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HomeMy WebLinkAbout15660 a.�_.. �._�___ ____...�__.���.�., ._-.�.�.�...�__...__,.�.�� __..__,__.�__,..---.. � e_ _.�_ __._____. _...,.___.___ .__ _; �',��`�-.��' ^°-"�"~ CITY OF DIAMOND BAR ' ----1�--�- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ����4�D� W . 21660 E.Copley Drive Suite 190 (909)$60-3195 Fax(909)861-3117 PRESS '''9�'�f` BUII.DING PERMIT,APPLICATTON FIRI'IAI.Y _ , .,,. ¢ ADDRIESS �f35 �"1`�'������'• APPUCATION Q � � PERMIT � p/C o DATE NUMBER # � APN LOT�— TRACT A EE � �J ONST. GROUP p OWNER iVllkF-G�- �,f'�Q6A�3 p ADDRESS-56�� ZONING SETBACKS W CITY�+��l-?h�2- ZIP ��'ci TEL.�+�-y^ EESTG FRONT RW ❑ � APPLIGANT TEL. REAR __ ❑ � SIDE/SIQE STREET RW ❑_ � CONTRACTOR �' •�tl.i,��:i�: SIDE p ApDRESS �`�"L3"i�a'_+�'€�i'CI � CITY�.-A t�a;tp[:1� C�A- ZIP�R TEL.S 7S"''r-F��-� PROPOSE�USE o ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BWLDER OECLARATION SFR/ADDIREM O I NEREBY AFFlRM UNOER PENILLTY OF PERJUHY THA7 I AM EXEMPT FROM THE CONTRACTORS LI- G8f8g0/C3fPOR W CENSE UW FORTHE FOLIOWINO REASON(SEC.7o31.5 BUSINESSAND PROFESSbNS CADE:ANYCI7YOR (n U COUNTYVNiICHREWIRESAPEFlMtTTOCONSTRUCLQTER,IMPROVE.DEMOUSH.ORREPAIRANV57Rl1C- W pa110/D6Ck W TURE.PRIOR TO ITS ISSUANCE.ALSO RE�UIRES THE APPLICANT FOR SL1CH PERMIT TO FI�E A SIGNED W � STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF 7NE CANTRACTOPS LI- CENSE LAW(CHAP7ER 9(COMMENCIN6 WITH SECTION 7o0o)OF DIVISION 3 OF THE BUSINESS AND PRO- �'�' PooUSpa � FESSqNS COD�OR TNAT HE OR SHE IS IXEMPT THEREFROM ANO THE BASIS FDR THE�LlEOED EXEMP- TION.ANYVbLAT10NOFSECTION70.97.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof � ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(S50o)): � ❑I,ASOWNEROFTHEPROPEHTY,ONMVEMPLOYEESWITFIWAGESASTMEIRSOLECDMPENSATION, � ComrtlefCiel WILL 00 THE WORK,ANO THE STRUCiURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704L,BUSI- J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTYMhiOBUILD50RIMPROVESTHEREON,ANOWHODPE55UCHW0/iKHIMSELFORHERSELFOR = � 7HROUGHHISORHEROWNEMPLOYEES,PROVIOEOTHATSUCHIMVHOVEMENTSAHENOTINTENDEDOq m «� OKFEREDFORSALEIF,HOWEVERIHEBUILOINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z T�ON,THE OWNEH-BUILDER WILL HAVE TNE BUROEN OF PROVINO THAT HF.OR SHE DID NOT BUILD OR = IMPHOVE FORTHE PURPOSE OF SALE). W OI,ASONT7EROFTNEPROPERTY,ANEXCLUSNELYCANTRACTINGWITHLICENSEDCONTRAGTORS � TO CONSTflUCTTHE PFQIECT(SEC.r0a9,BUSINESSAND PqOFESSIONS CADE:THE CONTRACTORS LI- NyI118�1011 __._.._. ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPflOPER'iYWHOBUIL�SORIMPROVESTHEREON,ANO � Wl1000NTRACTSFORSUCHPRQIECTSWITHAGCNJi'MCTOR(S�LICENSEDPURSUANTTOTHECONTRAO QUANTITY DESCRIPTION FEE � iDFS UCENSE LAW.�. ❑IAM E%EMPT UNDER SEC. B.8 PC.FOR THiS REASON J � U � � � DATE OWNEH k- � W � UCENSEO CONTRACTORS DECLARATION W � IHEflEBYAFFIRMUNOFRPENALTYOFPEflJURVTNATIAMUCENSEDUNDERPROVI510NSOFCHAPTER � /� ��.{��yr���n�y.� � 0(COMAIENCINO WITN SEC'TICN 7000)OF DIVlSION 3 OF YHE BUSINESS AND PROFESSIONS CO�E.ANO Z ^`'C"'''�"'C'J `�'��� X MY UCENSE IS IN FULL FORCEAND EFFECT. p UCENSECLASS ��� LIC.IJO. ��� � V DATE �b`�Z—e� CONTHACTOR a W � WORKER5'�OMPENSATION DECLARATION Q � 1 HEREBV AFFIqM UNDER PENALTV OF VEfiJURY ONE OF THF_FO�IOWING�ECLAHATIONS: Z � _�HAVEANOWILLMAINTAINdCEflTIFICATEOFCONSENTTOSELP-INSUREFORWORKERS' _ � COMPEN50.TtON,AS PfiOVI�ED BV SECTION 37000F Ti1E 1A90R COOE,FOfi THE PERFORMANCE C� OF 7HE WOHK FOR WHICH THiS PERMIT IS ISSUED. W 0 � � _�HAVEANOWILLMA�NTAINWORKERS'COFAPENSATIONINSVFlANCE,ASREOUIREDBVSECTION QQ 970a OF THE LABOR CODE,FCR THE PERFORMANCE OF THE WORK FOfl WHICHTHIS PERMIT 15 ISSUED.MY WO 5'COMPENSA710N INSUR E CARRIER PND POLICY NUMBER ARE: CONSTRUCTION jCARRIER �Gt0-"(,1�,/��"��'�� I�'C�I�YYE'�S PLAN REVIEW � PIX.ICY NUMBER, W�'�ilf �CT�I GRe��''�I ELECTRIC Q (iHISSECT1ON�lE�NOTBECCMR,EfE00FhIEPEWNiISFORONEF0.N�IXiEDDOLU�RS(Etao)ORLESS� PLUMBING W ,Z ICEflTIFYTHATINTHEPERFOqMANCEOFTiEWOftKFOqWHICHTHISPEFMITI515SUE�,I MECHANICAL ��'��� (,�J SHALL N�i FMPLOY ANV PERSON IN ANY MANNER SOAS TO 6ECOME S'JBJECT TO THE -�—,��"?� (n WORKER5 CAMPENSA710N LAWS�CALIF AkB�A6FiEE�'HA71F I SHOULO BECAME INSPECTION FEE = SUBJECT TO THE VJORKERS'COM?E ON PROVISIONS OF SE 3760 0F THE U+BOR CAOE.ISHNIFORTNY117HCOMP WI7HTHOSEPROVISIONS. ISSUANCE 7 ��� p SMIP _��� � � �nnn p DATE:�� APPLICANT: J WARNING:FAILURE TQ SECURE WORKERS'COMPENSFTION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILPINESUPTOONEHUNOREDTHOUSAN� .� OOLLARS�S100.000),INADDITIONTOTNECOSTOfCOMPENSpTION,DAMAGESASPROVIDEDFORIN ENERGYPERMIT J SECTION3�OBOFTHEUBORCO�E,WTEREST,ANDAT70RNEV'S�EES. � _ RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMUNDERPENALTYOFPEftJURYTHATTHEREISACONSTRUCTIONLEN0INGAGENCY FORTHE PERFORMANCE OF iHE WOfiK FOR WHICH THIS 7ERMI7IS ISSUED(SEC.30W,CIV.C.). _ Z W � LENDER'5 NAME F— LENDER'SADORESS � TOTAL FEES ��, �Jl � I CERTIFY THAT I HAVE REA�THIS APPLICATION ANO STATE THqT THE A90VE MFIXiMATION IS COftRECT, � IAGREETOCAMPLYWITHALLCINANDCOUNTYOROINANCESANDSTATEL4WSRELATINGTOBUILDING � CONSTRUC710N,AND HEREBY AUTHORIZE REPRESENTATIVES OFTHIS COUNTV TO ENTER UPON THE ABOVE-MENTIO PpOPERTY FOR INSPECTION PURPOSES. 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