HomeMy WebLinkAbout15724 � -A, CITY OF DIAMOND BAR (/�� . . �' - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES `-% _ `21660 E.Copley Drive Suite 190 PRESS � (909)860-3195 Fa�c(909)861-3117 ���9�'� � BUILDING PERMTl'APPLICATION FIRMLY o ADDR'ESS �/��� �L� �C���/`-0��� ' �`�" DATE CATION } ;rJ � NUMB R f�.t � #/C� .� c� ISSUE {j .lki� TYPE OCC APN LO7 _ TRACT DATE "1 V�� CONST. GROUP � OWNER LL ADDRESS ZONING SETBACKS z CITY ZIP TEL. FRONT RW CJ ___ g APPLICANT _ TEL._ REAR !7 _ � , SIDE/SIDE STREET RW IJ � CONTRACTOR ��' `��^''' -��t � _ SIDE _ ❑` p� ADDRESS� �` �'�� ' d PROPOSED USE��) . �f' C: �'�+ 1, r'u � CITY ZIP 7EL. ` O o .�: .. " C„ w ARCWE 1 g DESIGNER - NO.DWEL. NO. NO. a ADDRESS UNITS STORIES __ BEDROOMS_ � CITY. ZfP TEL. � DESCRIPTION 5�.FT FACTOR PSF ADJ.AREANALUATION � ¢ OWNCR•BUIL�ER DECLARATION SFR/AD�/REM ; � O p I HEflEBY AFFIRM UNDEfl PENALT'OF PERJUflV 7HAT I MI[XEMPT FROM THE CONTRACTOFS LI- Gflf9GB/C8f{10fS W CENSELAWFORTHEFOILOWINGR'eASON(SEC 10.31.66U51NESSANDPROFESSIONSCOD[.AkVCITYOR (n ZCOUHiYYAiICHREWIRESAPEHMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANY57NUG W PdfiO/DBCk TUflE,PRpR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMITTO FILE A SIGNED S W STATEMENT THAi HE OR SHE IS LICENSED PURSUANT TO iFIE PROVISIONS OF THE CANTRACTORS LI- W � CENSE LAW(CHAPTER B(COMMENCINO WITH 3ECTION 700oJ OF UIVISION 3 OF THE OUSINE55 ANO PRO- u' PooUSpa FE5SqN5CO0E�ORTHATHEOF5ME15FXEMPTTHEflEFFlOMAN�THEBA5ISFORTHEALLEGE�EXEMP- (�} TKKJ.ANYVIOLATIONOFSECTION7091.59YANYAPPLICANTFORAPERMITSUBJEGTSTFIEAPPLICANTTO Z Re-Roof 'Z�G,<3��N � ACMLPENILLiYOFNOTMOREiHANFNEHl1NDRED�OLLAflS(f500).)' /-� CII,ASOVMEROFTHEPROPERTV.ORMYEMPLOYEESWITHWAOESAS?HEIRSOLECOMPENSATION, � Commercial � WILL001HE WORK.AN�THE STRUCTURE IS NOT INTENDED OR OFFEflFA FOH SAIE(SEC.7046,BUS6 _..! y NE53 AND PROFESSIONS CODE THE CAMRAGTORS UCENSE LAW�OE5 NOT APPLY TO AN OWNEq OF � PiiOPERTY NM1IO BUIIAS OR IMPROVES THEREON,AND VAiO DOES SUCH WORK HIlASELF OR HERSELF Oq � TMROUOIIMISORMEHOriTIEMP�OYEES,PROVIDEOTMATSUCHIMNflOVEAAEN75ARENOTIN7ENDEDOR m Q OFFEREDFOPSALEIF,HOWEVER7MEBUILDINOORIMPROVEMENTISSOIDWITHiNONEVEAHOFCOMPLE� � TION.THE OWNER-BUILOER WILL MAVE TME BURDEN OF PROYING THAT HL Ofl SHE DID NOT BUILD OR IMPFqVE WR THE PURPO&E OF SALEI. w f]I,ASOWNEROFTHEPROPERTY,RMEXClU51YELVCONTRACTINGYVITi1LICENSEDCONTRACTORS — �_ � TO CONSTRUCT THE PflWECT�SEC.70N,BUSINESS AND PROFESSIONS CADE:THE CANTFACTOHS LI- Vi11UdIiOn ._. I S ADJ.AREA W CENSEUWDOESNOTAPPLYTORNOWNEROFAPHOPERTY6YMOBl11L�50RIMPROVES7MEREON,PND — � WFIOCOMMCTSFORSUCMPflOJECTSWITHACONTflACMR(SJLICENSE�PUNBUANTTOTHEODNTMP (]UANTITY �DESCRIPTION FEE � TORS LICENSE UW.). j � p I AIA EXEfAP7 UNDER SEC.____ B.d P.C.FOR TH;S H[ASON � � 3 -------------- � � DATE __OWNEii__,__,...._— U , UJ � LICENSED CONTRACTORS D�CLARATION W I � 1 HEflEBYAFTIRM UNDER P[NAITY OF PE0.IUHY THAT 1 NA LICENSFD UNDER PROVISIOYS OFCHAPTFN � , � 9(COMMENCIN(3WITHSECiqN7oa0)OI"OIVISION30filiEBU51NESSANDP OFESSIQ� or:,u+n � l��5 MY LICENSE IS IN NLL FORCE AND EFFECT. �f'�J�r�Fj� yJ � m � UCENSE CLAS �1�� LfC.NO._ V•� �_ 4 � _�___" J i V oare I � ef ' CONTRACTOR C b`e�_^_.'_�w.,�g� a w � WORKERS'COMPENSATION DEGLARATION —� � IU N IHEflEBYAFFIHMUNDERPENALT'OFPERIURYONEOFTHEfOLLOWINGDECtARATIONS: y Z Q — � IHAVEANDWIlLMA1NTFINACEftTI�ICATeOFCONSENTTOSELF-INSUREFOf7WORK[RS' _ 'Zd- �COMPEN5A71ON,ASPROVIOEDBY9ECTION37000F7MELABORCODE,FOR7l1E7LFiFDnNANCE U _ ___ _ OFhIE WORK FOR WHICH'fH1S PERMIT IS ISSUED. g � — W _IHAVEANDWILLAUINTAINWORKEHS'COMPENSATIONINSUflANCE,ASflEOUIqFDBYSECTIOtJ ///��� Q 37aoOFTHF.LA80RCODE,fORTHEPENFOA!�ANCEOFTHEWOHKfORNniICHTHiSPERMlT1S � I'/ . 0 ISSIJED.MYWOFKEfi3'WMPEN�9A^pTKKJINS ANCECARRIERAN�PUIICVNUM9ERAHE' CONSTRUCTION .__ , " � � —' '—_"' _'"_/ ""' / � CARRIER__4�✓���/�.{,.�i�'� �'_—_ PLfON f3EVIEW __'—"' _ _"'__" _"'_"—__'__— :. �� {�r-[� �iy � POLICYNUMBER!�.L�/���r� ELECTRIC Q (�}{i$$EC170NNE�NOTBECOMREfEDOFTNEPEfY.IRiSFORONEHlMDf7E0DIX.lAR9(5f00)ORLESSA PLUM6ING -_-_--- ...—.- . Z ICEHTIFYh1ATINTHEPEflFORMANGEOFYHEWOFKFORWHICHTHISPEFMiTI51S5UED,� M[CI-IANICAL ,_,__.____ ___ _ (J 5HALLNOTEMPLOVANVPERSONINANYIAANNERSOAST08ECOMESU6JECTTOTHE ��ySPECTIDNFEE " (/] WOAKEFS'WMVEHSNTION LAWSOF CRLIFURNIA ANDAGREF:'fHA�lf-I SHOULUBECOMF. --_...._---_. -__.. � SUBJECTTOTHEWDRKERS'COMVENSATION 1 SOFSFC'ION37000FiHELA�OR` � COO ISHRLLFORTMWITMCOMPLYWITHT OVI51 . j ISSUANCE ...._____._ • "__'_ p DATE:� �� � APPLICANT: _ SMIP _.,_____'__._ • . W ___�—.—,_��� ENERGV P/C ------ J WqpNING FAILURE TO SECUflE WORNERS'COMPENSATION CAVEAACE IS UNLAWfUL,ANII SHALL BE --- —'---'-- -�--------'-- J � SUB.�ECTANEMPIOYERTOCRIMINALPENALTIESANUGIVILFINESUPTOONEHUNOREDTHOUSFND ENERGYPERMIT pOLLARS�Siao.000),IN A�DITION TOTHE COSTOF COMPENSATION.DAMAGES AS PFOVIDED FOR IN ----- -----�- __""'''_" , � BECTION37080F1}1ELABORCODE,INTEREST,ANDATTOHNEV'SFEES. RETENTIONFEE: ___._.,__, d CONSTRUCTION LENDING AGENCY PRE•ALT FEE: ____..,,_.._____.___ ___,___ � IHEREAVAFFIRMLINOERPENALTYOFPERJURVTHATTHEFEISACONSTRUCTIONLENDMGAGENGV ______.____ ______ FOH iHE PERFOflMANCE OF THE WORK FOR WHICN THIS PERIAIT IS I55tlED(SEC.3097.CIV.C.). W ____"_—_ _'— ___ , � LENOERB NAME _""_"""'"""_'_"""""___"""_"' . F-- LENpER'SA�DNESS___ -- � WICEflTIFYTHATIHqVEREAUTHISAPPLICATIONANDSTATETHATTNFABOVEINFOHMATIONISCORRECT. TOTAL FEES , ���� � IAGHEETOCOMPLVWITNALLCITYANDfAUNTYORDINFNCESANDSTATELAWSHELATINCTOBUII.DING CONSTRUCTION.AND HEREOY AUTHOfiIZE REPftESENTATIVES OF 7HIS COUNN TO ENTER UPON THF. ABOVE-ME�L3WNED PROPERTY FOR INS�ION PURVOSES. Z ,, COMMENTS__ ___—_.__.___ _ .__ � _i�d��'� T~i6' c/ ,} , ..----- ------.,.— m PERMITiEEN INT -..._— ___-- � ����'—"�'e.�-� �'�/�c..a - ' -- � SIGN REDFPERMITTEE /�� ATE = E' RECPT.N0. PAID B _ __VAIIDATION __ ~ WHITE--Depertment Copy,YELLOW—Fmence Copy,PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicanfs Copy . , ., . . . . � . . .' . . . . , . • . i .. ,. . . . i � _� . . ., ��,a . � �� � I ' . . ` , . ... .. . , . . . .. .. ' zf, . ' ' . . . . , .. .. , _. . ,. � ; ' . .. , ' , . ... . � , .' .. . ., . , . , -. . .. . " .. � . . I _ t. . . � " , . .. ., _ , ' � � � � � . � - - . _ . . . . . . , . ; ' . . � . . ; ' . .. ' . _ . � . : ` . I - ' 1 . . . ' , i �\ , ' I _' �I. ; ; � ; ; = � i : i I � ' �_ � i , � i , • i . ' � � : , . . ' i . i , s � � . li � , � �. , I ' - : � � ! � � � � ' � '� � ; ' � ' � � , - � �� i � ' � � � '_ � :� � , , ;' � �,N ,,y` � . , . ; � , i � '� � , �� � , , \'C] � , � r . _ i �: � . _ i , i . , ',' �/T ' . �y . �� � . . � - ' i i , � ' � �' f . I � � ' ' ' , , ' i _ . . . ' I _ - ' . . . � '. . � � i . • ' � � . � � .. , ; , , . . . . ' . , � t , ' . . . i , - � _ � . i �.-- - . . .. _ � � .J .� . .�_ _,_ .I _ i � . � , �, � . �. � , �. � � i . 1 � _V. � ���, ' i . . i . . j , . .. . . .. � _ .� . . , i , . . : . . 'j . . �� � y ` .. � _ ` � i ; , , I ' - . � ,i .�I � . , � I � � , . . � , • , � � ; �� ' . ' � ' _ � , � � � � �� , � � I ' � � � � � � � I 7 � I � _ . . I 'I 4 i . .. �' _ I _.. ,. &3szi t , , I . , i • .Y.. . , � i � ' � � . � . � � � � � i I � 4 � I � � . . . I � _ . _ i „ , , . , � � -: � ; _ � . , . , ' . . I , _ ' . . � , � � ! . . - .. . � . I I � � '. ' - "j ' I . � . . ._ ' . i . 'I � �-"�` � '� � � , . �, � ' � I 1 - - � . , � � � ' � . I i � . �! ' � . i . '' i .. i i , ��' � 1 . ' �' I . � o . � i . ' I � . � . - , ; . A � I I 1 i � � � ! � J k �f i i I r ; . ' ', ' � , , ; I . . , , , I � ' ' , i tr � , � � , , , :`j , � � i � ; . . � i � .. ' , .. .. .. . ..,_. . . , ' � ; ._.� _.. . .. .. :. .. . . .... � . . , .. . _.. ..... .,.� •< '.. . . ,. r �, . 1._. .. .. .� �. .