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HomeMy WebLinkAbout11757 CITY OF DIAMOND BAR COMMUNITY DEVELQPMENT DEPARTMENT C � 21660 E.Copley Drive Suite 190 t', � PRE5•5• (909)860-3195 Fax(909)R61-3117 �'""' BUILDING PERMITAPPLICATION � ! FIRMLY o�- JOBSITE . �j � w APPLICATION`� �2 � PERMIT � p/C G�_ ADDRESS �..J � DATE `� NUMBER #� ISSUE TYPE OCC � APN LOT 7RACT DATE 2 �� CONST. GROUp p OWNER �': ADDR SS ., • ZONING SETBACKS �� a � Z CITY � ZIP TEL. FRONT RW q p APPLICANT � 1 TEL ` " � � S DE/SIDE STREET RW ❑ � � C O N T R A C T Q R 1 '�, C SIDE ❑ E � CITY $S`r l ZIP L TEL. IC-' Y� ` PROPOSED USE � ��' /Y) ?C' W ARCWENG! � ' �z DESIGNER NO.DWEL. NO. NO. a ADDRESS � �. UNI7S _ STORIES BEDROOMS ; �• CITY 21P_�, TEL. � ti.. u�.. DESCRIPTION SQ.Fi. FACTOR PSF ADJ.AREANALUATION - � O., OWNER•BCILDER DECtARAT10N SPR/ADD/REM �, 1 HEpEBY AFFIqM 11N�ER PENqLTY OF PERJl1RV THpT 1 pM E%EMVT FROM THE CANTRACTOqS LI� � Garage/Carport �4 W� CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCA�E:ANYCITYOR U CWNT'K'HICHRE�UIRESAPERMITTOCONSTRUCT,ALTER,IMPRDVE,DEMOLIgry,ORREPAIRANYSTRUG � /ry w. TURE.ORIOR TO ITS ISSUANCE,ALSO REWIRES THE APPLICANT FOR SUCH VF.HMIT TO FILE A SIGNED W a�l BCI( a, ny 3..0�'0 '; � STATEMENT THAT HE OR SHE IS IICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRACTOqS LI- � {, � CENSE LAW(CMpPTER B(LOMMEPICWO WITH SECTON 7000)OF DIVISION 30F THE BUSINESS AND PRO- POOVSDa SO / - O Q O �'' � FESSIONSCODE)ORTHATHEOqSHE19EXEMPTTHEREFROMPNDTHE8ASI5FORTHEALLEGEDEXEMP- � I� V TION.ANYVIOLATIONOFSECTION7097.5BYANVAPPLICANTFORAPERMITSUBJECTSTH�APPLICANTTO Z Re-Roof �.. p CIVIL PENALN OF NOT NOPE THAN FIVE NUNDRED OOLLAHS(f500).): Z ❑I.ASOWNEflOFTNEPHOPERTY,ORAIVEMPLOYEESWITHWAGE5ASTNEIF50lECOMFENSATION, O COII1111BfC13I � WI�L DO THE WORK,PNO THE STRUCTUflE IS NOT INTENDED OR OFFERE�FOR SALE(SEC.70Aa,BUSI� � J �'� � NE55 AN�PROFESSIONS CODE:7HE CONTRACTORS LICENSE LAW DOES NOT pPPLY TO AN OWNER OF � �'� P0.0PERNWHOBNLUSORIMDqOVESTHEREON,ANDWNODOESSUCNWOFKHIMSELFORHERSEIFOR � f Q THf1011GNHISORNEROWNEMPLOVEES,PROV10E0THAT5UCHIMPRaVEMENTSARENOTINTEN0E00R m � OFFEHEOFORSALE.IfiHOriEVERTME9UILDINGOHiMPPOVEMEN7iS50LDWITHINONEYEMOPCOMVLE- � �E z TIINJ,THE OWNER�BUILDEH WILL HAVE THE BUFDEN OF PROVINQ THAT HE OR SHE 01�NOT BUIIO OR �' � IMPROVEFORTHEPURPOSEOFSALE�, f ❑I,ASOWNENOFTHEPfiOPERTY,AME%CLUSNELYCqNTRACTIN6WITHlICENSEDCONTRRC70HS � � TO CANSTqUC7 THE PROJECT(SEC.7094.BUSINE55 AND PROFESSIONS CODE:THE CONTRACTOqS LL � ValU8lI0f1,_�_ ADJ.AREA , W' CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPEqTYWHOBUILOSOflIMPROVE9iHEREON,ANO � � � WFIOCANTRACTSFORSUCHPR0.1ECT6WITHACIXJTRACTOR(S�UCENSEDPUpSUANTT07HECONTqp�. ' �UANTIII' DESCflIPTION FEE y Y TOFSLICEN5ELAW.). {� � ❑IAMEXEMPiUNOERSEC.___ _.__B.6P.GFORTHISREASON Q .,��� � "_..."" _`_ `__ � � � M' LL' DATE ,_ OWNEH__. . U P' � W ¢ LICENSED CONTRACTORS DECLARATION W � [.L I HEFEBYAFFIRM UN�ER VENALTY OF PERIURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER G ry� � ,� I'. a, 9(COMMENCIN6 WITH SECTION 7a0o)OF DNISION 30F THE BUSINESS AND PROFE9510NS CODE,AND Z • � •�-�'.�.� ! ° �� w MV LICENSE IS IN FULL FO AND EFF /� m i t�' �.�J' a �✓�..C_. f � LICEN3E C S �r llC.NO. I n j i _� � V DATE � — CONTRACTOK, ' E Il� v 0- W i'_ � � WORKEFS'COMPENSATION DECLARATION Q y � � b�� � 1 HEREBYAFFIRM UNDEP PENALTY OF PERJUNY ONE OFTHE FOLIOWING DECURATI�NS: Z �t; � _IHAVEpNDWILlMA1N7AINACERiIFICATEOFCONSEtirTOSELfdNSUREFORWOHKERS' = t�,� � PENSATION,ASPROVI�EDBYSECilON37o00FTHELABORCO�E,FORTHEPERFORAIANCE W k --— FTHE WOqK FOR WHICFi THIS PERMIT IS ISSUED. � . � � . IHAVEANDWILLMAINTAINWOflKERS'COMPENSATIONINSUFiANCF.,A3REWIREDBYSECTIpN � Q 370a OF THf LA80R CODE,FOH THE PERFORMANCE OF THE WOPK FOR WHICH THIS PERMIT IS /y ISSUEO.MY WOpKER$'-C vENSAT ON INSURANCE CARRIER AND POLICY UMBE+AHE: CONSTRUCTION ' (,�� zCARRIEfl +Y����--�����— PLAN REVIEW �3v. 9� --- �. � aoLICYNUMeER__ ELECTRIC �L + R 4 o (n+�ssecncxaNEmrroTeeoor.w.E7eDOFnieaetn.trr�s�auetax�oaeooeuMs(S�ro)atlEssl. PLUMBING � •��J � Z I CERTIFY TMAT W 7M[VERFORMANCE OF THE WORK FOq WHICH THIS PERM�T IS ISSUE�,I MECHANICAL I� ���� �� (J SNTLLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOME6l/BJECTTOTHE , y���' � WORKEPS'COMPENSATION LAWS OF CAUFORNIA,ANO AGREE THAT IF I SHOULD 9ECOME INSPECTION FEE `_ F SUBJECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 3]OOOF THE LABOR i�pq '� ) �.W � G`O�E,ISHALLFORTHWITMCOMPLV WI�7yf�jo �gVISIONS. �SSUANCE �9�� fn .id� � `�_ A��L_L�Jf��,�"� SMIP �` j '7bI _ . p DATE:_✓_..L�� APPLICANT: � � S, � WAHNING FAILURE TO SECUHE WOqKERS'GOMPENSATION COVERAGE IS IINUWFUL,AND SHALL 9E ENERGY P/C ___ _� i(F,� . LL SU&IECTANEMPLOYERTOCflIMINALPENALTIESANDCIVILFINESUPTOONEHUNDRE�h10USAND ENERGYPERMIT 6, DOLLARS(5100,000),IN PDD�TION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDEO FOR IN -- (F J SECTION37aBOFTHELABORCADE,INTEREST,AN�qTTORNEY'SFEES. RETENTIONFEE: "� � +�' �" �i p CONSTRUCTION IEN�iNG AGENCY PqE-ALT FEE: �,r�p � �t! � IHEREBYAFFIRMUNDERPENALTYOFPEqJURYTHATTM'cflEI5AGON5TqUCTIONLEN0INGAGENCV f�� FOfl THE PERFORMANCE OF TH WOflK FOfl WHICH 7HIS PERMIT IS ISSUED(SEC.3097,CIV.C.). �"f� W ��- f� � LENDER'S NM7E_ . __ _ '��1 N F_- LENDER'SAODRESS ?' a ICERTIFYTHAiINRVENEADiHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORqECT. TOTAL FEES IY'� ` •O �� � � � IAGREETOCAMPLVWITHALLCI7YANDCOUNTVORDINANCESPNOSTATELAWSRELATINGTOBUI�DING . �� � CONSTqUCTION,AND HEREBY AUTHORIZE REPRESENTAiNES OF THIS COUNTV 70 ENTEfl UPON THE �y Z ABOVE•MENTIONEDPROPERTVFORIN57ECTIONPUNPOSES. `' COMMENTS_._ � o. ,l`1' �� tr"- _ m E TTEE NAAIE(PFNNT). �v < �C..��t � "..�. � (q SIG N U F P R TTEE OATE � RECPT,NO._ PAID BY i VALIDATION ~� WHITE—DepaRment Copy,YEU.OW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy � � � a , �r-"'� � �� _—�--- r`_"•.e �, � i I �`T'� ' E � � ��. � � � � z � � � I ��� i i 'i I � —�- I �j� i `7 .�"�' � ` i 7 � � . � � ::! �. i ' . -_l: 1 �, ,�.. j �_ � ; �. �. � � (_ f ` � �„ i � � _ � i � ;: � �� � �� ' I ' i - . 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