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HomeMy WebLinkAbout10384 CITY OF DIAMOND BAR �� COMMUNITY DEVELOPMENT DEPAR'A'MENT �-,.•�� C 21660 E.Copley Drive Suice 190 (909)860-3195 Fax(909)861-3117 y.\ j� PRESS '""'{ BUILDING PERMITAPPLICATION FIRMLY � JOBSITE J� ( � � APPLICATION PERMIT ^� •� • P/C o ADDRESS_��\���.�1 �(��� I '(�.► �► DATE j NUMBEF �' '� q $ ISSUE TYPE E OCC APN �,�- LOT RACT DATE CONST. GROUP p OWNER � C�v( p AD ESS �. ZONING SETBACKS Z CITY• � 'I l TEL. � '`� FRONT RW ❑ g APPLICANT '�'1.L TEL. REAR _ � � - SIDE/SIDE STREET � RW ❑ � CONTRACTOR SIDE ❑ ADDRESS � CITY ZIP TEL. PAOPOSED USE � �-��Yv<:'✓ w ARCWENG/� �, z DESIGNER ��� ,,,� � w �' _ NO.DWEL. NO. NO. a ADDR SS � CIN �- ZIP a' TEL. UNITS STQRIE BEDROOMS � cr� DESCRIPTION SQ.FT: FACTOR PSF ADJ.AREANALUATION � OWNER-BI;ILDER DECLARATION SFWADD/REM O I HEREBV AFFIRM UNDER PENALTV OF PERAI0.V THAT I AM E%EM7T FROM THE CONTqACTORS LI- (�jafBQB/CflfPOfl W CENSEUWFOHTHEFOLLOWINGREASIXJ(SEC.7031.SBl1SMESSMIDPROFESSIONSCODE:ANVCITVOR (n U COUNT/NMICHREOUIRESAPERMITTOCONS7RUCT,ALTER,IMPqOVE,DEMOLISH,ORREPAIRANY57qUC- W Patio/Deck Z TURE,PRIOR TO ITS ISSU/WCE,A150 HE�UIRES THE APPUCANT FOH SUCN PERMIT TO FIIE A 9GNE� w STATEMEN�7HRT NE OH SHE IS LICENSE�PURSUANT TO 7HE PROVISIONS OF TME CANTIIACTOqS Lb W � CENSE LAW�CHAPTER 9(COMMENCING WITti SECTION 7a00)OF DIVISION 3 OF THE BUSINESSAND PRP � POOVSpB FESSIONSCODE)ORiHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEf(EMP• (J V TION.ANYVIOLATKKiOFSECilON7031.5BVANVADPLICAN7FORAPERMITSU61ECT5THEFPPLICANTTO Z Re-Root � ACML PENALTY OF NOT MORE THAN FlVE HUNDRED DOLIARS(5600�.): Z ❑I,ASONMEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, Q �mmercial WILI DO THE WORK,AND hiE STRUCiURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.7o4a,BU51� J � NE55 AND PROFESSIONS COOE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PqOPEHTY WHO BUILDS OR IMPROVESTHEREON,AND WHO DOES SUCH WORN HIMSELF OR HERSELF OR Q THROUGH HIS OR HER OWN FAIPLOVEES,PROVIDED THA7 SUCH IMPROVEMENTS ARE NOT INTENDEDOR m 0 OFFEREDFORSlLLEIF.HOVJEIIERTHEBUILDINGOFIMPROVEMINTISSOLDWfTF11NONEYEAROFCOMPLE� Z 710N.THE OWNER-Bt11LDER WILL HAVE THE BURDEN OF PROVIN�THAT HE OR SHE UID NOT BUiL�OR � IAIPROVEFORTHEPURPOSEOFSALE} W ❑I,ASOWNEROFTNEPROPERTY,AME7(CLUSIVELYCONTFACTINGN7THLICENSEDCONTMCTORS � TO CANSTHUCT THE PHOJECT(SEC.7016,BUSINESS AND PHOFESSIONS COOE:THE CONTRACTOHS LI� V81U8110f1 ADJ.AREA W CENSEUIWOOESNOTAPPLVTOANOWNEROFAPROPERTYWF708UIL�SORIMPROVESIHEflEON,ANO � WNOCONTRACTSFORSUCHPROJECTSWITMAWNTRACTOfl�S�UCENSEDPURSUANTTOTHECOMRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � C I AM E%EMPT UNDER SEC B.8 P.C.FORTHIS REASON Q � U LL � �ATE OWNER V 0 W � LICENSED CONTRACTOflS DECLARATION W � I HEREBV I1FFIq1A UNDER PENALN Of PE0.IURV THAT I AM LICENSEO UNDER PROVI5104S OF CHAPTER � d D�COFIMENCING WITH SECTION 7000�OF DNISpN 3 OF THE BUSINESS AN�PROFESSIONS CODE,N10 Z lX MY LICENSE IS IN FULL FORCE AND EFFECT. m � LICENSECL4SS LIC.NO. j � J V DATE _ CONTRACTOR d W a� WORKERS'COMPENSATION DECLARATION � I HEREBV 0.FFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING OECLARA71ON5: Z � _INAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _ Q COMPENSAT�ON,AS PpOVIDED BY SECTION 97000F THE LABOR OODE,FOR THE PERFOHMANCE W Q OF THE WORK FOR WMICH THIS PERMIT IS ISSUED. � w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSUPANCE,AS RE�UIREO BY SECTION i Q 37000F THE IABOR CODE,FOR THE PERFORMANCE OF 7HE WORK WR WHICH hIIS PERMITIS ' � �� � � ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIE'R AND POIICV NUMBEHARE: CONSTRUCTION � � J - j CAFRIER PLAN REVIEW y�n 0 POLICV NUMBER ELECTRIC Q I�� 4 1 fY�Q� Q �!�••1 1 F a rx o ��sSEctiortr��noiBEca.+aEi�oFn+ErEn�rsrataaEt�x�nr�DDa�uu�S1m)a��EssA PLUMBING `� �. w .P Z I CERTIFY TH0.T INTFiE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PEHMiT IS ISSUED,I MECHANICAL J�/s •• C�, ' C7 SHALL NOT EM%.OY ANY PERSON IN ANV MANNER SO AS TO BECOME SU&IECTTO iHE � WOHKERS'COMPENSATIONLAWSOFCALIFOFNIA,ANOAGREETMATIFISHWLD9ECOME INSPECTIONFEE _ = SUBJECT TO TME WORKERS'CAMPENSATION PROVISIONS OF SECTION 37000F THE U1BOR - /T'�f CODE,I SMA1.L FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE � .��L V 0 p DATE: APPLICANT: SMIP ,_ � WARNING FAIWRE TO SECUfiE WORKFAS'COAIPENSATION CAVERAGE IS UNUWNL,AND SHALL BE ENERGY P/C � SUBJECTANEMPLOYEPTOCRIMINALPENALTIESANDCIVIIFINESUPTODNEHUNDREDTHOUSAND ENEHGYPERMIT DOLURS�5100.000),IN ADDITION TO THE COSY OF COAtPENSATpN,DAMAGES AS PROVIDEO FOR IN --- � SECTION 37080F THE LA90R CODE,INTEREST,AN�ATTOHNEY'S FEES. RETENTION FEE: OCONSTRUCTION LENDING AGENCV PRE-ALT FEE: � IHEflEBYAFFIRMVNOERPENALTVOFPERJURYTMATTH�qEISACONSTRUCTIONLEN0INGAGENCY FOR TNE PERFOHMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). Z W � LENOER'SNAME F- LENDERSADDRE55 � ICEFTIFYiNAiIHAVEFEADTHISAPPLICA710NqNOS7ATETHA7THEA60VEINFORMATIONISCORRECL TOTAL FEES W IAGHEETOCOMPLVWITHALLCYfYANDCOUNTYOR�INANCESANDSTATELAWSRELATINGTOBURAING � CONSTRUCTION,PND HEREBV AUTHORYLE REPRESENTATIVES OF THIS CAUNTY TO ENTER UPON THE ` S� AB9VE'RIEMIONED PROPERT'F INSPFCT URPOSES. 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