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HomeMy WebLinkAbout13006 (16) 1�,` CITY OF DIAMOND BAR � ` DEPARTMENT OF COMMUNYTY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 '° ..,,...,; (909)860-3195 Fax(9(?9)861-3117 PRE$$ ���' BUtI.DING PERMIT,APPLICATIdN ; `;�` - , . :�. .; .',":::,<.�,�,' .;;;.;:�.r. ,„„ .; ,, .. FIRMLY � JOBSITE • l ;�, ; �`t APPLICATION`) Q � PERMIT � a � .P/C " o ADDRESS '� � � �� DATE_ `�'-� i � NUMBER l�� #_ � ISSUE TYPE OCC APN LOT ti�ACT_ �� _� DATE CONST.__ GROUI' p OWNER ���,.��.� �����}'k ; ADDRESS �% 0 _.�,��— ZONING SETBACKS O CfTY ��` ` 1/� ZIP C='�TEL. ;��_�_(�,�.. FRONT qyy n REAR _ r� o APPLICANT_____ TEL.___ S!f]EISIDE STREET RW CI � CONTRACTOR � ��°h% GL_� 1 �-`��'�ti SIDE _1 � ADDRESS_ __� o CITY�L, r��!,�,���� ZIP � ' TEL.=�t°�.�,_��•' PROPOSED USE_ Q ARCWENG/ � 6ESIGNER - NO.DWEL. NO. NO. a ADDRESS UNlTS _ STORIES BEDROOMS � C!TY ZIP TEL.---- � us DESCRIPT!dN SQ.FT FACTOR PS� ADJ.AREANALUATION � OWNER-BUIL�ER DECLAP,ATION SFR/ADD/REM O I NERE6V AFFIRM UNDEF PENALTV OF PERI:IRV THAT I AM E%EMPT FROM T�E CON?RACiORS_I� G8(d9B/CBfPOfl W CENSELAWFORTHEFOLLOWINGREASON(SEC.7037.SBUSiNESSANDPROFESSIONSCODE:ANVCITVOR (J� ___ U COIJNTYWHICNREQUIflESAPEflM1iTOCONSTRUCT,ALTFR.lA7PR�VF.,DEMOLISH,ORREPAIRAHYSTRUG W FBtio{DE!Ck � TURE,PflIOR N ITS ISSUANCE.AL50 RE�UIRES THE APPLICFNY FOH SUCH PEPMITTO FILF,A SIGNF.O W __ STATEMENT 7HAT F7E OR SHE IS L'CENSEO PURSUAN7 TO THE fROVI510N5 OF 7HE CONTRAC70R5 LI� � CENSE LAW fCHAPTER 9(COMMENCING WITH SECTIDN 7000)OF DIVISION 3 0F T4E BUSINESS AV�PqO� V' Po01/Sp2 _ FESSIONSCOOE��iTHATHEORSHEISEREMPTTHEPEFROMAN�?HEBASISFOR7HEALLEGECF%E!AP- (� � TION.ANVVIOLATIONOFSECTION7037.5BYAYYAPPLICARTFORAAEAMI?SU&1F.C?SPHEAPPLICAM?O � Re-Roof � ACIVIL PENALN OF NOT MORE THAN FIVE HUNDRED DO:LARS(£�tl0).;: � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITH+NA6[SASTIIEIRSOLECOMPCNSA'ION, � (;O(i1f116!CI3I__ � WILL DO THE WOFiK,AND THE STRUCTURE IS NOT INTENOF�OF,OFFEflED FOa SP.LE(SEC,7044,BU51� � � NE53 NVD PROFESSIONS CO�E:THE COMT?.ACTORS LiCENSE LhW OOES NC?APPLY TO 11N OWNER OF PFlOPEATYWHOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORHHIMSELFOHHERSELFOR -� Q iHROUGV'.kISORHERONMEMPLOVEESPHOVIDEDTHATSUCHIMPROYE6IENTSARE�O7INTFNCFDOR m " W OFFERmFORSALEIF.HOWEVERiHEBUILDINGORIMAROVEMEHTIS50'J'WITHINC?IEVEAROFCOMPL6 � ZTqN,THE OWNER�UILDER WILL HAVE THF.BURDEN 6F PROVIn�G?NAT HE OR SI IE�ID NOT ifUII.D OF � iMPROYE FOH THE PURPOSEOF SALE). ' W ❑I,ASOVfNEHOFhiEPROPEP.TY.AME%CLUSNELYCONTRACTIir'GWR}iUC;t1SE�C^NTRACTOflS —'— p[ TO GONSTRUGT THE PRQIECT(SEC.1oN,9USINE55 AND PROFf5510N5 CODE:'f'E CON�RACTORS LI� �/aIU8I1011 �� ADJ.AREA L'J CENSELAWOOESNOTAPpLYTOANOWNEROFAPqOPERTYWNO9UILDSORIMPAOVEST11EflEON,ANO - �—_-�_ — --- � N'HOCONTRACBfORSUCHPROJF.CTSWIh'ACANTRAC'OR(5!!.ICF.hSFDPIiRSUAVTTOTYECON'aaa qUANTIN DESCRIPTION FEE WRSLICEf:SELAW.I � ____ _ o ❑!ANEXF_AfPTUN6ER5EC.__._____,__. B&P.CFOA"'H!Si?EASO'v Q�i �____ yy f � - .'—'__ ��__—.—_.-- �A7E _ _OW4ER _ _ __ __ ______.____ V i � -- IL` �_ —' E- LICENSED CONTRACTORS DECLARATICN W� "[' - - �' I HEREBV AFFIPM UNDER AENALiV OF PERIURV TNAT I AM LICEN:.ED U!aDeR�ROVISIOYS OF CHAPTFR (� 9 f�MENCIN(3 Wfi}i SECTION 7a00�OF OIVISIOY 30F TiiE BUSINE55 d4D PflOFi:SS'01JS CO�f,AN7 V � e " � MYLICENSEISINNLI QRCEANCEFFECT. �� 7 k � � J (� ^� 07 � �'�l.�T�Li �'. ' l «� / .��i?_ �� —.-��-�- � "t�1�FL c� � � LICENSE CLASS �=�r•�__ LIC.NO.� �„�l>. . tI1-- � wDATE��=�� ^.CNTRACTOR,_�'� S��i� d.i�--- V ��....� ._� � WORKEP,S'COMPENSATIGN DECLARATIOI�! { Q � IHEREBYAFFIRMUMDERPFNALTYOFPFtiURYONEOFTHEF01.'.OWINGDCCI.ARATIONS: z 0 � IHAVE�N�WILIMAINTAINACERTI(ICATEOFCONSF.NTTOSELF-iNSURE�6RWORl(6R5' 4 I QCOMPENSATION,AS PROVIDED BY SECTION 9]OJ OFTYE!ABOZ CODE,FOR THF,PF�FqRMANCE J ___ OFTHE WORK FOF�NHICH THIS PERMR IS ISSUED. '�'�� —� i a r � _I NRVE I1ND W:LL&SAItJTAIN WORKERS':QMP^cNSATION INSUP.ANCE.A5 FF.O'JIRF.D AY Sf_CT!OA I � 37oa OF THF.LA9C9 CO�E,FOfl iF1E PERFOFIMRNCE OF'HE WORK FOR WRICH THIS PFRMIT IS � � ISSUED.MY WORKF.5) PEN NSUFA r��,{lE,R�411�(J.IC1'kUMft�R ARE: i CONSTRUCTION _ j CARRIER ����/ p�n.+l�'J t ----- I PLRN REVIEW -- ------- -� ---- � PCLCY IVUMBER__..__ 4:�7 EL�CTqFfi, �� Q �-f�'._�;�.��_..-.. _ ----------- �`�- -�( � Q (fHSSECTX)NNE�NOTBECOMREfE�OF7FIEPERM"fISF(:RO�:"eFrJNDaED67_[NS(SIOn;09�65} �UMBINE� ___ __ _, ;,�,��-,�"' I � 1 CEflYIFY 7HAT IN iNF PERFOR�AANCE OF THE WORK FO'�WN;CN TH'S?Ea?AI'IS ISSUED I PJ�ECHANICJ\L __.,,__,_ _ C°J � SHRLL NOT EA�IPLCV ANY P[RSON INANY MA�NFa 50 RS'O BFCO�!E SUI3Jf:CT i0'HE � WORI(EFS'COFAPENSATIOMLAN50FCA�IFOR�IA,AWDA�RFETHAT�FISF{pULD6FCANE iNSPECTIONFEE ____� ______ �..,-__ � SUBJECTT0T4EWORKcRS'C01.1PENSATIONGqO\'!SIONSOFSF.CTIDN3'/.^.UOFTN�'..A�IOR � `�.�� � CADE,ISHALLFO(/QT 17HCOAIPLYW1IHTH(: EPROVISIONSF � ISSUANCE _________, ____,__ .__ �t _�__ p p j 1� h-t.�. l.• /'�' I.L' SMIP � DATE:���;" "_' AFPLICAMT: _______,�__'' (^�/�, _ � N/ARNING:FAILl1RLT0 S[CVRE WORKcRS COMPENSATI04 COV�RACE IS U"lLAWFUL, ND 5 AL'0 ENERGY P/C ���__�yd{d�_ SU&IEC7ANEMPLOYERYOCRIMINALPENAiTIESANOCIVILFMESUG'OONEHUNfiIE . SANO ��f � DIXLARS(5100,n0o),INAD71T10NTOTHEC05T0=CONP[NSATiDN,�AMRGESA5Pa0\�IDE�FORIN FN�RGYPERMI'�� �.+ J SECTION 8709 OF l}1E LAeOR CODE,INTEFEST,AN�ATTOflNcY'S fEES. RETEN t ION FE�� '���Y-��`��i,'��� a�! � fL "__ '__ �ar �r'_�.,_L` �i' � — �Lfi��'S7 �= A-�=� - ,,,�:�•, O CONSTRUCTIONLENDINGAGENCY PRE-ALTFEF: 'w�r._K..� �r.. a_• ""'� _ � IHEREBVAFFIRMUkDERPENALtYOFAER.IURYTY.AT7HERE1S0.CON5TR�CTIOY'.'cNDINGAGCNCY _ � � FOR THE PERFORMANf.E OF THE WORK FOFi W i11LH TMIS PF.RMIT I4 ISSJED(SEC.�D91,CIV C j. . . .. Z IL � LENDER'SNAME_"'___'__""'_"__ _-_ -- _"_ _"'_'_'___'__'_'___""" ' .. . . . 1= � LENDERSADDRE55______.—"__'---'----__"--_--_---'--'_____ .' — .. � TOTAL FEES „�'j�, G' � IGERTIFYTHATIHHVEREADTHISAPPLIGATIONANDSTATETHATTHEABOVEINGORMATIONIS('ARRECT W 1 AGFEE TO COMPLV WITH ALL CRY AND COUNTY OPDINANCES AtdD STATE iAWS RELltTING TO BV!L07NG � CONSTFll1CTION.ANCNEREBVAUTHORIZEFEPR[SENTATNESOFTHiSCOUNTYTO:.NTEflUPO4THE ' ' ' ' � ' � AROVE-MENTI04ED PROPEFlTtl FOR INSPECTION PUFPOSES. � � COMMENTS p � / t.� J --'-- — J /� �d.�� � 1+.� ('^�� � _i-�..--e.-ii^ �s1 .�.i+�7L:iL!�E-,i t�=-9.-'___'— — -- . QPERMITTEE:AM�IPRINi) ��p /� _ '___ . 'I � '_ � L ��1 e . �� .��'7 ^�-`4= G� ..1 . . �p,,��...� `1.�_t-1.. L:—_.L.{- . � SIGNATUtiEOFGE�(All�l'EE �A7E '—'_'_.L"' �"_"' _ �� _��„ .. . .. ' . L / i c...� Z RECPT.NO. 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