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HomeMy WebLinkAbout17046 _ — � _ _— _ �CITY OF DIEAMOND BAR t,/'P --�---- I)EPAItTMENT OF COMIVIU*�]ITY&DEVELOPMENT SERVICES _� � M f �� - 2 L 825 E.Copley ISrive (409)&60-3195 Fax(903)861-3117 {�RE$$ `,<va�`�' BuiLDY�vGPERMITA�pLICA'ri1�N FIRMLY } JOBSITE � � C APPLICATION " �'��e PERMIT ` P/C �°"�" ��� o ADDRESS � � `� � � � DATE � � ������NUMBER L�� # �� � � ���� � ISSUE (.,`� TYPE OCC APN LOT TRACT '"'�'"v\ DATE CONST. GROUP p OWNER � '�� � �' �°'` o ADD ESS '` � ZONING SE'iBACKS Z CITY e�''°` ZIP TEL.�,f"�P^�'S.."���1� FRONT RW ❑ � APPLICANT ' TEL. �. �, REAR _ ❑ � 4 �" � t���—� SIDE/SIDE STREET RW ❑ ¢Z SIDE ❑ CONTRACTOR��1CA p ^,. � AbDRE `��"-"1^l"i s--, .w` e� � � CITY �_ ZIP�TEL. ' ` ��°� PROPOSED USE o ARCH/ENG/ , z DESIGNER � ADDR S � � � NO.DWEL. NO. NO. � CITY�t1 ZIP�� T ,.�.,` ,��� UNITS STORIES BEDROOMS cn DESCRIPTlON SQ.FT. ' FACTOR PSF ADJ.AREANALUATION p� OWNER-BUfLDER DECLARATION SFR/A�D/REM O p I HEREBY AFFIFM UNDER PENALTY OF PERJURY THAT 7 AM E%EMPT FROM THE CONTRACTORS LI- � Gef89E/Cfl�POfI �W �.CENSEtAWFORTHEFOLLOWINGREA50N(SEC,7a31.56USME5SANDPROFE5510N5CODE:ANYCITYOR (/� U � COUNTYWHICHFEQUIRESAPERM�TTOCONSTRUCT,ALTER,IMPROVE,DEMOLISN,ORFiEPAIRANVSTRUC� w ��TURE,PRIOR TO ITS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO W Pafio/DeCk � SiATEMENT THAT HE OR SHE IS LICENSED PUqSUANT TO THE PROVISIONS OF iHE CONTPACTORS LI- � .CENSE LAW(CHAPTER 9(COMME�7CING WITH SECTION 7000)OF DIVISION 3 DF THE BUSINESS AND PRO- � POOVS(J3 � Q 'FESSIONSCODE)ORTHATHEOR$HEISIXEMPTTHEREFROMAN�THEBASISFORT4EALLEGEDEXEMP- (� �V TION.ANYVIOLATIONOFSECTION,7o31.5BYANYAPPLICANTFORAPERMI75UBJECTSTHEAPPLICANTTO Z Re-Roof . 'ACNIL PENALTY OF NOT MORE T AN FIVE HUNDRE�DOLUIRS(5500).): 0 ��, ❑I,ASOWNEROFTHEPROP�RTY,ORMYEMPLOYEESWITHYJAGESASTHEIR50�ECOMPENSATION, ❑ Cofllmeroi0l - � z �.WILL DO THE WORK.AND THE STPUCTURE IS NOi IN7ENDE�OR OFFERED POR SALE(SEC.7oe4,BUSI- J ,�. �NESSAN�PROFESSIONS CODE:THE GONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF -- ��-�j�Af10PERTYWHOBUILD50RiMPROVESTHEREON,ANOWHODDESSUCHWORKHIMSELFORHERSELFOR � �.�'.��,�THPAUGHHISORHEROWNEMPLbYEES,PFOVIDEDTHATSUCHIMPROVEMENTSARENOTINTEN�EDOR m ':� "�.OFFEREDFORSALE.�F,HOWEVER,�7}1EBUIL�INGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPIE- � ,Z �''��.TION,THE OWNER-BUILDER WILL HAVE THE BUFl,DEN OF PAOVING TMAT HE Oft SHE DID NOT B111L�OR .��,IMPROVEFOFiHEPURPOSEOFS�ALE). � ' ❑I,ASOWNEROFTHEPROP�ERNAMEXCLUSIVELYCOMRACTINGWITNLICENSE�CONTRACTORS � �'',',TO CONSTRUCT THE PROJEC7(S�C.7044.BUSINE55 AN�PROFESSIONS CODE�7HE COMRACTORS LI- Vfllllfltl017 � ADJ.AREA W � CENSELAWDOESNOTAPPLYTOANOWNEqOFAPROPERNWH06UILD50RIMPROVESTHEREON,AND � �:�,�WHOCOMRACTSFORSUCHPROJECTSWIhIACONTRAC70R(6)LICENSEDPURSUANTTOTHECONTRAG pUANTITY D SCRIPTION � - FEE � �TORSLICENSELAW.�. 0� �. ❑I AM EXEMPT UN�ER SEC. B.&P.C.FOR THIS REASON �,JQ ..� � � � �. DATE � OWNER� � d ',. W � LICENSED CONTRACTORS DECLARATION W ¢ �� IHEflE6YAFFIRMUN�ERPENALTYOFPERJURYTHATIAMLICENSEDUNDERPROVISION50FCHAPTER � ��� d 9(COMMENCINGWITHSECilON70o0)OFDIVISION30FTHEBUSINESSANDPP,OFESSIONSCODE,AN� Z • X . MY LICENSE IS IN FULL FORCE AND EFFECT. : � p � �'�3�3��1� g � �.�.LICENSE�==�IIC.NO.__ a � . U DATE V -CONTRACTOR � i Q J W � WORKERS'COMPENSATION�DECLARATION a - � IHEREBYAFFIRMUNOERPENAL'fYOFPERJURYONEOFTHEFOLLO'NINGDECLARAilONS: Q , Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' Z' � ¢ COMPENSATION,ASPROVI�EDBYSECTION37aoOFTHELABORCO�E,FORTHEPERFORMANCE (J Q OFTHEWOPKFORWHICHTHIS'PERMITISISSUED. . ' � W _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSU9ANCE,ASREQUIREDBVSECTION - Q 37DOOFTHELA80RCODE,FORTHEPERWRMANCEOFTHEWORKFORWHICHTHISPERM1T15 _��}� p i� `� pFa. 'y, � ISSVED.MVWORKERS' MPEN ATIONINSURANCECARRIERAN�POLICYNUMBERARE: CONSTRUCTION "a���-.�' �� ` � CARRIER PLAN REVIEW �__.��a,<�.�� [� Z POLICYNUMBER ELECTRIC. v � �",.d ¢ �r�j � (IFIISSECTKNJNEmNOTBEO�MPLEfEDOF'iHEPERMRISFORONEHUNDRED00lLARF�SIO�ORlESS). PLUM8ING 1 W Z I CERTIFV THAT IN TH�RERFOFMANCE OFTHE WORK FOR WHICH iHIS PERMIT IS ISSUED,I MECHANICAL � .°�� ,. (3._..... �.SHALLNOTEMPLOYAN`PPERSONINANYlAANNERSOAST06ECOMESUBJECTTOTHE , (/� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,PNDAGREETHATIFISHOL1lO8ECOME INSPECTIONFEE � Sl18JECTTOTHEWORKEfiS'COMPENSATIONPROVISIONSOFSECTION3�ooOFTHELABOR � �6 �-p . � CODE,I SHALL FORTHWITH COMPLY T IONS. ISSUANCE' „r 9 ,�y� ��' � `w WARNINGFAILURETOSECUREyypLICANT: � ' SMIP �, i���k� �\}�-..,�+-,��.,� ���,.,,�J� DAT�57� �-� A � ENERGY P/C '�aa°t� - � ��� ,J flKERS'COMPENSATION COVERAGE IS UNLAW FUL,ANC SHALL BE .,t p �y SUBJECTANEMPLOVERTOCRIMINALPENALTIE6ANOCIVILFMESUPTOONEHUNDREDTHOUSAND g�- p r DOLLAFiS(§1W,o00),INA�DITIONT�THECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORIN �ERGYPERMIT�' °�'� d ' J SEGTION37oeOFTHELAeOFiCOOE,IN7EflESiA��ATTORNEY'SFEES. ' � �' aC RETENTION FEE: � � OCONSTFIUCTION LENDING AGENCY PRE-ALT FEE: �;�� '.�a�'�� � IHEREBYAFFIRMUN�ERPENALTYOFPERJURYTMATTHEREISPCONSTRl1CT10NlENDWGAGENCY '�y°.-�+� ' � u d FORTHEPEfl�OHMANCEOFTHcWOHKEORWHIGHTHISPERMITISI55UED�5EC.309],CIV.CJ. �-..-.,-..,�..��„ --�� Z � a..� �"W � ,� ._-..._.7.._...T"'��'=�—. W j LENDER'S NAME g� `�m.! ���.�,� � F- LENDER'SA�DAESS � T � � /�,, � �� r�l WICEFTIFYTHATIHAVEREADTHISAPPLICATIONAN�STATETHATTHEABOVEINFORMATIONISCORflECT. TO IAL FEES ��•� ��t��"� �����"� � � � "1^. � � '� IAGFEETOCOMPLVWITHALLCITYANDCOUNTYORDINANCESANDSTATELAWSRELATINGTOBUILDING ,�,-,� " J � CONSTRUCTION,ANDHERE6YAUTHORIZEREPRESENiATIVESOFiHISCOl1NTYTOENiERUPON7HE �°`'^`��q Z ABOVE-MENTIONEDPROPERTYFORINSPECTIONPURPOSES. COMMENTS -�'�v� O Y\S % 9 • \�l 1�L? � � P I EE ME(PRINT) Q (!J ,r�°. � 51 AT PERMITTEE DATE - � RECFi:NO. PAID BY VALIDATION WHITE—Department Copy.YELLOW—Finance Copy,PWK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy � . . .:. . :� � s� �. ,. i. ��.< .., . . .. � r w,fi v u� .... r4 .xv� . � '�°�..� a=.. v :a� x � x' a a r; s� '�a s # ` i.� � � ..: � ;. s �- � a � � s � �a� � � +� a��"�,�,�a �' � ,�. � ";,�x "� '*�`.� t a ��, a a a � a� r � �z � * � o- :� * .� � � .� � x . �' � :i '� �'°�"� "��#� ���.�.�.a'�'^ k � ��. r K .� s s�'�.' 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