Loading...
HomeMy WebLinkAbout11270 (5) _.___ _..._. . _.. __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 _ ,, # o 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 ❑ CONTRACTOR D������ �0'�'�'"S��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 STATEMENT THAi HE OR SHE IS LICENSED PURS'JANT TO THE PROVISIONS OF THE CONTRACTORS 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 OFFEREDFORSALE.IF,HOWEVER,THEBUILCIRGORIMPROVEMENTISSOLDWITHINONEYEAROFCOPAPLE- 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.;. � � 0 U T AM EXEMPT UNDER SEC. 6.8 PC.FOR THIS REASON U � --_ . . ... 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� �y ig 1 � 0 LICENSE CLA/SS !.D LIC.NO. A�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 aouCYNUMeER_ 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-7 1" �,� jJ �?'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: p�*' � IHEREBVAFFIRMUNDERPENALNOFPERJURVTHAiTNEREISACONSTRUCTIONLEN�INGAGENCY __ Y 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 � - � CONSTFUCTION,ANONEfiEBVAUTHORIZEREPRESENTATNESOFTHISCOUNTVTOENTERUPONTHE _. ��. . � � ZABOVE-MENTIIXJEO PROPERTY FOR INSPEC�ION PURPOSES. COMMENTS � �� �� '� � . . . .,. .. ,..,.. .� -.= � �y��{t l.�.S`:fi'R f�F{'J��`�1- .. „ � . . .. . . . . .. ... �.. . m PERMITTEE NAME(PAINT) ¢ /�.� '��—„ �'�l�—�� , . ,. . � ,[�i at.—�-+- ___ _'_' . . . � $IGNATl1REOFPERMITfEE DATE � L!' ` ' = FiECPL NO._ �•� __ PAIO BY � �VAUDATION ~ WHITE—Oepartment Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOIAENROD—File Copy,GREEN—Applicant's Copy �� ' � -� � � � l"^' �'� � � •,r t ,.., .�: y . .. .,:.. ., :.'.,.., •a._;f. i ... . - ,.., .:t s ':',i�, ., r �.:,;.� :. �. -: . , `, ` �. �� ������� ��s �� , r. ".. - . :: � �...� � . �. W � � a � , � ' � i - v ' � '� � , � � ,. ,; , ._ .: . .... :. .. _ , _, . ...._ i � ,c�s�� st�Y.;�� S I � }=�V`�?���7?�-�- _ _ .�-.__�_ __.._� ____ _.._..�J �"��r. ,-�����"�f��=` �� � �' ��-�� :-��a�T� ..._�_..� �_ : � _.__ .._.__ �.,_..___.� .�� .�._ _— ____-- v'� _� _ � ���cr, tQa�`,��"a""'o� � � f �.�L_kJ�'�� � 't� taC`if? ��",ts�T i �`.'µ. _. -- -- --- - ��� �� �� �� ��_____..._.��....�_____�.. . � � t.���?-� �LC;�� �a�h�E�l�li � -�-.-- _ _ • ---- ' ._ ` _. ______ ��'���`"���� ( ti � �� ._€_�� �'�;����`t���9'1L9�i"���� i � � � r_��g� ��s �����p - ---- ----- � ( �€a-"�.�s�Lr-��t=��CJ§V��3�%�iu' �_��__ _____- __ �_ __.��. __.__� Y. ____ ____ _ _._w�.__�______1�__ _._._ ,,-�- - � -, e� �p� � c.f��t� � � �.�4lttl�3 �-a%. i-�C.'sg€`� �3�r"�+�� € � " .._ ._�_.�W_.��".�_.�. _ �_____._�_______ _,� s }���rt' �'-"�xs r�a3�� ' � � �T �a�'a��L��i��'��`i i -�..__ ' - �� ____ �.._._.._.�_� � ��a n��:�r"�._�T��`r�' trt� 3 s,p� ' � ""� i __�,s�-'i�EC1��x�. � _. ____.; n.. � a r� _..._.� �' ,. ._.(L��__�._____�_ �"- ��� -�.....,�, _.,-t;� � , . _ ._.. ._._....... .>- __�. ._.»��.a._. .. _� , � ' _.__�_w_—.e �?._C�?��:�L��� I � �'dL. ��r"-�,€�9E�sa � _ ..�_ .� _�...� _--_�___.� ._._.... _� ___—, � ��;��r���(.��d�`�'€:�� __.__..�� ' F3�t��'��h� _.��. ( � ---�*---- -,. .��;__... � �`..' 1�i- ���a;�;i _ ._._.� � __ �'-M-s=;C;II..�C`-al-i �i��a'��i��� i � ��-sC'����' �-���t��w��`' �� I— i �1�al.�s"�£�".�1��C31Rl.a �- ; . —���'���'��'� ��' � ^__-i--�-- � � �'�"'' �!��T�!� --��__�'�w�. �---- � , - .--i � � � , _ _..P_.._� ---�-�----______...----... �_.._ ,tl._ � � E.wi'i� .�d�"��ra.�'i,...�ol°�� ..�.._. �_�.�_.m i �.W...m 1 ; ��'1i�€... ' ��d`v�.�a���._ . . .. . E - = ��-1 � � .._M�_._�y_„.�. � � +"s���. ����,.��i��!�� � + � `��€ ;�r�� � } . ' � _ _ _ .�___ __ ___. ._ _ __. - ____ _€ �� r�.?@ �w��������,f'.�"'';�i _ � __L�_ ��F�.�iE�"� �i1t�,��_ � ' � ' � � -_____ � ' � � ���;�?�a��.x�. ;"���'�=t�� �_._.�.� ' 4�,�E°l`�"a"�s:`�7J�� �,w— f _ __. ____ _ ___ � �. �=�,�� ��4�. � _. `. ��� __-- .�� � � � ��I�T! i:;t'�E�' , � ��,IsJ'��t�F'�I�F��'IC� ��,�. > �� _ —__� —�� ..------ �..._.___�--_�__ �_ � __ w_...-- ��=��r'� i��_.i_. � � ., ; i �,� �'"t'� ��f��'. , m .�:_ —� �°"`���t i?���` � __m�__ ..� ..�._ � ;=I ��',�:�'�'I���� ____-_— __ _... � � �� � � L._�i.SP�.�.,.Xd�.��"a.£[ _._. ..._ ` ..,. .m,___"___�"�"�""�'"_.„.4 §�""2�" Efk"'es'S� E�SdIL.. m.�.�....�.�.�.m,�..._.�...�.. ....._.e...� t ���F�� r��.'a-����������_.._. ' _M� -------� ' r��`tiz ;�?-4 �'�'$��`. s=lhif+.� i „ _. �_._.. , _ � _. ..._._ — � -- _ 3 i'$�z�r�i,.�.� ��::i.a��ii(a�i . ', '•�i�'-J 1-C,�a.�.+ ��irt`.� -_:._ _...�_._...._� ; % �.���. �._...��.e:.a_armu����_�____ .._-._.._I ' , j ! � � ,I��t�,@�a...r'L.�ii�€s�'68��1a _�. _ � _ t . �,�°de oi..�°�._...._.e...._.,, . . � , � �— . . _.._�—� i }-- � -� _____m___ � ..__,...r._.-.. _ _� . . ' .-.._______�..�_-____ .. ' � � - �� ... � 3 F ' . � �,.. . . : .., _._ ._._._-.—«... � , : : �.. � �. :..:. -�.,. .,.�.� ..�..�.�-_.T..�,,. _. . ..... 1 � �s � _ - -_-'__._ ,.--�-. �. .. ., .,_ . -. ' - . .. .. .,,, "... . - - .� .� �v..; .; s i � ��}�'��u���'�z `"' _ . .:� ,: , .�,� . , r� _ . ,,.: .: ,,. � ma....._.��.�_._��..___. _� ` � _` , , „ , � ,,;�", � �........ ____.._ __. __ _. � �.�.._....._._ � ,, . . . -. . . . . :. � ., � � ---..a.�._._.. _._ __ , _. ,;.T . .�.... . r-�icE• ..w.__. � - � "" �� �_.,.. ' �. . .. ,_....,, ., .-.. .. _._ ... � ." . . . : ,�..�-^^ t I _ -...� .. . �, .. .... .,. ` . . ..... . . � '� ...._._...._..__.,_ ___..._.... "___...�........._. �..,.. . .-�. ., .,. ., .� � . . . . . . . . .�. .^hl f ' . . Iv (_..v..........�..�._.._._,. .�..m...�........ _..m. ._ "_ �� ^ � ._........_.............._....._..._.. } ��. .�F} 'r:.. ,. �' .�, � ' .. i ' :: �. '.:.�. '.}I.l) . �y, . . ,. . Y. ;i t' .. .� ., .:..:..: . -. _.1 :;., e. :'R. .y . ���,,. ...i.. _.,., ,r. ,. .. ..� . . .,,-.r ,.. .n,.�:._:,� �..;. �'.__._.�._ _....Pa ... . . _ .__ . � ��.�����"����."�Ie� , ���. ..... .... ... ...,�. �,. - -; �r.::�::: � „�� .. . --__ �.:_.�_._. _�� �_ � � � �. ���� ��'t`,�� �� - --T ,,—,---x�--- �� , �_� e.� . . :... .. ." `�'—«- _ � .::::: _�...:.:.;n:.'.,.::� � . .�� - . .. . ... _ ,� a: '. ... - .: S:'. �_�{ �,.._ _n m�..w �.. " � .. .:.:� _ . . .. . . . ': r . � .. _ .. .._._ _' Y . __.-.m...a.__».._ .�...__ € ._.. -. S ���� ....�_,..�..........s.. . ......._.__ _ ...��.�»_. { � ; .. .:� }. .,ci . . � � .... :.s." :.�'- F@ � �.. @ E ,� ��� _._.r,_�s...__ " ..-,. . . .. . , , � � .�......�_ �^ - . . .�.: .... � .. .�. . . , � � .:.. .::. . - �3. . . .. ' ... ... ., .. .,... ... .. . ._...... .... . .. .... .. � .:: , � �'.-;•,- ' :,� . . �. .__. .. p