HomeMy WebLinkAbout12169 _ 1�� CITY OF DIAMOND BAR
. DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
216b0 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 � ��� PRESS
"*" BUILDING PERMIT APPLICATION FIRMLY
�� JOBSITE !!��►�% �. �I�r J ��r�� APPLICATION� � 7 PERMff� I/�� P/C
ADDRESS t� � v 4— G • � DATE �A' � NUMBER a-•✓1 1��� #
$ ISSUE E ' TYPE OCC
APN LOT RACT DATE CONST. GROUP
� OWNER
O —
� ADDRESS /' � ZONING SETBACKS
� CITY ZIP - TEL. '� FRONT Ry1/ ❑ __
APPLICANT TEL. REAR ❑____
� SIDElSICE STREET RW ❑ __
� COtdTRACTO SIDE ___ ❑___.,____
� ADDRESS
� CITY ZIP TEL. PROPOSED USE
w ARCHlENG �
z DESIGNER — —
W — NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� � CITY ZIP TEL.
<n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I HEREBV AFFIRM UNDER PENALTY OF PERJUHY THAT I AM EXEMPT FROM THE CONTMCTORS LI� GHf898/CBfPOfi
» W CENSELAWPORTHEFOLI.OWINGRE0.SON(SEC.7031.581J51NESSANOPROfESSIONSCADE:ANYCITYOR (n
� C.) COl1NTVNMICIiREWIHESAPERMRTOCON5TRIICT,ALTER,IMPROVE.OEIAOLISH,ORREPAIqANY57AUG �J,f pgI10/DQCI(
W TUflE,PRIOfl TO IT6 ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PEFMIT TO FILE A SIGNED W
SiATEMENT TMqT ME OR SFIE IS LICENSED PURSUANT TO TME PROVISIONS OF TME CONTRRCTOflS LI-
� CENSE UW(CHAPTEH B(COMMENCINO WITH SECTIDN 7000)OF DIVISION 90F THE 61151NES5 AND PR0- V' POOVSP3 —
�� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTH[flEFflOMANUTHEBASISFOflTHEALLEGEDEXEMP- (�
V TKKtl.ANYVIOLqTIONOFSECTION7o31.5BYANYAPPLICANTFORAPERMITSUfUECTSTHF.APPLICANTTO Z Re-Roof
� ACIViLPENALTYOFNOTMORE7HANFNEHUNOREDDOLLARSIS500).):
� UI,AS0Y4NEROFTHEPROPEiiN,OqMVEIAPIOYEESWITHWACESASTHEIRSOLFCAMPENSATION, 0 COfiIfflBfCi81
YIILL 00 iHE riK7RK�ND TME STHUCTURE IS NO7 INTENDED OR OFfEREO FOR SALE(SEC.70M,BU51- J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWMEH OP ?
PqOPERTY WHO BUILAS OP IAiPROVES THEFF.ON,AND WHO OOES Sl1CH WORK HIMSFLF OR HEHSELF OR
� 7Hq0UpH11150RHEROWNEMPLOYEES,PROVIDEDTHA7SUCHIMPROVEMENTSM1FENOTINTENDEDOR m
O ,OFFERE�WRSALEIFHOWEVEfl,iHEBUIIDINGORIMPftOVEMENTISSOLDWITHINONEYEAROFCAMPLE-
Z TION,7HE OWNERAUILDER WILL MAVE THE AUflDEN OF PROYING THAi HF OR SHE OI�NOT BUILO OR
� IMPROVEFOftTHEPURPO5EOF5ALE�.
W C71,ASOWNEROFTHEPROPEHTY,AMEXCIUSNELVCANTRACTINGWITHLICENSEDCAMflACTOqS
� TO CONSTRUCT TH[PRQIECT(SEC.7W<,BUSINESS AN�PROfES510N5 CADE THE CANTRACTORS LI- V8I11£111011 ADJ.AREA________.._._,__
WS CEN&EUWDOESNOTAPPLYTOPNOWNEROFAPROPERTYWH00UILDSORIMPROVESTHEREON,AND -
F WFIOCONTMCTSFORSUCHPR0.IECTSWITHACONTflACTOR(5)LICENSEDPURSUANTTOTMECANTRFG QUANTITY DESCHIPTIDN FEE
� 7DNSLICENSEUW.).
u 1 AM EXEMYTUNDER SEC._______,_______,_ B.8 P.C,fOR THIS REASON Q
� —_--- _'_ ---__'__"_ U
!t_ �
�ATE ONMER U
W
O LICENSED CONTRACTOAS DECLARATION W �
� � ._.�._ �r '�
I HEREBV AFFIN/A IIN�ER PENALTY OF PE0.1l1RYTHAT 1AM LICENSED UNDEfl PROVISIONS 0F CHAPTER � ' / ' �
�Q� 8(COMMENqNf3 YYI7N SECTION 7000)OF DIV1510N 90F THe BU5INESS AND PHOFESSIONS COUE,ANU /'
X MYLICENSE IS IN FULL FORCEAM1D EFFLCT.
lL .�'° �
0 LICENSEC�6p��� LIC.NO. �
� x J
V DATE__,y CONTRACTOR d
W
� WORKERS'GOMPENSA710N DECLARATION a
� IHEREBYAFFIRMUNDERPENALNOFPERIURYONEOFTHEFOLLOWINGOEGUflATIONS. �
vj Z
Q
� IHAVEANDWILIMAM1�TAINACEHTiFIChTEOFCONSENTTOSELF-INSUHEFORYIOHKEfiS' �
� COMPENSATKKJ,ASPHOVIDEDBYSECTION37000FTHELA90FCWE.FOPTHEPERFORMANCF W
n� OF THE WOFK FOR WHICH THIS PERMIT 19155UED. �
� .A. IHAYEANDWILLMAINrA44WORKERS'COMPENSATIONINSURANCE,ASREOUIFEDBVSECTION
� 7T 37000FTHELABORCOOE,FORTHEPERWRMANCEOFTHEWORKFORWHICHTHISPERMITIS
0 ISSUED.MY WOP ERS,�'ryCO PEN ATION INSURANCE CARRIER I POUCY NUMOEfl ARE: CONSTRUCTION
J __—__..... _
� CARRIER (! � �� PLANREVIEW ----,------.--.--
� VOLICVNl1A18EN EIECTRIC j( J-�gf}�
� (MISSECTpNhE�NDTBE00A1P1E7E�OFTVEPEP1JnISfOi1�NEMMAiEDDOL1Ni5(St0010RLESS). PLUMBING _ __._—"'—�° '� �✓
Z ICER7IFYTHATINTHEPEHFORMANCEOFTHEWORKfORWHICHTHISPEFiMITISISSUEO,I MECHANICAL � .._____.___-�____,
('}' SHALLNOT EMPLOYANY PERSON IN ANY MANN[R SOAS TO BECOM[SIJBJF.CTTO THF
�(n WOFKEHSCOMPENSATIONLAWSOFCALIf-ORNIA,ANDAGREETHATIFISHOULOBECOME INSPECTIONFEE __ __.___ ,��" ej.�
� r Sll&IEC770THEWORKEHS'COMPENSATIONPROVISIONSOFSECTION370DOFTHELABOR �f/�
� �,DE, SHALL FO THWITH COMPLV WI7H THOS'���P/r�JnS N5. ISSUANCE ,,.,____. ___�_G % a/ _
�� �� :�/ //����. SMIP
�p DATE: AP%.ICANT: __� s --�-� '—"��-�---�
�' ENERGY P/C ---,--.- -,-,---
� WAPNING: AILURE To SECURE WOFKERS'COMPENSATION COYERAGE IS UNLAWFUL.AND SHALlOE
'�" SUBJECTANEMPLOYERTOCFiIMINALPENAITIESANOCIVILfINESUPTUONEHUNDPEDTHOUSAND ENERGYPERMIT
DOLLARS�570o.a0o).�N ADDITION TO TiE COSTOF COMPENSATION,DAMAGES AS PROVIDEU FOR IN — --�-----�-- ------�---�--
J SECTION3]oBOFTH[�ABOfiCO�E,INTEREST.AN[7ATTOHNFV'SFEES. RETENTIONFEE:
�. _"'_"--__'_"_'—
O CONSTRUCTIDN LENDING AGENCY PHE-ALT FEE: �� __ � +°'�T,
r� '�
;� I HEREBY AFFIRM UNDER PLNFLTY OF PEflJUHY THATTHERE IS AGONSTflUCTION LENDING AGLNCY f d ____
FORTHE PERFORMANCE OFTHE wORK fOR WHICH THIS PEHMIT IS ISSUED(SGC,3097,CIV.C.).
Z �
W
:�• LENDER'SNAME _ ._'___ __ �'_' _ _ __"__
_"�i
F— LENDER'S1D�RE55___ _._—__._--_--
�� ICERTIFYTHATIHAYEREADTMISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORflECT. TOTAL FEES
W I AGREETO COMPLY WITHALL CIN AND COUNTY ORDINANCESANU STATE LAWS RELATING T06UILOING
� CONSTRUCTION.ANDNEREBYAUTHORRfFEPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE //
� RDOVE-MEMIONEDPROPERNFORINSPECTIONPUHPOSES. _ _ 6�F\a��.
Z� COMMENTS � a ur
�� �� `;-��
m ---
� PERMITTEEN NT �,�,...y. )' � _""
� �J4 1
} �� .
SIGNA7UtiEOFPERMIT�E �DA7E �� �j �� �� /
= RECPT.NO. '" /,�.—PAID BY __�4.:' VALI�ATION_,
' ~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
.�.,.._.;. .i__. . (- ( I 'i ` i ii.�,
' t F€ , . . i . �t i �. . . ( �
� �)�k�f�,. k ..� i i `Y �`., ` ri��
�S L k d3 ,�, �'1 '
t3c"d
� ��1 ¥_��.i Y� Y' . i . . - _ I I. r i i' _ ! � i I € °�
P� y i� �t . I ' . . k.�, i _ I y I 3 � ' 6s
i �� � � ' � � ; �, 3, .
`E�x t�� m .f� a a _ - � i�� �,,
4 i� i . ; — ' '' i -�� i M1� �
�� t3g1Y �� t � � • ( ,. I . � d � '
� ',
k 4l # .�' � � I , � 1 �Y
� i�����'�8��4���e ar� ��r a . `'�� - i � � ' , . � � � � � � � � ( � � � ��.,, .��
a .s�i,5 s s'an s a, . I � � � � i
' �5t' S t �� -9�# e �. ', � � j � � � . ' � ..i .{ � � ,,_� _ � i _ ; ,... "s�'�-�i�
t �
�4� �y f }� -_-. .._ . ,. __. ,
, . , , :. � � ' , '� ; . � I , �� � , i , �,.
. � � . � . � � � - � G , �
.
' .
, : f �., .i .� , � . . �. ' i . . i � i ,
1
�
,
. � � , ,� ' . t . . . . �s..
. �- � . , . : ..,__'_ . ,'_
, , . , ; ; ,
j . i
; , , ,
;
�.
,
� � , , , ,
, , ;
„ , � , , , ;
,
� , , , , , f
1 ; • � i � i ; � i �x.
. . . , . � .i � I
E r '. i t i i { ' i i ' � . . � Y � � - . . " � ' ,. i .t
� I
� '
f I � ( � �. I 4 I..
. . . ' ' i I . ' � . `, i � . _ f � � ; � i � ' � • ' a �' ,:
, i j ' ' ? � ; � � � ! � � � � i j i i I � j �' 7D.. � �j
,
� ; � � I � j � ` � � ( I � ( I � � � � I . ' "���r� �, �'
,
� � j � ' � ! ��' � .�
; , a I i i
� � � i , � i < < i . � . _� � _�. r - � r -- -I ' '�' �, .
� '
' I ; � I i { j � .'� I ti ' .. '�� f -f� r �M
1 � i
� j ,. � � � T
I _ � ' • 1 � I � �i � 7) :� .� � ��f i �_ a� ( i } � f � �^ � .
.� I i `l �>
� i : ; . , i I "-� � .I i E i���G� �I. " i �.i � � a'�'�a� $ -ae
t i � � � ���a �� �i � �� � ���_:� i. � rr , � � ��^i ''� Y,;'
; � ,. ` I I .. ,r-.I'' � I , r ' ( )- 3 ��` � '� ,
� i ' ' � , ��3 ��' ' I I{- �� � �
' �1 ��' ' r I.. ��� V.� I� �� '7 �� � I��( �� �s„� ��f �
i � C:
, � , ` i i i, . . ( � ( ' � - �7'` i -� ' ( � x.'�� �,
� - � I I i� ' ' � "'�'�.� '� �� � . . . �`- �-.� �z �i!t �.. � ��' � M,
� ; f ' I (. ' ! 2�� `� , i I � '_ I �.�n t 4 s. . �f
� � � i f I i � � �"�� � `• ' � � : � I :"}� I i � s
i i . , I ; ; � �
+ � � : G ; i i I I. . : ' �YR" __ - ....'" _'," '� I I - ^ r
:
� i
i � � : i l.___ `
�
E f i
: � f ,, k � , f : ,- i ; I . ; ,.. � " .
� . .
. t .
I �
E � � � . , � � � � : , a ( � , � ' ' � I r � ( �'"�
, , . � ,
i
�
� _ I I � ' f � � I f � � � � I � . i �
� � � I F i I � I � � � �. . 1 - , I ' � i .. { � I f �a
� , ,
: i ; ; ' 1 � ; I . '� . i I , � i �„
, �
. ; � � � �
�
' ' � � � _ —�- ' - ---- - -
�
:
� : , : � . , � ` . � _L i � � i
i �
: � ' , i � ; ! ,. i '. ,_ � f y-
� ` � ( �._ �..� I �
� � . , I , � ; i ,
� � I ; ' ; ' � � � � � � � � i � � , ��'
, � ' � � , I ' : � � � � � , � � i � d��
�
� ` i ; i � I � , � I ' . , ` i j ( � � ; i ���i
i
, , � � � ' � 1 � � , ' ; �`fi�
� � i � i � ' i i � . � I i : ; i i : ; I ��c.� e
' , � .
.._.... �_ _:�_.. . ..: _ ... ... .._. .w._.. _._�... . - -----.. _ . �. .... . �.. ..,.. .. . .�_..i....... .w_... �._ �. ._ i_� ...._... _.. ... __ - -__._ �,
I ' ' M
i '