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HomeMy WebLinkAbout17305 (23) _�� CITY OF DIAMOND BAR � �� � DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES �,�' �_ �. 21825 E.Copley Drive (909)860-3195 Fax(909)&61-3117 PRESS � '%9��� BUILDINGPERMITAPPLICATION FIR Y o DDR'ESS� (� h f; S�F�. Q ('S �� APPLICATION C PERMIT 6,�j� ) P/C �—� DATE NUMBER I ✓ . J # � ISSUE TYPE OCC `r APN LOT TRACT DATE � CONST. GROUP p OWNER .��lTT S�};,�le vf1�r� o ADDRESS K ���5 p rt� IS ZONING SETBACKS Z CITY - ZIP q►�c S�YEL. FRONT RW ❑ � APPLICANT TEL. REAR n � - SIDE/SIDE STREET AW � QZ SIDE CONTRACTOR ^. ❑ ADDRESS ^ o �i-�, V,pL PROPOSED USE_�e.A/-UFF CSJ y✓�'P=_�(��'V\,V If,k�l� ZIP�� TEL. 0 --r--- oARCH/ENG/ W DESIGNER NO.DWEL. NO. NO. a ADDRESS � CIN ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTIQN SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFlRM UNDER PENALTY OF PEftJUPY THAT I 0.M EXEMPT FROM THE CONTRACTORS U� Gef1JB/C2fF10fI W CENSEUWFOR?HEFOLLOWINGREASON(SEC.7o31.58U51NESSAN�PROFESSIONSCODE:ANYCITYOR (n U COUNTYWHICHREOUIRESAPERMITTOCONST9UCT,ALTER,IMPROVE,�EMO:ISH,ORREPAIRANYSTRUG W TURE,7RIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W PdtiO/DeCk � STATEMENT THAT HE OR SHE IS LICENSED PURSl1ANT'O THE PROVISIONS OF THE CONTRACTORS LI- � � CENSE LAW(CHAPTER 9(COMMENCING'MTH SECTION 7000�OF DIVIS'ON 3 OF THE BUSME55 AND Pq0- POOI/SP0 Q FESSIONSCODE)ORTHATHFORSHEISE%EMPTTHEREFROMANOTHEBASISFORTHEALLEGEDEXEMP- (� V TION.ANVVIOLATIONOFSECTION7031,SBYANVAGPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z qe-Aoof ACNIL PENALTV OF NOT MOpE THAN FIVE HUNDRED 00'_LAflS(ESDo�.): � ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COfI1f118fC18I Z WILL DO THE WORK,ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEG 7044,BUSI� J � NE55 AND PROFESSIONS CODE:THE CONTRACTORS UCENSE LAW DOES NOT APP�Y TO AN OWNER OF � PROPERTY WHO BUILDS OR IMPROVES THEREOIr,AND WHO DOES SUCN WOflK HIMSELF OR HEiiSELF OR Q THROUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSAFENOTINTENDEDOR m — 0 OFFEREDFORSALE.IF,HOWEVER,7HEBUILDMGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BUfiOEN OF PROVING ThIAT HE OR S4E DID NO7 eUILD OR = IMPROVE FOR THE PURPOSE OF SALE). W fl l,AS ONTIER OF THE PROPEPTV,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS � TO CANSTRUCT'.'HE PROJECT(SEC.7o44,B'JSMESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU8[IOl1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPEHTVWHOBUILDSORIMPROVESTHEREON.AND � WHOCONTRACiSFORSUCHPROJECTSWITHACONTRACTOR(S)UCENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTIDN FEE Y TORS LICENSE LAW.). Q ❑I AM EXEMPT UNOEF SEC. B.S P.C.FOR THIS REASON Q � U ti ¢ DATE OWNER �— Q W � LICENSED CONTRACTORS DECLARATION W � I HEREBYAFflRM UNDER PENALTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � e(COMMENCINGWITHSECTION70o0�OFDIVISION3OFTHEBUSINESSANDPROFESSIONSCODE,AN� Z �X MYLICENSEISINFULLFORCEANDEFFECi m � LICENSE CUlSS C� � LIC.NO.y� � V DATE �C� '"� O � (,, CONTRACTOR '�E_i� d W � WORKERS'COMPENSATION CLARATION Q � I MEREBVAFFIRM UNDER PENALIV OF PERJL'RV ONEOFTHE FOLLOWING OECLARATIONS: Z Z IIIAVEAN�WILLMAINTAINACERTIFICATEOFCONSENTTOSELFINSUREFORWORI(ERS' ¢ 2 ¢ CAMPENSATION,ASPROVIDEDBYSECTION»ooOFTHELABOFCODE,FORTHEPERFORMANCE U Q OF T E WOftK FOR WHICH THIS PERMIT IS ISSUED. � � I HAVE AN�WILI MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION ,�"`� O 37000F THE LABOR CODE.FOR THE PERFORMANCE OF THE WORR FOFi WHICH THIS PERMIT IS ISSUEO.MVWORKERS'COMPENSATIONINSURANCECARRIERANDPOLICYNUMBERARE: CONSTRUCTION J ' . ¢ CARRIER � � � PLAN REVIEW � Z POLICYNLIMBER W C� y9 t&9–�•. ELECTRIC Q � (IHISSELTKKJNEmNOTBEGCMPlEfE00FiHEPEFM115WRIXJENUPARED00LLAR5�y100)ORLE55). PLUMBING Z I CERTIFV THAT IN THE PERFORMANCE OF iHE WORK FOR WHICH TI-.IS PERMIT IS ISSUED,1 MECHANICAL C� SHALLNOTEMPLOVANVPERSONINANYMANNERSOASTOBECOMESL�BJECTTOTHE � WORKERS'COMPENSATIONLAWSOFCALIFCRNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE � SUBJECTTOTHEWORKERS'COMPENSATIONPROV yONSO�ECTION37ooOFTHELABOR � � �CO�OE,I^S�H,A�LL F�OflTHWITH COMPLY WITH�JYe �6�. ISSUANCE p OATE:(�V s�L APPLICAFf: ✓ � SMIP �L�_ J WARNINGFAILURETOSECUREWORKER MGENSATIONCOVERAGEISUNLAWFUL,ANOSHALLBE ENERGYP/C �y SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUP700NENUN�REDTHOl15AND ENERGYPERMIT DOLLARS($100,000�,IN A�DITION TO THE COST OF COMPENSATION,�AMAGES AS PROVIDED FOR IN � SECTION37oe OFTHE LA90P CODE,INiEREST,ANDATTOPNEY'S FEES. RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMUNDERPENALTVOFPERJVRYTHATTHEREISACONSTRUCTiONLENPINGAGENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEJ;SEC.309],CIV.C,�. Z W — ? LENDER'S NAME � F— LENOER'S ADDRE55 � ICEFiTIFVTHA7IHAVEREADTHISAPPLICATIONAN'JSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES � �� W I AGREE TO CONPLY WITH ALL dTV AND COUNTY ORDIVANCES AND STATE LAWS RELATING TO BUIL�ING � � CONS TION,AND HEREBV AUTHORIZE REPRESEN'A7NES OF THIS CO'JNTY TO EMER UPON THE Z AB E�ME IONED PROPERTV FOR INSPECTION PURPOSES. o � ` COMMENTS � \ F�. m PE (PRIN � �� I Uj GN oFPERMITTEE �A7E = RECPT.NO. 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