Loading...
HomeMy WebLinkAbout13738 h ;+ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES _� , 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ���'��' BUYLDING PERMTI'APPLICATION FIRMLY y�, JOBSITE �G/� �� APPLICATION• _- ��� PERMIT �`� � P/C o DDRESS � � _ 5����"�` �� DATE_ � NUMBER # � ISSUE TYPE OCC APN_ LO�T�– TRACT_ DATE CONST. GROUP � °C OWNER ?�;�,1c �Yf'��„+. L'v✓ � ADDRESS �7- � Ci �rl l�'�� �� ,��fL ZONING SETBACKS � � C�TY..f.li yi�t.wlc i�j.� ZI ��JL-_S TEL. �/`� 'z���}'-..)1f� FRONT __ RW U �� APPLICANT 7EL. REAR ❑ SIDElSIQE STREET RW !J � � CONTRACTOR �� A�f' 6 SIDE _ (-l.__. _ � � ADDRES I J� C��.�nx uvl�---�-------- � � CI1Y �� ZIP ��'I�3'�/ TEL.J1`l Y'� 1 JS'`i/�' FROPOSED USE d C�n^""� 1'L- �(,i�/tr N /� w ARCH/ENG/ � 'a�^ ,�'� a��„„ - r WDESIGNER NO.DWEL. � NO�� NO. a. ADDRE9S — UNITS STORIES _ BEDROOMS___ � CITY_ ZIP TEL. c� cn DESCRIPTION S(�.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFWAD�/REM O '� p I HEREBY AFFIRM UNDER PENAI.TY OF PERNHV THAT I AIA EXCMPT FqOM THE CONTPACTORS 1.1- � GaragelCarpon W CENSEIAWFOqiHEFOLLOiVIN�NFASON(SEC.7031.SBUSINFSSMlOPROFESSIONSCOOE'.PNYCITYOq C1 COIINryWHICHFEWIflESAPEFAIRTOCONSTRIJCT,ALTER,IMPROVE,DEMOLISH,OFFEPAiRANVSTFl1P W Patia/Deck � Z TUqE,PRIOR TC ITS ISSUANCE.ALSO REOUIFES iHE APVLICANT{'OR Sl1CN PERMiT TO FIt.E A SIGNED W STATEMFNT THAT HE OR SHE IS IICEN5E0 PUflSUPNT TO THE PROV!SIONS OF TME GONTPACTOHS LI� W � � CENSE LAW(CHAPTER 9(COMMENCING WIT11 SEC710N 7oao)OF DNISION a OF 7H[BUSINF.SS AND PRO- wVSpa FESSIONS CWE)OR THAT HE OR SHE IS EXEMPT 7HER[FpOM AND 1'H[UASIS FON TNE ALLF.GC:�EX[MP- � TION.ANVVIOLATKKJOFSECTiON7031.58YANYAPPLICf�YTFORAPERMITSU&IECTSTHEAPPLICANTTO Re-Roof 2�f A CIVIL PeNALTV OF NO7 iAORF 7HAN FlVF.HUN�RED DOLLARS ISsoo�.): - Z~ ❑I,RSOWNEROFTHEPqOPERTY.ORMYEMPLOYEESWITHWAGESASTHEIR50LECD61PEN5AYlON, VALLDO iHE WORK,AND 7HE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALF(SEC.7044,BUSI- � Q CommerCial " N NE55 AND PROFESSIONS CODE:7HE CONTRACTORS UCF.NSE LAW UD:S NOi APPLV 7'O AN OWNiR OF � PFiDPEHTY6Ni0 BUIlDS Ofl W PROVES THEREON,ANU WHO�OES SUCH WORK HIMSELF OR HER5ELFOR � THROUNINISORHERONMEMPLOYEES,PROVIDEOTHA7SUCHIMPFOVEMENTSAfiENOiINTENDEDOR m — QOFFEHE�FORSPLEIF,HOWEVERTMEBUILOMGOHIMPROVEMFNTISSOIUWITHIYONEYEAROFCOMPLE Z TI0.V,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PHOVING 7HA7 HE OF SHE DID NOT 9UIlD OR � IMPROVEFORTHEPURPOSEOFSILF.�. OI,ASOWNEROFTMEPflOPERTY,MIE%CLUSIVELYCONTRACiINGWITNtIGf.NSE�lX1N7RACTOHS — � '— WW TO CONSTNUCT YHE PHQIEC7(&EC.7064,Bl7SINE55 AN�PROFESSIONS COUE:THE CONTflACTORS LL V8I118�i0n CENSE LAW DOES NOTAPPLY TO AN ONMFR OFA PROPERTY WHO BLIILDS OR IMPROVESTHEFFON,AND _ -----'--�---- --- ADJ.AREA______ � YhiOCONTflACT5FOR5UCMPROJECTSYhTHACON"iRACYOR(S�UCENSEDPURSUANTTOTHECONTNqC- QUANTITV DESCRIPTION FEE � TOHSLICENSELAWJ. Q ❑I AM E%EMPTUNDERSEG _____9.L P,G FOR THIS RERSON ]� _ � _. � LL DATE__ ONlNER_ F"' � "—_ L � LICENSED CONTRACTORS DECLARATION � I � 1 HEFlEBYAFFIfild U4OER PENALTY OF PEHJURY 7HAT 1 P}A LICENSEU UNUER�ROVISIUYS UF ChIAPTER L�_ I � 9(COMMENCINGWIIHSECTION7000)OF�IVISION30F711EBUSINESSANDPfi0=F55104SCO�C:,AND X MY UC[NSE IS IN FULI FOFlGEANU EFFEGf. m LLJ � r.: J o LICENSE CLA 5_�� �L LIC.NO. _�'/ ���� - � J V DATE ����___ CONTRACTOR '� 0- W � WORKERS'COMPENSATION DE�CLARATION � [d•3�� �- � IHEREBYpFfIRMUN�ERPENALTVOFPERIURVONEOFTHEFOLLOWINGOECIAPATI�YS Z Q L] _IMhYEhNDWILLMAINTAINAGEfYTIFICATECFCONSENTTD'oELF�IN5UFEFOHWORKc'FS' � � COMPENSdTlON,AS PHOVi�[�9Y SECTION 3700OF THE LABGH COUE.FOH TFiE PFRFORMqNC(= w OF THE WORK FOR WNICH hiiS PERMIT IS ISSUEO. � d -- W ____._i MAVE iV1D WILL MAINYAIN WORKERS'COMPENSATICN INSURANCE,AS REQUIRED 6V SECTION � 370DOFT/1ElA6ORODDE,FORTHEPEFlWHMhNCEOFTHEWORKFURWHICI{TfiISPERMITIS I � ISSUF.D.MY WORKEflS'COMPENSATION INSURPNCE C;AR/a�[-F M1D POL'CV NUMBENARE. CONSTRIJCTION .,__,_. ._____—....._.__.. _i _ _ _ � CARRIER J�,���/ '' '�_._ n�^�� PLHN REVIEW -- P L,----' '' � -- —...---------"-- - ----- zPa.tcYNUMeER ,� . �j I__�_'�'.,5��"Z-'_.____--1?i_�/_.(-�.._. ELECTRIC �C . ._..,_ .. 0 (fW55'eCTIONN�NO1'BE�AGLET[�OFhEPEFUNfISFORONEhUPDfteDD(XtAR5S100)ORLESS). PLUMBING _ _____.__ _ � 1 CERTtFY THA7INTHE PERFORMA4CE OF THF WORK FOH WHICH THIS PERMI715155UED.I MECHANICAL ..,,,_,...._._._.__ , . ., �.; C} SHAILNUTfMPLOV'.JJYPERSONiNANYMANNEA50AST0(iE<'A.U�ESURJfCTTO?IiC � . (n WO�KERS'COMPENSPTIONIAWSOFCALIFORNIA,ANDACiREETMATIFISHOULDOECOMF INSPECfIONFFE ._.___.. � __...__._—_ � � � SUBJECTTOTHEWORKEflS'COMPENSATIONPFlOVISIONSOFSECTION37000FTHELABOft � CODE,I&HALLFOATHWITHC.OAIPLYWITHTHUS[PROVISIUNS. �SSUANCE _ U SMIP V � p DATE: APPLICANT: . . —__.'_"__—__',_ '.".__ �___ _ .. . W ENEAGY P/C ,... �' '� . . J WAfiNINCFAIWHETOSECUP.EWORNERS'COMPCNSATIONCOVERAGEISUNLAWFUL,ANDSHALLlIE � . .. _'--'_'............._—'—._....""'' LL SU&IEC7ANEMPLOYFRTOCRIM!NALPENAL'fIESAN�CIVILFINF.SUPTOONEHUNDREDTHDUSAND ENERGYPERMff . - DOLURS�i100.000),IN ADDITION Tq TME CO3T OF COMPEN3PTION,UAMAOES AS PftOVI�ED FOfl IN ------- -------- — � 5EC7�oN a�ae OF THE LABOR CODE,INTERESL AND ATTORNEY'S FELS. RETENTION FEE:� V_ _'_'....._' W CONSTRUCTION LENDING AGENCY PRE-ALT FEE� a. _..------------ - -' '-'-- � I HEREBY AFFIflM UN�EFl PENALTY Of PeflJURY THAT THERE IS ACONSTFUCTION LfN�MG AGfNCY � FORTHE PERFOR�NANCE Of TNE WORK FOR WHICH THIS PERMIT IS ISSUED(Sf.C.7097,GIV.G). ---- �"-� ����� � ��` ---- '-`— — .W —..._'_—"—'"' —__"_'_'_""_"'—__'_'--"—'__'— � LENDER'S NAME_....,_ "'"' __—"—'—'_"'—' F-- LENDER'SADDRE55__"___"_"' ___'..._ "_'_—'_' WICERTIlI'THATIHAVEflEADTHISAPPLICATIONANOSTATF.TkIATTHEABOVCINFORMATIONISCORflECT. TOTAL FEES L .� I AGREETO COMPI.Y WITH PLL GITY AN�COUNTY ORDINANCES AND STATE IAWS HF.I.ATING TO DUILDING � CONSTRUCTION,ANDHEHEBYAUTHpqIZCR[PRESENTATIVESOFTHISCOUNTYTOENTEfiUPONTHE Z A80VE-MENTIDNF.UPROPERNFORINSPECTIOYPURPOSES, ' COMMENTS ,/,7 ..... �� ___'_'....__. _._,.—_" _'_ ' / � _ /�� ��-/ �.. ���[s�%'o,�:'� �r"�- ---� ----- ---—--------- - --- mt PEflMITTEEN �i T� . ��"� �A/ � . '_'_' �.� ���'.i"�,,.�.� ``' -- - — ----1�- -- �- Uj SIGNATUREOFPERMITTEE DATE = AECPT.N0.-�__ PAID BY VALI�ATION ~ WHITE—Departmant Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOL.DENROD—Fiie Copy,GREEN—AppiicanPs Copy � �r-- -�� �� � � _ � � � ' � � . , `� ; ' I; � i , -_' �; �, , , i: �� I , :� � � � i,. ; , �`! i � _ � � ,. . E i ' j ! �� ' I i . -. � " � �, , � � � , ,, , � i . - � , . � � " � ' � �; � . � _ , . . i � . ' ��, _ . .. ... - . - I , . ' � , . . . � � . �� I �� ^ . . . . . . . .M . . � . � � �' - . . . , . I . � . . . . . . � � . - � � �; . . i . , i 7 � . ' ; � I �I , � .. . .i i 1� k . i � _ ' � � .�.._ . � 4` . . � . ' , _ ! . .. . . _ � ��E � � � � ,� I � � , . . , r , . � �i�� _ � . i , i . .. � R ` � ., , ; ; , ` . ��`-'� , � i , � , ; . � � :, ' �� . • � � 4 r. . i , I , ' ' ; � ; ) �' k: , , � , : � , � , , � - i , ; � � i � � , , ; g, . , � I ; � . [ i - .. . . � .. . y . � � �. . � ', � , , � � . � �i�f: .. � � ; � . . � . ' ' . . I:�,` .. . ; �'_ , . ; . ,' �- T ( i' i i � � � S - I � � �� � i I , . . I . . , �I , . ' � �. i I I' � r � � ,. .� ' � . ' , i. , � - � . , � : ; i � , j � �� , � °g'' � ' � " i �t . , `, . _.I. . i _' '_ f � ! , i �.� . i � � � �. � , . . � � .�. i. ' i � .f.. ' .. ' � � � �. �. Q, � Q ' _ � ' s „ � � � ; ' � I � ; . i I I � � . ; � � � Cr-- � i � � ' � I � ; � � � � i '^; � ' i i , i; \ , . , ; - : , , . . .. . . � i � ; i i , . � �i �� � � � �. � �' , . �, � � . .; � , . , � � � � ' � �; , � � . . , . ' ; ' . � . . ' � ' _ � . , ' , . '' . . j , � � .�. ... . ... ... .. ,. . .. , . _...... .. . . ..... . . . _ .,.... . .. . :