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HomeMy WebLinkAbout17592 (667) CIT'4'�F DIAMOND BAR ---�'�`� --- I9EPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES � ( � 21825 E.Copley Drive {909)86U-3195 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATIUN FIRMLY QJOBSITE J�y�.`9'�7 �J�f4�p �SLL`rR DATEC��'N eL�- �--�a�-. PERMIT ���� �#/C ¢ ADDRESS_6�/4/!� NUMBER o ISSUE TYPE OCC °T° APN LOT TRACT DATE CaNST. GROUP °C OWNER O ADDRESS_ � �� I�'/Y�� �" ZONING SETBACKS oCITY���.�"ZIP���TEL�'�'t--"-�L REART RW � p APPLICANT TEL.__=s� SIDElSIDE STREET RW ❑ � CONT6aACTOR � � �' SIDE CI � CITY �SS ZfP L. - PROPOSED USE y V°r�' � C' O -�� oARCH/ENG/ ����� � a 1� w DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORI S BEDROOMS = CITY ZIP TEL. � DESCRIPTION SQ,FT, FACTOR PSF ADJ.AREANALUATION u� � OWNER-BUILDER DECLARRTION SFWAD�/REM O � I HEFEBY AFFIRM UN�ER P�NpLTY OF PEFJIIFY THAT I AM EJ(EMPT FROM THE CONTRACTORS LI- � Garage/Carport W CENSELAWFaRTHEFOLLOWINGPEASON(SEC.7o37.5�BUSiNES5AfVDP50FE5510N5CODE:ANVCITYOR Z. CWNTYWHICHREQUIRE�SAPEflMITTOWNSTRUCT,A4TER.IMPROVE,DEMOLISH,ORREPAIflANYSTRUC- W Patio/Deck W' T�RE,PqIOR TO ITS ISSUANCE.ALSO REQUIRES THE APPLICANT FOP SUCH PEflMIT TO FILE A SIGNED w � �������STA7EMENTTHAT HE OR$HE,IS GCENSED PURSUAN7 TO iHE PROVISIONS OF THE CONTRAC'Oq5 Ll- CENSE LAW(CHAPTER 8(COlAMENCWG WITN SECTION 7000)OF�IVISIGN 3 OF THE BUSINE55 AN�PRO- u' POOUSpd , FESSIONSCODE)ORTHA7HEORSHEISEXEMFTTHEREFROM0.NOTHEBASISFOfli4EALLEGEDEXEMP- � VTION.ANYVIOLATpNOF5ECT10N7031.5BYANYAPPLiCAIYrFORAPERMiiSUBJECT57HEAPPLICANTTO z Re-Roaf �--'� �. ApVILPENALNOFNOTMORETMANFIVEHUNDRE�DOLLAflSfSSW).): Q ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITH3NAGESASTHEIRSOLECOMPENSATION, ❑ COmmerCial ` Z WILL 00 THE WORK,AND,THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BUSI- .J � . NESSAND PROFESSION5 GODE:THE CONTRACTORS LICENSE LAW�OES N�iAPPLV TO AN OWNER'JF = �'PROPERNWHOBUILOSORIMPFOVESih1EFiE0N,FNDWHODOE55UGHWORKH�MSELFORHEftSELFOR � 7HROUGHHiSORHEROWNEMPLOVEES,PROVI�EDiHAiSUCMIMPROVEMENTSARENOTINTEN�EDOR m W OFFEPEDWRSALE.IFHOWEVER,hiEBUILDINGORIMPElOVEMEN'ISSOL�WIiHINONEYEAROFCOMPLE- Z TION,THE OWNER-BNLDER WILL HAYE THE BURDEN dF PROV!NG THAT HE OR SHE DID NOT B111L0 OA � IMPROVEFORTHEPURPOSEOFSALE). ❑1,AS OWNER�F THE PqOPERTY,AM EXCLUSIVELY CONiRACTMG WITH LICENSE�CONiflAC70R5 Q 'TO CONSTRUCTTHE PROJECT(SeC.1044,BUSINESS AND PROFESSIONS COOE:THE CONTRACTOR3 LI�, ValUdllO� ��� AQI.AREA_ W� ''CENSE�LAW bOES NOTAPPLY TO AN OWNEfl OF A PFOPERTV WHO BUlLDS OR IMPROVES THERE-0N,ANO �', � � WHOCONTRACTSFORSUCHPflOJ6CTSWITHACqNTRACTOR(S)LICEN5EDPURSUANTT07HECONTRAC- QUANTITY DESCRIPTION FEE Y TORSLICENSELAW.7. � C I AM E%EMPT UNDEFi SEC. B.&P.0 FOR THIS REASON U � � � OATE_ � _aWNER U Z W o�. LICENSED CONTFACTORS DEGLARATION W ¢ � IHHiE9YAFFIRMUNDERPENALTYOFPERJURYTHAiIAMLICENSE�UN�ERPROVI5IONSOFCHAPTEfl � �'�., s(COMMENCI�JGWITHSEC'fION70p0)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE.ANO Z X�, MY LICENSE I$IN FULL fOflCE AND�,EFFECT. �� �S LICENSE CL45S ��� LIC.NO.�/ � V, DATE �'�� '�-�..�+— CONTRACTOR_�� d W �� WORKERS'COMPENSATION�ECLARATION a �' V �' IHEREBVAFFIRMUN�ERpENAI.NbFPERJURYONEOFTHEFOLLOWINGDECL4RATIONS: U� Q d� „INAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ COMPENSATION,AS PROVIOED BY SECTION 3]oa OFTHE LABOP COOE,FOP TNE PEAFOfiMANCF U Q OF7HEWORKFOftWHiCHlHISPERMITISISSUEo. � � w __IHAVEANOWILIMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREQUIREDBYSECTION ' p� Q 3�ooOFTHE�A00F2Ca�E,FOHTHEPERFORMANCEOFiHEVJORKFORWNICHTHiSPcRM1T15 � g�,� � ISSUE�.MVWORKERS'COMPENSATIONINSURANCECARRIERANOPOLICY MOERARE: CONSTRUCTION � rr° q ,S`�'��' �uic�l� � cqeeiER . PLAN REVIEW Z aoucrNUMs�a "�"�� ELECTRIC __ ¢ 4. ((HISSECTk]NNEmNOi6EDJMPLEiEDpFTHEPEPM715WRQVEHUN�RmUOLLARSi§100)ORLESSj PLUMBING Z��' ICEflTIFYTHATINT:IEPERFORMAVCEOFTHcWORKFOftWHICHTHISPEF1Ml'ISISSl1E0,1 MECHANICAL �'} SHALL NOT EMPLOYANI'PEFiSON IN dNY MANNER SOAS TO BECOME SUBJECTTO THE � WOFKERS',COMPENSATIONL4WSOFCALIFORNIA,AN�AGFEETHATIFISHOl1L�8ECOME INSPECTIONFEE SUBJECT TO THE WORKEFS'COMPENSA"f10N PHOV W"IONS OF SECTION 3700 OFTHE LABOfl � ' ISSUANCE r` -C.� CDOE,I SqHA�L�FOpRTHryWITH COMPLY WITH TqHO�SE PpFOVISIONS�. �*��y, ��-q, � �'°'.'Yal,'�(d�+"A __�+''�J�-'/ C�� � SMIP �Y ',v p oATE: PP,LICANT. _�_� _ *—.,s . J WARNINGFAILUPETOSEGYIHEWQRKERS'COMPENSATIONCOVERAOEISUNLAWFUL,ANOS�IALLBE ENERGYP/C � SUBJECTANEMP40YERTOCqIMiNALPENALTiESANDCIVILFINESUPTOONEHUNDFEDTHOU5AN0 ENERGYPERMIT ' DOLLARS(5100,OW1.INADDITIONTO'�.iHECOSTOFCOMP6N5ATION,DANAGESASPROVI�EDFOpIN J �. SECipN37CBOFTHELAHORCOO�,�,INTEREST,ANDATiOFNEV'SFEES. RETENTIQNFEE: � _' 0..� �'CONSTFUCTION LENOING AGENCY pRE-ALT FEE: O �;�'�, IHEREBVAFFIRMUN�ERPENALTYC�FPERJURVTHATTHEREISACONS7flUCtIONLEN�INGAGENCY . FORTHE PERFORMANGE OF TI1E WqRK FOfl WHICN THiS PERMIT IS ISSUED(SEC.3o9�,CIV.C.). Z W ' _ S�� �. LENDER'S NAME �. �. '� �ENDER'SA��RESS W�, �. ICEflPFYTHATIHAVEftEA�iHISAPPLICATiONAN�STATETHATTHEABOVEI4FORMATIONISCORRECT. TOTAL FLES � L����� �.��,IAGREETOCOMPLYWRH�LL�CITYANOCOUNTYORDINANCESANDSTA7EL4WSRELATINGTOBUILDING � �'� ':',CONSTFUCTION,AN�HERE6Y'AUTHOHIZEREPR=SENTATNESOFTNISCOVNTYiOENTERUPONTIIE �.����AHOVE-MENilONEOPROPEFlYVFORINSPEGTiONPURPOSES. COMMENTS � � ,I�iO'�'� � ����. 4 m ' PEF ITT ENAME�PRINi - Q �`+�/ � 9 _7�q (/JI. , �.'�.�y _.�� '4 —��r"m/M'���•-tf al.�. � SIGNATUFl O PERMITT � ', �ATE r Z RECPT.NO. 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