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HomeMy WebLinkAbout17397 (670) ^ _�` CITY OF DIAMOND BAR DEPARTMENT OF CO1VdMTJNITY&DEVELOPMENT SERVICES -� _ _ ,� 21660 E.CopleyDrive Suite 190 �•_� PRESS (909)860-3195 Fax(909)861-311? � /' ������ BUiLDI1NG PERMIT APPLICATION FIRMLY l"���, r�1��. � _ � JOBSITE �y� APPLICA I N _ PERMIT ° P/C o ADDRESS� �� DATE ��"���� NUMBER # � ISSUE TYPE OCC r APN OT TRACT DATE CONST. GROUP p OWNER "- ' �` ZONING SETBAGKS , � CD�s �� ,,, � FRONT RW ❑ g APPLICANT r T " REAR ❑ � ' SIDE/SIQE STREET RW ❑ � ,CONTRACT � ���- +Fa',�i /' SIDE ❑ AD R , � � " ` PROPOSED USE o CI :I.�' T wQ AROWENG/ W DE$IGNER NO.DWEL. NO. N0. y , RDDRESS ;� ,.CITY ZIP TEL. ROOMS UNITS STORIES BED � DESCRIPTION SQ.FT. FACTOR PSF ADJ:AREANALUA710N ��� �� � � �� ��(7WNER-BUi�DER DECL4RATION� SFR/ADD/REM � � � � � ' 1 HEREBY AFFIRAA UNDER'PiENALN C7F PERtt1RY THAT I AM EXEMPT FROM THE fANTRAC70R5 LI- G8f8JE/C8fP0�i W'. �.CEtdSElJ1WFORTHEFOLLON°iNCjpEASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITYOR (n , U�. 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' ' � � i �i WILI DO TtiE WOAK,AND THE$TRUCTURE IS NO"f INTENOED 6fl OFFEREO FOfl SFLE(SEC.7044,BU51- J �I ��I', ��NESS pI�PHOFESSIOPdS CO�E:',THE CONTRACTORS'LICENSE UW OOES NOTRPPLY TO AN OWNER OF � ', , �, .. , ���PROPERTYWI�OBURDSORIMPROVESTNEHEON.AtdD'�WNODOESSUCHWORKHlMSEIFORHERSELFOq I '�� „7HHOl1GHHISORHEHOWN'EPAP�OVEES,PHOVIDE�THAP54CNIMPROVEMENTSAFENOYINiENDEDOA m „ ��� .Q; '�,OFFEREDFORSALEIF,F{OWEV/ER;THEBUII;DINGORIMPROVEMEMISSOIDWIiHINONEYEARCFCAMRE- " � i Z �'TION'THE OWNEYi�BUtLOER WIL1 HAVE THE BUR�EN OF PAOVING THAT NE OR SHE DID NOP&UIID OR �., �� i � 'IMPROVEFORTItEPUFPOSEOFi,SALE1. '. . � � I W, ' ' ��I,ASOWNEROFTHEPAQPERTY,/eMEMCLUSIV'cLYCANTP,ACTINGYdIYNLICENSEDCANTRACTOR5 � � '�, '.�,. ,TO CONSYRUCTTNE PRQIEGT(SEC.7U44,BUSlNESS AND PftOFESSIOM1'S CO�E:TF1E CONTRACTOFS LI- v$BU2810P1 � ADJ.AREA_ �I �I.l.LI .CENSELAW�OES.NOT9RPLYTaANOWNEROFAPR6PERTYWHOBUIL�SORIMPROYE57HEREON,AND - i, .'�; ,'WHOCONTRACTSFORSUCHPRQ,IECTSWITHAWNTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCflIPTION � FEE � � ,.,.�, ';.TORS UCEPISE LAW.�.. . '. . . ,. . . ,, . �, ^� ❑YRM EXEMPTlN10ER5EC. � B.8 P.4 KORT4IS REASOti� � Q S � . I� -u'—� ��DATE�� OWNER � . . �, , , Z � I Q LICENSEDCONTRACTORSDECIARATION w � �FIERE6YAFFIRMUNpERpENAi,TY,OFPEFUUAtlTHATIAMLiGENSEDUNDERPflOVISION50FCHAPT.R � �', D(COA�MENqNQi WRH SECTIOIV�P000)OF�IVISION 3 OF THE BUSINESSANO PROFESSIONS CODE,AND 7 � � . � MY LICENSE i51N FU DAGEANp EFFfCF. � ' m , � LICENS ///���...AAASSS S � ��' IIC.NO.� �� '� �' ,, . I � �ATE��� CONTRAGTO�_ .�.:�� d LtJ '�. � WOfiK�RS'COMPENSAYIfJN DECLARATION = �, � @ �'�, �. I HERE9V AFFIHPA UNDER VENALTV OF PERJURV ONE O�THE FOLLOWI'NG DECLARATIONS: Z �'�, �� , �IHA4EANOWILLMAiIVPAINACEHTIfICATEOFGONSENTTOSELF-0NSUREFORYYOflKEflS' _ COMPENSRT'�ON,AS PROVIDE�BYSECTION 3700 OFTME L480R CDDE,FOR 7HE PERFORMANCE �U �, � tlF THE WORN FOfi WHICJi THIS PEpk{iT IS lSSl1rD. � � '� �,� _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANGE,AS REOU!RED BY SECTION � �' �i 37000FTHELA90RCOqe�,FORTHEPERFORMANCEOFTHEWORKFORWHICHINISPERFA1T15 � ISSUEQ.MYWORKERS'flOMPEN5A710NINSURAMCECARRIERAN�POLICYNUMOERARE: CONSTRUCTION �','' , � caRRiEq PLAN HEVIEW i �;�. aoucvwu�assp � '.. ELECTflIC Q , (iHtSSECTI�MIN�NOF$E�M1�REfIDOF?IiEPEFSI4TISFORIXJ D�I.LARS 65�. PLUMBING ._ �Z'' I CERTIfYTF-0AT INTHE�SR�ORMANCE OF TfiE WQRK F WHICH iS P IT IS IS D,I MECF7ANICAL � (,'� SHALLNOY EMPLOYANY PEfl5QN IN ANY MAfdNER 5 S TO BE ME S JE E �'�, q]�. �� WORNERS'COPAPENSATION LA�^�SOF 6ALIFORNIA, D AGRE HAT IF I BECOME INvPECTION FEE � SUBJECT TO THE WOftK�RS'COMFENSATION PR ISION F SE 7oa OF THE L4BOR , i �� E,I ITH COMPLY WITH THO ISIONS. �SSUANCE � ������ - - � _ _ _ . _ _ . � il �,� DATE� "f APPLICANT: � �SMIP �'i J� .WAflNING FAILUAETQ SECUFE�OHKBRS COMPENSATION COVEFiAGE IS U 'WFUL, ND SFiALL BE ENERGY P/C . � . SU&IECTANEMBLOYERTOGRI INAIPENALTIESANDCIVILPINESUPTO HUN�R THWSAND ENERGYPERMIT �G�F� � � 'a�,(�'I ' I ��' �OI-LAPS(S1o0.o0�),IN A�DfTION TO THE COSTOf COMPENSATION,DAMA 5 AS FFO IDED FOR IN y�� --r y y� ',, �'��,SECTION 37080F THE LABOR CQDE,INTEREST,ANDATfORNE1"5 FEES. j � RETENTION FEE: ' _ .q C4�NSTRUCTION LENDING AGENC� � PRE-�LT FEE: ` _ j ��,�I HEREBYAFFIRM UNOER PENAI.ITY OF PERJURV THATTHERE I5 ACONSTRUCTION LENDING AGENCV i"-- t _.__ �f ' . .FORTHEPEfiFCRMANCEOFTH�WORKFORWHICHTHISPERAS171SIS5UED�5EC.303],CIV.C.). -� �� - -- �. -- . ���� � '� � ' �'.� .. ,. . . . LENDER'SNAME ', F-����'�;,;LENDeR'SADORESS , ���..ICERTIFVTHATI�HAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES . ,��� ��I�I'I 4; ,;IAGREETOCOMPLYWjT}iAIL,C.ITVAN�CAUNT/ORD�NANCESANDSTATELAWSREUTINGTOBUIL�ING � ;�,ii�'„CONSTRUCTION;ANOHEFEBY,AUTHOIafZEftE?RE� NTATIVESOFTH!SCOUNNTOENTERUPONTHE " ' � :''ABOVE-MENTIONEDFROPERN��OPINS P4J OSES. � �. 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