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HomeMy WebLinkAbout11700 Jln/'` F � CITY OF DIAMOND BAR � ---����— DEPARTMENT OF COMMUNITY&DHVELOPMENT SBRVICES '� 21660 E.Copley Drive Suite 190 ,�� (909)860-3195 Fax(909)861-3117 � PRESS ����p�^�� BUILDING PERMIT APPLICATION FIRMLY y JOBSITE �� DATECATION J I� G� NUMBER� #/C �r " o ADDRESS��I��� ,�YG��_...� � APN LOT TRACT C-' � ISSUE TYPE O C p OWNER ��!''�A�ILji��� S f'/Ij �.J�L�_ DATE � Z CONST. GROUP "' ADDRESS_� ��+%' � .i Ci ZONING SETBACKS Z CITY - �.,°j�IP�� TE � FRONT RW Cl_ g APPLICANT , - EL.,' REAR ❑__� SIDE/SI�ESTREET RW ❑.__ � CONTRACTO� � �_' SIDE Cl_ p� ADDR 5S /r�/r"1�� ,,,,/ �1� yl-` ; pROPOSED USE.� � CITY � � �ZIP TEL���i� w ARCH/ENG/ i z DESIGNER � �� NO.DWEL. NO. NO. � ADDRESS " 0 • UNITS STORIES BEDROOMS � � CITY IP G�'�' TEL. ' — ! � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM � I HEREBY qFFIRM UNOER PENALTY OF PEHJIIHY THAT I AM E%EMPT FilOM THE CONTRpCTOR51.1� G8f9gB/CafpOK W CBJSEUWFORTNEFOLLOWMGNEASONISEC.J031.59U31NF.53ANDPROFE5S10NSCODE:ANYCINOR �, (n 1 UZ COUNTYWHICMREWIHESAPERMITTOCONSTpUCT,ALTER,IMPROVE,DEMOLISH,OFiREPA1qANV5TRUC� �j.I pg�lOIDBCI( � TURE.PRIOR TO ITS ISSUMIC6,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W S � STATEAIENT THAT HE OR SHE IS LICENSED PURSUANT TO TNE VROVISIIXJS OF THE CONTRACTORS LI� i CENSE tAW(CHAPTEfl 9(COMMENCIN6 WITH SECTION 7aa0)OF DIVISION 30F THE BUSINESSpN�PRO� � POOVSPB � FESSqNSGODE)OHTHATHEOq3NE19EXEMPTTHEREFROMANDTHEUASISFORTHEALLEGEOEXEMP� , (� TION,ANYVKKATIONOFSECTION7031.6BVANVAPPLICqNTFORAPERMIT9U&IECiSTHEAVPLICANTTO Z Re-Rooi � ACIVILPENALT'OFNOTMORFTHANFNEHUNDHEDOOLURS(SSaO).): � ❑I,�150WNEROFTHEPROPERT(ORMYEMPIAYEESWITNWAGESASTHEIflSOIECOMPEN5ATI0N.. � Commercial 6 Z WILL00 THE WORK.Ml�TME STRUCTURE IS NOT IMENOED OR OFFERED FOH SALE ISEC.70a4,BUSI- , J � NESS AND PROFESSIONS CODE THE COMRACTORS LICENSE-LAW OOES NOT APPIY TO AN OWNER OF � PFWPERiYWHOBUItDSORIMPROVEStHEREON,ANDWHO00ESSUCHWORKHIMSELFONHFRSELFOR � � 7HROUGHHISORNEROWNEMPLOYEES,PROVIOEOTHATSUCNIMPROVEMENTSARENOTINTEN�EOOR � W OFFEAmFOPSRLEIF,FIOWEVER�TIEBUILORiGOflIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE� � TqN,THE OWNER$�RUER NALL HPVE THE BURDEN OF PqOVING THAT HE OR SHE DID NO!BUILU OR � IMPflOVEFORTHEPURP06EOFSALE�. W ❑I,ASONMEflOFTHEPROPEHTI:PMEXCLL151VELVCONTFiACTIN6WRHLICENSE��NTPACiORS � (= TO COI�ISTRUCT TME PHOJECT(SEC.70w.BUSINE55 AND PqOFESSIONS COOE THE LONTRACTOflS LI-'. VelUfltiOn ___, ADJ.AREA__ __ _ W CENSEIAWDOESNOTAPPLYTOANOWNEROFAPHOPERTYWHOBUtLOSORIMPROVESiFIEftEON,AND, ' � 4RIOCON7MCTSFORSUCHPROJECTSWITHACONfRACTOR(S)LICENSEOPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE � TOfiS LICENSE LAW.). y . J O ❑IAMEXEMPTUNOEflSEC._ ______.__�.BP.GFOqTHISFEASON�� � Q ; � V . a j u' DA7E OWNER—._ _'�—."— . V � � LICENSED CONTRACTORS DECLARATION '• W � � INEREBY�FFIHMUNOERPENALT'OFPEFJURYTHATIAMLICENSEDUNDERPROVISIONSOFCHAPTER � d B(COkiMENCINO WITH S'eC710N 70.ro)OF DIVISIQN 3 OFhIF.OUSINESSANU PNOFES510N5 CODE,ANU Z ! X MY LiCENSE IS M FULL FOFCE FND EFFECL– 11J � 3 J # � UCENSE ClAS�S_ ,���I LIC.NO��/ �"�CJ ��. , ,�� j a �j DA7E__. � !_=L.._ coNTRACTOR�(a�y���_��� � d + W � Tc� � c� WORKERS'COMPENSATION DECLARATION -� U � 1 HEREBY PFfIpM UNOEF PENALT'OF PEAJURY ONE OF THE FOLLOWING DECLAHATIONS: � � d i I � _IHAVEANDWILLMAINTAIryACERf�FICATEOFCONSENTTOS[lF-IUSUREFOP.WORKfftS' Z � GOMIPENSATION,h3PROVIDEOBVSECT1IXJ370oOFTHELADORCOOE,fORTHEPEFlFORMANCE W � OF THE WORK FOfl WHICH THIS PF.FlMIT IS ISSUEO. � � �.IHAVEANDWIILMAINTAINWORKERS'COM7ENSATIONINSURANCE,ASiiEqUINEDBYSECTION Qd 37000FTHELABOflCODE.FORTHEPERFORMANCEOFTHEWOpKFORwNICHTHISPFFMITIS ISSUEO.MV WORNEFS'COMPENSA71ON IN NCE CA RIEN IWO POLIGY NUMB aae: CONSTRUCTION df� 6 D ! � � C" .�i'��.���. PLAN REVIEW �����i�„t"t_"_`-- — CARRIEft=� � i � POLICY NUMBER�� d7��"=�-'�f'. ELECTRIC ._.�.___ _ -�_._.—_.._._ � —�����-`5�"��- j � (IH65EC1%INNE�NOTBE00APLETEDOFII�EPEWNfSFORONEVnNDfL.�700LLARS(5100)OPlESS�. PLUMBIPIG __.____'. _–'. .�__–.�___ i � � Z ICERTIFYTMATINTHEPERFORMANCEOFTNEWORKFOflWH�CHTHISPERMITISISSUED,I �MECHANICAL _______ ,_. __ � � SNALINOTEMPLOVANYPENSIXJINPNYIANJN[RSOASTOBECOMFSUBJECTTOTHE -- – – _ � WORNERS'COMPENSATpNLAW50FCAlIFORNIA,ANDAGREETHATIFISMOUL08ECAMF INSPGCTIONFEE ,,,,_�__ . �� SUBIECTTOTHEWORKEftS'COMPENSATIONPFOVISIONSOFSEC710N37000FTHEU�BUR (SSUANCE _._:_j.�!o� S CODE.ISHALLFORTMWITHCOMPLYW�TNiMOSEPROVISIONS. --��---� �— —�—� ( � SMIP --'1--=F-^�---_.– p �ATE:_ APPIICANT. '._.__" –"—____ . --'–_' W ENERGY P/C --- --- .'..- ----' --'-- WppNING:FAIIURE TO SECURE WORKCflS'CAMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE LL Sll&IECTANEMPLOYERTOCRIMINALPENALTIESNdOCIVILFINF.SUPTOONEHUNORLOTHOl1SAN0 ENERGYPERMIT __.__ DOLIARS(t100,0a0).IN ADOiTION T07HE COST OF COMPENSqT104.OPMMiES AS PROVI�ED FOfl IN --- � t J SECTION31oBOFhIE�ABORCODE.INTFfiEST,AN�pTTORNEYSFEE3. RETENTIONFEE: _,___ ,_���__, .._ 1 W ,� � CONSTRUCTION LENDING AGENCY PHE-ALT FEE: __._. -._—` .._. -=..- - � IHEREBVAFFIRMUYDEflPENALTYOFPERJURVTHATTHLREISACONSTRUCTIONIENDINGACLNCY � FOP THE PERFORMANCE OF THE WORK FOR W411CHTHIS PERMIT 15155UE�(SEC.?a9),CIV.C.). --- - - — --_ — W � lENOER'SNAMF,._,_ — _ . . ..-- .__.__' ' __ � ___ --'_' F_-� LENOER'S,4DDRESS__.� � W ICERTIFVTHATIHAVEREADTHISAPP4CATIONANDSTATE7HATTXEA90VEINFORMATtONISCORHECT. TOTAL FEES � " � ' "� � I AGHEE TO COMPLY WITH ALL C1TY PND COUNTY ORDINPNCES AND STATE LAWS pELUIN6 TO BUILOING CONSTFUCTION,AND HEREBY AU7HOHIZE REPHESENTATIVF.S OF i1115 COUNTY TO ENTEF UPON THF j Z PHOVE•MENTIONED PROPERTY FOR INSPECTION PUHPOSES. � COMMENTS _ _ . _ � � �r � • �.s'`�� --- _. -- — � _ - m PEHMITTEEN �1 py�s — - -. .- � = SIaNATUR bF PE ITf�E�J��OpT��'— — ���� 3� RECPT.NO._��o PAID BY VALIDATION. �? ~ WHITE-DepaRment Copy,YELLOW--Finance Copy,PINK-Assassor Copy,GOLDENROD--File Copy,QREEN-ApplicanYs Copy i ! _ _ . _ __ , a �s �^. - � � ya I i.�( ,I � I `.J � `� �g''Y'1 b �.`' x ; k '. � . - ' E ,� �� � � ' ��� 5,��, �st .iS � � �'�¢ i� ;� � � 3 ; ^} �� _��� i �� ta. �� �k,} s ° : . � ,1,_ � ri � � � � � t � � �� - � �� - � �� �. 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