Loading...
HomeMy WebLinkAbout15252 �� � CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SER��ICES 21660 E.Copley Drive Suite 190 PRESS ���+»���,w BUILDING PERMTT APPLICATION FIRMLY � JOBSITE q� APPLICATION �'" JO'-e�� PERMIT �'�'����- P/C o ADDRESS ��'�� �C�C��� � � _ DATE ��� r +�°'i�_ NUMBER �� a $ ISSUE I� ,{` TYPE OCC APN LOT TRACT DATE L �+'� CONST. GROUP p OWNER �1V1 �\'�i'� ADDRESS���1.����`��5� �� • ZONING SEfBACKS Z CITY'C7`Q �n, ��.@V� ZIP�'II`7GS— TEL.90C( � +�3 REART RW j g APPLICANT �Co\ii�"� �S.y'v� TEL.�i�(.��r7S� Z SIDE/SIDE STREEI' RW ❑ � CONTRACTOR SIDE _ ❑ � AD�RESS o CITY ZIP TEL. PROPOSED USE o AliCHlENG/ z DESIGNER NO.DWEL. �JO. NO. a ADDRESS UNITS :iTORIES BEDROOMS = CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBY AFFlRM UNDER PENALTI OF PERJURY 7HAT I r1M[%EMPT FROM THE CONTRACTOP,S LI� � Garage/Carporl W CENSELAWFORTHEFOLLOWINGREASONISEC.7037.SBUSINESSANDPROFESSIONSCODE.ANYCI1YOR CJ COUNTVNMICXPEIXIINESAPERMITTOCONSTRUCT.PLTER,IMPROVE,DEMOLISH,�RHEPAIRANYSTRUC- r' Z TURE.PRIOR TO ITS ISSUANCE.ALSO REDUIRES 7HE APPLICANT FOR SUCH PEHMIT TO FlLE A SIGNED W Pati/DOCk � STATEMEN7 THAT HE OR SHE IS LICENSED PURSUMfT TO THE PROV1510NS OF THE CONTRACTORS L6 � CENSE lAW�CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 30F iHE BL'SINESS A1v'D PRO- �'L' POOUSpB FESSpNSCO�E�ORTFIATHEON5HE15EXEMPTTHEREFHOMAN�THEBA5ISFORTHEALLEGEDEXEMP� � TIOM.ANYYIOLATIONOFSECTION7031.56�ANYAPPLICANTFORAPERMIiSU&lECTSTHEAPPLICANTTO z Re-Fioof � A CINL PENALN OF NOT MORE TNAN FNE HUN�RED OOLU1qS(isoo�.): � ❑I.ASONRIEROFTHEPROPERTY.ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSA710N, � COfnm9�Cial _ NALL DO7HE WOFK,AND THE S7RL'C7uRE IS NOT IkTENDEO OR OFFERED FOFi SALE ISEC.7ata,BUSI• J NE55 AND PROFESSIONS CO�E:THE CONTFACTORS LICENSE lAW�OES NOT APPLV TO AN OWNER OF � PROPERiYWHOBVILDSORIMPROVESTHEREON,ANDWHO00E5SUCHWCRKHIMSELFORHERSELFOR � � THROUGM HISOR HER OMM EMPLOVEES,PROVIDED THA7 SUCH IIl.PROVEMENTS ARE NOT I>1TENDm OR m QOFFEREDPORSALEIF,MOWE1fER771E8U1L�INGOHIMPROYEMENTIS301DWITHNONEYEAROFCOMPLE- Z TION,THE OWNEH-BUILOER WILL HAVE TXE BURDEN OF PROVING THRT HE OH SYiE DID NOT BUILD OR IMPROYE FORTHE PURPQSE OF SALE). W :LQI,ASDWNEROFTHEPflOPER'TY.AMEXCLUSIVELYCANTRACTINGN'RHLICENSE�CONTRACTORS � 70 CONS7RUCTTHE PROJECT(SEC.7oa4,BUSINE55 AN�PROFESSIONS�DE:THE CONTRACTORS LI- V81UdtiOn no�.nHea W CENSEUWDOESNOTMPIYTOANOWiVEROFAPROPERTVWHOBU1LA50RIMDROVESTHEHEON,ANO � N1FiOCONTRACTSFORSUCHPROJECTSWITIACONTRACTOR�S)LIC'cNSEDPURSUAhTTOTHECONTRAG QUANTITY DESCRIPTIOIV FEE TORS UCENSE UWJ. ) ^ � U TAM EXEMPT UNDEfi SEC. B.8 P.C.F THIS REASOY Q i ` � � � r - ��,t--,�-- . ZDATE��^�'� OwNEA ��i\`1 1�1r\R`r� _ U � ". Q LICENSED CONTflACTORS DECLARATION -� � � w I HEREBV AFFIRM UNOER PENALTY OF PERJURY THp7l AM UCENSED UN�Efl PflOVISIONS OF CHAPTER � d B�COMMENCIN(iWITHSECTION�OW)OFDIVISiON30FTHEBUSINESSANDPROFE55!ONSCOOE.AND Z X MY LICENSE IS IN FULL FORCEAND EFFECT. � LLJ O � � LICENSE CLASS LIG.NO._ J V pp7E _ CCNTFiACTOFl a W __ � VCORKERS'C�MPENSATiON aEGLARRTION -� Q � U � I HEREBYAFFIRM UNGER PENALTV OF PERJURV ONE OFiHE FOLLOWING�ECLARATIONS: Z — Q 0 I HA4E Ft�ID WILL MAIN7RIN A CERTIFICATE OF CONSEN?TO SELF�I45URE FOR WORKEFS' 2 � COMPENSATION,ASPROVIDEDBVSECTION3'/000FTHELABORCODE.FORTfiEPERFO4M4NCE W � OF THE WORK FOR WHICH TMS PFRMIT!S ISSUED. � 1� — I HAYE AND WIIL'MAINTAIN WOHKERS'dJMPEM9ATION IhSUr�ANC'e,AS REDUIREo BY SEC710N Q 37000i THE IABOR CODE.FOR TSiE DERFORMA.NCE OF?HE WORK FOR W41CN THIS PERMIT IS �/�/� � �SSUED.MY WORKERS'COMPEdSAi:CN IUSURANCE CARRI'eR AND PO!ICV MUMBEN AqE: CONSTRUCTION _ � J � _ __ PLAN REVIEW ._,__ GqflAIEF_ � POLICYNUMBER ._ ELECTRIC _ � 6 0 RFiSSECfYJNNEH�NOTBECJM,PI.ETFDOF711'cPEi�17ISFORQ`tEHINI]Rc"DDCltAR515100{ORLFSS). PLUMBING ____ � I CERTIFY TMAT IN THE PERFORM0.NCE OF THE WORK FOR WHICH THiS PERMIT IS ISSUED,I MECHANICAL __ SHALL NOT EMPLOY ANY PERSON:N ANV MANM1ER 50 A5 TO BECAME SU9JECT TO'HE � WORNERS'OJMPENSATIONLAWSOFCALIFORNIq,ANOAGREETHATIFISHOULOBECOME INSPECTIONFEE Sll&1EC770 7HE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 0F THE LABOR � = CODE,t SHALL FORTHWITVI COI�PLY YNITN THOS'e PROVISIONS. ISSUANCE ___ � �j p DATE: APPLICANT: '__ SMIP _ "�'� ` m �V � ENERGY P/C 8�`�E —� WARNINGFAIWHETOS'cCUREWORKERS'CCMPENSATIONCAVERAGEISUkIA�VFUL,ANOSHNLLBE — y� �+ J SU&IECTANEMPLOYERTOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNDREDTHOUSAND 7� LL OOIURS(StDU.0o0).�NAO�ITIONTOTHECOSTOFCOMPENSATION,DAAAAGESASPROV!DEDFORIN ENERGYPERMIT '@,,,I����P�J�� I�����57. t� � SECTION 3TOB Of 7HE LABOR CODE,INTEREST,AND ATTORNE�"S FEES. RETENTION FEE: }���TT���.T�T�_�N rC+T 1 T W CONSTRl1CTiON LENDING AGENCY PRE-ALT FEE: a � IHEREBYAFFIflMUNDERPENALTYOFPERJU�YTHATTHEfiEISACOYSTRUCTIONL'cNDINGAGENCY __ _ FOR TME PERFORMPNCE OFTHE WORK FOR WHICH THIS PEFMIT IS ISSUED(SEC.3097,CIV.C.�. Z W � LENDER'S NAME 1_-- LENUER'SADDRESS //��1 W IAGHEETOCAMPIVWTHALLCIiYANDCOONTYOFDTNANCESMASTATELAY�/SREUTINGTOBUILDINO TOTAL FEES �� `/+ � CONSTRUCTION,ANDHEREBYAUhIOflIZEREPRESENTATNE50FTHISCOUNTYTOFMERUPON7HE z ABOVE-MENTIONEDPHOPERNfORINSPECTIONPURPOSES. COMMENTS � ���� r _ i��. _ m � : q PERMITTEE NAME�PRINT� �� N � � � SIGNATURE�F PERMITTEE DA7E v`�,��� , � = RECPT.NO. _PAID BY VALIDATION ~ WH —Depatimen�Copy,YELLO'N—Finance Copy,PINK—Assessor Copy,GOLDENR06-File Copy,GREEN—ApplicanYs Copy . . . ._ u.. " .. . � .�v_.i�: � ... .. _ ...�, . �...... .... . 1 _ . . ... . :y.... � �. ... ..� ; ,...:... . -. .. . ........:. ��,: y:. ..�� $-;• °.;h P . „:`�'' u. .„ .�.� >. . .., °""i�' , .. :1A":'a:. "'':.'`c� , . . :�V,*�4_ .� ...,. .,; ,. ��Ft�''"'��.:.�..<....b.: Y...� °%' :"k..�. .",`gY.,^ �yp' ' '�f;.;+-}4 4� r ,�? .ycx t '� � �4t 9r '€i t s� c''�S � � � � ' ���, � 'Ai. �, .. s, ... .. ,u �£ ......,., .v�• .t�� H,E �d .. , � x . .f Yi Y.�. �' 4 * - ' , x� .k( " ' - , . . _. _. .. �� .. .. .4. . .. e .. . '- �. ' ' . . . ._._.. . _ .. ' _.._.._..... ....................__.._.. . ......."_.... _.. . __ . ....... .. ......"""_'....... _.__. . ""�,... .. ... .. _ . _ '"'_.. .. ..._."__ ..... __... . .. ,., .... �.. . �. . .,.;..`,� . . ' : ' ' ""....._._.-I ._. . . � ' . . . � . •� . �5,� �) . .."_..'i .__.,...... .__"... .... ........._ .._.. ...._. ..._...__..... ._._..........�,..__ . ..... ._ .. _ _ ...._. '_'. ._..__.. .. ._...�.._. .. ..,ia�n. ..' .. '.. .. � _ .;.,_ .... '. ' .... ... ... .. ......"... . ..... . . < � - • .� '....'. , � ....W d��. > � . . . .. � `__"..... .......... . ..... ___. ......,.,......_... .. _ ... ._ ... ...._"'_ . ........ .......__.. .. . ... . .... � "�', . ; i� ! ,, � � � . E�-. . . � . ' •".I.;'�,�.:� ��' i:'� : '. '.,:_;.: . , . ............."'"' ,.... ' . . ..., a, . _.._........._'. .....,_..' "'......._.....__'... ... ...._. . �. �-.�...�.,. . ,.. . . . , ,__....._. .... _.. .... . ... . .._... . ,.,.. .._...... _...... ...._..__..,_...._._... ...,.,_...... ....._...... -- �- - ---. .. ._. -- - _....._......_._._ ...-""'-_...""'. .....--- �� � ;,r e,..,i,� , ,., ,...,�� _ .i _ - . �.r�, -,�: 1.. . . . . , � • - t ..., :.. : . , : �•.. ........ ... - ----. .__ ............. , ......---.._ ...,..-----•---...._....__...,.. . -- ----.... ...__ _..- ---.. ...._ . ... .... ._.. . .. __.....------...._--._ - .. . .. --.. � ' " , , -- -w,.. _ .. ........_...._.............__.._. ..__ .. _............,....__ ..._.....__,.....----...... ....._._..�.... _..._..._....... ..--....._...------.........._....,.._._.........----. ...._...------ -... ; ,,, ..,.,.... ..,..._ _ . _.---..........._--• .,.,., .. , , <. ,.... . . . . . . . .. . . .... ..... i - __. .. .... _..-- - .. .. _ _........... ..-- -_. ......__..__._...---._...---...... ---------....._. .----.........----.... .._ .. ., ,.,, .. -•,:;�.,R.,._ .__ ... -. , � '. __....... ..... .. ....._.,.....__..__.._...._.... .....__.__.. ...`Y _ Y _'' _.._...�.. _.�...._...... . . ---.. ..._.__...... .......__... ....... . - ...... - ° , ,-,: ,._.... ,. , _ -- ----..... _- -_- . .. --_----..._..._,...... ....- - -....._._......�.._.. ......_. .—�: . . ..:, ; ,. .., ,. .. ..., :���i,, �U 3'�` . Fs- - _. _ :.... r ., . . ,.. _ �.�J `.._ .. .. . . .......=--. ... .,-<-- --...... - _ .... .......__. .... -. ----.. ._.. . ...._..._�..... .. ......... ..._.... ---_---- ,. . .. ��,. ,,, _ .• ,.� -., ,. , . __..... ....._... - - , .. . .. , • -,, __ . . - �,., - �;r:: ,k, , + ._... N ,....---.... ._ .. ..... . ........._.. ..... ....... ...__.......___._........_..............<... _ _ , ......._..,........,._.._.. ..-----'......_._..._._......_. .. --- . ... _ ..._ . .. ...."----'....... � ,. , ,_, . ,..;. , , _ , _� � � a � � S .. .....,. , .... . _�...e} _ _. _ _ ."' ,. -... . ."'"" ,.. ... _ .__.i.""_""" s ...-,. F � ,i �Zr(i`�,L-- - ...__.—���.. .. - ..�3�' _ . _ . . _ .. .. ..---- -----.-� '-- ---- ' - -. . _.. � '.i ; " - - , I: � =-•- � _ ,<c _...:,... . .._.. .___..... ....__ . . ...... _...__....._...r._._......._. ............-..._ ---......_.�...,_ _.. . . ._..,......---._.._._. .-----...._..__... .,........ _ . . .......... .- -- --.. .-., • .... ,. _... .. ,;,._.,,.._ � ..... : ----..................._ .. ._ .,.. � -.... ,,. _ -. , r �. ,. . . , , . . . ,.,: . , `.. .... .. . .... . ...... ..,_.... ._....c. ..._--- ...............--, . - „ , _ �>.,� � , ;....r:. .....� �.... _. .. .-_ , ..: . . . ..... . . ----.-.- �_ � ---..___._ .,...----...__. ._......._'_----. . ...,.. . ._._...,............__...._.._............ : .. � .. . - , . , ,. . _. _ .-:_...,. . _.._.......' — ._.._._.. _ --.... _. ..._- - -- - �-------- '-,..---.' _ ..... "......-�--- ..........._ ... ...._ . .__..... .---....... � • . .< � _' � ;^. a_., i. .,,...,r� LC�L�i"'d� .--. - .i-, �:.,�,,:,r, _ � -- ...__. .... .. � -!.. .. .... � `��E , : . ,,.... ..' ',' . .. ' , i.__ ..... ...._. ,...... �� _ ... . . . ' .. . ...__..... ,. _........... ._.. .._ ... ."'... .._ . . " ' ....._._.. ,........." _' "' ""'.._.... _ � .�.... . .� ... . x �:e,.,.8 _ .. .. __.. ...____._.___.._.....__... .._..___.......... � .. .i ..: _ i � .... . . ., . _. � ._........._.._.____ _ .........__. ..........___...'... _ ._. ...... ___' ............... __ ......_.... .... . '. _.. . ,_._ ._ ... ...��, i _ n . .. . .. ..... .... ._.._...._ .._ . . i � _� . � '.... :. . . . _", „ � a. �.. ._..... . .. ............... ...... ......._ .._..._... . _..__. .__ . _... ..__ .......__...........__.,.........'_.., ........._., . . . .....�, i.� �O , ZuC7�6W[� / . �7` _� ,. .. ,.; ._.. : , - _ ... .. ..._,_........ ..._.............. . .. . :. + ; . =:.: . ; __ _..._-- __ __ __. ..,- - --.�.. .......-- . ...__._.._........---- -. ... - - --...._ � ....,........ ;. .<. -- - .. ...--- .__.__. .. ---..�.. .. . .... ......_._.._.....---� .. . , ' x.. . .._. _'' _ .. � .... _�----....,.._....------: ----.,.....__.._.!_�.,.........-------..._....-----------i._...:..... -- --- -- ------ --... -- ----._..--.._..__.__.... ... _.__._.. ... ;.. . .. _ . . � , , _. , .._ ..............-. . .. ...---- •--.....--- --,.............._ ------._......------- -_ _.,......._--- ___....._._._....,...._..... _ , . .-i-- ->..�.. . . . ..'.. --- -......... ....__._..........._.._ . .. - -....... . .: .. _. , . , , ..... ......__.. ... ... _._._........ _ ..- -----._.,.... _ .. ---....,.._....---- -- ... ...... ..,,.... . _.... .... . - . , -,- •„ - . .... .. .. . ....._.. . .. .....__. _ .;. '. ,.. . ; , . Q ______�— , . .. . , , .. , � . • .. -- _ _ - - 2.04..0(�--- - -----.._..----... ._.... _ _ ............. . . .----..... .. _.. . _ . , . ___ . :` j . ..._-'.;. ,., , .. , '� . � . , .. .._. ...,. _. .._. ...._ _._. - - - -......---- --- _. -__..._._..�...�_ - ---- .�. ...; _.. . . . . :.. ,_ _-.- �,p , -� _ � V"'S � � �'" . .. ... ��1 .':.:'..- �„��- . _ . ...._' -. .. ....,... _.....,. ,. . ,. ...-� _ . ....< . � � ........ ...... .,._ ... ..... .T .. . _. ... — "` .._....--.. . ....... .. . .. . ._. ._... . .__ ... ._.._ ..__.... ......., . -�---. ... . .. ...._... _ . ,., � � , , ' { . , . .._ ..... ....._. ....""......... ""......... . ...�-.._.._....,. ._....... . ..."'_......�. ........ .._... ....'"' ""'""'. ._ .. .. .... . ._.� . . �.. ' " '__ . ._....,. . __'_'___ ;.....__ " ' .�.. . _ __'__' . . . , _ ._ '. '___. . ."" '. ; ... .,. - . . .. _ ...... . .. . .. .. ��, ... . .._. . � =� :, t': :,�., ..< . _" ' ' . ,. .... . :.. : :` ?...-�'-�rc-'. .....c-t'�'� �' ...----. .__,..._._....... . ..... .. ....... ..........----- _ . _,_.... ......_.__..._...---..__...............-•--- ..., � ,_ _ _.. - - _..- -. _ __..- - - - --- .. ............... . ....... ._.. ..---..._. ..... _ ... - --. ._---......._... ._ ....... . ...... : ; . '«;;, , .. . . :---.....--- .. ......._. ... _. . . - - -... ...... ...... ..........- -- --._.. ......---.. .._........._... ....----. ---..... ....... .. .._. ............_ . � ... ._,_. .. . . . , . .._:�.::� . . . , .. . . � . ... � . - „- �` . _ - �.._. , . ... . .. . , .._ , ..:,.., . , .. . ..w._._.... 3 . ,•'.'.+.;. : .. �.'.t:: . . . ,. ... r ; -..s�.�.. ..,.,. .•.� . .., i... .,,�,�...�. _ � .„� • . ...:,. . � ":� . ' �� .i..R.' t�,�.f "__. ...._'....._' ." ._'. ........... ..."...,. .. .._.. . ......_._._... . ..__ r .. x . ._ . ...................__. ........ .....__._.... ._....,... . ...._,. . . . . .j:S' . . ...�...�. ' . + :::�'i�i.'; �: x'�'� . . ... •S �i.,. . •'n , +. �:. ��c i �� v�; �., �. .x�.,y�:Y. .. ..__'....... .......... _.. . ...'.___. .,.... ....._. ....._. ,.,......._.__.. „_...... . .. ..__.... . ..._ .. . . .'.' . .. ,.. , .'.___'.........,.___....,. � 5'1' ' i�;- � � . . ..' ..,.. . ..:..,p,.'.., -. , �.,�: - ' .., •.c; '. . . .�.'.,ry ..� ' ...... .... ..... ....'"_"_._._ ..._' __ ' __.. ... . _. __' ' _ __"' " _.. . + ".. a 'u� : ...._.... __..... ... . ........ . ................... � r 5'. � � . ...s:.�.t'�� : ` . c� ' ..xii>v..., . .:r.. �.. :': '. ' '�...,'���.�.' .�Y.'t 1 i. . i :.. � •• ...�' .' ... . . '.... .. � .. , . ......"._._'.... .. ._. ......... ... . ...... ..: : '