HomeMy WebLinkAbout12895 (13) i
` C1TY OF DIAMOND BAR ,t.--
' '- ��"� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICE
21660 E.Copley Drive Suite 190 �,,�
� (909)860-3195 Pax(909)861-3117 �--� PRESS I
�����° BUILDING PERMIT APPLICATION FIRMLY �
� JOBSITE p� �y J y� , APPLICATION �-C_ PERMIT �, P/C �
A ADDRESS�(y I� ,�� �U(Z h?'L. � �! �.. DATE � NUMBER�_ #
c� ; ISSUE TYPE OCC
APN LOT TR T__ DATE CONST. GROUP
p OWNER i � `
LL A�DRES L ZONING SETBACKS
� CITY ' 21P I TEL._S - FRONT ' RW f_l_
APPLIC NT TEL. REAR ❑_._._____
z SIDEISIDE STREET RW ❑_
� CONTRACTOR f� SIDE _ ❑_._._
o A�DRESS 3 ' PROPOSEDUSE ���J
CITY ZIP TEL � !
oARCH/ENG/ — �
dDESIGNER NO.DWEL. NO. NO. i
ADDRESS� UNITS STORIES BEDROOMS !
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION I
O OWNER•BUILDER DECLARATION SFR/ADD/REM I
� I HEREBV AFFIMI UNDER PENAL7V OF PERJUFlV THAT I AM E%EMPT GROM THE COMRACTOqS LI- � � Garage/Carport I
GENSE U1W FOR iHE FOLLOWING REASON(SEC.7031.5 BUSINESS ANO GROFESSIONS COOE:ANY CITY OH
COUNTV WHICH REW IPESA PERMITTO CONSTRUCT,ALTER,IMPROVE,UEASOLISH,OR RE7AIqANY STRUC- �
w 111RE.PRIOfl TO IT9 ISSUMICE,ALSO RE-0UIRES 7ME NPPLICpNT FOFl SUGH PEFMIT TO FILE A SIGNED ; W PdtI0/DBCk �
STATEMENT THAY HE OR SHE IS LICENSEU DURSUM7T TO THE PROVISIONS OF THE CANTRACTORS LI� �
� CENSE UW(L7IAPTEH B(COMMENCINO WITH SECTION 700�OF DIVISION 30F THE 6USINF.SSAND PRO� ' LL' POOVSPB
� FESStONSCODE)ORTWRHEOHSHEIS[XEMP7THEFEFHOMANOTHEBASISKORTHEALIEGEDE%EMP- �. (�
TION.ANYVIOUTIONOFSECTION7031.58YANYAPPLICANTFORNPERMITSU&IECTSTHF.APPLICANTTO Re-Raaf
� ACIViI PENAITY OFNOT MORE THAN FNE HUNDREO DOLLARS(3500).)' Z
� ❑I.ASOWNEqOFTHEPROPERTY,ORMVEMPLOYEESWITVIWAGE5A5THEIF50l.fCAMPENSATION, � Commercial �
z YI�LLpO THE WOHIC,AND iNE STflUCTURE IS NOT INTENDED OR OFFERFD FOa SALE(SEC.7aas,BUSI� . _1
NE55 AND PflOFES510N5 COOE:THE CONTflqCTOFS LIGENSE UW DOES NCT APPLY TO pN OWNEfl OF ,
� PROPERTYWF100UILUSORIMPROVE57HEREON,PNDWFtO[bESSUCHWORKHIMSELFOPHERSELFOR � �� �
Q THqOUGH HISOR HEH OWN EMPLOYEES,PROVIOE�IHAT SUCH IMPqOVEMENTS ARE NOT INTEN�ED OA m
W OFFEREDFORSALE.IF,HOWEYERiHEBUILDINGORIMPROVEMENTISSOIDWRH14C4EVFAROFOJMPLE- ��
z TION,THE OWNER�BUILOER WILL HAYE THE BUHDEN OF PROVING THAT XE OR SHE DID NOT 9UII.�OR
� IMPROVEFORTHEPURPOSEOFSALE). I
f7 1,AS OWNEROF THE PqOPERIY.AM EXCLUSNEIY CONTRACTM6 WITH LIGENSED CONTRFCTORS ;
� TO CANSTRUCT 1TIE PflOJECT(SEC.70tA.BUSINE6S AND PROFESSIONS CODE'.THF.CONTRACTORS LI- ._�� V8IU0110f1 ___.___„_. _.___ADJ.AREA_,,,__ _._._._ I
W CENSEUWOOESNOTAPPLYTOANONMEROFAPROPERTYWHOBUILOSORIMPROVESTHEflEON,AND
� �� KHOCOMRACTSFORSUCHPROJECTSWITMACONTRACTOR�3)�ICENSEDPURSUANTTOTHECONTRAC- __ QUANTITY DESCRIPTION FEE
Y TOqS LICENSE UW.�.
� J �....
0 L'J I AM E%EMPT UNDEFl SEC._ ___8.&P.C.FOR THIS PEA50Y �; U
� '_'_ _'_ ""_' �[ �
Z �ATE _OYMER_'__ _..—_ '� W /'J
C �
� LICENSED CONTRACTORS OCCLARATION ,: �j
� I HEREBY AFFIRIJ UNUEF PENALTY OF PFRIl1pY THA71 AA1 LICENSED UNDER PHOVISIONS 0F GHAPiER .�' � � ''
� B(COMM6NqNOWITX5ECT10N7o00)OFDIVIStON30FYHE�U5INESSAhDPROfLSSIONSCADE.AN[7 Z —�`� Y
MY LICENSE IS IN KULL FORCE AND EFFECi °
LAJ � i
0 LICENSE ClASS LIG.N0..___ ____ _—. _� � �
�i V DATE CONTRACTOR__."_ _'___"_ d �
W
, � WORKERS'COMPENSATION DECLARATION a �
� IHEREBYAFFIHMUNDEHPENALrYOFPF_RIIIHYONEOFTHEFOLLOWING�ECLARATI0Y5: � �
� Z
O _IHAVEANDWIILMAINTAINACERTIFICATEOFCANSENTTOSELF-INSUREFORWOFK[RS' � I
Z COMPENSATION,ASPROVI�E�9YSECT10N37000FTHElAWRCAOE,FORTHF,PERWRMANCE U
Q OF THE M�ORK FOR WHICM THIS PF.RMIT IS ISSUEO. � �
W
1 HAVE AND WIIL MAINTAIN YlORKER5'COMPENSATI04 INSU7iANG[,AS REOUIRF,D OY SECTION
Q 3700 OF TME LABOR CODE.FOR7HE PERFORMPNCE OF THE WOHK fOR WHICH THIS PERMIT IS
� �SSUED.MYWORKEPS' P NSATIONIN ECA RANDPOLICYNUMBERPRE: CONSTRUCTION �_.._,,._ ,_„__._. ___.__
'_—"
� ' � ` ry -. • ..---- PLAN REVIEW �
CARPIER --"--'-
'_—'... _....__.. ..__ 5
� POLICY NUMBER � � .—. --- EI.ECTfI�C.`� (y�����. �
' _"—"'_ .____. ._._...._ r
� (fH166EC110NNEmNJTBECOqiPLEiEDOFlHfPERAN7ISFOIiONEHUNN�LU�OLLARfiISIm?ORLESS} ,PLUiU161NG __- __.
U � ��, 'r
_._.-__. ..—_. '__.-_.—
Z ICLRTIFYTHATINIHEPEflFORMANCEOF7HFW�RKFORWHICHTk11SPERMITI5ISSUF.U,I ANICAL ______ _.___.. ... ._.—.
(} SHALINOT EMPLOYANY VERSON IN ANY MANNEft 50 AS TO BECOMG SUBJF.CTTO TIIE ''
� WORKEflS'COMPENSATIONLA'NSOFCALiFORNIA,ANDAGRE[THATIFISHOUL00[COME INSPECTIONFEE _...... ...—.—_ - _ —
- SUBJECTTOTHEWORKERS'COM7ENSATIDNPFlOVISIONSOFSLCTION37000FTHF.LAEIOH ' . � � .
� 5 LLF RTMWITNCOMPIYWITHTN O�ISIO 5. ISSUANCE . . �.,� �
O / � � ��-��� SMIP �� -'- -� —� —�— i:
p DA7E:�_�_. APPLICANT: d _.._'_ _._'_ .._—.... '__ :
-.__'.__
J ENERGY P!C
J WARNING:FAILURETO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL.AND SHALLOE —'—" ' "'--"'-/yry -"""—"' "'—"—�— �
LL SU&IECT AN EMPLOYER TO CRIMINAL PENFlTIE3 MID CIYIL FINES UP TO ONE HUNDRED THOUSANU ENERGY PERMIT 1�yy �'
OOLIARS(5100.0OO�.INADDITIONTDTHECOSTOFCOMPENSAT�ON,DAMAGESASPf70VI�EUFORIN —"""' 747'a'm�---"""'—' '-'—'— �
J SECTION370BOFTHELA80RC��E.INTEREST,ANDATTORNFY'SFEES. ' FETENTIONFEE: � � _ '
,._.. "'-_. _.._..—.. .—.—. y
O CONSTFIUCTION LENDING AGENCY PRE-ALT FEE: �.��+���� .__. _ '�
����-�' �y''��[�p5;'�' �:
�- FORTEHEPEflIFOFMANCE FNp[W RKFOJqWHIGHTHSPRIMITS�ISSUED(SCN3o97oCIV.C�ENCY ___�yyg�YA�� 1a1`U[4.�DYSL�1.��� _____„ ___ M�
St'
�.
Z _— .._—' —' '_' '— t:
LLI —_' n
� IENOER'SNAAIE..__"'__—_ _'___ _-' '-'--
.-- ---- -- ----- --�- ------- i�
1— LENOFp'SA�ORE55_. -- --..--._—... ..--- ,/J����. `�]
� I CERTIFV THAT I HAVE HEA�TMIS APPLIGATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FEE� /��,�,�]/J '�'
w IAOREETOCOMPIYWITHALLGTVANDCOUNTVORDINANCESAN�STATEIAWSRELATINGTONUILDING t../C.�' /(�' 4�•:
� CONSTRLICTION,ANDMEREBYAUTHOFIZEREPR[SENTATIVESOFTHISCAUNTYTOENTERUPONTHE
6
ZABOVE•MENTIONED PflOPERTY FOq INSPECTION PURPOSES.
COMMENTS_. ___ _—.. — --- �%
� �,p
J ' (//'/ "__ __
� PEHMITTEE' wNT�^ '—"— '— ,i —.'_ . "— _'___
� . . / ..�� — r _._ �
,-•
Uj SIGNAT R OF PERM EE a E -;'�i�— � �
� RECPT.N0._ � PAID 8Y ., __,VALI�ATION._, _. �
WHITE—Department Copy.YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicanl's Copy
�S S . �....�.. ... � .......
� � ... ..,� ..�,.,. ..� ..,
� �
i I ' , i � — — � —� ` I �.
� �� � � ' � I I � ' : i ' � I i �� �
� i � i ( , � � i � j ; I � � ' � '
� z� , � i � ( ' I' � � ' ' � i � 1 � 1 � � � � � i i
� ' �?�"� ': i .; ' I : ' I � ' � ;' I - ' i � � �. i i � � ; ; � k
� �i I �� ; I j � � � I . � i ; ! � j � � §
� ���; ,,' � � � ' 1 � I � I � 1 I � � ' � . ' �� ' ��
��. j � � i � j � 7 � ' � � � � ! C
�� ,
� ���� � ' � — �- �—� ��—` � z i I i t � :_� ` ' x � ( � � � j i � �
' � , I � �
� �
� , ,- . ;
' t��4.� � : i _ , � � , i � t � 1 i i ' ' � � � �
I i
� �� � ' i � F � ' I � � � � 1 � � I � ; � � i
.. � �� � i � i I � I ; i � . , I � � � ; i, I , � I �
��a�� � .i I ` � � � I I � � i ; � � � 3 � i � i j ' I i ' � i !
: �
, ,
�� , � i � i �_ � I i i � � ' � � � � i �
,.. ._. � , ( i ;
� � � � � � �._. �__ �--i�� ! ; � r � a
s t � � ,�� � ..i . i � ',.� i = � ,�, I �+ I ' �, i I � � � i ' �
! a �
� � a�r V i i � ' ' ' j ' � `�i�f. � i i i �: � i � ' � � i
�� ���, �i', � i: � , � j � j , � � n � j 7 I . i
s^ `�> �7��� i —1 i � ( ; I a! ��' � ' i ' ' � i �,I � �': � � �
� rk� �� � I � rr I �.� � I � � ( i i i ��s � � i 1 i � � i i
4� �� '4"�rra� -� � �� � i j j � � � t:I I .. � � ,1 t f � � ; � I ,
�"" �"? '�� i � i , t I�� �' �i �i `� S � I i '�-> � I �' 1 � ' ' I � i
�> '�, ��t .�� � ��L I I � �� r� �� �� � '��� �� �.�1. � E � � � ) � � � ; � �
[
n K�'� � c ��r � �I � �— r � _�.� � '� t , i i ; �� i � 1 �, I ` � � � � ��
s"� ,� i "�" � �ui ' i � � � � - 1 ' i � �� � � i ' � I � � ; i +
b a� �y�., x � i � � � ' ��'� i — � ��,; : � � ; I i � ! !
� �e� { ;_ = 1 j ��. � i �
:. �. 4n �i ' I { I � � , .` � " x i` f I � i ! , j' � I V
�� ' � ! � ! i
. �' �`",: �,,.,,.��i I. � � � .. i . , . 1 � � � ' i � ' ` � , ',. i i I i i
� j ' j � ,; � 1 ' i � ' ! � � � i .
�.� "�, ,���� � I - � � � �, � � � � .., � � � � � I � � �: I � � . � -
�;�� .� � ; ' I E � .. � �� � ! � '' � I I � ( , . � j i i �
- � ' � j ! � ' i � j' ' I � . i
. ��'� ; � ,,' '__.I � ' ' ! � I � ` � , � j ` ' ; } ` I M
��� � � i 1 � -_.�I_.. �,..... - � � � ! i � �, i j
T� � � � 1
_ r _ � I .:_ t ' ,
��#� � _ � I I '.. 1 I 1 ! I '
� _
� � , ' ` i � � � i � i y
, j ' , ,
� - � � � � + ?
: , �... � . , � i �
�� -� .:.. . ,., _f _.. .... c........ 1`� ' � '
� � �
ab 'A � \ I
�;t�,+�.+ i � i , � , ,
3
.. ���� f � I i i.._..� i i �. '' � ; � i �5�� �'�p����� ���k1c� � z
I � ! �
. m��,. � + � I � � � � � j r i 1 � 1 I I � ����t"�����-�. s E�i' L {
m �
I
4� 48 � n i � i c � I � 3 1 : i 1 � t �'m �'� e£
i . ( ' s mx�v.a�s � .
� �'�"� � � " � ��� � �I i .i i � I � � ,, y�� i�F �'r � t � ��' _
_ � y�3 I � i S� . t --�. �°�f� 4 � � . � � t�'�'�� ".�.�i �w �s 4 �
� ,��� I ' i � I� = t i t .�I ._ � � � i � � '�:�=e�� �7�"" � q x� a� �
•i i i t � i r � i � � � � � - '�"�'��f x'�-� t-"+� a• !
�, � ; Y i '... t ' I I : � E r s��� : r� �
.n.�__!_.. ......._.. ._... .1._!..__�. �_......_.�_._.... t_.x_...s. �,.�...,_l_,.L._. .,,..? .t _..-,,.�_._...e.i ._i....�.. . .�.. ! � '� �m �` %s �,c a�"g�� j
� __.,. Ir � , ��� � � �" °
+� i , �
���� _ e .� . ...� , ,,.!�., z....... . .......�__ _-,..__.._ _�..,.�..3...�- .._. ._.