The URL can be used to link to this page

Home My WebLink About12807 (11) 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$ �/�E ��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 CONTMLTORS 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,l10WEYER,iNEBUILDINGORIMPflOVEMENTIfiSOLDWITHINONEYEAHOFGOMPLE- � 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 OOESNOTAPPLVTOANOWNEROFAPROPERTYNRiOBUILDSORIMPFOVESlHEREON,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: � � � iNAVEIViDWILLMAIN7AINACERTIFICATEOFGONSENTT09ELF�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�.qg'_--_�� ,�C� ___—...---__'..._"_ U "/ a � (iHISSECTiQVM1'E�MJTBEWr.1�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,.G'.�. ._.JZ'��-/vK naaicaN7� --��-- SMIP . .....----�L'��_. - la _..-----------.� 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�FPERJUftY7HATTHEREISACONSTRUC710NLFNDINOAGCNCV �+- FORTHEPERFOFMANCEOFTHEWORKFORWHICHTHISPEfiMITI515S11ED(SEC.7097.CIV.CJ. �� J� � 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�HEHEBYAUTHORIZEREPFESENTATIVESOFTHISCOUNTYTa�NTERUPpNTHE � 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 M1 ' I � � ��d� ' ' j i i ��' j ` , � I � i ! ' ; i i ; j ' �� { i �= j , i ( � , ; , i � � ` i '� ' � � ' � � i i i � � , � � i � , � , �^ � i � , : �� , - 1. r 't:- �--�-- -- � - - t_. � � F' � � � q , ' ' i � , � �� i . t . ', i ' , � ' I _ � , . ,- � � � , .. �,� ;. , +. �a ,, 3.; �� —_ � i ; � � � I , �� + ,i ( , ! � ' � S ' I � t 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 ' � � � 3`��. i ��y 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 � , � �, � , ' � � j ' ' � '�; ' ' ; ; I ' ryy*T�� ; j ' � ; I ' ' � i � � � . .,., ! i � { i j � 4� �s. +9 � � I 1 � I 'i � � �'� � I G 1 t I i � � � � I r� ' ' ( � . � F �' � � � ! '. I t �i ( . �f�'9 � � ' },.. � �' � �� ' � � � I � �� t\ � t �._ � �_._ - j I � � I � !� 4 i I I 1 i i � � � ; � � � +U . .. �__ �i ... , � - � . , ;� i �,� . � � � � , � .. � �� ;� _ , ., � � • ! � � f t - � � i ... i ! . � I ' #� � � , ; I i . � � � � �� ,. .� ` � , , t , � i \ f . � � , . . , � �. �.., i � ` � , I I � , ; , � � � � , _ �� t�, i i i___� _ _ i �_ ,v _� � i � � � �,�� j �� fi �+ � ( ! ,� �� "��'�� i � E i � � � I .t� �� r x` � sj I i ' ' } r �`�� t ' ` � i � � I � � { �e ,��.�^ �"��*�'� ��`�� ) � � �� I I �� I � � � ' T =. a�� a��-, � � s 'P Y � � '� `. ! � � _ I � C° I I1" � k 1 : fv'�`'�'� �3,� �, ��v � ; � os p � y r - k; � � I I � � � ; i fi";, j�-�" �.��:,�'��r, �,��rt , � � d � � t � � i ;. , i a a� ,��j €�� €�:s �� t � � i i r+�" �i � �. i i �� i � � �� " �� rc � i � +�� ..I � �� x _' �. ,, ' , � �, '._ � �" r��' rt 1 ��"y �€ �cFj�� R i � C z � IC t �� %�� .�. ` - �- { i � 4{C I' � .. � ��^ Y��{ a � � ' .: . .. e.T � ; i ,,. d �� j t . a ' , . � i �F�a,x �" � �h� .. i�.....:_1_.__._... ___.,._K!._. .4...,.._ �....1,....A.. .._...�_v .�,..J. .--""- -. .,:..y. ...._»w...,.� i _, ..�.., .. i