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HomeMy WebLinkAbout17915 (10) oi��� _ _ �.� CITY OP DIAMOND BAR �1w�� DEPARTMENT OF COIvIIvt[JN17'Y&DEVELt}PMENT SERVICES 21825 E.Copley Drive (909)$60-3195 Fa�c(909)8b 1-3117 PRESS `�%vM•`� BUIt.DING PETtMIT APPLICATIfJN FIRMLY y JOBSITE ��i ^'� i '�����r^� ��r�`�`'�-- APPLICATION �_.� C-,���U BER�� #fC �J� �! �- o ADDf2ES5 t � E-Ly dATE � �— ISBUE TYPE OCC APN_ �OT TFiACT--� DATE CC}NST. � t`,(3pUp pOWNER ��<_"� . v'V'^,1;,v��,Z,,,.i ��__ --- � ADDR S�-�S 1� L-t�t`�7. h�'�^ ZONiNG SETBACKS y--- �T� � �, a CITY t-v^,.uY�L y{ ZIP 75-1�TE�_,�+"_,.?G't�'( FRONT RW I � � APPLICANT c.,n�.t . TEL. 11 REAR r�� '_ � SiOEtSIDE STREET RW� t ___ a� GQNTRACTOR_ SIpE __, y� ¢ ADDRESS_. , ��—��,/�ti � ClTY �� 21P_� TEL. PROPOSED USE—.�_ � j �'� � T"�-t��t-t � ARCH/ENG/ W DESIGNER_..____ _. --- N0.DWEL. NO. NO. a ADDRESS cn UIYETS ST4R{ES _ � BEDROOMS � CITY _„ ZIP TEL. � - DESCRIPTION FL FAC(OR PSF ADS.AREANALl1ATION � OWNER-BIllLDER DECLARATION SPPJADD(REM O (J I HEREBY AFFIRM UNOEF PENlLL.TY OF VEFJURY�HAT I AM E%EMPT FqqM THE CONTRACTOqSI.I� (�jdf890/GB�POfI W CENSE{AWFOR7HEFOLI.OWINGREASON{SEC.7fl37.58U5INESSANOPfiOFE5510N5GOD[:RNYCITY4R (n C) CDUNTVWHICHREOIiIqE5i,PERMtTTOCANSTRUCT,ALTER.�MPROVE,pEMOt19H,�RREPAiRANYSTRUG W TURE,7RIOR TO ITS ISSUAIJCF,ALSO pEOUIRES THE APpLICAN7 FOR SUCH PERMIT TO FILE A 91GNEU w Patio/Deck � STATEMENT THAT NE di SHE iS tiCEhtSE�PURSttAt1T TO THE FftQYiSiONS O�TH�CANTRACTOPS L.1- � � CENSELAW(CHAPTER 9�CUMMENCIN4 WITH SECTION 7IX1o�OF DIVI510N 70F THE BU5INESS AND PRO� PoOUSpa FESSIONSCODE)ORTHA7HEORSHEISE%EMPTTNEREFROMANDTHEBASISFORTHEALLEGEDEXEMR (�' �-�� � T�N.AYYViOL.A770N6FSECTipNT031,58YANYAPPLICANTFORAPERMiTSU9.iECTSTtiSAPPt�CANTTO Z Re•Roof ApVII,.PENqLTV OF NOT MORE THAN PIVE HUNDRED DOIIARS(5500).); � l,ASOlMNEROFTHEPFOPEftTY,ORMYEMP{,QYEESWITHWAGESASTNEIRSqlEC6MPLNSATIOk, Q c0(IiR18fCidl � VYllt�7H6 WORK,ANO iHE 5TRUCTURE iS N07 iNi ENUE6 OR OFFERED FOq SALE iSEC.7oda,BUSI. � � NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW�OES NOT APPLV TD AN oWNER bF � PR6GFRTY NM4 BUILDS Ofl IMPi�VE5 THEREOhf,AN�Wk10 DOES SUCN WOR}C HIMSEIF OR MEftSELF pH WTHROUGHHISORHEROWNEAIPLOVEES.PROVIDEpTHATSUCNiMPROVEMENTSApENOTWTENUE�OH � � OFFEREOFDflSPLE.IF,HOWEVER,THEFIUIL�MGORIMPR6VEMENTISSOLDWITHINONEVEAROFCOMPLE- 2, TI�N,SH[OWNER�BUiIDEfl Wil�HAVG THE eu%l£?!oF pRc�viNG TNAT F4E OR SHE DtD N6T&UIL6 Ofl """' � IMPROVEFORTHEPURPOS[OFSALE), W ❑I.ASl7WNEPOFTHE:PROPERTY,AMk.XCW&IVELVCONTpACTINGWITN�ICENSEDCOMRACTORS ' jr TO GONSTRUCT tME Pfl4JEtT(SEG.1�4t,SUSMESS ANO PfiOF'ESSIO`1S CQDE:THE CONiRACTppS�i. V8IU8fi0Ii �• `�y 4` AD.},AREA W CENSELAWDOESNOTAPF'LY1lJpNOWNEROFAPRDPERTYWHOBUILDSORIMPR17VE57HEREON,AN7 -----���--- ��- � WHQCONTRACTSFORSUCHPROJEGTSWITHAGONiRAGTpR{5)l,ICEN3EOPURSUANTTOTNECONTRAC- {}UAPITITY DESCRIPTIQh1 F�E TORSUCENSELAW.�. � ('_i AM EXE�dPT UNOE3 SEC. __ ___ p.d P.C.FflFi TNIS HEASUN Q ''�` �+u� �\'T S� ....V (� ?s �T{��--� �y-- U i , l � DtTE t..�_z� _,_}�ER '�T_EvCn. r ,.t C"'fwtL.e�, {4+ U � iri.+ (T�... � � t�GENSED C4NTF7ACTOFtS DECLARATiON w d CC iHEREBYAF�tRMUNDERPENA�(YQFPEFUUHYiHAT1AMUCENSEDUNDEftPROVISIONSOFCHAPTER L� � (L B(COMMENCING WITH SECTION 7000)OF���'ISION 30F THE 9USINESSAND PROFESSiONS CODE,pND z � i 1�S 4 l S"� ll AIV LICENSE IS IN FULL FONCEAND EFFECT. `�- `� m � 1 tia v� —'... 'n-� LICENSE CLASS i_......___v LIC.NQ_!.. ,_,�___ � � J U pATE_.__ „__ GONTRACTOR ,,,,,,, d .. w � WORKER5'COMPENuATiON DECIARATiOt�l Q � i R{EREBY AFFIRFd UNDEH PENAtTY OF PERJURY ONE 6F'(HE FOIIQWlNG DECLAfiATiQNS: Z J � _IHAV£ANClWILLMAdNTA1NACERTIFICATEOFCANSENTTOSEIF-INSUREFORWORKERS' a 2 „� CAMPENSATION,A,S PflO410EU BY SECTION 3��OF THE IABOq COR[,faR7NE PERFQHtdANCE C} ,,,, pF THE WqRK FpR WHICH THIS PERMIT IS ISSUED, W � � � I HAVE AND WILL MAINTAIN WOqKERS'COAAPENSA7lON INSURANCE.AS RE�UIRED 8Y SECTION \ "SL � 3lP0OFTHE LABGR COpE,fORTH[PERFURMANCE OF iHE WORK F1}F WHICH TNIS PERMITIS � � I$SUED.MYWORN.ERS'(.'OMPENSAiIONiNSVRANCECARRIERAND{'pLICYNVAiBERARE: CONSTAUCT{ON _�_._�_� � ��_��� ¢ � cARR�ER......_ ,�.,___ PLANREV4EW _.— — .. _....._ �+� Z POUCV NUM6ER ..,._,_ EI.ECTRIC �_ �yf� , 4 — - � (h1S5EC'1fJNNFFJJNOTBEoOMPLE7E0oFTFIEPERMITiSKOROi�EHUNDHEDDC1.lARS(SIW)ORLeSS). PLUMBING __ L,�) ,�=� �. � fY Z I CERTIFY tHAT IIr iHE VERFOflMAtiC£OG T4E WORK FOR WNICH TNIS PEAMIT IS tSSUED,i MECFIAMGAI. _ ' `�f2 C7 SHALL NO�EMPI.I7Y ANV PERSON IN ANY MANNEH 50 AS TO BECOME SUBJECT TO THE ' ' '. "" -- ST (/� WQRKEftS'f.4MPENSA7iONLRWSOFGALiFOftNiR,ANDAGtlEETHA'If15MpUlD9ECOME INSPECT4QNFEE .--7' � SUBJF.CTTOTHEWORKERS'COMPENSATIQNPROVISIONSOFSECiIUN3�0UOFTMEtASOR �� � �- -�������� —�,?-'T"`"'--"' C06E,I SHALL FGFTHWITH C(?MPLY WITH TNOSE PROVISIONS. ISSUANCE _ _��� 4 —....—... . ..-- p DATE:�,_,,,,,,___ APPLICANT �_ SMIP --�— _ J WARNING:FAIWRE7O SE:CURF YlORKERS'COMPENSATI(?N CUVFRAGE IS UALIWKVL,AND SNAt,I eE ENERGY PIC _ ,� J� ,�.,� � _ � ����_—�' � SUBJECT AN FMPI.bVEq'�O CRIMINAL PENALTIESAN�CIVIL FWES UP l0 DNE HUNbRED TNOUSAN� ENERGY PEF�MIT DaltAftS{F10o.OMj.IN Af)DiTiON TQ TNE COST OF COA{PF,NSATXXJ,OAMAGES AS PROYIUE�FOft IN �_i..___ � SECTION 3�060F THE LA30R CODE,INTERES7 AN�ATTqqNEYS FEES. RETENTION FEE' ��'_ � < O GONSTRUG7{ON lENpiNG AGENCY PRE-ALT FEE: I�+�.__ �— __ „_ � i HERfRY AFFIftM UNDEfl PENAt'Y QF FER1UftY THAT THEftE IS ACflN51RU(:TiON tEN4iNG AGENCY � _` � LL FOR7HE PFPFOqMANCF OFTHE WOFiK FOR WHICH THIS PERM�T IS ISSUED(SEC.3U9],UV G.). �_="'-�L~� . .._..--"'_ 2 W J � LENDER'S NpME___„__.___...... ^ F- tENQEst'SaD6AESS _ - —._...—..,__. _._ I1 � ICEflTtFYTHATiHAVERcA�TNiSAFPLiCAT14NAND5TACEiHR�TMEA6OVEWFORMATiONi5C6RREC7. TOTA�FEES �� ���� � �Tw,� .�'� ���. J � � IAGREETOCOMPLVWITNAILGTYANbCOUNTYORDINANCE5ANDSIATELAWSFF"LATWGiOBViLOING ��J � � CONSiRUCiION,AN�HEAEAV AUTHORIZE REPR�SENTATIVES pF THIS COUNTV TO ENTEN UPON TME 1 ��J�' Z A�BOVE-MEN7�ONEDPfltipERTYFtIRiNSPECTI4NPVRPO.SeS. C��}MENT�S_____��J_, j �;�{.r'e..+�'1 ✓� '�".`l� � —_ ___-_— ��,�;���'•t''`t G ----_. ¢ PEPM B�t1AME(PRIN'f I ' � _� _�.' � y__ �/ � �� �- _ � , t- - � ATUREDFPEHMII•:E�.... �� DaTE �-�l.— - �. �i�� -�"�`�r7��—� � � RECF'T.NO. PAID BY�fL, VAt,IDATI6N_._____.__ WHITE-Department y,YELLOW-Finance Copy,PINK-Assessor Copy,GOtDENRO�File Copy,GREEN-ApplicanCs Gooy �'t .�. n � " �7� � - �i � r.�°�,� 4�,�E�� i� �h� s�i a°�r� : � � '.a",, n ."`.,� '��,��``'t. ., . . "� ,-..., � . . � � . . .. .. . - - . . . ... .. (i.��f� � ..'G�/ �..� .. � .. . � . . ... . . .... .. . .... .. ... . .... �. �/ � .. . tij�//rr7��� ... .. ._... .. � . .... ... .. . ..... ... . : _ . .. . .... .�G�-���.�.... ...... _ ., . ... �... . .... .. ... . .. ... ... ... .. . �: !��g��r 2.-'� .� ._... . ..... . �" . . . . .... .... ...� . ..... ����. -��z Z��� ,.� � -z���z �r _ � �zz-���rz � ���r � L � (� .�t _ � ,���- ��r � ��,�i�- �� _ .� ' ' � 3�isl��'�'� s;��,���.--�.;,,� . ��,� i°� - � ... . . . ... _. ..... . . .... .... __ _..... . , ss � " ��' ���s��4... ..... . .... .. . ._. �.. w . _ � u _ � � . ,:; ,E �"'.:��. . .,..,,v� ,,�,F.-.� �.�a..� . ..... . :.... .... .... . . . _ �J.!?t1[,��-- _ �''�oatQ(►�c� �. E�'t r°�i'czs /�-�,v� r�J, /�':.� �ra�c=2 . �,v✓tA-r,� S`tw^�s r '_ ,p!'�'rc-�-i �'cv.��ucJ -_ ��c_r7s p.�?. �vt�7 _ �"_7l•-(�r-o,Lr . _ �t � �� � _ _ ���� ��� �� ����� � i;t �� �������m��+�tz���`i� �?�`�"�.� e ��������������� �� �, aV.���� ��ar �v��� �, a ���'' _ _ — '� � �is � � ���������+ .� � �� � �����r�y, �����rv���� ���a.� r; - .. .._ . ... ... .. . .. . �����'��a�� .� ��,a. � ����� � � � �����'�?i���,�'��! ��`�-� ��.° .ee ,,� _ .. — —. ._ _. — — . �' �s �a�� ��' s� �'�w� � "r- "4"`x � �w�i7 � ��' ... . . . .. . .. ... n,d ? �-��x , s�� '2��f2.F.�` _..... . ._ _... _ . . .. � f,p� ��1 � � * �C� ��� ���� �d° ��� ��k,����� . �'P qt- �"�' .^g 11�` ,�.�:�.„=e:�muu'"�a. ... .. . . .._ .. . .. . ... . ... ��. . ..��,�,w >:.�- na�>a �> . z,. .,..e __ ._. ._. .. ._ ._ _. _. f1TTiQ [i�Y11f�1A1 CITY OF DIAMOND BAR DEPARTMENT OF CUIvIIvtUNI"I'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION a 0 0 0 0 w z 0 0 z m 0 w U Z W U F- 0 Z rn Y 0 w Z 0 a X W 0 I--� U w 0 Z a w 0 J Q Z Q 0 W Z (:3 F- WHITE-Department I�q(�y,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy trcW Pi-u,-W(k)4 f£J 9'e/° lcr5 i Q"'r/'Jo«z.t4;yt4-c S-C&4-s F