HomeMy WebLinkAbout16310 3 � -.. i _-:� � �! CITY OF DIAMOND BAR �"'��j , � "' ' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � I ,. j .� , 21660 E.Copley Drive Suite l90 "%�� i �'Y�„�.. (909)860-3195 Fax(909)861-3117 � ; , ,� PRESS BUQ,DING PERMIT APPLICATION FIRMLY IN JOBSITE y � c3 ����, yf �" DATEICATION �'v� ^�� ;P� NUMBER� #/C � o ADDRESS�-� �� �)�4�� �/ a- rr' � � APN LOT TRACT �SSUE � ,/�•"L �� TYPE OCC i DATE "� CONST. GROUP p OWNER �'f��'V D L7 ��(!� �' ADDRESS � �� ZONING SETBACKS � _=�'���� FRONT RW C�"^__ i W CITY _ ZIP__ TEL. � REAR � ❑_�_ � APPLICANT C i`'7 TEL. 51DE/SIDE STREET RW _ iJ__� � � CONTRACTOR- I/�i'"lc3-c��19 �) iC.e�'13�7P'-�/"''f.,_ SIDE [-I ; � ADDRESS f 7 %" '-��v7 I-c.t�t(--� PROPOSED USE l ��� � , r7�, � [L' i � CITY ;.� �-�' w'( ZIP TEL. -' �7� ,. , �� . . ,� _ ; o / : E.� ' ��•- :_. �� w ARCH/ENG/ j W DESIGNER — �' c � �'� ����-� NO.DWEI. NO. NO. � a, RDDRESS UNITS__ _ STORIES BEDROOMS I � CITY ZIP TEL. '--� i t1J - I tn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREIWALUATION i Q OWNER•BUILDER DECLARATION SFR/ADD/REM � � i NEREBY�FFIRM UNDER PENALTY OF PEflJURY TNAT 1 MI F.XEMPT FAOM iHE CONTRPCTORS ll� GdfBgB/CBfpOfl � W CENSELAWfORTHEFOILOWINGREASON(SEC.7037.SBUSINESSANDPftOFESSIONSCODE:ANVGNOfl (n U COUNTyWHICHPEWIRESAPERMITTOCONSTRl1CT,ALTEF,IMPROVE,�ElAOLISN,OPREPAIRANYSTAUP Z 7URE,PRqH TO ITS ISSUANCE,ALSO REWIRES THE PPPLICANT FOR SUCH PEHMIT TO FILE A SIGNEO � PatiO/DBCk W STAT�MENi THAT HE OR SNE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRRCTORS LI� � �SS CENSE LAW(CNAMER 9(GOMMENqNO WIT11 SECTION 7Wa)OF OIVISION 30F 7HE BUSINESS PNp PR0• �'1" POOUSpd 7G fES8qN5CODE70RTHATHEORSHEISEXEMPT7HEREFflOMANDTHEBASISFORTH'eALLEGEDF.XEMP� � - V TION.MIYVIOLATIONOFSECT10N7031.5BYANVAPPLICANTFORRPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof A CI41L PENAITY Of NOT MORE THAN FIVE HUNDRED ODLLAPS(550o)J: j � ❑I,ASOWNEROFTHEPROPERTY,ORIAYEMPIAVEESWITNWAGESASTHEIRSOLECOMPENSATION, ❑ COff1R16fCIdI ! WILL DO THE WORK,AND THE STRUCTUflE IS NOT INTENDED OR OFFEFED FOF SAL[(SEC.7oaa,BUS6 J � NESS AND PROFESSIONS CODE:THE CONTMCTOPS LICENSE IAW OOES NOTAPPLY TO AN OWNER Of � � PROPERTYW1109UILOSORIMPROVE5T11EREON,ANDYMDWESSUCHWORKHIMSELFDRHER5ELFOq � THRIXIOHHISORHEROYMEMPLOYEES,PROVIDEDTHAT9UCHIMPROVEIAENTSARENOTINT[NOEDOF m 'W. OFFERED GOR SALE IF,NOWEVER 1HE BUILOING Ofl IMPROVEMENT IS SOID WITHIN ONE YEAR OF CAMPIL Ll TION,7ME OVINER-BUILOER WILL MAVE THE BUflDEN OF PflOVIhO THAT HE OR SHE�ID NOT BUILD OR � iWPHOVEFORTHEPURPO5E0FS�LE). � L11,A50WNEROFTMEPflOPEflTY,AMEXCLUSNELYCONTRACTINGWITHLICEN5E000NTRRCTOflS ��ry� - - — � TO CONSTRUCT THE PRQIECT(SEC.�oa4,BUSINESS AND PFOFESSIONS CODF.-THE CbNTRACTOflS U� VeIUdIi0f1 __. �✓(/ ADJ.AREA__ W CENSELAWDDE5NOTA�PLYTOANOWNEROFAPROPERTVWHO6UILDSORUAPROV�STHER[ON,AN� = WHOCONTRACTSFOF5UCHfROJECTSWITHAQOM'RACTOR(S�LICENSEDPURSUANTTOTHECANTRAG ~' TOHSIJCENSELAW.). QUANTIYY UESCRIPTION FEE X i O �I Mi EXEMPT UNDER SEC._ _, _,___„B.&P.Q FOR THIS REASON Q _ � ' -�-- V LL � — DA7E OWNER__,_ _____ U O W ' � UCENSED CONTRACTORS DECLARATION uj ' � IHEREBYAFFlRMUNDERPENALfvOFPERlUIiVTHATIAAALICENSEDUNDERPROVI5lO�50FC11APTF(7 � �� � e(CONMENCING WYiH SECTKKi 7000j OF DIV1510N 3 0F THE 6USINE55AND PpOFE5510N5 GODE,AND Z _ X MY LICENSE IS IN FULL FORCE AND EFFECT. LLl �1 C�'" ?^� � ' � IICENSE CLASS _LIC.NO.,,,__ � �" � � I � � �- , J�, _"__"_ ' J U DATE 2.,i..� CONTRACTOR�!.��I__-,� a W T �' WORKERS'COMPENSATION DECLARATION Q � � !HEpE9V0.FFlRMUNOEHDLNALT'OFPER1URYnNEOFTHEFOLIOWING�ECLARAI'IONS: � ' 0, _IHAVEANDWILLMMNTAIHACERI7FIC.ATEOfCONSE4TTp5ELFINSUHCFORWORKERS' ' T COa1PENS�TION,ASPROVIDED0V5ECT1043']ooOFTHElAI30RCAUE,FORTNEPERFORAIANC.F `U � �' OF THE WONK FOR WHICH hI1S PERMII"IS ISSUED. � W �,�-� �y �I HAVE AND WILI M/JNTAIN WORKERS'COMPENSATION INSURANCE,AS PEOUIRED BY SECTION /�_� ,(,J ~K 3�o00FTHELNBORCOOE,FORTHEPERFOHMANCEUFTHEWORKFORWNICHTHISPERMITIS �' ,/C >�- � '"� �+ ']� i 0 ISSl1E�.MY WORKERS'CO/APENSATION INSURANCE CARRIEfl AND POI.ICY NUMBERARE CONSTRUCTI � __ � V m�� d __— � +�j CARRIER__"_ '`' � t�_'""'_ "'""_—'_— PLAN REVIEW • " l • -i��...°�, �?n n�---- ..._...------------ p 0 PouCYNUMBER .__ ___._..— ..."—'_' ELECTRIC '_ _"""___._.._.._ _.._ � � Q (iHIS^: IONNE�NOTBLOJMftE7FDOF7FitP�IiWiS��IiONEFttNJDf;EDWl;AF75(Etoo�ORLESS} PLUMBING '[�jT�J_."._'._ _-.'__-_"_"""_"... Z, ICERTIFYTHATINTHEP[RFORMANCEOFTHEWORKFORWHICHTHISP[RMITISISSUE0,1 MECHANICAL j,Jl_� --"""--_.- ______ SHALI NOT EMPIUY ANY PERSOY iN ANY MANYER 50 AS TO AFCCME SUBJEC7 TO fHE � �� WORKERS'COlA7ENSATIONLAWSOFCALIFORNIA,ANDAGPEETHRTIF15410ULDBECOME INSPECI'IONFEE __ _____,..._ � SU&IECT TO TME WOiKEFlS'COMPENSATION PFiOVI.SIONS OF SECTIOY 37000F IHF:1A90R � ... � � CODE ISHALLFO THW�THCOMPLYWITHTHOSEPROVISIONS. ISSUANCE � � _"- __''_'""'_ r �� ' L. L SMIP 0 1/� p OAlE: ' �. O(AP%.IGANT: ��__— ._ ""- �._— j; WMNINO: LURETOSECUREWORKEflS'COMPENSATIONCOVERA EISUNLAWFUL,ANDSHALLBE ENERGYP/C ,_______ .____._._.__ � SU&IECTANEMPLOVERTOCRIMINALPENKTIESANDCIVILFlNESUPTOONEHUNORF:DTHOl1SAN� ENERGYPERMIT DOlUlflS�51a0.000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR W — �----� -�----�--- � SECTION37oeOFTHELA90RCODE,IYTFRL57,AN0ATTOflNfY'SFEES. RETENTIONFEE: _.,.__.._ __..._._,_____... __ � CONSTRUCTION LENDING AGENCY PRE•ALT FEE: ,__ ___..___, ,_^_ � I HEREBV AFFIqM UNDER PENALTV OF PERJURV THAT 7VIGRE IS ACONSTRl1CTION LENDING AGENCY __ _ _ �__ FOR THE P[RFORMMICE OF THE WORK FOR WHICH TNIS PEflM1T IS ISSUEO(SEC.3097,CIV,C.J. z , � - �-- --- � LEN�ER'SNAME____. .--_ --_-- F_ LENDER'SA�DRESS I ¢ I CERTiFYTHAT I HAVE FiEAD THISAPPUCATION AND STATE THA7 THE ABOVE INFORMqTqN IS CORRECT. TOTAL FEES � ?j���V• I W IAGREETO(:OMPLYWITHALLCIiYANDCOUNTYORDINANCESANDSTqfELAWSflELATINOTOBUILDING � CANSTRUCTION,ANDHEREBYAUINORIZEHcPRESENTATIVFSOFTHISCOUNTVTOENTERUPONTHE i � ABOVE�MENTIONEO PROPERTV FOR INSPECTION PURPOSES. -__-__ ---— z COMMENTS__,__ � � m / �( �(� �[�� '-— --- .. -'-^— ` — d PEHMITTEEN�"y,/�E(RINT) � _ _ � l� l �r t -^�� �AT ,� � _,. _ _ � SIGNATFIRE RMI EE ��� DATE � _. RECPT.NO.__,__ PAID BY _,� VALI�ATION� ~ WHITE-Department Copy,VELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-Flle Copy.GREEN-Applicant's Copy . . _ .. ;_._ . ._. - ..- , , � � ..._ , , ,; : _. .. . , , I,, � ' � } �'�;� '--� � � � � � -. , . , �' r - , � , .�. .,. ,,.:. .._. ��. , � : . . , � . ; ...�, ,...� . , , . � � � �:�: '. . , � - , � , - . i i : E i . i - _ _. f! , . i ' � ... , i ,, I � : � � .. � ' . : � � � , t i � � � ' .. I � i � ! a , ,. �. i . �. i - . �. � ' � .. .._ i �` 6 „. . _ .. - . � - _ . ,� , �� t , i � (rQ ���� . � I - 1 � - . _ U . � � , - . ' ' � � � i ' , i. , �. . . R I i ' ; . . . . � , I �I � - ; . . - n i I i _ , .� . � i , ; . � . . . , �. . I : - - -- ; � , � , , ' , a � . . , , � - . . . . � : - I � � . ��, �� ' i I � 1 '. ' i ��i � : � � 1 �i � f � ; � I . . ��; i �` , � - � �' ! .. i ' i I � � . � � I � 1 ; � ' �: � � : f i � 1 i , I � . i i i � ! � � . i � � � I i , ! . : ; . , , . • , . . i ; � : ,, . � � �� , � � i . . 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