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HomeMy WebLinkAbout13000 ^ �,a CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVIELOPMENT SERVICES �� 21fi60 E.Capley Drive Suite 190 � (909)860-3195 Fax(909)861-3117 PRESS ����'�+� BUQ.DING PERMIT APPLICATION FIRMLY _.:. ... , , . ,.,.:.,.:<. .. . :.. :..':,..•.. . ..z,.,;. ., y JOBSITE '7�O i�EYI,AND nR . � � APPLICATlON � —L� ---��j PERMIT � P/C o ADDRESS Y ' DATE }" � NUMBER `-�� # 1SSUE TYPE OCC APN LOT�'�_7TRACT f ���__ DA7E CONST. GROU? � OWNER � : 1 _�Jf��_�,5,"L"' � p ADDRESS " ' �' ����i����— r ZONING SETBACKS � CITY rC.����fA Z!P . ,; TEL..�� REART RW C APPLICAN'f TEL._ �; Q V SIDE/SICE STREET_ RW f--_ � CCNTRACTOR �T -� SIDE �� ADDRESS a�baca S ( � Q CITY ZIP�'��TEL.�_�.1���� ;� PROPOSED USE�� � - (,�;�,-�i � C• ��---�A 41�-� o ARCWcNG/ z DESIGNER — w -'-- NO.DWEL. NO. NO. a ADDRESS � CiTY ZIP TEL. UNITS STORIES BEDROOMS � --- --- en DESCFIPTiON SQ.FT: FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDEFI DECLARATION SFR/ADD/REM O Q I}IEFEBY AFFIFiN UNDER PENALTV OF PERIURV THAT I AM EXEFAPT FROM THE CONTqACTORS LI- GHfft(]B/C8fQ011 L!J CENSEUWFORiHEFOLLOWINGREASON(SEC.7a31.5BUSINESSAN'JPP.OFFSSIONSCOOE:ANVCITVOa (f� U CqINTVW�{�CHRE�I!IRESAPERMITTOCOYSTRUCT,AL7ER.�MPROVE,DEMOLISH,ORREop�qAM'STRUC� W patio/Deck W TUHE,7RIOR TO ITS ISSUMICE.A1S0 RE�UIRES THE APVLICANT FOR SUCH PERMIT TO FIIE A SIGNEO W � STATEMENT THpT HE OR SHE IS LICENSED PURSUANT TO THE PROYISIONS OF THE CONiRACTORS LI� � � CENSE LAW(CHMTER 9(COMMENCING WITH SECTION 1000�OF D!NSION 9 OF THE BUSIhFSS AN�PPO� POOI/SPB FESSIONSCODE)ORTH4THEONSHEISE%FARPTTHEREFFiOMAN7hIEBASISFOfiTHEA.LEGE�E%E!AP� (!J -- � TION.ANYVIOLATpNOFSECTION7031.5BYANYAPPLICANTFORAPF.FlMITSUBJECTSTHEAPPLICANTTO z qe-Fj00f � ACIVIL PEWLLiY OF NOT MORE THAN FNE HUNDRED�OLURS(S�W;.1: , ' - ,o ^I,ASOWNEROFTHEPROPFRTV,ORMYEMP�OYEESWI7H4MAG[SAS7i�EIRSOLECOFAP[NSAT70h, L� Comme!cial � WILL DO THE WORK.AN�THE STRIICTURE IS NO71N7ENDE�OF OFFERE�FOR SkLE(SEC 7oe4,BU56 J � NESS AND PPOFESSIONS CODE:THE CONTRACTORS LICEN�E LP.W DOES NOT AAPLY TO qN pWNER OF ? PFOPERTV VhlO BUILAS OR IMPROVESTHEREON,AND WF:O OOES SUCN WORN HIUSELF OR HERSfLF OR WTHRIXIE4HISORNEAONTEMPLDYEES,FROVIDEDTHP7SUCHIMPROVEMENTSARENOTINTENDEOOR � O OFFEREDFORSALEIF,HOVlEVER'�MEBUILDINGORIMPROVEk�FN`ISSOLUWITHINONEVEAROFCOMPLE- � TION,7HE OWNER$UILDER WILL HAVE THE PUR�EN OG PROVING 7HAT HE OR SHE OID NOT 8:11'_D OR — � IMPROVEFORTHEPURPOSEOFSALE). py� C]I.AS OWNER OFTHE PROPERTY,MA E%CLUSNELY CONTR�CTING W�TH LICENSE[1 CAARRAC70RS — p[ TO CONSTAUCT THE PRQIECT(SEC.7M6,f3USINESS AND PROFFSSIOYS CADE,T'siE CONYRACTOpS LI- HdIU8Ii0� _ADJ.AREA_____, LL1 CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPER'.VWHOBUILOSORIMPRqVESTHEflEON,AND "--- - F WHOCONTRACTSfORSUCHPROJECTSWITHACONTRACTOR!S�LICF.NSEOPURSUAN?TOTHFCONTRAG QUANTITY DESCRIPTION � FEE Y TOR9 UCEN3E IAW.). _ o �I AM E%EMPT UNOER SEQ___ ____,__,___B,e p C FpR THIS aEASOPI q /1 _ i��J].�Sf�.'.v � _y, � � � __ —___ � ''Y (�G.l'�. lr�.iJ �, ��'�i' � DATE____..__ OM/NER_____._„_ F J o —:'_"__'_._—'_' W 1 __ Si1�TAie�' a� �� � LiCENSEDCONTRACTORSDECLAFATICN � r7 —_— 1��,��t�r��. � � _L t .? • I HEREBYAFFIFM UNOEP.PENAI.TY OF PER.1l/RY THAT 1 A>A LICEN c0 UNDEA PROVIS!O�S O�CHADT,ER � `' �, B�COMMENCWGWITHSECilON7C0o)OFDIVISION30FTH�;:US:PlESSANDPAOFF^,SIONSCCDf,AN� � `� ,�ZY'�i t- �3• �%1J X L1Y LICENSE IS IN FUIL FO E AND EFF r-�� I�'i— — _ , _ o LICENSECLAS _ `r � 7 T ���..e�_':��_ � — v'::��a��" Va`�a�"iL@L �t F- -�,-._ LIC,N0. � ,� -'�'� � � � ]_.�—._, �r�at�r heater r�. �t�' ❑aTs coNrancroa__ � a � � � �-�'�- , ,., �, _(_�_—�'_- �---�---�--�a,�� s�te� E� ou�t�et �• 3i� � W�RKERS7COMRE�dSATION DECLP,RATiOfv �F i F� L�.��- t ,•• � nI HEREBVAFF!RM tFlDER PENALTV OF PEAJURY ONE OFTMF FOL i.OWiNG OECLARATIONS: U � a � ' l. �� a,--[_.—_ �.�,��;;.��,� C= . l r'<. ( d _IHAVEANDN'ILLMAINTAINACEFTIFICA7EOFCONSENiTOSELF-INSIIREFORWORKEFlS' q� ,,�--- ' � CAMVENSA:ION,ASPR06hDECBV5EC710N37noOFTNF�A80RCODE,FO?THF.oEaFORMANCF. W_�~m__ ���,������'K f :'"71.M♦�,'�"�'� OF iHG N'ORX FOF WHICH THIS PF.RMIT S ISSUEb. � ^�-i�— �='�.� '�—_' y �' i _ I _ + _I NAVE AND WILL>AAIMAIN JlORKERS'CAMPENSA710N�NSURA.NCE.AS REO�JIRED EV SECT!C+1 Q 37U0 OF THE JBOA FOR THE PERFORlAANCE OF'N�1VORK F W�7CHTHIS PFRFAIT IS I ISSUED.SAV ,,M��ar�5�T!CN /YCECARRIERA -LICYNUME�FARE' i CONSTRUCTION _ _ � z��`2°GG�'��.,.,!'' _ .ls�"._ � ��'� ! i PLANR�VIEW ,------ , ------�----- . . ..- .. CARRIER ' 0 POLICVMIMBER____ _�� � Z �� - �'`, _ �- — � i �L�� '-- / / .��j �L� � C�'�SSECiiQ4NE�NO76ECLM�LEfEbOFiFiEPERAdiISFC�W.��.HU�OliF��l.ARS�,'S•00;07L�SSj. � � ; PE�iBLNG- '_—_.._ ---_ __ '. R.fiJ�:. CJ � �y —_ Z 1 CERTIFY iNAT M THE PERFOP.MANC[OF i HE V�.'^.RK FOFl WH:CH TNIS P=?MIT IS ISSUFD,I �`MEC,HA'V1CAL __ � SHALLNOTFMAIOYANYPERSCNINANYPr1ANNE450A5T08CCOM.ESUB:F.CT?OTHE ' — (j] WORKERS'COMPENSATIONLAWSOFCALIFORNiA,ANJACRFE711ATIFISHi�U;.Cf3ECOM.[ I 1NSPECTIONFEE _ _ 9.. __ r���.0, SUBJECTTOTHEWCRKERS'COMPfN5AT10NPRCVISIONiOFS_CTIQ!33�CCOF'HELABO� ' � � CAD�.ISHA 'FOFi�/1�HCOVVLVYI�ITH?HOS'P VI$�,pNS / t i ISSUANCE ______ (! t � / "_ � �ATE:�y��APPLICANT: ������'_._ _ ; ' SMIP � ��ire�,y�{cgg _ aJNo-Y—' � WARNING PAILURETO S FCUR E W O q KERS'C�MP E N S Ai I D N C O VF R A GE i5 U K I A W. 1L.A H�5 .L H E � FNERGY P/C ,_�-��___ __ _ � Sl1BJECTAYEM7LOVERTOCRIMINALPENALTIESANDCIVIL.'INECUPi00NEHUN 'cDTH san�o � ENERGYPERMl7� ^� DO:LARS($10n,000�.INAODITIONTOTHECOSTOFCO!AP�.45ATION,DAMAGESASPR . IARI� '�{'�" ��,�}-;+.J:.'� �. � J SECT:ON3lOeOFTHFLAC�ORCODE.IN7ERFS',A.\'DAtTORN[Y'S�EF_5. � i+�1!-sJ��Y`���i+�t"s+��'�^� pC � RETEN"fION F�.�T��;�.,r�.r.,,,;Y,��^Y��±�_ Q CON57RUCTION LENDIhG AGFNCY �� _ � _��' "" �_ ; PRE-AL.TFEE�` � I HEREBV AFFIAM UNUEFl P[NPLT'OF PF:RJURV THAT 1 Ne'RE IS A�OVSTRUCTION LGN�ING AGENCY _ FORTHE PER.'ORMANCE OF iHE WORK FOR WHIC4?HIS PF,RMIT IS ISSUED(SEC 308],CIV.C.). , Z W —'_---'_'__ _' -- � IEh�ER'S NMSE ____'_""'_'_' _"..."'__'_' F_ LENDER'S AODR'-`'.55 _ ___.,_,__ , _ � T�iAL FEES �J � � � 1 CER7IFV TNAT I NAVE READ THIS APPLICAT!ON AYD STATE TlIAT THF ABOVE INFORMATtON IS CORRECi. v � IAGREETOCOMPLVWITHAL�CITVANDCOINJTYORD�NANCCSAYDSTATELAWSFE:ATING?OBUILOING p � CANSTRVC:TION,ANOHERFBYAUT1iORRER[Pfl'cSENTATIVE50FTHISCWNTYTOENTERVPON7FIE I; Z AAOVE�MENTIONED PROP.RTV FOR INSP�CTKKJ PURPOSES � COMMEN7S_____ 4'✓ � c /'��'�''. ��/�ya�''F ���"�_s'��c� s � —TL_6._,[�'',��,.-.�`�---'� �, --------- — m PERIAITTEE N�AIA�(PRINT) �yJ�/�'_' � , d /.�!��..'��}y ��/..., " _"�� I' __"--_— ___ ' _ � si TUA o� Fr€FGi�r� onT -���.� � RECP7 NO.��'\��PAID BY £ YALI pN_ �- `.' 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