCARRECT. TOT/'1� FEES /�, - w 1 AGAEE TO COMPIV WITH ALL CITV AND COUNTY OR�INANCES AND STATE LAWS RELATING TO BUILDING v � CONSTRUCTION,AN�MEREBV AUTF10FiIZE REPRESENTATIVES OF THIS COUNTV TO ENTEF UPON THE � J'r� ��� � � � ZPBOVE-MENTIONED FROPERTV FOR INSPECTION PURPOSES. COMMENTS U � 1ti'�iiNt� �. � . -� � . m ¢ PERMITTEE NAME(PRINn � Cn __ � 516NAlUFEOFPEAMITrEE DATE G � VALIDATION = RECPT.NO. [! PAID BY , �'" WHITE—DepaAment Copy,YELLOW�inance Copy,PINIS—Assessor Copy,GOLDENROD--File Copy,GAEEN—Applicant's Copy , _ _.. �.. ,:.; „,. , .. ,z; ._.,,. ��� � � � , � � �'� � � � M,.. w. �—, .. � _. . �� .... � � „�� � , - R � � 4 : , � s � x::. , � ,-. � �;_.: ��i��< �, W-�-- , v � , ��C����1�3�5�' _ �. _ _ .�____ �. � �___... _ � Y:.', � ��''?�� E-°�'�?r,����-�'�-�� ; � � i � FF-�t� ��C�R�TS _ ._ _ �k�. .______�.�.___...._-- � �� ��.":.'`'F�'�C'Yr°°�a� =��I� �� _..____�__.�_ s tJhfl��F�' ��a�`e::7�iC}4.J�T � - � __�_��___ i___ - � � ,«���,ra i 1 ���E�;�?a � ; � �����F$ ��.C�C�R�`i��EC�U!`C , 3 .�.. _ , �.. . ___--_ ____ ---- -- �,. --- '`L��C���?�.,�� � ��X �3€���L,4���'C�t�i���l�'I.�i�. . � � � �.... __ d. ----�—�--� �__-} ____ ___._._ ____ __ _�_W __ W_..w.__..�_. _.__._.� -�--� �-IF��F'l..A��t3C�[�����,�,� � E ,��'�`�9$v`a��i� .� �l-�� ! ��x..re=W�� I ) � .. ._ ___. _. ._ _ �rs r�����fiC`� ? �(�3�'�. �#��iL ����r3 � ' _ ____..w__�..._ �. _ �g��t���i�-'€ �.�A��`'a;a�__�__ � '-._ _ ._. ! ��' ��li�����l��i ....._ __ � _l � _ �._ �_______ .�...�.� ��_,_..._. ___ __� - €m�Q �l��C°"$� '�'(�!_�t�91���� _� , '�. �i�S�L�'��� ��.�� ____m_.__�___.__. _��_ .________ �-;- r r._ _____—� � � '�f��-�`���`�l�t� i �_.___ _��...� g rd.�'��r- .�:.�'1�d-� _._�..:�__._ _ ���_.____ ____..�.�___� ��._..u.,... ,- � r �.__� � ���,'�E-'(�C"'a `_`--____"�-_.___----__ � ;�„s4.��"���_��t�,� � ______.� __ _ __�___.__-_____�_________ , ..._ .� �tT��,Ca�-� �"��� �'��� �W �.._....._.__ €�C7i.3CaFi C�A€�1�� _. i� ________ ._e-_.___�.._�_� , � �aC` 6r� t.'�..6��a���,�� �_�. i _-___ � � � F�i�i�E'C�ri,�;�Ii�6'.� � ��£ �$�.p^�.�_._p ����^��°9^ ..e..��..��...m.n...._.�.�_ f �LAi...'�tLLC'..�i�f'li�.r_.._.r 3 .�...,.__� ` v ��.6 F s t..Y"1.!E�... n S 'a.r% � � . . "` :._ ' �(`q.._.m_._.,..,-�...j_.... /`� �__.�....�._ ..... ...._. ......_._._..._.___.,.....___....___......._T _ _ _.� ��'' ��;�t'-�1F�'.r4����.:a � n F�V�i��9Y�tC'��7 ' t _ _ ��__ ____.._ ___ _ � _____ __.___..�.�__.._.�_.__}________._._ ._ � � �#,'r�r�� ����"' �.a�T'.?t�d __I._.�.._ _ P�-�'CV�%. _e.�_.___._-___.__ � ._.__. ___ 1 a_.m.�_____m___...___. ___ � �` �.. - -- ___ _ _ - ° "`";#�e��" ��'�'���i"��� � i C�FF�`��`�6����. � �__. . �°a%� ._: ._.� '._ __. ___.__. �.._ ._..�_ , _.. ��;°�'�"�1��, \t�a�;.�i�,`°� � C��sw�lC`rr`�Tl�'1°!J�° ; 1 __ _�mm...___�._�.. _._.. � _ ____�_ ___--_ __ �________�__.__.._.__.._.j��_�_.�... �� ... ;�'a�J�� � F����t�a=�� i �;�.,._.._ � ___... _ _a„�.,.___�__�_. �_�...__ . __�..._�_.._.__..� i _ _____ _._ , �����s� ?rA.��€� � ; �.������r���t��s�,�. ! � � __. _ __ __.�..__.� �P. __..�.n _ ._� �_�.�,� _�� _�__.__�a__._M__ ���=��'��-rl� �.. � ��l�i�� d���a� �. .,.� _..�... _m.w.�;�.�---..�. ____-_. _____.____ ( :___ � __ �-------!------ - .w.�.________ �° �"^ � ; C=��r�l �'�����'�� ' � �..� ,-�"���+� ��=� �� � ___. _._ ' _______.__ . ,� �.�_ , --�--------- �f�v��. ��°�T � ; � . F���'',��� �€�fin� � � � ..�.�.._ . _._ ___ ._.� _v._ : _ __� � ___ _ - ����� ���";�'��� �� - . I , �-���.?�T'� ��� 1 �'6����._ ; _ __ —_ -- � . . _ ______ ._. - ......-__ . , , �- . _ — __ � �=F'�!��..�?�s��`',�`s�` F ! I."���1. �°''�r�� F�.�;3i? __� ` ' � ___� _�.s__..�. __�__ .____. �..-- ; .�________ ,"°�;3���F'�:?���s�f�� ; I_��� __ ... - ; ��'�a��?�:�.�, � f ,�_.m..�. _._._._ ._.__.��____._. �.�..�...�_. _____._.._�.P____ __� � . _ ....__..____ _—_ �„_..��.___ �_;_._._m.._m__ i � , 1 E j —_� ' �-. i --�--------- — __...Pa��_ _ � _��. ; � � � . . ; � � • � ; N mw_�__�,�...__ , u � �,_. .- _ --— _ ,., > ,.., .�, _ . , y ,., . ['��.:,3�������``�� _..______.___._.,._.__ ��. _� . .___ ..�.__ -- �. --- _.��� .--- , r . .�... ._`�'.,�"s..--�. _ w� ��_��'...__1—Z.--�"1�_.�.�+d�z�P.._S.�---,�-�-----_.___ �'. �._i e � _... , �-_____._.___ —______..._._�.___�__._._ .__.�_��.__..�._.-.--- _._ _.__ .....�_._._._� � _.____,__.. __..._______---�__��._.__�__ �__..__._.._._._..w_�. �.� ��_.._�.._��_.__.__._._______��.�._...__.�._ . .. � , , ,., I _.�_- _____ _. ________--__----- - � , .�______w______�____�__. _ ..�. _�____ _ _.�. __._�.., .._..e..._ _ __.._ F " . . �,�. �...� . . � . . , � . _ . . . ... , .., � ' , . + F �.._�.....�....�...«��.........� _..�....__._.�....... . . . , '_�_�_�._....- ..._.____,."_ . �...,.. � .. . . .._. .. . ... 9 ^x]—fy���T�k ..._ .�.___.�v�_ .�.«�..: I ._ .�fi R i --..e.�_..�.�....»�........._. �.�....w.a........_....�._.._.._._.�_...ea._....�.m.,_. .__,._......._._._....� l . -{�`�.�...._. . JI i ���4 i�r i�;�"�1�"�a w`'9�.S��" _..�._._..�.- � � �s3 ����~� r�3�',d7 �i�� _ _ _ _.�_____. _..___a.._.�.____.._.__.___ .___.__.__..._�. _._____..._�, dY . " .:'� � @ti. .- i F�j�h�' .i } ., ,.} . . ..._..._„ ,� ...,,..........._.. _.. _._..—.._' _ £ � . J*i r^-`..,.`^--- ""o-'---'""""---'"r'--._m.��_..,- . . . , . . �! � �i..��� ' ' i � � r:f..�1�;..�.��-� r: '�,;___--__., _____a. _._...�..__. __._..�..__---.��a..__ ___—w � _��____'.._._�._____ _...._.____ � � , ':'.�. �` ��';t ;,t z"�° � a � �.... y. � _____.._.___ _____��_.._.___ _ _____._._______ ! - : �. Q� � � �. ; ���.__�..�...___� �._� ______._._.__._____�---____._ ��_ _..__ _____� ,:: �� . � , �.: � �. � , _.�___... . ._._..� ._.______._--- ___..��____�_...�_.v.__..._..�._____..—. __.__....._...�._-� . . . . , _ � m � x � � �, y .. , _.. , �.� � __.�__..�m��._______..�. ..._ � � � ; ` ! '�� : , s�.f, �, i � -- _� �- � . . �- . . ,� ° , . � .�. _._ ____�.�.:_�:�__. — ---�.�e.� �..�.. ....�.....,�.�... � ----