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HomeMy WebLinkAbout13770 � � ����- ��� r��� _ �� _ CITY OF DIAMOND BAR j DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES W 21660 E.Copley Drive Suitc 190 � (909)860-3195 Fax(909)861-3117 PRES$ f - . >M. BUILDING PERMIT APPLICATION _ � , FIRMLY o ADDR'ESS "��.�Q� �`�+�'���r�� ��_ DATE CATION — � NUMBER( ,� #l�`�'J� ISSUE TYPE OCC � APN LOT �I 7RACT A�C' DATE CONST. GROUP p OWNER �- 1) �� p AD�R SS ' �G ZONING SETBACKS � CITY • ZIP TEL. � O- P.� FRONT RW ❑ APPUCANT � €� TE v''d' REAR ❑ SIDE/SIDE STREET RW ❑ � CONTRACTOR �ef-�I.. PE-'�-��"r� c.=p`�ST.�vc . S1DE ❑ � ADDRESS �� ��C�-`LC�zR.ca n� �_�_. PROPOSED USE �`� �� '�1r CITY��'`�'r C'�:u'l"'+�CC3� ZIP ''Y i`��l TEL. �.++ Y5 n� w ARCH/ENG/ ��s�� � DESiGNER SYf�+``ti� j �`'t'�� „ d ADDRESS NO.DWEL. N0. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION OOtNNER-BUILDER DECLARATlON SFR/ADD/REM y.T 0 I HEfiEBY AFFlRM Ut�OER PENALTY OF PERJURY THAT 1 RM EXEMPT FROM THE CONTRACTORS LI- Gafe9B/C31pOf1 W CENSEIAWFORTHEFd.LOWINOREA50N(SEC.7D31SBUSINESSANDPROFESSIOP�CODE:ANVCITYOR (/� C..) COUMYNMICHREWMESAPERMITTOCONSTRUCT,ALYER,IMPROVE,DEMOLISH,ORREPAIRANYS7RUC- W pyti0/06Ck WTllPE,PRIOA TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOA SUCH PEFMIT TO FILE A SIGNED W � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF'HE CANTRACTOFlS ll- � GENSE LAW(CMAPTER s(�OMMENC�NG WITH SEGTIOId 7000)OF ONISION 9 OF THE BUSINESS AND PRO- � PooVSpa iESSiONSCODE)ORTHATHEORSFIEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (� V 710N.ANVVIOU�T�ONOFSECTION703t.5BVANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z R4'-ROOf � � � ACIVILPENFLTYOFNOTMORETHhNFIVENUNDREDDOLLAR5�S5oD).): � ❑I,ASONRJEqOFTHEPROPERTV,OAMYF.NPLOVEESWITHWAGESASTHEIASOLECOMPEN5ATI0N, O CPInrtIBICI&I ' � ' WILL�O THE WORK,AND THE STRUCTURE IS NOT INTENOE�OR bFFERED FOR SALE(SEC.7o4a,9U51- ,J NE55 ANO PtiOFE5510N5 COOE:THE CONTRACTOFS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTYWViOBUIIDSOqIMVPOVESTHEPEON,AN�WHODOESSIICHWORKHIMSELFORHERSELFOR = � THROUCiMHI$ORHEROWNEMPLOYEE3,PROVIDEDTHATSUCNIMPROVEMEMSARENOTINTENDEDOR � � � OFFEREDFORSALEIF,MOWEVER'�HEBUILDINGOflIIAPROVEMENTI55DLDWIYHINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDEii WILL WAVE THE BUqDEN OF PROVIN6 THAT HE OR SNE�ID NOY BllllA OR = IMPROVEFOHTHEPURPOSEOFSALE�. CJ 1,AS OWNEA OF THE PROPcR7Y,AM EXCLUSIVELY CAfdTRACTiNG W ITH LICENS£D CPNTRACTORS � � TO CONSTRUCT THE PR0.IECT(SEC.7oI6,BUSIkE55 AND PqOFES510NS CODE:7HE CONTAACTORS LI� VHIt18tlOf1 ADJ.AREA W GENSELAWDOESNOTA?PLYTOANOWNEROFAPROPERT.'WNOBUILDSORIMPROVESTHEftEON,AND � W4IDCONTMCTSFORSUGWPROJEC'SWITHACONTRACTOR�SILICENSEOPUFlSUPNT7qTMECONTRAG QUANTITY DESCRIPTION FEF. TORS LICENSE IAW.). J � ❑�AM EXEMPT UNDEA SEC. B.&P.C.FOR THIS REASON Q . � GC.L..� �� U �' � �� S(.-Gi l T � S �'� Z OA7E_ _. OWNER�—. ~ �.._3�5.� L � ��'T ('y � � y,.. 1 l/ � LICENSED CONTRACTORS DECLARATION ^ � -�� - � � I HEREBY AFFIRM UNDER PENPLN OF PERJURV THAT i/,M LICENSE�UN�ER FROVI510N5 OF CHAPT q � ^p � } `�� ,� � Y(COMMENCINO WITH SEC'fSqN 7000)OF DIV�SKKJ 30F THE BUSIWES5 AND PAOFESSIONS CADE,0. z �___._ ��' s 1 ��� MY LIGENSE IS IN FULL FORCE AND EFFECT. / � p LIC.NQ. S(Cr�il il � �� � � L'�T �+ �� �J/�� $1� (o LICENSE CIASS_ 4J ._ �/y� J ~ �ATE � -al �--�� � CONTPACTOR_�e��S�".'_S__'+'�Y%��-� t t � ��"�q���WG�RICEFS'COMPENSA710N DEGLAR�ON 5'�-_ , � a N .Ar t�. Qau [�.'T_ !}� � I HEREBVAF IF RM UNDER PENALN OF PERJURY ONE OF THE FOLLOWING DECLARAT10N5: a y .._ 1 �y A,� S��y� �, l� 1 � _L W' r � __IHAdEANDWILLMAINTAINACERTIfICATEOFCONSENTTOSELF-INSUREFORWORKERS' 2 ��_(- �,1i()OG+ -'�j•V.�. �4� � CD0./PEtd5AT10N,AS PHOVIDED BV SECTION 3lao OF THE Lt�AOR CO�E,F9R THE PERFORMANCE 1U aFTHE WORK FOR WHICH?HIS PERMIT IS ISSUED. � � W �i NAVEAND WILLMAINTAIN WORKERS'CAMPENSATION INSURqNCE,AS�9EQUl!!EO g'v SECTION /� ��` �`� Q97000FTHELABORCODE,FORTH[PERFORMAPlGEOF?H[WORKFORWNIC4THISPERMITIS ' iR�i5.1[�i _ ISSUED.MY WORNERS'COMPENSATION INSURANCE CAqRiER AND Pa�JCY NUM9ER ARE: CONSTRUCTION �I� K�{►I l J jcnRniew�.------- PLANREVIEW ��,�1=T_�..,-_ ___.—.—.—._ .....�--' ��� � aoucvNuueER ` ELECTRIC G � � � Q --- --- J']► ✓ Q (MISSECf'ANNE�NOTPE�.�LF.7EDOFIHEPER�ISFa10h'FFd1�OFtEb00LLAAS(SiW)ORLE5S1 PLUMBING , �yZ'C" " - � � � � ' W y Z I C[RTIFY THAT IN THE PERFOFMANCE OF 1HE WORK FOR tNHICH THIS PERMIT IS ISSUED,I MECHANICAL � �j SHALL NO?EMf'lOY ANY PERSON IN ANV MANNER St�AS TO BECOME SUBJECT TOTHE ��G" S� '"�,,��'j � WOqKERS'COMPENSATION U1WS OF C IFORfff���,,,Af.'O AGREE THAT IF�SH4ULO BECOME INSPECTION FEE tl SU&IECTTOTHEWOFKERS'COMGENS I �VISIONSOFSECTION37000FTHELABOF 6Q f� � CODE,ISHALLFORTHWITHCOMPLYW T1 PROVISIONS. ISSUANCE X'9 s.� L �1+`�j � �n q _._._�—_ SMiP a. z .... �.e ,.� �ATE�.•� •O "�l� APPLICANT: ��.�. �"�'t -- w WAflNINa:FA0.URE TO SECURE WORKERS'COMPENSATICN CO E IS L1IJIAWFUL,�SHAB E� � ENERGY PJC - � �y, SUBJECTANEMPLOYEflTOCHIMINALPENA�71E5IWOCIVILFINES P700NEHUNOREUTHOUSAN� ENERGYPERMIT � �OLLARS(i��.�).W ADOITIONTOTHE COSTOF COMPENSATIO OAMAGES AS PROVIDEO FOR IN '�/� � SECTIDN37080FTMElA80FlCODE,INTEREST,ANDATTORNEYSFEES. RETENTIONFEE: _._._ ""'�J� � CONSTRUCTION IENDING AGENCY PFiE-ALT FEE:,6'! ) I IHEREBYAFFIRMUNDERPENALTVOFPERJURVTHATTNERF.ISACONSTRUC710NLENDINGAGENCV ( �� �). � �G— fORTHE PERFORMANGE OFTHE W/ORK FOfl WHICH THIS PERMI715�SSUED(SEC.3087,CIV.C.). "'�— �f'4 'NDER'SNAME_ �!_ p� � � /�+ ER'6 ADDRESS ' ^ � .. , �THATIHAVEflEADTHISAPPUCA710NANDSTATETHATTh'EABOVEINfORAIATIONISCARRECT. TOTAL FEES 4 ���•D� 1'��`�, 'J COMPLY WITM AlL CITY AND COUNTV ORDINFNCES ANd STATE LA RELATINd TO BUIL�INO ' TION,MIOHEREBYAUiHOR2EREPRESENTATIVE50 ISCOU TOENTEHUPONTHE „"1� 'IONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS �`:y '^,d�r�i �'�'•(�E�''C.� ��� ��-i - ,. + 'wM °FIN7� . .-� ^' �-�' � i �. �_. ,r, ,f� 'EE � DRTE . ��-,,,,Aw"'��� RECPL N0.� PAIO BY VALIDATION WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN---Applicant's Copy - . . , � .. ,. .,� t...:�. -.� .,,. :�,r3�.'�. .:^.i�,. ��� �� ��$.�i..>-*�.�i�'�::. a sfl�. > ���"a ...�� �:�'� :�''�.:m�' S %� �:'��p :. � ���� ������� ��:���`����� � _'�' ,; a�';:�* "° '�a�`��.� �� � �t :: � � �, .' �x a�. _ �'� . , � "°� ��x � �� : � � � �� � _ ��� �.;a ���' "� `,���� � � �� �z � � � � � : � � G ; � ���a � ��� �+ �5� .,� �� �:�.a �� � . a � � �'� . 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