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HomeMy WebLinkAbout12319 (13) t CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 �`�� T (909)860-3195 Fax(909)861-3117 PRESS '���f W BUII.DWG P�RMIT A�pLECATION " FIRMLY _. , �- . . .. .; .. ., � . ,... JOBSITE / APPLICATION PERMIT � P/C o ADDRESS �3�� /C`+�� �� _ �"-�� �� ��� DATE___ kJMBER #_ c� ,a ISSUE � � � �y�"'t�PE pCf` APN LOT�� TRACT_� _ DATE �=��_CONST. GROUP p OWNER �/�w,r1 (�-..�-�. p AODRE�.S ` • 'j�_� _���� ZONING SETBACKS u� c FRONT RW �__ Z CITY o_ '�,_ ZIP�:�{ TEL.���-333 REAR � APPLICANT� TEL.___ SI�EJSIDE STREET RW z - - � CON?RACTOR SiDE _ � ADDRESS o CITY Z!P TEL. PAOPOSED USE_ oARCHlENGI � DESIGNER — NQ.DWEL. NO. NO. � ADDRESS --- — UNITS___ STORIES BEDROCMS � CITY ZiP TEL. -- � cn DESCRI?TION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATiON SFR/ADD/REM O 1 77EREBY AFFIRM7 UNDER PENALTY OF PERJURY THAT I AM EXF.MPT FflOM�r+e cor�rr.ncroRs u- GaragelCarpor, W CENSEIAWFORTHEFOLIOWINGREASON�5EC.7031.5BU51NESSANOPROFE5510NSC0'JE:ANVCI7YOR (n ,___�__ C.� COUNiYWHiCHREOUIRESAPERMITTOCONSTRUCT,AITER,IMPROVE,DEMOLISH,ORFE�p;FlqNVSTRJC- W Pytio/DeCk TURE.PRIOR TO RS ISSUANCE.AL50 REWIRES THE APPLIf,ANT FOR SUCH PERMIT TO F!:E A SIGNED W STATEMENT THAT HE OR SHE IS LICENSE�PURSUAN'TO�THE PRWISIONS OF h7E CONTRACTORS LI. � � CENSE LAW(CHMTER 9(COM0.IENCING WITH SECTION 7Doa�OF DIVISION 3 0F IHF.BU51NES5 AN0 oqp_ U- FooVSpa � FESSIDNSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- � — V TpN.ANYVI0LAT10NOF5ECT10N7IX51.5BYANYAPPLICANTFOR.;PERMITSUOJEC?STHEA'P'_ICAIdTTO Z RB-ROd( � ACML PEWLLiY OF NOT MORE T}iAN FIVE HUNDRED OOLIARS(S�W�.): -- - � CI,ASONMEPOFTHEPROPERT/,ORM�EMPLOYEESWI'HIVAGESASTHEIRSQLEC041PE4SATON, � COmmBrCial _ � WILL DO THE WORH.ANU THE STRUCTURE IS NOT IYTENDED OR OFFEREO FOR EAL[(SEC 7044.B'J51� _! � NES:AND PRDFESSIONS CODE:TME OJNTRACTOHS LICENSE LAW OOES NOi AP��v TO AN OWhER OF � PROPERiY WHO BUILDS OR IMPROVES THEREON,AND WHO�QES SUCH WORK HIMSELF OR 4fFlSFLF OH qC THROUGHHISORHEHOWNEMPLOYEES,PROVIDEDTHATSUCHIUPROVFMENTSARENOTINTENDEDOF � — QOFFEHEOFORSALEIFFION'EVER7MEBlAL�INGORIMPROVEMFNTISSOLJWITHMDNEYEAROFCOR7PL[- __ Z TION,THE OWNER-BUILOER WILL HAVE THE BUPDEN 6F PROVING THA7 HE OR SNE DIO M1OT DUY_�Ofi � IMPHOVE FOR THE PURPOSEOF 3ALE). ❑I,ASONMEROFTHEPROPERIV,AME%CLUSIVELYCANTAACTINGLYITHLICENSE�JCONTRACTORS I � 70 CONSTRUCi THE PRQIECT(SEC.7ol4,BUSINF55 AND PFlOFESSIONS CODE�THE CON7RACTORS LI� Valu3tion ADJ.AREA_____ !SJ CENSELAWOOESNOTAPPLYTOpNOWNEROFAPPOVERiVWHOAUILD50RIMPROVE57F+ERFON,AND =- � ---- --- ' � KMOCONTRACTSFORSUCHPROJECTSWIiF+ACAN7RACTOR(S)L�CENSEOPURSLIA?1TTUT4iFCON'RAC. �UANT�V DESCRIPTION FEE SO � TOAS LICENSE UW.). ,/� � ❑i AM IXFMPT UNDER SEC. B.8�.C.FOa T.Hlg qEASON Q __� � F�" {,L�h �rM E� ____-- �f � � ---- rL 4- _� `�V •� .ldCE'22 �'�^ V � OATF _--_""_ OYYNER_'_____"__' ""____'_'_"_'_ �" �y�1 L�Cj o .�'u � �t:`�' � g � L!CENSED CO�ITAACTORS DECLARATION W , . � ` � � --- — IHEflEBYAFFIRMUNDER?F.NALTYOFFERJURYTNRTIAUL!CENSeDUhDERPROV�510kSOFCHAPTE� �� (i e(COMMENCINO WfT71 SECTION 7000)OF OINSION 3 OF TME B:1SI.YESSAN�VFOFES50NS CC�^.f,NND z � S�� �X MY LICENSE IS IN FUIL FORCE AN�EFFECT. m "' � LICENS£CiASS LIC.NO. � }— —_— J I V UATE __ GONTRACTOR.__.___________' a I= -- u' � --- � WCP.KERS'C^MFENSAT?ON DC�LARATION ¢� � i � �I I HEREBVAFFIFM t1N�ER PFNALTV OF PERIURY ONE OF TNE FOLI.OWING�ECLARA?IONS: � �I—"_—' — � _IHAVEANDWILLMAINTAINACENTIFICATEOFCONSEN7705'ciF-iNSUREFGRWORKERS' TI � CAMPENSATION,ASPROVIDEOBVSECTIDN37000FTISE',0.BORCOD'e,FORTHEPE�iFORMANCE � 41____ OF THE WORK FOR WHICN THIS PFFlMIT IS ISSUED. LL' 0 � I. 'z i__ _ _I HAVE AN�LVILL MAINTAIN WORKERS'CAMPENSAT:ON INSIJRANCF.,AS RE0:114�D BY SECTiON � j 370o OF THE LAECA GODc.FOR THF PERFORMAVCE OF THE WOHK F()fl'NHICH TMIS PFRMiT IS I; ' ISSUEO.MY SYORKERS'CCLIPENSATION INSL'RANCF CAR:tIER APiD PULIC`/M1UM3ER ARE� I. � CONSTRUCTIOY J II I '"'_ " '_'" N j ; cnnaiER ___ __ __ ___ __ _____ ` ; PLAN FEVIEW _____ _ Q i POIICV NUN6'eR_ __--__"'_ "'..... "'.... .""'_.. ..... .—_'_ �' i ELECTRIC __ '___ _"' ' i" D 8 � �� (iHI55ECTIONNEmN0T8EW4PLEfEDOFT.IEPFRkT;SFGIiONFNUI[)RE07,k'.ARSjS'00)ORLES5) PLUMB!NG ,--------..— --,--- -- —. z �yy ICERTIFYhIATINTHEPERFORMAhCEOFTHEWOAKFO�tYiHICHTNISPf:FAlIT:51S5UEp,i ' I MEChlANICAL _ _______ ____ C} � SHALLNOTEMPIOYANVPERSONINANVMANNERSOASTOc3FCOMESU9J�CTTOTHE � � WOFKERS'COIJPENSATI04 LALNS OF CALIPORNIa,A1:D P;RFE?HAT IP I SHOUL'1 AF^01AE i � INSPECTION FEE __,_, __ __ ___. � SU&IECT i O THE WORKERS'COMPFtrSATION PLiOVISIONS OF SECTIDN 370o OF TNF�AFqR —If� � f CODE,I SHALL FORTNWITH COMPLY WITH TtiOSE PROVI°'CNS. � �SSUANCE ._______ ______ ___ 4 � ` ` SMIP p DATE:_ APPLICANT: _.________.-___— _----- --- _'— -- � � WARtIING FAILURE T.�SECURE WOR!(ERS'COMPENSATION COV[RAGE IS V�t��pWFIIL,AND SHA!'_8E ' . ENERGY P/C ______ � I SU&IECTANEMPLOVERTOCRIMINALPENALTIF.SANDCIVI_FIhESUPTOONENUNDREDTHOUSA�:D � � FNERGYPERMIT OOLLARS(S�oo.o0o),If1AD�ITIONTOT}iF.COSTOFCOMPENSATION,DAMAGE5A5PROVIDEJFORIti � � �--- ----�--�--- --- —�----- J i SECTION37CBOFTYELABORCODE,INTEqFST,ANUFTTORN[Y'S�EES. � �ETENTIONFEE: � � CONSTRUCTION LENDING AGENCY ' ?RE-ALT FEE: � � INEREBYAFFIHFAUNDERPE�AL7VOFPcR.:VRYTHATTHcREIShCOMSTRUCTIONLCNDINGAG[NCV � a- 3 FORTHEPERFORMA4CEOFTHcWOFKFJ.iWHIqiTHiSPERMITI5155Um(SEC309],CIV.G.) � -- � � — ' � LFN�ER'SNPME ._'___' _ ._'_____"'_ . . 1 1— � LENDER'SADORESS __.____ __ ___ � ICERTIFYTIIATIHAVER[ADTHISAPPLICAiIDNANOS?ATETHAT'(HEABOYEIYFOR?AATIONISCORR[CT. � TOTAL FEES ��� , �Q � I AGREE TO COMPLV WITH FLL CITY AND COUNN ORDINAVCES AND STATE LF.WS FCLATING TO BUILDING I � CANSTRUCTION,ANDHEREBYAUTHORIZe'REPqESENTATIV[SOPiHISCOUNTYTOENTERUPON7HE � ":�� �.�'.�4 Z A80VE-MENTIONED 9ROPERTY FOR INSPEC710N PURPOSES. , "�' . ^ �� COMMENTS___.__,_ '��__ � E.J �'l�� �...-��- aP£RMITTE E}W71 _'_ _--'"— __� _—_ _ __'_"'__ �.`���mrnwew������° . � . � SIGNAT RE OF PERMI . � DATE ~v�� �� — t , �� �� = RECPT.NO. `�!'_r PAID BY _F VALIDP.710N_'� ,_ � `�� WHI7E—Deparemen?Copy,YElLON1—Finanr.�:Copy,FINK—Assessor Copy,GOLDENP.OD—File Copy,GREEN—Applicant's Copy . . . . . ... . 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