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HomeMy WebLinkAbout13684 (7) R CITY OF DIAMOND BAR E��(PJ��'� DEPARTIVIENT 4F COM1bIUNITY&DEVELOPMENT SERVICES W . 21660E.CopleyDriveSuitc190 O`T � Q ZOOO PRESS ..,„,, (909)860-3195 Fax(909)861-311'7 . , , , - , 9�' BUILbING P�RMTI'Ag1'���ATTON . ., , ' „ µ- F��MLY } JOBSITE '�r`Z---�''J (� ��C b/°it ��� '��< < APPLICAIION PERMIT � P/C Q ADDRESS_�,��,/-�( t`1�.-�,r'V �3.��.- �"�� �r �� � DATE NUMBER ���� # � APN LOT � `�`"{ TRACT �'��G'' �'� qTE� ^CONST. GROUP �j OWNER ��°a`/�""GrSC� "' 1dZ-,JO&c�E`� �' °i' ADDRESS 2-r 2» C--y"G���.r/�G"-y ;��---` ZONING SETBACKS w CITY����`�'�"`� `�- ZIP ��d�� TEL�4'� � " FRONT RW ❑ � APpLICANT �,,�G�"P!•�t+.�t_cir.rr:��,�,TEL �ic4a��e �Q:t REAR ❑ � � SIDE/SIDE STREET RW ❑ � CONTRACTOR�.'� �� ""' :'=:�'a'd ��C�,7�,� SIDE ❑ g ADPRESS�rC2=- t r X Gc��r�.�-'L�+S`% . , CITY rGteKo:�� Z�p�._� TEL. `��S::2 PROPOSED USE � ARCWENG/ /f� ?d'"t ...• � � DESIGNEfi NO.DWEL. Np. NO. ADDRESS �� `� s � UNITS STORIES BEDROOMS � CITY ZIP TEL. cn � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILOER DECLAFATION SFWADp/REM O p t HEREBY APFlRM UNDER PENALTY OF PERIURY THAT�AM EXEMPT FHOM TNE CONTRACTORS U- �yrg98/C8l�OfI / W CENSELAWFOqTHEFOLLOWINGREASON(SEC.7o31.5&JSMESSANOPROFESSIONSCODE•ANVCIiYOR (/J _ C� COUNTYWHICHREtHJIRESAPEFiMITTOCONS7RUCT,AL7ER,IMPROVE,DEMOLISH,ORREPA�RANYSTHUC- W pati0/DeCk Z 7UHE,PRIOR TO ITS ISSUANCE,ALSO REQUiRES 7HE APpLICANT F�A SUCH PEBMIT TO FILE°A SIGNED �L� STATEMENT hIAT HE OR SHE IS UCENSE�PURSUAN7 TO�TNE PpOVISIONS OF THE CONTRACTORSLI- W -�^�.,� GENSE LAW(CHAPTER 9(COMMENCINQ WITH SECTION 7oDoj OF D7VISlON'3 OF TNE BUSINES$AND PRO- U' P��USp3 . ' FESSIONSCODE�OHTHATHEORSHEISEXEMPTiHEflEFROMANq7NEBF515FORTHEAIIEDE(SE7(EMP- (!S V 710N.ANVVIOLATIONOFSECTION7a31.5BVANYAPPLICANTKbRAPERMITSUBJECTSTHEAPPCIC'ANTTO Z R0-ROOf �„_ ACIVIOIASOWNEROTHE AOPERTIF�ORMYEMPLOVESW(sWAGESASTHEIRSOI,ECAMPENSr1TION, (] � 1NLL W 7NE WORK,AND TNE STRUCTURE IS NOT IN7ENOED OR��dFFERED FOR$ALE(SEC.'70ii,BUSI- J GofntTl6fCl91 - �.� N NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICEN$E LAV!DOES NOT XGPIV TO AN 01NNER OF � PROPEiYTY WHO WItDS OR IMRROVES THEREON.AND M1H0 DQES$UCH WORK HIMSELF Oq H£�iSELF OR � u.\'pC TNROUOM HIS OR HER ONM B�MLOYEES,PROYIDED 7YiAT3UCH IAVpROVEMENT&ARE NOT INYENDED pR m .:-z�p OFFEREDFORSALEIF.HOWEVERTHEBUILDM[3ORIMPFiDVEMFNi"15SOlDWITHINONEYEAROfiCOMPLE- � TION.THE OWNER-BUILDER WILL NAVE THE 9UROEN OP PROVING�7HAT HE OR-SHE DID NOT'BU11A DR � � IMPPOVEFORTHEPURPOSEOFSILLE). � ���' � ❑I,AS OtVAIER OFTHE PROPER"fY,AAL EXCLUSIVEIY CONTMCTINO WIlH LICENSED CONT?iACTORS � - a TD CONSTRUCT 7NE PR0.IECT(SEQ 7aM,BUSWESS AF10'PROFEESIONS CODE:iHE CAtJTFA'C7bp5'LI- VdIUdS1011 ADJ.AREA . - W CENSELAWOOESNOTAPPLYTOANOWNEROFAPROPEN7YWHQBUILDSORIMPROVESTHF.HEON,AN� � � WHOCONTRAC7SFORSUCHPROJECTSWlTHACONTRAC70Fi(S)L(CENSEDPURSUANTTOtHE'CONTRAO Q�JqNTITY D SCRIPTION FEE � . � TOii3 UCENSE LAW.). � p "O I AM EXEM�T UNDEH S�C._ B.8 P.C.FOR THIS REASON � � � DATE OWNF.R ,�P.�. . _ U � LICENSED CONTRACT S DECIAAATIOPJ W � 1 HEREBYAFFIRM UNOER PENALTY OF PEFUURY THAT I AM LICF.NSEO UNDER PAOVISIONS OF C'.HAPTER � � e(COMMENC7NOWITHSECTfON700o)OFDIVISION30�THEBUs'INESSANDPROFESG�ONSCODF,i1N� z ��� MY UCENSE IS IN Fi1LL FDRCF ANO EFFECT. m � LICENSE CLASS�_ IIC.NO. � � � j J WDATE .__ CONTRAC70R.._.�—_--_--� � a I � WORKERS'CfJMPENSATION DEGLARATIUN —�� �' � �MEFtEBY pF�'IRM UNDER PENAI.TY OF PERJURY ONE OF THE FOLLqWING DECLARATIONS: � U� � Q C9 __,1NAYEANOWILLMAIN7AfNACERTIP�CATEOFCANSEN"'70SELF�INSUAEFORWORKERS' '�I � COMPEN5AT!ON,AS PFiO`11DE{l BV SEC7104 37GOOF TNE LABOR CODE.FOR THE PERFOqMANCE C)� • 4 OFTPIE WCRK FOH WiiICH THIS PERMR IS ISSUED. '� O W _IHAYEIWOW111MRINTAINWOPNEPS'COMPENSA710MIN5URANCE,ASREQUIREDBYSECTLL�N / o � 3i00GF1HELABORCtlDE,FOS2TN60ERPoRAAANCEOfTNEWORXFOflW6iiCHTHISPERM171S 1!' .� �I'� /� ^' � ,w� I55UEO.M'WOR%ERS'�7MPENSATION INSUP.PNCE CARRIER AND POL'�,CY NUMBER ARE I CONSTRUCTION _X ��� � T J . .... . . .. ._....._._.... . _ ¢ r,qqqieR� ._ = I PLANREVIEW � � Pa_icruurseea i ELECTRIC � Rwss[criowNe�riaisEwtiu�.ttEiooFn��fmar�staa�e�-K.wraE�oaia�s�sioo)cx��Essa j PLUMBING ` � I CER7IFY iHAT W TNE PEHFONMANCE OF 7HE WURK FOfl WHICH THIS PeRhIiT IS ISSUED,i � MECNANICAL (yj SFiALI NOT EMPLO`!ANY PEf1SON IN ANY MPNNER SO AS TO BECOME SUBJECT TO THE' �y�y WORI(ERS'CCMPENSATIONL4WSOFCALIFOP.NIA,ANOAOREETHATIFISHOULDBECOhIE I INSPECTIONFEE SUBJECTTD THE WORKERS COMPENSFTION PROVISIONS OF SECTIOh 37600F1Tie LABOR „� � CODE,16NA4.GOY7THWiTHCOMPLVWITHTHOSC-PPOVISICNIS. ISSL16kNCE �" � 5MIP ���� p DATE:_, APPLICANT. J WAftNING:FAILIiflE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SUBJECTAN EMPLOYEfl 70 CRIMINAL PENAl71E5 AND CIVIL flNES UP TO ONE HUN�RED THOU9AND ENERGY PEFMIT � OOL(ARS(S7oo.00a),INAODITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVI�EDFORIN ���9 �,a g _J SECTION9�oBOFTHELABORCODE,INTEREST,ANDATTORNEV'SfEES. REfENTIONFEE: �d `@ A' �°°�'1`�`��-# Q �- �- � QCONSTRUCTION LENDING AGENCY PRE-ALT FEE f`;�� xr,-�,..- tl _ �� � I HEFiEBYAFFIqM UNDER PENAIiV OF PERJUM THATTNERE IS ACONSTRUCTION IENDING AGENCY S - � ' Q FORTHEPERFORMANCEOFTNEWORKFORWHICHTHISPERMiTI51SSUED(SEC.308'I,CIV.C.). ���x ,,. , � , _ � � Z . W � LENOER'SNAME _ _ F— LENOER'SADDRESS � ICEflTIF1'THATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEPBOVEMFORMATIONISCORRECT. TO IAL FEES � � I AGPEE TO COMPLY N!!TM ALLCITV PN�COUNTY OROINANCES qND STATE IAWS REIATING TO BUILDING � CANSTFUCTION,AND HEREBV AUTHORIZE REPRESENTA7NES OF 1HI5 COUNTY TO ENTER UPON THE Z ABOVEMENTKKdEDPPOPERTYFOR!NSPECTIONPUflPOS[S. COMMENTS � o ��g�,��t°.�*£ �,..�'!/'"�E�JL+�C-5 � m PERMIT��'E�(PRINT) �' � ��"`-1�'.L��-c•E-� G'C��� ��r�rrc'� �/j StGN0.TUR 7ERMITTEE DATE � RECPT.NO. PAID BY - VAIIDATION WMITE—Department Copy,YEILOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—FleCopy,GREEN— plicanP Copy �.,.,..<� "* �� a��r,'� �- �:x���:�€.��'�,���� �a��� �,� ,< G f :.s �������������� �`=������� . .. , . , �,, 4 � � r:.� ������"��. � {� . �a. �;:_ �� � �#� � �� �Esa . x;."*'"R' g 4 , � a�P G�.� t.$Y� �,'wb" � �'�� ., �'��'ti ' � �� ,�s� t� � ��.'t �. ���v,� _�W� F:. �e, �� ,. w=��+��s �t:^Rta. �`�� ;; � �'.�4.�2. ..,.,-:�.. ::. �...� �. "��.... �� , k��+:€�� "� �... -: ��. 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