Loading...
HomeMy WebLinkAbout16528 � CITY OF DIAMOND BAR � �'� DEPARTMENT OF COMMUNITY Fc DEVELOPMENT SERVICES : � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS A�' � BUILDING PERMIT APPLICATION � FIRMLY ' ^ _. APPLICATION �� � 0'" �� NUMBER�d" #lC' n .r�- .. � JOBSITE � Q ADDRESS , �� �� DATE � ISSUE TYPE OCC APN L T TRACT _ DATE CONST. GROUP p OWNER 'L ADDRESS _ G ZONING SETBACKS Z CITY r� ZIP � � 7EL �} FRdNT RW ❑ g APPLICANT � TEL S DElSIDE STREET RW ❑ � CONTRACTOR SIDE C � ADDRESS PROPOSED USE 'V F�Y � CITY Zl 7 L. � ARCH/ENG/ ]/� DESIGNER ��-"` � �,e,�� C`.a NO.DWEL. NO. NO. ADORE � UNITS STORIES BEDROOMS � CITY_s�_'���'"1Cl ZIP TEL: : ,� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION OOWNER-BUILDER DECLARATION SFRlADDlREM [] I HEREBY AFFlFM UNDEFi PENALTY OF PERIURV TNAT 1 AM EXEMPT FqOM THE CONTRACTORS L4 � GaragelCarport W CENSELAWPDRiHEFOLLOWINOREASON(SEC.7031.5BUSINESSAN�PROfE5510N5CODE:ANYdTYOR V COUNTYWHICNREWIRESAPERMITTOCONSTRUCT,Al7ERIMPROVE,DEAdOIISH,ORREPAIRANYSTqUC- W pyti0/DBCk � NRE.PflIDR 70ITS ISSUANCE,A�50 REQUIRES 7HE APPIICANT FOR SUCH PERMIT i0 FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS 9F THE CONTRACTORS L4 � CEN3ELAW(CNl1PTER9(COMMENCINaWITHSECilON700C)OFDIYISION30FTHEBUSINESSANDPRO- u" POOVSPB FESSIONSCODE)ORTNATHEORSHEISE%EMPTTHEREFROMAN�THEBASISFORTHEALLEGE�EXEMR (ry V TION,,WVVIOLATIONOFSECTION7031.SBYANVAPPLICANTF'ORAPERMITSU&IECTSTHEAPPUCANTTO Z Re-Rooi � ACIVILPENALTY Of NOT MORE THAN FIVE HUMDRED DIX.LARS(S6o0).): ^ ❑I,ASOWNEROFTHEPROPERTY.ORMYEMP�OVEESWITHWAGESASTHEIRSOLECOMPENSATION, � CDf1'Irt10fC18I ` � WILL DO THE WORK,M!D THE STRUCTURE IS NOT INTEN�ED OR OFFERE�FOR SALE(SEC.70l1,BUSI- _I NESS AND DpOFE3510N5 COOE:THE CONTRACTORS LICENSE LRW COES NOT APPLY TO AN OWNER OF � � PqOPER7YWFp8NLDSORIMPROVESTHEREON,ANDWHODOESSUCHWOFKHIMSELFORHEFlS6LFOq � THHq1GNHI50RHEROWNEMPLOVEES,PROYIDEOTHAT5UCF11MPROVEMENTSARENOTINiENDEDOp m QOFFEHEOFORSALEIF,NOWEVEfl,7HEBUILDINGOflIMPROVEMENTISSOIDWITHINONEVEAfiOFCOAIME- Z �TION,THE OWNER�Bl11LDER WILL HAYE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILO OR � IMPROVE FOfl iHE PURPoSE OF SALE�. �yy ❑I,ASOWNEROF7HEPROVERTV,AMEXCLU&IVELYCAMRACTINCiWITF'L�CENSEDCONTRACTORS � TO C�NSTRUC7 iHE PR0.IECT(SEC,'loN,BUSINESS ANO PROFESSIONS CAOE:THE CONTRACTORS LI- V81U821On _ ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEPOFAPROPEHTYM/MSOBUILDSOHIMPROYES7HEflEON,AND � VN�iOCONTRACTSFORSUCHPRQIEC7SWITHACONTHACTOH�S�LICENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION FEE � TOfiSIICENSE LAWJ. ❑I AM EXEMPT UN�ER SEC.__ B.6 P.C.FOR THIS R�ASON Q � U � u' OA7E OWNER�._ U � W LICENSED CONTRACTpRS DECIARATlON � � w 1 HEREBYAFFIRM UNOEfl PENILLTY OF PEfUURY TNAT I AM UCENSED UNDER PROVISIONS�F CHAPTER � � 9(OOMMENCINCiWITHSECTKKJ )OFD�V�SION�OF'H'eBUSINESSANDPPOFESSIONSCODE,AND z ��� MY UGENSE IS N FULI FOflCE EFFECT. �i � � 0 UCENSE C S LIC.NU. ' !� ' � �kTE ����� ,_ CONTRACTOR � d � �1'�' WORKERS'COMPENSATION DECLARATION ¢ = V � I HEREBY/iFFIRM I/NDEP PENALTY OF PEFJUflV ONE OF THE FOLLOWINC OECLARATIONS: � /� �/ Z C] +Y'• AVFANDWILLMAINTAINhCERTIFICATEOFCONSENTTOSELF-iNSUREFOFWOPKERS' 2 � COMPENSATfON,AS PROVIDED BY SECTION a7oo OF THE UBOR CODE,FOR THE PERFORMANCE 'U F THE WORK FOR WHICH THtS PERMIT I.S ISSl1F.D. � d w � Y HRVE AND'MLL MAINTAIM WOqKERS'COMPENSATION INSURANCE,AS qEQUIqEq BV SECTION /^ Q 37oaO��THEI.A80RCO0E.FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPEPM1T15 ! y"�fA��� � IS5UEO.MY KERS' EqJSA'ION SU�ANJC�tnC 9 ERAN�DcP,O�LICY�r 1UMBERARE: CONSTRUCT�ON "�� -r- � �pR��q �' �i��t"'i i" � (..( ��.1��. PLAN REVIEW O p icv NUMeEa --- ELECTRIC n ����'a�uor.�t7moFniE�sn.rt�sroRoniEia�roaEOD�lta.sK+oo�ai�Ess� PLUMBING ��L _ Z �CER7lFYTHAT IN THE PERFOflMANCE OF THE WORK FOR WHICH THIS PEflM1715 ISSUE�,I MECHANICAL (�j- SHALLNOT£MPLDYANVPERSIXdINANYMANNERSOASTO�ECOMESUBJFCT70THC uJ 4YORKERS'COMPENSATION U1WS OF CALIfOfiNiA,0.N0 AGpEE THAT IF I SH4ULD BE40ME INSPECTION FEE S SUQIECTT07NEWORKERS'COMPENSATIONOROVISIONSOF5ECTION37ooOFTHELABOR ISSUANCE ��-j CO2DE,I�SHALL�..F_ORTNWITHCOMPLY WI1H 7HOSE PR0-41SION5. o �L� ��_JS��y�'�._��_— SMIP p OATE: .4PPLICANT: — , . J ENERGY P/C ��� - � '-""r WARNINQ:FAILURE TO SECURE WYIRKERS'COMPE4SATION CAVERAGE IS UNLAWFUL,AND SFIAILBE LL SUfiIECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINE5l1PTOONEHUNDREDTMOUSAND ENERGYPERMIT DOLURS�5100.000),IN ADOITION TO THE COST OF COMPF.NSATION,DALIAGES AS PROVIDEO FOR IN J SECTION 3708 OF7HE LABOR CODE.INTEFEST,ANO ATTORNEV'S FEES. RETENTION FEE: �� � � CpNSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 NEREBYAFFIHM UNDER PENALTV OF PERJURV iHATTHERE IS A CON57A�CTION LENDING AGENCY � n- FOR'HE PERFORMANCE OF THE WORK FOR WHICH THIS PEfiM1T IS ISSUED(SEC.3 ,CIV.C.j, -------' . ..._..._.�..._..,...._.._.. Z W �,� - ' �� �Z �ENDER'SNAME i F_- LENOEFYSADDFESS _ _ w1 CEflTIFYTHAT I HAVE READ TliIS APGLICATIONAND STATE THATTHE ABOVF INFORMATION!S COPRECT. TOTAL FE�S � � 1 AGREE TO COMPLV WITH ALL CITY ANO COUNTY OR�INANCES ANO STATE LAWS RELATING TO BUILDING ��' � CONSTRUCTION.ANDHGAEBYAUTHORI2EREPRESENTATIVESOFTHISCOUNTYTOENTERUFONTHE Z ABOVE-MEN--_--'�ERTVFORINSPEGTIONPURPOSES. COMMENTS � r � ��s � QPERMITTEE N E(PRIN71 ( � �"'� �` 3IGNATUR PERMITTEE AT� _ '�J RECPT.NO. PAID BY P� VALIDATION ~ WHITE—Department Copy,YELLOW—Flnance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicaM's Copy ���� ��� ��,�.��_��� ��� ������������ �������� � � � � � � �����. �� � �� �. �.. �� �� ����� ,'� �.� � �' �� � �'�, ��g , � �� � � �.� � �^�� ��� �� �,��`� �.' ��` �`����'���.. � �M,�� ��� ���..� ����� �:�� ���� ��..:_ ���. � � � �.A . � � , ,—,� a ; � � � � --��,�� ; � w._ .._ _� _. __ ..._..,...w_.�.��.�..._.____ _. _ ._._... .___._ _ _ _.__. ____ , ;'"�w- �"a e�".?� �r s..c�-:�..�., � . ' . � : . . �. d"�.'.i �' �t *»,. �-�... �_._.._. ---,�-- �..... „g i E S � p � ..... ..,.._ .-...... . ._._.d�._...�...... ..... .......�..... ,. .._ � . ^a .. � _ . . ._._._... .� . ...._ 3 ', '��.. d';L� ^i' �_ a�.. ! . i a..}i�3L. C'" Z¢e.a� i�.;�t - -�* 7 �... k �..� { ._ ._ i...,.._.__..._._..-�.� . . . . .. __ .. _ . ..� .�z -,- . . " r` i f.. :� �..• � i � � � �Et € �t f_� C' �?'";""�(` ,'.F�„�,j .i.... . ' - ........ ,_ ... . .. :........... ".,,., ..... _........... ._-4._...._�___.:.«.. .._._..._ . ....__ . ._._ . � ....,,. ...„.�. .�M.............. .._._.__..._.._., ._..... � _ _.._w.... - .. . � ' �" � �'"'; k - . z� '� � '� p �'" P"�.9c � . .- . . � �.....�^ r�r',� ; - . . E 3€ :-?�$'" �`�9..�.��°i ��,{u � - . y-.......... _......_....�...w.........__..�_.__. ............�.._._._. '..._.m_.___._........_.._..................�-..�.-......_..�. ._..n_.'{.:w_ ......__..�.____�"._�......._�.,.......__,..,...�;:__..__,..,.. :..._..__.! ....,... . ...n ._...._..____.. ....._.._..__. ..{_ F .�_€4 '� �� t� _ � � � . . . � � f`���@ ���, rx"1�4f�ki ��-��;'� I . � ' _. � k . , ._ '. _.._._____'_.._....:.....�..._.�._........_�.�............._.._._._.....__.._—___am._,___.—.—�...........__....,.,,._....,......_._...__" .,�„ ..._ . _...„ ..... ___,. -.._.___ , ( 1 � � �� � I � � �� �", �-�� �`ats"'3 r<c �� _.. �....._ � _ _._. ___. _...._ _. _ _ ¥ �-i.�' .... '.,: � Sa�. - � . , . i �' � �i-�..,�.` �t� 1�x �� . ...._. ._ ._ - �- � :. ...._ ... � ......�....��f .�.m.. ... , .... . ...___ _ —��. - . �.... � p�,Sa a�.§ ,.,-"� �tf;''��*:k¢ °�� . �- iR.se�-� � --=� �-�_e�r�'4� �a g � 5��'.�"€ .. . _ . - �.w„ ,... . .. � ._... .. .. ._ .... . .__ _-- " . - . _. , ._ ........ ...... _ � ' - z t 3� , ,.. � ; .. �. ,, � l �. rx t- .�. � �.. .�... :. ..._.w. .} .._. � � '. £ ' �t � � ._ � F��"�tt`�„6� __ { -�- � - w. �. ....�€� _..��7. � �. _m�,._ ..__ ��. _ �. ___ ; ___._ a ' ."r{C^;..� C ' ,- �„c, ( �{ �, �. ... i € �`�G> �"8 �Wt`�"n �:�" .... _. ...�.. .. ... .. . .. _ � .. �.. ..._�_.[.. .�!y......._. ..�."':......_�....___ .._._-�_..�_._ ._. . - ..-._._�..._-... __.,. i ......_...__...._._. ___.____.........,.w......_.......... .. � � ' Y .� / � F ' ��� :.-'.� E � { � � � .> 4 � �:1 `m t j I'[i,�:k ......_ € d ._ _.,_.... ........... ._ t _ _..� .....�..._.. ..€,.,........._._...,....,____ r . .._.... �„, ' E � � _ �_ j� c� � t ; � a ��a��?_'-€��€'���, � � �� , __- _ .�_ � _ _ �__ __._..... . _.__ _µ__ _. � .. �.�.__....._�_----�� .�._�. ......_ _ M ..�. ,w� {� J. g'T _� m�.� '.�� � .�� � 4'� = F € i � Y"'S. � 7��'$ 4. ��..,1 ( f �.� . ...... . . . .. ____'�,...._....._... ...a.............M....... ....... . . . .... .__. . e..,...-.....,...._......."" . ._...._.. ' ' '_ ��.�, I �5, � _RI E - � � � , � ��'""1 6a }��°..1I„�� . .._._..._.� _ .. .:- �' � � ._ _ ..,."'�"'._._..�_-,.-._._,.._...�.._.....___....e__._..,..__.� �......_... .._......._._.,�w.,.,._.. .....�......_._....�.._._..�.____._.�... � .............. � ...�.»w._._.....,. . _ � .. , . ..„. - �W.� ,>, t b 4 s":s }�, R �la � � � � ' *..- 3 ���i�...3�H�t'`c�3� � � . . - . .,.�. .n.....,....�,....,....._j.........._..�...�.._._..m_.._"_.___....�.... i � ...� ._ ......._..............__..�.�.__......j...,:...._ .._............. P __._ r. 7 __..� .. ,..._._....__ .«. � .,. .__. _ —.._._.��- p;.".� t' .e 7�t $ .Sta._ i � ' �': �..'` �7 ra(d.sd��+ t _ _ : _......_.. _�...��..... ..._�..._��...........__. F._...�.............�..�'--�...,-,..__._.__.............__....r..e..._._._.._..._.:...—..�....,.�.w.._._............_.�.__�...______._._._.,,._..... � 3 � .�...__ . ...._ .. . . _.._,_�. ' ^-� : � � i ._,Y� . .,", �, . � -�-.1 � , �: �t�;t ��::�„� � .._ . ....................._...�.... ..._�....._. _ .....e...._�.._...............__�_�.. .L.�.. .,_.,.,. _....�..+_..........r.._..�____.....�.._..._...�..._._�,...� ......._.. .__'_ _.___._.__..�_. .. _ '�. ,:...°::;'6. G � [ �_`v�*�c ..��`�.... .;�_.iS"„�', 3 . � ,. .� t . , «..... _ ' ��..,..._..--. . . � ._..___ __.,........__. ...._....._.-___"__...____........._._..........m-_...,..�x,_.�...............� ......_._.w,�....._-.,...._......,.�....._..a ......... _ �.v_....-.._.....W�....m...�. _ K rr S 3 � .. � � I I 4 3�`;< �-,I ���3�`^� � � . �_ .__ _...__ ._,_�.�..... .. __.. ..._... _.... . . .__ ' ' � ..__._ _������� 'l�..e`9�__ _ � ' a� � � .. _._. ...._. w �_. _..__ _._._ .�_....._ .,._,___ _. _ � 4 �� � ' 8" .e e. _....-:�... . � O . •�:. .....�..�$. .C-.�. , 8 i 3 ...._—.r..___..._'"'—_ _4.......'__ _....... .___ ... _ __ __ * _ _..._........ _ _ �_..__...._ __..... _ ....�� _._...____.. _ � . . . .,..._.. x x�..� j . . . _ . �.. ....a ., P.� 7 . . . �.,., . .,. ... ......... ......... .....,....._..__._._.....�..... .........._.,._....�__,.....�...._..,..._._...._....,,.. - .._ . ._...._........�......................... �..... ._..._._._�...-...,.......__..' ' '"'.».»..._..,._.......�. ._. . ..�.. _ �.�� :...... i?.+' � °..s 7 �. . � � � '. A4� � ......... . z«_�:., � �.c._. � ____�........._._... _.m ..__._._......._. ..._.......... t.e�.. � � _- . — _...... .�� _...W._� —............._ _'_�� ..`._ _ __� . .......... _�....._... . _ . _ .. � . .'.�...�,J . :...i .i,l� . . �. , ��,: �., � ; : '..... .. .:.._._�....._.�.._._.,......._... ......_.:............... ..,.w_ ..,,.i...,.__�...�.._.......,_._.........._.._............_mJ_.................:......_ew....�.,..__.,....._..�...._.�......... ....,.__�____......:.M.v_-......_ _,... � � � s . . .. ...__.._.......m___�__1...=.�__........ ......�.-: t ) 1 ._. . . .. ._. ' .__... ..._...__. .... .._ . .... ,�. � .. _. . ; �§ � ���§�°'t��t$&H' '8 q,4u.�� � __........ . ... . a_.,.. .............�.._.__�..... '�^��M���!'�.�a's°..��-.•-t .. ,..:. #''�a.4�__ . __...._........._.._ ..___..._.............._....., ......................._.__..._ _ __._..... ...__..._...__...,..._..._.._.........a�... _,. _ : _ ,..._..._. __. ....... . . . �. � ' _ _ . ..,._ ._.. .___,.... '"'....... . �.a : -:-�-.._. . .- �r ��...�._:$�. . -:.:.. .1 _ -.. "� _ t.." _ �._......a._......_.....,..._:...,......._.._....__..._.........._.....-_...,......._d..._............__..._.w,.�.____....._._.._............._.___�____.�_.......___. . ` - e � .�t . ... . � ... ._. � .. .. � � , . . . . '.._____._....�._._ _.__...... .____._.._.,._. ............_......_..._.,..........._...._....., .__.......__._�............�_...._......__._.w. p�..._........ _ _ � .. _ti.......... ..._ ___ ..........._.. a ...... ..._ . ,......_.._._.._ ..................r _.. .....W s ..,..�'. .......,-. _ . .. x � �..._....,......._ . ...........�. ...__...«........__..,._�......................_.....�..,..,_ _._�..,..,.... .._...___....,............,..._.._�...._......-,.._._...._......... ...._............,...._._.. ............ _....._...................._._..._.,......,.,..................._............................__._._ ,�._.._! . j ;..._.�....A._..._.�,...,__._,..._...................___. ...._ _...,...._...... _n..... .,_..... __.......-. ..... ...,,. ,......_ ..� .____..�.._...............,_._.__._...._......_._... ............. ... _......, � . �..._._........n..._..___._....__................. _�.._,.�� .._......._.Y.-.-..,.-.- ....e.,._.,_._..._...,..___._.__......,...........-...__ ._ . . ._..._.__......... _. .... .. _......... _ . , . � . e....�._..__.._ ..................... ?_-.a.. .._.-.v�...........�.�.cc._.... ........._.,..._. . . . .. . , . .. . »� r p „ . . . e . . . . .. . � .i .. � . �...._.T_ __.._.... � . _ . .__ ...._...�, ._ ____. _.._......._.. __. _ "_—_� _'_'�._ �.,.-. __.. _._..� __"T, '_ -. S .-s-- .,�,.. s.:' Y�i � -.... . . . . ,. . .... '. ' . . . . .... ., .. ..� • , ...._. . .. .:.. , ro...;. 4:. ; . . . . . . ._._.._.....�_..�� ... . " . ' : �a .^� ^ ...__..........._.._._.......w... .......__�_w.._.....���...._....... ' � ..�,::� ?" 4 :"i..,.',..&w ._...._.., .____._.._..,._.__.... .._ ___ . ._........ _...___....____ .. ._........_... . � Pv.r'z..,,_.. �@ n. ......................._ ........ ....... .. ............. , �'M $d�" �} m.3�$:,�4.1`�� '�"�� .. , a � �..�, �a. �'� �_ �'a'��:�` � .....� . . . .... . . ..... . . , _. . . . .. _.._ �. . ��`���a����`���������� ��§�� . _._ .. __ _ _ � � ,r.?�:a���������� ��'��:� a � .... . ... _.. . ... .. .... . . � � � � � _ ..... � __... ._ „� �,.._ � ������� ��� �� � � �,����r,� r �.��� �.� ����� �������'����#� __ _..._ _ .... _____ _ .__ _.. __ ._.__ __... _� � � e� �� _ � �� �� -��� � ��� � �� � � � �_ _ -- ������������ ���� ���" _ _ ._ _. �,.d� �;��������� �"�§�„���"�, ::; _._ _ _ � �,�,� ��r��� �������,� , me. .__.�. _._.. .�..__._ . __. ..a.� ._.._._ �._ . ,.....__ __._ __.,_ ______.�_..... ._. ....._ _. . ._....._ ___._... _ ": � � _� . E �,`�� ���� �������r � € _.f k �- �t` � :� .r £� � 3 ...�. �. �.,._.�r.��.:: a�r,�:,�.,,. -__m....�.a_.._ ......._.__.. r___:.. . _,_..�........._ .......�_.._�.......___._._.._._.._......_._..,... .......... ....__._...._.._........ . Y