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HomeMy WebLinkAbout13438 (25) � �! ^ _�� CIT'Y OF DIAMOND BAR �' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 19(3 �` (909)860-3195 Fax(909)861-3117 PRESS ��,� BUII.DING.PERMITAPPLICATION FIRMLY Q` JOBDSITE °, � ,.i APPLICATION PERMIT I ��3� P/C RESS �� � DATE , NUMBER # o ,- „ ISSUE �,�, a I�� TYPE OCC °.° APN - .. LOT` T T DATE CONST. GROUP. p OWNER , ` . � �: p ADD sSS `� ZONING SETBRCKS °.°� CI . . z10 TEL. � FRONT RW ❑ z REAR ❑ ' o APPUCANT I - - TE 'r - SIDElSIQE STREET RW ❑ � CONTRAGT , � SIDE ❑ ¢ ADDR S ` PROPOSED USE � �"` � CITY ZIP TEL. � w ARCH/ENG/ � ' •� NO.D � DESIGNER WEL. NO. NO. ���� , -= C'TM , UNITS STORIES BEDROOMS � ADDRESS I ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION. � ,�,p . WNER-BUILDER DECLAF;ATION _ SFR/ADD/REM ��� ��� �� � LL7 �CENSELAW FORTHE FOLLOWI�ENALIV OF PERIURV THAP�AM EXEMPT FROM THE CONTRACTORS LI- G81'a9E/C0�(lOR � p. 1 HEREBY AFFIFiM UNDER - REASON�SEC.7031.68USINESSANUPROFESSIONSCODE:ANYCITVOR '(n _ . C.� COUNTYYdr11CHAEQUiRESAPER�ITTOCDNSTRUCT,ALTERIMPROVE,DEMOUSH,ORREPAIRANVSTRUC- �W. PaSlO(DBCK � W' NRE,PRIOR TO ITS BSSUANCE;�LSO�flEQUIRES iHE!<PPLICANT FOR 9UCH PERMtT�TO FILE A SIQNED� � , ' - � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO.THE PROYI510NS OF 7HE GONTRpCTORS LI- � „CBdSE LAW(CHAPYER 9(CAMMENCUlG WfTH SECTION 7000)OF DIVISION 3 OF THE 6USINE55 AND Pfl0- - �'L' PooVSpa � � � FESSIONSCO�E)ORTHATHEOFISHEISEREMPTTHEflEFROMAN�THEBA515FOflTHEALLEGEDEXEMP- �� , ,TION.MlYV10LAT10NOFSECT10�17031.58YANVAPPLICANTFORAPERMITSU&IECTS7HEAPPLICANTTO .. Z R2-ROOf '� ' � � ' A CINL PENALTY OF NOT MORE TiM'FNE HUNDRE9 DOLL4R5(YSoo).): � ��, ❑I,ASOWNEROFTHEPROQERTY,ORMVEMPLOVEESWITHWAGESAS7HEIRSOLECOMPENSAiION, � CommefCial �� " � � .Z�,. , WILL DO 74E WORK,AND THE STRUCTURE IS NOT INTENOED ON OFFEqE�fOR SALE(SEC.7044,9U51- J , . � 'NESS AND PHOFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO PN OWNER OF ,,,_ , , , PflOPERTYVIFIOBUILO50RiMP OVESTHEFiEON,ANDWHO�0E5SUCHWORKHIMSELFORHERSELFOR m � '�THROUGHHISORHEROWNEMP�OYEES;PRDVIDEDTHATSUCHIMPROVEFdENTSARENOTINTENDEUOR . �� ' L�.1 .�,OFFEREDWRSALE.IF,HOWEVE T}1EB111_DINGORIMPROVEMFNTISSOL�WITHINONEYEAROFCAMFLE � �� ��TION,THE OWNER-BUILDER WI �HAYE THE BURDEN OF PROVMG THAT HE OR.SHE DID NOi BUItA OR , �� IMPROVE FOR THE PUHP6SE 0�6ALE). �„ , ' ❑I,ASOWNEHOFTHEPRdPERTY,AMEXCLU5IVELYCONTMCTINGWITHLICENSEDCONTRACTORS � � TO CONSTRUCT THE PRQIECT(EC.70K.BUSINE55 AND PRQFESSIONS CODE:THE CON`flACTORS Ll- � V8IU8IlOfl ADJ.AREA� '� W�� '.CENSEUWWESNOTAPPLYT�ANOWNEROFAPROPERTYWII�6UIL0.50RIAAPiiOVESTHEflEON,AND . , ���^��WHOCdNTRACTSFORSUCHPR4.I�CCTSWRkACANTRACTOR�S)LICENSEDPURSUAN770THECONTRFG QUANTITY DESCRIPTION�� �'�. �, FEE ' TORS LICENSE L9.W.). ' � � �� OIAMEXEMPTUNDERSEG�.. B.BP.GFORTHISREASON J � �I f �' ' � ' dq; � � � �"�' a` a� , ,� OATE OWNER '��"" �i +"��/ U � LICEt�SED CONTFIACTORS DECLARATlON W I +„� �, IHEREBVAFFIflMUNOERPENALTYOFPERJURYTHATIAMLICENSEDUNDERPAOVISIONSOFCHAPTER �� . . � O CO pe. e�COMMENCINOWtYHSECTION�7a0a)OF�IVISION30FTHEBUSWESSANDPROFESSI N6 OE,AND � 1 J� MY LICENSE IS IN FULL FO ND EFFEGT. ,pJry m i � o' UCENS $S LIC.NO. - � F�� " '�,� i F- �.�^ ���;' DATE � C! � CONTRACTOR � / � � ��- ' ' L1J �� WOR�EFIS'CONlPENSATION DECLAFATBON Q oy, U � I HEREBV AFFIRIA UNDER PENAL�PV OFPEiiR1RYONE OFTHE FOLI.DWlNG�ECLARATIONS; z �� _IHAVEANDWILLMAINY/�IPlACERTIFICATEOFCANSEMTOSEIF-INSIfREFORWORKERS' _ �CAMPENSATION,ASPR YiDEDBYSEGTIQV37000FTHELP.BORCODE,FORTHEPERFORMANCE �U \/\ OFTHE WORK FOR WHI�H THIS PERPAIT IS ISSUED. m, []�� 7l , � � - � �"'1 HAVE AND WILL MNM IN WORKERS'COMPENSATION INSURANCE,AS FEOUIRE�6Y SECTION Q� i 37ouOFTMEIABOHC qE,FORTHEPERFORMANCEOFTHEWORXFORWHICHTHISPEAMITIS ISSU�.MYWDRK�MPENSATIONINSURAN IERgAN�DygPO�LICYNUM9ERARE: CONSTRUCTION y� CARRIER ���J�P 4YY�^ �/�.�'�/ � F' . . �^�*/p �', aoucvNUMSEa �" Y / -e ELECTRIC � � �"� / ¢ Q� (IHISSECt10NNE�NC��EC�EfEDOFIHEPERM1YTISFORONEHU!�REDOOlL4R5�$100�ORlESS). P M -.. 1 '�'�: Z I CERTIFYTHAT IN THE�ERFtlPMbP10E OF THE WORK FOR WHICH THIS PEFMIT IS ISSUE�,I � MECHANICAL �'"a `�s�" (,�J SHALL NOT EMPLOY AN PERSON IN ANY IAANNER SOAS TO BECAME SUBJECT TO THE ��'��" �p WORKERS'COMPENSAIONtAWSOFCALIFORNIA,AN�AGREETHATIFISHOVLDBECOME IN IONFEE -. -SV&IECTTOTHEWOR ERS'CAMPENSATIONPROVISION30FSECTIO 37ooOFTHELABOA ' p � � ISSUANCE `6�,.F� a� � TH COMPLY WITri E PROVISiONS. - ` � �. CODE,I SHALL FOFi�H , ' , ._.. �. � ���� �' d�� �ATE: IAPPLICANT: ' � � . - � �¢ �.. '�'���A'� 46�r'.� ��°' e,'�Y, WARNING.FAIWRETOSECUREIWORKERS'COMPENSATIONCAYERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C � '..��3'p� �� !���� SU&IECTANEMPLOYEflTOCRIIMINACPENALTIESANDCIVILFWESUPTOONEHUNDREDTMOUSAND ETIERGYPERMIT � A3s:'a��a���°a1'SM�� � OOLL4AS(5700.00o)JNAODITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDE�FORIN ��� y—�f�. '� —�s ��,�, SECTION 3Joe OFTHE LABOFi Cp�E,INTEREST,ANDATTORNEI^5 FEES. ' RETENTION FEE:a.r�'�' ^6k\"<�� Y�"y o�'�,��, CI NSfiRUGT10N LENDING AGENCY pREALT FEE: ��� PL'..; iHEREBYAFFiRMI1NDEFlPENA�.T.'OFPERJURVTHATTHEflEISACONSTRUCTIONLENDMGAGENCY - ' �" FORTHEPEFFORMANCEOFTF�EWORKFORWHICHTHISPERMITISISSUED(SEC.30W.CIV.C.). . ' � . Z.', �, . . . L4! . ��-'� LENDEH'S NAME �' _ ' � ' 8J-�. LENDEP°SAD�REBS �� �'. ICERTIFYTNATIHAVEfiEADT ISAPPLICATIONANOSTATE7HA'THEABOVEINFOPAEATIONISCORRECT. TOTAL FEES ' ���C��� ����. IAGREETOCOMVLVWITHALL6IT'AN�CAIJNTYORO�NANCESANOSTATELAWSRELATINGTOBl11L�ING � � . ��� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATNES OFTHIS COUNTYTO ENTER UPON THE � �'� ABOVE-MEN710NE0 PROPERTI�FOR INSPECT PURPOSES. COMMENTS - 4.. �' �I . PERMI � �c� �s� y� SI TURE OF RMITTEE OATE _. � RECPT.NO. PAID BY O, �� �.VALIDATION-. �" � ' WHITE—D artment Co YELLOW--Finance Co PINK—Assessar Co G IAENR06—File Co GREEN— �P PY� PY� PY� PY, ApPlicanYs Copy ....._. . _._. ��`: � ��:� � ` �� ��"� ': �� � � ��� � � � �� � � � � ,� � � � � �. 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