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HomeMy WebLinkAbout13911 � -- - -- ... � � �„�,,` CITY OF DIAMOND BAR �/��'�1 � DEPARTMENT O�COMMUNITY&DEVELOPMF,NT SEFtVICES l�� �v� . s ,� 21660E.Copley Drive Suite 190 �A (909)860-3195 Fax(909)861-311� . , PRESS ,,.._.._..:•.. "N" BUQ.DING PER'1VY1T APPLICATION __... �. ..:.».._.,...:.:_ :,��.. :�:�.,,.u:...FIRMLY � JOBSITE �- . . . ,. >- APPLICATION e PERMIT /�.' P/C�"(,�( �� o ADDRESS �� .1'" �, � y� DATE ��S- Gr ��j'_ NUMBER 9/I # f-1"'�Z,) � APN LOT TRACT D TEE �L � TMPE ,` OCC p OWNER _CONST. V'�I� GROUP �� p ADDRESS �'�I� ZONING SETBACKS � CITY �I'l/!Jd ZIP 9;��� TEL.q --�/�3j)I FRONT . . RW Cl APPLICANT TEL. REAR -� Q SIDElSICE STREET Ryy C � CONTRACTOR SIDE �, ADDRESS � C�N ZIP TEL. PROPOSED USE_�'f,�,Ty �ctu��. w ARCH/ENG/� �-n9 ���Gy z DES�GNER . W ���Li1G-• NO.DWEL. - _ NO. � NO. a ADDRESS_��� �•'" P�. 1��. �3 BEDROOMS� � CITY ZIP TEL. UNITS STORIES � �� �-;�� y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM " � �✓j.� �,/�? Q I HEREBY AFFIRM UNOER PENFLT'OF PERJURV THAT I AM EXEMPT FR00.1 THE CONTRACTORS LI- ♦ �y W CENSEIAWFOR7HEFOLLOWIMGREASON�SEC.7o.91.58U51NE55ANDPROFESSIOtiSCODE:ANVCITYOR � GaragelCarport ' //•i, L�ID, . 4;'ir ZCOUMVWHICHREWIflESAPERMITTOCOfJSTRUCT,ALTER,IMPROVE,DEMOLISH,OflREPAIRANY5TRl1C- W ��, � � W 7URE,PRIOR TO ITS 139UANCE,ALSO REW IRES THE APPLiCAN7 FOR SUCF7 PERMIT TO�FILE A SIGNED W PatiO/OB(�( �,�i� $'�"'• � STA7EMENT'iHA7 HE OR SHE IS LICENSEO PURSUAN7 70 THE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CMAPTER e(COMMENCING WITH SECTION 700D)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOI/Spa F,W�� p�` � FESSIDNSCODE)DRTHATHEORSHEISE7(EMPTTHEREFROMANDhIEBA515FOR7HEALLEGE�EXEMP- (� -- r'�+5 d� ��� V TION.ANYVIOLATIONOfSECTION70315BVANYAPPLICANTFORAPERMf.'SU&IECiShIEAPPLICANTTO Re-Roof � � y� � ' P p'�, - � A GVIL PENAI.TY OF NO7 MORE THAN FNE HUNDRED�D:LARS(35007.): Z d�i&- a' "` �–�'�F�'_ � u1,A50NMEROFTF!EPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIq50lECOMPENSATION, Q . ' . I,,r,r•. Z WILL DO THE WOqK,AND THE STRUCTUHE IS NOT INTENDED OR OFFERED FOR SALE�SEC.7044,BU51� J Commercial _.- ,a�,�a�,%'''.��,��. ; � NE33 AND DROFESSIONS CODE:THE CANTRACiORS LICENSE LAW DOES NOTAPPLV TO AN OWNER OF , y ,.,;, y�� . PROPEHTlNRIOBUILDSOHIMPROVES7HEREON,ANDWHOOOESSUCHWORKHIMSELFORHERSELFOq � �� �.C«:� ' }(� '�;,'•.: " Q 7HROUGHHISORHEHONMEK1pLOVEES.PROVIOEDTHATSUCHMPROVEMENTSARENOTINTENDE00R m '�"'V�'�' Q OFFEREDFORSILLEIF.HOWEVER,THEBUILOINGORIMPROVEMEMISSOLDWITHINONEVEAROFCOMPLE- � �} �''' Z TION.THE OWNER-BWLDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BVILD OR W IMPROVEFOPTHEPURPOSEOFSALE). r� O I,/S ONMER OF THE PROPERN,M1 EXCLU9IVELY CONTRACTING WITH L!CENSED CAMRACTOFiS � TO CONSTRUCT TiE PRQIECT(SEG.�014,BUSINESS IWD PROFESSIDNS COOE:7HE C6NTRACTORSlI- V8IIl8t1011 .�P ADJ.AREA W CENSELAWDOESNOiAPPLYTOANOWNEROFAPqOPERTYWHOBUILDSOqIMPROVESTHEREON.AND ' � WHOCONTMCTSFOqSUCHPROJECTSWITNACANTFACTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTIIY DESCRIPTIOV FEE Y TOFi51JCE1SE UW.). � ❑I AM EXEMPT UNDER SEC._ B.8 PC.FOF THIS REASON a � ✓ '�� 3 �_ � ��_ � DATE OWrIER H o LICENSED CONTRACTORS DECLARATION � � IHEREBYAFFW/AUNOERPENILLTYOFPERIURYhiATIAMLICENSEDUNDERPROVISIONSOFCHAPTER � /J�ry_i� �. D � e(COMMENCINGWITHSECTION7000)OFDIVISION90FTHEBUSiNESSANDPROFE5510N5CO�E,AND K/!'�� �x� MY IICENSE IS IH FULI FORCE AND EFFECT. I Z Fah� o � �j�6 i i� � ��rf'S C (� � LICENSE CLASS LIC.NO. � / r � . �C � ' - O � .= DATE ��.��_ CONTRACTOR ��~ Q �r �O G� � � WORKEAS'COMPENSATION D RATION �= � I HEREBV AFFIRM UNDER PENALTV OF PEqJURY OYE OF THE FOLLOWING DEclARA710N5: V .J � � Q � r' 2�lU - � _IHAVEANOWILLMAINTAINACERTIflCFaTEOFCONSENTTOSEIF-MSUREFORWORXERS , � COMPENSA710N,AS PROVIOED BY SEC710N 3700 OF7HE IABOR CODE,FORTHE PERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�. W � � � _I HAVE AN�WIIL MAIMAIN WORKERS'CAMPENSAt10N INSURANCE,AS REQUIRED 9Y 5'cCT10N /) Q 970aOFTHEL480RCODE,FORTHEPEflFORMANCEOFTHEWORKFORWHICHTHISPEHMITIS J I/��D ISSUE�.MYWORKERS' ENSAT INSURPNCEC RIERANDPOLICYNl1MB9RARE: CONSTRUCTION �� � � a { i) ' � CAARIEH PLAN REVIEW f.��'�� '�l'r} 0 POLICY NUMBEF�_JJ v �, a � ELECTRIC � •� � (fHiSSECTtJfJN:�fV�TeE�L..��E00FhEPEFA9�I5FORONEHUPDREDDOL1A34(S'ao)or{LEssl PLUMBING _�� r. D� p w � �^, � s �ao Z I CERTIFV 7HAT M THE PERFORMMICE OFTHE WORK FOR WHICH TNIS PERlAIT IS ISSUED,I- , `ME�CHANICAL'��� � �"'���.���J�'"i:'` : ""'.'.. C�S SNALLNOTEMPLOYANVPERSONI�ANVMANNERSOASTOBECOMESUBJECTTOTHE � (A WORNEPS'COMPENSATION LAWS Of CALIFORNIq AND AOREE h1AT IF 1 SNOULD BECOME ���� INSPECTION FEE � Sl'&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTpN37oaOFTNEIABOR .� � CODE,I SHALLFOfiTMWITH COMPLY WITM iHOSE PRO ISIONS. ISSUANCE � p DATE: "'C o APPLICANT: - SMIP � -- � — J WARNIN6:FAILURETOSECUREWORKERS'COMPE ATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C � , � � SU&IECTANEMPLOYEFiTOCflIMINALP�NAL71E5AIJ�CIVILFINE5UP70bIJE�HUNDRE6THOl15AND '� � — � f_ w ��r C — '� � r DOLIARS(5700,000),INADDITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORIN ENERGYPERMIT �.���_O WSECTION37080FTHELABORCODE.INTEREST,AN�ATTORNENSFEES- RETENTIONFEE: ___ O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �— � I HEREBVAFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONS7RLICTiON LENDING AGENCY ' ����•� �' /�� FOR THE PERFORMANCE OF THE WORK FOR WHICH7NIS PERMI715ISSUE�(SEC.3a97,CIV.C.). W �� � LENDER'SNAME_ ^Z '�, C� (y/,`, ���_!a__. ..:H LENDER'S ADORESS. ' � I � TOTAL FEES ////�.� � i CEHTIFY THAT I HAVE READ THIS APPLICATION A�D STATE'HATTHEABOVE INFOqMATION IS CORRECI:�t� /�/, � W IAGREETOCAMPLYWITHALLCITYANDCOUNTYORDPIANCESANDSTATELAWSRELATINGTOBUILDING ( r � � CONSTqUCTION,ANOHEREBVAUTHORIZEREPRESENTATIVESOFTHISCOUNTYI'OENTERUPON7}1E � . ... � - � , . .. , � ... , ,,,. . A80VE-MENTIONED PROPER'TY fOq INSPECTION PURPOSES. COMMENTS O / �}- � i,e$C.� ���?R✓� C�Tc��.�yl :�r'" C o`rtS/�-rx� � PERMITTEE NAME(PRINT) Q � �����j, � StONASU P MI E " DATE � � RECPT.NO. """' �7 gy VALIDATION WHITE—Departmant Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Cc�py,GREEN—Applicant's Copy ' 1 . 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