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HomeMy WebLinkAbout13077 'ti, �� CITY OF DIAMOND BAR - ! DEPARTMENT OF COMMUNITY&DEVELOPMENf SERVICES � 21660 E_Copley Drive 5uite 190 (909)860-3195]Fax(909)861-3117 PRESS ��M�'� � BUILDING PERMTI'APPLICATION FIRMLY o JOBSITE ��^��7�` C,Q��G �.,���� DATE ���� I '!_NUMBER ! �� ! `� # - !"1��:�,3.�� APPLICATIO _CY' PERMIT P!C Q ADDRESS 7 /Cat�J�._� � � APN LOT TRACT DATE � ���T-1 CONST. GROUP °C OWNER / ^� � O ' C ZONING SETBACKS o ADDRE�Sq.— //��`O �/ •r,�C''��1, w C�.�.Y . Z�P ,-�i FRONT RW � � APPLICAN � T�y�u�� REAR � � — SIDE/SICE STREEf RW =7 CONTRACTO � •^ : ',i' SIOE ❑ p� ADDRES � ""�� ��_ � CITY r 1�'� ZIP�,7� T _ S/� PROPOSED USE 2fC� � ARCH/ENG/ /,}� d �,� �. __�'�7c'_/�y. ��- � � �° ' G DESIGNER l.�..� .f '�--� � �, - � ADDRESS �S �2�E C�P NO.DWEL. VQ. � NO. � CITY � ZIP T '. .� 7' - UNITS 3TORIE`S"— BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUILDER DECLARATION SFR/ADD/flEM O p I HEAEBY AFFIRAt UN�ER PENALN OF PERIURY?HAT I AM EXEMPT FRCM THE CONTRACTORS LI- G8f8gE/Ca�port W CENSELAWFORTHEFOILOWINGREASON(SEC.7037.58USINESSANDPROFESSIONSCOUE:ANYCITYOR (n C9 COUNTVWHICFIREWIRESAVERMITTOCONSTRUCT,ALTER,IMPROYEOEMOLISH,ORREPAIRANVSTRUC- W PH�1O1D9Ck W TURE,PRIOR TO RS ISSUANCE.ALSO RE�UIRES THE AAPLICAN7 FOR SUCH PERMIT TO FILE A SIGNEO W STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAiTEfl B(COMMENCINO YATH SECTION�OOD)OF DIVISION 3 OF THE BUSINESS A4�PRO- � Pool/Spa FESSIONSCADE)OflTi1ATHEORSHEiSEXEMPTTNEREFROMANDTHEBA515FORTY.EALLEGEDEXEMP• � r TION.ANYVIOLATIONOFSECTION7031.5BVANYAPPLICAMFORRPEflMITSUBJECTSTHEAPPUCANTTO Z Re-Roof '�' � ACML PENALTY OF NOT MORE THAN FNE HUNDREU DOLLARS(5500).): � ❑I,ASOWNEROFTHEPROGERTV,00.MVEMPLOYEESWITHWAGESASTHEIfiSOLECOMPENSATION, ❑ Cofi�tOfCia1 � VYILL DO THE WORY(,AND THE STi3UCTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEG 7040.BUSI- J � NESSAN�PflOFESSIONS CO�E:THE CONTRACTOAS LICENSE UW OOES NOTAPPIV TO AN OWNER OF ? PROPERTY WFiO BUILDS OR IMPROVES THEREON,AND MMO DOES SUCH WORK H!MSELF OR HERSELF Op � 7TIROUGH HIS OR HER OVM EMPLOYEES,PROVI�ED THAT SUp1 IMPROVEMENTSARE NOT INTENDED OR m QOFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMEN71SSOtDWITHINONEYEAHOFCAMPLE• Z TION.THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE 010 NOT BUILD OR � IMP�VEFORTHEPURPOSEOFSALE). W ❑I.ASOWNEROFTHEPROPERTY,AMEXCWSIVELVCONTRACTIMGWITHLICENSEOCANTRACTORS p � TO CONSTRUCT THE PRPJECT(SEC.70M,BUSINESS AND PROFESSIONS CODE:THE COMR4CTOR5 LI- V�IU821 4 mm� ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPEfYiYWN�BUILD50RIMPFOVESTHERE04,AND � WFiOCONTRACT3FORSUCHPRQIECiSWITiACOhTRACTOR(5)LICENSEDAUP.SUMffTOTHECONTMC- QUANTITY DESCRIPTICN FEE � TORSUCEkSELAW.). ___ 0 ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON � _ 3 — � LL DATE OWNER _ � Z � O LICENSED CONTRACTORS DECLARATION W � I HEREBYAFFlFM UNDER PENJLLN OF PEiUURY THRT IAM LICENSED UNDEA PROVISIONS OF CHAPTER � d Y�COMMENCWOWITHSECT1ON7ooD)OFDIVISbN30F?HEBIJSMESSAN�PROFESSIONSCODE,AND Z _ X W UCENSE IS IN FULL FORCE AND EFFECL m IJJ ��}j� � LICENSE LASS LIC.NO.___JS�' �� . � ~ ?.c' V DATE '� � � COPITRACTOR�q��. d W � WORKERS'COMPENSATION DECLARATION a "' � ,9 U � 1 HE IRM UNDER PENALN OF PERJURV ONE OF THE FOLLOWING DECLARATIONS Z � ✓IHRVEAND MAINTAINACERTtFICATECFCONSENTTOSELF�lY5l1REFORWORKERS' = 9 s �np �€w,3t.� � COMP TION,AS PROVIDED BV SECTIDN a7000F THE L480R COOE,FOF THE PEflFORMANCE �U � i�� `�� � i fj°��'� OF E WORK FOfl WHICH TMIS PERMIT IS ISSUED. � � "-���'"�+ -. W I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURAhCE.AS REQUIRED BY SECTION �- a'!v: . � ,r� Q 37000F THE IABOR CODE.FOp THE PERFORR9ANCE OF THE WOR%FOR WH'CH THIS PERMIT IS T�d �' 4 j��° �'� -/� ��� �YJL_��t�;:.�:���::. !`z�_ `E ;. 155UED.MYWOR�EflS'CO E�SATIONI.NSyURAN�CECAflRIE�ANDPOLICYNl1MBERARE'. CONSTRUCTION � t_>. S j CARRIER� ;.+��^�' I PLAN REVIEW _ ��a�. �'. � POLICV NUMBER�� �='� _..— ` ELECTRIC _ Q � (hiSSEC170NI�E�NDTBE00A�LEfIDOFhIEPERNJf�SFOR�NEHUnDREDWILPfi5�E7oo1�RLESS} PLUMBING Z I CERTIFY THAT IN THE PE5FORMANCE OF TME WORK FOR WHICM THIS PERMIT IS ISSUE�,1 MECHANICAL _ C7 SHAIL NOT EMPLOY ANY PEfl50N IN RNY MPNNER SO AS TO BECOME SUBJECT 707NE � WOPo(ERS'COZAPENSATIO4LAWSOFCALIFORNIA.AN EETHATIFISHOULOBECOME I�CTIONFEE ____ F SU&IECTTOTHEWORKEFlS'COMPENSATEONPFOVI NS TION37ooOFTHElA90R � �i CADE,I51-ULLFORTHx/ITHCOMPLYWITHT EP VI ws. SSUANCEy _ __._ L��,�Ji J O ��s��` - ��� , t�'L(�`L— `p CA�C'��(�� �!./ APPLICANT. � J ENEAG`!P/C _. _ J WAFNING:FAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFl1L,ANDSHALLBE � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUWREDTHOUSAND ENERGYPERMIT DOLLARS(i100,000),INADDITIONTOTHECOSTOFCOMPEYSATION,DAM�IGESASPROVIDE�FOFIN - - - � SECT10N37000F1HEL0.BORCODE,INTEREST.ANDATTORNEY5FEE5. 1 RETEM'IONFEE: ____ `�- C�L.� 3 a CONSTRUCTION LENCING AGENCY PRE-ALT EEE: O �e+ � �-._..,� � I HEREBV AFFIflM UNDER PENALTY OF PERJURV THATTHERE IS A CONSTRUCTION LENDING AOENCV � /��. l-! f J"� � FOR THE PERWRMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUED(SEG.3ae7,CIY.C.). � �� z =,!•:a'� ;,__� w /� � LENDER'S NAME_ •p � q { _y'--b`-1—T-.J_.�- F— LENDER'SAODRESS _ —._—_ W ICEHTIFYTHATIHAVEREADTHISAPPLICATqNANDSTATE7NPTlHEABOVEINFORMATIONISCORRECi. TOTAL FEES � �� � �� � I AGREE TO CAMPLY WITH ALLCYTY AND COUN7Y ORDINANCESAND STATE LAWS RELATING TO BUILDING � CONSTRl1CTION,ANDHEREBYAUTHORIZEREPRESENTATIVESOFTHISCOUN'VTOENTERUPONTHE z ABOVE�MENiIONED PROPERTY FORINSPECTION PURPOSES. COMMENTS J� � / � ¢. P MITfE AME(PRIM) � � ,-,.�� � � E DF PERAlITTEE U/ITE — RECPT.NO. PAID BY � VALIDATION ~ WHITE—Oepartment Copy.YELLOSA!—Finance Copy.PINK—Assessor Copy.GOLDENROD--File Copy,GREEN—Applicant's Copy ,.. ..,. . �..,.,.:: . ; r., .. .., .. . . ., .,... .... .. ............ ..,.......,_ . ., ...,., .,... . . . . �. . . � ,. . .. . , �r . . . . .. • _,'; - ... . . ,. . .. ... . ..i • . . . . .. ..... , .... ' . 'x ' y�, x �.. . ,h y� Y ! .'#W` h f 1 .,.� . , � �. , . � .:T" � , .�,.. : ,. } . . � . . , t". r>� , .. . . ., ,.�< .,,.. .. . F. . ,. . � . . . .. . .. . . ,. . , ' "' ' . .__... . __'.._ _ . . _. . . ' _ "_"' . . .._'_ " '_" .' _.__ " ' ' ' __ ' ' "' .--.. .. __.._ ._ ,_.........._. .._,_.. . .. .. .. . 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