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HomeMy WebLinkAbout15292 (19) ._ _,,,_,_,_..__.w�_ _ -___----_____..__ __---_� __._.__. _ ..._-.�--- .. _. , _._ _ -- � ' ,"" ��G� - _�.,,� CITY OF DIAMOND BAR L�/`���J DEPARTMENT OF COIVIMUNITY&DEVELOPMENT SERVICES : w , 21660 E.Copley Drive Suite 190 q�,,.. (909)860-3195 Fax(909)861-3117 Pf�E$S BUII.DING PERMIT APPLICATICIN _ FIM�I�LY .: . .. ,..: �.��� ,,,.:.; , � JOBSITE �`� � �� APPLICATIO n`� " PERMIT o ADDRESS �L-� ���+�s��1�-3Z- � DATE �✓ � NUMBER �� � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNE��� �` ADDRESS � �'�� �'T7•. "'� ��• ZONING SETBACKS � CITY�����i���a�� ZIP�I""1 `'u TEL.S' � REART RW ❑ APPLICANT TEL.� C za. SIDE/SIDE STREET RW C � CONTRACTOR _ 1.�.� SIDE C pG ADDRESS -3S��Z'� �`J-'�;iiZ�! o CITY(i,A*�.L?-+-e"t�f"i ZIP��Z3'iCL TEL.���r.S''"`��-�---a PROPOSED USE .►- J � ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS cn UNITS STORIES BEDROOMS N CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUIL.�ER DECLARATION SFRfADDlREM O p I HEREBY AFFIfV�I UNOER PENlLLTY OF PERJURY THAT�AM E%EMPT FfiOM THE CONTRACTORS LI- G�fe e/C9 OR W CENSELAWFORTHEFOILOWINOREASON(SEC.7031.5BUSINESSAN�PROFESSIONSWDE:ANYCITYOR (� 9 � C,7 COUNTYVhIICViREIX11RESAPERMITTOCONSTRUCT,AlTER.IMPROVE,�EMOl1SH,ORREPAIRANVSTRUC- Z NRE PRIOR TO 17S ISSUANCE,ALSO REQUIRES TNE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/�eck � STA7EAIEM THAT HE OR SHE IS LiCENSED PURSUANT TO THE CROVISIONS OF THE CONTRqCTORS LI- � � CENSE UW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- POOUSpa FE6SIONSCODEJORTHA7HEDRSHEISD(EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (� TKKJ.ANVVIOUTIONOFSECTION7031,6BVANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Root � ACIVILPENALTYOFNOTMOflETHANFIYEHUNDREDDOLLARS(5500�J: � ❑I,ASOWNEROfTHEPROPERN,OHMVEMPIOYEE5WI7HWAGESASTHEIRSOIECOMPENSATION, ❑ COmtrl8fCi01 - WILL 00 THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI- J y NESS AND PqOFES510N5 CODE:THE CONiRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER Of PROPERTYWFIOBUILDSORIMPROVESTHEREON,ANDWHOOOESSUCHWORKHIMSELFORHERSELFOR � � THROUGHHISORHERONMEIAPLOYEES,PqOVIOEDTHATSUCHIIUPROVEIAENTSARENOTIN7ENDEDOR m �O OFFEREDFORSALEIF,FqWEVER'M1�EBUIIDMGORIMPROVEMENTISSOIDWITHINONEVEAROFCOMPLE- Z TKKJ,THE OWNER-BUILpER N'ILL HAVE THE BUR�EN OF PROYING THAT HE oR SHE DID NOT BUIL�OR = IMPROVE PoR7HE PUqPOSE OF SAIE). W Ut,A30WNEROFTMEPROPERTY,AMEXCLUSNEIVCONTRACTINGWI7MUCENSEDCONTRACTORS Q[ TO CONSTRUCT THE PRO.IECT(SEC.7oN,BUSINESS AND PROFFSSIONS CODE:7HE CONTRACTORS ll- V3IU811Df1 _ ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEHOFAPROPERiVWHOBU1LD50RIMPROYESTHEREON,AN� - � NM1IOCONTRACTSFORSUCHPRWECTSWI7HACONiRACTOR(S�LICENSEDPURSVANT70THECANTRAP QUANTITY �ESCRIPTION � roas ucENSE tnw.y. FEE ❑IAM E%EMPT UNDER SEG B.8 P.C.FOR THIS qEA50N Q � U W � UA7E ONTIER F— Z w � LICENSED CONTRACTORS DECIARATION W Q 1 HEREBVAFFIRM UNDER PBJALTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPiEH �,/ y�,,y ��.�+_ � Y(COMMENCINOWIhISECTION7000)DFDIVISION30FTHEBUSINESSANDPROFESSIONSCOOE.AND Z '�"' �A� ���"';-'"'���"""�",� � r 6 IAY LICENSE IS�N FULL FORCE AND EFFECT. � LICENSE CLASS �'�3 4' LIC.N0. ���-�--�—�'� � V DATE �'�R-°Ga C6NTRACTOR !��Y-1 �� - d W � WORKERS'COMPENSATION DECLARATIO�y �� � � N IHEREBYAFFIRMUNOERPENALTYOFPERJURYCNEOFTHEFOLLOWING�ECLARATI,NS: Z � _IMAVEANOWILLMAINTAINACEIiTIFICATEOFGONSENTTOSELF-INSUREFORWORKE S' ¢ COMPENSATION,AS PROVIOED BV SEC'ION 3700 Of 7HE 1A60R CODE,POR THE PERFORMANCE U O OF THE WOPK FOR WHICH THIS PERMIT IS ISSUED. � � _IHAYEANOWILLMAINTAINWORKEPS'COMPENSATIONINSURRNCE,ASREC]UIREDBVSECTION Q 37000FTNELA90qCADE,FOflTNEPENFORMANCEOFTHEWORKFORWHICHTHISPERM1T15 ISSUED.MV WORKERS'�MPE-N�–SYAT�ION INSl1RANC'Ej�C,ARpIER AND POLICY NUMBER ARE: CONSTRUCTION � CARRIER 1 ,�iiC'I�'iZF'i'i' G.I'`�..�'`LA.��i:�:�.� pLAN REVIEW zPOLICYNUMBER �3'1���C�..;��;C^s���3'"' ELECTRIC ¢ .. . � L Q (lF0.SECfqNNE�NOTBE�MRETF�OFiHEPEFVMISFORIXJEHUNMED (EtoD) LESS. PLU�MBI_NG _ y+� � ICERTIFYTHATINTHEPERFORMANCEOFTHEWORKFORWHICHTHISPER�11171SISSUE�.I MECHANICAL ____���� C3 SHALL NOT EMP:OV ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE (n WORKER5 COMPENSATION LAWS OF CAL!FORN10.AN�0.GREE THAT If I SHOULD BECOME INSPECTION FEE S SUBJECiTOTHEWORKERS'COMPENSATIONPR6U IONSOFSECTION37oaOFTHEIABOP CODE,ISHALLFORTHWITHCOMPLYV,TI7NTFIOSEPRO 5. ISSUANCE --p-��— p DATE:� ��t�-7 APPLICANT: �"F' ^"'�m. SMIP +da�p„�,_��_�_�O�O�O W � ENERGY P/C � WARNINp:FAILURE 7C SECURE WORKERS'COMPENSATION COVEPAGE IS UNLAWFUL.AND SHALL BE �y SU&IECTANEMPLOVERTOCRIIAINALPENALTIESANDCMLFINESl1PTOONEHIINOREDTHOUSAN� ENERGYPERMIT OOLLARS�fi00.000),INAOD�TIONTOTNECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORIN � ��_ � SECTION37oeOfTHELA80RCO0E,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: i� OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIRM�N�ER PENALTY 6F PERJUFY THAT THERE IS ACONSTPUCTION LENOWG AGENCY fOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�(SEC.3oB7,CN.C)_ Z W � LENDER'SNAME ' H IENDER'SAO�RESS � I CERTIFV iHA71 HAVE READ THISAPPLICATION AND STATE THAT THE A80VE INFORMATION IS CARRECT. TOTAL FE ES ` y�� IAGREETOCOMPLVWITHALLCI7YANDCOUN7VORDINANCESANDSTA7ELAWSRELATINGTOBUIL�ING ,) ( � CANSTRUCTION,M10 HEREBY AUTHORIZE FEPFESENTATIVES OFTHIS COUNTY TO ENTER 11PON THE Z A90VE-MENTIONE�G OPEPTV FOR INSPECTION PURPOSES. �/� �, 1 COMMENTS � ����L,.\'��!i�-.1��J.C..'�� m PERAIITTEE NAME(PRMT) –����"' 4 � _�� ..... �� _._ / � -C.--•.-..:_�_- ._-- �}...�._.._ I! 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