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HomeMy WebLinkAbout17956 (30) l...__- . � _ _. _. CITY OF DIAMOND BAR � �y� -�� DEPARTMENT OF CONIIvfUNITY&DEVELOPMENT SERVICES � � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS `%�' BUILDINGPERMITAPPLICATION FIRMLY } JOBSITE 1 G 3 8 �,n�N<<< APPLICATION �� �G�(��ERMR � P/� o ADDRESS DATE � NUMBER # $ ISSUE � v?f TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER R:�Fa (��A,vN AODRESS l b�8 �P��-I�LL ZONING SEfBACKS z cirr Oi/fwwNL{ 14�v� ZIP TEL.q04 7iLJ-.562R REART RW O g APPUCANT _N11�I2.+s I S}n+.a,v—C� TEL.'�/?�j-5S7D SIDE/SIDE STREET RW ❑ � CONTRACTOR M ic.{►AiL 'S;in�.vC S _fjI0�=4£�:•D/_�S SIDE O ADDRES ' � � c � CITY ZIP�t7�-`]TEL ���9 L-'.L9-'S D PROPOSED USE A � Y� �-� w ARCH/ENG/ z DESIGNER NO.DWEL NO. NO. nw, ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLAFATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENALTY OF VEfWNY TMAT I AM E%EMPi FROM TME CON7MCTORS LI• G3�8g0/C21pOR W CENSEUWFORTMEfOLLOWIN6REASON(SEC.70]1.5BUSINESSANOPROFESSIONSCODE:PNVpTYON (n U COUNTYVMItliREOUIRESACERMITTOLONSTRUCT.ALTERIMPR0VE,0EM0U91.ORREP�IRANVSTRUC• W PatiolDeck �LNRE,PH10R TO RS ISSUANCE,AL50 REW IRES TME ADPLICANf FOR SUCH PERMIT TO fILE A SIGNED W � STATEMENT 7HAT HE OR SHE IS LICENSEO VURSUANT TO THE iROVi510NS OF THE CONTRACTORS L4 .� CENSE lAW(CMAPTER V(COMMENqN6 WITH SECTbN 700D)OF DIVISION J OF TNE BUSINE55 AND PRO- u- PooVSpa � FESSION500DE)ORh1ATHEOH5HE15E%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- V TIDN.IWYVIOLATIONOFSECTION7071.6BYANYMPIICANTFOR�PEHMIT5UB1ECT51NEAPP�ICANTTO Z RaRoot � ACMIPENALTVOFNOTIAOFETWWFIVEHUNDREDDOlURS(15007.): , 0 DIASO�NNEROFTHEGROPERT/,ORMYEMPLOVEESWITHWACESASTHEIRSOLEfAM�ENSATION, � COrtIrtIBfClel Z NALL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70H,BUSI• J NESS AND DROFESSIONS OOOE:TNE COMRACTORS LICENSE UW DOES NOTAPPLY TO M10WNER OF � VaOPERTVYN�OBU0.DSORIMPROVESTHEREON,ANDwHODOESSUpiWOHNHIMSELFORHERSEIFOR � [L THROUCHHISORHEROWNFA1ClOVEES,DROVIDfDTHAiSUCMVAPROVEb1ENTSARENOTMENDE00R m W pFFEREDiORSALEIF,11Uh'EVER711EBULDINCORIIAPROVEMEMISSOLDWITMNONEYEAROFfAA1PlE• � TIDN.THE OWNER�BUILDER WILL HAVE THE BURDEN OF PRONNO THAT HE OR SHE DIO NOT BURD OR Z MiRWEFORTMEPURPOSEOFSALE} = O4�OWNEflOFTHEFROPERTY./ME%CLUSNELYCONTMCi1NGW1iHLICENSEDCONTMCTORS � TO CONSTRUCT 7HE PH0.IECT(SEC.70N.BUSINESS AND VNOFESSIONS CODE:THE CONTMCtOHS LI� VaNdtlOfl ADJ.AREA W CENSEUWDOESNOT�7PLYTOANOWNEROFAVROVERTYYR108UM1DSORIMPROVESMEREON.AND � N'HOCONTMCTSFORSUCMGPWECTSWITHACONTRACTOIi(SjUGENSEDGURSUANTTOiHECONTMG QUANTITY DESCRIPTION FEE � TO0.5LICENSELAW.). � O IAM IXEMPT UNOfR SEC. B.l PG FOHTHIS REASON U � � LL" OATE OYMER V W �¢ LICENSED COHTRACTORS DECLARATION W CL 1 HEREBYAFFIRM 11NDER PENALiY OF PERNRY THAT IMA LICENSEO UNDER GROVISIONS OF CHAPTEH Vr d i�CWUENCINd WITH SECTqN 7000)OF DMSION]OF 7ME BUSINESSAND PROFESSIONS CODE,AND Z X MY LICENSE IS 1N FUIL FORCE/W0 EFFECT. m 11J p ��� � � LICENSECLASS l�—I L�C.NO. �,)...!G�I�Z � 1--- � on� /2'�1-U2 corrrAacroa NOMtc✓o,GKS a w � WORKERS'COMPENSATION DECLAFATION a � � U N IHEREBYhFFIRMUNDERiENALTYOFPERJUfn'ONEOFTHEFOIIOWINODECLAM710N5: � Z Q � �IHAYEANDWILLMAINTAINACERTIFICATEOFCONSEMiOSELHNSUREFORVJUtNEfl3' _ Q COMPENSATqN,AS7ROV10EDBY5ECTION77000FTHEV�BORCODE.FONTMEPERWRMANCE �U OFTME WORK FOR WHIp1TH15 VERMIT LS ISSUED. � C �IMAVEMlD1MLLMAIMAINWORKERS'COMPENSA7qNINSUiUNCE,A5RE0UIREDBYSECTION /�t /\� Q 77ooOF7HELA90aCODE,FORTHEPEHFORMANLEOFTNEWORKFORWHICHTHI9PERMITIS � � �'1 � ISSUEO.MY WORKER5 COMPENSATION INSUFIANCE CARRIER M1D VOIICY NUMeERME: CONSTHUCTION � v�� jCARRIER PLAN REYIEW � PoLICYNUMBER ELECTRIC � (MSSECTICNNEmNOTBECOM'LEfEDOFMPERMT6FOii0NE1MDPED00lUN3lt�W1���1 PLUMBING Z XICERTIFYTNATNTHEPERFOWAANCEOFTHEWOPXFORWHiQ17H15PERMiTI5155UE0.1 MECHANICAL (p SHALLNOTEMPLOYANYCERSONINANYMANNERSOASTOBECOMESUBJECTTOiME � WORKER5C01APENSATiONLAwSOFCALIFORNI0.ANDAGREEiHATIF15110ULDBECOME INSPECTIONFEE SV&IECTTOTHEWORKERS'COM�ENSATIONPROVi510N50F5ECTiON77o00FTHElABOR �SSUANCE s CAOE,ISHILLLFORTMM7HCOMPLYYAIMTHOSEP�lOV15lONS. //JJ ` � pDATE:����'OZ APPLICANT: ��,ll!��i'1�6L=— SMIP • ��� � ENERGY P/C WARNIN6:FA4URE TO SECURE WORKERS'COA�PENSA7qN COVERAGE IS UNUWFUI.AND SHALL BE � SUB![CTANEMPIOYERTOCRIMWAL7ENALTIES/WOCMLFWESUPTOONEHl1NORE�i/10U51W� ENERGYPERMIT OOlURS(S�00.000),MI ADDITION TO THE COST OF COMPENSATION,ONAAOES AS PHONOE�iOR IN �h � SECTIONJ70lOFMELABORCOOE,W7EREST,ANDATTORNEY'SFEES. RETENTIONFEE: v• pW., CONSTHUCT�ON LENDING AGENCY PRE•ALT FEE: O � IHEREBVAFFIRMUN�ERPENAITYOF7ERJURYTNATTHEREISACONSTRUCTIONLEN01N6AGENCY FORTHEPERFORMANCEOFTHEWORKFORWMICHiNI50ER1AITI5155UED(SEC.]DGI,CIV.C.). ^ � � =l 1 � ` LENDERS NA1AE \ � LEN�ER'S�DORE55 � ICERTIFYTNATIHAVERFJATMISAPVLICRTIONANOSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES , � � � W IACREETOCOMPLYWITHALLQTYMlOCOUNTYORDINANCESANOSTATEUWSREUTINGTOBUILDINO � CONSTRUCiION,ANDHEREBVAUTHOWZERE�RESENTATIVESOFTNISCWNTYTOEt1TERl1DONTHE �Qa-�� � ZABOVE�MENTIONE�OROPERTVFORINSPECiqNPUFPOSES. COMMENTS � M�G�VhLC. SiiYtpNG15 � VEflMITTEENAME(P INT) ����r�.w►-v�-,cC� 1r-29—oz � SIGNA7UREOFVERMITTEE D�1E RECPT.NO. PAID BY VALI�ATION � WHITE—DeDartment Copy.YELLOW—Finance Copy,PINK—Assessa Copy,G LDENRQD—File Copy,GREEN—Applicant's Copy ..v- .,, , �� , :"�:;'..< .. _ _ -.t-.. . ��u;.r,..'�� , .. ..,at..-a+', .�.. . . ..;�,Ya,� _� ..< .m;,;n,, . .. �a��:7�.v�r�;.r;��.� .. ., . _ . ,�,a�. . , c-.- , �. .: . . .. 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SEPTIC TANK � LANDSCAPE/IFRIG. SEEP PIT/LL ' ON SITE IP�1P5. GAS AIR TEST FINAL Z�NING FINAL CONST. 'Z I . F!RE DEPT. FINA! FINAL HEATING � � � HEALTH DEPT. FINAL FINAL ELECTRIC � j DEV. FEES PAID FINAL PLUP�1E31NG � ENERGY � e)= �r' c�.-� +�Ci i�� __,_�._.�__..___��:=::.:__._, _._... � cor,nr,nEN-rs -- - -- . _ ________ . ----- - SEPTIC TANK SIZE SEEP PIT/U SIZE `�� - ; �,w��� — � , 1 . _