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HomeMy WebLinkAbout12976 (14) � 1 ;� c� CITY OF DIAMOND BAR ' c�-) �`j � -- DEPARTMENT,OF COMMUNITY&DEVELOPMENT SERVICES �., � � 2166D E.Copley Drive Suite 190 -� . PRESS v�'. (909)860-3195 Fax(909)861-3117 ', , BrtJII.DING PERIVIIT APPLICATION ' FIRMLY o ADDRIESS r���'1 JY��t� �C�d��- APPLICATION �--�-.--C��NUMBER t ����#!C : DATE� � APN LOT� P ISSUE ` � d TYPE OCC ' .- �J .TRACT �' �� DATE ��� � CONST. GROUP . .�j � r ".rne�'1.�. , d�-.�.l' 1� ' . . �� . . . . . . � .. OWNER I p ADDRES � j,�p@'^' ' ZONING SETBACKS � CITY �' ZIP TEL.7%` FRONT RW , ❑ APPLICANZ �� TEI. � REAR C] Z �� SIDEJSIDE STREET RW ❑. � CONTRACTOR. Id Lfr /'�fiL't , SIDE . ❑ � ADURESS ��._ PROPOSED USE o CITY�1 r a5�'�_���u ZIP_ .�'2. TE�' �. ,"� f o ARCi-UENG/ . .� `DESIGNER �.' _ � q, ADDRESS . I - � CITY I ZIP TEL. NO. MS .' , NO.DWEL. NO.',. UN�DESCRIPTION SQ.F7STORI FACTOR PSF' ADJD.AREANALUAT'ION'. '��,,,�/� j .,,,� .,, , . . �YVNER-BUILDERDEQLARATION . ' � � SFR/ADD/REM � � � � � � � �� � ��� � �sEa 7osis eusmesSFwo aROFessroNs cooeTAAcroas u- , ; � .Garage/Carport �� � W CENSELAWFOflTHEFOLLOWIN RFASON ANYCITYOq . .(n STATEMENT THAT HE OR SHE I�LICENSEp PURSUANi 70 T-IE PROYI610N5 OF THE�pM�y STFUC ., �f,J_I_.pati0/DBEk I HEREBY AFFIRM UNDER ENAL7Y OF PERJURV THAT I AM EXEMAT FROM 7HE Co :C3 CqUN7Y.WMGHAEOUIRESAPE MITTCICONSTRUCT,AL7ER,IMPROVE DEMOLISH,oRREPAI �'�� SO'.R�OUIflES THE APPLICANT FDF SUCH PERb11T TO hILE�A SIGNED ,� ( ' � RACTOR6 LI �, �TION.ANVVIO�LATIONOFSE�CTM�ING4VITHSECT90M7W0)OFqIVISIIXJ3OFTHEeU51NE5$ANDPRO- , ",u' POOI/SpB , � � � Z T4RE.PRIOq TO ITS ISSUANCE AL z ❑I,ASOWNEROfTHEPRO ERTY�EMPTiHEREFROMANDTHEBA515FORiHEALLEGEDEXEMP- �(� ���� ����� � , FES9qN9CODE ORTHATHEOF�SHEI U O�! 03(5BVANYAPPLICANTFORAPERMi75l10JECTSTHEAPPLIGANTTO � Z' Re•Rppf . �F„ ��ACMLPENALTYOFNOTMOREtHhN'FIVE'riUNDRED�OLLARS(E5ao).): - , �o �' ORMYETAPLOYEESWITHWAGESASTHEIFSOLECOMPENSATION, �' ���- CORIffIOfCIdI ' i, , �� .;.YlILL00 THBYVORK,.AND TNE�SI RUCTLLflE.15 N071NTENDED OR OFFERED FOR SAIE(SEG.7044,6U31- ,J. , ' NESSPfD PFbFESSfONS CODE:THE CONTRACTORS LICENSE LAW DOES NOTAPPLtlTO AM OWNER OF .�j � PROPERTYWHqBUILDSOflIMPJF�VESTNEREON,ANDWHO�DOE55UCHWOflKHIMSELFOR:HERSELFOR � ."� �"THROUGHYiiSORHEROWN6MryIOVEFS,pPOVIOE�THA7SUCHIMPpOV@AENTSARENOTINTENDEDOR "m - � � � �����• 'Q �OFFEREDFORS4IEIFHOWEVER,iHE@UILDINGOflIMPflOVEMENTI550iDWITHINONEYEAROFLOMPLE- � ' - 'i � �.�, ':TION,THE OWNER-BUI4�ER WILL HAVE THE�BURDEN OF PROVING THAT HE OR SHE OID NOT BUIID oR � , . . = IMPROVEFORTMEPURPDSEOP�SAl,Ey. .� �. '� I� ..W.., 1� NiRACTORS ' , � ' ❑I,qSOWNEROFTHEPR<PEpTY,AM EXCWSIVELYC�NTPACTING WIiH LICENSEDCO �� TO CONSTRUCT THE PRPIECF($EGi 7044,BUSINESS RND PROFE5519N5 CODE:1'HE CONTqACTORS LI- . V31U8110f1 ao�.aaEa ,LL7 CENSEL4WOQESNOTAPPIVT�qNOWNEpOFAPROPERTYWHOBU4DSORIMPFiOVESTHEREON,AND - '�'� `MiDCONFRACTSFORSUCMPflQJECTSWITY.ACONiRACTOR(5)LICENSEDPURSUANTTOTHECOMRAG ' QUANTITY DESCRIPTION "' ' ' � - - '� FE�� I � TOflSLICENSELAWJ. ' � . .. �. I '.o' ❑IAM EXEMPT UNDER SE I. � � � � B.3 P.Q FOR 7HI�PEASON ... ;�- . � . .. " ." � i W F — I §YNER . .0 . i � oATE LICE SED CGNTRACTORS DECLARATION � CL �,i HEREBYAFFIRM UNDER PENAL ��OF PERJURYTHAT I AM LICENSED UNDEH PR�VISIONS OF CHAPTER /�� , . , � 'p„ '�9�COMMENCINO WITH SECTiOry OOOJ.,OF��,ONISION3 OF 7HE 9USINESSAND PROFESSIONS CODE,AN� . Z }��Pi i.���Cr��Y��1 �"�� � X �MY UCENSE IS IN Fl1LL F6 D EEFECT. p p ° � !— ,�LICENSE CLASS . �� . . � LIC.N0. . ;V3"� �.• o-".��� :j- � � . . . ' �,.�.���I.. ;. . , ;J, "DATE ..�, ' ...... CONTpACTOR ..- . . - . .- . ., a . . . . .,. ,. . ��� WORKEiiS'��,COMPENSATION DECLARATIONI;i� � Z,,. Q . � _ . . �-��' V . � �,I�HEREBYAFFIRPAUNDEflPENALI OFPERIURYONEOFTHEFOLLOWMGOECLARATIONS` - � �� ' . � � �__IHAVEAN�WILLNAIWTA(Jq'CERTIFICATEOFCANSENTTOSELF-INSUREFORWORKERS' z ��CpMPEdV$ATIONASpq Ib��E158Y5EGTION37a00FTHELABORCADE,FORTMEPEFFORMANCE' � � 'OF T11E WDFlK FOR WHI H,THI$PERMIT IS ISSUED. � ,. �[31 ' . . . "'1 MiiVE A'fVOYVILL MAiNYA N 1NpP1KER5'CAMPENSATION INSURANCE,A3 REQUIRED BV SEGTIDN Q' '370o4F.THELA80FlC0���FOFBTHEPERFORMANCEOFTHEWORKFORWHICHTHiSPERMITIS , �, CECARRIERANDPOLICYNUMB�RARE�. CONSTRUCTION _ ' 0 ISSUEO..MY WORKEAS' eyMPEP15ATfON WS RqN ' _ �O ... ...roucv ;�'��� ' I PLANREVIEW � . . \fCAFqIFR 17 � 'k wuh9eEft -� � . . ELECTRIC �aC . . � ,: (h+ISSEcnauNea�HOT� oJMR.EfEooF'n-IEaEiunrrASFoaoMEHunDRE�o�luasgtao)oRLEss). PWMBING - ICEflTVFYTHATINTNEP R��RAdANCEOFTHEWORKFORWHICHTHISPERMITI51SSl1ED,l MECHANICAL ' � SH&LI,NOTEMPLOYANY�fR$bNINANYMANNEq5�A5TOBECAMESUBJECTTOTHE � WORKERS'C�h1PENSAT �.ASVSOFCALIFORNIA.AN�AGREETFIATIFISHOUL�BECOME INSPECTIONFEE � '"Sl1BJ'E'CTTOTHE`�1RKF�5'C47MPEfJSATIONPROVISIONSDFS€CTION370aOFiHELABOR �� - , - � � � - �` I.i,. ' � ''.GODE,I SHALL FpRTHWi M CpMPLY WITH THOSE PROVISION3. j p ISSUANCE �gy �:d° �! , � r � , �,�.�� �'����11Z� SMIP . ��d.ffi.,���������-��� �I onrE:�� pviicnn�r. _ �p�T � � ' ENERGY�Y6/�.'��uY� f'�..'�l�i' � rg�� WARNIMG.FAYIUFEXtlSE'CURE� R2ERS'COMPENSATIONCOVERACEISUNLAWFUL,ANbSHAIIBE �"r=�3 '�U&IECTANEMPLOVEfiYiOCR� �NA�pENALTIESANDCIVILFNESUPTOONEHUNDREDlHOUSAND . ENERGYPERMIT ' �, '�OLLARS({900,000��;lN AD01T10?3'fp'�YME COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR IN , �, �i SECTION97080FTH, €,'.,�TEREST.AN�ATTORNEY'SFEES. ' RETENTION FEE; � E Lo1gOR CO IN ,��- ��.roaTwEaEa�rROArea�wcEOFir�"i�WOF �CTIONLENDINGAGENCY PRE-ALTFEE: � - � i � � . - q PERJURYTHATTHEPEISACONSPRUCTIONLENDINGAGENCY ' RK FOR WHICHTHIS�PERAMT IS ISSUE�(SEC.30a7,CIV.CJ. — . . ��i �'.LEN�ER'SNAME�' , ' ' .. F-�,, "LEN�ERSADDRE$S� . . � TOTAL FEES � �'�ICEF171FYTHAiIHAVEREADYHI HF?p4�CATIONANDSTATETHATTHEABCVEINFORMATIDP115CARRECT. � ;�'.IAGREETOCAMPLYW}THALLCI,.pNDCDIJNTVORDINANCESANDSTATELAWSRELATINGTOBUILDING � � ���CONSTRUCTIONaM1D'MEREBY R�ZEREPflESENTATIVE50FTHI5COUNTYTOENTEHUPONTHE - � - � ;� �PHOPERTY F i R;INSPEC710N PURPOSES. COMMENTS - '�ABOVEI�AENTIONE o , i� �� �� � '.PERMITT E( IM) . . ¢ �. _`.L�['J - � . �, ... � e/y ��j IGNpiU ERM9TTEE I �.� . OATE �'- � � , .�,;�. � . . :,.... AECPT.NO. PAID BY VALIDATION � � - ~ "'�� � � � �'��'�� �� "WHITE—De atlment Co VELCOW—Finence Co PINK—Assessor Copy.GOLDENR06—File Copy,GREEN li�'s Co . . 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