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HomeMy WebLinkAbout16999 (26) _�\ CTTY OF DIAMOND BAR � DEPARTMENT OF COIvIIvtUNITY&DEVELOPMEM SERVICES �� 21825 E.Copley Drive (409)860-3195 Far(409)861-3117 / PRESS "��� BUILDING PERMIT APPLICATION .� FIRMLY Q ADDRIESS "'�Z-1 `'U���( �,�"tLL�- DATECATION 2.' D� NU BER� � p/C � „ ISSUE TYPE OCC APN LOT TFACT DATE CONST� GROUP ¢ OWNER �j"• � T !' � 0 p ADDRESS '7i�n � � j • ZONING SETBACKS z CITY �}v�.��c.u1 SC�✓ ZIP TEL�'J__,,�t'r FRONT / Ryy p � APPUCANT TEL. REAR p �� SIDE/SI�E STREET RW p CONTRACTO �t��'1`�L� N11t"� SIDE p � ADDRESS 'L'l�. Gcnnrnn Ft�. � CITY _�Q�t ZIP���'iEL._�( . � PROPOSED USE_ ���—��1S� �?Cf,�j 71� ��/D w ARCH/ENG/ I �1J 77� F'Li4-�- �1-.�A �1 z DESIGNER 1 �'�1 nw. ADDRES r N0.DWEL NO. NO. � CITY � ZIP � TEL. — 7 • , UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNEF-BUILDER DECLARATION p SFR/ 0 EM C p 1 HEREBY AFFIRM UNDER iENALTY OF VENJRY THAT I M1 EXEMPT FROA1 7HE CONTMCTORS LF GaragelCaryort W GENSEUWFORTMEFOILOWINOREASON�5EC.7C71.68V51NE55ANOPROFE5510NSCODE:ANYCITYOR (n U COVNTyWMIp1qEWIRESAPERMITiOCONSTRUCT,A:TER,lA1PROYE.DEMOLISI,ORREPP1qANV51RUC• (L W TURE,PHqR TO ITS iSSUANCE.ALSO REOUIRES THE APPLICANT FOR SUp1 VEFMIT TO FIIE A SIGNED W PdSiOIDBCk STATEMENT iHAi HE OR SME IS LICENSE�M10.5W W7 TO TNE PROVISIONS OF TH'e CANTRACTORS lb �� CENSE UW(d1APTER Y(COA141ENCIN6 WITH SECTION 7000)OF CIVISION 3 OF THE BVSMESS M1�PRO� � PooVSpa FESSqNSCODE)ORTHATHEORSNEISEXEIAPTTNEREFpOMµDTHEBASISFORTNEAILEG[DEXENP• C7 V TION./N`/VIOLATqNOFSECTIONTW1.68YANYMPLICANTFORAGERMITSU&lECT3THEAPPIICANTTO Z Re•Foot � ACMLFENAL7YOFNOTMOqEiWWFNENUNOHEDDOlURS(SSoo).} � Z ❑4ASOWNEROFTHEPROPERTY,ORMYEM7LOYEESWITHWAGESIlSTFIEIRSOLECOMPENSATbN, ❑ COrtlmBrti21 WIlL00 THE WORK.AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7W�.BUSI� J N NE55 AND VROFESSIONS COOE:THE CdJTRACTORS LICENSE UW DOES NOT APPLY 70 AN OWNER OF VROPERTYWViOBUILD50RMPROVESTHEREON,AN�NTI0DOE55UClIWORNN1A15ElFORHERSELFOR � CL 7HROlM1iHISORHEROK?lEA�PLOVEES.PROVIDEOTHATSUp/1MPROVEAIF4TSARENOTWTENDEDOR m O OFFEREDFORS�LEIF,HOWEVE0.TMEBUILOWGOf11MPROVEIAENT1550lDWITHINONEYEAROFCOMRE• iqN,TME OWNER�BUILDER WILL HAVE THE BUROEN OF PROVIN6 THAT HE Ofi 5ME DID NOT BUILD OR � IM7ROVE FOR THE GURPOSE OF SALE� � � /� �yJ ❑4�OWNEROFTHEPROPEf�Y,AME%CLUSIVELYCONTMCTMGW77Ml�CENSEDCONTMCTORS ¢ TO CONS7ftuC7 TNE Pq0.1ECT(SEG 701�,BUSIN[SS M!D PROiESSIONS COD[:THE CONTRACTOflS LI� VBIU0ti011 ADJ.AREJi W CENSEUWDOESNOTAVVLYTOANOVMEROFAPROPERTYWMOBUILDSORNAPROVESTNEREON.M10 � WHOCOMMCTSFORSUp1VR0.1ECT5WITHACONTMCTOR(SJLICENSEDPl1R5UANTTOTMECONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE UW). � ❑1MIE%EIAPTUNDERSEC. B.tP.C.FORTHISREASON Q C 1� r � � �i ' i/ • LL' DATE OwNER F- o W V�"A,�,v � UCENSED CONTRACTDFiS DECLARATION w � IHEREBY�FFIRMUNDERPENALTVOFPERJURVTHATIAAI�ICENSE�UNDfRPPOVI510N50FCHAVTER � p., 9(COAIM[NCWGWRHSECTION7000jOF�INSION�OF7HEBU51NE55ANDPROFE53�ON5CODE,AYD Z x A1YlICENSEISINFULLFORCEANOEFFECT. 0 LICENSE CIAS UC.NO. �O"��O,Z � V DATE y � CONTMC70R'�� W a W � � WOAKERS'COMPENSAT�ONDECLARATIO�� . ��'�`� U pt)r.��✓ � ✓{ a N IHEREBYAFFIRMUNDEHVENIILTYOFVERJURY0NE0FTHEFOLLOWWCDECURAT S: Z , � _IHAVEANDWILL�IAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _ Q COMPENSATpN,ASPROViDEDBYSECTION7�ooOFTHEU80qCODE,FORiMEFEnFORMANCE U Q OFTHEWOPoCFORMMICHTHISPERMI715155UED. � � Qw _IHAVEANDWILLMAINTAINWORKERS'COVVENSATqNINSURANCf,.l5RE4UREDBVSECTqN 770o OF THE UBOR COOE,FOR TH[PERFORNANCE OF THE WORK FOR WHiCH TNIS GERM�i IS 155UED.MY WOFK 5'COMPENSATION INSUFANCE CAARIER M!O POLICY NUAIOER ME: CONSTRUCTION J 1 j CMRIER � t�4�Q ���lt� - � �C�_��.���" �� l PLANREVIEW Z va�cvnui.�oea ' ELECTRIC _. ._ . ¢ �- -- � (nassEcrpwr�mr+oreEcar.nFrmoFnF�w.+rtsranceErtironE�oatuaR+m�oa�css). PLUMBING I I{--�= �'=�~' 'r—�— Z ICERTIFYTHATWTMEFERFORMANCEOFTIEN'ORKFORN'HICHTHiSFERMIT�515SUED.1 MECMANICAL � " �� ��� U C7 SWLLLNOTEIAPIOYANYVER50NWANYMANkER50A5iOBECOME5UBIECTTOTME N WORKERS'COAIVENSATIONUWSOFCAIIFORNI�ANOAGREETNATIFISNOULDBECOME INSPECTIONFEE � SUBJECT TO THE WORKf RS'COUPENSATqN VROVISIONS OF SEC7ICN 7700 OF TNE LABOR � s CODE,ISHALLFORh71NTHCOMPLVWITHTH05EPPOVI510N5. ISSUANCE � p OATE: APRICANT. SMIP �..'��r � WARNiN(3:FAILURETOSEWREWOFNERS'COAIFENSATIONCOVERAGEISUNUWFUI,ANDSHALLBE ENERGYP/C �-�—"--�--. � SUFLIEC7ANEIAPLOYERTOCFIM:NALPENALTIESANDCMLFINESUPTOONEHUNOHEDTIqUSAND ENERGYPERMIT � DOlURS(f toa.Doa),P!ADDIiION TO1HE CAST OF COMPENSA7qN,DAMAGES AS PPOVIDED FOR IN ¢ SECTpNJ7o60FTHEUBORCODE,INTEREST,AND�TfOfWEY5FEE5. RETEMIONFEE: oCONSTRUCTION LENDING AGENCY PRE-ALT FEE � IHEREBYAFFIRFAUNDERPENAITYOFPEPJURVTHATiH[fiEISACONSTRUCTIONIENDW6ACENCV FOR THE iERFORMANCE OF THE WORK FOR WMid1 TNIS PERMIT IS ISSUED(SEC.709I,CIV.C,�. Z W � IENDER'S NAME � F— IENDER'SADDRE55 � TOTAL FEES � � � I CERTIFY TMAT I HAVE READ THIS APPIICATqN AND STATE TMATTME ABOVE INfORNATpN IS CORRECT. W IAGREE TO COMPIY K7TH ILL�LRY AND COVNTY ORD'NlW CES nN�SUTE LAw'i REUTWC i0 BUILDING � CONSTRUCTION,ANDNEREBV flREREPflESENTATNESOFTHI5CWN7YTOEMERU70NTHE � ABOVE�4ENTIONEDPROPERTY OR SPECTIONVURVOSES. z COMMENTS 0 J � m CERMITTEE NA/AE(PRI ) Q � . /rC/ I!1 � � / � � SIGIUTUREOFPERMI OATE � RECPT.NO. PfUD BY _ VAUDATION WHITE—Department Gopy,YELLOVl—Finance Copy,PINK—Assessor Copy,GOLDENROD—FileCopy,GREEN—ApDl�canCs Copy �t � a ".ii !_'�'FF�.��r4k.1��`�G_I �^I�f',.4 . r S -r^.. ..1 t_ 1 4�•_. . � � . ���`,4.t ....`�• �4�f1, � i���..^, ��..��... .�.�..._..�����. .....-._..__..._.._. � . ___�... � ... ... . .... . . .......... _'"."_'"__" _.___ " ".__.__. . .. _.__. ._.�___ ' �A`Eej. F� � l`�1 ' 4." f.-. . ;,' y"ILL f F �� . . , {���',� r... : �.�-:1`' �� �� .��r4::�� f_. ����:�� ' - . . . . , .. . . . . . . . . . . _.._. ._..._ . . 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