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HomeMy WebLinkAbout10538 .,,,�''��� � — C1TY OF DIAMOND BAR �,s��'�'" COMMUNITY DEVEL�PMENT DEPARTMENT 6 ... 21660 E.Copley Drive Suite 190 j � '�4 � PRESS � (909)860-3195 Fax(909)861-3117 '""'�W BUILDINGPERMITAPPLI ATION � � FIRMLY � JOBSITE APPLICATION PERMIT P/C o ADDRESS r � DATE NUMBER D � # �� � ISSUE s�TYPE OCC APN T TRAC DATE _ CONST. GROUP o OWNER � ADDp-��`SS d ZONING SETBACKS z CITY f�J ZIP TEL. �JJO'I_�8d`L FRONT RW ❑ g APPLICANT TEL. REAR ❑ Z SIDFJSIDE STREET RW ❑ Q CONTRACTOR SIDE ❑ o CITI' EL/I-��_ �P�1�� � S" PROPOSE�USE I� L �N-f S �.l Sa � �-' o ARCH/ENG! z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CI7Y ZIP TEL. UNITS STORIES �_BEDROOMS � �n DESCRIPTION SQ.FT, FACTOR PSF ADJ.AREANALUATION � OWNER-BI:ILDER DECLARATION SFR/ADD/REM O 1 HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT I AlA E%EMPT FROM THE CANTRACTORS LI� G8l8(�B/C81POR W CENSEUWFORTHEFOLLOWINGREASON(SEC.7o31.58USWESSANDPROFES5iONSCODE:ANYCiTVOR (n U COUNTYWHICHREQUIRESAPERMITTOCONSTqUCT,1ILTEH,IMPROVE,DEMOLI9H.ORREPAIRANYSTRUC- W patiolOack NRE.PRIOR TO ITS ISSUMICE A1S0 HEOUIRES THE APPLICMIT FOR SUCH PERMIT TO FILE A SIGNED w STATEMENT THAT HE OR SHE IS LICENSED PIJRSUANT TO THE PROVISIONS OF THE CONTRACTOf1S L6 � � GENSE LAW(CMAPTER e(CAMIA�NCIIiC.WI7M SECTIbN-7tiDOj'OFDNISION 3-OF THE�USTNESS RND�PRO- LL' Pool/Spa FESSIONSCOOE�ORTHA7HEOHSHEISEXEMPTTHEREFROMAND7HEBASiSFORTHEALLEGEpEXEMP- (� V TION.ANYVIOLqT10NOF5EGTON7031.5BYqNYAPPUCANTFORAPERMITSUBJECiSTHEAPPLICANTTO Z Re•Root ( � ACNIL PENALiV OF NOT MORE THAN FIVE HUNDREU OOLlARS(5500)J: " ' '' " "' ' ' a r'•I,ASON7VER OF THE PqOPEHTV,OR MY EMPLOYEES WITH WAGES A$TH�Ifl SOLE COMPENSATION, Z 0 Commercial WILL�O THE WORK,AND TF�STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE ISEC.7044,BU51- J N NE55 ANO PROFESSIONS CODE:THE CONTFACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF � VROPERTV WHO BUdAS OR IM7ROVE5 THEREON,ANO NMOOOES SUCH WORK HIMSELF OF HERSELF OR � THROUGH HIS OR HER OWN EMPLOYEES,PPp�/IDED THATSUCH IMPROVEMENTS ARE NOT INTENDED OR m 0 OFFEREDFORSALE.ISHOWEVER,THEBUILAINGORIMPROVEAdENiISSOLOWITHINONEYEAROFCOlAPLE- Z TIqJ,THE OWNER-BUILDER WILL HAYE THE BURDEN OF PROVING TIi�T HE OR SHE DID NOT BUILD OR = IMPROVE FOR THE PURPOSF OF SALEJ. W ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS Q TO CONSTRUCT THE PflOJECT(SEC.7aa6,BUSINESS AND PROFESSIONS CODE:THE CONTFi4CTOR5 LI- V31U9I1011 ADJ.AREA W CENSEUIWOOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND = WHOCONTRACTSFORSUqiPROJECTSW�THACONTRACTOR(5)LICENSEDPURSUANTNTMECONTRAC- QUANTITY DESCFiIPTIC)N FEE TORS LICENSE LAWJ. � ❑I AM EXEAIP7 UNDER SEC. 9.8 P.C.FOR THIS qEASON Q ��� U .P � � a'� OATE OWNER U � Z W ¢ LICENSED CONTRACTORS DECLARATION W � 7� OC 1 HER�Y AFFIRM UNDER PENPLTY OF PERJURY THAT IAM LICENSED UNDEfl Pqpy�SIONSOF C p/AVTER / �� W9(COMMENCINGWIT CTION7 OFOIVISION30FTHEBUSI E ANDPRO��SCAqE,AND m ` ^� S -- X MY LICENSE IS IN F L F RC FELT. / r � � 0 LICENSE LIC.NO. � V OATE CONT CT OJ. W � WORKEFS'COMPENSATION DECLARATION ¢ � I HEREBv ACFIPM UNDER PENAI.TY OF PERJURV ONE OF7HE FOLLOWING DECIAqATIONS: * Z Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELFINSUqEFORWORKERS' a 2 ¢ COMPENSATION,AS PROVIOED BY SEC710N 37000FTHE LABOR COOE,FOR THE PERFORAAANCE U Q OF TME WORK FOR WHICH THIS PERMIT IS ISSUED. � W _I HAVE ANO WIL 1 AI WORKER'COMPENSATI IN RANCE,AS qEQU ED BV SEC710N Q 9700 OF THE LA R 'H PERFORMAN OF E WORK FOR H H THIS PERMIT IS �� � p°'� ISSUE�.MV WORN S NSURA I RA�6y0 . UMBERARE: CONSTRUCTION n[•�,� J �� �--- j CARRIER � L PLAN REVIEW Z POIICYNUMBER ELECTRIC Q � (iHSSECTpNNE�NOTBECOMPLEfEDOF1HEPERM1YTISiORONE D (E� ORL PLUMBING Z I CERTIFY THA7INTHE PERFORMANCE OF7HE WORK FOfl WHICH TXIS PERMIT IS ISSUED.I MECHANICAL C�S SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOqS TO BECOME SU&IECT TO THE (/j WORKERS'COMPENSATION LAWS OF CALIfORNIA,AND AGflEE TMAT IF I SHDUL�BEC041E INSPECTION FEE SU&IECT 70 7HE WORKERS'CAMPENSA7KKJ PROVISIONS OF SECTION 370o OF 7HE LABOR = COOE,1 SHALL FOflTNWITH COMPLY WITHTHOSE PRWISIONS. ISSUANCE _ -���p�55 � � yv ip DATE: APPLICANT: SMIP {P J WARNING:FAILURE TO SECURE WONKERS'COMPENSATION CpVERAGE IS UNLAWFUL,AND SHAL�9E ENEFiGY P/C LL SUBJECTAryEMPLOYERTOC INALPENALTIESANDGIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPEHMIT OOLUIRS�f100,000J,IN AO ION TO THE COSTOF COMPENSqTION,OAMA6ES AS PROVIDEO FOR IN ¢ SECfiON 3]OB OF THE R CODE,tNTEREST,AND A7TOfiNEY'S FEES. RETENTION FEE: OCONSTRUCTION LENOING AGENCY PRE-ALT FEE: _ � I HEPEBV AFF UN�E0.PENALTV OF PERIUqV THAT7HERE IS ACONSTRl1CTION LENOING AGENCY FORTHEP ORMANC OFTHEWORKFORWHICH.jHISPERMITI515511ED�SEC.3097,CIV.C.). Z w � LEN�E NAME f– LENOERS ¢ 1 EflTIFYiHATIH E ADTHISAPPLICAT NANDSTATETNA THEABOVEINFORMATIONISCORRECT. �OTAL FEES � 1 AGf7EE TO COMP iiA��CITY AN� NTV O INPNCES D STATE IAWS NELATING TO BUILDING a; CANSTRUCTI HEREBYAUTH F2 R ES NTRTIVES FTHISCIXI T.`l��NTERUPDNTHE ABOVE�M P R FOR S pNP POSES. ��J /� COMMENTS � /F Y m INT� � a ���p, � �— � � (/� 516NATUREOFPERMITTEE DPTE = RECPT.NO. _ FAID BV VALIDATION_ ~ WNITE—Depanment Copy,YELLOW—F'ance Copy.PINK—Assessor Copy,GOLDENROD--File Copy,GRE —Appil6anfs Copy J ;. ....,....,... .:..,..... . .. r., .... .... .:: . ., ,,;�,,�: .....s , . . . ....W.:;::,irA..^i �..;�,,:�}.,.kr. �ic: �.;.2,j�1.:r ,4'.:"Vs.. .2L.yc.a�- �s. q: << ,.� ..1,�., �;. .. ,.� ��..:�...:.w . . : -. „... .. �� ., . . .�.�: � ..,. �•..r"�. . �1.: ,•c�-.•:.• .�'• . .���.:.. ..... � . � . . .. � ., ., � r•0:: •- ... . .... ��. .. .�"e.....�FY'�.� . .t , . . . :T"� .�. ts��� ��.��������_�1�� __ .. . �,.::.., .__ ���L!'�W.r�N�F'� ��3:r4�1s""6� , ' . . . .. _ j • ,.. ., . .' ��•.$ i � � , ■ � B p ��` � , � 9 - n . . � . ..� �-�..,..«y�x . � . . �"�'�:�1..":e_'li_'+.�v. .. � . . . . . .. � ��,, . � .. . .. � . . �. _. . _ . .n .i �s JrT�3�lCbC - . _. . . ,,. . .` .. , � � �_��. .. , ... ,,,.; _ _,. . . . ;�.�..�,�... .,.... ------k--' Fi.00R '�' ---------------'�-{�- •�._... , :. 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