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HomeMy WebLinkAbout14844 , _�� CITY OF DIAMOND BAR � „ ,,.`* DEPART1:�fENT OF COMMUNITY&DEVELOPMENT SERVICES �3 �� 21660 fi.Copley Drive Suite 190 (909)860-3195 Fa�c(909)861-3117 PRESS ����A»°��' BUQ.DING PERMIT APPLICATION FIRMLY � JOBSITE ' �� W �� � APPLICA110N ' PERMIT ' P/C � ADDRESS DATE NUMBER # c� ISSUE TYPE OCC APN LOT TR DATE CONST. GROUP p. OWNER � " ADDRESS ZONING SETBACKS O Z GTY l �I� P !' T L • FRONT RW ❑ g APPLICANT TEp�. � '�+ ' REAR ❑ 'l SIDEISIQE STREET RW ❑ � CONTRACTO SIDE ❑ � ADDRESS - PROPOSED USE � CITY ZIP d� EL:� `� � ARCH/ENG! W DESIGNER NO.DWEL. NO. NO. a. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEI. N DESCRIPTION SQ.Ff. PACTOR PSF ADJ.AREANALUATION c� p� OWNER-BUILDER DECLARATION SFR/A��/REM O Q. 1 HEREBY AFFlRM UNDEH GENPLTY OP PERNHY 7HAT I M1 EXEMPT FROM THE CONTflACTORS LI- _ � Gerage/Carport '�W- CENSEIAWFOR7HEPOLIOWINORE450N(SEC.7o31.68USINESSANOGROFE5SbN5CO0E:ANVCITYOR C.� CDUNTYMMICHREWIHE9APERMIT7000NSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIflANYSTflUC- �, � paNO/DeCk :W--_ NRE,PHIOR TO RS ISSUANCE,A150 iiEWJIRES THE APPLICAN�FOft SUCH PERMiT TO FILE A SIQNED �. _�; STATEAIENT THAT HE OR SHE IS LICENSEO Pl1R5l1ANT TO THE PROYISIONS OF THE COMflACTOR5 L4 - CENSE UW(CHAPTERe.(COMMENCIN�WITH 6ECTIDN 70D0)OF DIVISION 30F THE BUSINESS AND PR4 -� PODUSPB �� �FESSIONS COD�ORTMAT HE OR SHE IS EXEMPT 7HEREFROAI AND TNE BA515 PoR THE ALLEGED EXEMP- _� TION.ANVVIOLATIONOFSEC710N7097.SBYANVAPPLICANTFORAPEfiMITSU&IECTSTHEAPPLICANTTO ��Z R8-ROOf .��: ACMLPENALTVOFNOTMORETHANFIVEHUNOREODOUApS�S600).): _�-, OI,ASOWNEHOFTHEPFlOPERTY.ORMYEMPLOYEESWITHWAGESASTHEIflSOLECOMPENSATION,: �0 CoRifllBtCidl WILL DO THE WORK,AND THE STRUC7URE IS NOT IMENDED OR OFFEFlED FOR SALE(SEC.7044.BUSI- .J :NESS/WO PpOFE5510NS CODE:THE CONTMCTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF ��' -.PROPERTYVhiOBUILDSORN.{PROVE57HEflEON,ANDNMO�OESSUCHWORKHIMSELfORHEfl3ELFOFi ,-m ��,' `THROUGHHISORHEROWNEMPLOYEES,PROYIDEDTHATSUCHIMPROYEMENTSPHENOTMTENUEDOR - �w- �OFF6iE0WH5pLEIF,HOWEVER,THEBUILDINGOflIMPROVEMENTISSOIDWITHMONEYEAHOFCOMPLE- -��- �`710N,TME OWNEH$l1iLDER 1MLL HAVE THE BURDEN OF PpOVINa THAT HE Op SHE DID NOT BUILD OR -Z�- -IMPROVEFORTHEPUHP0.SEOFSAL�. . ,'W', - ❑I,ASOVMEROFTHEPHOPEifTY.AMFXCIUSNELVCOMRACTINGWITHLICENSEDWNTRACTORS- - --�-:_ 'TO CONSTRUCi iNG PRQIECT(SEC.7044,BUSINESS AND PROFE6SIONS CODE:TN6 CONTHr�CTORS U--� V01U8�i0n ADJ.AREA .CENSELAWOOESNOTMPLYTOPNOWNEROFAPNOPERTYWHOBUIlD50R�MPflOYESTHEREON,AND. �-�;�. :_WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR�S�LICENSEDPURSUANfTOTHEWtiTFAG QUANTITY DESCRIPTION FEE �:TWiS UCENSE LAW.). j-o� ; ❑IAMEXEMPTUNDERSEC. 8.8P.QFOfiTHISREASON ���,, U - -�i.- .. ; � . u-' o�re owriEa ' U w �B LICENSED CONTRACTOHS DECLAiiATION W ,(L� IHEREBYAFFIRMUNOERPENALNOFPERJUflYTI'IATIAMLICENSEDUNDEftPROVI510NSOFCHAPTEA � � /yy)y . f ��.p_? 9(COMMEttCiNOW17HSECT101V7000)OFDIVISION30FTHEBUSINESSANDPROFES510NSCA�E,AND ,_ z ���+e' �� x' MY L.�ENSE IS IN FULL fORCEANO EfFECT. �. m :4LI't .., � . .,,0� LICENSE C LIC.NO. � � ,� � - �.,',W,` UATE� CONTRACTOR d ::r��= WORKERS'COMPENSATION DECLARATION � �i U ���-' IHER�YAFFIRMUNDEPPENALTYOFPE0.IURVONEOFTHEf-0LLOWINGDECLARATIONS: tn, Q -�' IHAVEANDWIILMAINTAINACER'fiFICATEOFCONSENT705ELF-MSUREFORWORKEFS' S ':�; SATION,ASPROVIOEDBYSEC710N37000FTHELAB�RCODE,FORTHEPEFFORMANCE U� - -. -HE WOHK FOR WHICH THIS PERMIT IS ISSUED. . � �i --W� IHAVEANDWILLMAINTAINWOPKERS'COMPENSA710NINSUPANCE.ASREQUIREDBYSECTION ��Q- e7000F7HEU+BORCODE,WRTHEPERFORMANCEOFTHEWONKFOHWHICHTHISPERMITIS `0-. ISSL/ED.MYYYORK 5'COAIPE SATIONIN URAN AR RANDP UC ARE: CONSTRUCTION . %�:, , CARRIEH � - PLAN REVIEW r) izY Poi.icrnuMaen " ELECTRIC �9 r �-ar'� - �russH.maur�rrorseca,cf.EreooFn-��rrxrsFoaorietf.�ro�woou�s5�aqoa�ssF PIUMBING � ' � ... .��;. . .. . . . . .. ... ,W� -�Z, ��CEPTIFYTHAT INTr1E PERFORMANCE OF THE WORK FOR WHICH THIS PERAIIT IS ISSl1ED,l MECHANICAL o,[}e _�:SHA2.LNOTEMPIOYPNYPER&ON�NANYMANNERSOASTOBECOME9U0JECTTOTHE -.�.��", .`� -WORKERS'COMPENSFTIONIAWSOFCALif-0RN�AANDAGREETHATIFISMWLOBECOME INSPECTIONFEE -:�� � SU&1E T TO TH VJORKERS'COMPEN PiiOVI510NS OF SECTION 37ooOF THE LABOR �SSUANCE �� `-O, E SHALL RTM THCOMPLYW O OVI510 S. ::p�: DATE. .� �APPLICANT. -SMIP ��,3��_� ��5�s� . 'W' ENERG �WAflNING:fAIWRETOSECUREWOtiKERS'COMPENSATIONCO EISUNLAWFUL,ANOSHALLB �J('9 L, a,a� . '��y'4,,; SU&IECTANEMPIOYER70CHIMINALPENALTIESANOqVILFMESUPTOONEHUNDREOTHOUSANO ENERGYPERMIT - {��1 A Y31'���v� �' i� � pOLLARS(5700,000),INAODITIONTOTHECOS70FCOMPENSATION.DAMAGESASPROVIDEDWRIN 7�g qp g`q�,'{�+ �j�p �j�,ti �-���J' SECTION97DBOFTHEUIBORCODE,INTEREST,ANDATfORNEI"SFEES. ' RETENTIONFEE: r,gt,�5P.15'E1V�a_��%>`��l - � 2; -'�� CONSTRUCTION IENDING AGENCY PRE-AL7 FEE: :�:=>�> INEREBVAiFlRMUNDERPENALiVDFPERJURY7HATTNEREISACONSTiiUCTIONLENDMGAQENCY "��' FOfl THE PERFORMANCEOFTHE WORK FOR WHICN THIS PERMIT IS ISSUED(SEC.30B7,CN.C.�. Z LENDER'S NAME �� �-t_—' LENOEH'SADDflESS �� -���- ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEPHOVEINFORMATIONISCORRECT. TOTAL FEES '�w� IAOREETOCOMPLYWITHALICITYANDCOUNTVORDINANCESANDSTATELAWSRELATM�TOBUILDINO �� COMSTRUCTION,AN�HEREBYAUTF10fl12EREPRESENTATIVE50FTHISCOUNTYTOENTERUPONTHE � / ,_Z: ABOV6MENTIONE�VRDPERiY FOR IN&PECTION PUHPO ES. COMMENT / " �� �Q. 'm. PEflMITTEE NAM ;:a.. ;v_� '; �. SIaNATUPEOFPE EE UATE c��,: RECPT.NO. 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