Loading...
HomeMy WebLinkAbout17209 --� _._ CITY QF DIAMOND BAR ,C � � DEPARTMENT OF COA�A�fUNI'I'Y&DEVELOPNIENT SERVICES � 21825 E.Copley Drive ��w (909)860-3195 Fax(909)$61-3117 PRESS \%ywy�� BUILDING PERMIT APPLICATION FIRMLY } JOBSITE t� �-7 � n �,� Dc�� APPLICAT�� PERMIT ,�� p/C / Cf o ADDRESS_ �TP.�(�� 1�� DATE � S� � NUMBERG�=_ # a( � TZ.� � ISSUE TYPE OCC APN�Z��S LOT_�_ ACT �-7�?-,�___ DATE CONST. GROUP p OWNER U �c,,`,�'� ��- �_ _ o ADDRE�S�1I� �G�A i Ge EJ(���.4, ZONING SETBACKS Z CITY_ I�.n,.e.. ZIP TEL. FRONT Ryy � � APPLICANT TEL.��'Ld �NS(, REAR p z SIDEISICE STREET Ryy ❑ Q CONTRACTO C SIDE p � ADDRESS ' ,_,�- � C�TY r�ti:n p ZIP G��� TEL. PROPOSED USE /C� � o ARCH/ENG/ /1,uj_��,�, z DESIGNER � a ADDRESS NO.DWEL. NO. NO. cn UN ITS STORI ES BEDROOMS � CITY ZIP TEL. � DESCRIPTIQN SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADDlREM O p I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT 1 AM EXEMPT FROM THE CONTRACTORS LI� GBfdIJB/C2fPOR W CENSELAWFOqTHEFOLLOWINGREA50N(SEC.7031.SBUSINESSANUPROFE55'iONSCODE:ANYCITYOR (f� U COUNTVWHICHFEDUIHESAPERMITTOCOVSTRUCT,A.TER,IMPROVE,DEN� LISH,ORREPAIfiANVSTRUC� L,`��j w 7URE,PRIOF TO Ii5 ISSUANCE,ALSO REQUIRES THE APPLICANT FOR CH PERM�T TO FILE A SIGNEO W Patio/DBCk 7 � � STATEMENT 7HAT HE OR SHE IS LICENSEO PURSUANT TO THE P SIONS OF THE CONTRAC70RS u� � CENSE LAW ICHAPTER 9(COMMENCING WITH SECTION 700o IVISION 3 oF 7HE BUSMESS ANO PRO� �'�' Pool/Spa FESSIONSCODE)ORTHATHEORSHEISE%ENPTTHER MAN�THEBASISFORTHEALLEGEDE%EMP- (� V TION.ANYVIOLATIONOFSECTION7o31.5BYANVA CAN7FOFAPERMITSUBJECTSTHEAPPLICANT70 Z Re-Roof � ACIVIL PENALTV OF NOT MORE TNAN FIVE HU EO COLLAPS(ESoO).): Q ❑I,ASOWNEROFTHEPROPERTY,O EMPLOVE[SWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial z WILL 00 THE WORK,AN�THE STRU E IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.704a,BU51� J � NE35 AN�PROFESSIONS CODE:T ON'RACTORS LICENSE LAW DOES NOT APPLV TO AN OWNEH OF = PqOPERTVNM1IOBUIlD50RIMP ESTHEREON,ANDWHO�OESSUCHWOqKHIMSELFORHERSELFOR wTHROUGHHISORHEROWN LOYEES,PFOVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m � OFFEREDFORSALE.IF,HO ER7HEBUILDINGORIMPROYEMENTISSOL�WITHI40NEYEAROFCOMPLE- Z TION,THE OWNER-BUIL WILL HAVE THE BURDEN OF PROVING THAT HE GR 54E DID NOT 6uIL0 Oft = IMPROYE FOR THE PU OSE OF SALE). W ❑1.AS OWNE F THE PROPERTV,AM E%CLUSIVELY CONTRACTING WITH LICENSEO CONTRACTORS [� TO CANSTRUCT T P0.0JECT(SEC.7044,BUSINESS AND PROFESSIONS CO�E:THE CONTRACTORS LI- V2IU8IIOf1 O��'� ADJ.AREA W CENSELAW� NOTAPPLYTOANOWNERO:APROPERTVWHOBU�LDSORIMPROVESTHEREON,AND � WHOCONTR SF095UCHPROJECTSWITHACONTRACTpR(S)LICENSEDPUflSUANTTOTHECONTRAG QUANTITY DESCAIPTION FEE Y TORS LICE E LAW.). � ❑ M EXEMPT 11N0ER SEC. g.&P.C.FOR THIS AEASON Q � U � D E OWNER � Z U � L�CENSED CONTRACTORS DECLARATION W ¢ CC IHEREBYAFFIRMUNDEfiPENALTYOFPERJURYTHA?IAMUCENSEDUNDERPROVISIONSOFCHAPTER � d 9�COMMENCINGWRHSECTION7ooa�OFDIVISION30FTHE8USINESSANDPROFESSIONSCODE,AND Z �X MY LICENSE IS IN FULL FORCE AND EFFECi m � LICENSE CLASS ��Y�1 C� LIC.NO. / ���Z� � � V DATE ���7�D�, CONTRACTOR L.�G �Lr•s�� . J W � WOFKERS'COMPENSATION bEC�ARATION ¢ � IHEREBVAFFIRMUN�ERPENALTYOFPERJURVONEOFTHEFOLLOWING�EGIARAl10N5: Z Z _I HAVEAND WILLMAINTAIN ACERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' ¢ ¢ CIJMPENSATION,ASPROVIDEDBYSECTION3]ooOFTHELABORCOOE,FOqTHEPERFORMANCE U Q OFTHEWORKFORWHICHiHiSPERMITISISSUE�. � �W _I HAVEAND WILL MAINTAIN WOHKEr75'COMPENSATION INSURANCE,AS RE�UIRE�BY SECTION 37000F THE LP$OF CODE,FOR THE PERFORMANCEOF TI-.E WORK FOR WHICHTHIS PERMITIS �,�� ISSUED.MY WORKERS'CAMPENSATION�INS^URqNCE CARRIEF AND POLICV N'JMBERARE: CONSTRUCTION 1 j CAqRIER �b'�C.� t�-'t)�rt PLAN REVIEW �'• �CI Z POLICYNUMBER�Q ELECTRIC Q 7 � (iHLSSEC'pNNE�NOTBECOMPLETEDOFTHEPERMITISFORONEHUIJ�FE000lLAR5�5100)ORLESS). PLUMBING Z I CERTIFI'THAT IN THE>ERFOPMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE ,.,„,„„„.�„„ � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGaEETHATIFISHOULDBECOME INSPECTIONFEE '"""""'.^��-•-^� SU&1cCTTOTHEWORKERS'COMPENSA' OVISIONS � N3]o00FTHELABOR "T-'� � '� - � CADE.ISHA FORTHWRHCOMPLV TH PROV ONS. ISSUANCE " '"'�'��� ^' �v�� )] - � DATE: (b APPLICA T C i� SMIP f { ....._. � v W WARNING�FAILIIR O SECURE WORKERS'C PENSATION VER S UNL4WFUL,AN�SHALL BE ENERGY P/C '� ��•��l �j J � SU&IECTANEMPLOVERTOCRIMINALPENALIESM10CIVILFINESUPTOONEHUNDREDTHOUSAN� ENERGYPERMIT � ' DOLL4RS(E 100,000;,W ADOITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOF IN J SECTION 3)oe OF THE LABOR CODE,INTEREST,MJ0 ATTOFW E1"S FEES. l 1TI\ o� RETENTION FEE: v'+� ---`_._'�---_._..___._. i Q CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � ���-�'--�=��-�--_"--�-,! � IHEREBVAFFIFMUNDE(7PENALTVOFPERJURVThATTHERFISACONSTRl1CTION'..ENDINGAGENCV _ FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI7IS ISSUED(SEC,]09],CIV.C.). Z W � LENDER'S NAME F— IENDER'S ADORE55 !'� w� � V i � ICEflTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFOFMAT�ONISCORRECi. TOTALFEES I,Q/I.-3�,/' � 1 I AGREE TO CAMPLY WITH AlL CITV AND COUN?V ORDINANCES ANO 5T4TE LAWS RELATING TO 9UILDING 4 � CANSTRUCTION,ANOHEREBVAUTHOP�ZEREPRESENTATIVE60FTHISCOUNT'/TOENTERUPONTHE � ABOVE-MENTIONEOPROPERTVFORINSPEC710NPUqPOSES. Z COMMENTS � Cu� � . � .e C�a.1✓� �f '� a Q TT EN (PR T) 3Q.� 0 �Q 20U � 51 OF EE DATE = RECPT.NQ - PAID BV VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLD NROD—FileCopy,GREEN—ApplicanYs Copy ... .. . _ ., .� . . ,.. ._ .. . .;... :. s. �� .�na<.•, .:,z,,:,� ..,,. zK�z� „ . �>. .. �� � . , ,.�:�-� . .. �. .�:;nti����.: ,, .. �s.a , , ,... .._,.. .� .:. .. ... . ...., . . . .. , .. ... . . .^;r. . . .. ; „� �:.:3� � ;� �., �" �..5��<a���§r,��i��� �:E:�^9,�� e� P�'3.�., �r a„�s�`� ��`.� � r �$;�._� �� �.�. �� -:�'� ��fi�� '��" ,���� � �...`�.�� `�'��:�� � �� .:;,; �m�'.::,:. �q���'���� � ����' ��' � •� ����# ������ # � � �m�.a���� �� � ... � a � ���� � ��,� � � � �� ��� � � '� ���� .._ ��� ...� '� � #.� 4 `�,i. � ���' ��� �n�. rt�. :.. ffi� �,: a �:�+ a - �s �_ �$ ��.,: ��`�.�� ���'�� . ....,#=k ���'�:�� �. .-'i ...�r.-a�a���^�..�.�:�>�,�� :m:.��`_.a�.�.�$.;.h� ;`�,'�*..� .. . .� ., �..::�:�ws �.e.t,..., #E��� . � t.�.:�+' ��a�::._�a�a.� �!s,.m.:::� ...'� . � � €• �'. '�� � � �. ( .€. � �`i �� t',- ! � . $ i 1 . ___ �__ .... __ _ _ ..__ � ......... ..... .._......_. _ ...._.. _. , q ___ N ] , �� : s _tti'�I� s �. ."' ; /e`�"Yp,j"�5 r a'l+•r.T.._ ` ..7"ar1 t"i t �,nf ... >�.._. .._...._._.._....._.�_"— .. � .. _._ � __ ._ ..... . . S . ..._.. .s' ........... . ....... ......... .__ .. _...,. ___... � �a .'L € @�s 1.. �. '�.1 I ' :q��) r � �.'z.. 1 �.?� ...... .. . _..._. �[,..- ._. .._..__..r_'-'._�._ ._. _ _.;.... ..._.._._..,.,.._ _,__........_.__.....__.._.___--__"..._.___ ". � �...... � ?�� xr�,�,- :`i..,o- . �,, , � i � . �[.'a € =id .�� �. E3°�L i,��� .._':: __ ..__.. �...__.s..___......._�._ _......_..__..� . ._.._.._ ... ... . ... ,... .. . ..... ..__ ....... _ � �"., y r..,t,.. , � t �.3. r st c�c s�"L._.... � ''�� . _ __ � _-_._ _._....._ ._. � _.... �.. . _. . ._... ....�,�. __.... _,'.. � �� ���p � � �..y. �s. �`4.� � �ii,' :va .._ ........__....m._..� ....._.,__._.__.�_.__ _........_. " z ..... ... ._._..... ._ ....�......... ......... __..........__ .......... ..__ .__ _ . . ... . , �ada='i�' r a.r:"p�s E ,�, ' �€t; `�-�a r?:t"'T.€f, i.�ai`�4�� �._. ........._ _._.........�_.....,.�.._._.......__�_._._..__...._ j j �_._ a _._.._ . __......_.... ._...........»........,._.... ........_ ___.._ ...-�..... ..-i � ���.,�c�... ...N C� ��� .: j ,..... ...... .. ... _. �, �--r ��.-z� ) e �'.�1 .. __ .__ .__ .. ..... ;; �_ .. .....� ..�.____ . __._ .... .__._ ... ...� -`-' , , _, R� -r�-s, 3 pz� % i� p_ i��L`}�€ ��{..��� � r�t�,� " � a ... � ,a � � � � !u .3 a� a� _. ._ .__ �. , ______ , € . _ _ _. _____.__�._ .. , ___ _ _. � ��.3�.J�' �f;�;�°�_4�� . . �- �.T" "�%5-,1,,31�;� ' -: � � .......1....-.,....,,,..e...e...__......_�.............._ ....,_�....._.....__...... _.._._. . .�...__....,,.__,..._...... ... ....... .____....,......_ .....<..�....�.�_.....�.........�..,.._....._.__ _ �,_...__.. ._...._...._��.__r........_.....�._.__............_._.w.�..._.�......._ �..z. � r^ 7 f'�t.d [�L..`` ��i a�.,. . . ��� '"`E�' -' - . ..._ _.._..._..�.�._..._.�...? �:. . . . . ..,_,.,_... .... .... .......... ._ . . ..� . ._... �,__.+..�.�_.�w.�.._._ :..__.....�...._.._.».._......___.__....�-., k ..... . .. _ .__ . . r, � �? �.,.J��t.e..E r �:� �t> �°-:.,,. : � ����� t t € � "� €<�-'� � ._,_ ._. .��. .. ._.._.��.., . _... ..._. .._......__.__. .__.........'..- .�.. 'r- ::. . ,,._.. .� �_ .^.�,._.._ .... ..�_ . �-._T�_�� ''�i �-�..4.e���"'t lr' € , s...E.d�. a :�'1� S�a_� _' .... ..... .'"___.._......_.;�..._ ......_._.......,._�..._..........�.._,__.....__ ..._........._.. .... .... ..._...._... . ......w_.. � ........... ..__,. ..,�..�..__w_�._.__ i :!`a� �' �lJ_'a t � �, .. ""�fi �: �' �i« �.... ��'.., .; -:;7 s € �. .r.,. �,,.... �,.� > i � .. ..�-s,... ...,_..._.., ......-_...................__.......,._..._._...... ... .... ...... ... .. .� . _ �_ .__�.. ...w....M_ _.. , _ ..... _... .... �_".�• � ���t`,' ;d __. i g�" ;# y �;t t'�{` ; ....,a, .m � ..�EY.,..i E � ... . ... .._____�.. ,... _ ......... ...._._. ____ _. ......... ................... ......... __._._....... _ ± ....._ . .. ..,......,...�... ...._. .. ..._.. . fis.8 8 'i`S � . .. ! C3PR� . � �.:�i ._� .._ � _...._�� Y , s.��...�.._.. ____ . .. ....... . .._..._ .. .w.... . . . .............. _ .�.,, . ___.,......_..-. ..._.__......_._.€ _'..,..", ,. r r � 1 :-SI.. � . . � �i� >�?�:.. � r''�ti, ' 1 ' tn. .��a'r ._ _ ` . .�E_.r:. �w . '. , . .. . . _. __._._.. :. ._.._____—____.._ , __--___..__._,. .... --- _ __.__ _.__. __.__.. .. _ _____._._ ...__.___ ___. __..__ y .. ,; .-, " ..�.�-� . :e�`�.; � ����� ---i �.,�� av���'�_(.3" -�e. ��,,� ' .��4�, *�'� ..... )..._...____.._____...._.�_.. .._. _ . _ ..�___.__.....�......_ ... ._..-- - --__._ ______ ..._._ ._s,_ � .. _ . . _. ... _. � "r ;�,> � � `��� ���i a ��� __�.�._ �_.__. __ v.� � � ..._. __� � . _ --_ __ � ., E �� � _ __ �.- �,€� r�� ` ; _— ----- __ __ . __ ... __..__._..________ _._.__....�_ ____ ...�. .___..__ ._. . _. _. _.._ ___...._ .._�_.____.._ . . 3 ; �% � ..4 i a�e ?t1�.^}.,� ;� € ; I �"..�'x" � :��rl...�.... ; , . �:✓ � ;. _._.._. _.__._ __...�__.____._.......__W._�.._.._ _.__..._.....y._._............ ..._..._........_._.__......_.,.._....._._..._� ........ ...._..._..._..._.......,,,_.____. .._...._..._..m._..,...__ .._..._..,.....,.......... .-__.,.......,..._.... ._.............._.__._..... w�¢_._ + . - .. ..- : , .....�y �.. 7:�� t .. � bl` � �' �:v�3 C . .' [� �°�. { � + � - ....._. .,..._ .. ..__.. - ... .........� ._.........._................._ .__._�__ ........ . .... ..... _. ..�. ...,.�.. § I�,: e f f d 3�-S P. . ... . ;�� , �, ��S � _____�".�' � __ __-� ____��' -��_0{_ _ _. _ _... ___ .�.�.._� � ; �r.�4,...�. �s�_. ; ��,a^.�.� � � � �-3.��:,� � 4.P. �v4-: , , � � ---- __ ___....___��..._�.___.._�_�._.________.�__________ _ _ _._..___.__ �_._._.__�.� _.______..___.__ . � �=n � -� — � `f, � � ` � ,� s � A_�, r, ; , �;E� �_� � �:fi � __ �w_.�_�.� ,..._._..__ �.___�.._.�... _,___�. __... _....._. ._.____.._. ___.. .______ _ _.. �_ � �'�ii�s;�.�..� € �:�^ C9 ..C^. ....... ��"::i�c..�-'f.4 � ., E t.�..._....�..�..m....._�.'�_�.."�..:.._.., ._. ...... � --- `---_-_.-___. ..................__..._._......�.�...._.:._......... ....__:........ ......_..._......__.,....,..,..........._. . .... ;........ ..... ........... ..._.�...�__....,._.__�_........�_.._...,,._w..... . .. i q,_.,�... ........_�.__.........�...___..�_. . . _...-,_..._....._........ .__. � ,...., .... _.. ........ .. �r��.� �;r . ,.� ��....._ __.....� � ._ . .,..._._.. ........... . a : . ... . � ... ., � E � ��g�.���'�_�._: ���.����__ . [ �__....._._........._................__�. ............e.. . .......,..._-.__�._.. _-_ _......_�...............r.______._.,....._....._.�...._'."'.""""`___� . %� .'� : . --_. ._--- - �-- . .._— -._..� � . . ......_ _._...:..._...,__ . . . _..-___. �...--.- ..._.._- _.. . , E € t :,,.� ...�M% � � .�..�b`�ae�r1�,' � d .^; � _ ___M...__...,._.. ___ __... _____..�....__,�_......._ .._.__.._.. _,.._r__. ..._ .. __.......___r__......___.,._..__._._._n<_.___._.��__—_ _..� �............_ _.._._____ � , E �. ...__.......v..__ . ..... __�_....__ ___._ _ . ___ _. .�.,....... ...�......._.. ___._....._.__...�_.....�..__�...._.__.� _ . ... . ..__.�� ._::_�.___._ __.._. _--____ �......_�... . ._ � , t .�.�_._.____ ____._.---___ __.�. ...___.�__ ..__._.__..._ ._...__ __ _._.�... ....._____.._.. __.__._.._�..._._.. _�.___.._. �.. _......... _._._�.w._. _, � � �__.._�__ _ ._..._.____....__ ._....�. . ._.__..._.._.._. ....._...._..._._.m._....___ __. .... . ....._...�.. ._...____._� _.._ _._.�_...... . _r_ ._......... _......... _...._.__ �._ __� a ;_____... ._...__ .....____...._. _w__..._ _.._�.._.. ._. . ......_.. __......___ -- _ _..._. _.._.....__..._...._.� _.__......._ . ...._..___ � _...... .. . _ ��__. __� i �_ ........._.._----_.�..._._..._.........._..__...._........_...w__...... ......._.. .._...-----.._w..._.___.__.---_-._____.��_ ___.._...._.__.. �_..�. ._„_..�.�.....�.�..._� § t E........�.....�.w......._........._..._........._.�....�....._._._._..�.....____...._..._._.._.____'__......._._.---___._'-__...........�..�._......_._.�.._.�_.Y......_.._..__........m_._.�..-.�.....M,....................................._....._._._....._..._.. ......_.....�..�..__._._._..._,_......_.___�....,....... I T_ � ._........................................,..............._,._......_.........,............_._.........___.�...__.._...�....._......___...,v....,.._.__"____—__....._........ ._... .......... ............_..............-.....,............, ................... .............._...................�.......... ..,_........,,,.,.,�._..__ _ 9 ........_..__.._......_._........__....§ 3 7 1 .........,....._.. ._..._.___.__._._._�...._._.,....-.....,.....�........ . ......e............ . ..._......._._.._... ....... .......................�...._.............._._............_......�.,.... . ..._._..._... ..___._.._...............,_..n_...._.3 � ... ...... ... ...... ... ..._"___.__ � ` ::���t;m��-`�y.�r� �:'.:: � _.__.�... ___...._ i �.. r` �.. ... ......_� .._.. __..... _.�..___._....__.__.......___._. . ......__._W . _ . ._ ....______ _____ _.. _ _.. _ __ ____i �. „�,,.�,,,,�C�}}�.�.s#�.r .±e. ...::, „'_........_.................... } i ? E � � �:� ��� �a� ��i ���� �.._..._._..._................_ ...,..._. ..�._�....�......_.______.,....� ...._..........,_.......-..... . . ...... ...__�...._......._.. ..........._._._____.._._..__.._..........✓._........Y.r..� __..._ E � �� ������ ����� - � .:.. - 2�� �a __......_._,..�..__....._...._._......._. _._--_.. __....._..._... .... .............. ..........._....._....�._,_...,.....___._�...�.................�.........___' .. �� �'�� ��' ._w_e.��......._........._..�..�____w .... .�.... . . { . � . ." .;{ - P °��' � _. . ............. . . ................_...._..__..._.._._._._.__ : � ��'��s � � .� .,,,.._. ....._.._.........._.............._._.__..____. _..._..._�._..�_._............_................_......_._...._....._......................_.___.._..__ _ _.._.....� � �:: ������ S � � � � � . � _�...._,......__._.._..__...............�..._....,..,,__. ........e....._.__._,_........... _.__......___. ......___.�. .._ . _.._ ... . �����.: ..... _... _. . .. ,. � � " �Y���= � " . . . ..... .._ ..._ ..e . . __ �......... ...__ . . -- ... .. . .� � 4����. �� � � ' �. ; "�.."> .� .. a�,.4.� �� �. __.e. ...__.�_._. __ ... _ _..._..._.. _...._ . __. _.... . .. ..... . ...._. ._ .___�.___ �..... ._____._._. _ ...,i �.......:.».,..., w.. .__ _._a.. _._.._.v,am..._ ..... .�..mesa.,�, .......:�...:,._.e._m__�. :,m,..,....a.a�,m�.,.,..m�. ..���._. m,...::.,,�....... ' e..�.�,.::,�,�.�... . ..,,. _.___ ....m.__..__. :.. ..,. :::..:..:,...m:....._._..»�,..x�.:..,._...e,...:.,....,......w�.x.u.....:.