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HomeMy WebLinkAbout15988 ''��CITY OF DIAMOND BAR � a- •� '----��----- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES f � a 21660 E.Copley Drive Suite 190 -''� ' (909)860-3195 Fax(909}861-311� �_.��- PRESS �� "ti^' BUILDING PERMTT APPLICATION FIRMLY o� JOBSITE f�� �;��� APPLICATION PERMIT P/C ADDRESS '�� _ DATE � �� D NUME3ER � # � ISSUE TYPE OCC APN LOT_ T CT DATE_ � � CONST. GROUP °C OWNER _ �__ --- O " ADDRESS � ZONING SETBACKS W �- FRONT _ RW U z CITY ZIP TE REAR n g APPLICAN7 __. TEL._ SIDE/SIDE STREET RW J z � CONTRACTOR p �'� '��� SIDE C;_. _ o ADDRESS � � PROPOSED 11SE Y�✓6= tl� �,S�'� CITY ,�_�/I�- ZIP TEL. — � ARCH/ENG/ C�� - g�� Z DESIGNER w — — NO_DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES _ _BEDROOMS y - .� cn DESCRIPTION SQ.FT, FACTOR PSF ADJ.AREANALUATION p� OWNEH-BUIL�ER DECLARATION SFR/ADD/REM O � I HEREBY AFflHM UNDER PENALTY OF PERNRY THAT I AM E%EMPT FROM THE CONTflACTORS LI- � Garaga/Carport W CENSEUWFORTHEF4lLOWINGREASON(SEC.7031.SBUSINESSANDDROFESSIONSWDE:ANYCITVOH U COUNTYWNICHflEWIRESAPERMfTTOCON5TFIUCT,ALTER,IMPROV[,�EMOLI9h!,ORFi[PAIRpNYSiRUG W Patio/Deck IUFE,PRpR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO PILE A SIGNED W STATEMENT THAT HE OR SHE IS IJCENSED PURSl1ANT 70 THE PFOVISIONS OF THE CONTR4CTOHS ll- � �� CENSELAW(CHAPTER 9(COMMENCINO WITH SECTION 7oD0)OF OIVISION 3 0F THE BUSINESS ANO PRO� � POOVSpB FESSqNSCOOEjOflTM�TMEORSHFISEICEMP7THEREFROMANOTHE8A515FORTHEALLEGEDEXFMP- (� -- � V iION.ANYVKKATIONOfSECTIIXJ7031.56VANVAPPLICANTfDRAPEAMITSUBJECTSTFiEAPPLICANTTO Z RB-ROOT � ACMLPENALNOFNOTMORF.THANFIVEHUNOREDDOLLAf15�5500).): � ❑I,I150WNEROFTHEPFiOPEPTY,OpMYEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, COnImBfCiil WILL 00 THE WORK,AND THE 3TRUC7UR[IS NDT IN7ENDE0 OR OFFERED FOR SALE(SEC.70dd,BUSb � N NESS M1D PROFESSIONS COOE:TiE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTY WHO DUILDS OR IMPqOYES THEREON,ANO MTiO DOES SUCH WORK HIMSELF Oq HFRSF.LF OR Q iHRWCHNI30RHEROWNEMPLOYEES,FROVIDEDTHA75UCHIMVpOVEMEN75ARENOTINTEN�E00R m — Q OFFEREDFQRS4IE.IF,HOWEVERTNEBUILOINGOqIMPHOVEMENTI550LDWRHINONEYEAROFCOMPLE- _ 2 TqN,7HE OWNER�BUILDER V/ILL HAVE THE BURDEN Of PROVIHG THA7 hE oR SIiE OIO f�OT BUIL➢OH � IMPROVEFORT1iEPlJfl?OSEOFSALE�. W UI.ASONMEROFTHE7ROPEHfY,AME%CIUSIVELYCONTRACTINAWITY.IICENSmCANTRACTOR3 �� a TOCONSTflUCT TNE PRD.IECT(SEC.7044,BUSINESSAND PROFESSION9 CODE:IHE CIXJTRACTORS LI- VaIf18f10f1 �� ADJ.AREA W. CENSELAWDOESNOTAPPLYTOANOWNEflOFAPflOPEP.TYWHU8NLU50FlIMPfiOVESTHEREON.AND — ' -- - ' F WFIOCONTRACTSFORSUCHPROJECT54NTHAC9NTRAC?JR(S)LICENSEDPURSUMITTOTHECONTRAG pUAN711Y DESCRIPTION FEE x TORSLICENSELAW.). � CL a ^ ❑IIUA E%EAIPTUN'JERSEC. ___6.8 P.G f(�THIS RE4SON _,_ _ $ U --------�-------------�-�-- � � UATE—_ __' '""" OWNEH"_"__'_-- _ � "— 0 L� "_ _ _—_'_' � � IIGENSED CONTHACTORS DEGLAFATION � � 1 HEREBY AFiIflM UNDER PEMAI!Y OF PE(UURY Th1AT IAM LICENSED UNDER PROVISIONS OF CNAPTER � � � B(COMMENCIlYO WITH SECTION 70P1)OF UIVISION 30F THE BUSlNE55 AND PROFESSIOkS CO�7:,AND z _ __ ��� MY LICENSE IS W FULL fORCEA�b EFFECT. m � uc�sE cPu�J$�s � tic.No. 4F� 7 t�Z"' � —_- W~ DATE,I// y�p CONTRACTOR n. --- -_--u- .%% 6�'�__-_-___..._ _—_ - ___ _ -- � � d WORKFRS'COMPENSATION GECI.ARATION � - � IH[REBYAFiIRMUN�ERPENAI�YOFPERJURYCINF:OFTHEFOLLOWINGOECIAFihTIONS: z � __:HAVFA ILLMAINTAINACFqTIFICA7F.OFCONSENTTOSFL�-INSURFFORWOHKFliS' ','dr� �' —__-- -- COlAP SATp7V,AS PflOVIDED BV SFCi1CNJ i]OOOf THF LpPOR CODF,fOF17HE PF.RFO�IMANC[ W � OF E WORX FOR WHIrH THIS P[RMI71S ISSUED � I � ___IHFVLANDWILI.MAINTAINWORKERS'CAMPENSATIONINSUHANCE,AuR[QL'IHE�BYSEf,TION ' � 3700CF TIiE IABOR E,F( THE PFfti'OHMf�h'CE Of Tk1E WOHK FOH WN�CN TI:IS PF.HMiT IS �, ISSUED.MYW KEFl'(AMP NSRiION IN.`.UfiR4CE CAR!iIER AND�OI.ICY NUMilER ARE' CONSTRUCTION � 1 ...- _.-..- � CARRIER L'. _ -� � PLAN REVIEW ---------'-'----...-- --.._._.._.. .------ � eaicr NUMuen____� ' ELEC7RIC ,� , -.,.--------------' � (fHI6SECTCNNEF.CINOTBEIX��LEfEUOF'f��EPERMTISf0�9ON[MMLM[DUql,'�RS(5100�CH7LE551 PLUMBING _ ,��_.._.__- _____________..___ � ICEflTIFVTHAYINTHEPERFORMANCEOFTHEWORKFORWHiCHTHISPEqMITI5155UF0,1 MECHANICAL '__'_'...'_'__- "..._'__"" (.'j 51WlINOiFMPLDYANYPER50NINANYMAWIERSOfST09cCOMESU9JFCTTOTH[ : . y WORKEflS'COMPEYSATIONLAWSOFC0.LIfOP ANDAC.RFF.THATI�ISHOl1lDOCCO�Uf: INSPECiIONFEE j++�,ali � '1 "���,�__ ��"S.'S = SU&IECTTOTHEWORKEHS'f.OMPEN6ATION ISION ., TION37000FTHElADOF -�..'�,51,9� - - - CODE,I)SHALL/{FORTHWITHCOMPLYWITHT PRO uION ISSUANCE J''�7-; �{ /( �_� p DATE:��,�0"(�,_ APPLICANT: __ SMIP »�'•'� e✓1����.�/'S�!$SJ�yAa� ��)(.� , � ENEAGY P/C }� %��,r1�1s��1 ,g r e y' qg� WARNINO:FAILUf1ETOSECUREY�ORKERS'COM N ATIO COVERAGEISVNiAWFUL.PNUSHALLUE - Y� ;M��'-d`7d'��Y�---�-- LL SUOJECTANEMPLOY[RTOCRIMINALPENAL7IE CIVILFI�ESUPTOONEHUNDREDTHOUSAN� ENERGYPERMIT ______. DOLLARS(St00.d10�,INAbDITIONTOT1iFCO5T f MPI:NSATION,OAAIAGESASPROVIDFI]FOqIN �-�----�-�-- � SECTION 3708 OF THL I.ABOFi CODE,INTER[5T, nrroArvcrs F[Es. qETENTION FEE: __. _,_______._____ ._______ a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: p ---- ------ - � I HEHEBYAFFIRM UNDEN PENALTY Of PCRJURV THAI'1HERC IS ACONST(iUCTION LENDING AGLNCV n- FORTHEPERFORMANCEOFTHLWORKFORWHICHTHISPEfiMil'ISISSUED(S[C.3o37,CIV.C.�, ---" ---""- W '__ � LEN�ER'SNAME______,__ _ - -- i_ LENDER'SADDRESS ¢ ICERTI�YTHATIHAVEREADTHISAPPIICATIONAN�STATETHATTHEA90VEINFORMATIONISCAFHECT. TOTAL FEES �• � W IAGREETOCOMPLYWITHA�LCI(YANDCOUNTYOHDINANCESANUSTATELAWSRELATINGTO�UILDING � CONSTRUCTION,AN HEREBYAUTHOHIZE HEPRFSENTATIVES OF 1'IiIS COUNTY TO ENTEFi UPON THE Z AeOVE-MENTIONFD FOPERTY(�O INSPECTIONPURPOSES. COMMENTS p. _.'__'___'___ -" � . � ------'- "-- '- ' '-'-- ----' -- - � PER IiTEE IEIV I , ___y__""'_....__ Q ,., - .. C��/1 cn. /G � SIGNATUREOFPERMI EE � DATE � �� � � RECPT.N0. 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