Loading...
HomeMy WebLinkAbout12857 (13) _� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 - PRESS 9� BLJILDING PE ��9)861-3117 ..f- 1 " (909)860-3195 Fas RMIT APPI,ICATION : -_ � FIRMLY Q AODDRIESS ����I ���.-�.�� {-� i AT�ICATION �s'�-'�"� PERMIT "2 4 g� P!C NUMBER, � `� # c� I p+� S S U E y TYPf O C C APN LOT TRACT�Z 1�� DATE CONST. GROUP p. OWNER �`?'� �'-- �.�I . , _ , �` ADDRESS�� � ^ ZONING SETBACKS' ,, � . , , „ . � CITY , ZI ?EL`C� REART , , , � RW ❑❑ TEL. � SIDE/SIDESTREET RW ❑, � APPCICANT I���� . SIDE ❑ ! � ADDRESSTOR �.� PROPOSED USE .,::w.�� ,.�� , : � ZIP� TEL. CiTY I � ;,; „ � � ARCWENG/ y� p , ; z DESIGNER FJ�'�'I�iE�"'�'1�.11L�f3`�i� ,�. � ADDRES$ I N0.DWEL. i N0. � NO. y CITY � , ' IP TE � � "CTOR P5 OMS ,I � UNIDESCRIPTION SQ.�STORIE A�` � F ADJD.AREANALUATI6N �. , WNER-BUICDER DFCLARATION SFR/ADD/REM ` ;'``'rr � ��� [>� I HEB�V AFFlRRI UNDER PENALTV OF PERJURV TNAL I AM EXEMPT FHOM THE COMRACTORS LI� G8f2g8/CBfpOR 1�{, ` � .�.. � �W 'CENSELAWWRTFIEFOLLOWIN FiEASON(5EC.7031.SBUSINESSANDPROFESSIONSCADE:ANYCIT/OR ,(n . � COUNIYWHICHHEWIRESAP�tT7000NSTFit1CT,ALTER,IMPROVE,DEAIOLISH,OAREPAIRANYS7RUC _ W peti0/OBCk s4a TUPE,PRIOR TO ITS ISSUANCE, 50 NEQUIRES�TF�APPLICANT FOR SUCH�PERMIT TO FlCE A SIGNEb .� STAlEhENT 7FiAT HE Ofi SHE IS LICENSED PURSUM7T TO THE PROYISIONS OF THE CANTMCTORS U� �� k . � CENSE LAW(CNAPTEht B�COMM NCWQ WITH SECTION 70aG)OF DIyISION e OF THE BUSINESS AND Pq0- POOUSpB ��a s FE3510NSCO�E�OR7HATHEORISHEISEXEMPTTHEFEFflOMANUTXE0A515PoRTHEALLEGEDEXEMP- (� '�TIDN.ANYVKKA7bNOF3ECT1�Y,091.5BYANYAPP�.ICANiFORAPERMIi9UBJECTSTHEAPPUCANTTO - Z- fR8-ROO) �,F ���A CML P�NALTY OF NOT MORE AN fIWE HUNOq W DOI.LARS(5500).): �;-i ,� ❑1.+15OWNEHOFiHEPRO EPTY.OflMYEMPLOYEESWI7HWAGESASTHEIRSOLECOMPENSATION ' �. COfi11118fC13I � `,N4LL 00 THE WOpK,.ANO THB 57LRUCTURE.IS NOT INTENDED OR OFFERE�FOR SALE�SEC.7044,BUSI J � 'NESS AND PPOF6SSIONS COOE:I!H6 CONPRACTORS LICENSE LAW DOES NOi APPLY TO AN OM/NEF OF � ��,PflOPERTYWHOBUILDSORIMPflpVESTHENEON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � � � '�.'� � ��'� � '.� ',iHROUGHHISORkEPONMEMbUOYEEB,PROVIDED�THATSUCHIMPROVEMENTSApENOTINTENDEDOR m '- ' " . :L1.7 �OFFEHF�FORSN.EIF,HOWEVE{iITHE�l11L�INGORIMPROVEMENTI550LDWITHINOIJEYFAROFCOMPLE� ' ,Z �710N;FF1E OWNER-BUILDER�WI�HAVE THE BURDEN�6F PROVINO TFWT HE OR SHE DID NOT BUILD OR . �IMPROVEWRTHEPUHPOSEOF µE). � �.� ',� � �❑I•ASOWNEHOFTf�PPA1�EF�Y,AMEXCLU51VEL7CONTFiACTINGWITHLICENSEDGONiRACTORS ' �f0 WNBTRUCTTHE PNOJEC7(SEC.7Q41,BUSINES$AND PROFESSIONS CO�E:7HE CONiMCTORS LI- . V811Ja[IOfI � ADJ.AREA � i '�CENSELAW�OESNOTAPPLYTO OWNEROFAPROPERTYWNOBUILD50RIMPR�VES'fFIEREON,AND , �i� "WFIOC9NT'RA67Sf-0RSUCHPR IECTSWfTHACONTRACiOR(S)LICENS�PURSUMITTOTHECONTRAG QUANTITY' DESCFIPTIQN "' " "' � ' ' ' FEE X �TORS UCENSE LAW.� .I . ... . . . . . . .. . . . � Q ❑I AM EXEMPT UNDER SEC. B.&P.4�OR THIS REASON U � � . , �lL. ., ,. . ' � I '�' . ,.. . � . �, �,— OWNER V. . . ��,�� �� . DATE I ..�2 . . . . , .. . W . .. � � UCEN�ED CONTRAGTORS DECLARATION w � ' � �� g�6 'IHEREBYAFFIRMUN�EflPENAL OFPEflJURYTHATIAMIICENSEDUNUERPNOVISION50FCHAPTER � '�,��8(COMMENCINO�W17HSECTIONY, )OFUIVISIOh30FTHEBUSINESSANDPROFES510NSCO�E,AND Z 'X AIY UCENSE IS IN FULL FOqCE AN�EFFECT, m ' ' LLI /p��y :�o�, UCENSE �p N . LIC.NQ �� . �j.. .. ' ���. '�OATE .. � ��.U' . . � �. � J .�� .. .. . � � CONTRACTOR 6 �C- � WORK�RS'COMPEN5ATiONDECLARATION U ��. � , . �� � IHERE9YAFFIRI�AUNDERPENAL bFP�RIUPVONEOFTHEFOLLOWINGOECLNRATIONS: � � � i!9 . Z_ " � .._3� .�. ,. O __,IHqVE�ORNFOFWHI AC�FNf�FICATEOFCANSENiTOSELFdNSUREFORWOflKERS' _ ^ I�'i � WILLMAINY¢�I COMPEIJfiAT�ON AS Ppb�IDED 6Y9ECTION 37000F THE LABOR CODE,FOR THc'PERFORMANCE UW ' .OFSNEWO THISPERMITIS'ISSUED. � W' ����VEAfiDWILLMAIN�AI�WORKERS'COMPEN3ATIONINSURANCE,ASRE�UIREDBYSECTION � ' - ' � ' '� p i Q 37000FTHElABOPC(J#E FOq7HEPERFOPMANCEOFTHEWORKFORWHICH7HISPERMITIS � �y� � � �SSUED.MYW RKERS MPENSATION INSURANCE CAARIER AND POLICY NUMBERARE CONSTAUCTION �y i 0 j��. CAPRIER '"��� :� .. . PLAN REVIEW ✓1.�L � POLICYNUM6ER � , . E�EGTRIC � �e� � I� , .d � .(rH�ssEcnavi��nor�E ' , oFrr�aEarxr�sr�aon;Er!uwaE000unas�Sia�loa�Ess�. PLUMBING �,��s p�� � � .ICEHTIFYTHA7NTHE�FE kORMANCEOFTHEWORKFOqWHICHTHISPERMITISISSIJED,1 MECHANICAL �S�lv� II'� � SHpl.LNOT'.EMPLOYAMydER50N�NANYMANNERSOASTDBECAAdESUBJECTTOTHE �I (/,� VIOpKEAS'COMPENSq7I EAWSOFCALIFORNI0.ANDAGREE7HATIF�SHOULDBECOME INSPECT�ONFEE �I � SU&IECTTbTHEWOpK�i$"bOMPENSATIONP,ROVISION50FSE TlOfyp70UOF�HE`LA80A ' � - [� � q1S�ALL� FORTHWI cbw+h�vwin+naosEaaowsi /i ISSUANCE � ♦ , a �r. �—� �' �d p UATEi�.I h PL:ICAN7:. . � SM9P . f � I � '� " �� � ENERGYP/C �• Y� _ .'WARNINd�FAILUaE�iOSEWqE RKERS,'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE j�-� �y �:�SU&IECTAN EMPLQYEFiTO CRI{�II li�:PEM�LTIES AN�GIVIL FINES UPTOONE HUNDRED THOUSAN� ENERGY PERMIT � � L� ��—I� OOlLAR6(S1W�oDo1�M1AD0�TIO1�T TF}EICOSTOFCOMPENSATION,DAM/GESASPROVIDEDFOqIN �' � �i �.sECTwNaxoaoFn�e�Aaoacq .u�T�aEsr,nraoarroaNersF�s. � RETENTIONFEE: � �1.,� ��, OC ```��` �, �i � C���STpUCTION LENDING AGENQY PRE-AL7 FEE: ' � �� '�.IHEREBVAFFIflM.UN�ERPENP�7'(O�PERJUFYTHATiHERE'ISACONSTPUCTIONLENDINGAGENCV � I �'�FORTME PERFORMpNCE OFTH� t1qK WR WHICj1 THIS PERMIT IS ISSUED(SEQ 9091,CIV.C.). . �I'. W Jj�j� �� �� '��LENDEP9 NAME i I ����N7 J . - - � 1— ��LENOERS.WOflESB - ���� I TOTALFEES Zr�I� r��I aZ��3 �� ' W ,ICERTIFYTHATIHAVEREADTHIS PpL�CqTI���STATETHATTHEABOVEINFORAdATIONiSCARpECi / � IAGREE70fAMPLVWITHALLC1�fYiFWPCOUNTYORDINANCESANDSTlTELAWSREUTINGT08UILOMG �, � � . . �. '�:CONSTRlIC710N;ANO HERE6YAU�;RIYE Fj�PRESENTATIVES OF THIS COUNTYTO EMER UPON iHE " �I �ABDVEA-MEM"IONED;PROPERTY W �'SPEGSION P/U�RPOSES. - � .� ,. � �.1�4'1,�:.�'�.lJ I�i���V�,,, T . . . . COMMENTS -� . . ' .. . � � (,q .QI PE , EN B( M) I I.�, f��. . . 7 C.. Z� � . . . y 1 i � i SIGNAT FiE OF P M 0 � . ._ ; - RECPT.NO. PAID BY � �VALIDkT10N � " � � � '� �'i `WMh'E—Da anment Co �YELLOW—Finencs PINK—Assessor Co GOLDENROD—File Co GREEN— pliranPs Ca �� � � . P PY� ��PY. PY. PY, AP PY ' ����` �� ����� � �� ������"`����� ��� � ' . , , w � � � �� �,>� � w � � � � R � a � � � � . , n �� � �� , g � �� ���� ; � E ,��������� �; _ � �'�--��s ������r��'��.����� �������� � �-�.;- �� �,�, �_ , � u:�.�-_ :��c� ��sv.�����:� �_;�:_ ._., ..�..!.� '�.�°���.� �� j�����..-� . �_ , _ � z � �— - ' � ' �__—__ ��.� � ���� �-�.s,�w�:����� � �� � �-��:����������� ; �:� , . ?. � E ,�, f �� � , �---� , � , �:�,4..� _ l � � � ..�-,`�-"��°= ���_{��� �,. �' i=€� �'�..s���ct � } � �'.a . -�-� � �—�-�g t � � � ������ s � . ? q� �"�"" :?�'�" t i_.."`.� m' .' ' ' .._ , ..""" s rz x2.t rt/` P'' si-� c����..-."^'--_ �. . .. . � s �. �tJ�' �' , , ) . , °��i'� ��,...#-:+,.��'.'�'+�3d,>E:�l�d`at�li_....___""""� s, ..,.- •. . , ,T,-. R .: �,._�._ Y.�.,_��_._._..p.M..___..�__._�_�--.�. .�_._...�� € .w.,-t--�- �w_ �,_ �� K p r-; �--y. � r�•r_. . . � � , . ' ..�.. �� [. € �1���r'��'��. ���,...s�5��?;�'Y�S � ; � ' ..�" �..m.w.......�.�... � � ' � ' a��"9Y'4 C,°<�s Y1-¢.r._ � p �,:�-�-�.--,�-.:_ ., g .e... -�--� � s- .-- ._"_`___.,..,�.....�.. .._ � �-.v.... � �� �, ��� ����'' ���r,��r,+�'' �" s_�_....�._.I 1 ��" �C.���������<, . � ._._.��.��...w._�..�___�,_:.� g��'g^g p pjj ._..._ p^;y'�}.�{�.�.__.�. � E€ a�91 r�°Sa.✓°S� tti^�S"��#Y"s# �.�i�a��i^��' N� ����MF�^ � � "�°et`y �3�a�:.1 S7�rRyl�4i" ��__�_._ .�� _.�._�� F ; ��.3��+.s�'el �a � mm-� F�'� �.:������C � .��. __-__�--. � ` .a��- � _.� ��� _� �....�. ..� _._._ � �'i"�,� a �€ �'u�. A . ��f`��-+��+��� � ' , ! ' > �' , 5s�-� �----- ' �- ' .... ..,...�.. :. ; 5����.a�;�` �'� '���• " � �v� `?�`.����F���.3�s,^� � �� � � ; !�C,�J����=' ��3� t t`. ,�_ ,��.. E �r�",-���...�,,.__�_..,.�� .�=ik���:��t��t,�;�..i���`� �� _"��� �. ___. .�,_.�.�� �.. -� ___J_r,.:.__,.. ; ��t�"�����s,�E,�.� ��:^�`�`. �i � e��� � �4�C�L����"-���; E. �_ ��.. __e:d_�..� .. � ��� ����f���3"�� ` � i c=���7 i��g��°�� � � � i, h � --3 � �,?- q b6� t1H � �'� �� .._.�.:.� _.�:_.:.� �''�-1 � ��v��:e.3'..� €�d 9 __-___��� ' . . � . � '"' � i.:��', q�t p� a"u �m„° ''�- .�.._. ��.....- ,:�,t-� 3.�(k��s� ___.-�.� .�._.._...� .�,- ,--W.,...� iv t ! J ��,.d��� � } � E� . . � ......... .�....w._ , .,�,�.. �._ . . '�'�'r�-.,�..; @'0rl. :�iti�71 � �%��._,�,,.�,�;. �� . p! �� 1��a.�.' `5-,dr�.��l�h�sa'� � � m�, .���.. . .� , �..�..._,._ .. �C.a�dw:'i _...�._�.___--m� ���..��. � � 1 �:?�:�� .�;1'��._� � -�...m_,.� �� .�_._���""7`"�'_`_.: .m�._..___._._..�._�e ____�..� ._._i � � ���� ��'��a �� j, � � E � �.,����.���x!tr�`/��1�. � E � � �.�.�.�. -,�a� _�.. -i " ;:s� �' 4�t� s. � , , . ,_ � �'s���s��fr��1P� �� � x � ; � ���.. ' f'+ �.. �._._�_... �._..�—��...�_��_.�._.�. �_.�,�.�.._ �_____- � �.�_.____.P_ 2. a �__._� �4: �.["EY""E.'� °�'�" E . . Y^�sa {* .�.�i�Y'.[4YE(„ _..m.. , P i --..-+.-- ,.9 ���� ���� �__�.......�.�..�e�t �,...._...._...m.. ��-�3'��7 a (�! '�a C;t .��.;� .�....�...��.,-.�...�.. . . . ' . ,.__.���ti���t� _.:.� m_ �._._... v ._.. � .� ������,@ ��.�r g t��� .�,...� ! _..,.,� � `�''� 9?�Q�'�� �, . :�.�r'�; ...___.�., f...___ ��..m.�.___.,._,. ; ... _._.;� .� ......,,,_....�._w_^-' '---€-� '"m'"" . r� n era ..__. .___.....: ._.,�..., ,___"__-w-..�._...�. ,--,-...�....._.r.:._.._.-i, �`"'�eP�- a��., a��",�,�,,,,u.,�...�. � . �� €'�t� K'S �,.'3�BM4 L+ . � �� �. . .':_.,.. ��. i �. �. � �.�.�.,..._.._......_....v.v...-»»m._ � ! �n_._..__..�.�_�..y � ° ��'���..�e„ s�'�'k��'h�� sw�� ��..;, � � �f4tC'�;=��'kP � . „�.....__.,..,..�..... � .�.....�......., ���� � c,� __�__a._._..._.�.... . .� �...�,..__,_._...__..__..w.�,.{._�..._.__....�.. ..__�__,___�_�..._..�.�.._, �.��,��_,...�.,_._.. �:�._ ��� € � t � . ..._...�e..a...� ...�'--�....�.�......�......_..�....._....,�'� E l��„�,.�p'� �.„ � � � , ���� ��— ����" ,�---���..�.� .,._fi � . ������� �,� ...�_..�.� � �._..�.._._.�._._�_„w_.�..d_ :.uw. _.:v...,_--_�.�.. .__.. �. ., � f� , — , . � . , . �.____W __ �_.�:k____v.v , ���,.� g� fi�„�� „ ��..�� { �„ _� .. _ . _ � '. _ _ i 9 � , ��36�����t��`�a t�, k . ..... .�,.._.,..,�._.7� ��-..� �,. .�t .,., � ..,.�� _ ,.,. . . . . . � . .- . ' ' .. � � ,,. . . , . . . .: , ....__.,..�..,, .. . .._._.. .._....... _._...._" __ — - . _...__.., , - , � � � � . , '_.- ����'---� d m.�..,,.,,._.�:v.�.---_„""' .� __-'.____ ..�.�...� �..._....�_.,....__.,._^�.•___.._.....�.._._..._..� .._,_..�i ��. . . . . . .. � � � �' , �__,..�...._.�.._...�w.___,.,_._......._........_..�..._.,.�,_,_.�.�....,�.�,.......�.., , �.�_.._-d ��,. .�.'�.-_ ._..,_.... .. � . . ..-�____m._� .......�.__._-.._._._.___���....�__�.� _ ._'__-._....�. ..,,.__� � ...w�,.�.. ..,,..........,....�.....,.�, r - . �_._...... _........__.,.e.-..�_.....�.,.�.--...... . _.... � _�..,_.�._.,.._....,.._......�--..,.�.,�...._..� . � �. .� �. ' , . �. 3 ....�. . � . . . .,. . . . __.�.. ..�.........,_�......— , . . �....._.._.. �. . _, . �i,�!,�-�__— �-... , � .m.�.._...........�....».,......�..»,_,_.-.��__..�..._.......�..,,..,_.W... �.w.�..,�.., _ �._�..-_W.._„_ ....,.....,�... ._ . , � .........._ ' �, r . i, ...,.._.._..._ ..�,....._...... _.�.,-�..�._._.._,.....,.. _---•-` ' p - �,..'_: .. . '� � . '� . .. � � '� � I:��... i � � . . ., . . . �....._�.�._._...,._._...___�.__.__.:._.__._.�v. _..._ _ _ .� . .. .. -� . --- � YT � � � :..���%.-§.�..����4�%'���.:"'t."'�.�.�. �_,.._.�,... _.....-.,...,.,�......-_.�.. . �. ,..�,.� __._u_, ,. . _�-...-;�.....a�,_-...-.�..-- � ;����' �!�`r�.� "�tPo;�: ._._�.___..______ __�.__�._._..____.. ..w_..�__._... � __._,,_�. __w ._. I ai�m ��� ��:n�'� �� . �� ����_.��,��.�����. ������� �. �.� , , �f.i . . . .. � �.�.,�._�_____ .._:._„_.�- � :. .; , -, , � . I A ,�' .�, � � ���� � , . i��� i''."_""..� � _,.� �.�.,�..,..._...�.�� �..�.�.�. _ ..�. ,_.,_...�__-__----�--�- i d W i a : , V �.��,__ ._._�..�_�..,..._._._..�_..,..��_�T�_.��._._...___A_ _�.....-.-. _...___��.�.. �..i.. ' � � ' � ,�y �m � I i �a , : �.,�� _ _._._..____._.�. _.m__._.___._�....__.. �x�,:_.�. _..___._��_��..._.�_„� I� W ._', N � � �-�---- � � I; � � '� �` � .�,_���� � _��,,...�. �.��._�..� rv �i� �� � �,�,�.�e�W.�,�...;�.�� �� �,,.,���.��.�,�...� „�„�, ��,.,�.��.. - ��,��� .��