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HomeMy WebLinkAbout11270 ._.___ _..._. . _.. __w._______�___. . _._..�_. . ___, __..,.____,_.�.__. __ __ ,_ _ -- _._ , _ � < .. .. • _. . �: .-- -'»- CTTY OF DIAMOND BAR ,_ '� COMMUNITY DEVELOP1vIEIv'T DEPARTMENT � � 21660 E.Copley Drive Suite 190 w � PRESS �� (909)860-3195 Fax(909)861-3117 � �y�P� BUILDINGPERMITAPPLICATION FIRMLY o ADDRESS �� Q I I H ��[{��/7 ��C� /�ll/�I�I',�G'� SSUE ATIO�� 1 ' '�—TYPE R C���� P/C _ ,, # � OCC APN LOT TRACT DATE CONST. GROUP p OWNER MH��'C CI"7��/��H 7 G�G o ADDRESS 2 �/ 1V . ZONING SETBACKS Z C�7�y�/�}/'�Jry/1+/� �t'iR ZIP ,r�� TEL. �(I�Af?E�i FRONT RW ❑ o APPLICANT ,/u7/�id'�lll�f G CRy/diN°�f,S Z TEL.e��.fY1S:l'J"3� S DE/SIDE STREET RW O Z cic� , SIDE ❑ m CONTRACTOR D������ �0'�'�'"��p�'� �a-'�l°�3 � ADDRESS SSd B /V• /�OX/�/�il C!-+�d`f�=, is -- PROPOSED 11SE �,,,��'d�,M��� � CITY elZ-�S�tid c-''<-�• ZIP ��J�� TEL. tF'lS-S�tdr� w ARCH/ENG/ z DESLGNER - NO.DWE�. NO. NO. � ADDRESS UNITS STQRI�S BEDROOMS = CITY ZIP TEL. `n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BCILDER DECLARATION - SFR/ADD+REM O 1 HEREBV AFFIRM UNDER PEN0.lTV OF PERJURV THAT I AM EXEMPT fROM THE CANTRACTORS LI- G8f090/C2fpOR �W CENSELAWFORTHEFOLlOW14GflEASON(SEC.7037.68USINESSAN�PROFESSIONSCODE:ANVCITVOR (J� C.� COUNTYWHICHREQUIRESAPERMITTOCONSTRUCT,AITER,IMPROVE,DEMOLISH,ORREPA1R�AtJ`/�S7RVG W patio/Deck � TUNE,PRIOR TO ITS ISS'JANCc,AL50 REOUIRES THE APPCJCANT FOR SUCH PERMI7 TO FlLE A SIGNED W W STATEMEM THAi HE OR SHE IS LIGENSED PURSl1ANT TO THE PROVISIONS OF THE CONTYiACTORS LI- �...., � CENSE lAW(CHAPTEFi 9(COMMENCING WITH SECTION 700d)OF DIVISION�3 O�'THE BU$INE55 ANd PIiC- � PooUSpa � FESSIONSCODE)ORTHATHEOfiSHEISEXEMPTTHEREFROMAND�HEBASISFONTHEALIEGEDEkEMP- � V 7ION.ANVV1oLA710NOFSECT'��oN7o3t5EVANYAPPLICANT'FORAPERMITSUBJECTSTH6APPLICANTTO � RB-R001 � A CIVIL PENAL7V OF NOT MORE TFIAN FIVE HUNDRED DOLLAFS�SS00).): 0 ❑I,ASOY/NEROFTHEPflOPERTY,ORMYEMPLOYEES'4VITHWAGESASTHEIRSOLECOMPENSATION, � Commercial Z WILL DO TME WORK,AND THE STRUCTURE�S NOT INTENJED OR OFFERED FOR SALE(SEC.7abd;BUSI- J � NESS AND PROFe"SSIONS COOE:THE CONTftACTORS LICEIJ5E lAW DOES NOT APPLY TO AN OWNER OF � ` � PROPERTVWHOBUILCSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHER�SELFOR e [[ 7HROl1GHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMEN7SARENOTINTENDE00R m w OFFEREDFOFSALE.IF,HOWEVER,THEBUIL�IRGORIMPROVEMENTISSOLDWITHINONEYEAROFCOPAPL6- 0 TION,THE OWNER-BUIL�ER WILL HAVE THE BLIRDEN OF PROVING TNAT HE OR SNE DID NOT 9UILD OFi ' Z IMPROVE FOR THE PURPOSE OF SALE�. �"' " ' _ ❑I,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELYCONTRACTINGWITHLICENSEOCONTRACTORS /'� � TO CONSTRUCT THE PROJECT(SEC.7044,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- VaI110l1Of1 � Ps'� ADJ.AREA � W CENSElAW�0E5NOiAPPLYTOANOWNEROFAPROPER'tYWHOBUILDSORiMPROVESTHEREON;AND � WHOCONTRACTS�ORSUCHPROJEC7SWITHACONTRACTCSR(S�LICENSE�PUftSUANTTOTHECON'RAF QUANTITY DESCRIPTION � FEE TORS LICENSE LAW.;. � � � U T AM EXEMPT UNDER SEC. 6-8 PC.FOR THIS REASON Q — CC LL' �ATE OWNER � '� � - Z W � LICENSED CONTRACTORS DECLARATION ��j ¢ CC IHEREBVAfFIRMUNDEAPENALTYOFPERJURYTHATiAA7LICENSEDUN�ERPROVISIONSOFCHAPTER �yr � 9(COMMENCINGWITHSECTION7000)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCO�E,AND Z X MY UCENSE IS IN FULL FORCE AND EFFECT, m W g� ig 1 � 0 LICENSE CLA/SS !.D LIC.NO, ��p��a�J � U ppTE�{�'_ �e� CONTRACTOR(/��^I!LL�f�E�.jL I//�A✓irh n- W -....,. ,. ... � WORKERS'COMPENSATION DECLARATION� d � I HEREBY AFFIRIA UNOER PENAL7Y OF PERJURY ONE OF THE POLLOWING DECLARATIONS: � � Z Q � IHAYEANOWILLMAINTAINACERTIFICATEOFCONSENT70SELF-INSUREFORWORKERS' 2 ¢ CAMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE.FOR THE PERFOftMANCE W OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. cZ . . � w _I NAVEAND WILIMA�NTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 37000FTHELABOFCODE,FORTHEPERFORMANCEOFTHEWORHFORWHICHTHISPERMiT15 � '�^,/,, f�� ISSUE�.MY WORKERS'COMPENSATION INSURANCE CARRIEH AND POLICY NVMBER ARE:�� CONSTRUCTIQN j cARRiER PIAN REVIEW . .......... . ...:..... .....�,..�..,. . . .,,,..�,_... _.... ...___._. . . Z POLICYNUMBER_ ELECTRIC ___.—_ ¢ (iHISSECiIONNE�NOTBEO�MPLEfEDOFTHEPERARISFOROtJEI-AlNDFiEDDOLWdS(5100)ORLESS). PLUMBING � � Z ICER7IFVTHATINTHEPERFORMANCEOFT.HEWORKFORWHICHTHISPERMITI515SUED.I MECHANICAI �J SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE � WORHERS'COMPENSATIONIAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE SU&IECT TO THE WOFKERS'COMPENSATION PROVISIONS OF SECTION 3700OF THE LAE30P .� o � � � CyADE/,I SHALL FORTMWITH COMPLY WITM THOSE PROVISIONS. �SSUANCE Q b�f 1" �,� � �?'fa_I:C''Z SMIP �� � DATE: APPLICANT: ��L�1� C C��+'-..9. J � ENERGY P/C WARNING:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE �y SU&IECT.ANEMPLOYEFTOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNOFEDTHOUSAND ENERGYPERMIT _ DOLLARS(5100.000).IN ADDITION TO THE COST OF CAMPENSATION,�AMAGES AS PROVIDED FOfi IN � SECTION 3�oe oF THE CABOR Lb�E,INTEREST.AN�ATTORNEY'S FEES. � � � � RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBVAFFIRMUNDERPENALTYOFPERJURVTHAiTNEREISACONSTRUCTIONLEN�INGAGENCY � 0- FOR THE PERFORAAANCE OF THE WORK FOR WHICH THIS PERMI'IS ISSUED�SEC.3097,CIV.C.�. Z W S LENOER'S NAME � F_— LENDER'SPDDRESS -�. �. � ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEA00VEINFORMATIONISCORRECT. TOTAL FEGS ��'Q�� w I AGREE TO COMPLY WITiI ALL CITV AND COUNTV ORDINANCES AND STATF LAWS AELATING TO BUILDING � - � CONSTRUCTION,ANOHEfiEBYAUTHORIZEREPRESENTATNESOFTHISCOUNTI'TOENTERUPOtJTHE _. ��. . � � ZABOVE-MENTIIXJEO PROPERTY FOR INSPEC�ION PURPOSES. 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