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HomeMy WebLinkAbout12658 ; € . � -- � �„� CITY OF DIAMOND BAR 'ti. '� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRE$$ �'��'� BUILDING PERMTI'APPLICATION FIRMLY � � A�DRiESS�'E7� � F OCK- I � �IL � DATE CA710N � /� � NUMBER_�_�-��'#/C c� ISSUE �, TYPE OCC APN LOT TRACT DATE__ 7 1 CONST. GROUP °C OWNER _� �`'� /U O p ADDRESS�"Z�n�/V �C�.� Q/ L I�6 ZONING SETBACKS Z cirr jJ►Arz o nr� f��Z ZIP�� TEL FRONT RW U_.___ APPLICANTb n t�CJh TEL REAR [L___ g �A��n��z--go r—�- b SIDE/SIDE STREET__ RW ❑ � sioE -- _ n_..__ � pCONTRACTOA N___--�� �' ��_ ADDRESS�A"�r� �/ GL<v �T (� � C-- } PRCJPOSED USE��;,W"`"- '�-6,' t�� ZN'�' � — 0 CITY 14�/=�(1►� 21P���� TEL�'F� "' �� ---- W� ARCH/ENG/ ''cEf e ; �„ W DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIFS BEDROO S � CITY ZIP TEL. „_ ------ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARA710N SFFUADD/REM O 0 I HEflEBV AFFIi�/U4DER PENNLN OF PEFLtt1RY THAT I AM E%EMVT FqOM THE CONTRACTORS U- � Garage/Carport LjJ CENSEUWFDRTNEFOLLOWINGFlEASON(SEC.7031.50USMESSANDVROFESSIONSCODE:ANYCITYOfl , U COUNTYWHICMflEdUIRESAPERMI7TOCON8TRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANY9TqUC- �J,J pySiO/DBCI( � TUR�PPIOp TO ITS ISSUMICE,AL50 REOl11RES THE APPLfCANT fOR SUCH PEHMIT TO FILE A SIGNED w STqTEMENT THAi HE OR SMF.IS LIGENSEO PUIiSUANT TO iME PROVISIOkS OF THE CONTRACTORS LI• W CENSEtAW(CHAPTERD(COMMENCINOWITHSECTION70W)OFOIVISION30FTHEBUSINESSANDPRO- u' POOUSPe FESSIONSCOOE�ORTHATHEORSHEISEXEMPTiHEREFHOh7ANDTHEBAS!SFORTHE/ILLEGmEXEMP• (7 U TION.PNYVIOUTIONOFSECTION703t„•,BYANYAPPLICANTFORAPF:RMITSUBIECTSTNEAPPLICANTTO Z Re-Roof �}� f�O � � ACMLPENAL7YOFNOTMORE7HANFlVEHt1N�REDOOLURS(f500}.�: � ❑�,ASOWNEROPTHEPfiOPENTY,Ol1MYF.M7LOYEESWITHWAGESAS'fHEIHSOLLCAMPENSATION, L� CommB�Cl71 WILL f70 THE WOqK,AND THE STflUCTURE IS NOT INTENDED OR UfFEflF�FOR SALE(SEC 70<a,BUSI- J � NESS NJO PROFESSIONS CODE:THE CONTRACTORS LICFNSE LAW OOES NOT APPLY TO AN 01YNEfl OF � PROPERTY WHO BURDS OFi IMPROYES THEREON,AND WHO DOES SUCH WORK HIMSELF DR HERSELFOR (y^ THpOUGSiHISOR1iEROWNEMPLOYEES,PROVlDEDiHFYSUCHIlFPkOVEMENTuAflENOTINTEh�E�Oq m �� QOFfEREDfOR5f1E.iF,MOWEYERSMEBUIIDINGOHIMPROVEMENTI550LDWITXINONfVEAHOFCOMPLE g TqN,THE OWNF.R�UILDER WLL HAVE THE BURDEN OF PROVING THAT HE OR SHF:�ID NOT BUILD OR � IMPROVEFOflTHEPUFPOSEOFS/LLE), __ W f.11,ASOWNEROFTHEPROPEflT;AA7E%CLUSIVp.YCONTMGTIN3WITHLICENSEOCONTMCTORS - m � TO CONSTPUCT 7HE PRQIECT(SEC.7044,BUSINESS AND PROFESSIONS CA�E:THE CONTqqCTOflS L4 V81Udfi0n • � ,______{�DJ.AREA__,,. W CENSELAWDOESNOYAPPLYTOANOYMEHOFAPFOPERTYWM08UILDSORIMPROVESTHEflFON,ANO - -�- -- � NAqCONTRACTSFORSUCHPP0.IECTSWITNACONTRACTOF(5)LICENSEDPUHSUANTTOTHECONTRAP QUANTITY DESCRIPTION FEE � TORS IiCENSE UW.). __ � ❑INA EXEMIPT UN�Efl SEC.�_._`_ B e PC.fOfi THIS ftEA50fV Q � ---'----- � � li' DATE'__'—'_ OYMER_-"...._..-"'__ '_'"_—' U o W �6 410ENSED CONTRACTORS DFCIARATION � {�' IHENEBYAFFIpMUN�ERPENALTYOFPERIURVTHRTIAMLICENSEDUNDERPROVI310N30:CF1AV1[ft � �• B(COMMENqNGWYfH&EC710N7oa0�OF01VI510N30FTHEBUSINESSANDPNOfF5S1.^,NSCODE,AYD Z _ _ XAIYI�ENSEISMFiILLFORCEAN�EFFECT. /�/� /�, m p LICENSE CLASS / _LIG.NO.!✓ • �/��� ` V�j�'. � U �A7E_�r � CONTFlACTORRJ1-l.<<.O/�I� /�V�� d ' W � WORKERS'COMPEN5ATION DECLARATlON -, � U � IHE bVAFF:pAiUN�ERPENALTYDFPERJURYONEOFiHEFOLLOWINGUECLARATI04S', Vj Z C] �IHAYEANUWILI.MAINTAINACENTIFICATEOFCONSENT705ELF�!NS�IiEFORW�RiCFP.5' x �' COMPENSATION.ASPROVIDEDBYSECYION97WOFTMElA6OHCOD'c.FOHTHEPERFORM.4NCE 'U _ _ _ � OFYHE WORK K�R WHICk1 THIS PF.HMI715ISSUED. � � ---__ ' � ,�yl HAVE ANO WILL MAINTAIN WOFKERS'COMPENSATION INSIIflANCF.,AS H(:QUIREO BY SEC�iON Q31aoOFTHELR00RCODE.FORTHEPERFORMANCEOf7'HEWORKFORWHICHTHISPERMI7IS p✓"���' �� � ISSUED.MY WOflKERS'CO/MP}ENSATION INSURANCE CAPRIEfl ANII POLICY NUM6ER ARE: CO TRUCTIO .__.__.,,_ _��� � . ..' "'- "' CARRIEA,�T{���"_.�G['v� � � - ---... PLA EN/ _ ..—�_ --- ----. ` ZPOLICY NUMBER__"" "'_-"'—'"-'- ELECTRIC -_""' '-"'_ ""__ _'_-_-"___ Q 0 (RiSSECiKWNE�N�TBECt"M��LEfEDOFTHEPERMf(ISFOqONEMN�RED00LLAR5(570.�)ORLESSA PLUM0ING -__"_ __—_'_"' _"" W '.._'-""_ z I CERTIFY THAT IN THE P[RFO(iMANCE OF THE WORK FOfl WHiCH THIS PERMIT I515S11F,D,1 MECHANICAL _ ___,,, ' � SHALLNOTEMGLOVANYPf.R50NINANYMANNEfl50ASTO8ECOMES119.lECTTOTI!F. . �/j WURKERS'GOMPENSATKKJ LAWS OF ChLIFORNIA,ANU AGFiEE l hIAT 14'�SHOUL�UECOME INSPECTION FEE __,.,_ " �' SU&IECT TO THE WORNER6'COMPFNSATION PROVISIONS OF SECTION 3700 OF THE LAdOR p ~ COOE,1 SHALL FORTHWITN COAIPLY WITH THOSE PROVISIONS. C .-.--.----, - -.-._- � ��`� O� / j -.._ _._..__ p DATE:`� APPLICANT. '__��47' �G ��'7 _,_ MIP __' ..__—.._ �' U �_-_._. � ERGY P/C J WAqNING�FAILURE705ECUFEWOPKER5'COMPENSATIONCAVF.HAGLISUNlAWFUL,ANDSHFLLBE —�-�,�- ��'--- -��------�- -- � SU&IECTPNEMPLOYEflTOCRIMINALP[NALTIESANDCIVILFINESUPTOONEHUNDRFOTHOUSAND ENERGYPEFMIT DOLLARS(S1ao,000),INADUITION�OTHECOSTOFCOMPENSATION,DAMAG[SASPROVIOE�FOflIN '-"-' '--- ------"- -- � SECYK7N 37060F TM[LABOR CO�E.INTEREST,ANO ATTORNEY'S FEES. RETENTION F�;jTY OF i)iAlUf�j�'�_..__. __..__,._ � CONSTRUCTIONLENDINGAGENCY PREALTFEE:�'�,J�.D..W�i AN��i.C�AFR'�'�,______ . O ' Q IHEREBYAFFIflMUN�ERPENPLTYOFPERIURYTHATTHEflEI5AWNSTHUCTIONLENUIN�A6ENCY �- fOF7THEPERFORMANCFOFTH_E�WORKFORWHICHTHISPERAAITISISSUED�SEC.30B7,CIV.C.�. � �� � � - ---��-� � `"" -. /7^� ___'—'_"__ � lENOER'SNAME_'_S/����-•-�—�.v;� —"- _'---' '____ '__'—_ , /y ___- ""-_...._. __.-.. h^ IENDER'SADDRESS __ --.-�.L.-- � ICERTIF'/THATIHAVEfiEAUTHISAPPIICATIONANDSTATETHATTHEABOVEINFORMATION15GOflH[CT. TOTAL FEES G/'9 � IAGREETOCOMPIVWITH/LLCITYANDCOUNiYORDINANCESANDSTATELAWSRFLATINOTOBUILDING ��,�� /�� CONSTRUCTION,la�D HEREBY AUTHOHI'LE HEPR[SCNTATNES OF TNIS COUNTY TO ENTEfl UPON TME ( � AF30VEMENTIONED PiiOPEflTY FOR INSP[GTION PUHPO5E5. — COMMENTS,------- - ---- ------ C — � ,�,{�t.( It'L�'I ---- ---- m — a PEflMITTEE PRINT � , " ' � . j�/ . C -�� -- -----— ------ N SICNATUR ITTEE DATE •��--_--�__ .... RECPT.NO. _,.__.__. �� PAIDBY ,VALIDATIO , � -- WHITE—Deparlment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanP's Copy ,,-�•" .�,,, � _a.,_ , ..f.,_, , ...�.�_. � ' t �i " � : 1 I ����� � r 'fr �, � � f E � i ;I � i _ . 8 B 1 2r�'.F '�t," p� i � � � s y .. . � ' 'il i a, ' � �,. . . . �� � � � � - -' _ �� . � i . . a I" "� I� 1�- � � � � � �[ � ��C� i I � � I � ''.�� 5� I I 3 .�1 I�t � . � 4 y �ti � i, . ',� �� >i< 1 � - �_ k{ I� 5 3. 3 _ I . , ;' . T �I � ��� � � � �� 7f ? . i ''. . 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