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HomeMy WebLinkAbout11280 ---�'-,'�"'t-----• CITY OF DIAMOND BAR � � � COMMUNITY DEVELOPAZENT DEPARTMENT �� �� �Ilf �'-.�:� 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Pax(909)861-3I17 � '„�' BUILDINGPERMITAPPLICATIO\ FIRMLY � JOBSITE . � �1 rt�-�` . ''� `::: '�� •`;; " '~, APPLICATION �� PERMIT % P!C o ADDRESS����V �-�+����''��'��"�"��� DATE � _�_��,NUMBER # o ISSUE TYPE OCC °r° APN LOT TRACT DATE _CONST. GROUP p OWNER �''Z-�y �� � " ADDRESS G � �•. C� <.'Iz,g� ZONING SETBACKS � FRONT RW �___ o CITY � - ZIP TEL. APPLICANT TEL. REAR � o SIDE/SIDE STREE'f RW �_ Q CONTRACT �'��' "= :.�X'��'r�u SIDE � ___ ADDRESS � CITY ��C, 21P � '� TEL.�"�'' � �"- PROPOSED USE �w ARCH/ENGI b zDESIGNER NO.DWEL. IJO. NO. a ADDRESS UNITS STORIES _ BEDROOMS � CITY ZIP TEL._ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION u� ' � OWNER-BI:ILDER DECLARATION SFR/ADDlFiEM O � I HERE6Y AF:IR!A L'NDER 7EUALTY OF PcR�URY THA:I AM EXEMPT FROM'Hc CONTRACTORS LI- Gafage/Ca�port W CENSEL0.WFCRTHEFOLLOWI�GREASON(SEC.�o31.58USL�ESSANDPROFE5510NSCCDE:ANVC'TVOR (f� U COUNTYWH:CHREQUI�iESAPEP.MITTOCONSTRJCT,ALTER,IM?ROVE,DEMOL!SH,ORREPA:RANVSIRUC- W Pd110/DBCk Z TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRE�'HE A�PLICA�T F09 SUCH?ERMIT TO GILE A SIGNE� W W STATEM[NT r�pr,r.�OR SHE:5:JC=NSE�?URSUAIT TO'Hr PROVIS�ONS OF TNE COti7FAGTnqS LI- . . . � CeNSE iAW�CHAPi ER 9�COMh!ENCIYG WIT.i SECTpN 7WC)'OF DIVISiO\3 0F TNE BUSIf<ESS AND PRO- �' Pool/Spa ' � ' ' � � FESSIOtiSCOOEIOPTHATHE095HEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEG2DEXEMP- (�j � 7ION.ANVVIO�A7lONOFSECTION7o315BYANVAPP_:CANTFORAPERMITSUBJECTSTHEAPPLICASTTO Z Re-Reof � A CIV::.PENALT'OF NOT MOFE THAN FIVE HUNDRED DOLIARS(ESDO)j. � ,71.ASOWNEROFhIEPFOPERTV,09MVEM70YEESWi HWAGESAST'�EIASO_ECO\1PENSAiION. � Commercial z WILL DO THE WORK,ANJ THE STRUCTURE IS NOT INTENDED OR OFFERED FOfl SALE(SEC.7GWa,6USI- J NE55 AN�PROFESSIONS CODE:TiiE CONTRACTORS LICENS=LA'f!DOES NOT AP�LY TO AN OWNcR OF � ?ROPEF1'�YYlHOBU!LOSORIMPROVES'HcRECN,AN�Wi��OcSSUCHWOFKHiMSELFORHERSELFOR m � THROUGHHI.SOfiHEROWYEMPLOYEES,PROVIDE�THATSUCHIIAPROVE4fE4T5ARENOTI\TENDEDOR W OFF=RE'JFa75A!E.IF,HOWEVER,TME�UILDINGORiMPROVEkEtiTISSOLDW:THINO\EYEAROFCOMPLE 0 TION,TH[OW!:ER-BUILDEF W:LL HAV'e THE BURDEN 0=oROVING'HAT HE OR SHE DID NOT 9UILD OR � IMPFOVEFORTFIEPU2POSEOFSALE�. � � Ll1,ASOWN'cROFTHEPROPER'V,AMEXCLUSNELVCONTRACTINGVJITHLICENSEDCONiRACTORS � TO CONSTRI:CT THE PRO.;ECT;S"eC.7o4c.gUSINE55 AND?RO�ESSIONS CODE TNE CONTRACTOFS LI- VBIUd[iOfl ADJ.AREA W CENSEL4W�OESNOTAPPLYTOANONRJEFOFAPROPea„WHOBUILDSOR!MPROVESTHEREON,A�D � NhiOCOh'TRACTSFORS'JCHPROJEC'SY�ITHACONTFACTOR�S)Li�YSE��UP.SUANTTOTHECONTRAC- Q�JANTITY DESCRIPTIOIV FEE Y TOaSI.ICENSELAW.). � J � L_IAU'e%EMPTUn:DERScC. __ ____B.BPC_FOFTFIISREASON U _ �i "_ — � � DA'E OYJNER � z W � LICENSED CONTRACTORS OECLARATION i j ¢ � IHEREBYAFFfRMUNDeaPE�AL'YOFPERJURV?HATIAMLIC'c\SEDUNDERPROVISIONSOFCHAPTFR 'D J I R^ � 9(CONMENCINGWITHSECTION�CoO�OFDIVI5:ON30'74E3USINESSANOP90Fc'SSIONSCO'JE,AND Z '" � � W MY UCENSE IS IN FULL FORCE AND EFFECT. * m � LICENSE CLASS G� LIC.NO.����� � H � -�F�py1 J V DATE t �- �� . COMAACTOfl� � .a ,5�� ��'`t a W a� WORKERS'COMPENSATION DECLARATION / -� � �Jf/,,/' U � IV,EREBVAF:IRMUNDERPENA:TVOFPERJI;R�OVEOFTHE:OLLOWING�'eClARA710N5. , � — � Z Q � ;HAVE AND YlILL�9AINTAIN A CERT:�!CATE OF CONScNT TO SELF-INSURE FOF WOFK'cRS' _ Z COl.1P'cNSAT:ON,ASPROV:DcOBYSECTION37C00FTHELA30RCO�C-,FOaTHEPEFFORMANCE U a OF THE WORK FOR WH!CN THIS PER�dI�IS ISSl1ED � Q W I^AVEANDW;LLMAIN'AINYdORREPS'COh'PENSATIONINSURAf�'CE,ASREOUIriEDBYSECT:ON Q 370�Or THE LABOR CODc.FOH T4E PERFORlAANCE OF THE WORK FOR WHICN THIS PERMIT IS � ISSUED.IIV WORKEFS'COMPEYSAi iON INSURANCE CARRIER ANC POLICY IrUMRERAR'c: CONSTRUCTION _____ ___ __ J i" � CARRI�R������: ��'� �(���`) PLAN RFVIEW _,--,---.---.----- -- Z POLICY NUMEER___'� '1�_J:� �I-=I•" t3.L I ELECTRIC ---- f'1� Q � !i}1.SSECTiONNcEGNOT6E�AP.ETE�OFhfP'eRMf�ISFORON_HUrDREDDOLlAAS(E100jOiLESF i LUMBIN {�V __ W z I CERT:FY THAT INTHE PERFORAIAN.^,E OF TFE WORK FO�WhI:CH TNIS PERMIT.IS ISSUED.1 MECHANICAL (�j SHA�LN07Eh'.PLOVAM1YPERSONINAtlY!AANNEaSOAST06ECCMESU6JECTTOTH= � WORKE.RS'CCMPENSATION�AWSCFCA_IFORNIA,ANDNGR�ETHATIFISHOULDBECOME INSPECTIONFEE �_ j SUBJECiTOT�.EWOR{ERS'COh:PFNSATIONPROVISIONSOFSECT'.0�37COOFTHE'.A30R — � CA�r-,I SHALL FOR'HWITH COMPLY YliTHTHO�PaOViSIONS. ISSUANCE � > �e'�^--�r.. SMIP p DATE:��'`��_��`APPLICANT: J�'-� __ -- . -- ----- W ENERGY P/C J WARYING:FAILURE TO SECUR'e WORKERS'COSIPENSATIO\COVERAGE IS UNLAWFUL,AND SHALL BE ---- �/� � SUBJECTANEMPLOVERTOCRIMI�+IALGENAL-1'eSANOCIV:LFIY'eSUPTOONEHUNDRED�HOUShND ENERGYPEflMIT iT� 4 � � 'JOLLARS�51 O'],OM},IN ADDITION TO THE COST OF COMPEKSATION,DAMAGES AS PROVIOEO FOR IN — J SECTION 3708OY TFiE LABOR CODc,INTEREST,ANO ATTORNE"'S FEES. RETENTION FEE: � _—__—__—_'_-- a CONSTRLJCTION LENDI�JG AGENCY PqE-ALT FEc: ___ O � I HEREBYAF=IRM UNJER PENA.�Y OF P�RJ RV TNA'T�iERE ISACO45'RUC'ION LENDIhG AGENCY _____ fOR'HE PERFORMAYC.E OF THE YlORK FOR Y.'riICH THI3 P�RM:T IS ISSUE�(SEC 309],C:V C.). I Z W ___-- � LC-�DERStiAME ___ _. —___— _ H LENDER'SAD�Re55 _—_ � IGERTIFVTHATIHAVERc/1�7MI5APPLICATIONAtiDSTATETHATTnEA50YENFCRMATIC':ISCORRECL TOTAL FE�S �/�� I� d I AGREe TO COh:PLV W�.TH ALL CiTY AN�COUNT'OFD�NANCES ANO STAT�L4W5 R'cLA`i�G TO 5U.L�I\G � CONSTFUCTIOv,AND HEReBY AUTHORIZE REPRESEtiTAT�VES OF 7.iIS CCUYTv TO E47ER�POM 7HE Z A40VE-MEM;OYEDPROPERTY�ORINSPECTION?'JF.POSES. COMMENTS_____,_._____._ ____ � ���`�_ _ _ '. 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