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HomeMy WebLinkAbout14807 � ! �� CITY OF DIAMOND BAR `� � - DEPARTMENT OF COMMUNITY&DEVELOPMBNT SERVICES � � � w 21660 E.Copley Drive Suite 190 ? � (909)860-3195 Pax(909)861-3117 PRESS � ��'����"� BUQ.DING PERMTl'APPLICATI�N FIRMLY 4 ADDR'ESS�� 1 '1� L° LW 1G C'. �i�,��' APPLICATION PERMIT -/�����yJ��J P/C � p .� DATE_ ' �"'� NUMBER! _1 � � c� ISSUE TYPE OCC �' APN LOT TRACT DATE CONST.� GROUP ;: o OWNER �> �Gf.S6dC1G � p ADDRESS�1 r'I C• �.C,�IC � O Y'• �` F� ZONING SETBACKS 3; Z CITY �I�'iitlf►G(l(� Q7(1 L�'ZIP �7 ,' TEL Ue � ., :'• FRONT RW I�__. j, g APPLICANT/�C�-ir:ti� C�Y1t'YC2.C�-�{gTE �ID���f3ll REAR __ U_. SIDE/SIQE STREET RW Cl_ � CONTRACTOR C: b �' i� _^ SIDE ❑ ____ ADDRESS �. f" l�tifi � t' � CITY�C3C t"✓1'�l� ZIP�V� TE �r]�� �iI�' 7j�f PROPOSEDUSE � � o ARCHlENG/ I; � DESIGNER NO.DW[L. NO. NO. ` ADDRESS � UNITS STORIES _ BEDROOMS�_ f^. NCITY ZIP TEL. �.�.. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION �' Q OWNER-BUILDEfl DECLARATION SFRlADD/REM O � p I MENEBY AFFIRM UNDER PENALTY OF PERIURY THAT I AM EXEMPT FROM Tt1E CONTftACTORS�I- G8f8QB/CBfPOfI �R W CENSELAWFORIHEFdlOWMIGREA50N(SEC.7o3t.5BU51NES3ANDPROFE5510N5CODE:ANVCITYOH (/� _ �' U (pUNTYWMICMREWIRESAPEflMITTOCONSTFUCT.ALTER,IMPROVE.DEMOLISli3ORREPAIRANYSTRUG LLI P9110/DBCI( � TURE,CFIOH TO RS ISSUANCE,ALSO qE�UlAES THE APPLICANT FOR SUCH PERAIIT TO FIIE A SIGNED W � STA7EMENT THA7 HE OR SHE IS LICENSED PURSUANT 70 THE PROVI510N5 OF THE CONTMC70Fl5 LI� � . � CENSE LAW�CHAPTER 9(CAMMF:NCING WI7N SECTION 7000)OF DIVISION 30F THE BUSINESS AND PR0. POOUSpe � � FESSIONSCODE)ORTHATMEORSMEISEXEMPTTHEREFROMANDTIIEBASISFOR7HEAi.LEGEUE%EMP� (!f � TpN.ANVVIOLATIONOFSECTION709i.5BYANYAPPLICANTFORAPERMI7SU&IECTSTHEAPPLICANTTO Z Re-Roof � ACIV0.PENALTY OF NOT MORE TNAN FIVE MUNORED OOI.�ARS(5500�.): ❑I,ASOWNEROFYHEPHOPEflTV,ORMYEMPLOYEESWITHWAGESASTHEIR50!ECOMPENSA7�ON, � CORIfi1BfC18I � � � MfiLL DO THE WORN,ANU THE STRU(:TURE IS NOT INTENOEO OF OFFEREO f'OR SALE(SEC.7o9a,BUSI� J � � NESSAND PROFE&SIONS CODE:THE CANTRAC,iORS LICEN6E LAW�0E5 NOT APPLY TO AN OWNEq OF = PflOPERTY NR10 6U�LD5 OR IMPFiOVESTHEREON,AND WMO[pE5 SUCN WORK MIMSELFOR HERSEIF OR � THROU6HHISOqHERONMEMPLOVEES,PROVIOEDTHATBUCHIMPROVEMENTSARE40?INTENDEDOR m � � ,OFFFREDFORSRLEIF,HOWEVER.7}1EBUIl�INGORIMPROVEMENTISSOL➢WITNINOIVEYE0.ROFCOMPIE� z TION,THE OWNER-BUILOER WILL HAVE THE BURDEN OF PpOVING THAT HE OR SHE DID NOT BUILD OR � IMPFIOYE FORiNE PUflPOSE OF SILE). _ S ❑I,AS OWNER OF THE PROPEFiTY,AM EXCLUSIVELY CANTRACTING WITH IICENSE�CONTRACTORS Q TO CONSTRUCT THE PROJECT(SEC.7044,BUSINESS AND 7POFESSIONS CODE:THE CONTflACTOPS LI- V81Ufit10f7 ADJ.AFEA I; W CEN6ELAWD�ESNOTAPPLYTOANOWNERUFACROPERTYWHO�UILDSORIMPROVESTHEREON,ANO � � �� —�--- l'�; � WFqCONTMCTSF�RSUpiPflQ1ECTSWITFSAGOHiRACTOR(S)LICENSEDPURSUANTTOTMEGONTRAG QUANTITY DESCRIPTION FEE F� TORS L10EN&E UWJ. . � � ❑IAM EXEMPT UNDFR S�C. _B.&P.C.FOR THIS REASON Q ��� � -- $ -- —-------- U ¢ �: u' DATE oWNER—""— _""'__'__ F"' U � w � LICENSED CONTRAGTORS DECLARATION uj E� lL IHEREOYAFFIRMUNDEAPEN/LLNOFPERJURYTHATIAMLICENSEOUNDEflPROVISIO450FCHAVTEfl E' � 9(COIAAIENCINf1 WITH SEC710N 7000)OF DIVI510N 3 OF TNE�USINESS AND PROFESSIONS GOOE,RND Z C� T ��� MY LICENSE IS M FULL FORCE AND EFFECT. CD � ) � LICENSE CLASS �- �� UC.NO._ �J,�� j � V DATE CONTRACTOR ��� _[(i 1�_�._� ':+ a � W ' ' � � W RK S'COMPENSATION DECLARATIUN � —� ti�� � ¢ N U f I HEREBY AFFlRM UNDER PENALT'OF PERJURY ONE OF THE FOLW W ING D[CLARATIONS: �' � Z !: � IHAYEANDWILLMAINTAINACER7IFICATEOFCONSENTTOSEIF-INSUPEfORWORKERS" 2 i: � COMPENSATION,AS PROVI�ED BY SECTION 37W OF THE LABOR CODE,FOFTHE PERPoRMANCE �U - OF TME WORK FOR WHICH Tii15 PENMIT IS ISSUED. � �'F 0 W _I HAVE ANO WILL MAIMAIY WORKERS'COMPENSATION INSURANCE,AS RE�IIIRED BY 5ECTION j? Q37000FTMELABORCWE,FORTHF.PERFORMANCEDFTHEWORKFORWHICHTHI3PERMITIS �. ISSUED.MYNlORKERS'COMPENSAT INSURAN ECARRIENANDPOI.ICYNl1�IBERARE�, CONSTRl1CTION S' � . . _ ___'__—'_"—_....__......_ e+ 1�� �: y cAaa�ER �7�C-1� u 1�. _. ...._ .......... PLAN REVIEW ;:, c.��('^� '._ __ __..__..._...._.___--_...�_'_. —_'—_...— ZO PaICVN�MeEf7 ��,I_t-'�� 't'r L1=_�' ...� `ls'� ELECTRIC i'. � —.....__..—.....__.._..-- -.-'. —jq —.._.. — Q 0 (RUs3[CIqNNeFVNoiBEaxnPLEfEnoFnEaEroMSwaoMEF0.N1%3Eo (f7w)oal PLUMDING --.-------- C1-'��--- W MECHANICAL Z I CEflT�FYiMAT IN THE PEPFORMANCE OF TME WOAK FOR WHICH TFiIS PERMIT IS ISSUED,l ---�-,— , — --------- II (} SNALL NOT EMPLOY ANV PERSON IN ANY MANN[R SO AS TO BECOM'e SUFLECT TO THE � "' C; �/j WORKERS'COMPENSATIONL,AWSOFCNLIfORNIA,ANDAGHEETHpTIFI3HOULOBECOME INSPECTIONFEF _,.______...,,__.___ z_ 6U&IECT TO THE WOHKERS'COMPENSATION PLIOVISIONS OF SECT�ON 370o OF hIE LA90R i' = ISSUANCE -.----.-_--- ---,- "s_ f CADE,I SHALL FOFlTMWITN COMPIY WITH TMOSE PROVI510 S. -- ----- °--�— ` Q f � SMIP k p DATE: ._. APPLICANT:�u �i1 ���� ." '— y� ._ �����A�......_ i W ���Q rs � ENERGY P/C " � ._ �. WAFW ING:FAILURE TO SECURE WOqKERS'COAIVENSATION COVEHAGE IS UNLAW FUL,AND SHALLBE p`'aA'.^F"�'�'H}F'a'----'--- -�5 i-1- q'� � SU�JECTANEMPLOYERTOCRIMINALPENALTI[SANDGIYILFINESUPTOONEHUN�IaFDTl10�SAND ENERGYPERMIT " � � }��'�y�� � ,__ __ __ B OOLURS(SI00,00o),INADDITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDF.DFOHN -�y.{�y{�g -' - � SECTION 3]oe OF THE LABOR CODE.INTEREST,ANDA7iOHNEY'S FEES. RETENTION FEE: _______"""_��� ____ � W CONSTPUCTION LENDING AGENCY PRE-ALT FEE: �g a- -' --— ------- -- 0 � IFiEREBYAFFIqMUNOERPENALTYOFPERJURVTHATTHf.f1EI5ACONSTRUCTIONtENUINGAGLNCV � FORTHE PERFORMANCE OF TNF:WOFlK FOR WHIGH TMIS PERMIT IS ISSUED(SEL,30W,GIV.C.�. -""—'� ��� � ��� � � � � �� W _'_' —" ___'... _..—"_"" _"—_ _ q � IENDEP'S NM1E_"______'____ �.� ______ � F— LENDER'SADDRE55. ..-- —.--.---- ------ a ICERTIFYTHATIHAVEREADTHISAPPLICATIONANOSTATETHATTHEPBOVEINFORMAT EG fOTAL FEES ��W�� � � IAGREE TO COMPLY WITH ALL CITV AND CAUNTY ORDINANCES AND STATE LAWS RE T IlD G � �� CANSTflUCTION,ANDNEflEBYAUTHOHIZEREPRESENTATIVE50FTM�TVTO RU T ZAB�E-MENTIONW ERTYFORINSPECTIONPURPOSES. MENTS___ _. _._—_. — � ��r�'.�'�.� - ------- _ � � _ � �--- m PERMITTE F�� T) ' —'—'— ._—.. .'—_ _" a ����7 '. . .. __ �/7 - ^ F"%�%f . �� +�✓ �. � ` . — — '—' .. .—'- ---- � 16NATURF.OF PERAIITTEE = RECPT.NU. PAID BY _..,.___.. _____.—VALIDATION ~ WHITE—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENR06—File Copy,GREEN—Applicant's Copy �.. �.. _ , , ., .. _ _. � ; , , , _, , � � � � : � F , � i � ' 4 • ! i I � ` i i � i � i i � ! ; f , � � � � � , , , , � , � , � � , , � ' i. . ' -- -� ,- = ;_�_ ' �._ . �. �_. .. � , � ' ' , ( ,� � � � ' j � � � ' , . .. . .i .. _. .. _ .._ ._�... __ � �� =;. I ' ' � ' i I , � ( � ; I � ' , ' ' i ' . _ ; . , .. �,� . , r.r . . . . . . - . � � . . € � 3 , - t. . . � , r . - . � ' s ' - ,�, ' I . ' I . � c t i rI . � I �i ; � � ; i . 5�k I � I ' 1 � � 1 .� r : ... ... ___ .._ .... _ ... .__.... _ . . �.. .. .,., . .G_ I..... � .�. . _. .:�. � . � � ,- .. ... ......__. .. .,. 1 ar � . i I' ' i , � �. ' ' - �� � ,� i. I .. ' �. � I ' � �i � � ' , I ',.� � • _ �� ,, ., �� ,, _ . , I �. , �.' .,. r � . 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