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HomeMy WebLinkAbout11055 _..._. . �_��,.. - . - �"� CITY OF DIAMOND BAR � � � � � � COMMUNITY DEVELOPMENT DEPARTMENT rj �,� f � 21G60 E.Copley Drive Suite 190 � � / PRESS (909)860-3195 Far(909)861-3117 � i � ' ��'"""� BUILDINGPERMITAPPLICATION �..._.--�''� FIRMLY ,/� c y JOBSITE �/�� � /,! �, /s�� � �� APPLICATION �,�/�i PERMIT //A /C o ADDRESS c r` 5�� DATE�� � _ NUMBER �� �_ oro ISSUE TYPE ���� OCC APN LOT TRACT DATE CONST. GROUP p OWNER o ADD �SS �'�r.O ZONING SETBACKS z CITY � `� ' TEL. � FRONT RW � � APPLICANT TEL. REAR ] � SIDE/SIDE STREET RW �l z Q CONTRACTOR�I SIDE _ � _ o CDDRE55 ZIP TEL. PROPOSED USE �i�L'- • �— ^ w� ARCH/ENGI � w DESIGNER_ NO.DWEL. JO. NO. a ADDRESS UNITS :iTORIES BEDROOMS = CITY ZIP TEL. — � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNEF-BI:ILDER DECLARATION SFR/ADD/REM p 1 HERE3Y AFFIRM UNDER PENALTV OF PEFiJ'..RY iHAT I AM E%'e!AP?FFOM TF:E COVTRAC70RS�i� Garage/Carport W CENSELAWFORiHEFOLLOWINGREASON�SEC7C31.5BUSIN'cSSANDPROFESSI0N5CODc:ANYC11VOri (n U COUNTVWF.':CHREQUiRESAPERMITTOCANS'RUCT,ALTER,�MPROVE,Dc'MOLIS�,ORR=PAIRANYSTRUG W z TURE,PRIOR TO IT£I&S'JANCE,ALSO R'cQUIRES THE APPUCANT FOR SJCH PERN!T TO FILE A SIGNED w Patio/Deck STATEMENT iHA7 HE OR SHE IS LICENSED PU95UANT 70 THE P�aOVISIOhS OF THE CONTRAC�ORS�4 � CENSELAW�GHAPTeR9(COMMENCI�GWI�HS'cGTIOV1oGa)OFD:VISION30FTHEBUSIYESSANDPRO- � POOUSPe F`c5510N5COJc�ORTHATHEOR5HEI5E%EMPTTHcREFR0ILAVDTHEBASI5F05THEAL�EGEDE%EMP- (� 0 7lON.ANVVIOLATIONO�SECTION703t.55VAYVA�PUCANTFORA�ERMIT5U6JECTSTHEAPP!ICANTTO Z R0-ROaT E �� � ACIVILPENALTYOFNOTMOR�THANF:VENUh�RED�OLLARS;35C0).): „ � _I,ASOWNEROFTHEPROPEF7V.ORMYEAAPLOVEESWITHbVAGESAS'HEIRSOLECOMPENSA'ION, � COfI1fIl0fCidl z W!LL DO THE WOr7K,AND'HE STRUCTURE IS NO'INTEh'DE�OR OF:E9E�F09 SALE(SEC.70C4,BUSI- J � NE55 AM1D aROFESS�ONS CODE:"HE CONTRACTCRS LICEM1'SE lFW 70E5!:D'APP�Y TO AN OWYER OF � PROPERTYWNOBUIL0.SOHIMPROVCSTHEREON,A�JWHO�0E53UCHYlORKHIMSELFORHERSELFOR m Q THROUGHHISORME.iOWNEMPLOVcES.PROVIDEDTHAiSUCH�MPROVE6IEN?SARENOTIM1TENDEOOR W OFFEREDFOaSALE.IF,HOWcVER,T'cBUILDI.\GORRdPaOVEA1ENTI550L�WiTHIKO.�FYEAROFCOMPLE Z TON,7NE OWNER�BUILDER WILL HAVe'THE 6URDEN OF aROVING THAT Hc OR SHE DID NOT 6UI'�D OR � IMPROVEFORTHEPLIR?OSEO=SALE). W CI,ASOWNeROFTH[PROPERTY,AMEXCLUSNELYCONTP.ACTING'.VITHL:CENSEDCONTRACTORS [[ TO CONSTRUCT THE?�i0.1'eCT(SEC.7od4,EUSINE55 AND PROFESS10ti5 CODE:THE CONTRACTORS LI- VdIUatI0r1 ADJ.AREA W CENSELAWDOEStiOTA?PLYTOANOWNEROFA�RO?E9TYYIH06UIL�SORIMPROVESTHEREON.AND -- � WHOCOtiTRACTSFORSUCHPROJECT5WI-HACONTRACTOR;S)LIC_YSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTIOIJ FEE Y TORS LICE�SE LAY7.). � I�I AM EXEMPT UI:DER SEC. 8.8 P.0 FOR THIS RcASON Q � U � � JAiE OWNfR � Z W � LICENSED CONTRACTORS DECLARATION W � 1 HEREBY AFFIRM U!:DER PENALTV OF PERJURY THAT I A�A LICEVS'cD UN�ER PROVISIONS OF CHA7TER � d 9(COMMEACING VlITH S'cCTION 7CC0)OF ONiSION 3 0%'HE BUSINESS AND PaOFE5510NS CODC-,A`!D Z I X MV UCcYSE IS IN FULL fORC:ANO'=FFECi. ��J � UCENSE CLASS�� LIC.NO.�� ��� j 1- s J V DATE _ CONTRACTOa d I W � � � ORKERS'COMPENSATION DECLARATI Q � IHE�EBYAFFIRMUNDER?ENALTYOFPERJURYO�EGFTHEFOLLOWINGDEGARATIONS: Z ' � IHAVEAN�WILLMAIYTAINACERTIFlCATEOFCO\SEN'TOSELF-INSUREFOflWORKERS' _ 4 CAMPEhSATION,ASPROVIDED9YSECTION3��oOFTHELABORCODE,FOqTHEPERFORMANCE U � OF iHE WORK FOR W HICH Tn15 PERMI7IS:SSUE�. � � 0 W IHAVEANDWILLN.AIITAINWORKERS'COMPENSATION!NSURANCE.ASREO�IREDBYS�CTIOY 1 Q �GOOFTHErABORCOOE,FORTHePERFORMANCEOFTHEWOFKFORWHICHTHISPER'A:TIS � ��j ISSUED.MY WORKERS'CO ,ENSfT N INS RANCFJ.'fjRRIER � ?OLICY M1'UMBERARE� I CONSTRUCTION ✓ Q a6�' PLAN REVIEW � CARa.ER����r� �`�'".Y_ '___ Z aoucvnuM6ER_ �s� ELECTRIC _ ¢ 3 Q ((}1155ECi%NVNEEDNOTBcWMP.E'E'�O=THEPERMITISf-0RIXJEHUNDFgD�OLLAR5�y100)ORIt.'-C.S). PLUMBING _ ZICERTIFYTHATiNTH[PERFORMANCEOFTHEV:ORKFORWHICHTHISP'cRMI71515S:,ED,I MECHANICAL __ (3 SHALLNOTEMPLOVANYPERSONINANYMAhTERSOASTOBECAMESUB.,EC7'O�Hc � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDA3R'cETHATIFISHOULDBECOME INSPECTIONFEE _ � SUBJECTTOTHEWORK'eR5'OJbiPENSATION flOVI510N50F5 'ION3�GJtlFiHELA90R ---- - �E,I SHAI OR'.THWtiH CON.PLY WiTH' SE PROVISIO � ISSUANCE '� l � ��y � � � - / 1 p DA7E• !'� APPLICAN j .���1 SMIP _ J WARNIK(`i.FAILURE705ECUREWOFKERS'COMPENSATIONCOVERAGEISUNLAWFUL,AN�JSHALLBE ENERGYPlC � SUBJEC?ANEMPLOYERTOCRIMINA�P"cNALTIESANDCN:LFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT �JOLLARS(510a.0o0�,M ADD!TION TO THE COST OF COIA�ENSATION,DAMAGES AS PROVIDEO FOR:N — � SECTION37080FTHELABORCO�E,INTEREST,ANDATfOaNEV'SFEES. RETENTIONFEE: __ � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O — � IHEREBYA�FIRMUUDERPENAL'VOFPEPJURVTHATTHEREISACANS?RUCTIOM1LENDI!�GAGENCV n- FORTHEPERFORMANCEOFTHEWORKFORWHICHTH:SPERMITISISSU'eD�SEC.309],CIVC.). ----- Z W j IENDER'SNAME_ ______ _______ y F-- LENDER'SA7DRESS w I CERTIFY THAT I NAVE REA�THIS APPLICA'IOY AND S-ATE 7HATTHE ABOV�IYFOR!AAiION IS COFREC7 TOTAL FE ES / ��� � IAGREETOGIXAPYWITHALLGITYAIDCOUNTI'ORDI`lF�'CESA\D57ATeLAWSRELAT�NG'09UI�DING L � CONSTRUG�I N�HcRE3Y ORIZc REPa`eSEtiiATNeS CF THIS GOU\T1'TO E��EP L'POh THE � ,/ \ ' � ABOVE-M I�ED PROPEFTY INSPECTIOY Pll POSES. �,��� /—� T�/,Q ����..,d . 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