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HomeMy WebLinkAbout15185 (17) ���,�-� _�\ CITY OF DIAMOND BAR G�/�.� .,T: DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �G� � � 21660 E.Copley Drive Suite 190 .,...._.,...., (909)860-3195 Faz(909)861-3117 .� PRESS ��_ BUILDTNG PERMTT APPLICATION -- FIRMLY � JOBSITE ��'�CJ� sii/S,OCJ�G12�-ST �. � APPLICATION PERMIT �� P/C o ADDRESS DATE NUMBER # � ISSUE TYPE OCC .- APN LOT TRACT DATE CONST. GROUP p OWNER �.��7[�� I,��iTIJ� � ADD SS� ZONING SETBACKS W CITY�� ZIP �� TEL.�L"� FRONT Ryy ❑ � APPLICANT TE�. REAR ❑ � SIDEJSIQE STREET RW ❑ � CONTRACTO FC-,� �T..Y$57�Lc.z�KfLS' SIDE ❑ Q CITY ESL�'tts�.C[� ZIP �Z TEL. S�OJ�� PROPOSED USE o ARCH/ENG! �Z,, DE51GNEfl NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. cr� u� DESCRIPTION S�.F1' FACTOR PSF ADJ,AREANALUATION � QWNER-BUILDEft DECLAflATION SFR/ADD/REM O i HEREBY AFFIflM UNDER PENALTY OF PERJURV THAT I�M EXEMPT FROM TME CONTRACTORS LI� G0�8J8/C8lpOh W CENSEUWiORTHEFOLLOWINGREA50N(SEC.7037.5BUSINESSANDPROFESSIONSCODE:ANYCITVOR (f� COUMYWHICHHEGUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W P8t10/DBCk W NflE.PRIOP TO fT3 ISSUANCE,ALSO REQUIRES THE MPIICANT FOR SUqi PERMIT TO FILE A SIGNED W STATEMENT THAT NE OR SHE IS LICENSEO PURSUANT To TF7E PROVi510N5 OF THE CONTRAC70R5 LI� � CENSE UW�CHAPTER 9(COMMENCINO WITH SECTION 1000)OF DIVISION 30F THE BUSINESS AND PRO- � POOUSpB FESSqNSCOOE)ORTHATHEORSHEISEXEMPTTHEREFROMANDIHEBASISFORTHEALLEGEDEXEMP- � TION.ANYVIOLATIONOFSECTION7037.68YANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLiCANTTO Z Re-Roof � ACMLVENALTYOFNOTMDRETHANFIVEHl1N�RE��OLLARS(SSoo).): � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMP�OVEESWITHWAGESlSTHEIRSOIECOMPENSATION, � Commercial � VALL DO THE WORK,AND THE&TiiUCTURE IS NOT WTENDED OR OFFERED FOR SALE(SEC.704<,BUSI- J � NESS ANO PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW�OES NOT pppLY TO AN OWNEfi OF � PqOPERN WFIO BUILD3 ON IMPROYES TIEREON,AND WHO DOES SUCH WOFiK HIMSELF OR HERSELF OR � 7TiROUl3HMI50RHERONMEMPLOYEES,PPOVIDEDTMATSUCNIMPPOYEMENTSARENOTIN7EN0EDOR m Q ,OFFERE�FOfiSPLEIF,HOWEVER,TMEBUIL0INGORIMPROVEMENi1550LDWI7HINONEYEAROFCAMPLE� Z TION,THE OYJNER�BUIIDER WILL HAVE THE BIIRDEN OF PROVING THAT HE OR SHE DI�NOT BUILD OR = IMPROVE FOR THE Pt1RPOSE OF SAIE). �,y� ❑I,AS OWNER OFTHE PF�PERTY.AM ERCLUSIVELY COMRACTING WITH LICENSED(:ONTRACTORS � TO CONSTRUCT TNE PR0.IECT(SEC.7otd,9USINESS AND GFOFFSSIONS CODE:TNE CONTRACTORS LI- V8I1)OflOf1 ADJ.AREA � CENSEUW�OESNOtAPPLYTOANONRJEROFAPROPER7VWHOBUILDSORIMPpOVESTNEREON,AND WFIOCONTRACTSFOFSUCHPRQIECTSW!THACONTRACTOR(S�UCcNSEDPURSUANTTOTH£CONTAAG QUANTITY DESCRIPTION FEE Y mr�s ucENSE uw.). � ❑I AM E%EMPT UNDEF SEC. B.6 P.C.FOR THIS REASON J � 4 � U � � DATE OWNER v Q W � LICENSED CONTFlACTORS DECLARATION W � I HEREBV AFFIRAI UN�ER PENAI.TV OF PERJURY TNAT I AM LICENSED UNDEfl PROVISIONS OF CHAPTER � �g a, 6(COMMENCINO WITH SECTION 7a0o)OF DIVISION 30F 7HE BUSINESS AND PROFESSIONS CODE,AND � .���"v f X MY UCENSE IS IN NLl FOPCEAND EFFEC7. Z � LICENSE CLA/S^S ��"'� UC.NO. ����� � V DATE �O'�Z.�"'� CONTRACTOF d W � WORKERS'COMPENSATION DECLARATION ¢ � �HEREBY AFFIIIM UNDER PENALTV OF PENURV ONE OF THE FOLLOWING DECLAftATIONS: Z � i HAVEMID WIIIMAINTNN ACER7YFICATE OF CONSENT70 SEIF-INSURE FOR WORKERS' _ CAMPENSATION,ASPROVIDEOBVSECTION37ooOFTNELAAORCODF_,FORTHEPERFORMANCE U � OFhIE WORIS FOA WHICH THIS PEFMIT IS ISSUEO. � � F _I HAVEAND WILL MAINTAIN WOflKERS'GOMPENSATION INSURANCE,AS NEOUIftEO BY SECTI�N d 37000FTHELABORCOUE,FORTHEPERFORMTNCEOFTHEWORKFOFWHICHTHISPERMIi15 0 ISSIIED.MYWORKER�'COlJPEHYS_ATIONINSURANCECigg��,,IE,R�A�NDPCLICYNUMBERAFE: CONSTRUCTION j CAFiq1ER_ � '�GI��C.� C�y-M-'�`�"7���`L�h S PLAN REVIEW Z POL�Y NUA�ER____� _ `PJ�L?Je�.J_"'�\ - -----– ELEC7RIC , ¢ 0 (iHISSECT�NYE�NOTBEO�MPLETEDOFThIEPEi�.ifTISFORONE11lMARm�G1A(iS(E100)ORlE55). PLUMBING ' Z I CERTIFV THAT N THE PERFOFiMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL (} SHALl.NOT EMPLOYANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECTTO THE � WOflNERS'COMPENSATKIN LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULO BECOME �NSPEC710N FEE S SUBJECT TO TH5 WORKERS'CAMPENSATIO NS OG SECTION 370o OF THE LABOR - C�OsDE�,7c5�HAsLL�(FO1RTNWITHCOMPLV 1'HOSEPROVI ISSUANCE ,��y � r7°�L�7'�✓ APPLiCANT� � SMIP �'1j'!*V(1L'7�T� C�IV iJ BP'11t p OATE: .._ 'irl�d-�.7r—�Itt#�� �.�+r}�J J WARNMG:FAIWRE TO SECUPE WORXERS'COMPENSATION COVEFAGE IS UNLAWFIIL.AND SHALL 8E ENERGY P'C ��r�rr �r�Tl.i�T��A F'�F'.1 Z �y SU&IECTPNEMPLOVERTOCRIMINAIPENALTIESANDCINLFINESUPTOONEHl1NOREDTHOUSANO ENERGYPERMIT DOLLARS(S!00.000).IN AODITION TO TNE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION3�o80FTHELABORCODE,INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: � CONSTRUCTION LENQING AGENCY PRE-ALT FEE: O � IHEREBYAFFIRMUNDERPENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLENOINGAGENCY FOF THE CERFORIAANCE OF iHE WORK FOR WHICH THIS PERIAIT IS ISSlJEO(SEC.3ae7,CIV.CJ. . Z w � LENDER'SNAME I_ LENOER'SAD�RESS W ICEHTIF/THATIHAVEFEADTHISAPPLICATIONAN�STATETHATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES � �/ � IAGREETOCOMPLYWITHALLCITVANOWUNTYOROINANCESANDSTATELAWSRELATINGTOBUIL�ING �[Q CANSTRUCTION,AND HEREBV AUTHORRE REPRESENTATNES OF TiiIS COUNTV TO ENTER I1PON THE � ABOVEMENiIONED OPERTY FOR INSPECTION PURPOSES. � �����s .,��r t COMMENTS �� � m PERMITTEE NAME(PF T� /+ � �-,`� CA¢ {�^-^�-7p"G.C..J �-..� _ � SIGNATUREOFPERMITTEE DATE = RECPT.NO. 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