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HomeMy WebLinkAbout16548 CTTY OF I3IAMOND BAR ----�''�` — DEPARTMENT OF COI�IlVIUNITY&DEVELOPMENT SERVICES �"'"� 1 I � � _ _ 21825 E.Copley Drive � (909)860-3195 Fax(909)861-3117 �� PRESS ''%�r� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE APPLICATION �r'�b s PERMIT P/C ADDRESS,���9�1 �U�,L1L�6k , DATE � � NUMBEF�� � # � ISSUE TYPE OCC APN �OT TRACT DATE CONST. GROUP p OWNER J� '��C��'� ADDRESS� CJU�i`2e_'�s�rlf ZONING SETBACKS z CITY s i 21P TE . FRONT RW ❑ � APPLICANT �i� � T� .3b�/'°�'�e�I REAR ❑ Z SIDE/SIQE STREET RW ❑ ¢ CONTRACTOR �� �.+L���p/u� SIDE ❑ � CIT`( ES ,c/�L I G ZIP - �'E . ,��°y��,�I PROPOSED USE `r Gd��� d'eW �:. w ARCH/ENG/ , z DESIGNER P I ����J"�-C�C.a� r �� r'°�- � w NO.DWEL. NO. NO. ' �'�,,�- � ApDRESS D -��" `l " UNITS STORIES BE�ROOMS � CITY ZIP T . ' fc1S^�� �n � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� O�/JNERrBUIL�ER DECLAFtATION SFR/AD�/REM O p I HEREBV AFFIRM UN�ER PENALTY OF PER.IURV THAT 1 AM EXEMPT FROM THE CONTRACTORS!i- GaragelCarport W CENSELAWFORTHEFOLLOWWGFEp50N(SEC.7031,SBUSINESSANDPROFESSIONSCODE:ANYGTYOR (n . U COUNTYWHICHREQUIRESAPER ITTOCONSTRUCT,ALTEfl,IMPROVE,DEMOLISH,ORftEPAIRANYSTRUC� w TUflE,PRIOfl TO ITS 155UANCE,lyL50 qE�UiRES THE APPLICANT FOR SUCH PERMIT TO FILEASIGNED W Patio/DeCk � - � STAiEMENT THAT HE OR SHE IS LICENSED PUflSUANT TO iHE PROVISIONS OF THE CONTRACiOAS LI� CENSE LAW(CHAPTEfl 9(COMMENCING WITH SECTION 7Caa)OF DIVISION 3 0F THE BUSINESSAN�PqP LL POOUSpB 0 FESSIDNSCODE)�RTHATHEOR$HEISIXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (� V TION.ANYVIOLATIONOFSECTIONi7a31.5BVANYAPPLICANTFORAPERMITSUeJECTSTHEAPPLICANiTO Z Re-Roof p�Q � ACNIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLL4RS(5500).): Z ❑�,ASOWNEROFTHEPROP�RTY,ORMYEMPLOYEESWIiHYJAGESASTHEIR50LECOMPENSATION, � Commercial - WILL DO THE WORK.AND THE ST UGTUFE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BUSI� J � NESSAN�PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV i0 AN OWNER OF � PROPERTY WHO BUILDS OR IMPROVES THEREON,ANO WHO DOES SUCH WOaK HIMSELFOFi HERSEIF Oq � iHPA�GHHISORHEROWNEMPL�OVEES,PROVIDEOTHATSUCHIMPROVEMENTSARENOTINTENDEDOii - m O OrFEREDFORSALE.IF,HOWEVER,I7HE8Ul_OINGOFIMPROVEMENTISSOIDWITHINONEVEAROFCOMPLE- � TION,THE OWNEF-Bl11lDER WILL'iHAVE THE BURDEN OF PROVINO iHAi HE OR SHE DID NOT BUILD OR � IMPROVEFORTHEPURPOSEOFSALE). W ❑I,ASOWNEROFTHEPAOfIEfliY,AMEXCLU5IVELYCONTRACTINGWITHLICENSE�CONTRACTORS �py Q TO CONSTRUCT THE PRQIECi(S C.7044,BUSWESS AND PROFESSIONS CODE:THE CONTRACTORS LI- ValUBtiOf1 6d"� ADJ.AREA W CENSE LAW�OES NOTAPPLYTO.N ONMER OFAPHOPERTY WHO BUILDS OR IMPROVES THEREON,AN� � WHOCOMRACTSFORSUCHPROlECTSWITHACONiRACTOF�S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY �ESCRIPTION FEE � � TORSLICENSELAW.). 0 � ❑I AM EXEMPT UNDER SEC.�� B.&P.C.FOR THIS REASON Q � V LL' �ATE OWNER F- Z U � LICENSED CONTRACTORS DECLARATION W ¢ � I HEREBYAFFIRM UNDER PENALT�'OP PERJURY THAT I AM LiGENSED UNDER PFOVISIONS OF CHqPTER � p_, 9(COMMENCWGWITHSECTION7b00)OF�IVISION30FiHEBU51NE55ANDPROFE55iON5CODE,AND Z �X MY�ICENSE IS IN FULL FORCE ANP EFFECT. m � LICENSEC�CLASS LIGNO. � � � V �ATE a3 ^ cs�-`+� �� T CON�RACTOR a W � WOFKERS'COMPENSATION DECLARATION a � IHEREBYAFFIRMUNDERPENALT`'OFPEFiJURYONEOFTHEFOLLOWWGDECLARATIONS; Z � IMAVEAN�WILLMAINTAINACERTIFICAiEOFCONSENTTOSELF-INSUREFORWORKERS' a ¢ OMPENSAiION.ASPflO�IDED�YSEC710N37ooOFTHELABORCO�E,FORTHEPEFFORMANCE U Q OFTHE WORK FOR WHIC THIS��PERMITIS ISSUEO. � Qw _IHAVEANOWILLMAINTAI WORKEFS'COMPENSAiiONINSURANCE,HSNE�UIRED9Y5ECT10N 37o00FTHELABORCOD�,fOFlTHEPEPFORMANCEOFTHEWOFKFORWHICHTHISP=RMIT15 J CARRIER I SATIONINSJRANCECARPIERAN�POLICVNUMBEqARE: CONSTFIUCTION � > ISSUED.MYWORNFA�MPE ��� pLANREVIEW . Z POLICYNUMBER ��f� �`-"' '='-l- .�., . _�c'��� ¢ ELECTRIC - - � (iHISSECTIONNEmNOTBE'i�'AREfE�OFlHEPERMfTISFORONEHLNDREDCOLLAFiS�510�ORLESS). PLUMBING Z 1 CERTIFVTHAT INTHE PE�FOR^AANCE OFTHE WOPoC FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL + � y C!3, , SHALLNOTEMPLOYANY EflSONINANYMANNERSOASTOBECOMESVBJECTTOTHE � WORKERS'COMPENSATIC�N LAWS OF CALIFOflNIA,AND AGftEE THAT IF I SHOULO 6ECOME INSPECTION FEE 7-y�- „��^" = SUBJECTTOTHEWORKERS'CdMPENSATIONPflOVI510NSOFSECTION37000FTHEiABOR �--(y CO�E,I SHALL FOfiTHWIT�i COMPLV WITHTHOSE PROVISIDNS. ISSUANCE �'-� • 'J p DATE: A�PLIGANT: SMIP ��-�`�� �� W I ENERGY P/C J WARNINGFAILURETOSECUREV•IORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,AN�SHALLBE � SUBJECTANEMPLOYER70CRIMItiALPENA.TiESANDCIVILFME5UPT00NEHUNDPEDTHOUSAN� ENERGYPERMIT � DOLLARS(E7 W.oW),M A�DITION'''O TH�COST OF COMPENSATION,DAMAGES AS PPOVIDED FOR IN � J SECTION37o90FTHELA80RC0 E,INTEREST,ANDATTORNEY'SFEES. . e w , FETENTION FEE: , O CONSTFiUCTION LENDING AGENCY PRE-ALT FEE: � I HEFE6V AFFIRM UNDER PENALTY OF 47EAJUftV THATTHERE IS A CONSTRUCTION LENDING AGENCV FOR TH'c PEPFORMANCE OF THE{NORK FOR WHICH THIS PERMIT IS ISSUED(SLC.3a9],CIV.C.j. — Z W __— j LENDER'S NAME � F-- LENOER'SA�DRE55 � � ICERTIFVTHATIHAVEREADTHIS'IAPP�ICA710NANDSTATETHATTHEA90VEMFORMA�IONISCORRECT. TOTAL FEES � � � W IAC,REEiOCOMPLVWITHALLCITNANDCDUNTVOFlDINANCESANDSTATELAWSRELAiINGTOBUIL�ING �y___� � � CONSTRUCTION,AN�HEREBYAU�HORIZEHEPRESENTATIVESOFTHISCOUNNTOENTEFiUPONTHE J � 5/ ,�� �q. � ABOVE-MENTIONE�PROPEflTY FOR WSPECTION PUR?OSES. 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