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HomeMy WebLinkAbout13613 � . � ! �� CITY OF DIAMOND BAR DEPARTMENT OP COMMUNITY&DfiVBLOPMENT SEF:VICES 21660 E.Copley Drive Suitc 190 � , --rtw PRESS (909)860-3]95 Fax(909)861-3117 ,`',�a'.:. Bun,�nvc r�x�rr arri,icATio�r FIRMLY y JOBSITE APPLICATION PERMIT � � �} P/C Q ADDRESS � DATE NUMBER !_��� I �. # � ISSUE � L� �G TYPE OCC -- APN O TRACT DATE 1_CONST. GFOUP p OWNER �+- ZONING SETBACKS Z ODn IP TEL. � FRONT RW_ G g APP CA T T L. REAR ❑ ' SIDElSIDE STREE:T_ RW_ � � CONT ACTOR I ,.' SIDE __ � Q ADD SS PROFOSED USE � CI L. o AR / - z DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES � BEDROOMS � CI7Y ZIP TEL. � DESCRlPTiON SQ.FT. FACTOR PSF ADJ.AREr1NALUA710N � OOWNER-BUILDER DECIARATION SFRIADD/REM � p i HEREBY AFFlRAI UNDER PENMTV OF PERJURV THAT 1 A!A EXEMPT FROM THE CONTRACTORS L.- G8f2JB/CefpOR W CENSEUWFORTHEFOILOWINGHERSON(SEC.7031.5BUSINESSANDPRO�ESSIONSCOOE:ANYCITYOft (n C� COUNTYWHICHREOUTAESAPERMffTOCONSTRUC'T.ALTER,IM�ROVE.DEMOLISH,ORREPAIHANYSTFlUG W pati0/DBCk � WlURE,DRIOR TO ITS lSSUANCE,AL50 REQUIHES THE APPLIGANT FOR SUCH PEHMIT TO�F!LE A SIGNED _ �_ � STATEMENT THAT HE OR SHE IS LICENSEO PURSUAM TO THE PROVISIONS OF THS CANTRACTORS LI� c CENSE lAW(CHAPTER 9(COMMENqNG WITH SECTION 7000�OF DNISION 3 OF THE BUSINESSAND PRO� LL POOUSPO VFE3SIONS�E)ORTHATHEORSHEISE%EMPTTriEREFFiOMANDTHEBASISFORiHEALIEGE�EXEMP� (� V TION.ANYVICIATIONOF5ECT10N7031.58YANVAPPLICANTFORAVERM175U&IECiSTMEAPPLICAN7T0 Z Re-Roof � A CIVIL PENALTY OF NOT MORE THPN FNE HUNDRE�OOLURS�L5o0)J: � ❑I,ASOYYNEROFTHEPR07ERTV,ORIdYEMPLDVEES'NITHWAGESAS7HEIRSOLECOMPENSATION. � Commercia! WILL DO THE WORK�D THE STRUCTUHE IS NOT�N7ENDEO OR OFFERED FOfi SALE ISEC.7o4a,BUSI� J NESS AND PqOFESS10N5 COOE:THE CONTRACTORS LICENSE LAW�OES NOT AGPLY TO AN OWNEP OF � PROPERTYWFiOBUILDSOHIMPRO"ESTHEHEGN,ANOVAIODOESSUCHWORKHiMSELFORHERSELFOA � __ � THRIXJGHHSOqHEROWNEAIPLOYEES,PROVIDEOTIiA75UCHWPROVEMENTSAREN�TINTENDEDOR m QOFFEREDFORSALEIF,HOWEYERT`�EBU�IDINGORIMPROVEMENT!SSOLD141THINONEYE4ROFCOMPLE � Z T10N,THE OWNER-BUILDER WILL HAVE h1E OURDEN OF PROVIkO iNAi NE OR SHE DID NOT BI11LD Ofl � IMPROVE FOR THE W RPDSE OF SALE). ❑I,AS OWNEPd OF THE PpOPERTY,AM EXCLUSNEI_V CONTRACTING 4NTH IICFIJSED CO�iTRFCTORS � TO Cpt,iSTRUCT T1iE PpOJEGT(SEC.7o4i,BUSINES�AND pr�ess�ows cooe.THe coNiqncroAs u- Valuation __ ADJ.AREA W CENSEL/�WDOESNOTAPPIYTOANOWNEAOFAPROPEFliYWHOBUILD50RIMPROVESTNEREON,AND � WHOWNTRACTSFOflSUCHP�ECTSWITFIACONrRACTOH(SyL14EN5EDPURSUANTTOTN.ECONTRAG QUANTITY DESCRI?TICN FEE TOIYS IiCENSE LAWJ. � -' �9 C,�. � O ❑IAM EXEMPY UNDER SEC. B.3?.C.FOR?H!S REA504 U � _ � LL' OATE OWNEfl, ___ V W .— o UCENSED CONTRACTCRS DECLARATION w � I HEREHV AFFIRM UNDER PENALT'OF PER�uRY TNP7 I AM IICENSED UYDER PROVISIONS OF CHA?TFR a, B(COMMENCItJf3 W1YH 5ECT10N 7000j OF DIVI510N 30F 7HE 9U5ME55 ANG�ROFEuS!ONS CDUE,AYD 'Z X A1Y LICENSE IS IN FI:LL FOFCEAND EFFECi. m , tL /�� � LICENSECIASS �],_.___ L1C.N0.�, �Z F � H H v � — V DATE� CONTRACTOR �- W � +� � WORKERS'GOMPENSATION DECLARATIO �,�� � 0 U / J j � I HEREBY AFFIRM UNDEP.PENALTV Of PfiRJURY 04E CFTHE FOlL01NING DECLAR�S: ��Ja a r Y .�� •.Y � _iHAVEANUW1�LMhINTAINACEH'IFICFTEOFCONSekTTOSELF��NSUREi-0R`NOFlKERS' S - COMPEN3A7tON,AS PROViDED BY SECTION 37oa Of"Hc'LRBOR CODE.FOR THE DER�ORUIPldCE �U OFYHE Yh7RK FOR+NNICH THIS P£RMIi IS ISSUEO. ' � 0 _� W I HA4E AND W!LL MAtNYAIN NKJRKEflS'COMFENSATION INSURANCE,AS R��UI7iED BV SECTION Q 37o00FTFiEl.OdOR CO�E, OR�HE P^cAFORMANCE�Jr THE WORK FOF WHICHTMIS PEPoNITIS ---^— .d ISSUED.NY' F.RS' P AiIONINS CECARRIE NDPOUCYNUMBERARE. CONSTflUCTION � C1RRtEA _ _ , ^) PLANREVIEW _ .w`'r. � � POLICV 4UMBER �/� ELECTRIC �"�-F.a°p� +�C 1 0 (ItiiSSECIp�lN'eEJNOTBEOCY.SPLF.7IDOFiHE roar6�Eti� Eiaoiaa�/' . PLUMBING _---__ "��` a-� .�,: r � ICERT!F:THATINTHEP'cRFOFMANCEOFTNEWORKFOAWHICHTHISPERMITU155UED.l NECHANICAL _ _ " -��p �a (�" �HALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME S�'6JEC?iC'HC- INSPECTION FEE � WORKERS'COMPENSAT!ON L1W5 OF CALIFORNIA,ANO ACi7EE THAT IF I SkOULD�ECOMC- -- '• r.{'"�',�• � S�&IECTTOTHEWORKERS'COhiPEY5ATI04PROV15iON50F5iCTION37oDOFTHF.LABOR --__ V, ^ 1 CADE,I SHALI.FORTHWiTNCCMPLY WITH THOSE PA9VISIONS. 1JSUANCE Y`�'^` ✓�� � �j' p DATE: __ APPLICANT: SMIP ___ �.i a '�� ,:":, nS�E. ^. �_,..:,�_,+..f Y –� WRRNING FAILUflE TO SECURE WORKERS'COMPE45AT�ON COVERAGE�3 UNLAWFUL,AN�SHALLBE ENERGY P/C __���" -+ '�J%�'" LL Sl18JECTANEMPIOYEATOCRIMINALPENALTIESIW�CIVILFINESUPTOONEHUNOREDTHOUSAND I ENERGYPERMIT �>�J/ OOLLARS(f10D.000),IN ADDITIDNTO THE COST OF COMPENSAT10Y,DAMAGES AS PROYIUED FOR IN J SECTIDN3�OBOFTiELABORCODE,IN7ERE5T,ANDATfORNE�'SFEES. RETENTIONFEE: � a CONSTRUCTIONLENDWGAGENCY PRE-ALTFEE: _ Q I HEREB�AFFIRM UNOER PENALTlOF PERJL'RV THAT TNEFE IS ACONSTRUCTION LENDING FGENCY n- FOA THE PERFORMANCE OFTHE WOflK FOR WHICH THIS PERMIT IS ISSUEO(S'eC.3oA],CIV.C.). iz _ it e •-� ,�. � �ENDER'SNAME__ —_ �� F— LEN�ER'SADDRESS _ — /� � I CERTIFV TMA:I HAVE READ THIS APPLICATIDN ANO STATE THE A90VE INFORMATION IS�AFRECT. TOTTIL FE ES � i AGREF TO COMPLY W1TH ALL CITY ANO COUNTY OaDI. ES NO STl7E lAWS RELATiNG TO BUILDING � — CONSTRUCTION,ANDHE BVAVTF�RIZ'cREPRES TIVES FTHISCOUNTVTOENTERUPONTH'e ZAHOVE�MENTIONED PE FOR INSPECTION RPOSES. COMMENTS � Q PERM NAME�iR � . — � � - -� � SIG TU E P MI EE DAT� - � FECPT.NO. +� �' PPID BY o VALIDATION WHITE--Departmant Copy,YELLOV�—Finance Copy,PINK—Assessor Copy,GOLDENROD—File C�opy,GREEN—ApplicanYs Copy ' . ' . . . ,,.- . ,.F , . L��`�. _. ,.��3 . . .��a°. �`., . ., i, 3 .. $ fa�' ; S t�� 4� �,v5 4 �. .,�Fyli:�^�e i.a � i .} , ,r. =t .. , ..._. . . .. ,..,., " "".' 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