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HomeMy WebLinkAbout17206 (446) _ __ _ __-�.----. CITY OF DIAMOND BAR � � I3EPAR'TIO�NT OF COMh�UN1TY&DEVELOPMENT SERVICES - 21825 E.Copley Drive ' , (909)860-3195 Fax(909)861-3117 PRESS '`'%.v��'�' ' BUILDWGPERMITAPPLICATION FIRMLY � JOBSITE APPLICATION PERMIT P/C � a ADDRESS� � DATE �� J "� NUMBER� # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER ' I 1('f.d��l3e C�.� ADDRESS ZONING SETBACKS oCITY � '�l� Zlp��TEL. ' FRONT RW ❑ APPLICANT � TEL. REAR ❑ � SIDE/SIQE STREET RW ❑ z � CONTRACTOR I �, SIDE ❑ o ADDRESS � PROPOSED USE "" CITY ' ZIP /' � �TEL. � I w 'ARCHlENG/ � z DESIGNER I NO.DWEL.���G���r��K10. NO. y 0. ADDRESS ' I UNITS STORIES BEDROOMS � Ci�`f ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/1lALUATION p� � 0 NER-BUILDER DECIARATION SFWADD/REM � O 0 I HEREBY AFFI,RM UNDER�P NALTV OF PEPJUflY 7HAT I AM E%EMPT FiiOM THE CONTRAC?ORS LI- GdBgE/C81pOft � W CENSELAWFORiMEFOLLOWINGREA30N(SEC.7031.58USINESSANDPflOFES510NSCODE:ANYqTYOFi (J� U COUNTYWHICHREQUIRESAPER ITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR9EPAIRANY£TRUC- W pgi10/DBCk � Z ��TURE.PRIOR iLl ITS ISSUANCE, LSO RE�WIRES iNE AP?UCANT FOR SUCH PERMIT 70 FILE A SIGNE� � W STATEMENF THpT HE OR 6NE 5 ICENSED PURSl1ANT i0 iHE PFIOVISIONS OF THE CONTAACTORS LI- W � CENSE LAW(CHAPTER B(COMME�'CING WITH SECTION�o00j OF�IVISION 3 OF THE BUSINESS pNU PRO- � PooUSpa � � �FESSIONSGODE)OR'HATFIEOR$HEISE%EMPTTHEREFHOMANDiHEBA5ISFORTHEALLEGEDEXEMP- (� V' '.TION.ANYVIOLATIONOFSECTIONI7031.SBVANYAPPLICANTFORAPERMITSU&lECTSTHEAPPLICANTTO z R0-ROOf �A CIVIL PENALTY OF NOT MORE TWAN FIVE HUN�fiED DOLLAFS(5500).): ❑I,ASOWlJEROFTHEPROp RN,ORMVEMPLOVEESWITHYJAGESASTHEIRSOLECOMPENSATION, � COffIRIB�GIOI �' �WILL�O THE WOPK,AND THE ST�UCTURE IS NOT iNTENDED OFt OFFEREO iOR SpLE(SEC.7�c4,BUSI� J �' ��.NESS AN�PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW OOES NOTAPPLY TO AN OWNEA OF � ''PROPERTYWHOBUILDSORIMPqQQ VESTHEREON,ANDYVHODOESSUCHWORKHIMSELFORHERSELFOq [C �TNROUGHHISORHEROWNEMPL�YEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENOEDOR m Q �.OFFEREOFORSALE:IF,HOWEVER,iHEBUIL�INGORIMPROVEMENTIS50LOWIiHINONEYEAROFCOMPLE- Z ,TION,THE d�NNER'.BUIL�ER WILL HAVE iHE BURDEN OF PROVING THAT HE OF SHE�ID NOT BL/1LD OR �., ��.IMPROVEFORTHEPURFOSEOF ALEJ. W., �� ❑I,A90WN�ROFTHEPRO ER?Y,AMEXCLUSNEIVCON'RACTWGWIiHLICeNSE�CONTRACTORS [r' �TO CONSTRUCT iHE PROJECT(S C.7044,B1151NES5 AN�PROFESSIDNS CADE:THE CONTRACTORS LI� V8IU2110f'� PJ�+ ADJ.AREA , W'� 'CENSELAW�OESNOTAPPLVTO NOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHERC�J,AN� ��� ��WNOCONTRACTSFORSUCHPRO�ECTSWITHACONTAACTOR(S)LICENSEDPL1pSllANiiOTNECONTRAG QUANTITY DESCAIPTION FEE � ' �TOflSLICENSELAWJ. ' i �'� � ❑I AM EXEMPT UNDER SEC._ B.8 P.C.FOR THIS REASON U ' � � LL �ATE DWNER � � Z' W Q� LICEN ED CONTRACTORS DECLARATION J � � CC � I HEREBV AFFIRM UNDER PENAL7�OF PERJl1RYTHAT IAM LICENSEO UNDER PFOVISIONS OFCHAPTEF � Q.. .:9(COMMENCING YJIiH SECTION 7 00]OF DIVISION 3 0F THE BUSINESSAND PAOFESSIONS CODE,AN� .Z X '.MV LICENSE IS IN FULL FOftCE AN EFFECT. W .p [O o�. UCENSEC, SS �:�� LIC.NO.�� �.�- j . U'. '�ATE �� ��� CONTRACTOR ___ a W � WORKF�RS'COMPENSATION DECLARATION ¢ , U � IHEREBYAFFIRMUNDERpENALT110FPERJURYONEOFTHEFOLLOWINGOECLARATIONS: Z 0 _IHAVEANDWILLMAINTAII�ACERTIFICATEOFCONSENTTOSELF-INSUREFORWOPKERS' _ . ¢.' COl,APENSATION,AS'PROV'DED BY SECTION 3�0o OF iHE LABOR CO�E,FOR iHE PERFORMANCE �U OF THE WORK FOR WHICH THIS 7ERMR IS ISSUE0. � � ��� _IHAVEpNDWILLMAINTAI WOPo(�R$'CAMPENSATiONI'JSUftANCE,ASFE�UIREDBYSECTiON � Q.� 37a00FTHELABp:RCODEFORTHEPERFORMANCEOFTHEWORKFORWHiCHTHISPERMITIS r� J ISSUED.MYWOR� Ry5' TIONINSURANCECARRIEftANDP JCYNUMBERARE: CONSTRUCTION Vft j cpaaieq ._ PLAN REVIEW Z�. POLICYNUMBER ELECTRIC ____ _ _ _ _ � Q R}il$SECTKKJNEmNOTBE PLEfEDOFTHEPERM,TISFCAIXJEHUN�RED00LLAP5(5100)OqLESS). PLUMBING W ('� — � I CERTIFYTHAi INTHE PEF�FORMANCE OFTHE WOflK FOR WHICH 7HI5 PERMIT IS ISSUED,I MECHANICAL . (,� SHALLNOTEMPLOYANYPIERSONINANYMANNERSOAST09ECOMESl1BJECiTOTHE � !'/ � a . [n WOflKEHS'CQ�PENSATIONLAWSOFCALIFOP,NIA,ANDA6FEE7HATIFI�HOULDBECOME INSPECTIONFEE . = SUBJECiTOTH6WORKE S'COMPENSATIONPROVlSIONSOFSECTION3'looOFTHELABOP �, ,✓1 a COOE,I SHALL PORTHWIT COMPLY WITH THOSE PROVISIONS. ISSUANCE �� R �b i`1 r"a J's.+t �v( Q . SMIP ��� " �� p DATE: A�PLICANT: i J WAFNINGFAILUflETOSECUREW�AKEqS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C r��-.... �j SUBJECTANEMPLOVERTOCRIMINf�AIPENALTIESPND�CIVILFlNESUPTODNEHUN�FIEDTHOUSAN� ENERGYPERMIT �:. y tl -- — DDLLARS(5��.a00),INADpITIONTbTHECOSTOFCOMPENSATION.DAMAGESASPflOVIOEDFORIN .-_._ .,, , .,. _ G,0 � SECTION37080FTHElABOpCOD�,INTEREST,ANOATTORNEY'SFEES. RETENTIONFEE: �• � COf�STRUCTION LENDING AGENCY pRE-ALT PEE: _ � IHEREBVAFFIRMUNDERPENALlVIOFPERJURYTHATTHEREISACONSiRUCTIONLEN0INGAGENCY a FORTHEPERFORMANCEOFTHEWOFKFORWHICHTHISPERMITISISSUED�SEC.309].CIV.C.). 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