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HomeMy WebLinkAbout17296 (670) CTI'Y OF DIAMOND BAR /� - '�''"� `� ---� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �/� �_ �,,, � � 21$25 E.Copley Drive (409)860-3195 Faac(909)861-3117 PRESS ��%������` BUILDING PERMIT APPLICATION FIRMLY JOBSITE APPLICATION f�, PERMIT l P/C 0 ADDRESS 2352�23526 T�-i.n Springs DATE �D �w O� NUMBER "����# � � ISSUE � .Z/_ TYPE OCC APN LOT TRACT_ DATE Y� D CONST. GROUP p OWNER Qear Cr�ek c'.,anvon I�A o ADDRESS_{�Z�__Ih�. F[�t's�i�l Rlv[�_ �� ZONING SETBACKS gCITY Q32'�IqIlt ZIP91711 TEL3�}-�].Q�_ REOART RW O APPLICANT TEL. SIDE/SIDE STREET RW ❑ z Q CONTRACTOR �Y� �f CO. SIDE ❑ o ADDRESS 9�Fi F_ �'i�a ��__ PROPOSED USE RaT'oof• Rarnve existin� roofing to deck o CITY ��� ZIPQl7�7 TEL.����C�7 o ARCH/ENG/ . �z DESIGNER N0.DWEL. Np. NO. a ADDRESS UNITS STORIES c�nP BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT FACTOR PSF ADJ.AREANALUATION � OWNER-BUIL�ER DECLARATION SFR/ADD/REM O p I HEREB�AFFIRM UNDEfl PENALTY OF PERJURV iHAT I AM E%EMPT FPOM THE CONTRACTORS LI- G2f8JB/CBfpOfl W CENSELAWFORTHEFOLLOWINGAEASON(SEC.7031.58USINESSANDPROfE5SI0NSCODE:ANYCITVOR (n ZCOUNTYWHICHREQUIRESAPERMITiOCONSTRUCT,AITER.IMPROVE,DEMOLISH,ORREPAIRANYSiRUF W P8t10/D2Ck W TURE,PRIOR TO ITS ISSUANCE,AL50 REW IFES THE APPLICANT FOR SUCH PERMIT TO FILE A 51('iNED W STATEMENT THAT HE Ofi SHE IS�ICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTER 9(COMMENCING WI7H SECTION 700oj OFpIVISION 30FTHE BUSINESS ANO PRO� u' Poo��Spa FESSIONSCO�E�ORTHATHEORSHEiSEXEMPTTMEREFROMAN�THEBA515FORTHEALLEGEDE%EMP- (� � TION.ANYVIOLATIONOFSECTION7031.5BVANYAPPLICANiFORAGERMITSUBJECTSTNEAPPLICANTTO Z Re-Roaf A CIVIL PENALTV OF NOT MORE THAN FIVE HUNORED OO�LARS(ES(»).): Q �I,ASOWNEROFTHEPROPERN.ORMVEMPIOYEE5WI7HYJAGESASTHEIR50LECOMPEN5A710N, 0 Comfn6rClal Z WILL DO THE WORK,AND THE STRJCTURE IS NOT INTENDED OP OFPEREO FOR SALE(SEC.7C44,BUSI- J � NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOTAPPLV 70 AN OWNEii OF � PROPERiY WHO BUIL�S OR IMPROVES THEAEON,AND WHO DOES SUCH WORK NIMSELF OR HERSEIF OR CL THROUGH HIS OR HEF OWN EMPLOVEES,PPOVIDED THA7 SUCH IMPFOVEMENTS ARE NOT INTENDED OR � QOFFEREDFORSALE.IF,HOWEVERTNEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFGOMPLE- Z TION,THE OWNER�BUILOER WILL HAVE THc Bl1R0EN OF PROVIN�TiiAT HE OR SHE�ID NOT HUILD Oli � IMPROYE FOR THE PUR?OSE OF SALE�. W ❑I,AS�WNEROFTHEPROPERTY,AMEXCLUSNELVCOIVTftACTINGWITHLICENSEDCONTRACTORS � TO CANSTRUCT THE PROJECT(SEC.�044,BUSINESS ANO PROFESSIONS CO�E'THE CON7RACTORS LI- VeIU81iOf1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHUBUILDSORIMPROVES7HEREON,AND F WHOCONTRACTSFORSUCFiPROJECTSWITHACONTRACTOR(S)LICENSEDPUflSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORSL'�.CENSELAW.�. � ❑I AM EXEMPT UNDER SEC._ 6.6 P.C.FOR 7HI5 REASON U � LL ¢ DATE OWNER U Z w � LICENSED CONTRACTORS DECLARATION w ¢ � I HEREBY AFF�RM UNDEN PENALTY OF PERJUPY THAT I AM IICENSE�UNDER PROVISIONS OF CHAPTER � d 9(COMMENCING WITH SECTION 7ooaJ OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AN� z �X MY IICENSE IS IN FULL FORCE AND EFFECT. � � IICENSE CLASS C-�g NTC LIC.NO. Lt�7 j V DATE S 9'���`� CONTRACTOR��1� ��(�� '�� a W � WORKERS'COMPENSATION DECLARATION Q = U � I HEREBY AFFIRM UN�EFi PENALTV OF PERJUqY ONE OF iNE FOIIOWIVG�ECLARAT�ONS: � C!� Q 0 _INAVEAN�WILLMAINTqINACERTIFICATEOFCONSENTTOSEIF-INSUREFORWORiCERS' _, COMPENSATION,AS PROVIDED BV SECTION 3�0o OF THE IABOR CODE,KOR THE PEPFORMANCF U' ¢ OFTHEWORKFORWHICHTHISPERM17151SSVED. � 0 � '�_IHAVEAND'MLLMAINTAINWORKEiiS'WMPENSATIONINSURANCE,ASREQUIFEDBYSECTION ' Q 3]DOOFTHELABOqCODE,FOFTHEPERFORMANCEOFTHcWORKFORWHICHTHISPERM171S e,����� ISSUED.MV WORKEftS'COMPEN9ATION INSURANCE CARRIEA AND POLICY NUMBERARE: CONSTRUCTION w � CARRIER�31nPYl n�'�Noa�ti�nnal a�.aN aEviEw � POLIGV NUMBEFi �I-r�x.,¢A ELECTRIC Z ¢ � (iHISSECTIJNNE�fV�TBEGOMPLE�EDOFTHEPERMRISFORONEHUnDREDDOILARS(5700)ORLESS). PLUMBING Z I CEFiTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUED,I MECHANICAL (�3 SHALLNOiEMPLOYANVPERSONINANVMANNERSOASTOBECOME5U8JECTTOTHE � wORKERS'COMPENSATION LAWS OF CALIFOPI.'IA,AND AGREE THAT IF I SHOUL�BECOME INSPECTION FEE = SU&IECT TO THE WORKEPS'COMPENSATION PROVISIONS OF SECTION 3�0o OF THE LABOR CADE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE p DA7Er APpLICANT: SMIP � D w ENERGY P/C '--� WAFNING:FAILURE TO SECURE WORKERS'COMPENSATION COVEFAGE IS UNLAWFUL,AN�SHALL BE J � SUBJECTANEMPLOVERTOCqIMINALPENALTIESANDCIVILFINESUPTOONEHUNDRE�THOUSAND ENERGYPERMIT DOLLARS(ElOa.000),IN ADD:TION TO THE GOST OF COMPENSATION,DAMAOES AS PROVI'JED FOq M - � SECTION37080FTHELABORCO�E,INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: �. a CONSTRUCTION LENDING AGENCY PREALT FEE: ¢ IHEREBVAFFIRMUNDERPENAL'YOFPERJURYTHATTHEREISACONSTflVCT10NLEN,�INGAGENCY � FOR 7HE PERFORMANCE Of THE WORK FOR WHICH THIS GERM�T IS ISSUEO(SEC.309�,CIV.C_�. Z W � LENOER'S NAME F= LEN�ER'SAODRE55 w 1 CERTIFY THAT I HAVE READ THIS APPLICATION�AND STATE 1FIRT THE ABOVE INFORMFTION IS CORRECT. TOTAL FE ES '�S O � I AGREE TO COMPLY W1TH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS AFLATING TO B'JIL�ING � CDNSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTATNESOFTHISCOVNTVTOENTERUPOR'TIiE - Z A30VE-MENTIONEO PROPEFTY FOR INSPECTION P�'RPOSES. COMMENTS = T�1 71I1�)Y'Ligl]� QPERMITfEE NAME�PRIM) � Uj SIGNATUREOFPERMITTEE OATE _ � � � RECPT.NO. PAID BY VALIDATION ~ . NJHITE;Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy . ..d,��;�uy:s�3v��?z'J�'�.,+ts:,.�,l+e, J'b::��r.:�� ><u -�..�.,:.,,. �aw.,;:.; . .�- .. ,:,,...a..e.de 4st:;4�.n,�x . �v.a,:.<,:t!.�.aa.�rm:.r ,. n„:., . t. . ,� , ". ., , . .. . ... . ... � . .. . .� -.: �: ..;- .... .. ..;tr - � ....�� +a1tj ".�,'"' � F� s4�'P ��-"'':�.tl,��.,�k� �"+i�,1T �.�4`i �P.x.,a����8 .� x� : 84'J�`� �"'r�" f � ti�`":>n�.9' ,��� �g�� .'+ � k��` ,* .F. ��.. 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