Loading...
HomeMy WebLinkAbout17029 (10) � CITY OF DIAM�ND BAR ��j �� � La � 1�'�`'` DEPARTMENT OF CCII�Rv1!UNIT'Y&DEVEIAFMENT SERVICES y � 21825 E.Copley Drive �.,�,�� `'i� '' ��09�sbo-s i 9s FaX�909�sbi-s�i� `t;� �' ``� PRESS � .,��'. BUILDIIVG PERMIT AFPLICATION FIRMLY *� JOBStTE 2� �'"} � APPLICATIO PERMIT P/C � ADbRESS�__� � q�0�1�"'�� �l,�I L _ DRTE � .�� � NUMBER j��� # L�' � 3 tp l � ISSUE , TYPE OCC � APN LOT .. TRACT _ pATE � � O� CONST.�._� GROUP p OWNER �''- ADdRESS ZONtNG SETBACKS gCITY ZIP TEL. FRON7 RW O APPLICANT u TEL. AEAR �_� � SIDEISIDE STREET RW � ,`=m� CONTRACTpRT E '�115 ����'�✓�i(�IS} SIpE [�_ � ADDRE3�_,.�l�� !..L�i t �S j � CITY-�!Q���.�c.�_ Z!P 9�76.L. TEL �'�—�� PROPOSED USE �'+�'1 � �IY w ARCH/ENG/ .523 333,5 WdES�GNER� — NO.DWEL. NO. NO. �y ADDRESS — UNlTS STORIES BEQROOMS � CtTY ZIP TEL. � dESGFtIPTItJN SG2.Fi' FACT4R PSF ADJ.AREAIVALUATION p� QWNER-BUILDFR�ECLARATION SFf4(ADD/REM � (� 1 HERE6V hFFiRM VNpER PENALfY OF PEiiJU%V TI1A7 I AM EXEMPT FROM TNE CONTRAC70R5 LI� G8f8(J8/G3fPOf1 W GENSEIAWFORTHEFOLIOWINGREASON(SEC.7091.SBUSMESSANDPROFESSION9COOF:ANVCITYOR f� C..} �OtH{TYWNICHftEQUIftESAPEFiM17TOCONSTAUCT,AITER,P.APftOVE.bEF.��ISH,ORR=FAlRANYSTRUC- �jJ patio/Deck W 7URE,VRION TO ITS ISSUNNCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERAAIT TO FILE A SIGNED W .,.� n�r STA7EMEM THAT HE OR S'.HE 15 UCENSED PURSUAN7 TO 7HE PqoVISIONs OF 7N6 c�NTRACTpRS li� � �� .�r-. CENSE CAW({:HAPTER 9{f,'{�MMENCiNC WiTH SECTION 7000j OF OWISION 3 Oi THE DUS�NESS ANU PRb� �P60U M FESSIONS C4DE1 Ofl THA7 HF pR SHE IS EXEMPT THEREFROM AND THE BASIS FOF THE ALLEGED E%EMP� � TION.ANYYIOIATK?NOFSGCTfONT031.ffBYANYAPPL3CANTF4RAPEfM41T5U&IEGTSTMEAPPLICANTTO Z RQ-RO01 � A Cft+�L PENAI.iV OF NOT MORE THAN I'N[HUN�REf7 OOLI,ARS(5500�.): � ❑I,ASpYMEqOFhIE:PROPERTY,ORMVEMPLOYEESWITHWAGESHSMEIRSbLECOMPENSATION. O COmmetCial � WftL 00 THE W4P1C,AND�31E$TRUCTURE IS N07INTENQED Oft OFFER'ct}FqR SRCE{SEv.704A.BUSt� J NESS AND PROFESSIONS GODE:THE GON'RACTORS LICENSE LAW DdES NOi APPLY TO AN OWNER OF � PROPERTVWH09VILDSONIMPFlOVESTHEREON,ANDWHODOESSUCHWOqKHIMSFLFOPHER5ELFOR � C[ THF�UGH HtS OftliEROWM EMPIOYEES,PFtOVIDED THAT SUCH�MPROVEMEN�SARE NOt MtTENOEDDR m W OFFEREDFOHSALE.IF,HOWEVER,7HEBUILDINGOpIMPROVEMEN71S50LDwIiHINONEYEAROFCOMPLE� � TIQN,THE OWNER�9UILDEH WILI HAYE iHE BUROFN OF PR�YfNG THAT HE OF SHE DID NOT BUtI�Oft """ � tMPpOYEFORTHEi'URP09EaG'SA�E}. = L::II.A56WNEROFTNI:PRpPERTY,AME1(CLVSIVELVCONTRACTINGWITNLICENSEDCONTRACTOHS W ,I} „ [� TO CANSTRUCT THE PROJh_CT(SEC.7�4t,BUSINE55 AND PROFc5510N5 GODE:TME GONiAACTORS lI- V31U21lOti ' 4 LfO ADJ.AREA W CENSEUWDOESNOTAPPLYTY?ANOWNEROFAPROPEflTYWHOBUILDSORIMPROVESTHEREON,AND � WHOCANTFlACTSFORSUCHPROJECtSWITHAGONTRAG'OH(5)LICENSEDPURSUANTTOTHECONTRAG� QUANTITY L?ESCRIPTIQN FEE T(TRS UCENuE IAW.}. �`' � ❑1 AM EXEMPT UNDER SEC. ,,,,_..,...... B.&OC.FOR TN�S REASON Q • �1:..� � ��1.. . V,t� , , "`�i �_' -._ ...._.. � ... � � ^- OATE 4WNER � � ......_..._ U p �ICENSED CONTRACTflRS QECIARATION w (Y I HEREBV AFFIRM UNDEF PI:NAI.TV OF PERJUFY THA7 I AM UGENSED UNUER PROV1510NS QF CHAPTER � 1 , ' �r m� J/h S.'�;' q,,, s{COMMENC�NG W1Tt{SECI"iON l000)OF DMSIDN 3 OFTHE 8t3SiP1ESS AND PftOFE5S�6NS C�E.AND Z 7 /� 7�+' }G MY UGENSE IS IN FULL FOH�E AND EFFECT � � L�CENSE CLASS G 4.,��¢___LIC.NO, ����/�� j � � �h ���v ~ OATE�L1�,�-iy-�_- *r'-F C41�TRAGT4R..___`i.-"'_' a � �� . 1"..L�. , •r'�. ... �7 `f�U w `�.�._ � W{JRKERS'C{1MPENSATIdP!DEGLARATIOfJ U �� f,,2. -!A� ` � I HERE �RM UNDER PE:NALTY OF PERJURY ONE OF TH'c FOLLOWING DECLAPATfONS: � Z O IHAVEANbWILLMAINTAINACER?IFICATEOFCONSENT705ELF-INSUflEFORWOflYfER5 = CAMPfNSATPQN,AS Pfl6ViDE�6Y SECTION BTaD 4F iHE 1A30R C06E,FOft iHE AERF6RMRNCE U � 6F THE WORK FOP�NMICH THIS PEFMIT IS ISSUED. � 1� � I HAV£ANp WILI MAINTAIN WOHKERS'CdAiPENSATION INSURANCE,AS REOUIRED 6Y SECiION �}yy.,�.�, � 37000FTHE LABOR COPE,FOpTHE PERFORMANCE OFTHE WORK FdR WMICH THIS PEPMIT IS �+ — ���,�� ISSUED.MY WORKERS'GOMPeNSATiON INSUR.4NGE CAflRIERANO POUCY(vUMBEH ARE: CONSTRUCTION �� _ 1 „"r--� cnaRiEa_ __ Q- V __ PLAN REVIEW ��•7f ����2" .��.'�j„T � POLICV NVMBER`t�.t 7�,,,, "'� ELECTRIC ¢ , � .... ..� ..�. (i}iS5EC7KXJNEEDF.KI76EWMPLEiF06Fn�PERMtTtSKX2oNEV�cA�DREOCa.tAPS{StooyoliLEss}. PLUMBiNG y� - lAi ` ,W't,' t CERTIFY TNAT W THE PERFORMANCE 6�THE WOFIK FOft WHiCN THIS PEAMIT IS ISSUE4,� MECHANIGAL _ �� �� ��L' (3 SHA4L NOT EMi'LpY ANY PEFiSl7N IN MNY MANYEfl 50 AS TO B:GOMt SUBJECT TO THE � WOpNERS'COMPENSATIqNLAW50FGALIFOFNIA,AN�AGREETHATIF15HOULDBECOME INSPECTIONFEE � ,,,, SUBJECTTGTHE WOP,1tER5 G4MPENSATIOM Pft0 N50F SECTtQN 370aOF'NE lA&OR "J' ��� � CopE,I SHALL FdRTHW17H COMPLV WITH i PROVIS 5. ISS�.lANCE � f��,��� r Q ��?�__ p 6A7E',S;J.�����APPLiCANT: SM(P ��----;� _ � — � ENEflC�Y P1C J WAflNiNG:FAILUfiE T�SECVflE WbftKEftS'CdMPENSATYJN±AVEftAG`t IS Uh'IAWFUI.,ANp 5HAL�8E � 5UBJECT AN EMPLOYER 70 CRIMINAL PENALI'IES AND CIVIL FINES UP 7(SONE HL'N�RE�THOUSAND ENERGY PERMIT DOLLARS�S�W.000).IN npG�fION TO THE COST OF COMPENSATION,DAMAGES AS PRqVIDE�Fo:t IN --� � --�--�— J SECTIUN37080FiNElA84FtfADE,INTEREST,ANDA1TOflNEY'SFEES. RETENT�ONFEE: �` �� � . CONSTRUCTiQN IENDIMG AGEMCY PRE-ALT FEE: ,^,,,,, ,_,,, . � I IIEREBV AFFIfiM UNDEF PEIVALTV OF PERJVRY 7HAT THERE IS A CONS7RUCTION L[NDING AGENCY . FOR THE PEIiFOftMANGE OF THE WOftK FOR WHICN TMIS PERMIT IS IS5UED{SEC.3097,CIV C.}. �"""� ������ � w � --�� � � I.ENDGfiS NAME _,_ _ .._-_ '� ' ^ __ _ t- LENpEA'SAOOAESS�_. .�.. � ICERTIFVTNATIHAVEREADTHISAPPUCATIONANCISTATEIHATTHEA90VEINFORMATIONI5CORREC7. TOTAL�EES ���'i� �� W�`�� �� � IAC�REETOCQMPIYWiTNALLGiTYAND�:VUN(YOftDtNANCESANDSTATECAWSREldiINGT08UI�DIN6 � CONSTR ildN,AND HEREBYAUTHORIZE REPFESENTATNES DF THIS COUNTY TO ENTEfi UPON THE �, ABOYE�M TIONE�PROPFRTY FOft INS7ECTION PURPOSES. � / caMn�Er�rs __� � --�.�'_�--T - U�--t�-__ ,� �-r-�-��-� ���-__-- m PERMII"rEE NAME iPFINTj )!7 , _ .. aC '� �� — _.. . i . � _�� � SIGNATURE 41F PER ITTE6 D TE � FtECPT_t�0. PAIO BY t-- � VA�7DATION _ ��� t Co YELLOW—Finance Co PINK—A5sessor G LDENROD—File py, py, Copy, Q Copy,GREEN—Applicent's Copy � � � �`�_����-�:.� . y� i ��.�s� ��� �i +��`re� ��r. €.k� �_ ��� � - �-��_ ,r�.: _.'_. . . � _. ,.7 ��7. '`__.�_ ._ ... .. .. ..... . .' . . ... . . ._ . ... . .. ... .. . .. �. . . � -:.- '� . , .. . , . . , ;.._...._.__. , . . . ! ...�(.;1!"��� ' -. . � . . .. .. . . , .. . . .. .. . � . , . � � j . `. y�.,,i—" . . . . . . . . . . .. . � . _.., ., . . ' . .. . .� .� �. .. ... ._. ... ,i � ti ...�..... . . . . . �, .- � . � . . . . . .. . .. . . `"�—�� '� - � . ... Z-2�—0�,,. �� 1�-irYj? � . ,, � �.: — . . °�� �- ��_� � { s _ � �. • � � �.� s ,v�� � �a �. _ � �,� � .; � � : � . �..�� _ � ,. K- � d = �� �„ .�yz „� �� � � � � _ r� � � n e , � -.� . � . _ _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)8603195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY APPLICATION f PERMIT P/C DATE d .�o�-� NUMBER# U r-3 �� ISSUE{�,TYPE OCC DATE U CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE � PROPOSED USE�"e"! �/'� N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM � Garage/Carport W Patio/Deck ' Pool/S� Oc,� Z Re-Roof � Commercial m Valuation � .d�ADJ.AREA QUANTITY DESCRIPTION FEE /^' U F- U W J W Z 1 //�/� �U.sue' � . N v.-y'v a U Z Q 2 U W CONSTRUCTION . PLAN REVIEW�� � �� 2" ELECTRIC y�� �� PLUMBING yL<�s / MECHANICAL� /„Z�t� INSPECTION FEE Y ISSUANCE t�)!� (,f?��- SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: � �"' PRE-ALT FEE: TOTALFEES„� �� � �" (p�,, �� COMMENTS �, a� RECPT N0. PAID BY VALIDATION t Copy,YELLOW-Finance Copy, PINK-ASSessor�Copy�GgLDENROD-File�,bpy,GF 2-2i-(Z,