Loading...
HomeMy WebLinkAbout17244 (26) CITY OF DIAMOND BAR � -- �`' -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES r Q_ �,,� 21825 E.Copley Drive (909)860-3195 Fax(909)$61-3117 PRESS "'%Y� BUILDING PERMIT APPLICATION FI R LY o� JOBSITE �,���/`,,.���;��M��iT� DATEICATION ,� �2 �� NUMB R f � #/C ADDRESS �/(.�J,' o� ISSUE TYPE OCC APN LO TRACT DATE � l Z � CONST. GROUP p OWNER p ADDRES�S ZONING SETBACKS z CITY ZI TEL. - FRONT RW ❑ � APPLICANT TEL. REAR O o SIDE/SIQE STREET RW O Q CONTRACTO SIDE ❑ Q ADDRESS Q CITY��p��.�.,__ 21P lEL. � PROPOS USE o ARCH/ENG/ "��ta�r��� w DESIGNER N DWE� NO. N . a. ADDRESS UNITS STORIES BEDROOMS � CITY 21P TEL. � DESCRIPTION SQ.�T. FACTOR PSF ADJ.AREA/VALUATION � � OWNER-BUILDER DECLARATION SFRlADD/REM O p I NEREBY AFFIRM UNDER PENALTV OF PERJURY THAT i AM EXEMPT FROM THE CONTflACTORS LI� � Garage/Carport W CENSEl4WFORTHEFOLLOW�NGREASON(SEC.7091.SBUSINESSANDPROFESSIONSCODEANVCITYOR ZCWNTYWHICHREOUIRESqPERMITTOCONSTRUCT,ALTERIMPROVE,OEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck W TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SiGNED W � STATEMENT THAT F1E OR SHE�5 LICENSED PURSUqNT TO TFiE PROVISIONS OF THE COMflACTOR3_I� � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7o0D;OF DIVISION 3 OF THE BUSINESS AND PRD- V'� POOI/Spd FESSIONS COOE)Ofl THAT HE�R SI1E IS EXEMPT THEREFROM AND iHE BA515 FOR THEALLEG E�EXEMP- � TION.ANVVIOLATIONOFSECTION7o37.5BVANYAPPUCANTFORAPERMITSUBJECTSTHEAPPUCANTTO � Re-Root � A qVIL PENALTV OF NOT MORE THAN FIVE HUNORED DOLLARS(E500).): p ❑I,ASOWNEROFTHEPFOPERTV,ORMV'cMPIOYEESWITHWAGESASTHEIRSOLECOMPENSATION, G CO�1RIefCldl Z WILL DO THE WORK,ANO THE STRUCTURE IS NOT INTEN�ED OR OFFEPEO FOR SALE(SEC.7044,BUSI- �1 NESS ANO PROFESSIONS CODE:THE COMRACTORS LICENSE LAW DOES NOi AP?LV TO AN OWNER OF � PROPERTYWH09UIL�SORIMPROVESTHEqEON,ANOWHO�0E55UCHWORKHIMSELFDAHERSE�FOR � � THROUGHHISORHEflOWNEMPLOYEES,P�OVIDE�THATSUCHIMPPWEMENTSARENOTINTENDE00R � W OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMBJTISSOIDWITHINDNEYEAROFCOMPLE- 0 TION,THE OWNEP�BUIIDER WILL HAVE iHE BURDEN OF PROVI�'G THAT HE OR SHE DI�NOi BUtID OR Z IMPROVE FORTHE PURPOSE OF SALE). � ❑I,ASOWNEFOFTHEPROPERTY,AMEXCLUSIYELYCONTRACTINGWITHLICENSE�CONTRACTORS � TO CONSTRUCT THE PROJECi(SEC.7D64,BUSINESS ANO PROFESSIONS CO�E 7HE CONTPACTORS LI- V81U8I1Of1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPq07ERTYWHOBUILOSORIMPfiOYESTHEREON,AND � WHOCONTRACTSFOflSUCHDRQIECTSWITHACONTRACTOR�S)LICENSE�PI'�PSIJANT70THECONTPAC- Q�JANTITY DESCRIPTION FEE Y TOR9 LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC.__. B.&PC.FOR THIS REASON v � Q � flA7E _OWNER__ U � LICENSED CONTRACTORS DECLARATION iy � IHEREBYAFFIflMUNDERPENALTYOFPERJURYTHATIAMLICENSEDUNDERPflOVI51CNSOFCHAPTER � � 9(COMMENCING WITH SECTION 7000)OF DIVISION 30FTHE BUSINESSAND PROFESSIONS COOE,AND Z `X IAV LICENSE IS IN FIILL FORCE ANO EFFEC7. m O � � � LICENSE^CLASS LIC.NO.� ' J V DATE�„µ� CONTRACTOR n- W � WORKERS'COMPENSATION DECLARATION Q � I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOILOWING DECLARATIONS: U f/J a � IHAVEANDWILLMAINTAINACER7IFICATEOFCONSENT70SELF-INSUREFORWORKEFS' _ a `CAMPENSATION.AS PROVIDEO BY SECTION 3'/OOOF TME LABDR�A�E.FOfl TME PERFORMANCE 'U OF THE WORK FOq WHICH THIS PER411T IS ISSUED. � � w I HAVE ANO WILL MAIN?AIN WORKERS'COMPENSATION INSURANCE,AS RE�l1iRED BY SECTION %� ,/I Q `3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �V� � rI � � ISSUE�.MV WORK S' PEN TION WSURANCE CAf�1R,lF[R�e�N D POLICY NUMBER FRE: CONSTRUCTION a Q �j�� � l/V�f/ PLAN REVIEW � CARRIER -- Z POLICY NUMBER�Q,�� �O��� ELECTRIC Q � (IHISSECTKKJNEmNOTBEGI7MPLEfE00FTHEPERMRtSFORONEHUI�DREDD011AR5(E1D�)IXdLESS). PLUMBING _. Z ICERTIFYTHqTINTHEPERFOfiMANCEOFTHEWORKFORWHICHTNISPERMITISISSUED,I MECHANICAL (�$ SHALLNOTEMPLOVANVPERSONINANYMANNERSOASTOBEGOMESUBJECTTOTHE � WOPKERS'COMPENSATIONLAWSOFCALIFOpNIA,ANOAGREETHATIFISHOULDBECOME INSPECTIONFEE SUBJECT TO THE WORKERS'COM7ENSATION PFOVISIONS OF SECTION 37oa OF THE lABOF � CODE.I SHALL iORTHWITH COMPLY WITHTHO5E PROVI510NS. 1SSUANCE �� pDATE� APPLICANT: SMIP , W ENERGY P/G --� WARNWGFAILURETOSECUREVJORKERS'COMPENSATIONCAVERAGEISVNLAWFUL,ANDSHALLBE —'"-� �J—y SUBJECTANE6IPLOYEHTOCRIMINALPENA'.TIESANDCIVILFlNESUPTODNEHUNDRE�THOUSMND ENERGYPERMIT __ DOLLARS�f100.o00),IN ADDITION TOTHE COSTOF COMPENSATION.�AMAGES AS PROYIpEO FOR IN � SEC710N3]aBOFTHELABORWDE,INTEREST,AN�ATTORNEV'$FEES. RE7ENTIONFEE: � d CONSTRUCTION LEN�ING AGENCY PREALT FEE: � I HEPEBY AFFIRM UNDER PENALTY OF PERJURV THA'THERE IS ACONSTRl1C710N LENDING AGENCY n- FORiHEPEPFORMANGEOFTNEWORKFORWHICHTHISPERMITiSI55UED(SEC.3o97,CIV.C.j. Z W S LEN�ER'S NAME � H LENDER'SADORESS ._.___.. � �Y/. I � ICERTIFVTHATIHAVEREAOTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES w I AGREETO COMPLV VJITH ALL CITV AND COl1NT�ORDINANCES ANO STATE LAWS RELATMG TO BUiLDMG � CONSTRUCTION,ANDHEREBVAUTHORI2EREPRESLNTATIVESOFTHISCOUNTVTO'cNTEFUPONTHE Z ABOVE-MEN"IONED F OPERTV FOR INSPECTION PU/F�POSES. COMMENTS J� _..! ��"�' �/ � � _ m PERMITTEE NA (PRINT � �-�'7�'�'t7 ��� �.---Q� � SIGNATVRE OF P EE �� Z RECPT.NO. PAIO BY VALIDATION ~ WHI7E—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOL�ENROD—File Copy,GREEN—ApplicanPs Copy ����'.k �,"+'_ . .,: :�-;._.�..:.-.:;....,. .. . ... � '- ..3r :-Trr. �`$D tN�a, vr",�rt; .ad41H:..n4'lea' Y ...r..�e , . ... . .e�,.. ;.., �ar': . , .... ...s -. �..-.:, .�., .;..�'��.,... .., . '§..v' -.�.t .w;:�. � .., ., � . . ,.., �. � �c.i-�,p ,...w�..:'.. „ . � ..:,�.,.�.. .;� ,.; ,...:....- ..��:.. .��..... t �,M� � x �.Y �.�"�a� S�.r�a��m 3�, �'�.&",:. s ,�;; a�r" .�a ,. ��.,,��� �.. i..E.:.�':"��..� ,� �.�" „s'" a�� .� � � *�.��v �°# ;i?.��a��;. '� m?� -' � ,. � � ::� p �.� �m'�, �=�, ".":���"�� u ��§s. � �a ����`� �� ��+ ��� �" � � �� '��a��� r � �� �� ��„ � ��� �` 4 � � � a� �� �. .. '�.�., �.... '�,,,,,.� �€s�'�ffikS� �" :N '� �e �.A �,m;x€a 8 ` � � `� ��`w �' �a:�s �;�. �. �. ��m ;��t� e�_ .a^�� �a;°�w��- .•a�; 3��. ._, : ,:�,M'� �� E.���. �a��� .���... �����,� ."��a���'� .� =m�a�ia .... ���`�� � . .�� i.� �`. � � �[.; € � _ .m T ' �z-.`"."". ' q � r` yt �"a tt r� � s' _ . � j�f _ _. _. _..,.. � } ,. . .� _ _ � � � � €� k� ��. � . .,, � � s. ^`} ^�? R s _....���. _. ._.......�,__.... __.,.___.... _._._.. ._,_.... ....�... ___....�.... � ._�:_.�._..�.._..,._.�..,.__. �._.__._.....__.__. _ _ .�..___�......_a_.....,..,_..,....._._.._..,.....___.........___.�....� € ..; E._ a �,.., ,. ! � : �r�,t� � � s ^ .:��€� '_._... , .._: g _�i � 1 � �1�.s� � �5, .�� �. i � � aa i g �.?Y L"� i .i Y.» .. _..... .. ... .... . . ... .._. � �'�' C" :��t^� �0�i 4(�" �"��£ _._.. . . ...... ......_,..._...._...� " _ ._._....._,,._. _______m.._....._.__............ .............. _............. ___.... ,... ..'. ..... ' .. . _ ... _,.� �,,. , ., �.. Y �,f"^s � „ � i�f�,N .. . '.¢ � ......., •' .._ � .3.:s ,� ... .... .�...........,.___ .... .,._ _._,_____-_� .............. .. �_ . ___ .._._��..........._.__. .........,...._ _.,....._..._.___�....�............ __...� .... . _ ___. . ,... > . .........�.._ �._..__.............._.....__.....�...__.�._......�.,......-- ° ��:'t? ` ,s��.e. � �° € :s�� � �:W¢ _. . � $ _. _ _ / / �/ {�. _ ._ _... . . _ , � �"� ?� �� �. „ �1�� - I_j.yJ�'1. 1C- /�"'sZ.!V., r> �- r�� � -��� � ___._�.._... _.3 __ �- _ ( ___. _. . _r _ � � __... . �__�..__. .._ . ..___.�_��.�__ ._.._ .. ; � � .., P�1 r 9 � t�� � ',, � ! � G r��s �� P.E.,.�`(i �"> " ' • � � 7 ....:.. ..:..,. �__......:.. ___._.._.,.. ._._�e............ _.,.«.__.w....... _...�..�._...._.._.__.._._..____ ._...... } .. ....._............ ..._. ..... .,_. ..__._,..._ ..�__...._........_.......�......._.. ....__..... . ._....� ' � � G?.�"a; � z1s"`- i. � �k"' �.:.a �€ :: ...� __..._�..._._�,, � + _....;:...� �. .-_....... . �__.e........__�. _...�_...._ .�__.......__.....�.._...._._.__ __. .. �___._._.�._.._.........__. . . ._.._�_._.Y._.............._._.._�.-__� g � [ a:a`�a" � .._ ��t.. .§ .' �'. € � �5T" i,:�`�t. �; ��, g __ . . . .. ._., ._. _ . .. _._.... . .. . j �;'°� R� ' F—'_ � ' i € � ���-,�€ �; �; -� _ __ ._�. .�_ _—_ � — , _.__ ___..�_. �__�w . __ __.._��,____._ ____ _�. i � :s�a�-...� � �r'�4. ,;` . -.n r�r�� . ',�� �._. ...... ..� .._..... .__ ._� 3 � � ..... -..m� ._. W..�,,_ .. ............. ....� ._.....�........mm...... ...._.�._.,...... ....._ ...._ _�.�._._._ -_._ __'__..._.__ _'�'--___..._....,.._._._...___ . .._.._. � ._ ..,f.. ..., � ;.ps�¢�i �s' : �� t��� ! . . ... .. ... _. . �' ��'...�... �� ...... ._...._ �......._.,.._ __ ._ _.__. ....... ... � ..w W�,� .,. .,._ .__ ___, f x t" �� 4( .�,�..,- .. ._ ,.. ...,_. ____._.._...._....__.. _._............ ............. ._....._....�. _._.. ....,....._........_..__._..,.,......,.. .._........._.�....... .............,...,...._.. .. . ........_....�........,.,.. ¢ .� .. .... ...,...3 .. �.,..... 4 ..� �.. $ "� i i , . ,�4�,, f"a �i�`i�� ' . .� it' �'�xl i. ', � �., � 3 � � .� .€� s �� . . � ..._ _______...._ ._ .rt€�' ?����.: _. ... . _. �__ _.._.�...__ .__.. .__._ _ ......._... ,.._. � s .. ._. ... , . ...�.,. .._........ ��....t � ._ � ,_.._..... ..... ........ ...�.., _�_�.__.._.__._ ' 1 �x _ � q ' � '"� . � ! � ? �� � ����°' �'��b t��s ,.. . _._i R 4 � . . .... __._..._..., �. .._._._.._........._........ _.. ..._.__ _i. .. _,... .... ... � — . _ _ ._ ._...... ..�_ �..______ . µ� � j - a�t�". '� 1"I� I C� a x 3 .. ........__,W..... ._. . _ � ._ __._.,...._...._.....� _...._ __...________�_<__��[ . ,_._ _ _ _....._ _..._,._... ...j_�__-_____�.__�. .,.... ___ � .�?`".:. 1� a�ra.'�f ! , � �...r�.��� t..,� �s�i"t,�t. � '_ _ v_ __ � __.�_. � _... _ �.. ...3 _ _ � ��� �'� i � i ry1� 4 ' €. _.. � _ ___.____.___. _ ...___ _._ ..._._ _,___��__. � �.. .. . .._.._r.. .. _. .� . .._ _ __._... _.._.�.. .. . .___..�__�.,_ � ���,.x. !::�= „ I � :r�`.�'� �':�'�.3�? .. �� _ _.._ . __ _ ____ __ _.._-- � —__ �___.__... _ __.. ; � _ ,._ :-� M._.__.w._ ___ ..� � �. �t$�... ,.:"P.�'aL �". , � ' ' c�"?t.i ._c_r� < �'§� :.., { , ., ,a. . .n :"i._ � ........ ._ ...�.. _.,_...��._....._._..w......_ ,._....,.......... .,............._......_..._..�.._.............. ' t�lb ,�F '� '���� ' �3__ � .q�`._ _.._,.....�..�.�.........._� --�...� �._�__r.�____. ___ _,. __.µ__., ..� . ,.. -i ,:� t.`'.r a, ?�, �:: I � , � __ '----__ �___ �_.._._._......_,..__. __ __ ��._ ..��. ___..._ ._.�w_..,. ._..�_____m_�.�. __..___c..._. „; -.. -� : € ... o- fi—.t.j �"4 ,i. i�Lr ' - '3� �t� �'. i t � � ; t . > ..�.P.,-..,,...�......,._.._.....__..�._..._. .. _..�__...�„_,..._.._.._,.........__s....................._ _....__........._.........,,,..._..�._�. � . ........ .. _...... ........a.».....__...._.,.�...._. _.................._..._.,..._...... ._....._._._......._ t � •__ j ';�'a:Fa p € '_.S�y,�.YP}lfi,:? � . �':k�' - �� : .._ .'�....._.�...� __..._,._.... ..............�..__..........,_.............. ... ......_.. ..........._....._ : s .�«...Zs._..... ��..._«...r....,.w.....,...,. _ �. ...z � _ ._ , .. .. ._... ... x .. ....... _. f � ..,.m.�.. ..� .. .. .....,.. ._...._.._. . .. ... —.�._ ' _� ����" �� e���T�; � '�� �.__ -; z ________._. _ _ _ _'.__ T.___.._,_ __ _, __, .���___ _ __ � � .�� �. ?�x�" „�,��� � _._....,..... ..�.. __ _.w_..._.. ...__._ . _. .._ ___ � , . , , # � ,.�� � .r� ¢ 9� � � �� .., r �����a"�� ���w:� � ..�-. . _____-_ _---- ---_...._ ___ _. .__. �.._..._____ __. � � _.._��..______ # __,_._ _. ..___...._..�.__.__a i _..._v._ _ .�._._._.�__.._____. ...... _...__.._._.. _.. .__._.__........ _.._..,...... � A .. e ..........._.. ___,._ �.._ ..____-___._�...�__ _ ._..___ _ �_.____.�-----� � _.. ___._�._______ . _.... ........._.�_�__� _.._______....�.....m..._..... ..,_........_. ._.._.._........_✓.... _._..._....�.�._. , � �l _�...._.____.__ ____.__.__.____�_ ......._.__.w� _....__�..._.�_.. _..._....__ .. ... .. _....__._........._., _..____,._....._.__._..._.__.� __. ......._..___. .. ...... . ......�.�...� .._� s �._.�.m_. �. _._..._..._.�____. ._._... m.......__.�....___.... ..._.____ _..._..__� .._._._ ____.__...___.._✓.�.._... . ...._.___________�._________ _.....__. _____._; � � ���_ __ _. � , _ - — __.�. .. _� .._._ E _..__.._._ __,. _ ._____._ ._......� _.__�_______.__ _.___ �, ,.�__...__.�._. ..________...� ___..___...._____._.____...___�.. _._. _�._._ W�....__._.� ___ � � . ..,__ ... _..._ .._._ ..,____........__._......._.__.,�... .........._..�.,..».._.....,... 9 ... ..____._.._........._....._._.__.._.._........_......._......... ......� __....__._....._........_....._.......""__._.._....,,..._.__._..._._........ 96:�:aa y�� �;"a� �� � . .. ____.�...»..! { .^ � ___......... . I 5 v' � � :.:.� xa'��,.,.. ...._.._..._.._..�.._,__'___..... �..__.....__..�.._, ......_.__.___...._......._. __ _....._._..._ � ............._ ....._.___m.._..._........�......__...._.__........._.__....�...____�............_ _ _..__.__.�_w____( : �,"��:.:i, � ... -�-____..........._.........__...... 2 s �� t g � � � _ __�_ .... __..._. __ .. ... _._ ...._ . ...__ _.____—________ � _ � � _. _.. �' .�< �� t � ���sz� � :. � � ___ _ . __ . _._ _-- .._ __ _ � s ' ������ �.. �� ; � �� �����;�`�`��� _.___.._�..._..�. .... ._ _.....___—___�.._.. _____.� .____. . ... . . .._—__ � �.� __ �� � ��� � � �� � ���+� � _. _. .... __ _ .__ _....__w_-�__ � ��:� �� �� s � �� �� �a , � � � .� _ ___ _ ._. _ _......_ __ __.__ _�_ _ __.. ___ _____ �:. ....,. . o- � ���.����� �� � � ������ � _ � _�___ _._. . - --,- -, __ _ ._... - --�_._.__w. _ . _ � , � .. .� ��>. �� ����:.:. ._ �..�._ _ ._�_�___ _ _ . _ .__. M...�.._____ ___ . . .... ;��.....�»,,._��,,�.:.....n.,_.. ...,..�.,�__�,�,,...._�s�.e.�_��.. �,....„<..,_..m�����._ __._,._.� .�....::.�,,_....� ��...g.�,w�.�,�,�,��4��«.....x.�..�...._ , ��....e�,,,�._a