Loading...
HomeMy WebLinkAbout14105 �x ���. �� CITY OF DIAMOND BAR P � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVTCES 21660 E.Copley Drive Suite 190 (909)860-3]95 Fax(909)861-3117 PRESS ���9�` BUILDING PERMIT APPLTCATION FIRMLY }t � � L � ' �, � � APPLICATION+ �� � �' PERMIT >-' (J JP!C � JOBSITE �' � o ADDRESS G: ��'����T y_r..� � DATE "'L ��L" NUMBER ' +i / ri c� ISSUE TYPE OCC APN LOT 7RACT DATE, CONST. GROUP °C aWNER �� ", p -�' . ADDRE ` �C � ' S e L.d. ' ti'+.� �' ZONING SETBACKS Z CITY _ ZIP ��f3� TEL. REART— � ❑ -- � APPLICANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOFi �'Q- " �� SI�E U_ AD�RESS 7,�,�, " � �.C?7�-�. � CITY �'�'=C-�' +l�ZIP ' � � -EL.GC � � PROPOSEDUSE_ _ o ARCWENG/ � DESIGNER NO.DWEL. NO. NO. a ADDRESS — UNITS STORIES BEDROOMS � CITY ZIP _ TEL. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECL4RA710N SFR/ADD/REM O 1 HEflEBY AFFIPoA UN�ER PENALTY OF PERri1HV THAT 1 AM EXEMPT FROM THE CONTRACTORS 41- GBfd J@/C7fil01t CENSEUWFORTHEFOLLOWINGREASQ��SEC.703150U5ME55{1NOPROFESSIONSCO�E:ANYCITYOfl (n U COUNiYKTiICHHEOUIRE3APERMITTOCONSTRUCT,ALTER,IMPROVE,OEMOLISH,ORFEPAIRANYSTRUC- W Patio/�eck � TUNE,CR�OR TO ITS ISSUANCE,ALSO RE�UINES THE APDLICANT fOR SUCH PERMIT TO FILE A SIGNED W .� STATEMENT iHAT HE OR SHE IS UCENSED PURSUAN�TO THE PROVISIONS OF TNE CONTRAGTOqS LI� � C[NSE UW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPO- u' POOVSPB FESSqNS COOE)ORTHATHEOR SFiE IS EXEMPTTHEFlEFFOMANO THE BA515 FOR THEALLEGED E%EMP� TKKi,ANYVIOLATKKJOFSECTION7031.6BYANYAPPLICANTFOflAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Foof � RCMLDEMpLiYOFNOTMOPETHANFIVEHUNDREDDOLUR5�55tr��.j: � ❑I,ASOWNEROF7HFPflOPERTY,OqMYEMPLOYEESWITHWA6ESA3THEIRSOIF.COMPEN5AilON, � COmmOlC181 WILL DO THE WOqK.AND THE STRUCTUflE IS NOT INTENDED OR OFFEqEO FOR SALE(SLL`.]Od4,BU51� J NESS AND PROFESS�ONS COOE:THE CONTFiAGTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � PROPERTVWFIOBURD30RIMPROVESTHEREON,AN7WHODOESSUCHWORKHIAISELFORHERSE:FOA � Q TNflOUGMHI50RHEHONMEMPLOYEES,PflOVIDE�TFIPTSUCHIMPROVEMENTSARENOTMiENOE�OR m nOFFEREDFORSALF_IF,FiDWeYER,THEBUIIDINGORIMPROVEMEN71550LDWITHiNONEYEAflOfCOM%.E- z YION,THE OWNER$t11iDER WILL NAYE THE 6URDEN OF PRWING 7HAT HE ON SHE DI�ND7 9111LD OR � IMPROYE FUR TNE PURFOSEOF Sr1LE). � ❑I,ASOWNEROFTHEPROPERTY,AME%Q.USIVELYCOMAACTINGYAhILICENSEOCONTHACTORS Q TO CONSTRUCT 111E PqPIECT(SEC,7o�M1,9USINE55 AND PROFE5310NS CODE.TNE CONTRAGTORS LI- VflllJfll1011 __..._ADJ.AREA W CEN6EUWDOESNCTAPPLY70ANON?lEflOFAPROPERTYWFi06UIW50RIMPRO`lESTHEREON,AND ������� � � �-- "-- F YY}IOCONiRACTSFORSUCMPNQIECTSWITHRCON�FLICTOR(S�LICEYSEDPURSUANTTqTMECONTR0.C- QUANTITY DESCRIPTION FEE Y TOR9 LICENSF LAWJ. o ❑I AM EXEMPT UNDEH SEC.,_,__ ,___,B.&P.0 FOfl 7HI5 REASON � __ �J _'_' _-_""_-_'_"- � � � _ �A7E OWNER_______—___ _._ U W � LICENSED CONTRACTORS UECLARATION W � 1 HEREBYAFFIRA7 UNDER PENPI7V OF PF0.IUFV TNAT I A�1 LICENSE�UNOER PROVISIONS 01=Cf fAPTEH � -� ,.�o �}..,,y��a d- Y�' � e(COMMENCINGWI7MSECTfON7o0o)OFDIV�S:ON30FiHE8U51NES5ANDPBdFESS10N5CO�E,qMD z �f�±�;i:,� � ' X MY LICENSE IS IN FULL FORCEPND EFFECT. ,F� I � ' LLI � � �� � � t..Tt'9�'/�/j�.. �C.!� ! � LICENSEC SS �'-� �� LIC.NO. --� '� J </� VDATE � .• - -- CONTf1ACi0R.� 7 f� . � �. , '' ` �" ,. � WORKERS'COMPENSATION DECIAfiAT10N .r� 'J��'� -� j ¢ � I HEHE AFFIHA{11NDER PEMAISY OF PERIURY ONF OF THE FOLLOWING DECLAFiAT�'( � U — � Z 0 �IHAYEANpWI:LMAIU'AMACFfl'IfICATC:OFGX]NSENTT05ELf-INSUREFOR'NORKeRS' _ � COMPENSATION,ASPROVIDEnA�SECT10N9IooOF7HELA60(iC00[,FOHiHEPERFORMANCL iU _ OFTHE W09K FOR WN:GM THIS PEFlMII"IS ISSUEU. � � W i HAVE ANO WIIL IAAINTAIN WORKEFS'fAMpENSATION INSURANCE,AS flEQUIRE�BV SECTION Q 37000F 7HE LABOR GWE.f-Pq THF.�'[RFORMANCE OF THF WOflK FOR WHICH iH15 P'cHM1T IS ' ISSUED.MYWORKEFSGOMDENS�A,,Tp,��/NSII EOAHRIE�ANDPOLICYNUMBEPARL: � � CONSTRUCTION ,,,,_._ � j CAHRIER ".���/'�yd J�T-� ����)i�O(,� ---- -/� 1_ PLAN REVIEW �-'- ----- -- � %! ------- ------- ------- � POLICYNUMBEH�/��� M ���/�✓ _:...�'_ ___' '....-_"_ '__" �-�------- ELECTRIC � (IHISSECiK1PJYEWND7BECCNFILTEDOFhEPEPMTSFORONEF0.J�s7REDDIXIARS(51oo)ORLESS) PLU�MS�i _._---__ _-_—_�--y-� Z ICERTIfYTHATINTHEPERFORMANCEOFiHEN'�F7KFORWHICHTHISPERMITISISSIlEU,1 MECHANICAL ._,___._—.� .__..___. - (� SHALL NOT EAIPLOY ANY PEliSON IN ANY S1AN4ER S�AS TO BCCOMi�SUOJ[CT?O TNE t � WOFlXER$'CCM9PENSATiONLAW50FCAll1"ORNI�,ANOAORF.THATIF OUL�BECOME INSPECTIONFEE _._.___. __. __�S__ SU&JECTTOTHEWORKERS'COMPEN OVI510 S FSE 10� ooOFTHELAHOH , � C�%DE,13HAl.LFOR(!{�'ITHCOMPLY ITHTMOS PRO I N5. ISSUANCE l _ _ ____ .��_____,__ 0 SMIP ' �.—."..- p DATE:�.��° I APPLICANT: - . __-___""_.-.._ _� __ ._...- W WAPNING:FAiLUfiETOSECUHEWORKERS'cOMPENSATIONCOVEFA4EI5UNLAWFUL,ANDSHALLBE ENERGYP/C � '' � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUN�REDTHOUSANU ENERGYPERMIT �i�."—.._ �_ , DOLLAPS�f�Ca,Ooo),INAf7UITi�NTOTHECOSTqFCOMPENSRTION,DAMAGF.5A5PHOVIDEDFOriIN —j-- — _ __'—"_ � SECTION37080F7MELABORCODE,INTEREST,ANDAYTOflNEYSFEES. RETENTIONFEE: ..., ' W CONSTRUCTION LENDING AGENCY � PRE-ALT FEE: .. �---�-- � -�-�---- ---��----� O r Q I tIEPEBY AF�IRM UNOER PENALTV aF PEFJURY THAT THf:RE IS A CONSTHIJCTION LFNDING AGENCY _ _ d• FOnTHLPERFORMANCF.O�THEWOPKFORWHICHTMISPEHMITI5155UED(SEC 3087,GIV C.). � � �Z _ _'"'_ __. � LENDER5NAME ...._._.._._._ ` H LFNOEHSADUflESS___'_""___"""'___'......_.._ � ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORAIATIONISWRHECT. TOTAL FECS �, � I AGREE TO COMPLY WIl'kl ALL CffV AN�CAl1NTY OR�INPNC[5 AN�STPiE LAWS RFLATING TO BUILOING � CONSTRUCiION,ANDHEREBYAUiHORI'I.LHEPRESFNTATNESOFTNISCOUNTYTOENTERUPONTHE ---- —_— ABOVE-MENTIONEDPROPEH FOFiINSPECTIONPURPOSES. COMMENTS___. � ---.�,�="----��--�"-L--------- - - -- , m PERM E(PflINT) '__'___ __' ¢ ) �•�� .y�_ - �.� - � . 1 —._ _ � SIGNAT RE O FF.RMI E� -'-'—-�—"-"DATE " - �^' _„ = RECPL NO. ___PAID BY __�__VAl1DATION_ ~ WHITE-Department Copy,YELLOW-Finance Copy.PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Appiicanfs Copy t . .. _ . , ,.. . . . .+ _ , ' , . ' . .. i . . . ' . . • ..., . . ' ., ; , . . � • '� . _" _ - . .. , - t..x i .. , . � . .. � � � : . � , . j , � , I .. k -. . .. i.:' , , . � , . . .. � .. , < . : . ' ; � � � ,' � i I 4 I � , �� i � i �I � �,F . . . � , ' . ' ' ' i . . . � � j . . � j . . . , . , . i : i . . ; • i . , . . . . . . . , . , . , . , . i . � ' ' i � ' � � . � � �� � i : . � . , . �. � ., ..._ . , � _� j i y . i ; ; � � � . i i ; �� � I � � � � �� � , � �� � � ��� � i ' �' � � � 1 � � � � � I , ' .. , ' � . .' .. i ' i i ���' � � � � '. i � I � � ��: i ' . . . i � i � � � l,� . ; � I j i .. . � 4 . . _ � � . _ ��dr� � . . � . ' ���y�, .5��.. � • i . i ' _ ' � , - . ' . . � . � ' .. . , � . ��� .. i �. � , i � : . i , ., � .. - I �_ I ` . . , � ' � . ��- ! i . � � � � I . ' � �i i � I� 4 � � , . � � f. . , �. � � ' � � � . � . � .. j I � , �. �f� .. ' I � � � � � � � � � � �#�t � � 5��� s , I j i I . � i I �:� ' � � . ' . " j � � � ;, ; ' i — � i � � _ , ' I I - � - � ' i . , _ . . .{ ,- � S. .._ . _"""' j '' ' �F{ . 1. � . - I i . . I , , - . 1 ' � ' , � ' � ' ' . . � - ': �. ' . I . . , ,, �,�� . f , ' ' ' , ' � . ' i . I � I � I � 1 1 . � i I . �; � . . , . . I I , � � i j ' fn. � �, � ' ' � � ' � � � , , i ' ' � .� ' ' i i I , I � i � i � j i i i � I �h � I , i j ' i i i i , i � I ����C� � j , , , � _ .. � . �_ I . s' .. :, i._._ _ .,_ .. _ � ; I