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HomeMy WebLinkAbout10323 CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT � .„,.G . 21660 E.Copley Drive Suite 190 � (909)860•3195 fax(9b9)861•3117 PRESS '""' BUTLDING PERMIT APPLICATION FIRMLY } JOBSITE i�"ti�°y--�e;,,�,d �c" t3�L�G APPLICATIO °� PERMIT P!C o ADDRESS ? s' DATE � NUMBER__���# c� ISSUE TYPE � OCC APN LOT � 7RACT DATE__ CONST. GROUP p OWNER � � � ADDRESS � ZONING SETBACKS Z CITY ZIp ' L, `" '� FRONT RW I 1 APPLICA TEL. REAR f� � g SIDE/SIDE STREET RW U � � CONTRAC�OR �.��� C•��.s�.CS��r icx.;� �c;, SIDE I-1 � � ADDRESS�t"C7�— Ae(�+C�v.�:�c�+C ��"6 S `''�Glu . � CITY�..�.a..rf't S�+c.�_� 71P� TEL.�IoZ��`_-�`��j, PROPOSEDUSE w ARCH/ENG/ � `���Zi2. _ f�) _ � DESIGNER ��:' - ' s' ' - ��.ESS" NO.DWEL. NO. NO. � a ADDRESS � ��� � �h° �'� i"P' UNITS STORIES BEDROOMS � cirr �u�.i����t��cE�,ziP ���'�TEL.��'EW�1't•�b$ �� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O OWNER•BCILDER�ECLARATION SFR/ADD/REM A p 1 HEREBV AFFIflM UNDER PENALTY OF PERNHY THAt I RM E%EMPT FROM TME fANTqACTORS Lb G8�890/CBfPOR W CF.NSEUWFDRTHEFOILOWINGHEASON(3EC.7037.56U51NESSANOPROFESSIONSCODE:ANVCITYOR (n U COUNNWHICHREOUIqESAPEFiMITTOCONSTRUC7,AL7ER,IMPROVE,DEMOLISH,ORREPAIRANYSTfiUC� W pati0/DBCk i wTUHE.PRIOR TO ITS ISSUANCE,AL50 FEQUIRES THE PPPLICANT FOR SUCH PEflMIT TO FlLE F SIGNED STATEMENT iHqT HE OR SHE IS LICENSEO Pl1RSUPNT TO THE PROVISIONS OF THE CONTRACTORS LI� � � CENSE LAW(CHMTER e(COMMENCINa WITH SECTION�Ooa)OF DIVISION 30F TNE BUSINESS AND PR0. � FaoVSpa �� FESSIONSCOOE)ORTNATHEORSMEISEXEMPTTHEREFFOMANOTHEBASISFORTl7EFLlEGEDEXEMP• � � TION.ANYVIOLATIONOFSECilON7071.5BVANVAPPLICANTFORAPENMITSU9JECTSTHEAPPLICANTTO Z Re-Root ACIyIL PENALTY OF NOT MORE THAN FIVE HUNDRED�OLURS(S500j j: � Z ❑I,ASOWNEROFTHEPHOPERTY,ORMVEMPLOYEESWITMVlAGESASTHEIRSOLECOMPENSA710N, 0 CORIRIBfCl01 WIIL DO THE WORK,AND 7HE S7RUCTURE IS NOT IMENUED OR OFFEREO FOR SALE(SEC.704a.BUSI- J NESSAND PROFESSIONS CO�E:THE CONTRACTOHS LICEN&E LAW DOES NOT APPLV TO AN OWNEF OF � N PFOPERTYWHOBUIlD50HIMPROVESTHEPEON.ANDWHODOESSUCHWORKHIMSELFORHEHSELFOfl � ti [C THi1WGHHISORHEROWNEMPLOYEES,PROVIDED7HAT5UCHIMPROVEMENTSARENOTWTENDEDOR w OFFEREOFOHSALE.ISHOWEVEfi,THEBUILDINGOPIAIPROVEMENTIS50LDWITHINONEYEAROFCWAPIE- `q. � TION,THE OWNEF�BUILDER WILL MAVE THE BUROEN OF PflOVING THAT HE Ofl SHE�ID NOT BUILD OR IAIPFOVE FOR THE PURPOSE OF SALE). � w ❑I,ASOWNEROFTHEPROPERTV,AME%CLUSIVELYCONTRACTIN6WITHLICENSEDCONTRACTOR5 ---- (L 70 CONS7RUCT THE PROJECT(SEC.7044,BUSINE55 RNO PROFESSIONS CO�E:THE CONTMCTORS LI- VelUeliOfl ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTYWMOBUIL�SORIMPROVESTHEREON.AND � � WHOCONTRACTSFORSUCHVqQIECTSWITHACONTRACTOH�S�LICENSEDPIIRSUANTTOTHECONTiiAC- QUANTITY DESCRIPTION FEE TONS LICENSE LAW.). � � ❑I AM EXEMPTUNDER SEC. ._, 8.8 P.C.FOR THI5 REASON U � lL. � DA7E _,____OWNER U � W � �Q LICENSED CONTRACTORS DECLARATION W �' fL I HEREBYAFFIPM UNDEfl PENAL7Y OF PERIUHY THAT I AM LICENSED UNDER PROVISIONS OFCHAPTEfl � � d 8(COMMENCMG WITH SECTION 7000)OF DIVISION 30F THE 6USINESS AND PROFESSIONS fA�F.,M!U Z �X MV LICENSE I6 IN FULL FOH(:E ANO EFFECT. m � � LICENSE ClASS_� LIC.N0._���J����..',���'�_ L j i� ~ DATE_���°� '�" ,���� CONTRACTOR�'�•-,3�`a'e4+.E+�C.iC'l 1 y,. a � W � � WORKERS'COMPENSATION DECLARATION ��C t Q � � IHEflEBVAFflHMUN�ERVENALNOFPER,IURVONEOFTHEiOLIUWINGDECLAMTKKJ� '����� U � Z 4 .� 0 __IHAVEANDWILLMAINTAINACEFYfIFICATEOFCONSENTTOSfIF-INSl1REFORWORKERS' _ y COMPENSATpN.ASPHOVI�EOBVSECTION370oOFTHELABORCWE,FORTHEPERFORM/WCE U � ¢ OF THE WORK FOR WHICH THIS PERAIIT IS ISSUED. � � ,y�} � W s�. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION Q � 37000F TFIE LABOR LODE,FDR TH[PERFORMANCE OFTHE WOflK FOR WHICHTHIS PERMR IS ISSUEO.MY WORKERS'COMPENSATION INSURANCE CARHIER AND POLICY NUMBER AHE: CONSTRUCTION ___ � j CAHRIER C='L� p��� / __ PLAN REVIEW – —.-- � Z POLICVNIIMBE(i �M1'C_.!S{ V ��E�1�a � L2 1 ELECTRIC ¢ 0 (iHlSSECiqNNE�NOT8E00h1PLEfEDOFhEPEFUATISFORONEFRN�DF{tUDJLtNi5R1001ORLESS} PLUM8ING � Z I CEFiTIFY THAT IN THE PEFFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUEO,I MECHANICAL _ C�S SHALL NOT F.MPLOY ANV PERSON IN ANY MANNER SDAS TO 9ECAME SU&IECTTO THE 4 WOflKERS'COMPENSATIONLAWSOFCALIFORNIA.ANDAGREETHATIFIS1i0UL00E(:OME INSPECTIONFEE a �� Sl18JECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37oo0FTHElABOR � CODE,I SHALL FORTHWITH COMPLV WI7H THOSE PHOVISION. � ISSUANCE ___ _ _ o ��ry -� � ' � DATE:� � ` APPLICANT: � '�. SMIP W ,` s ENERGY P/C �� WARNING iAILURE TO SECURE WOflKERS'COMPENSATION CAVERAGE IS UNIAWFU4 NND SHALL BE — J LL SUBJECTANEMPLOYER70CRIMINALPENALTIESpNDCNILFINESUP70oNEHUNDREDTHOUSAND ENERGYPERMIT �i � OOLU1flS(51ao.o00�.INADDITIONTOTNECOSTOFCOMPEN3ATION,DAMA�ESASPROV10E0FORIN � J SEC7ioNa�oeOF7HELABOFCODE.INTERESLANDAITOHNEY'SFEES. RETENTIONFEE: � � � O CONSTRUCTION IENDING AGENCY pRE-ALT FEE: � � 1 HEREBYAFFIRM UNDEfi PENALTY OF PERJURV TMAT THERE t5/GONSTpUCTION LENOING AGENGY __ � FOR7HEPEHFORMANCEDFTHEWORKFORWHICHTHISPERMR151SS11ED(SEC.3097,CIV.C.). W � LEN�EWS NM1E � h'� LENDER'SADDRESS __ w 1 CERTIFY THAT 1 HAVE READTNIS MPIIGATION AND STATE THAT THE ABOVE INFORMATION IS COPRECT. TOTAL FEES � � 1 A6REE i0 COMDLY WITH ALL CIN AND CAUN7Y ORDINANCES AND STATE tAWS RELATING TO BUIIAING . CONSTRUCTION,AND HEREBV AUTHONIZE REPRESENiATIVES OF THIS COUNTV TO ENTER UGON THE � ABOVE�MENTIONED PHOPERiY FOH INSPECTION PURPOSES. � J �: COMMENTS (`��� a ,ia � `"'� ��l•�'�y_ ��'�.A.'ti.� p ¢ PERAIITTEEN 1�� INT) 0 ������ a 1�� �y� � CI) /'j ��„ P_��d'_..� XhY�_ y 8-TONA7URE RMITTEE DA � RECPT.N0. 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