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HomeMy WebLinkAbout14717 Y CITY OF DIAMOND BAR `�f� -- DEPAItTMENT OF COMMUNITY&DEVELOPMENT SERVICES � .y 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS `��'��^� BUQ,DING PERMTT APPLICATION FIRMLY y JOBSITE `" h CJ ���7�' �`°' DATE'CATION� � � ��^ NUMBE� � � #/C Q ADDRESS ��°l N . �i.. �� � ISSUE TYPE OCC � APN LOT�_ TRACT DATE CONST. GROUP p OWNER '1 f/A�/k: tJti'' ' 6) . o ADDRESS 1 • � h� �. V +T ZONING SEfBACKS z CITY S�ZIP � . TEL I' !-, FRONT RW U,_ g �� �� � �g.�.��� APPLICANT n "l. ,• � �� .n��EL. �� SIDEISIDE STREET RW ❑� � CONTRACTOR � SIDE n _ � ADDRESS ROPOSED USE � '{'- `.�Y�i � ' / �; !.%1��i r '^ � CITY ZIP TEL. + oARCWENG/ L) � >�0�' y= <_. �!�✓, C..a , iz DESIGNER NO.DWEL. NO. rNO. � ADDRESS UNITS STORIES __ _BEDFi00MS � C1TY ZIP TEL. �n DESCRIPTION SQ.FT. FACTOR P5F ADJ.AREANALUATION p� OWNER-BUILDER pEC1AHATION SFR/ADD/REM O Q I HEHEBY AFFIiiM UN�ER PENAL7Y OF PEP.JURY THAT I AM EXEMPT FqOM THE COMRACTORS Lb Ga(H9B/C9fPoR W CENSEUWFOR7HEFOLLOWINGREASON(SEC.7031.5B115ME55ANDPROFESSIONSCO�E:A�YCiTYOR � (n U COUNfVWHIf%1qE0UIRESAPENM1T7000NSTRUCT,ALTER,IMPROVE,DEMULFH,ORpEPAIRANYSTRUG � W PeSiO/DBCk z lUflE,PRpfl TO 175 ISSUANCE,ALSO REW IRES iHE APPLICANT FOR SUCH PEFMIT TO FILE R SIGNEO � STATEMENT THAT HE Op SHE IS LICENSED PURSUAHT TO THE PqOVISIONS OF 7HE COMRpCTORS LI� w c CENSELAW(CHAPTEfle(COMMBJCINOWITHSEGTION7000)OFDIVISION30FTNEBU5INESSANDPRO� � � POOI/Spa V FESSIONSCOOE)ORhiATHEORSHEISEXEMPTTHEREFROMANDTNEBASISFORTHEALLEGFUEXEMP� V TION.ANYVIOI.ATIONOFSECTION703f.58VANYRPPLICANTFORAPEflMITSU&IECTSTHEAPPLICANTTO ' R8•R00� �.'^� � ACMLPENALTYOFNOTMORETHAMFIVEHUNDREDDOLLARS(=5ao).j: ❑I,ASOWNEROFhIEPROPERTV,ORMYEMPLOYEESV.7THWpGE5A5THEIHSOLECAMPENSATION, C� COfi1fI78fC18I �. WILL DO THE WOFlK,AN�THE STi�1CTUqE IS NOT IN7'ENDED OR OFFERED FOR SALE(SEC.7o4a,BU51� J y NES:ANO DROFFSSION.4 COOE:TNE CONTMCTOPS UCENSE LAW DOES NOT APPLV TO AN OWNER OF � � PROPERI'�ViFiO BUILDS OR IMPRDVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELFOR � 1HqOL1GHHISOR1iEROWNEMPLOYEES,PpOV1�EDTNATSUCHILiPqOVfMENYSARENOTINTENOEDOH C� W OFFEREDFORSALEIFHOWEYERNEBUIL[71NOORIMPROV[MENTISSOLDWITF9NONEYEAROFCOMFLE� Z� •TIOAI,THE OWNER�BIIILDEN N�ILL NAVE THE BLIPOEN OF PqOVINCi THAT HE OR SHE�N NOT BUILD OR W� iMPfWVE FOR THE PURPOSE OF SALE). ❑I.ASONMEROFTHEPNOPEHTV,AAIEXCLUSIVELYCONTHACTINGWIiHLICENSE�CANTRpCTORS ' Q TO CONSTRUCT THE PROJECT(SEC.70M,BUSINESS ANU PflOFE5510NS CODL:THE CONTRACTOfl3 LI- �� � VBIUBIlO(1 ' 1�G�1'_ ADJ.AREA__._._______ W CENSEUWDOESNOTAPPLYTOANOVMEROFAPqOPERTYWH09l11LDSORIMPflOVESTHEREIXJ,AND i -" ' — Z 1M1000NTMCTSWR9UCHPROJECTSWITHACONTRACTOR(SJLICENSEOPURSUANTTO7HECONTMC• • QUANTITY DESCRIPTION FEE �Y�y�-L� TORR LICENSE LAW.). � x Oe{�]IA EXEIAPTIJNDLRS6. — _�,^�B.8 P-C.fOR iHIS REASON� �: U �� �"'�.� � UATE� �.i'�? ."_-'.__ ._ � 'OWNER U �' LICENSF_D CONTRACTOFS DECLARATYON w � IHEREBYAFFIFiAUNDERPENALNOFPEAJUpY7HATIAMLICENSEDUND[RPROVISIONSOFCHA7TER � I a 9�COMI.EYCINf3WRMSFCYlON7000)OFDIVISION30FTN'c0U51NE55ANDPROFE3310NSCADE,A7JD Z _ YC' MY LICENSE IS IN FUtI FONCE PND EFFECT. m lli � � LICENSE CLA55 LIC.NO. _ ___ � �j _"'___ � DATE_ CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q �' U � IHEREBYAFFIRAIUNDEHPENALTYOFPERII/RYONEOFTHEfOLLOYlINaDECLARATIONS: Z S - L� IHAVEANpWILLMAINTNNACEfli1FICATEOFCANSENTTOSELFIkSUREFORWURKEHS' � � �!APENSATION,AS PROYiDE�BYSECTION 37CA OF THE LABOFi CODE,FOR THE PERFORMANCE � �U '� OF THE W9RK FOR 1YMICHTHIS PF.RMIT IS ISSUED. � � W _IHAVEANOWI�LMAIMAINWOHi(ERS'COMPENSRTIONINSUfiAhCE.A5flE0l11RED�YSECTION 4 f � Q 3�O�OFTHELABOACOOE,FOflTHEPERFORMANCEOFTHEWOFKFOqWHICHTHISPERMITIS � (J 0 ISSU6D.MY WORKEHS'COMPENSATION INSUf7ANCE CARRIER PND POLICV NUM6ER ARE: ' �CONSTRUCTION ,,.__ ___,_ _ ,��'�/ / � __' ' ". �'y� '—' '-""'_'�'_'_ ^ .. CAHN�ER PLAN REVIEW �: paICYNUMeER_ "__ ""__ ELECTRIC _' ___ ..�.-_. ...__.. ____ Q (hiiSS[CTIONNE�NOTAEOJM'IETELIOFT}�PERlMI3FOi7Cf�1EfAMOR"cDWl.1/AS(Et00�ORLESS} PLUMBING .. _�. .__. _...-'- --'-- Z I CEFTIFY THAT IN THE PEflfORMANCE OF THE WORK FOfl WHICH THIS PERMIT IS ISSUED,I MECHANICAL , ._.__,_ ,__ __ -I� (} SHAILNOTEMPLOVANYPEN550NINANYMANNER50ASTD0ECOMESU�JECTTOTHE � ) � - Uj WORKERS'COINPENSATIWLAWSOFCALIFORNIA,AND�QREETHATIFISHOULOOECOME INSPECT�ONFEE _ __,__. �� -v � SUBIECTTO THE WORKERS'COMPENSATION PROVISIONSOF SECTpN 37000F THE LABOR CWE.ISHALLFORTMWITMGOMPLYWITH71105EPqOYI5:ON5. ISSUANCE _„_� �f_�_��- � SMIP /l J -,. p DATE: _ APPLICANT: __ _. —�---- -----' "'---...'--P 7-� � ENERGY P/C .__ WAHNINO:FAILURE TO SECUflE WORKERS'COMPF.NSATION COVERAGE IS UNLAWFIIL,ANU SHALL BE --�j-'7� 4 SUBJECTANEMPLOYERTOCRIMINALPENALTIE6ANDCIVILFINFSUPTOONEHUNOqEDTHOU3AND ENERGYPERMIT �+'1___ �� DOLtA(iS(5100.000),INADDIlIONT07HECOSTOFCOMPENSATION.�AMAGE5A5PROVIDE�FORIN --�--- ----- J SECTION3�a90F7HELA8DRCO�E.INTEREST.ANOATTORNEY'SFEES. RETENTIONFEE: � �7ppqI *7���y � �Y7!'#Ytl3t.�tY1Y'��- —' � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �T PY7 9'�intn � �C� p �-�T��.r�7l3-VCF�I'1C.�--�-��-----'— �� � � IMEREBVAFFIpMUNDERPENALTYOFPEFlJURYTHATTHERF.15/CONSTRUCTIONLENDINGAGC-NCV � FOFTHEPEqFORMANCEOFTHEWORKFORWMICHTHISPEHMITISISSUED(SEG.30W,CIV.C.). "�� � � — —�-1' -'- Z � W — '--'--- '- _ �.--_'""--- � � LENUER'SNAME_____' __' '___" "'___ _"_.f' _ � F- LENDER'SADDflESS �_�_..- —_._-_ I� W ICERTI�YTHATIH/VEREADTHISMPI.ICATKKJANDSTATETHAiTHEABOVEINFOIiMATqN�SCORflECT. TOTAL FEES � v p,. I AGREE TO COMPLY WITH ALL CITYPND COUNTV ORDINANCES AND STA7E IAWS RELATING TO BLIILDING CONSTqUCTION.AN�HEREBYAUTFiORIZE REPHESENTATIVES OF THIS COUNTY TO ENTEfl UPON TME ZABOVE•MF.NTKKJFU PFiOPERTY FOR INSPECTION PURPOSES. COMMENTS _____ ..___ _,,, __ mkf`tN P� �/��'�i�:7�11C z•� i�i'v�.1�i_�� -- - -- ���� �f, � � �/���/�_ --- �,,,..j :I - y -, -t----;f� � �SIONA7UREOFPEPMITTE �ATE RECP�„��AIDBY _� VALIDATION ` �� � ~ WHITE—Depertment Copy,YELLOW—Financa Copy,PINK—Assessor Copy,GOLDENqOD--File Copy,GREEN—Applicanl's Copy � � � _ L�; _ - _ __ _. ___ , , -"� ,� m :` _ � .� x�tz�; : j , � � , ; �� ;,�, ,� �":, i !��'"_,, ' 3 ' ' i ^ I � , F�!'y �r`` ��i�,� i i\�� i �_ � � - sd � � fi'� � I - � . ` � ' ,< .,I � J ' ) f � ; �- ' II ' i . 7 .1 ' , f . . ; � � f '; �; �I ��-.�: , �TMYi' v.'� � � I ' t I ' . � I' - � .,f. 5} � � � � I � �- - F F. y �'� .r �'� � ..-t ' _�� ��� � � � ' {��' J ' � � '• � I t'' � ' ;y3 1 4 I (1�`� � � {�� � �i.. . .. .. . V `� ���.,. 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