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HomeMy WebLinkAbout17013 (44) `----_�.�-- CITY OF DIAMOND BAR �� : � DEPARTMENT OF COMMUNITY�DEVELOPMENT SERVICES ,; -3 21825 E.Copley Drive (409)860-3195 Fax(9�9)861-3117 PRESS '%v���' BUILDING PERMIT APPLICATION FI R M LY � JOBSITE ' J APPLICATION �"�' °� �i PERMIT _��'i�O P/C o ADDRESS l-+ DATE �0 ��� 1 NUMBER �� # � ISSUE TYPE OCC -- APN LOT' TRACT DATE CONST. GROUP p OWNER p ADDRE ZONING SETBACKS z CITY�/�j(�y��_ ZIP TE . - FRONT RW C p APPLICANT � TEL. SIDF/SIQ�STREET RW C z ¢ CONTRACTOR " � � SIDE C � ADDRES$ PROPOSED US o CITY, ZIP�TEL. �.S�nj Y1�'`1 � �" w AFtCHlENG/ { z DESIGNER � W NO.DWEL N . NO. � ADDRESS UNITS _ STORIES BEDROOMS �'' CITY ZIP TEL. c� , cn DESCRIPTlON SQ.FT. FACTOR PSF ADJ.AREANALUATION , ��,0;., O�/NER-BUILOERDECLARATION SFR/ADD/REM � . .p', �,, . �I HEREBY AFFlHM UNDEfl PENALTY OF PEfiJURY THAT i AM EXEMPT FROM THE CONTRACTOflS LI- G8f890JC8fPOfI ,�W� '� CENSE'LAWFORTHEFOLLOWINGREASON(SEC.7031.56USINESSANDPROFESSIONSCODE:ANVCITVOR (n �U�� I.CDUNTYWHICHFEQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG ..,�W� I.TURE,��PRIOR TO ITS ISSUANCE,ALSO RC-0UIRES THE APPUCANT FOR SUCH PERMITTO FILE A SIGNEO W Patio/DeCk SiATEMENT THpT HE OR SHE IS ICENSED PURSUANT TO TtiE PROVISIONS OF THE CONTFiACTORS LI� �;i CENSELAW(CHAPTER9�COMME�CINGWITHSECTION��7oao)OFDIVISION30FTHEBUSINESSANDPFO� LL P�USP2 FESSIONSCODE)ORTHATHEOR�HEISEXEMPTTHEREFROMANDTHEBASISFOFTHEALIEGE�EXEMP- (� � Oi, TION.ANYVIOLATIONOFSECTIO 7o31.5BYANYAPPLI'CANTFOflAPERMIT5U9JECT5THEAPPLICANTiO Z Re-Roof � �; 'AGNIC RENALTY OF NOT MORE THIAN FIVE HUNDRED DOLLAFS(5500).): �:, ❑I,ASOWNEflOFTHEPFOP�ERTY,ORAAYEMPLOXEESWITH-WAGESASTHEIR50LECOMPEN5pT10N, � COf71f1t8fC18� - . Z�„ WILL�O THE WORK,AND THE ST�IUCTURE IS NOT INiENDE�OR OfFERE�FOR SALE(SE0.7044,BU54 J �;.'�;� NE55 ANO PROFESSIONS CO�E:jYE CONTRACTORS LICENSE LAW�OES NOT APPLYTO AN OWNER OF � 'I PROPERTYWHD9I11LDSORI�,APRbVESTHERFON,ANDWHO�DE5St1CHWORKHIMSELFOfiHERSELFOR '��i��'.'.i THflOUGH HIS Oq HER OWN EMPLOVEES,PFOVIDE�TFIAT SUCH IMPROVEMENTS ARE NOT INTEN�ED OR m '�'0�,,',�';�'OFFERED FOR SAI.E IF,HOWEVERITHE BUILDING OR IMPROVEMENT IS SOL�WITHIN ONE YEAROF COMPIE Zi �TION,THE OWNER-9111LD�R WILIJ HAVE THE BUflDEN OF PROVWG THAT HE OR SHE DID NOT BUIL�OR ��, ,.IMPROVEFORTHEPURFO5EOF�ALE), w�.',�, � ❑I,ASOWNEROFTHEPROJFEFTY,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS . � ���I'',�70 CONSTRUC7 THE PROJECT(qEC.7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACiORS U� V81UeUa ADJ.AREA W'�,' '.CENSELAWDOESNOTAPPIVTObNOWNEROFAPROPERTYWH00L11LDSORIMPROVESTHEREON,AN� FI ''�, WHOCONTRACTSFORSUCHPRO�,JECTSWITHACONTpACTOR�S�LICENSE�VUFiSUANTTOTHECONTRAC� QUANTITY �ESCRIPTION FEE ' TORS'LICENSELAW.). ' �i�, ❑'IAMEXEMPTUNDERSEC�� 8.&P.C.FOR7HISflEA50N Q �, U LL, � , DATE OWNER U ZI ,,,�', , LICENSED CONTRACTORS DECLAFIATION W ���¢!., � . . �. � ''�!.�, I HEREBY AFFIRM UNUER PEIVfLLT,M OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � '.,��,.' 9(COMMENCING WITH SECTION�aa�)OF DIVISION 3 OFTHE BUSINESS ANU PROFESSIONS CODE,AN� Z ����XI MV LICENSE IS IN FULL FOflCEAND EFFECT. ��I LICENSE C SS_�,�` —LIQ N0.���IY� j w'�, �ATE'A��Z''�( CONTRACTOR , 1 �'a�'' 4YORK�RS'COMPENSATION DECLARATION -� Q ��',,�. 1 HEREBV AFFIRM UNDER PENALTj'OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: Z ���,�, _IHAVEAftlOWILLMAMTAINACER7IFICATEOFCONSENTTOSELF-INSUREFORWORKEriS' _ ¢;, .CAMPENSATION;A5PR0}�IDED BY SECTION 370o OF THE LABOR CODE.FORTHE PERFORMANCE 'U � OFTHE WOFK FOR WHICFI THIS PERMIT IS ISSUED. 11 Q,'. � _,;I HAVE ANO WILL MAINTAI WORI�RS'CIX�A?�NSATIDN INSUPANCE,AS RE�IJIRED BY SECTION `I',� a ���' 37000FTHELA6qRCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHiHISPERMITIS � �.C`o �t^\ ��'I ISSUE�.MV WORICEAS'C PENSATION INSIJRANCE CARRIEsR�AND POLICV NUM6ERARE� CONSTRUCTION p�'L� �.�1 �j,�.�' caaqiEa '�V I PLAN FEVIEW ',�', POLICV NUMBER � ELECTRIC � ��.�. (i}iISSEC�IONNEmNbTB�Wtv1PLEfEDOFiHEPERMRISFORONEHUNDREDDOLLARS($100)OFLESS). PLUM8ING ICEflTIFYTHATINTFIEPERFORM.4NCEOFTHEWORi(FORlVHICHTHISPEflMITI5155UED,l MECHANICAL ('}'�'., �SHAIL NOT EMP�QYANY��ERSON IN AIJY MANNER SO AS TO BECOME SUBJECT TO THE , �, WOPKERS'COMpENSATi�NLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE . - . SUBJE¢TYOTHEWORK�FS'COMPENSATIONPROVISIONSOFSECTIIXV3700OFTHELABOR �'' 4,'! �' � �CO�E,ISHALLFQRTHWIHCOMPLYWITHTHOSEPROVISIONS. ISSUANGE�-.�%� T\ ^ - 6y��� d � SMIP h m - > %"" p'� DATE:.�` f�PPLICANT: �i ���, ��" ENERC-�`!P/C�����: �. (.�! .s . J WARNING:FAILUflETOSECUREvyORKEHS'COMPENSATIONCWERAGEISUNLAWFUL,AN�SHALLBE fi h �—y�, SUBJECTANEMPLOYER'�TOCRIMINALPENALTIESANDCNILFINESUPTOONEHUN�REDTHOUSAND ENERGYPERMIT DOLLApS(E10D,aao),IN ADOITIONITO TF4E CDSTO=COMPE�'SATION,DAMAGES AS PROVI�ED FOF IN t J SECTION 3�oB OF THE LP.BOR GOpE,INTEREST.AN�ATTORNEY'S FEES. � 1 flETENFION.FEE: O '�� . ,C INSTFiUCTION LENDING AGENCY PRE-ALTiF�Ei,°.�- . _ -,,..." "� �; IHEREBYAFFlFMUN�ERPENAL'CYOFPEF3JURVTHATTHEREISACONSTRUCTIONLENDINGAGENCV FOFi THE PE[iF4PAlANCE OF'iHEI,WORk FOl3 W HICH THIS PEFMIT IS ISSVEO(SEC.3091,CIV.C.). Z'. w ;j". LENDER'SNAME � � �F`;��. LENDER'SAOORE55 1 �'� I CERT!FYTHAT I HAVE READ THIS APPLICATIONA�D STATE iHAT THE ABOVE INFORMATION IS CORRECT. TOTA�F E ES � '"V� �� ',�i IAGREETOCOMPLYWITH-ALLCITVANDCOUNTVOR�INANCESANDSTATELAWSRELATINGT06WLDING � 5 ,;�',, CONSTRUCTION,ANDHEP.E0YAl7THORIZEREPRESENTATIVESOFTHISCOUNiVTOENTERUPONTHE Z„ ABOVE-MENTIONED PROPE Y P,OR WSPEG7ION PURPO5E5. 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