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HomeMy WebLinkAbout13953 II CITY UF DIAMOND BAR �' �� --1�"-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES a �. 21660 E.Copley Drive Suite 190 �-��'" (909)860-3195 Fax(909)861-3117 PRE$$ "��"� BUILDING PERMIT APPLICATION FIRMLY y JOBSITE .��� � y� �,�� � �� APPLICATION�/ �. � PERMIT /�� P/C o ADDRESS J, �:� +!%'{� �^ DATE D NUMBER # $ ISSUE TYPE OCC APN LOT TRACT DATF COfJST. GROUP °C OWNER "L ���_ o ADDRESS � ��� '��� a '�t��_ ZONING SETBACKS z CITY �� ZIP �✓ �s•�TEL...� r� 'P� FRONT RW lJ___.__ g APPLICANT TEL. REAR _ _ I�1_ zd SIDE/SIDE STREET_,. __ RW lJ ____ � CONTRACTOR e� I�� � i•� SIDE r!___ � ��/� � AODRESS_„�� "'Y'r =. �7_ Gt- --- a CITY� y�P �`' � .a TEL.' . I .S��'�' PROPOSED USE - .- — a ARCWE G/ � �� � --- � DESIGNER_ - w --- NO.DWEL. NO. NO. a ADDRESS_ = CITY ZIP TEL.. UNITS ___i STORIES BEDROOMS � — y --- DESCRIPTION SQ.FT. FACTOR PSF ADJ.ARErWALUATION p� OWNER-BUIL�ER DECLARATION SFR/ADD/REM O I HEREBY AFFlRM UNDFFl PENALTV OF PEfL1UHV THAT�AM EXEMPT FROM THE COM'RACTU7S LI- G8f8QB/CBfPOII W CENSELAWFORTNEFd�LOWINGREA50N(SEC.7P31.SBUSINESSANDPROF[SSh�NSCODF.:ANYCITYOH (n U CIXINIYNhi1CHqEWIRESAPERMITTOCONSTflUCT.ALTE7i.IMPflOVL,�EMOIISH,UpHFVA1RANVSTRUC• W Pyt10/DBCk � TURE,PPIOR TO ITS ISSUANCE,PLSO RE�UIRES THL APPIICANT FOH SUCH PERMIT TO FILE A SIGNED w _ � STATEMENT THAT NE OFl SHE IS LICENSED PURSUlJIT TO TF1E PROVISIONS OF THC GONTRAClORS LI� � '� CENSE UW(CNAPTER 8(COMMENCINQ WITH SECTION 7a00)OF UIVISIUN 3 OF THE BUSINE55 ANO PRO� POOUSPB FE&SbNSC00[�ORTHATHFORSHeISE%EAIPTI'IiEREFROMPNDTH'eBASISfORTNF.AILEGEOEXEMP- � V TION.MIVVKKAiIONOFSECTION7091.5BYANYAPPLICANTFORAPERAIITSU&IF.CTSTh1EAPPLICANT'O Z Re-Roof � ACIVIL PENAL7Y OF NOT MORE THAN FIVE HUNDHED OOLLARS(ESW).): O � LJI,ASOWNEROFTHEPHOPER7Y,ORMVEMPLOVEESWITHWAQESASTHEIRSOLECOAAPF.NSATION, COfTIfilBfCi21 VALL 00 THf WORK,�f7D THE STRUCTURE IS NO'i IN7ENDED OH OF(ERFO fOFl SALE(SEG 7049,BUSI� J-__ � NESS AND PflOFESSIONS GODE:THE CANTN/CiOflS UCENSE LAW OOES NOTAPPLY TO hN OWNFR Of � PROPERNWFIOBUI:b50RIMPROVESYHEHEON,APIOWHODOESSUCHWORKH!MSELFOHHERSELFOR � � � THROUGHHISORHEROWNEMPLOYEES,PRO`JIDEOIHATSUCHIMPROY�MENISAHEtiOTItd7ENDEDOfl � Q OFFEREDFOHSALEIF,NOWEVER,THEBUR.�INGORIMPqOVEMENTI550tDWITMiNONEYEAROFCAMPL[- _ _ � TION,THE OWNER�BUIL�ER WIIL HAVE THE BUR�EN OF PROVING THAT 7iF OR SHE Dlp NOT DUII�Oq — � IMPROVE Fqq TNE PURP0.5E OF SALE). W ❑I,ASOWNEflOFTHEPROPERTY.AFaE%CLUSIYF:I.VCANTfiACtM6'MTHIICENSEDCONiRACT�RS '-"-- ----- - � TO GONSTROC7 THE PRQIECT(SEC.lOnd.gUS117ESS RkD PROFESSIDNS CCUE.?HE CON1 RAC10Rs LI- ValUa4icn_____, _,_,___ ADJ.ARFA__,.,____________,_ __ __ W CENSEUWDOESNOTAPPLYTJANOWNEROFAVflOPER7YWi108U1L[150Ri:APiiOVFSTHkREOY,AND � NM1IOWN7MCTSFORSUCfi?ROJECTSW17H�CONTR�CTOR(5)LICENSEDPUR.'.;AN7T07HEGONTRPG QUANTI7Y C[SCRIPTION FEE � 70RSLICENSELAW.J. ___ _ _ of]1 AM EXEMPT UNDER 5EC. _ _B.3 P.C.FOR TMIS REAS(YJ Q I ___ 3 _ U � - — ----."--.-.. K . OATE OWNER____—____'_'__'_'___ F.� � O --__-- —'--'_-�'-- W � LICENSFQ CONTRACTORS D6CLARATION W ' � --- —_._ .—_ — IHEREBVAFfIFilAUNDERPENAL7YOFPEPJUP.V1'H0.'(IRMiICkMSkUU4�L(iPROVI510N50FCHAPTER U, d Y(COMMENCINGWITHSEC7'ION7!qoJOFDIVISION30FT!IE?USIN'cSSANDPRU�'ESSiON.iCODF,MU Z _� MY Lh:EN9E IS IN fULL FORCE MD EFFECT. y _' � LICENSE CLA55'�'~��� _._____ LIC.NO. _ �";���'���� _ � -__ '` � �___'_ U DATE ^ ��R ��___ CUNTRACTOR� � ���_� _' _,✓��_ d -� W /� � WO�KERS'COMPENa^ATION DFCLARATIUN ,�y �'r��3 � V U ���fIG��� L� Cr.;f;� �n,i� � / v � �HF.REBYAPFIRMUNDEtiPENAI:fYOFPERJURYONF.OFTHEFOLLONII.NG0ECUIR;TIONS � � _IHAVEANDWILLMA!N'fpINACERTiFlCATECF(`ANS�NTTOSELF�I:ti3UREFORYJdNKc S' ' x —- _—_ �� COM7ENSATIOY.AJ PROYIDLD dY SECTION 370�UF THE IABOR CUDE.FOR TNE PEfiF�(iM, 'E u, Q OF THE WOft;C Fpp W{{�CIi THIB PERMIT IE ISSUEO. � W .6�I HAVEANU WILL I.UINTAIN WORKEFS'WMPEYSA?ICN INSUR4I:C[,AS REOUIREL`3Y SF.CTION ''\ h- Q� T 1o00f TNE IA9Cfl CODE,FOR 7HE FERFOFMi�NCE OF THC WOFK POR WHIc:H TH�S PE FIS- ISSl1E^.MY WUNKFRS'CbA1PENSATION INSUP.FNCE CAFiRIF AND POI ICV Nl1A1B[f :� CO STRUCTION ______...______„_, _"-"' jJ �'�y��� , CApR1EH�aC:�'��'qrr.r+.,t'Ly�_�y fF''if�r.'��:..---- I ,�P N FlEVIFW -------- � PIX.IC7RUMBER_L_4.o�I_�; ��d ��,T�I�' � 'I f I(JE CTRIC ------._...._ ----.- ---._. . ¢ "__""__'"'_'_ � Q}USSE�iGM1NEEDNCITPE0�4�LCfEUOFii�PERN1'li'iCilqVFfAFDNEU �(Stoo)ORLFSS� PWM8ING �'����, Y=. ' -__'_______' _ N��-.a.... �'� � .!'::i.:.,..• � I CERIIFY THAT 14 T}iF PERFORMANCE Of TMC WORK F01i WNICIi THIS PEfiMiT IS ISSUED.I MECHANICAL � � SNALLNOTEMPLOYFNYPEHSONINANVAIANYEASOASTORfCOME5U0JECTTOTNE � ����� � �� � � (/� WORKENS'COMPENSATICXJLAWSOFCALIFORNIA,ANOAGFlEC:THAiIi'ISHDULCIH[COMf.' INSPECT�ONFEE .__._ ,___ _ _ _ __ SU&IL=CT TO hiE�YOFKEflS'GOMVF.NSA�ION VROVISI(XVS Oh SECiION 370///D///OF TH[IAEIOFl y •:, u +' �17 " Q �,I SIIAI.L FORTHWITII CDMPLV WITN:H056 PROVISIONS ' � * ENERGY P!C ` �5�� �Y��•�� ��!-- —,��f � ....---�-�---- F— t:r; {+ p DATE: � � APPLICANT:� l_ .__��",�'�__._ ' � _'�;y�-c�v— _ "__ LLI �.._ ��Z L ,I.(�.:�::'.i;',7 n..�:!' J WARNING:FAIIURE TO SLCUf1E WOIIKF.RS COMPF:NSATION COV[R�GE IS UNLAWFUI,ANCISHALL eE - � t• � SU&IECTPNEMPLOYERTOCRIMiNALPENALTIES�NOCIV!LKINESUPTOONEHUNDREDTHOUSANO q TT 3 T��,��:'f.i ��`�'�'�?��%-�•..��: �•�+ . �OLLARS(S1a0.0oo),IN ADDITION TO 7HE COST OF CAMVENSATION,OAMAQES AS PROVIDED FO�IN [NERGY PERMIT }��''-^'�__,.,_____ ""-"__ � SECTION37080FTHELA90RCOOE,iNTEREST,FNUAT70HNEY'SFEES. �[-TENTIONFEE: _"_"""__ "- _ '-__'___ _____'___ d CONSTFlUCTION LENDING AGENCY PRE-ALT FEE: , — ..---�---- --.......--- O' -- :� Q' IMERE[iYAFFIHMUNOERPLNALTlOFPERJURY7HATTHEHEISACONSTRUCTIONLENDINGAGENCY F � fORTNE PERFORMANCE OF THE WORK FOFi WHICH THIS PERMI715155UED(SEC.30J7,CIV.CJ. - -- '"-""'�--'--- Z � W ___'_"_"_'--__"_"__—__'_'__ '. � LENDER'SNM1E _-'_""'""_'-"'-'__ - - "''_-_"'- """_..."__' �5. 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