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HomeMy WebLinkAbout12705 CITY OP DIAMOND BAR �\ �.. ... .. ._1�`�..__. . �� ��, DEPARTMENT OF COMMUNITY 8z DEVELOPMENT SEI2VICES . 21660 E.Copley Drive Suite 19D f �� (909)860-3195 Fax(909)861-311% PRESS ��9M' � BUQ.DING PERMIT APPLICATION FIRMLY i a� JOBSITE � � APPLICATION�l r� � '� NUMBEFt��• `° . fi/C ADDRESS DATE �� � APN LOT TRACT ISSUE TYPE OCC - DATE CONST. GROUP p OWNE��I%C'��. LL ADDRESS C'J��J�'� ZONING SETBACKS � r• L' FRONT RW_ Cl.. CITY ZIP_ TEL.��i�✓ 7 �� � __ ��~`� REAR f:J___ APPLICANT _ . TEL.�7g'l�-/-i'�t'S SIDElSIDE STREET RW f-1 a� CONTRACTQp•3�t��� �.C�.�1�.�r� SIDE __ �! ADDRE�SS l J/ � """Y�`tJ's�iJ.l.. lh�� � CI1Y�F1�ir�s..�,�'�"�" ZIP po � TEL. `+�f_'�'-!<;J��i PROPOSED USE_r���� .��I�L�L, y'7i"G�� � � C.t�`l�'�.Z,.;,7 ..Y3 ' ttT`'rj'TY"�''1 Ft��7;7 �'V!f?�t� ��" w� ARCH/ENG/ i ti7,.;77> `5 tf7F1-�.F=" _��it.c�-�--- '�i:i F� � W DESIGNER_ — Np.DWEL. NO. .�"'�' a� NO. ADDRESS ��- UNITS_ STORIES ____ BEDROOMS �' � CITY ZIP__ TEL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDEFi DECLARATION SFRJADD/REM O � 0 I HEREBY AFFiRM UNDER PENALN OF PERJURY THAT�AM EXEMPT FROM THE CONTMCTORS LI- G8l8QE/C0f{10ff W CENSELAWFORTHEFOLLOWINGflEFSON(SEC.1a31.50USiNESSAN�PfiOFES510N5CODF:ANYCITYOq (n U COI�NTYWHICHFC-0UIRESAPERAIRTOCON57RUCT,AI_TER,IMPHOVE,OFMOUSH.OHRFPAIRANYSTRUC- W patlo/Deck Z Tl1HE.PRIOfi TO ITS{SSIJANCE,AlSO REOl11RFS THE APPLICANT FOft SUCH PERMIT TO FILE A SIGNED 'W, STATEMEN7 THAT HE OR SHE IS LICENSED PURSl1ANT TO TME PROVISIONS OF TME CONTRpCTORS LI• W � CENSEIAW(CHAPTER 9(COMAIENCING WITH SECTIDN 70D0)OF DIVISION 30F THE BUSINE55 AND PRO� LL" PODVSpa � FESSIONSCOOE)ORTHATHEORSHLISEXEMPTTHEREfROMANDTHF:BASISFORTHEALL[GF:DE%EMP- (� TqN.ANYYIOLATIONOF5ECT10N7031.5BYANYAPPLICANTFQRAPERMIS5U9JLCT5THEAPPUCANTTO Z Re-Roaf ,) ACIVIL PENQTY OF NOTMORE THAN FIVE HUNDRED DOLLARS(S5o0)J: Z ❑I.ASONTIEHOFTHEPRbPERN,ORMVEMVLOVEESWITMWpCESASTHEIRSDI.ECAMPENSATION, 0 COflIf718fC18I N7LL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE(5EC.7044,BU51• _I NE55 AN�PROFESSIONS CODE:T/iE CONTRACTOR5 LICENSE LAW DOES NOi APPLV TD AN OWNER OF � PHOPERTVNM1iO@URASORIMPROVESTHEREOY,AN�WFIODOESSUCHWORK4iIM5ELFORHEflSELFOR � � THIWUGHHISOflHEROHRJEMPLOYEE9,PROVIDE9THATSUCHIMPROVEMENTSARENOTINTEYDEDOR m � w OFFERE�FOHSALEIF,HOWEVER,THE9UiLDINGOFIMPROVEMENTIS50.�DWITH!NONEVEAROFCAMPLE 0�= TION,THE OWNER�9UILDER WILL NAVE THE BUROFN OF PqOVMG THAT HE OR SNE�I�NOT(�UILD OR = IMPROVEFOHTHEPURPOSEOFSALE). W ❑I,I150WNEROfTHEPROPEfi�Y.AMEXCLUSNF.IYfANTRACTINGWITHLICENSEDCONTRACiORS � TO CONSTRUCT h1E PRQIECT(SEC.701G,6115ME5S ANO PROFESSIONS CA�E:THE CONTHACTORS LI- VBIUH�1Of1 ADJ.AREA W CENSEUWDOESNOTAPPIYTOANOWNEROFAPROPEFNWYOBU1LD50RIMPROVESTHEREON,AND ---------- �� Yh1OGONTRACTSFOflSUCHPRQIECTSWITF!ACOYTRACTOR�S)IJCENSEDPURSUANTTOTfiECONTRAC- QUANTI7Y DESCRIPTION FEE Y TORSLICEN5EUWJ. 1 � '_'—____---_—_-- J — o ❑IAMEXEMP7UNDERSEC.___,_,________.____________A BP�C,FORTHISREASON � U �. � , �ATE___ ,___OWNER � � �� ��' LICENSEDCONTRRC70FSUEC�RA710N W � __ _ OG IHEFEBY�FFIRt�IUN�ERPENALTYOFPENURVTHATIAMLICENSEDIJN�EHPROVISiDN50FCHAPTER � �( 9(COMMENCINO WITH SECTION)a�o)OF DIVISION s OF THE AUSINESS ANU PROFESSIONS CAOE,AND Z X, MYLIGENScISINFULLFOflCEAN�EFFECT. 6l1 �e-� � I /�� ;! � �� LICENSE C/LASS��,�9 LIC.NO._ �/�t �1c�`^� ; j '�=. DATE_!�,'.�_��L__CONTRACTOR���___ a- � �, WORKERS'GOMPENSA710N DEL'LARATION -j -- ; �- Q ��` IHEREBYAFFIqMUNOF.RGENALTYOFPEfiIURYONEOFTHEFOI.LOWINGDFCIrRATIONS: ' z ! L7� _,_IF4,VEAND1YILlMAi'lTAINACERTIFICATEUFCOPISEN?iDSELF-InSUflF:FOFlSYOF.KE"fi5' 1�— '� CO/APENSATION,AS PROVIDED 8Y SFCTION 37000F THF LAAOR CO�E,FOA THE PERFORMANCE ' W _ _ OFTME WORK FOR WMIGH 7HIS PERMIT 19155UE0. � � ___1 HAVEAND WILL MAIMAIN WORKERS'COMPENSATIOY INBUMNf.E,AS REQUIREU BY SECTION `Z 37000F THE IA60R COUE.FOR TMF.PERFORMhNCE OF THE WORK FOR WHICH THiS PERMIT IS � .✓ � ISSUED.MY WbyflKEflS,'�COMPENSATION IYSURANCE CARRIER AND POLICY NUMBER ARE: CONSTPUCTION � T .___.._�..' _]'—_'_--'___ � CARRIEfl G'G•-i''L;��'1� --_ PLAN flEVIEW ��!1 ----.............__-------- � > '1 -y � POLICV NUMBER ���/�'�'��.•'+�Y.SL_L.��__ --- ELECTF2IC ......'""'___'—_—'—_"—'_""' . � (IHISSECTIONN�NOTBE07MPLETEDOFINE('ffUNtISFORIXJEHUNQ7EDDq1AFLS(S10D)ORLESS} PLUMBING p _—__._...'_ _ �((� . '_ � Z� I CEHTIFY THAT INTHE PERFORMANCE OF THE WORK FOq WHICH THIS PERMIT IS ISSUED,I MECHANICAL .____�.�_�1.7 3 („�S! SHALINOTEMPLOVANYPERSONINANVMANN[RSOASTOBECOMESU9JECTTOTHL �(n; WORKER5'COMPENSATIONLAWSOFCAUFORNIA,ANDAGREETFiATIFI5Fi0UL�0ECOME INSPECTIONFEE SL�&IECTTOTHEY10flKEHSCOMPENSATIONPflOVISIONSOFSECTION37000FTHElABOR {�'� +�.+ '1` S CO�E,ISH RTHWITHC0b1PLVWITHTH,O�SEPRfOVI510NS. ISSUANCE GIT'I�`Y'7Qy�F_T���7��i'��-�� -� ✓ O DATEC��Z�ICANT: _r�'���--� SMIP �6J.�L11\�f'11tl1..A �?l�k�4A�__—'-..— .o �i______ �� ENERGY P/C ' J WARNINGFAILURETOSECUFEWORKFfiS'COMPFNSATIONCAVERAGEISUNLAWFUL.ANOSHALLDE --'����-�-�--'�------- � SU&IECTAN&MPIOYERTUCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNDR[DTHOUSAND ENERGYPERMIT DOLLARS(5700,000),IN AOOITION TO 7HE COST OF COMPENSqTION,DAMAGES AS PHOVIDED FOH IN —•��----- � SECTION37080FTH[LA�OHCODE,IMEREST,ANDATTORNEY'SFEE5. RETENTIONFEE: ____ _..._..._.....'—_____—_"''_—_ �, CONSTRUCTION LENDING AGENCY PpE-AL7 FEE: ___._,________._____._____.__..__,_,_._,_ O �. I HEREBY AFFIflM UN�EH PENALTY OF P[RJUflY THAT THEflE IS ACONSTRUCTION IFNDING AGENCY n- FOfiTHE PERFORMANC[Of TH[WORK FOR WHICH THIS PEHMIT�S ISSUED(SEC.3087.CIV.C.). Z W _'—"_.__.—' "'."—___—_—._—__'.._..___' ^�� LEN�ER'S NAME__ "___""'__ '__"_— __--""""" F- LEN�ER'SADDHE55..,"_'_""" ............_...___'__'— � ICEflTIFYTHATIHAVEflEADTHISAPPLICATIONANDSTATETHATiHFABOVEINFOflMATIONISCORRECT. TOTAL FEES Y 4 � IAGREETOCAMPLYWITH/1LlCITYAN�CAl1NNORDINANCESANOSTATFLAWSRFLATINGTOBUIL�ING ,,,ppp+++ � CANSTRUCTION,ANDHERE6YAUfHORIZEREPFFSGNTATIVESOFTFIISCOUNTYTOENTEHUPONTHE ( �j��n �f\G � ZABOVEMENTIONEDVROPER7YFOflINSPECTIONPUHPOSGS, COMMENTS 4 U ��� ' _�_"'_'"_..._'___'_.—..._'—_"--_...__'_ � ;Z�'�� _����=����� --- — -- � ��N ��� �---��-- ��•���1 --- ------- -- �----- y SIGNATUR OFPERMITfEE ( OA7E �� � FiECPT.NO.__,._. � PAID BY VALIDATION —� WHITE—Depahment Copy,YELLOW--Finance Copy,PINK—Assessor Capy,GOLDENROD—File Copy,GREEN—Applicant's Copy � 1 . � , a ..� ,. � i . 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