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HomeMy WebLinkAbout15483 ���'' `` CITY OF DIAMOND BAR -----��-- DEPARTMENT OF COMMiINITY&DEVELOPMENT SERVICES � �W . 21660 E.Copley Drive Suite l90 (909)860-3195 Fax(909)861-3117 PR�SS '���'ti�"� BUILDING PERMTT APPLICATION FIRMLY � JOBSiTE n APPLICP.TION � PERMIT�Y°� P/C � ADDRESS ��I I �� • �<��•�� ��l t`�i•'- !.�i•• DATE � NUMBE � � # � ISSUE TYPE OCC APN LOT TRACT___�_JT_ DATE J p OWNER _fi,l'i;{:�ir'�- ,fi a`!K,"i�r',r N-. '((q �"� r.� � CONST. GROUP LL ,j ,� , � �r �. �'�— p ADDRESS_,,s.l I - ��':(..,— �.�t. i'./�._ j,��,- ZONING SETBACKS Z CITY �'' .�� .+it f ii� ZIP '�%1'i..3 TEL. �-r)�r.��t t:;(�S.,i FRON7 RW ❑--- g APPLICAN '.��1�!`�r;;i� f''�a o.r��> TEL.(, `t 1'; �'%[.�5� REAR U---- Z , , r% `�--- SIDE/SIDE STREET RW__ fl_____ � CONTRACTOR __ _ SIDE U _ p� ADDRESS PROPOSED USE �`n't`� ���J'Peti P�-' �.%�1� T A�i 5� O o cirY ziP r��. : .c�.a��c;,� ^ �:•rs.. C, i.t1C�d. w� ARCWENG/ DESIGNER �5 - N0.�WEL. NO. '"' N�. a. ADDRESS � CITY ZIP TEL. UNITS ,_ ST IES ___, BEDROOMS u� v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECLARATION SFR/ADD/REM O � I NERE9Y AFFlRM UNDEH PENALTY OF PERJURY THRT I AM E%EMPT FqOM THE CONTRACTORS LI� GHfe9BJC8fP01t W CENSELAWiORTHEFDILOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITVOF (n CJ CpJN7YWHICHREWIRESAPERMRTOCOtJSTRUCT.AI7ER,IMPROVE,OEMOLISH,ORREPAIRANYSTFUC- W P8I10/DBCI( � 7URE,PPIOH TO ITS ISSUANCE,ALSO RE�UIR[S THE APPLICANT FOfl SUCH pERMIT TO FILE A SIGNED W � STATEMENT THA7 HE Ofl SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CIXJTRACiOfiS LI� CENSE L4W(CHAPTER B(CO!AMENCING WITH SECTION Y000)OF DIVISION 3 OF TH[BUSINESS ANO PRO- � POOVSPB FESSIONSOD�E)ORTFiATHEOflSHEISEX[MPThiEREFflOMAN�THE8A515FOqTHEALLEGEDEXEMP- (� V 710N.ANYVqLAT10NOF5EC71ON7031.58YANYAPPLICRYTFORAPERMITSU&IECTSTHEAPPLICANTTO Z R8-ROOf A;i� � ACIYILPENALT/OFNOTMORETHANFNEHUN�REDOOLLARS(55ao).)� � 'yf�I,ASO4MEROFTHEPROPERTY,OflMYEMPLOVEESWITHWAqESA5Tf1EIftSOLFCOMPEN3ATION, C� Commercial - WILLDO TME WORK,AND THE STRUCTURE IS NOT INTENDEO OR OFFERED FOR SALE(SEC.704/,DUSI- J � NES3 AND PqOFESSION3 ODOE:7HE CONTRACTORS LICENSE LAW�OES NOT Aop�Y 70 AN OWNER OF � PROPER�Y V/Fi0 BUILDS OR IMPROVES THEHEON,AND VAiO DOES SUCH WORK HIMSELF OR HERSELF OR ( [L 7MPoOUGM HIS OR HEROWN EMPLOYEE3,PflOVIDEO iHATSUGM IMPROVEMEN7SARE NOT INTEN�EO OR m � O OFFEREDfORSAIE.IF,HOWEVEH,iHEBWL�INGOfiIMpROVEMENTISSOLDWITHINONEVEAROFCAMPLE- � Z 71DN,THE OWNER-BUILOER WILL HAVE THE BURDEN OF PqOVING THA7'HE OR SHE 010 NOT BUILD OR — � � IMPHOYEFOiiTHEWRPO5EOF5P1�. w f.11.ASOWNENOFTHEPHOPERTY.AME%CLUSIVELYCANTRACYI"16WITHlICENSFACONlRAC70R5 � TO CANSTRUCT TNE GRQI[Cl'(SEC.7094,9USINF.SS AND PROFESSIONS CADE:THE CQYTRACTORS LI- VdIUdlI0f7 ADJ.AREA___ CENSEUWDOE3NOTAPPLYTOANONTJEROFAPROPERTYWFIOBUItDSORIMPROVESTHEREON,AND — '-- ------- � WHOCON7MCTSFORSl1CMPRWEC75WITHAfANTMCTOR(5)LIC'eNSEDPURSUANTTOTViECONTRAC- QUANTITY DESCRIPTION � FEE � TORS LICENSF LAW.). �¢ [J i M1 EXEMPT UNDEH SEC._ B.8 P.C.FOA THIS REASON Q U LL DATE_^' .L. L�!^ oWNER___s��� N:��` � %O� ' U z -- 1 ------�.L�%------..,_. pIICENSED CONYRACI'ORS DECl.�1RA710N W � �HEREBVAFFIqMUNQFRPF.NALTYOFPERJURVTHATIAMUCe'NSEDUN�ERVROVISIONSOFCi1AP�ER � � B(�MMENGINGW17HSECTION7o00)OFDIVISAN30FTHEBUSINES5AN�PHOFGSSIUYSGOUL,AND z ____ _ MY LICENSE IS IN FULL FORCEAND EFFECT. m Q � � UCENSE CLASS___ ___LIC.NO.'___'_'_____'._"'__.__ � F— � V DATE_ CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION ¢ NIHENEBVAFFIRA1l1NDERVENALTYOFPEfUL/HYONEOFTHEFOLLOWiNGOEC�RATIONS: Z O IHhVEFNDWILLMAINTAINACERTIFICATEOFCONSENTTDSEIF�INSUREF9RWORKtRS' Z ---- —_ — Q COMPENSATiON,AS PR041DE0 8Y 3ECTION 37o00F THE LABOR CODE,FOR 7HE PERFORFMNCE W OF THE WORK FOR WHICH h115 PEflM1T IS ISSVED. � � _I FIAVEAND WILI MAIMAIN WORKER9'COMPENSATION INBURANCE,AS REOUIRED BV SECTION �{ �j Q s7aoOFTHELAeORCO�E,FOFiTHLPERFOflMANCEOFiHEWORKFORWHICH?HISPERMITIS _� �U A�� ���_( I551JE0.MY WOPKERS'COMPENSATION INSUflANCE CARftIER ANL]POLICY NUMBER ARE: CONSTRUCTION l� � /� �T -�------ . � CARNIESI____..____ _ PLAN REVIEW _.. _,__... —_________—_-_........___________.._—___—__ Z Po��cYNUMeER _'--____—___— .__""_._.—_ ELECTflIC _.._'__— __—_ ¢ � (fHISSCCiX7NNFIDNOT6EC(M+PlETEOOFhEPEFttkTISiOF70N[VAMORLDDOLINiS(S7a0JORLESS� PLUMBING , _ _j�" ' ' ��'+. �-- .. ' "_'___'._'— W ., "; . a.'�b" ___'_"" Z I CERTIFY THAT INTHE PENFOf7MANCE OF THE WOHK FOH WHICH THIS PFflMIT IS ISSUEU,I MECHANICAL -�•� ..."__"'_—_"'_"" __. (} SHALLNOT EMPLOYANY PEFi50N IN AYY MANNER SO AS TO�CCOM[SUI3JFCf 10 TH[ � � WOflKFRS'CAMPENSATIIXJLAWSOFCALIFORNIA,ANDAGftEETXATIFISHDULDBECOME INSPECTIONFEE „_,_________,__ _ __ ___ SU&IECTTOTFiEWORKERS'COIAPENSATIOUPIIOVISIONSOFSECTION37ooOFTHELAA0f1 �Y P[{` ��� ,��_� �j CO�E,ISHMIFOR7HWITHC0�11PLVWITHTHOSEPROVISIONS. ISSUANCE ,,,,,,,,,,,,, ^,j_E,F' ��[�p�� __ �^ � SMIP �11�.'—a.r ..; �' , (�—� p DATE: _ APPUCANT. __._....._._...__"__'__--__'_"_"_" _..—_— } -i'-� ... _"__'.'_�._�" LLl •-e�.�s<,_.i'' �i1�tg.:�•.4� .s,.a't'� ..._ J WAPNING:FAIIME TO SLCU{7E K'OFlKERS'COMPENSATIO�COVERAGE IS UNLAWFUL,AND SHALL 8E ENERGY P/C . !1 y ��q'�"�'Mj SU&IECTANEM.PLOYERTOCRIMINALPF.HALTI[SANUCIVILFINESUPTOONEHUYURF.�THOl1SAN0 } �`+� �+�=�'',��� U- ENERGY PERMIT �" �r`v`i�=• DOLLARS(5700.000),IN AODITION TO THE COST OF COMPEN5ATION,�AMAGES AS PflOVIDE�F�R IN — �t���rl�` -��--- � SECTION37080FTHELABORCODE,INTEREST,ANOAITOHNEY'SFEES. RETENTIONFEE: ___ _ ___ __ "_—"""__'..._'____'_'_ � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: p ------...----- ----- -- • � I HEREBYAFFIRM uNOGH PLNALTY OF PEFiJURV THAT THERE IS ACANSTRUCTION IENDINO AOENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH iH15 PERMIT IS ISSUED(SEC.3087,CIV.C.). —�-'""----�-----'--"—----"'"" "'"'"--"-- W _ _____.___—_.______—_-- — ___._.__- _ � _ _____ LENUER'SNAME ._...—.._...__""'___-----___""'""__""_""""_ f'- LENDFN'SA�DttC-SS_.._.._ (� p W� TOTAL FEES C( (� I CFRTIFV TMAT I HAVE FEAD iHISAPPUCATIONAND STATF.THAT THE FBOVE INFORMATION IS COFR[C7'. �� .. / `� � 1 AGHEETO WMPI.Y WITH ALL CITV ANO COl1NTY OR�INANCESAND STATE LAWS RELATING TO 9UIL�ING � � CONSTRUCTION,ANO HEREDV AUTHOFlRE RLPRESENTA7IVES OF THIS COUNTV TO ENTER UPON THE Z AE30VEMENTIONED PROPERTV FOF INSPEGTION VUHPOSES. 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