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HomeMy WebLinkAbout17236 (23) -----��``°°---- CTfY OF DIAMOND BAR p��;:;� � �, I7EPARTI�fENT�F COIvARU1VITY&DEVELOPMENT SERViCES �� - 21825 E.Copley Drive (909)8b0-3195 Fax(904)861-3117 PRESS ��v��� BIT�LDING P�RMIT APPLICATION FIRIIALY y�, J08SITE PJ �� 9 ' APPLICATION ' y PERMIT P/C a ADDRESS_���(ei.N{� � ° DATE ���` L'� '�� NUMBER � �� # � ISSUE TYPE OCC APN OT TRACT DATE CONST. GROUP p OWNER � �', o ADDRESS �.f "�f� i�.C<.�.t�.C�. ' ZONING SETBACKS z CITY� ° Z!P � TEL. FRONT RW C o APPLICANT TEL. SID�IDE STREET RW ❑ z Q CONTRACTOR SIDE ❑ o ADDRESS PROPOSED USE �� F '���p/ � S���J t7r �`f CITY ZIP TEL. �r o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. cn cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/flEM O � 1 HEREBV AFFIfiM UNDER PENALTV OF PEfl.NRY THAT I AM EXEMPT FROM 7HE COMRACTOq3 LI- G8fd9B/C3fpOfl W CENSELAWFORTHEFOLLOWINGREASON(SEG7o31.56U51�E55ANOPROFE5510N5CODE:ANYCITYOR (n C.� COUNTYWHICHREQUIRESAPERMITTOCONSTPUCT,ALTER,IMPROVe,DEMOUSH,OflREPAIRANYSiRUC- - W TURE,PRIOR TO RS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMiTTO FILEASIGNED W Patio/Deck , �� STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROYISIONS OF THE CONTRAC70RS LI- . CENSE LAW(CHAPTEfl 9(COMMENCING WITH SECTION 7aoa)OF�IVISION 3 OF T7iE 3USINESS AND PRO- V' POOVSP2 �. FESSIONSCO�E)OqTHATHEORSHEISE%EMPTiHEREFROMANDTHEBA515FORTHEALLEGEDE%EMP- (� V 71ON.ANYVIOLATIONOFSEC710N7o31.5BYANVAPPLICANTFOflAPERMITSUBJECTSTHEAPP'JCANTTO z Re-Roof �� � ACIVIL ENALTY OF NOT�MORE THAN FIVE HUNDRED DOLLAHS(E5o0).): '�I,ASOWNEROFTHEPPOPERTY,ORM7EMPLOYEESWITH�WAGESAS?HEIRSOLECOMPENSATION, Q Z WILL DO THE WOFK,AND THE STRUCTUflE IS NOT INTEN�EO OF OFFERED FOft SALE(SEC.7044,BUSI- J COf111'nOfCle� - � NESS AND PqOFESSIONS CODE:THE CONTFACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPEFlNWHOBUIL�SORIMPROVESiHEREON,ANDWHODOE55UCHWORKHIMSELFDRHERSELFOR � � THROLIGHHISORHEROWNEMPLOVEES,PROVIDECTHATSUCHIMPROVEMEMSARENOTIN7ENDEDOR � Q OFFEREDFORSALE.�FHOWEVER,THEBUIL�WGORIMPROVEMENTISSOL�WIP,iiNONEYEAROFCOMPLE- Z TION,THE OWNER-BUIL�ER WILL HAVE'THE BUR�EN OF PROVMG TfiAT HE Ofl S4E OID NOT BUILO OR � IMPROVE FOR THE PUFPOSE OF SALE). ❑I,AS ONMER OF THE PROPERTV,AM EXCLUSIVELY CONTRACTING W ITH LICENSE�CONTRAC70RS Q TO CANSTRUCT 7HE PROJECT(SEC.7044,BUSINESS AN�PROFESSIONS CODE:THE CON7RACTORS ll- V81U8tiOn �� �+ ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUIL�SOF11MPfiOVESTHEpEDN,AND �� WHOCONTRACTSFORSUCHPROJECTSWI7HACONTFACTOR(S)LICENSEDPURSUANTTOTHECONTftAC- QUANTITY DESCRIPTION FEE � Y TORS LICENSE LAW.). Q ❑I AM E%EMP7 UNDER SEC. B.&P.C.FORTHIS REASON Q � U � DATE M C,}''�4 a+P.J i. OWNER U � LICENSED QONTRACTORS DECLARATION W ¢ � IHEREBYAFFIRMUNOERPENALTYOFPERJUflYTHATIAM�ICENSEDUNDEFiPROVI510N50FCHAPTER � � 9�GOMMENCMGWIiHSECTION7o0o)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND z �X� MY LICENSE IS IN FULL FOFCE ANO EFFECi. m � LICENSE CLASS LIG.NO. � U DATE CONTRAGTOFi � W � WORKERS'COMPENSATION DECLAAATION a � 1 HEFEBVAFFIRIA UNOER PENALTYOFPERJURV ONE OFTHE FOLLOWWG DECLARATIONS: Z � _IHAVEANDWILLMAINTAINACEflTIFlCqTEOFCONSENTiOSELFINSUREWRWORKEFS' a - ¢ CAMPENSATION,ASPROVI�EDBYSECTION37o00F7HELA90RCOD�FORTHEPEitFORN,ANCE � �U Q OF THE WDHK FOR WHICH THIS PEPMIT IS ISSUED. � �W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATIDN INSURANCE,AS REdUIFEO BY SECTION 37000FTHELABORCDDE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS � �� �J"`�, J ISSUE�.MYWORKERS'COMPENSATIONWSURANCECARRIERAN�PDLICYNUMBERARE: CONSTRUCTION 6 L�1 j cqRRiER PL4N REVIEW Z POLICVNUMBER ELECTRIC Q ' 0 (IHISSECl10NNE�NOTBECOMPLEfEDOFTHEPERMRISFORCNEHU�RE�Wt1AR5(510010RLES5). PLUMBING W z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOft WH:CH 7HI5 PERMiT IS I5SUE0,l MECHANICAL (,�} SHALLNOiEMPLOYANYPERSONINANYMANNERSOASTOBECOMESl16JECTTOTNE �/j WORKERS'COMPENSATIONLAWSOFCALIFORNIA,AN�AGflEETHATIFISHOULDBECOME INSPECTIONFEE � SUBJECTT07HEWORKERS'COMPENSATIONPHOVISIONSOFSECTION37000FTHELABOR . Y f'yp�rP CO�E,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE �'�./ p DATE: APPLICANT: SMIP 4 �� W J WARNING:FAILUFE TO SECURE WORKEflS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHAL!BE ENERGY P/C J SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND � DOLLAflS(5700.000),INADDITIONTOTHECOS70FCOMPENSAilON,OAMAGESASPROVIDEOFORIN ENERGYPERMIT J SECTION 3708OF iHE LABOR COOE,INTEREST,ANDAiTOqNEY'S iEES. � �, � W RETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBVAFFIRAAl1N�ERPENALTVOFPER.IURVTHATTHEREISACONSTRUCTIONI.ENDINGAGENCY FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PEPMIT IS ISSUE�J(SEC.309],CIV.C.). Z W _. � LENDER'SNAME � F-- LENDER'SADORESS $.�� ¢ I CERTIFV THAT I HAVE REA�THIS APPLICATION AND S7ATETHATTHE ABOVE INFOFMATION IS CORRECT TOTAL FEES � "��'✓ w I AGREE T�COMPLY WITH ALL CITY AND COUNTV ORDINANCES AND STATE UWS R3ATINGTO BUIIDING � CONSTRUCTION,ANDHEflEBYAUTHORIZEftEPflESENTATNE50FTHI5GOVNTYTOENTERUPONTHE � ABOVE-MENTIONEO PROPEflTY FOR INSPECTION PURPOSES. z COMMENTS � �f.t�t F> I',�G � -- J ���.�� � ------- ¢ PERMIT NAME(PRINT) � �'�"��� �l -> � SIGNAT E PE OATE F RECPT.�O. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Capy,GOLDENROD—File Copy,GREEN—ApplicanCs Copy .',""ii ..,_..,. �: ,...,... .,...._�.. _...,�.,. ..a.� . .w .;.�J Y_IN S+.v e..-wo u.bhr mi.: m v "N'"" f t ., r . .., „ ' ..... , .., . .� . , .... ... ...:s � rv # ���� x r ��� � 5 ... , :3. *. .c . .. �. , . ,r. a�'^ �� :. . ����.�. , s:���, �� ,�x�.*. 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