HomeMy WebLinkAbout10710 `�
- - CITY OF DIAMOND BAR ,�` 1
COMMUNITY DEVELOPMENT DEPARTMENT �'
•.,,.,� . 21660 E.Copley Drive Suite 190 i�, / PR ESS
(909)860-3195 Fax(909)861-3117 ; � /
'""" BUILDING PERMIT APPLICATION %" FIRMLY
� } JOBSITE ^� � y�d � ..� p �� � �,p APPLICATION _. ,,� l?-� PERMIT f��/CI P/C
o ADDRESS �1i���!'9 �l��/��d,.,,. ,�, ,F b DATE � NUMBER #
� c� ISSUE NPE OCC
APN LOT TRACT_ DATE CONST. GROUP
� OWNER �d)'"r`; ' �r � �i7.sr: "i 'qtt : /�r.� �e�' i� '
� o ADDRESS�°�,���'-�' �:� i�/.�� �'�'`�` ZONING SETBACKS
Z CITY� "f�t 'ri� ZIP 1 �1''�'�TEL.��i�p"�•./'N� FRONT RW I.I
� A REAR f_1
o APPL CANT '" �- TEL. ���9 _M
, "� :�7't-.�'�' SIDE/SIDE STREEi RW ❑_
m CONTRACTOR SIDE ❑
� � ADDRESS PROPOSED USE ��'��"` ��
� CITY ZIP TEL. , � ���
oARCWENG/ �
� z DESIGNER NO.DWEL. O. . '
a ADDRESS UNITS STOR�ES BEDROOMS
� CITY ZIP__ TEL.
� N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
p� OWNER•BI:ILDER DECLARATION SFRIA�D/REM
O
0 I HEREBY AFFIqM UNDEF PENALTV OF PER�URV THAT 1 AM EXEMPT FROM THE CANTRACTORS LI- G8f898IC8fpOfl
W CEN5ELAWFOHTHE�OLLOWMGREASON(SEC.7031.SBUSINESSAN�PROFESSIONSCADE:ANYCITYOR (n
U CWNTYWHICtiflEOUIRESAPERMITTOCANSTRUCT,ALTER,IMPflOVE,�EMOLI6H2ORREPAIfl�STRUC- W P8}IO/OBCk
w TUHE.PRIOR TO ITS ISSUANCE,AL50 REWIflES THE APPLICANT FOR SUCH PEHMIT TO FILE/151GNE0 W
� STATEMENT 7MqT HE OR SHL IS UCENSED PURSUANi TO THE PROVISIONS OF THE CONTMCTOR6lJ-
� CENSE LAW(CHAPTER e(COMMENCING Wlhl SECTION 7000)OF�IVISION 3 OF THE BLISME35 ANU PN0. u' POOVSpO
Q FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEQEDE%EMP-
V TION.ANYVIOLAiIONOFSECTION7031.5BYpNYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Re-Roof ,� �
� R CI`�IL�NALTY OF NOT MOflE iHAN FIVE HUNDflED DOLLARS(SSOD),):
� ��(SONMEROFTHEPROPEHTV.ORMYEMPLOYEESWITHWAGESASTHE�R50LECOMPENSATION, � COI11111BtCIaI
Z Wlll/00 THE WORK.AND iHE STPUCTURE IS NOT IN7ENDE0 OR OFFEFED FOft SALE(SEC.701i,BUSI- J
NESS AND PROFESSIONS CO�E THE CONTRACTORS UCENSE UW OOES NOT APPLY TO AN OWNER OF
i � PRODERTYYMOBIlILD50flIMPROVESTNEREON,ANDYMObOE55UCHWOqKHIMSELFORHEHSELFOR m
� � TMqOU6HH190RHEROWNEMPLOYEE3,PROVIOEDTHATSUCHIMPflOVEMENTSARENOTINTENDEDOR
L1J OFFEHEDFORSALE.IF,HOWEVER,iHEBIJILOINGORIMPqOVEMENTISSOLDWITMINONEYEpROFCOMPLE-
I Z TIDN,THE OWNER-BUILDER WILL HAVE THE BUflDEN OF PROVING THAT HE OR SHE DID NOT BUItD OR
� IMPROVEFORTHEPUfiPOSEOFSALE).
f�I,AS OWNER OF TME PROPEATY.AM E%CLUSIYELY CONTRACTING WITH ULENSED CONTRACTORS
� TO CONSTRUCT THE PROJECT(SEC.70aa,BUSWE55 ANO PROFESSIONS CODE:THE CONTRACTOqS LI- V211181i011 � ADJ.AREA,_
W� CENSEIAWDOESNOTAPPLYTOANOWNEHOFAPFOPEHNWHOBUILOSORIMPFOVESTMEPEON,AND —
F WHOCONTpACTSFORSUCH7ROJECTSWITHACONTRACTOR(S)LICENSEOPURSI1MlTTOTNECANTRAP QUANTITY DESCRIPTION FEE
Y TOflS UCENSE LAW.).
� J
� ❑i AM EXEMPT UNDER SEC._________..._____.—__ B.8 P.Q FOfl THIS REASON U
� �_— Q
� �ATE ` OWNER_ �.�_ ,.,�—�S„�'��� V
Z W
� LICENSED CONTRACTORS DECLARATION �j
' � I HEAEBY AI'FIAA1 UNDER 9ENALTV OF DENURY TiiAT 1 AM LICEYSEO L'NDER PROVISIOh50FCMAPTER V.
�� 9(COMMENqN6 WITH SECTION 7000)OF OIVI310N 30F THE BUSINESS 0.ND PflOFESSIONS CODE,AND z
AIV I�CENSE IS IN Fl1ll FORC[AND EFfGCi. m
V.1
�� LICENSE CUSS LIC.NO. �
V DATE____�_..._,�_—_—_ GONiRACTOP a
W
� WORKERS'COMPENSATION DECLARATION Q
� y U
N I HEHEBY AfFIflM UN�ER PENALTY OF PERJURV ONE OF THE WLLOWING�ECLAFATIONS: Z
Q
� � _IHAVEANOWILLMAINTAINACEFTIFICATEOFGONSENTTO5ELF�INSUFEFORWORKERS' _
� 7-d- COMPENSATION,AS PflOVIDED BY SECTION 3)OOOF THE LABOR CODE,FOP THE PERFOIUAANCE W
OF THE WORK FOR WHICH THIS PERAIIT IS ISSUED. �
W '
I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSUMNCE,AS REOUIflEO 8Y SECTION .y ,�y
Q �a�o00F THE LABOR CODE,FOR THE PERFORAIANCE OF 7HE WORK fOR WNICH THIS PERMIT IS �cr....l4' — "f��/ / � '
lSSUE�.AIY WDRKEPS'COMPENSATION INSURANCE CARRIEfl AND POLIGY NUMBEP ARE: ONST _�7 / �
j CAFlRIER PLAN REVIEW _._ t
ZraICYNUMBER______ — ELECTRIC _,
� �iHISSECfIdJNE�NOTBE�TF110FTFEPERMRISFIXi�NEMY�DPED�OLIARS(5100)OFiLE5S1 PLUMBING
0
Z I CERTIFY THAT IN TF1E PERFORMANCE OF THE WOFK FOR WHICH iH15 PERMIT I6 ISSl/ED,1 MECHANICAL
(,�J SNpLL NOT EM7LOY ANY 7ERSON IN ANY MANNER SOAS TO BECAME SUBJECT i0 THE -
� WORKERS'GOMPENSATIONLAWSOFCRL�FOPNIA,ANDAGREETHATIFISki0ULO8ECOME �NSPECTIONFEE _
9 � SUBJECT TO THE WORKENS'COIAPENSATION PROVISIONS OF SECTION 3100 OF THE 1A80fi �SS , • �, •
� � CD�E,I SHALL FOF7lHWITH COMPLV WITH THOSE PROVISIONS.
O �P n � ,
p DATE: .�_"_'_ APPUCANT: _.,______'�'--_"— — ' —
w ENERGY P/C __,�•� p `�
J WqRNING FAILURE 10 SECURE N'ORKEflS'COMPENSATION COVERAGE IS UNLAWFUL.AND SHALlBE y -
�y SUBJECTANEMPLOYENTOCRIMINALPENALTIE5ANDGVILFINE5UPTDONEHUNOREDTHOIISPND ENERQYPERMIT � _
ODLLAFi5�5700.OW),INAODITIONTOTHECOSiOFCOMPENSATION,DAMROESA3PROVIDEDFOflIN -�— —
�' SECibN37oeOFTHELABOqCODE,M1iEREST,ANDATfORNEV'SFEES. RETENTIONFEE: ___
d CONSTFUCTION LENDING AGENCY PqEALT FEE: k.�.� B'1 L� �Q�(
0 w .. aR .f �s:•
� 1 HEPEBV AFFIRM UN�ER PENALTV OF PERJURY THAT TNERE IS ACONSTFlUCTION IENDING AGENCY
FOR T11E PEFFOFMpNCEOF THE WORK FOR WHICN TH�S PERMIT IS ISSUED(SEC.3087,CIV.C.).
Z
W
� LENDEH'SNAME —_� — __
F LENDER'SADOHE&S -
w ICEHTiFVTHATIHAVEREAD7HI5APPLICA710NANOSTATETHA7THEABOVEINFORMATIONISCORRECT. TOTAL FEES ��� �
d IFGflEETOCOMPLVWITi1ALlC17YANDCOUNTVORDINANCESANDSTATEUWSREUTINGTOBUNAING
� CONSTRUCTION,AND HEREBYAUTHORIZE HEPRESEMATIVES OF THIS CWNTY TO EMEfi UPON TME
Z ABOVE-MENTIONED PROPERTY FON INSPECTION PURPOSES. COMMENTS
� i:� . ,�,�� p _ :°�� _
� • "n -"
� PERMITTE�E�F�NT� � � 6 G � � .�
�� I A. p_.
= SIONA EOFPERIAIITEE DATE
RECPT.NO. �PAID 8Y�'' �'� VALIDATION �^"
~ WHITE—De arlment Co YELLOW—Finance C py.GOLDENROD--File Copy,GREEN—
p py, opy,PINK—Assessor Co Applicant's Copy
.�, _�_._... �_ .__. --
�__�.....-. _ ._ , - � I i -__,..! � ._. _. 1 �- _____�.. � �_..__.�.�.'.�.� �_�_ �. .i' E.
� uz c�i � g; { ��;-n•-n���-� �a en v� � c-�m,�n i� � � a -n 4�l g l-;I crx 71 m � .n
�II �.�'it^.71 a � f I z�z!� � slm m r�ri�� rr�a Xi� �IOkG� Qi7o {'j� ItiS I�p��-' ry7 .
:PYI"6� ,! � � - � I D�AiDID��d, fn ,T3 �� :�r -I�;J�C�CjC.�OiD ��� ��bfol'"1 G$i-i ..
�-1� I ��� :i � � il ri Iri. �Df'� �� m � �� �-���GiI�C� -t � ��m v�ml � r;. .
'���� �� � i ; �: �I�nlx C;i37 �c ts 17 '✓' y�z-I..�{tm�2�x��,.c�'z m '-3I-�j �i��� -r�D
. j . .r!rim Q �=i .-i? r ,� ��I I .SlFn ��x'v'"t C:C'S
��� i yT7` c!m i -i r s� �i m x,q L i �,I �<'� � 7�
�; � : r ��.,,Ir= Di, z c.�;� � r�r-lcn..{<,} m m � �,�
� � . I I �
�.� L" ;r, � , z; z �u�,� �i u ��.:�
. � i:} L4:� . G i t77, -� +75 � r'L7
:� J7
D
� �_ - I In m
i ��� �i m� �� ;...i v:ii- �,. �b ;��`i""i��o�--� . ., ��< �m.c � s�l..,
j , :..a z,. ,y _ c.. raw�>., _izi � _ �
� cn�.i ' �� ' . Ctj ��D�s;� , �. � I�i����!�;�iz� .�� 1.I�� � `� C va. 0
E �m, � � ' j j � j ,� �c'�ni I�' �a ���I����n��''�� I���' "� ��.� ml
, i , � � � f ; I .� �. �! �� � {' i_ I � i� �-i
� ; � ' ' t i I ,� ; ;� , , i ` f � � i ., i
3 'I I � �: 1. I I � .1 � �. � I T�� .' +���' � j �
� i � ,I � ' 1 � � .i I � � I I ' � I I �'� � ` I �
E r I = � � � � ; � , " ����', � !� :` ; � �I � ,I j! I�� � � �: i � t _�, .
� l ' i j � � � I � � _� � �_ � I L I i �. �v� v' � ', i � ��<
� I I ` I I I � �~ i I i� � �' �' i �'- I � .i `}- , ��+.:j`�, -`-i+ �.
I i t
�� ( � f � � � .� � �f I I : � , I �' � � I I �� I li '� ' � i�.. � �,�'= I � �
� : � � i � � ' � I � i '.I � -� � I �'��j , � �--'� I .�� � I,
� 'i i � � 4 i i i �
� � .� { i I I ; I j ;i � i I � ; i I � � �, � � i � , � - �
;_ ' , I ' I " ' � , � : i., ( , � � ;. .I i ; � i `.- i i i � �
� ,� � , �
i � � < < � � ; ,� � E � �
� i ^ � � , � , ' � i `! I ! ' � � � ° '�' I` I I �,. , � �
f i ; � � p � I i, � j � � j � � I I � � 'i ! � ,� i � � � � :i I ' i I � ` �
s � ' � �_ � I � .i. � i i � :.�
' r �"-_ � ! � I , � � � t � f �' � ,i ;�-t-� �i__ _� �1--�� ---��-�-t'-s � ' � :`fa
: i i i i.- � ' I + i ' I ' � rr ..,��i�C �„�o �-' (� r, ��� ���;x����c�c T. "'� �
I �.. i t-- i ; - a I'�Tti���' rn ��cr. 9iDl= p� i_�? m �i--rl �r' � p�p � D �
� . ...... .... - �._ , �, � i ,Ti Tl.f'i N�'t'..'� (n{y.l� �r�� . �Oi 4� '
-n O C Q z C3
_� I I � � I ' i �,z,� �,� �_
i j i � _ _ c� � � � r, t�i �.�� �= mm� ��� ,�
I '� �+ rFl -n
. ' � I I . ' �... � �-� ✓a� � � ,� -i1��..�1���= -_- a��ip�� D.,A,� z� m��. �" � �i'.� �
I 1 9:: � � I � ; I "i,❑ -c l O i- a <-I.- ��n z f 'v� z D ��z ar -n -n`�i;
�. ' � � ;, , , � ' ;.,i ' ' ml � z�` "' ���� i��n � v'i ^ c z ai� •r,� � �,� s�s' .�
,+ i 1 I -i � � �,-c t I'v n,: z � e: � ,zi i n � �
� I :'i � i ��:� � 7�N yi ��co <__I� � G �^�j,p��i i� m'��O�O c,;. - � �?
� i �< ! � I rc � { j:, � z n � �lo oi� z �
�; `� { ` � � � i : � i,- :� D �i � i ���� � �a�'�� � �, c) v � �.�
� � _;1 f � -_ t: ,p � 7 i i � . �`• I�I� �lo c � � �
.' �1 i_ � � � � ' 1 i ��il i _rl ; I h -: � � �_ f i � �� ��ay � � �
; � � ' i _ � � .i i f i : I..I i � �i D'� � .
7 � � � _ � � i� i i. �' ��. ' I ,i � `J � .I
c � � i ��, I � I i r. � � � � I i � � I � � .i I I, i � ('I-'� I
: ; 9. � � � < i � � I � ,. , ' 1 � � i
f j � � i ;� ; i i i i � { _+ .� �-�-{ ' �--G J�'--{__�u_ �_.
I i I � I' i I �� �; i. I I i� � ' : �`� � �
! ; �: I , i -I � i- , � � � �` � i � �
� i � � : � , i ' , i �
i ' � ,: ; � i f ; � i' , .� .
� I �� � i I' I _� I 1 I ; j�. f � � �- `i { ;; � ;I I.�� '� :.
,� - i I 1:. 1 i (� .� � �.� I� j. i I -i .-L. � .I �.' � i � ( t� - � _� � 4�. .!_._,. �'�, I. � �.���
i .i ; I I� � i i �� i� ���.� � � a � I
, `
k ! I .' � i .,'I � � i j� . � � I .",I _ .�.� � � �: j I '� � ',- I � ��:i j ; �� . � � ;�t I' `f � .
� ' ' � ,
i
; �11� � i i , � ;� .� � .. � il � ' � � � I - �.f�� � I � � I E ��` � �:'� � II
f I ,( ' > � I :I � - � � I �_ � �"�� i � � r � i �
` � j °j �� I �] ��i,-' � = I�. � � � i,: � l�'�� :4 i ; � E�,� : ��� ���
ri .� �_'i I I I I I� �,` ' � w I ,-r: I i 1 .�.�- r -�� "{ .� � i I� ; .. �. .F `-. ,:s ,�"
` � ; ' ':: I � � - � I , I {.- , ;•.� � ' V� ^� g
`� f . : � � � . � � i i � . E � ��.I r., �;.. i-. ( i I -��� � i E �; �st �
y o ;; i ` � j _._�, _ . I I 1 ' I 'i I. i � � I � � ,1 : � E . � �-.�.:,
, � j �. I � i
� i � . .
,h-�_. _._.._: ��1�.._., _.�_.�_.... _.�� 1 _t�,.,_'.._._.. .� ' _ -____.!_..i.I_J...�i_.L.__L...,.�.__..i..kl._.�.....�.€.......i..,»i_,.._1�..,�.._-,.A,....i,:„y.._s_..z.:��.,..�__.,�..._i....�,..