Loading...
HomeMy WebLinkAbout12807 CITY OF DIAMOND BAR �.- - "? — DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � ��, :'�'\1 �W . 21660 E.Capley Drive Suite 190 � �� - (909)860-3195 Fax(909)861-3117 j� PRESS ��9K' BUII,DING PERMIT APPLICATION "��` FIRMLY � JOBSITE APPLICATION 7� PERMIT 1-� ` PIC o ADDRESS Z 2�p I� LAZ/ M�D�7K� D� DATE ��" �� NUMBERI,��-� x c� ISSUE TYPE OCC APN LOT TRACT _ DATE CONST. GROUP p OWNER G�vyy�E� �pA _ � ADDRESS Z2G) L4Z MEA.DOk� j7�Z. ZONING S[TBACKS w FRONT RW ❑ gCITY ZIP TEL. _ APPLICANT TEL. REAR ❑ Z SIDE/SIDE STREET RW U_ � CONTRAC70R L/V� �/AE ��T�Z/G SIDE ❑ ._ � ADDRESSZ � � V '��^� pROPOSEDUSE ��QN�/N`i L4`IDv'T O�./yLl7'�i � CITY�/l�l�l�R. ZIP�t,{� TEL. 3L0-�Ps�'I w ARCH/ENG/ — Z DESIGNER 5�c�►�► Prs�s�' NO.DWEL. NO. NO. a ADDRE55�13Lr �/ GtJSIT L N�V•L ��A�A.. UNITS STORIES OEDROOMS___ y CITY��jL.�S/JAL+� ZIP���. TEI.�►�+� ��b/!2 � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER•BUILDER DECLARATION SFR/ADD/REM O 0 I HEREBY AFFIRM UNDER PENALiY OF PERJUPY 7NAT I AM fXEMPT FflOM THE CONTRACTOFtS LI- � Garage/Carport W CENSEIAWFOHTNEFOLLOWINGRFASOk(SEC.7031.SBUSINESSAN�PqOFE5510N5C0'�E:ANYCITYOR � U COUNTYWr1iCH(iEWIRESAPERMITTOCANSTRUCi,ALTER,IMPHOVF.,DEMOUSH,ORREPAIRANYSTflUC- � W patio/Deck � TURE,PRIOR TO}�S IS3UANCE,AL50 RC-0�IRES 7'HE APPLICANT FOR Sl1CH PERMIT TO FILE A SIGNED W � SiATEMENi 7HAT HE OH SHE 13 LICENSEO PURSUANT TO THE PROVISIONS OF THE CANTMCTORS LI� � CENSE LAW(CHAPTER 9(COMMENdNO WITH SECTION 70D�)OF�IVISION 3 OF THE 6USINESSAN�Pfl0- � POOUSpd FES410NS GODE)OR iHAT HE OR SME 13 EXEMPT THEflEFROM AND THE BASIS FOR THE ALLEOED EXEMP- U TqN.ANVVIIXATIONOFSECTION7a31.5BYANYAPPLICANTFORAPERMIT5l1B1ECT5THEAPPLICMITTO Z Re-Roof , � ACML PENALTY OF NOT MORE THAN FNE HUNDRED DOLURS(SSDO).�: � ❑I,ASOWNEROFTHEPROPENT',OPtAYEMPLOYEESWITHWAGES4.STHEIRSCILCAMPEN5ATI0Y, � Commercial WILL DO TME WORI(AND THE 57'RUCTURE IS NOT INTENDED OR OFFERED FQfl SALE(SEC.7040,BUSI- J •NESS AND PiiOFESSIONS CODE:YHE CONTRACTOR&LICENSE L4W DOES NOT APPLY TO AN OWNER OF N PFqPERTVWh108UILD50flIMPROVESTHEREON,ANOWHODOE55UCHWORKHIMSELFOFHER5ELFOR � Q THROUGHHISORHEAOVMEMPIOYEES.PROVIDEOTHAT5UCH1lAPROVEIAENTSARENOTINTENDEDOq m W OFFEREDFORSAI.E.IF,FIOWEYER,iNEBUILDINGORIMPflOVEMENTISSOLDWITHINONEYEANOFCOMPLE- � z TION,THE OWNEH�BUIIUEH WIL�HAVE THE BURDEN OF PROYING fMVAi HE OR SHE�ID NOT BUILO OR � IMPROVEFORTHEPURPOSEOFSRLE). O I,AS OWNER OF THE OROPERT�:0.N EXCLUSNELV C�NTqACTING WRH LICENSED CONTRACTORS � � TO CONSTRUCT TNE PRQIECT(SEG TO�a,BUSINE55 AND PqOFES510N5 CODE:THE CONTPqCTORS U� � VBIU3110� __ __ ADJ.AREA_____,___________ ' W CEfdBELAW OOESNOTAPPLVTOANOWNEROFAPROPERTYNRiOBUILDSORIMPFOVESTiEREON,AND � VYFpCANTRAGTSFORSUCHPA0.1EGT5WIfHACANTRACTOfl(8)LICENSE�Pl1R5UANTTOTIIEWNTflAG QUAN7ITY DESCRIPTION FEE Y roruucEwsEww.7. ss. � ❑I AM E%FMPT UNDER SEC._�,_-__.__----..----..B.&P.G FOR THIS REASON Q I �DL`J _ �' � . ----- � L 4 i � ~ � � : � DATE_._ "'_OWNF.R.___'—___._____'._"""'_..'__'."___- V d LICENSED CONTRACTOR5 D[CLARATION W � � I HEREBY AFFIRM UNOER PENPLTY OF PER.IUFY THAT I AM LICENSED UKDER OROVISIONS UF(:71APTER � � p„ 9(COAIMENCINOWITHSECTION700D)OFOIVISION30FTHEBUSINESSANOPflOFE5510N5CODE,AND Z ^ MYIICENSE IS M iULL FORCE RND EFFECL m �� 0 LICENSE CUISS ��__LIC.NO.V���/e� `��p � � pp7�1z-�6_� CONTflAGTOR L�vV��(W � ' � WORKEfiS'COMPENSATION DFCLARATION_ ��"� /u � U � I HEREBY RFFIRIA UNOER PENALTV OF PERJURY ONE OF THF.FOLLOWI4G DECLAFAT NS: � � � IHAVEANDWILLMAIN7AINACERTIFICATEOFGONSEMT09ELF�INSUREFORWORKERS' 2 CqMPENSATION,ASPROVI�[DBVSECTION37ooOFTHEL480RCODE.FORTHEPERFORMANCE W OF YHE WORK FOR WH:CH THIS PFRMIT IS ISSUE�. � W �I HAVEl�ND WILL MAINTAIN WORKEFS'CAMPENSATION INSURANCE,AS REQUIRED BY SECTION O37000F TNF LABOR CA�E,FOR THE PERFORMANGE Of THE WOflK FOR WHICH THI3 PERMIi IS _ ISSUED.MY WORKERS'COMPENSATION INSURANCE CARfl1ER AND POUCY NUMBER ARE: / CONSTRUCTION J //''''''��J "'..._..._ -__......'"' _ 7 CpRR1EA S�� {vN� � PLAN REVIEW __'_"'_'_— '___'___'__....._......."' "_''_" £""'y�� ZPOLICY NIIMBER Q Z�I�.q�i'_--_�� ,�C� ___—..._____'..._"_ I��-/ a � (iHISSECTiQVM1'E�MJTBEWr.�rEOOFiIEPEMNTISFOROM[HUWF+EDOq1AASIE1oD)�RLESS). PLUM8ING _ ----....--.--..___, -._ _'-- w MECHANICAL z 1 CEP7IFY THAT IN THE PERFORMANCE OF THE WORK FOR WHIGH TNIS PEflM.IT IS ISSUED,I (,� Sh1ALLNOT EMPLOY ANY PEF4SON IN ANY MANNER SOAS TO DECOMf SUBJEC'�TO THE � _ � � WOFKERS'COMPENSATIONLAWSO�CALIFOfiNIA,IWDAGREETHATIFISHOULDBECOME INSPECTIONFEE _.._.._.—.._.._.__ _...�-�✓-'- - 3UBJECTTO THE WORKERS'C�MPENSATION PROVISIONS OF SECTION 3700 OF TNE LA60R �'/{rry x� = ISSUANCE _....._— ......._�..�_ , CODE,ISHALLFORTHWITHCOMPLYWITHTHOSEP OVISIONS. J� `�. C p,�.c. ._.IZ����/O APPLICANT __..�'_ SMIP . ....._-__�L'��_. _ lD _..'_.__'..._.__."_.— J ENERGV P/C J WARNINGFAI�URETOSECUFiENIOflKERS'COMPENSATIONCOVERACEI&UNLAWFUL,ANDShIALLOE — ""--"'--'-""'--"----"'--"""' - �-y SU&IECTANEMPLOVLHTOCRIMINALPEN�LTIESAN�CIVILfIN[SUPTOONEFIUNDPEDTHOUSAND ENERGYPERMIT f�'�T�,.(�F TlT AkRs�N'�T'g��� ..__ OOLLARS(5700,OW�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGF.S AS PROVIDED FOR IN �iv � SECTION37aeOFT11FLABONCODE,INTERESi�N�ATfORNEV'SFFES. RETENTIONFEE: �TTTT T�TAT(` 4ATT`'�I�AT.T.'T�,.,__,_,_______,,._,_._ a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: _.�_. _--.—_......__— 4C IHEREBYAFFIRMUNDERPENAITV�FPLRJUftY7HATTHEREISACONSTRUC710NLENDINOAGCNCV �+- FORTHEPERFOFMANCEOFTHEWORKFORWHICHTHISPEfiMITI515S11ED(SEC.7097.CIV.CJ. ������ � ZW -_...'_T_—.._—___._._..._....__._ _'— � LENDEH'SNAME.._- ... _'_"'_-""_-'_"""_"' - ' F-- LEN�ER'SA�DRE55__.._--'_"_ '-__"'_""_'_-..._'-'_-'--'..._— - � ICERTIF`lTHA71HAVFREADTHISAPPUCATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES E w I AGR[E TO fAMPLY WITH ALl CIT'AND COUNlY OR�INANCES ANU STATF LAWS RELATING TO BUILOING � � CONSTftUCTION.AN�HEHEBYAUTHORIZEREPFESENTATIVE50FTHISCOUNTYTOENTERUPONTHE � ABOVEMENTIONEO PROPERTY FOH INSPFCTION PURPOSES. � Z � COMMENTS-------�-�--.....---�—�-----�--- — � --�i4`l�y�.__ � -'---_...---- '- -----'-'--- m PEFlMITTEE NAME(PFINT '--' ___"' - —"-'--' � 2-/6-�i'o -- rv> , .� N ATUREDFPERMITfE UA7E = RECPT.P10. PAID BY __�`7 VALIDATION__ ~ WHITE--0eDartment Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy -�- - - -----__.__, _ __. _. _ ��fi�.n� '� ,._ �.. '.�.. i ' _ _.---! i.. _ - � �x{� ! I ' I ' ' � I ' ( i !. '� i. ��_ I � i i � � I , I � � ��� i ' ' i ( � � � � ! i M1 ; I � � `�� � , i I � � � � � � ! ' i i � � ' d� � �� I t ���_ � { I �.` I ;,� � � ( � � '� ' I � � � I 1 '� � ' � 7 � � � i I I j � . , , j � I � t f i �^ � � i : '��'�� .�..� ' ;;.. r t._. 'r.._.�__.. _.� ,—_ �' - - ..t._...I ; I I r'� � + .. t � � I .- � , i ���� � � � �- t ' � � :. � � � - _ r ` ; � i i i ,. I , � , . � � , 3 � � �. _ �''�� 3.� '�# ` - ' I � ' i ' , � �' ' ��� + ,i ( , ! � ' � S ' I � t i I , I i I i I t i 1. ( Y..._ � I i i � ! . ��� i � ; -.��, , >-� , —7 t > ';- � � - � � � � I � ' 4 ; � 9 �� i y ! )`� 'Y Ic„� i � � � �'Y � � F '��� � � I f ' � � � -s+` i ,��i 9 ! � F � { � { �'�P j, � � i � i � � : �i 3� g I., ,. f I V srv 1� f �e V �� �'-'i ��, i i r ., Y` 'i .� � I ( �_u ,�� j i ; ( �. 1 � � I � �. s. ��,'� t�' In, ( ?' . � �� � I I � I i � � � (� � �� ' � � i '�° �4a�a F - C Ck �� � � � ,�.; �^ i � . I i . , �b� N.d ��� I C, I �` � � � ��, i l � ( � �I -�� ' I � � _ � , � � � i: � i i� it � - u� ii � � I i � � 3€E � ,i� � � � � ! - � �.. t���' 1 t �^ �v ��I � .i ' � .�i (� ... � � � ' � i � � 1p# i � p . _ — " fl ar � �y� �` I � I ,� � -� t i��l ai�a � � - '�� � � � �f � � � � i i � � ��' �� ,.,, ; ; ` l c {� --<.:--''--- I c� r--� � , ��� ' i I ` � � i' ' 1'. `�w A =!Y i_ { I � I �I.. I - ��` ����� � � � t � �� �k - - � ( � � i � � ��,�� i � , � , � � ; , i � , � � ; � � ; , � i i , i � , � �, ,� � { i ' � ; � ' , � ; , : � � *��� � ; � ; i ' � � ; ; ! I � j ; � ; ; _ s,r ,r. � � ' � , i I � I �� � i . ; G , i � j E � ' ' � r � i ' ' " ' I � � I �. i � ' � [ _ ���' � ' � , �' �, � �, � �� f ` � � � ' � ' ` � ��d� ,t\ � .__i' � �' I � � I \ !�i 4 ' I �; � i � , = ��� � `v � �._ __ �,. � , �. ; ; � � � , T � • ' � � � � � ; � � p..,..� :, I � � v�. i � �� � � ���� � ; � � � � � � � ` f ,� , � � : � � �--.. .,;. ; ' i � � � '�_ � _� .� � , �. _ _ � .. . ; ;, t_� �__ i ! , *� = ,v { � i w �L#� ��� � � j ������,�fi��" ti � ; � i 5.�� ,� Y � �� I s�� I ' , I I � _.� i ! � �: � � � � � � i { :� � 'i F y������,����uv t�.,:� r f M'�� ) ,� � [ � � � �. ' �'�f&�$ .�f3'F�'2 Y. '��' 1 � ',� � � I ;;� � ii ; I - I I d 1 � . T �; ���3���� s�#�- s a �rr � � �� `d � � I ' � I r' i ir� I k � "��rv���l���,� �, ^����,�vrv�� � �s � � S � k: I � I I � � i � � ! �. j�-�" 'L'���:�'��r, �,��rt , � � � :� ' � i � i ;. ; ' , o�� sj €��� £��3 ��� �� i �� i � ��, �i i �; i i �� i � � � �;� ��� � �� t�� � p� � � � � .�`� � .� I i � � � � � � �. ' � "��, �rt 1 ��"., �€ �cFj�A a i i C � t " �� � -, - � { �. � �� � ', _. � �'}���"���� Y�z� m'�y I � p�; � : . i e.r I - i i a � .��_ �i . � � �� � � � F�re�'� �`" Y t��l� � h�. .. i�,.....:_1_.__._... ___.,._K!._. .'4...,.._ �....1,....�.. .._...�_v .�,.J. ' • -".-- ...._»w.....�__.�..,�_. i _, ..�.., ..�__._. i