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HomeMy WebLinkAbout16555 �,.�� CITY UF DIAMOND BAR � `---- "��''"'� ��--- DEPARTI�IENT OF COMMUNdTY&DEVELOPMENT SERVICES f 21825 E.Copley Drive (909)8503195 Fax(909)861-3117 PRES$ ":.v��.. su�1.Dr1v�P�'��P�.iCAT1oN FIRM LY � JOBSITE g��,�� �% �� ��f DATE �/r� 1f�.J I NUMBER � ����# �I`� APPLICATION PERMIT P/C o ADpRESS a °-° APN���I� �"'L�i9�f��"� TRACT ISSUE „�. TYPE �1�,�Q OCC p OWNER �� , � �&� DATE � �' CONST. , v �' GROUP 0 ADDR�S "�`. �"� �' j $ a ZONING SETBACKS Z CITY ZIP � TEL. C3;9 ` FRONT RW C � APPLICANT TEL. �r v-� �`���' REAR C z SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR SIDE ❑ � ADDRESS ,,,�� � CITY ZIP TEL. PROPOSED USE '' � z DES G/NER` C+��IC�"�°��� �'��I�� � w NO.DWEL. � NO. � NO. � � ADDRESS � CITY �e ZIP e� TEL � �y�g� `,� - UNITS STORIES BEDROOMS � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION . O . OINNER-BUILDER DECLARR710N SF AD`�REM � ' � p I HEREBY AFFIRM UNDER PENALTV OF PEFiJURY THAT I AM E%EMPT'FROM THE CONTHACTORS LI- � Garage/Carport � W� CENSELAWFORTHEFOLLOWINGPEASON(SEC.7037.58USINESSANDPROFESSIONSCODE:ANYCIiYOR V. COUN7YYlHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG � w� TURE,PHIOR TO Ii5 ISSUANCE,ALSO REQUIRES TNE APPLICANT FOR SUCH PERMIT 7o FlLE A SIGNED W Patio/Deck � �� �. STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO'HE PROVISIONS OF THE CONTPACTORS U- , 0CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 70DOJ OF OIVISION 3 0F THE BUSWESSAN�PR0- �'1' PooVSpa � �. , FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFflOMANDTHEBA515FORTHEALLEGEDEXEMP- � V". TION.AMYVIOLATIONOFSECTION703I.5BYANYA�PLICANTFORAPERMITSU6JECTSTHEAPPLICANTTO Z Re-Rooi �; '� ACIVILPETIA�TYOFNOTMORETHANFNEHUNDRE��OlLAqS(5500).): " ❑I,ASOWNEFiOFTHEPROPERTY,ORMYEMPLOYEESWITFJNAGESASTHEIR50LECAMPENSATION, � COmmefGial Z� �. WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR oFFERE�FOR SALE(SEC.7oaa,BU51- J � ��,'','NE55 ANO PROFESSIONS CODE:THE COMPACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �� '.�,.PflOPERTY WHO BUILDS OR IMPROVES THEREON,AN�WHO DOES SUCH WORK HIMSEI.F OR HERSELF OR w'��,.'.��THROUGHHISORHEROWNEMPLOYEES,PqOVIDEOTHATSUCHIMPROVEMEMSAqENOTiNTENDE00R m Q� '.OFFEHEDFORSALEIFHOWEVER,THEBUIL�INGORIMPROVEMENTISSOLDWITHINONEYE4ROFCOMPLE- Z�'. TION,TryE OWNER-BUI�DER WILL HAVE�THE BUROEN OF PROVING THAT HE OR SHE 01�NOT BUILD OR W;,��,IMPROVEFORTHEPURPOSEOFSAL�.' ' ❑I,AS OWNER OP iHE PROPERTY,'�AM EXCLUSNELY CONTRACTING WITH LICENSEO CONTFACTORS �'. 'TO CONSTRUCT THE PROJECT(SEC.7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V2IU3llOf1 ADJ.AREA ' W'�, CENSELAWDOESNOTAPPLYTOANOWNEROFAPpOPERTVWHOBUILDSORIMPROVESTHEREON.AND �'�'�'WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEOPURSUANTTOTHECONiRAC- ' QUAMTITY DESCRIPTION FEE Y,'. iORSLICENSELAW.�. 0�;� � ❑I PM EXEMPT UN�ER SEG �`B.h P-„Q FOR THIS REASON Q f} � " � ,m` ,`�,�y� � � U � LL���.� OATE �� OWNER ',I— ��� a: ��G � � �' ��` C��� � LICENSED CONTRACTORS DECLAFATION W �� I HEREBYAFFIRM UN�ER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � �, (y'� .9�COMMENCINGWITHSECTION7000)OFDIVISION30'rTHEBU5WES5ANDPROFESSiONSCODE,AND LX MY LICENSE IS IN Fl1LL FORCE AND EFFECT. m �, r�� e� ��' � LfGENSECLA55 LIC.NO.___ '_ . V�. DATE_ CONTRACTOF d W �� WORKERS'COMPENSATION DECLARATION a �. .-3 _ .,..�� �. �' IHEREBYAfFlRMUNDERPENALTYOFPERJURYONEOFTHEFOLIAWMGOECLARATIIXJS: Q ``.�: ��. ,� 0� _IHAVEPNDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUPEF�RWORKERS' _ aCAMPENSATION,ASPFOVIDED9VSECTION37ooOFTHELABORCO�E,FORTHEPERFORMANCE �.0 Q OFTHEWDRKFORWHICHTHIS�PERMITISISSUED. �� QW _IHAVEANDWILIMAINiA1NWORKERS'COMPENSATIONINSURANCE.ASREQUIREDBYSECTION 3700 OFTHE LABOR CODE,FOR iHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ��' d�` � ISSUED.MVWORHEAS'COMPENSAiIONINSURANCECARRIERANDFOLICYNl1M8ERARE: CONSTRUCTION J � � CARRIER PLAN REVIEW � �. ��q ZPOLICYNUMBER ELECTRIC 1! ¢ O, � (iHISSECTONNEEDNOTBEO�MREfEDOFhiEPERMITISFORONEHUN�REODOLLARS(81�o)ORLESS). rPLUMBING Z 1 CEflTIFY THAi INTHE PERFOftMANCE OF THE WOFK FOft WHICH THIS PEPMIT IS ISSUEO,I MECHANICAL ,�,� � C'3 SHALL Noi EMPLOYANY PERSON INANY MANNER 50 AS TO BECOME St7BJEC7 TO THE . s,._� (/} WORKEFS'COMPENSATION LAWS OF CALIFORNIA,AND AGREETHAT IF I SHOl1L�BECOME INSPECTION EE �:' SUBJECTTOTHEWORKERS'COMPENSATI�NPflOVISION50FSECTION3]ooOFTHEL4BOR , "d"' y��p-� = CO�E,I SHALI FORTHWITH COMPLV WITH TH0.SE PFpVI510NS. ISSUANCE � � P �.ld'\d o <i �"� ` - 1 -�— � p DATE: APPLICy4NT: SMIP —�+ � ENERGY P/C � WApNING:FAIWRE TO SECURE WORKEk5 COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ' �—y, SU&IECTANEMPLOVERTOCRIMINALP�NALTIESAN�CWILFINE5l1P700NEHUNDRE�THOUSAN� ENEFGYPE �: �f � J' DOLLARS�51oa,00u),IN ADDI710N TOTHE CQST OFCOMPENSAiION,�P.MAGES AS PROVIDED FOR IN SECTION3�oeOFTHELABORCODE,INYEREST,ANDNTTOFNEY'SFEES. --_ oC RETENTION FEE: -"""'- `, OCONSTRUCTION LENDING AGENCY PRE-AL7 F E: _ �`�� �� IHEREBYAFFIflMUNOERPENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLENDWGAGENCY � FOR THE PERFOFMANCE OF THE WORK',FOF WHICF17HI5 PEFMIT IS ISSl1ED(SEG 3097,CIV.CJ. W � . � LENDER'SNAME fi �� i I— LENDER'SAD�RESS 333 w ICERTIFYTHATIHAVEFEADTHISAPPLICATIONANDSTATETHATTHEA60VEINFORMqT10NISCOflRECT. TOTAL FEES � � y� � IAGREETOCON.PLVWITHALLGITYANDCOUNTYOROINANCESANDSTATELAWSRELATINGTOBUILDING � d� V� � CONSTflUCTION,ANDHEREBYAUTHORiZEREPRESENTATNE50FTHISCOUNTYTOENTERUPONTHE Z ABOVE-MENiIONFD PFOPER7V FOR INSPECTION PURPOSES. COMMENTS � ya �, l�' (+���'�'i . ¢ PERMI-EE NAME RI T) � � �n - a; i � ; - ,�9-i.°�°� a :: /q y� �� SIGN� - E �ATE (.,� l,i VALIDATION �I RECPT NO. . PAID BY ''� WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOL�ENR06—File Copy,GREEN—ApplicanYs Copy � � : , � `r�nb u rw� M �. � . 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