Loading...
HomeMy WebLinkAbout16501 (23) _��,,�� CITY OF DIAMOND BAR ,/�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES l.._`�/ w 21660 E.Copley Drive Suite 190 (909)860-3195 Faa(909)861-3117 PR ESS �"�� BUII.DING PERMIT APPLICATION FIRMLY � JOBSITE �_���� �� � DATE � � �V�� NUMBEA �� � # APPLICATION PERMIT P/C � ADDRESS � ISSUE TYPE OCC APN LOT RACT DATE CONST. GROUP p OWNER .�.- p ADDRESS ZONING SETBACKS � CITY _ ZI���--TEL. REAR RW ❑ APP 1 ANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE ADDRESS � CITY ZIP TEL. PROPOSED USE � l� o ARCH/ENGJ � DESIGNER NO.DWEL. NO. NO. ADDRESS CI Z�R TE . UNITS STORIES BEDROOMS � - _ tn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATIDN Q OWNER-BUILDER DECLARATfON SFR/ADD/REM O Q I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AIA EXEMPT FROM THE CON7qACTORS LI- G2fege/CdIpOR W CENSEUWFORTHEFOLIOWINGREASON�SEC.7031.5BUSINE5SANOPROFESSIONSCODE:ANYCITVOR (n V COUNTYNMICHREW{RESAPERMITTOCONSTRl1CLALTER.IMPROVE.DEMOLISH,ORREPAIRANY57RUG W pySlO/DBCk Z TURE,PHIOR TO ITS ISSl1ANCE,ALSO REaUIRES THE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED W STATEMEM THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTHACTORS LI- W � CENSE LAW(�PTER 0(COAIMENCINO WITH SECTION 9000)OF�IVISION 30F THE BUSINESS AND PR6 LL' PoOUSp& FESSpNSCOOE�ORTHATHEORSHGISE%EMPTTHEflEFROMANOTNEBASISFORTHEALLEOEOEKEMP- � TKKi.ANYVIOUTIONOF3ECTION7031,6BYANVAPPLICANTFOPAPERMITSUBJECTSTHEAPPLICAHTTO Z Re-Roof � A CIVIL�ENALT/OF NOTMORE THqN FIVE NUNDRED DOlLARS�S5o0).�: ❑1,11SOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTMEIRSOLECOMPENSAiION, C� COlfIR18fC18I g VALL 00 THE WORK,AND THE STRUCTURE IS NOT IMTBJOED OFl OFFERED FDR SALE(SEC.7041,BU51- J � NESS AND VROFESSIONS CODE:TNE CANTRACTORS LICENSE LAW DOES NOT APPLV YO AN OWNER OF = PROPERTV WHO BUIIDS OR MPpOVES THEREON.ANO WHO DOES SUCH WORK HIMSELF OF HERSELF DR CC THROUGH HIS OR HERONM EMPLOYEES,PROVIDEO hiAT5l1CH IMPROVEMENTS ARE NOT INTENOED OH m � OfFEREDFORSILEIF,FbWEVER'�1'�EBUILDINGORIMPROVFMENTISSOL'JWITHINQ4EVEAROFCOMPLE- ' ' ' '"'"L ' '""tr � TION,THE OWNEF�BUILDER VYILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR � IMPROVEFOHTHEPURPOSEOFS/LLE�. - W ❑i,ASOWNEROFhIEPROPER?Y,AMEXCLUSNEIVCANTMCTINGWITtILVCENSEDCONTRACTOq3 � [[ TO CONSTRUCT TME PR0.IECT(SEC.7oN,BUSINE55 AND PROFESSI6N5 CO�E:THE CONTRACTORS LI- V2.IU8�100 ADJ.AREA W CENSELAWDOESNOTAPPLYTOAfdOWNEROFAPROP[RTVWHOPUILDSORIMPRO4ESTHEflEON,AND — � Yh1000NTRACT5FOR5UCHPROJECTSWITHACONTRACTOR(5)LICENSEDPUPSUANTTO7HEC6NTRAG QUANTITY DESCRIPTION FEE Y TORSLICENSEUW.). g ❑I M1 EXEIAPT UNDER SE,C. _,__ B.R P.G F�R THIS REAS6N J U 3 � � DATE _ OWNER_ U � UCENSED CONTRACTORS DECIJtiRATION W � I HEqEBY AFFIRM UN�ER PENALTY OF PENURY TNAT 1 AM LICENSED UNDER PROVISIOtJS OF CHAP'ER � '"l � Y(COMMENCINO WITH SECTION 7000)Of DIVISION 3 OF tHE�USINESS ANG PROFESSIONS CODE,ANO z �� �+�� MY LICENSE IS M FULL FORCE D[PFECL -�+ m -�Z���R�/ G.� � � LICENSE CLASS LIC.NO. //��� _ � V �ATE � "`� CONTRAGTOF� �- -- — WORK�RS'COMPENSATION DECLARATIGN� � � d � 1 NEHE AFFlRM IINDEH PENALTV OF PERJl1RV ONE OF THE FOLLOWING DECLARATI�NS: Z � IHAVEAMDWILIMpIN7AINACF_qTIFlCATEOFCANSEN7TOSELF-INSUREFORWOFKERS' _ Q COMPEfVSATION,AS PflOViDED BY SEGTION ai000F THE LABOR CODE,FOR THE VERFOfiMANCE �U F THE WORK FOR WHICH THIS PERMIT IS ISSVE0. � LL� � IHAVEANDWILI.MAIMAINWORKERS'COMPENSATION�NSURANCE,ASREQUIREDBVSECTpN O37o00FTHE:A60FtCODE,F6RTHEPERFORMANCEOFTHEWORKFORWHICHTHISP MITIS � RSUED.MY WOi S'CUMPEN.;471�0.N INS�UR/W^CE CARRIERANO POLICY NUMBE CONSTRUCTION �j CARFlIEN ��c.� F�.. _._ PLAN REVIEW p� ro���c-v`Nunne � ELECTRIC '��j�'"�� �(iNISS=-cfi�N�� TeEmMt�EfED Tt-"_vEfUM wH1��E�DOLLaas(S1ao)ORLEss>. PLUMBING _ `I � �� ,Z I CERTIFYTMAT IN TH£PERFORMANCE OF THE WQFlN.FOft WMICH THIS PERMIT IS ISSUED,I MECHANICA� _ (!j SHALLN�I EM?t,OY ANY PERSON If.�IWY MANNEft 50 AS TO BECOME S'JBJEL'T TO THE � WORKERS'COMPENSATION�AWS CF CALIFORNiq AND AGFEF.THAT IF I SHOULD BECOME INSPECTION FEE � SUBJECT TO THE WpRKERS'CAMPENSATION FHOVISIONS OF SECTIIXJ 370o F'HE LABOR �� `--�f\ — CODE.ISHALLFOR7HWI?HCOM➢LYWITHTHO ROVISIONS. ISSUANCE ��bJ � �7� � �, � �� SMIP p DATE:���!L�,�L/APPLICANT: _ � "'. �ry J WARNING;FAILVqE TO SECUFE WORKERS'COMPENSATION COYERAGE IS UNLAWFUL,ANO SHALL BE ENERGY P/C � SU&IECTANEMPIOYERTOCRIMINALPENALTIESAN�CIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT WLLAR51S100.0001.IN A�DITION TO THE COST OF COMPENSA710N,DAMAGES AS PROVIOED FOA IN -- � SECTION 37oe OF TNE UBOR CO�E,INTEREST,AND ATTORNENS FEES. RETENTION FEE: pW. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEREBYAFFIRMUNDERPENALTYOfPERJUHYTHATTHEREISACANSTRUCTIONLEN0INGAGENCY �- FORTHEPERFORMANCEOFiHEWORKF�ORf.WHIC///FFFj��/RHHilSP RMITISISSUEO( C.30W,CIV.C.). . . � LEN�ER'SNAME��IV/���� � 1_ LEN�EWSADpRESS_ � TOTAL FEES � ,��� � ICEFTIFYTHAiIHAVEREADTHISAPPLICATIONANOSTATETHATiNEABOVEINFORMATIONISCORPECT. W I AGREETO COMPLY WITH ALL CI7V AND COUNTY OR�INANCES AND STATE LAWS RELATING TO BIJILDMG � CANSTRUC710N,AND HEREBYAUTHORIZE REP ESEN7A71VES OF 7HIS COUN7Y TO EN7ER UPON THE �" Z 0.BOVE�MEN710NED GROPERTY FOR INSPE 71 PUFPOSES. COMMENTS o �w�� � ��'1' �'S" _ m PERMITTEE E(PRINT) _ � //' � ' � �f' ,+-�."' +f:" � SIG RMITTEE � � DAT� '- = RECPT.NO. PAID BY VALIDATION ~ WHITE—De artment Co YELLOW--Finance Co PINK—Assessor Co GOIAENROD�--File Co GREEN— IicanPs Co P PY. VY� PY. GY� APP PY .,. .r� .�-,.,.i.: . .:,. .,,;q... ...,. .:..,.. .,.. ,, .�. {y ... . . . ., y iT 'J . .. . � , . �.... .. , t,,.:.�',,. �. .....:.,. ,.. ... '- � ��� � 3J�F���s..J 'k� , ;�. ., ���� ����� �'a���� . . .-.. ,. ., . .. . �. � �`� �.`� � � s � � � ��� � � � X �� � ��'' �, ,��� , , „ � ,�: k� �^;�^� � ,�^� . _. .�'�' � .. � �meA .�_�-� � ,_ . . „ � .;.. Y �� .�� � p5 °'#�� f3',r-'�. ��� � � . ' � C LSJL.+"�S .Slss�� i ' � - ! .. ..� ... .. k_ . _. _..._._.............�..,,.........-._.__._._.� .. . .._..._.._._.: �.a..... —,�_—} .�.. .. . .,.. .. a � d"T..J"'.3`„'r��i���t���.�?.. �[ .. � ��i`r�����,t�P�r� . , .; . .. - ' "3 �y _ .... ._.,... ..,_ ....__ .._. .. _....._.._....�...................._ d � .�._. ......,._.,,_ ...�___._��.......... . � . .._ .......... : �' ��.`I�i� .:�`�.g�!� �_._ -�-. .. � ` ;��'�1�( -' ��`�"'� �'�.at�;?_ _ _ _. . �_ _ � _. _.. ___ _ �______� _ _4.__ � ^ r!-ti�;,. r�� � �� �,�. � � �; �i�`�tg 1: '����� i,[`��`,',1�' .��. t� � a ____.._.�.._...._ � __ �—~~- ____t._� ._ _�___w _ _ _.__ ._�....�... �~aB:.��`' c r�h,�" . ' � . . . 3 ! i l�P��€ �iL� ��.s``..r9��se� ?'i°��i�� _� �:......__ ._.,.._......__..,.�... ...__._.. 9 § - - �._...� —..�...�.�. �_. �_. ....�.�. ...�.... �€�-�,�s �r-,�.r � ,w r�FF'?_tg� �t��=�.����f��r� 4� ___w_._ __�.__._ - _ _. .. . ._.� _.... --- .._..._ ..�.___ ' �rl,=_����' ����,o� � � i �����;e�", �''sr.�r� a� s,� E I�._�_. �_.._�.._ ._.._.._��_._._ �_���._..... .��. � .;._ , . _ ___w._�._.._..____. �_�-._.w.._.�.__ __.M___w_._.___._�._.____.__ ._ __�_---___ _ � ___�. �� ; i t�.,�`a��� �t-����` �z6� � . _ �-_..___ � ���" �"s�°�z��' �ai� _� w _ ` A_�._._�.�____r _... t ._._.... ------- . __._. .. � c,��P�,�€�.1L� A3 s t� ��''"?�3 a � �... ''�C'€ ���.'���`' ��f��� � � � - � _...__ _....__. ___�. �._.__ ... _.�� �._._-- �� �i�r e� � . �� I � s �tt` 4"����� ___;_� .._._ . �____ .____.._ � � : _� _._ _. ____._ _._____ ___,_�.__� '��;�'�-rl-'S-t�' �'��a 4 � ���i�i�€���a � � �.,e, _ -- ___ _-- ---�_._ _ ;-- ��.��ta�$ '' _F�c '"�l� 3 � �nt�a4:f��1'���1 � _. �__.____. __ .._...�.._�__ ._. ._ . .., � _ _ _._._.__ _._,_____�..___.�..__..__ __ _ _�.�__....._ ._ _�__... ���sz� af8 - �� C'�iPj�3R€a� _. � ___ ._..,..._...._.__ � � %-�l"��� � t,.: '�.?..lq��.{� �,. { -.........._w_.._ ��� _.............__ .._.... � .. '�.. ..._.. � __�._ �. ._..._.. .__ . . _..__�.._.�.. . j,.___ � ��?C"�aa�`e t""` '� �c.°�� = i i 2�``�''�': �1_ �'�"}�3C � _✓ _�_._. __ ________��__�_____.. .____ ____...��._.w. __ _.___.__ ___._�. ._ _. _..._�_�____ � � � _._ __,.. __ _--- �i � r{ � ��`�t . ? � i F'�`�� ����.,;I��-; I � 4 ......_ _. . ..........._ .. �_�__'._�.., >_ ��,..'� .,_� . �_.... �..._.....��_._..,..m.. ' 9 ...„�-....�_ ....__.._ .__ . �����.�E a "�. €6 i¢''t��� � j F , ��`�����a�il i .. . . . ...� � . �_ ._. _.__. � __.�....�._______..___........_.__.._-----.....--.�---,-_� ....._._ ._�. �.„�,. _ ...3 ��'�9 'i�" -�% .�€ �g g�i�,c � . .. � .. � '. �s5'"�. � A s� �k1�' �. � �. � . �..�.. ..._. .m....__...._��,.._� �.. . ._�...__.._.._. ..e.. � � � _ . ...... ------ ----r.__._....._.�__ ......_ . _. .. . ..�_.! s n {t A�� . �^. . I . �„,,, r��.,,,.���� � �.. � ! � ' ���t t 4..� 'I�k.-,a i 9. ....5 � • �_._ ___ .._w___�__ ? ..n.. e..._.___.- . �.. .. y _.__._.._ _ .-..._..___..._._ .. _._ .,,... ...._. ..._._. ���r'i � __ i Q�..Cb �. _ -- � `e���a� �� (� � � � � � �_______ __�e f�_.._��.. _.__...�..�._..,...__ ._ .� .. _..._.�_�__v._.._. �__._ __. ._._ r, ;� . i ", - � � �+-���'.`t � i . t_a��m �n��� ��� � a ._.,,---;,----- ! . __�._ _ _ ._._.-��.__m__ _._._....__ � _....,_...._ _. _.__ .._ _ ......_._. T . .....E r °-x . � j E L�' �G._�����_ � � __:_. :�_...._.._,....._....._a...e.____"_._ �- ... . ._._ _..m...._......_.�_..� � ._......__...,....._.._._.._.,...._____�.. .____._.__ � wa.`:^ s,.�s�' � € s=� sa s�� ��.., ; C __ _.Uw..m___�__.� z._ �:_..___.__�. .«�__ _ z____ __...._ _ .. ......_.__ .... ..._. a ! - _Y :.,,� T , j € �.t c.�C c r(:�� �." ,��`�-, _. _ ....�.�.... � .. �+--_�_.........� . _ ___.__ . .,___.. . . .. . _.._._T. ...... . ,': "t i V�8 . . � . i � � `��.,t . ,s`� d '�S e'u-�q� _ ....,. ..,... . _ _ _... ............�...._._....�....,e..._m� � _.,...�__.._..._ . �.� . -.-....... _.�_�.�..._k�. ..� ._.., % :.i� €'1 ��. �.�.. ( � . �y��'V. f�'�'-� �z�.�.�1 - .[ a .._. _... ..,....�.._....._.�.._..__� ..___..__...e..�._�.� _. -C--.i__._ . . ,. ....�....__._.__.....,,_.___._ _.......... ._�.___._.....,._.�! .__.............�...__ ......... . . ,_..,.....g �. � �", _ _. . j .-' ��..�"�...� �$. ... � �w�: ����� � . � . _ t... � .. . . . .,,.. --..._.._..__. __�.___..__.__. ... . _ _ . _ ..,...._ . .. _ � � 3- .. . . "__ _..__.._.. ;__e_.....m.m.._ �.,...._�.w_._._...._.._ . .__._. k �r�a re .�. ..... .._._.......... . _i .. . .. . E . : � I t�,.. '� .i ��Sa `" .' �'�' '.. � j ....._.___.._......_._.�...._.._ _...._.._,._.�.�_.�__...,,..J.....��._......_��_ s... .�,e��'" ...��.. �#�"a�� .c.,��. . �: „ ..._ __....... _�._._...... . ...... . � . , _._.._. i ,._-. . . � - ,_�•�..u�,, s ,�� . _ . �..t :. . � ~- s. , t: - - .. � � +0�sv.�; ���a� .4'^�r•4.d8 . .. . . f � � w k ,..<e� d �, 7 �... a '3 ..._.,.�.,...____.._.'_....�. _..._�______..._._.,_........�__. ��._._..._. ......._ .�J,., ..�__..___._.�.__.._.�.�...____m_.__._�._._ ....__..,_ .�. .....»......,.-__ _......_.�.....� ; > q'�..........._........�.,.__._..........._.......-..._....__._......................�.......__.__...�......__.........,..,.,........... ._____.__....,......,........_�......,,.�....,,,..........._..._,...w.._..__.._._._ ._"_'... .... . ...__....,. ..�_...___._.........,............._...._..�.�......._.�._.�._.._._.� .. ..........� 1 � +___`...�-.........._............................rv._-,...._..,_.____..T...___._,.__ ."__._.___.—.__"_' _.__._'__'""___.__ ._........... ................,.....__.,_.,...._.._..._.__'_.__. ___.."_..._ ._........... .. .. ..... ...,_-_.,__ ..____..__.'i i j u! l_..._.�..,._._._....,....... ._...._._.�«_.............._�...__._.._..,..»...�.__...___�_._.__....._.._.,....e._.__w.___...__._._..,..__.__......�..,......._._.._....._...m - . ... .. .d { ...._._"�""�"_�_____._....._.._ ._................ .......... ........ f . . - _' _ . ' ' ' _ C '� ...............__�_.�...._._.._�...._._.,......_�..m...,....................,�.,._._..._.....,...._.. ._...,._..�...___ . � . ' �'..�.......w..._...�......._�...�.,.._.r.._..... ..,.... ...�,._____.. . . ..........�..�__ _._.i_. �;_..._...,.........._.�.__.._ ;...._..._._.. ..,._.__. .,. ._. _ . ._. ,. _ . � � � � . . I . . . . � . � ...... f �.,...............,,.....e.......____.............�.__._...._.....__�_._......____..,_..�...,,..._,. ._.__._.. _._.._'."_.._... _.._�.__ ..._.._.._...... ........._........_....�_..,.._.._.,...._ __............__._........_.......,...__._....................._..._�.._...._.._......._...,,.... ': ...._......._.,.,..._.__......_ ___-._.......� � f .,.._�_«.. ... ,.. _.._..._.�_� �mm_.m»....._... �_:_:_..._ m. ._.�..____�.«_..... .. ...w..e«.. ..... . _......._,i _____.. �.._.w_.�.._......._._ . `s �_.____ _._.____-___.�.._..__.___-._.___ .._....�_........__�_._.____._._______..---..................__.._-------._..... ...._,._�_-___ � _,_.._.._..___ _.....� _.. ....._.. _..__� �__,_ .n.d. , , . ff i � .._ ._— __._. . �,_._ _� ____.__��____._._..,_......... ._...u......_.M...._......_._�,._.,�._.___�_.__._,._.._._:...._� ° ___._.< ____.__.._s §.,�-�^^� � . . - . � . . . . . . . . 3 ga.:i.i.-.f"' sGs C.sR s4�.°, ...p.s .. ..... , ......,__ . .. . i ......-.._. ; >,,.;"� .; � S rr ..._..._.._.....,_.._...__._.__. . ..._.__.....�...�._...._..�_.__._._. .......__.__.__.._...._.__._. ... ..._....... ........._...,...... ......_...,...._.. ...:._:..:,._..._ ...____._......_..._..........._... ..'"'..... @ '='i:,;%.. �e:{w�' :?s�,.w ....... . 3 � � ........�....v�.,.�. . . .... .� . , .: _... . ._. . .............. .......� ....... ...... . ._,._ ..._ .. .. . � � � �� � _ , ti a. � �� ; , k, � �� : " ;� _ _.______�__._________.._�..�._.�..._._.._._.__�._ .........w__ _.._.,_ ___..._�.._._._._�� .�.._._ ..__.._____..,_ ...._.. _._ ..._.. 3 �� � �� �� " & � � "�'� �� _... ....... ...._ .._-__ __....... __..___._ .._..... �� � �� �� -__......,.___ Y . _.__ __ ___._. _____ __.._ ; �} � ��� � �� ...________ -— _ .. ..______ ._. . ___..._� �._____.._.---3 � � �„ � �5;���a� ,�,.. ___ __.m__.__.__ __.m____._ ; � � � � � �� � $3� �,� ----_ Y_..__._m.m ..�..__ _._. _.._. ._. .............._�._._..e_._.__._._....- . -... � .. _�..__... .. ....... _.... .. ._____ � � ��� � �. ��� F _._ . __ . _ _ � ,;e � �, �:. � �._...._..._�_,_� ..�.__��e._..�...... _______-___ .._.�._. _..___. _____ __..._. . . __ ___.___.__...._ ___� �. � x �� �� . ,.:. � � �.,g� .> ��� __.__. .._w.�w._� .. _._ _