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HomeMy WebLinkAbout11119 _�_�._.�,...-.�.__..-_.._,._...-.---,.._-- - .._.__ „ _ __...._ __-----— -- -� -----__........,- - __.... . __._..�.�.._- ��`�::.�"", .. - � ����'-`r-- CITY OF DIAMOND BAR � � COMMUNITY DEVELOPMENT DEPARTMENT .'�,w 21660E.Copley�ril�eSuite190 �RE�JS (909)860-319�Fax(909)S6]-3117 ���'' BUILDINGPERh4ITAPPLICATTON FIRMLY � JOBSITE /� APPLICATION f // PERMIT P!C Q ADDRESS��� ���� C��'I �- DATE____��I��_ NUMBER I�_ # � ISSUE e TyPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER ��I�� �a �f i��'7"" � p ADDRESS /` /� .,� 1��6i,ST c- ZONING SETBACKS w j C• ���, ��7�� `-!I FRONT RW �i o CITY � ZIP�/7��, TELf'���F- � APPLICANT TEL. REP'R L-- � � I SIDE/SIDE STREET RW L ¢ CON7RACT G �� J SIDE �_ � ADDRESS ' Q ^ _ PROPOSED USE_ CITY hc � t� ZIP 7/�Bi`TEL E� �w ARCH/ENG/ — � DESIGNER NO.DWEL. � NO. NO. 0. ADDRESS UNITS_ STORIES _ BEDROOMS = CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BI;ILDER DECLARA710N SFR!ADDlREM C p I H'e9EBY AFFIR�d UNDER?E\qLTY OF PcR.URY THA'I AM EX[MPT FROM'HE CONTRAC'ORS LS G8�e98/C3�(JOf[ W CE�SELA'.NFCRTHEFO�LOWItiGREASO'J(SEC.'03!.58USIVESSANDPROFESSIONSCO�E:ANYC�TYOR (,/) U COUNNYJHICHR'cQi:19ESAPER.MITTOCONS'FUC'ALT'cR,RAPP.OVE,DE670LISH.ORREPAIRANYS'RUC� W P8ti0/DBCk ` Z T�RE,?RIOR TO ITE ISSI:ANCE,ALSO REQUIRES TH=AP?LICAtiT FOR SUCH PcRMIT TO FILE A SIGNE'J W W STA?EA:eNT THA'Hc OP.S4E IS LIC[NS'c�PUFSUANT TO THE PROVIS�OtiS GF TuE CONTRACTORS LI� — � CENSE L4W(CHAPTEF 9(COMMENC:NG W�TH SECTIOY]CJD)OF DIVISIOY 3 OF TNE BVSMESS AN�PRO� � PoollSpa FE55':ONSCOJE)OflTHATH�ORSY.EISE%ER"PT7HEREFRO\1AND�tiEBASISFORTHEA!LEGEDEXEMP� (� Q �ION.ANVVIOLATIONO%SECTION703�.55VANVAPPLICA�\TFOaAPcRMIi£U8.'ECTSTHEAPPLICAN?TO �. Re-Roof � ACIVILPENALiYOFNOTN.ORETNANiIVErUNDREO'JOLLA�S�SSCO),I' Q Q LI.ASO'NNEROFTHEPROPERTY.OR`AYENPLOVEESWITHIYAGESASTHEifl50LECOMPENSA"ION, COmfTIB�CIdI � WILL DO THc VlORK,AND TH'c STFUCTURE IS NOT INTENDED 09 OFFER'cJ FOR SALE lSEC.�G<4,BUSI- J NESS AND PROFESSIONS CODE:THc CONTflACTORS LCENSE UV!DOES\07 APP.Y TO AN OWNER�OF � PaOPERTYWHOBUIL�50RiUPROVES'HEREON,AN�WHOOOESSUCHWOf1KHIMS'ciFORHERSELFCR � � THROUGHHISORHEROWNEN.PLOYEES,PROVIDEDTHA'SUCH'�.MPROVEMENiSARENOTINTEtiDEDOR m W GFFcR=JFORSALE.IF,HOWEVER,THEBUIL7;NGORIM•�ROVEME\TISSOLDW!THINOYEYEAROFCOIAPL.� 0 TION.?HE ON'NER-6UILDER WIL'_HAV'c THE BUR�EN OF PROVING THAT HE OR SNE DID NOT BUILD OF Z IMPROVE FOR Ti:E PURPOSE OF SA_E;. � ❑I,ASOWNEROFTHEPROPERTV,AME%p.USIVELYCON-RACTINGW'�THLIGEtiSEDCONTRACiORS :.IJ � TO CONSTRUCT'HE PFOJECT(SEC.7o4d,BUSINe55 AND PROFES�IONS CO�E�.TNE CONiRACTORS U� VeIU8U0f1 _ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOYMEqO=APROPERTVWHOBU:LD50RIM?ROVESrHEREON,AV� - � WHOCON?RACTSFO�uUCHPROJECTSWITHAfANTRnCTORi51LICENSEDP:;RSUANTTO7H'cCOVTflAG QUANTITV DESCRIPTIOV FEE � TORS L'CENSE LAW). � J I AAA EXEMPT UN7ER SEC.__.__,.__ _0 S o.0 FOR 7HI5 qEA504 Q � —. U 2 LL DAiE OWN[R � Z U W � LICENSED CONTRACTORS DECLARATION W Q � I HEREBV A�FIR.'.1 U\D=r7 PENALTY OF PERJURY`H�T I APA L'C'cNSED UN�ER PROVISIONS OF CHAPTER jJ p d 9(COMME�CINGWITHScCT!ON7CCD)OFDIVIS:0�30FTHE9U51'JESSAN7�90FESSIONSCODE.AND � �f / • C.- `X .NY UCEf45E IS IN FULL=ORCc AND'cFFECT. m � LICENSE CLASS �'-�� LIC NO. J �� � � ` /� � U DATE�=�sT CONTPACTOR L'� �CdC1i�X'L` o- w � WORKEFS'COMPENSATION�ECLARATION Q � U � I HEREBV AFFIRM UN�ER PE4A�TY OF PER.I:RY ON'e OF TNE FOLLOWNG�JECLARA710N5: (fJ Q L] I HAVE AN�W!LL MAINTAIN A CERT'F:CA'E OF CONS'ctiT TO SELFdNSURE FOR WOFKERS' T COM�ENSA�IOti,ASPROVIDEDBYSECilOti37ocOFTHE�ABORGO�E,FORTHEPERFORMANCE U Q OF THE VlO�K:OR WH CH THiS PERMIT IS ISS'JED- � � y� w �[,_I FAVE ANO WiLI MA!NTAIN WOR�(ERS'COA!PENSATIOh INSURAtiCE AS AE-0UIRED B�SECTION '`a ✓e 3]0o OF THE LA30a CODE,FOR THE PEFFORh1ANLE OF THE W09K FOR R'riICH THiS PERMIT IS � ISSUED.A1V WORKERS'COA�Pc�SA:ION iNS:JRANCE CAR91'cFAVD POLICY Nl1M9ERARE� CONSTFUCTION __ �J � � ./i� PLAN REVIEW CAaRIER��,�:_ � Z aoucr Nu�as=_a--1—��}--Z�'��--7�� -�� ELECTRIC _ ' �� ° � � ¢ . � (f-IISSECTKKJNEmNOTBEOJ!.A�LE'E�C:THEPER�AT:SARONEHU�VD�ED00.LARSIS'COjOR.ESS�. PLUMBING .I S w MECHANICAL Z �C'cFTI=YTHATINTHEPERFOFAIANCFO=T=EWORKFORWHICHTHISPERMITISISSUED.I ___ �' SY.ALLtiO?EM.PLOYAA'YPERSONINAYYIAANNERSOA5T08ECOMESU6JECTTOTH� y ��q � � V:ORKERS'COMPENSATIONLAWSOFCALIFORNIA.AN�AGREETHATIFISY.D'J!DBECOME INSPECTIONFEE ___ilLaR • SU6deCT.TOTHEWORK'cP,S'CAMPENSATIONPROVISIONSOFSECiIOYs�OcO.'THELABOR ISSUANCE ��Jr��� f(�' u� = CO�JE.I SHALL FORTHYlIiH COF'PLY WITH TF+OSE oVi51oNS. —_� ,(_J' .— � y �+' -����__ SMIP p DATE: / _G% � f�APPLIGANT. ------ � ENERGY PJC _ _ J WARNING F/4ILURE TO SECURE WORKERS'GOM1"PENSATION COVcRAGE IS UNLAWFUL,AN'J S:�iALL BE � SU9JECTANEM?!OY_RTOCR:N.INAL?ENALT:ESANDCIVILRN�5l1PTOONEHUNOREDTHOLISAND ENEFGYPERMIT DOLLARS(E100.OM1,I.Y A�7ITION TO THE COST OF COMPENSATION.DMIAGES AS PROVI'JED FOR IN -- - J SEC'ION37080FTMELABORCO�'c.IN7EREST,AN�ATTORYEY'SFEES. RETENTIONFEE: � -- � CONSTRUCTION LEN�ING AGENCY PRE-ALT FEE: � --'-- � I HEREBYAFFlFN UNOEfl PENALTV OF PERJURV TF'.AT THERE IS ACONSTRUCTIOY LE�DING AGC:NCY a- FOR iHE PERFORh+.ANCE OF TNE V.'ORN:OR VJFICH TF:IS 7ERMIT IS ISSJED(SEC.309].CIV.C). ----� Z W � - � LE��ER'S NA41E____ ____- _ _ ___ F- LEN�ER'SADDFE55___ _�___ _ _ W� TOTAL FEES � • 1S� ICERT�FY'HATIHAVEREADTHISAPPLICATIONANDS7A'eT4AT.THEABOVEINFORMATION15CORF_C7. � I AGREE ro CONPLV N7'ri AL�CITY AND COUM1'T'/ORDIYAKC'e5 AND STATE LA'l.'S RELATMG TO 6UI�D'NG � C�NSTRUCTION.ANDY.caE5YAUTHORIZERE?RESEN�AT',VESOFTHISCOUNTV'OENTERU>ONTHE ABOVE-MENTICNED PFOPca7Y FOR IIdSPECTiON PUROOSES. z � connnn�n;rs___ —_ _ o ' ,�. � �_�✓ ����� - m PERMITT tE(PR:NY) � • c^.r':� -- __�� �"%".� —� — --�--- � S. 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