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HomeMy WebLinkAbout14444 CITY OF DIAMOND BAR -----��' � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21G60 E.Copley Drive Suite 290 pRESS (909)850-3195 Fax(909)861-3117 ����%������� Bi7ILDING PERMIT APPLICATION FIRMLY : . . .. .--- .... ...•----....----.__...... ............... ... .. _... . . . . o AD RIESS �����A�E'9.'J�]1�'��/ L�'V� DATEICATION �� � PERMIT I (..I(_ NUMBER L 1_ � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER �F�-1�I C_�iA,NS� Q ADDRESS��� �d�Cec7'A��lY�'1"f� 1-"d'�1£ ZONING SETSACKS W CITY Di14�'TEN�S �_ ZIP�j__)��TEL(��i" gCnL'7�75- FRONT RW � � APPLICANT �t C(� �'��+�e TEII3wt�s"3-5�9-5 REAR � � �-- SIDEISlDESTREET_ RW �l � CONTRACTOFi�_��.a���aZ1C.. � SIDE 7 � ADDRESS � ^ '� pROPOSED USE S�it�� Cl.�-'��L't� o CITY �>tZ�� �[SP'i ZIP_51�,� TEL ' � �"' °/ - w ARCH/ENG/ �� z DESIGNER NO.DWEL. NO. NO. a ADDRESS —..--.— -� — UNI�'S_ STORIES BEDROOMS � CITV ZIP TEL.__ � DESCRlPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SFR/ADDlRE�W O p I HEREBY AFFIqM UNDEFi PENALTV OF PEPJl1FY THAT 1 AM EXEMPT FROM hiE CCNfRACTORS L� G2f8CJ0/CBfPDfi W CENSEIAWWRTHEFOLLOWINGREPSON(SEC.7031.5BUSINESSANDPROFESSIONSfADE:ANYCITYOR (n U CWMVWHICHREWIRESAPERMITTOCONSTRUC7,ALTER,IMPFiOYE,DEMOLISH,ORREPAIRANYSrtiUG W pati0/DBCk WTl1RE.PRIOR TO ITS ISSUANCE.ALSO REOUIRES TME APPLICANT FOR SUCH PERMI7 TO FILE A SIGNEO STATEMENT l{IAT HE Oq SHE IS LICENSEO PURSUANT TO THE PRWISIONS OF THE CONTRACTORS L:• �S CENSE LAW(CHAP7ER D(CAMMENCING WI7H SECTION 7oo0)OF DIVISION 3 OF 7HE BU51NE55 AND'PRO� �� PooVSpa X FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEHEFROMAh�THEBASISFORTHEALLEGEDEXEMP� -'-- �j TION.ANYVIOLFTIONOFSECTIONi091.5BVANVAPPLICANTFORAoERMITSUBJECTSiHEAPPLICANTTO Z Re-Roof � ACIVIL PENALTV OF NOT MORE IHAN FIVE HUNDRED DOLLARS(ESOo).): o ❑I,ASOWNEHOFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTIiFIP50LECOMPENSATON, � Commercial Z WILL DO THE WORK.AND THE STRUCTURE IS NOT INTENOED OF OFFFRED FOB SALE(SEC.70a4,BUSI� J - NES�AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES�OT APPLV TO AN OWNER OF � PpOVERTYNM11oBUILDSORIMPROVESTHEREON,ANUVhiODOESSUCHVJORKHIMSELFORHERSELFOR � � THROUGHHISORHEROWNEMPLOYEES,PFOVIDEDTHATSUCHIMPqOVEMENTSAREN071NTENOE�OR m QOFFEREDFORSlLLEIF,HOWEVER,THEBUR�INGORIMPROVEb1ENTISSOIDWITHINONEYEAROFCOMPLE� z TON,TME OYJNER�BUILDER WILL HAVE THE BUROEN OF PROVING THAT HE OR SHE DID NOT 9UIlA OR � IMPROVEFORTHEPURPOSEOFS/LLE). W ❑I,ASOWNEROFTHEPROPEHTY.AMEXCLUSIVELYCANTflNCTINGV/!THLICLNSEDGONTRACTORS Q TO CANSTpUCT THE PR0.IECT(SEC.7044,BUSINE55 ANO PROFESSIONS CADE.THE CONTRACTORS CI� va1l18II0f1 ADJ.AREA � CENSELAWDOESNOTAPPLYTOANONMEROFAPROPERTVWHOBUIl�50RIMPROVESTHEREON.AND -- W11oCONTRACTSFORSUCHPRalEC7SWIhiACONTRAC70H(SILICENSEDPURSUANTTOTHECONTRAG QUANTITV DESCRIPiION FEE TORS LICENSE LAW.). O ❑1 AM E%EMPT UN�ER SEC._ __ .B.&P.G FOF THIS RcASON U � _'-""'__-__'"'___ CL u' DATE OWNER__ "'_ -_ � W � LICENSED CONTRAC70RS DECLARATION W ` � IHEREBVAFFIRMUNDERPENALTYOFPERJUAYTHATIAMLICENS'cDUNDERPFOVISION50FCHAPTEi7 � / �'Ce_a�/� �� I d 9(COMMENCINO W17H SEGTION�ooa)OF DIVISION 30F THE 6USINESS AND PROFESSIONS CADE,AND Z 6 ��-+� � MY UCENSE IS IN FULL FORCE AND EFFECT. /{ � �"ln�s� � � LICENSE CU1SS `�� LIC.NO. (�J L�7 Q�P_` J �+ V DATE_��c � _ CONT.RACTOR-�i�J�'•"' --- J...�_�' a � W ' — � WORKERS'COMPENSATION sJECLARATION ���3{�" Q —__ � I HEREBYAFFRIM uNOER PENILLTY OF PEFLAIRY ONE OF THe'FOLLOW:NG OECIARM1T1045: � Cn Z "' Q — 0 I HAVE AND WILL MAINTAIN R CERTIFICAYE OF CONSENTTO SELF-INSURE FOF WORKERS' 2 � COMPENSATION,AS PHOVIDED BY SECTION 3700 OF TIiE LA60R GODE.FORTHE PERFORMANCE �U OF THE WOflK FOR WHICH THIS PFRMIT IS ISSUED. � p _' -- W �I NAVEAND WILL MAIMAIN WORKERS'COMPENSATICN INSU�NCE,AS REOL'IRED BY SECTION d 37000FTHE LABOR CODE,FOH 717E PER:-0RMANCE OF'HE N/0Ri(FOR WHtCH THIS PERM!i!5 0 ISSUEO.MVWAORKERS'COMPENSATIONINSURANACE�CARRIERANDPOUCYNUMBcqpqE� N `CONSTRUCTION ___......_ � CMRIERyc�'�^���.�N,�+.��/�rI Lfdytlh�' �� �ti} PIAN REVIEW ._. ..-- --.-- � POL�CVNUMBER_y�(�����i__.r��-___�----�i=�-- ELECTRIC .___.__._.__ d � � �1115SECIK:NNE�Id�7TBECUAeLETEDOF7F!EPERM'Tb'�RCtiEHUMklEDDOLtAiL9{51aD;ORLESS) PLUMBING .----.------..- -� + � MECHANICAL -- Z 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORN fOR N'HICH iH15 P[RMIT IS ISSJ[�,i -- -- — (!3 SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECOMF SU&IECT TO THE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,0.ND AGREETNAT IF I SHOl1LO BECOME INSPECTION FEE -------- --_`� SU&IECTTO THE WORNERS'COMPENSATION PROVI S OF C`ION 3700 OF THE LA90R � CODE.!S1iALLF RTNriITiCOMPLYWIiHTH0.SE OV I . ISSUANCE _ ___ _ -_.._-_— _. O ��/ SMIP � � p DATE://_/��APPLICAM: __ ' __ _- _—.-'-_____ .-- . . w ��T ENERGY P/C _ ..__ J WARNING FAILURETO SEIXIRE WORKERS'COMPENSATION OYE GE:S UNLAWFUL,AND SHALLBS --""'" "—'- LL SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT _ — DOLL4flS(5700,000�.IN AODITIIXJ TO THE COST OF COMPENSATIOh,DAMAGE3 AS PROV:DED FOA IN � � SEC710N 37oe Of hIE LABOR CO�E,IN7ERE5T,ANDATTORNE�"S FEES. _—_ RETENTION FEE: __� � :i � � CONSTRUCTION LEND!NGAGENCV PRE-ALT FEE: � � �g O .�` `�'- - i� � I HEREBYAFFIqM UN�ER PENALiYOF PERIURY THAT THERE IS A C045TR1iGTION LENDING AGENCV �yy FOR 7HE PEFFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). — .C?� ,1 T ` ,��'�.""Y'iI � c� .ra,..d g Z , .. . ...... ,.. .«....... . :....�. w ____ � LENDER'SNAME - _'__'__-___._—__'_-__'_._ 1_- LENDER'SAODRESS_ ---'-- . •�• . ,w�•.,..,..,��-"^�. � IGEHTIFYTHATIHRVEFEADTHISAPPLICATIONANDSTATETHATTHEA60VEINFOPMATiONISCORRECT. TOTAL FEES � � W IAGREETOCOMFLVWITHALLCITYANDCOUNNORDWANCESANDSTATEIAWSREIATINGTOBUILDING 1 � COFISTRUCTION,ANOHEREBYAUTHORIZEREPPESENiATIVE50FTHI5COUNTVTOENTERUPONTHE Z ABOVE-MENTIONEDPPOPER7VFORINSPECTIONGURPOSES. ceMMen�rs__.____.__—__._--__ . o . . ... . :. . ....:_.,-., � � �+�� -- -- m PERMITTEE N RI ---- a � . cn ._ — -- � smruru o a � e oate �� � ` pqlD BY VALIDATION RECPT.NO. ~ � WHITE-Department Copy.YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD--File Copy.GREEN-ApplicanYs Copy ���• .sr�' b<�G �';�3a��''�`"����'b��� �5,�e5�''< �r s- �,�,�w,�s.�, ,.�;��v.,t�:. 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