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HomeMy WebLinkAbout12567 (11) Ir...,� / r`•�I CITY OF DIAMOND BAR / ---��-� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� , 21660 E.Copley Drive Suitc 190 (909)860-3195 Fax(909)861-3117 PRESS � ''w�°�' BUILDING PERMTT APPLICATION FIRMLY. N' JOBSITE � ./� ���/ a; ADDRESS r�'���� ���C7n ��� • APPLICATION � , PERMIT � P/C o DATE %C?• �-C?- 2 � NUMBER� # � 15SUE TYPE OCC APN LOT�_ TRACT DATE_ CONST. GROUP p. OWNER . � ADDRESS (-!'- ZONING SETBACKS z CITY_ ZIP TEL. FRONT RW ❑ p APPLICAN'f %� TEL. S DE/SIDE STREET RW ❑ �,'. CONTRACTOR `' ' C�ZY� > SIDE _ [7...____..__ I �:: ADDRES� � l ��;-=�'�'�"�t� ��;, 1>E� �t ��j C �.. CITY �J fl.�l-' ' ZIP��� TEL.`����E "%5�S� PROPOSED USE IU �.L/�'7.[' �(�(,`�� �J���`���C.(-�r o-. .r.���n�-c.c. y�i-c.r�x�, °�� �s-rr�, �4 wQ ARCWENG/ YI'(. f.l.,Wi P. f.t'`k�i'�/9"aL: Z ��7 , _ W DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP 7EL. cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREM�ALUATION �; OWNER-BUILDER DECLARATION SFR/ADDIREM � I HEREBV AFFIRM UNDER PENALTY OF PERJURV TNAT I AA1 EXEMPT FROA1 T41E CONTRACTORS LI- G8�B9B/CHfpOfl LLI CENSE(AWFORTHEFOLLOWINGREASON(SEC.7o31.5BU31NESSANDPROFE3310NSCODE:ANYCITYOft (Jj U' COUNTYNRiICHREQUIRESAPERMITTOCONSTRIICT,ALT[R.IMPROVF..�EMOLISH,ORFiEPAIRANY57FiUC- W PaliO/DBGk NRE,PRIOR TO ITS IS5UANCE,ALSO REQUIRES THE APPLICANT FOR 5UCH PERAl1T TO FILE A SIGNEU STATEMENT THAT HE OR SHE IS LICENSED PUflSJANT TO 7HE PftOVISIONS OF THE CONTRACT09S LI� W ��� CENSE U1W(CHAPTER B(COMMENCING WITH SFCTION 7000)OF OIVISION 30F THE 6USINE55 AND Pq0- U' POOVSPd ��� FE331QNSCODE)ORTHAiHEORSHEISE%EMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP- TION.MlYVKKATIONOFSECTION7091.5BYANYAPPLICANTFORAP[RMI'fSU&1[CTSTHEAPPLICANTTO Z Re•Roof '��:� A CIVIL PENNLT7 OF NOT MORE THAN FIVE HUNDRED OOLLARS(E600).�: �� ❑I,ASOYlNEROF7HEPFOPERTV,ORMYEMPLOYEESWITHWACESASTHEIViSOLECOMPENSATION, Q CGRIRIBfGl3� ' Z�. WILI DO THE WORKµ�THE STAUCTUHE IS NOT IN7ENDED OR OFFEflED FO(1 SALE(SEC.70A4,BUSI- J . ��Y -� ' NESSAND Pr70FE5510NS CODE:THE WNTRACTORS LICENSE LAW DOES NDT APPLV 70 AN GWNEFi CF N PROPERTYWFIOBIJILDSORINPROVESTHEREON,ANONRiODOESSl1CHWOFiKHIMSLLfORHERSELFOti m � THROUGHHISORHEf10WNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTIN7EN�EDOH Q� OFFEHEOFORSAlE1F,F10WEVERTMEBUILDINGOHIMPROVEMENTI550LDWITHINONEYEAROFCAMPLE-: Z 710N.THE OWNERAUIIDEH WILL HAVE iHE BUR�FN OF PROVING THA7 HF Ofl SH[DID NOT A111L�OR � IMPROVE FOR iHE PURPOSEOF SAIE). W I]I,ASONMEflOFTHEPROPERTV,AMEXCW5IVELYCONTRACTINGWITHLICEN3EDCONTRACTOR3 [L TO CANSTRUCT THE PROJECT(SEC.7�46.BUSINESS AND PROFESSIONS CO�E:7HE CANTRACTORS LI- ValUation _� _.� ~ ,,��L ADJ.AREA W� CENSEUWWESNOTAPPLYTOANONR7EROFAPROFERTYWHOdU1LDSORIMPROVESTNEREON,AND �; YAiOGONTMGTSFORSl1CHPflQ1EC73WITY.ACONTPACTOR(9)LICEN9EDPUR9UANTTOTHECONTRAC- ' QUANTITY DESCRIPTION FEE Y TORSIICENSELAW.). _ � J Q ❑1 AM EXEMPT UNDER SEC.________._ B.8 P.C.FOa THIS REASON Q 3 ' ______'_"_'_"'_—'—'___ ` lti � DATE___ OWNER U Z W � LICENSED CONTRACTORS DECLARATION W � I HERE9V AFFIFM UNDER PENPLTV OF PERNRV THA71 AM LICENSED UNDER PFiOVI5iON50F CHAPTER � d e(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESSAhD PROFESSIONS CODE.AND z X �MY LICENSE IS IN FULL FOflCE AND EPFECT. „�,� m �� ..`^�C� �. [ Is• � � � LICENSE CIASS_.�_�� LIC.NO. ���"7� u^` ` � ~ DATE._. �f'<.�_ ! t CONTFACTOFl__�1`_.._ _ ` d . lL .. _.._��� � _ oa WORKERS'COMPENSATIUN DECLARATION � � a � IHEREBVAFfIRMUNDEFPENALTYOFFERJUpYONEOFTHF.FOIIOWWGDGCLARAT1043: U � Z Q � _IHAVEANUWILIMAINTpINACEqTIFICATEOFCONSENTTOSEIF-INSUREFORWORKERS' _ � CAMPENSATION.ASPROVI�EUBYSECTION37000FTHElABORCWE,FORTFIEPERFOftMANCE W OF THE WORK FOfl WHICH THIS PF.NIAIT IS ISSUED. � � W _IHAVEANDWI�LMAINTAINWOqKERS'CUMVFNSATIONINSUHANC[,ASREqUIR[09VSFCTIOti � ' 4 37000F TNE LRBOfl CODE,FOR THE PEHFORMANLE OF THE WOiIK FOR WHICH THIS PERMIT IS �� � � o ISSUED.AIY WORKERS'COMPENSAiION INSURANCE CARRIER ANU POLICY NUMBER AFE: .. � CONSTRUCTION _,__ , , „__,__._______ __ __ _____.___.__ _,.l__ ___ __ j CARRIER ... {�.�'•L--YTY' '_. ..."" � PLAN REVIEW ---- .._.. ... .......- ------ �--- � ----- 0 POLICYNUMBGR �?���°���L7 � � ELECTRIC 0 (fFtlSSECf10NNEE0tJ�i8E00MPLEfIDOFhiEPERMflISFGiONEMJN)REDDOLlARS(Ef00)�). PLUMBING __ ll.1 Z ICERTIFYTHATINTHEPERFORM.9�CEOFTHEWOPKFORWHICHTHISPERMITISISSUF.0,1 MECHANICAL ._,____ (,'J SHqLLNOT EMPLOV ANY PERSON IN ANY MANNEP SOAS TO BECOM.E SLOJECT TO illE � WORKERS'COMPEN3ATION UWSOF CALIFOHNIA,l1NDAGflkE 7HAT IF I SHOULD BECOME INSPECTION FEE . � SUBJECTTOTHEWORKEFS'COMPENSATIONPqOVI510NSOF5FCTICN3l0DOFTHE1PROfi f CODE, SHALIFONTH ITNCO PLYWITHTHOSEVROVISION. ISSUANCE _,_y �vU . / �y �—� p DATE:��7 ��✓R�'_ APPLICANT. / SMIP ._�___ � . —_ _.____—_——_________- ...'_—___._--.__—_.'_...—_� W ENERGY P/C J WARNINO:FAILURETOS[CURFWORKERS'CAMPENSA710NCAVERPGEISl1NLAWFt1L,ANDSHALLBE —""-""""'—"' LL &ll&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESlIP700NFHl7Nf)REDTHOUSAND ENERGYPEFMIT .._ DOLIARS(5100.000).IN ADDITION TO THF.COST OF COMPENSATION,DAMAGES AS PROVIOED FOH IN --- ' J SECTION37�BOFTHELABORCODE,INTFf1E5T,ANDaTTOfiNEY'SFEES. RETENTIONFEE: � _ � CONSTRUCTION LENDING AGENCY PRE•ALT /�� �} p ��I'X Vi'DIAIVfVN�7B�-- _----_------- L7C I HEflEBY AFFIflM UNDEFl PENALTY OF PERJURY THAT THEFIE IS ACONSTRUCTION LENDING AQENCY ��q�q. �+r�� �- FOR THE P[RFORMANCE OF 7HE WORK FOR WHICH THIS PEPMIT IS ISSUEO(SEC.3097,CIV.C.). . .� Li1V L SAi'G 1� w —'__ " _""__"_"_'_ '"'_"_— � LENDER'SNAME__...—__._._. ._—""__""—_—'__.....""""'_"' 1— IENDER'SAODRESS. __..._..—__..._._.__ � ICEflTIFVTHATIHAVEREA07HISAPFLICATIONANDSTATETV1ATi11El1BOVF.IN�ORMATpNISCORRECT. T\JIALFEES � � � /. W IAGREETOCOMPI.YWITHALLCITY�NOf.OUNTYOFDINANCESANDSTATElAWSRELATINOTOBUILDINO � CANSTRUCTION,ANDNE47E8VAUTHOHIZEREPR[SENTATIVESOfTHISCOUNTYTOENTEflUPONTHE PBOVE•ME TIONED PROPERTV FOF INSPECT �PURPOSES. 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