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HomeMy WebLinkAbout12-1073 .s .� up �.,Q � . ,� k,.�.;- CG ��;`��, 1�����;�� � . � � CITY OF DIAMOND BAR � 1�,*�� �� �`+,a�� DEPARTMENT OF CONIl�IIJHITY&DEVELOPMENT SERVICFS r 3� i �"+�,'�<- � 21810 Copley Drtve,Dtamoud Bar,CA.91765 � �h,��..�;; (909)839-7020 Fau(909)861-3117 Building Iaspection HoUine(909)839-7027 PRESS I �`-�°` '�� ~`�� ���'^�'� BUILDING PERMIT APPLIC TioN FIRMLY ._r, : . � '� 'o ODR'ESS �`��� �G�'�'e �1 [Ti�IS DATE ATION '� I�' NUMB R �Z N�� #�/G c.� IS$UE Q TYPE OCC APN LOT TRACT DATE O Z Z CONST. GROUP p OWNER � ' o ADD S � ZONING SETBACKS Z CITY . ZIP TEL - - R�RT RW Q g APPLICANT TEL. SIDFJSIDE STREET RW � z � CQNTRACT � f.� SIDE ❑ . � � ADDR S � � PROPOSED USE �- ` r � E r r � L o CRY G �a.,' r�% � ' ZIP TEL 7I�- 5 71-1C71Y � , ,� . o ARC' NG/. , z DESIGNER NO.DWEL NO. NO. � ADORESS UNITS STORIES BEDROOMS � CITY ZIR TEL � DESCRIPTION S�.Ff. FACTOR PSF ADJ.AFiEANALUAT70N p� �OWNER-BUILDER DECLARATION � SFR/ADD/REM � O I HEHEBV AfFlRM IFIDFA VENALTY OF 7ERA1M THAT�A4 EJ�MPT FRO4 TME 001(TRACi00.5 lY GerapelCarpon 8 W15EUWF01ii}1EiOlLOhY710RE,140N(9EC.70Jt.6&13WESSANDPROFE5910N9COnEANYCITYOR . (n ' . . . U COUHTYWNI(x7RE0U1RE8APEfWiTOCd14TFYlCf.ALTERWPROVEOEMOlISM.ORREPAIRMIV37RUG W Pelb/DBCk ER � NRE.PRION TO RS ISSUANCE,ALSO REOUIRES TNE MPIICAH�FOR SIICN PEAYIi TO fILE A 57ONE0 W . . . � BTATEYEM THAT HE OR SHE IS LICENSED.PUf43UAHT TO THE PROVISIONS OF.TME�COHfRACiOH9 LL � . : � � CENSE UW(CFUPTER Y(COMMENCPlO WfTH SECTIDH 70a0)OF DIVISqN]OF 7//E BUSWE59 AND VRP PooYSpe FE&4101t4 COOEj OR TlIAT HE OR SHE IS EJfEA1PT THEfiEFFiOIA ANp THE BJSIS FOR T}IE ALLEOED EXEMP- TqN.ANY.VqlAT10NOFSECTIOH7a37.eBVAM'MPLIGWT�FORAPEA1117SU&IECTS7HEMPLICANiTO . Z Rg-Rppl A CIV�VENALTV OF NOT MOHE T/IAN FIVE HUNDRED DOLlAfL4(�6aoj.}, 0 ❑4A90YMEROfTHEPfiOPERTY.ORNYEYDLOVEEBNTTHIVA(iE8/�41HEIR60LECUMPENSATION. ' Q GOIfIf110fCI8I ' . . . Z WM.L DO THE M�ORK.MD THE BTfWCNRE iS NOT WTENPW OR OFFERED FOR SALE(SEC.�MI.BUSF J � .. . � NE83 NIO PHOFESSIONS CODE:TME CONTMCTORs UCENSE UlV DOES NOT APVIY 70�NI ONM£R OF j � � , P.ROVEFTY WHD BU6DS OR W PHOVE9 T1IEAEON.AND MM1iO DOES SUC3f N10RK/41J.4ELF OR HEIlSOF OA � 7HROUNIHISORHERONRIEMROYEES.VROVIDEDTHA7-SUCHWVROVEMBITSARENOTMENDmOR m . . .. . 0 OFFER�FOA&1LEIF.HOM/EVEIITFiE&11LDWDORGIPROVEMENTLSSOLDWI7HWONEYFAROFCOIIPIb .. . . . Z T1ON..THE�OWNER�&lLLDER WILL 11AVE TME BURDEN oF.PROVPNI THA7�HE OR SF1E DID NOT BUdD OR � CIPROVE FOR THE PURP0.SE OF 6ALE): �. W O1�40VMEROFh1EPROPEAf`l:AME%CLUS7VELYCONTRACTIN�WfT11UCENSEDCONTNACf00.4 . . . .. � m cor+srauci n�vr�aEcr(sec.�.euswess�vn v�ssioNs cooE:n�cor�rruc�nns u- Valuation AD,I.AREA � CENSEUWOOESNOTAPFLYTOANOWNEROFAPROPERTYYfF10BULD50RWVRWE9THEAEOH�Af� . . . . WNOCOMMCT6FORBUpIVHQIECTSWfT/iACONT{UCTORI�LICB�.4ED%1R6UANfTO1HECONiMP DUANTITY DESCRIPTION FEE � � TORS UCENSE UW.� � ❑1 AY E%EAIPT UNDEA SEC. - B.�V,C.FOH TVtlS REtiSON � . � � � pj�7E . . . . . . py�rP�Eq _ . �� • Z . . �. .... �. '_ . . (�. �Q UCENSED CONTRACTORS DECLARATION W . O 2 I NEREBY AFFIIW UNDER F6NAI.TY OF PERWRY TFIAT IAM LICENBm UHDER PROV19lON4 0F GIAPTER �. . . . . . . � ➢(COMMENCYKi WITH 5ECi1DN 70oo)OF DIVIS�ON 70F 7HE BUSWES9 M1D PROFE93�OflS COOE.A/m _ y. . . , . . . . . . 11Y L10EN8E 19 P1 FIAl ...AND EFFECT. � ln i � LIGENSE UC.NO., j_ . . . U DATE CONTRACTDR� t a . .. .- . W � WORKERS'COMPENSATIONDE TION ' � �� � ' � � - � �� � IHERFBYAFFIfWUNDERPFl1ALTV�OFPERJUiIYONEOFTHEFOLLO CLAMTK7NS: U � � . � � . � - � . . . . . . .. . . . � . . � _IHA W9IMAINTAWACEAfIFlCATfiOFCONSENTTOSELFWSUREFORNORKEAB' . � ENBATqN�AS PROVDED BY BECTION 9Y00 Of TNE U180R CODE.FOfi THE PERFOiWANCE �' . . . , Q T1�MIOPoC FOR V�VIIClI 7HIS VEMI�T IH 168i1ED. � . . 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FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION � SFR/ADD/REM O '1 HEREBY AFFliW UNDEA PElUL7Y.OF PEANRV TUT 1 M1 E%EMPT FAOA1 TH£COMRACTORS LL G8f890/C0�O11 W CENSEUWFORhiEFOL��WINC1REh90N(SEC.7o37.6BUSP1E55ANDPROFE5510NSCO0E:ANVCRYOR , (n . N C� COUNTYWHK7IREOU{RESAPERAdIT7000N9TRUCT,ALTER���.DEMOLISH,ORREPNRANY9TRUC- IW p9tIOiDBGk � TURE,PRqR TD RS ISSUANCE�L50 RC-0UiRES THE APVLICAHT FOR SUCH PERMIT TO FlLE A SIONED STATEMENT THAT HE OR SHE IS LICENSED PURSUAN(70 7HE PROVI510N5 OF.THE'CONTpACTORS ll- � p��Spe � CENSE UW(CYVSTER 9{COldIdENCWd WITN SECTION 7000)OF OIYISION]OF THE BUS�NE59 AND�PRO- Q FESSqNS CODE�OR THAT HE OP SHE IS D(EMPT7HEREFROM AND THE BASIS FOR THE ALLEOED E%EMP• V TION./JJYVKKATIONOFSECilON7031.68VANYAPPLICMlTFORAPERMITSUBIECTSTHEAPPLICANTTO Z q�Rool � A CIV0..DENALTY OF NOT MORE THAN FNE HUNDRED DOILARS IlSoo).j: � � ❑1A30VMEqOFTHEPROPERlV,ORAIYEMPLOVEE9NTT1i1MAGESASTHEIRSOLECOMPENSA710N, � O �mardal Z WILL DO THE WORK AND THE STRUCNRE IS NOi INTENOED OR OFFERE�FOR 9ALE(SEC,7Ws,8�15F J � NESS AND PROFESSIONS CODE THE CONTMCTORS LIC£NSE IAW DOES NOT APPLY TO AN OVJNER OF � � PROPERTVINNOBUILASOFlIMPROVE9THEREON.ANDNn1o00E55UCHwORKHIMSELFORHERSELFOR m _ � THROUCiHHI90RHEROWNEMPIOVEES,CROVIDEDTHAT5UG11MPROVEMEN�SAHENOTPl�ElIDEDOR QOfFERFDFOR9ALE1F./iOWEVERTMEBULLD�N60RIM7ROVEMFM4S50LD`NfTM�NUNEYEAROFCOMPLE• . Z TqN,.h1E�ON?JERAUILDEH WILL NAVE T7E BURDFN OF PROVINO lNAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE FURPOSE OF SALE). W ❑I,ASONRIEROFTiEPROPEHIY.AAIE%CIUSNELYCONTRACTIN�WRNIICENSEDCOHTRAGTORS � i0 CONSTRUCT THE PROJECf(SEC.7o41,�BUSWESS M10 PROFESSIONS CODE:TME CON7MCTOR9 LI• V01Ud�lOn ADJ.AREA� CENSE U�W DOES NOTMPLY TOAN OWNER OFA VROPERTV YAfD BUA.D9 OR I/APROVEB TiEREON,M1D ZF W1qCOMRACTSFORSUCHPR0.1ECfSWITiACON7MCTOfyS)LICENSEDVURSUANfTOTiEGONTMC qunrmTv DESCRIPTION FEE � � Toas uceNs�uw.�. O ❑I AM E7lEMPT UNDER SEG �B.a P.4 FOR 7HIS REASON � � Q I V" OATE . . . . oWNER - . ,. . _ . . V. Z . . . . . . W . . . �' � UCENSEO CONTRACTORS DECLARATION � -� � � � � � I HEREBV AFFIRAI UNDER PENN.TY OF PERJUH'I THAT IAM LICENSED UNDFA PROVISIONB OF GIAPTER � d G(CO/.Ul£NCINO YA7N SECTION 7oW)OF DNISqN 90i THE BUSItiESS hND PROFESSqNS CODE,M!D Z, . X 4Y LICENSE IS RJ FULL FO CE M1D EFFECT. m , L1J � � � UCENSE C LIC.NO.. J, . . V DATE CONTRACTOR t � . . . W ` � WORKERS'COMPENSAT{ON DEC ATION � � � � � � V � 1 HEFiEBV AFFlRM UNDER PENALTY Of VERNH'/ONE OF THE FOLLO . CLAM7lONS: Z � Q _1 FU D WILL M/UNTNN A GERTIFICATE OF CONSENT TO SElHNSURE FOR WORKER5 � Q /r�TtO1J.AS FROVIDED BY SECTION 3i000F THE LABOR CODE.FOR iNE PERFORMANCE W. THE WORK FOR WNICH THIS PEiiM1T IS ISSUED. � . � I HAVE AND WILL MAU(TA1N.M�DRI(ER.7'COMPENSATbN IN RANCE,AS REOUIRED BV SECTK7N Q �7000F�THE UBOR�COOE,FORTHE PERFORM/WCE OF E WORN FOR WHICHh11S PERMRIS, �SS�IO ISSUEp,My WpqK �Wi�ENSA � RANCE C ERAND POLICY NUMBERME: �CONSTRUCTION� jCARRIER � �T�i�� ' PVW REVIEW � POLICV�NUMBER � � ELECTRIC o �wsaEcnoar�rareEoon�rmoFn+�a�w�rsroa pqi�asls�pW PLUMBING W 1 CER7IFY 7MAT IN THE PERFORMANCE OF THE.WO wM1CH 7HIS FEfWR IS ISSUED,1 �NECHANICAL Z �j SHALI.NOTEMVLOVANVPER.ANINANYldPNN � !3 aecoME�sue�ecr7onie� �INSPECTIONFEE � VpRKER5CW1PEN5AT�OHLA�NSOfCP11F I DA ES}7ATIF3.5 OECOME . . S TOTHE ERS'COMPENSA P VISNN SECTION97U OFTHEUBOR ISSUANCE `��� . SHALL F MN1H COYPIV WI7H SE PROV qN. f O ♦ .SMIP L' �QD 0 DATE � PPLICANT:� . w ENERGY P/C J WAHNINO:��FAIWRETOSEWREWOFi10ER3'COMPE SATIONCAVEMGEISUNUWFUL.AND.9HALLBE �L uUB.lEG7ANEMPLOVERTOCRfMP1ALPENALTIE3 pVILFWESUPTOONEHUHDHEDTMOUSAND ENEHGY-PERMIT pOLUR9(f1ao.00o),W ADDI710N TO7HE COST OF 7ENSA7ION,DAMAOES AS PROViDED FOR IN ^� J SECTION 3708 OF 7NE LABOR CODE.WTEREBT,ANDA � YS FEES. 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