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HomeMy WebLinkAbout10625 - CITY OF DIAMOND BAR COMMUNTI'Y DEVELOPMENT DEPARTMENT .,.,w 2I660 E.Copley Drive Suite 190 PRESS (909)86P-3195 Fax(909)861-31]7 '^^" BUILDING PERMCI'APPLICATTON FIRMLY .,�. . .... - - . ._ � JOBSITE �,�,,� APPLICATION x �'"� PERMIT �'1/ P/C o ADDRESS e�I"lu/C, . DATE v ~ � " � NUMBER V� � . # $ ISSUE TyPE OCC APN L T TRACT DATE CONST. GROUP p OWNER � ADDRE ZONING SETBACKS Z CITY ZIP TEL. FRONT RW � g APPLICANT TEL. REAF ❑ � SIDFJSIDE STREET RW ❑ � CONTRACTOR ��2��nw� SIDE C o ADDRESS PROPOSED USE CITY R nl -� TEI._ o ARCH/ENG/ �U��A S'I7$$ Z OESIGNER NO.DWEL. NO, Np, a ADDFiESS UNITS STORIES BEDROOMS � CITY 21P TEl. — � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BI;ILDER DECLARATION SFR/ADOlREM O I HERE9V AFFIRM UNDER PENALTY OF PERJIJRY THAT I AM E%EMPT FROM h1E CONTRACTORS LI� G8fd9B/C3fPOR W CENSEUWFONTHEFOLLOWINCREASON�SEC.7D3f.50USINE55AfJDPROFESSIONSCODE:ANYdT'OFi (n COUNTYNMICHREWIRESAPEflMITTOCONSTFUCT.ALTER.IMPROVE.OEMOLISH,OFREPAIRANVSTFUC. w w TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE qPPUCANT FOR SUCH PERMIT TO FlLE A SIGNED W PatiolDedc STATEMENT THAY ME OR SHE IS UCENSED PURSUANT TO THE GROVISION5 OF TME CONTqACTOqS LI� � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION'l000)OF DIVISION 3 OF THE BUSINESS AMb PRO- LL' POOUSPB FESSqN&CODE)OflTHATHEOR5HE15EXEMPTTHER�FRQdANDTMEBA515FORTHEALLEOEDExEMP� (' � TION.ANVVIOLATIONOFSECTION7a3t.58YANVAPPLICANTFORAPERAlITSUBJECTSTNEAPPLICANTTO z Re-Roof � ACIVfLPENALTYOFNOTMORETFWNFIVEHUNDFEDDOLLpR5�f500).): G I.AS OWNER OF 1HE PROPERTV.OR MY EMPLOVEES W ITH WAGESAS THEIR SOLE COMPENSATION, Z � Commercial WILL DD TNE WORK,AND THE STRUCTURE IS NDT iNTENOED OR OFFEREO FOR SALE�SEC.7D4�,BU51• J � NESS AN�PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF ? PROPER7Y WHO BUIL0.S OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSEIF OR HER5ELF OH � THROUGHH�SORHEROWNEMPLOYEES.PHOVIDE�THAiSUCHIMPROVEMENTSARENOTINTENOEDOfi C� QOFFEREDWRSALE.IF,HOWEVER.hiEBUILDINGORIMPROVEMENTISSOLDWITHINONEVE0.qOFCOMPLE� � TION,TME OWNER•BUIIDER WILL HAVE TME BUflOEN OF PFOVING THAT HE OR SHE DID NOT BUIL�DR � IMPROVE FOR THE PURPOSE OF SALE). w _I.ASOWNEROFTHEPFiOPERTY,AMEXCLU5IVELVCONTRACTINGWITHLICENSEDCONTR�CTORS (r TO CONSTHUC7 7HE PR0.IECT(SEC.7oa4,BUSINESS AND PROFESSIONS CODE:7HE CONTR4CMRS LI- V81uBtiDn ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFRPROPERTYWHOBUILDSORIMPROYESTHEREON,AND � WNOCONTRACTSFORSUCH7ROJECTSWITHACONTRACTOR(S�LICEN6EOPl1R5UANTTOTHEfAMRAP QUANTITY �ESCRIPTION FEE Y TpqS LICENSE IANA). � �1 AM EXEMPT UNOER SEC. B.8 P C.FOR THIS REASON Q � U � � DATE _ OWNF_R U 0 W ��[ LICENSED CONTRACTORS DECLARATION W CC IHEREBVAFFIRIAUNDERPENALTYOFPERJUNVTHATIAMLICENSEDUNOERPROVISIONSOFCHAPTEp � /�'} ' 1 p_, B(COMMENCING WITH SECTION 7000)OF OMSION 70F THE BUSMESS AND PROFESSbNS CODE,AND Z G(/ � �X MY LICENSE IS IN FULL FORCE AND EFFECT. m � LICENSE 55 C�_ LIC.NO. j � J V DATE CONTRACTOR d W � WORKEF75'COMPENSATION DECLARATIDN Q � IHEREBYAFFIRMUNDERPENM.TVOFPERJURVONEOFTHEFaIAWINGDECLARATIONS. Z � _IFIAYEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSEIF�INSUREFORWORKERS' _ � COMPENSA710N,ASPROVIOEDBVSECTION37o00FTHElABORCODE.FORTNEPERFOHAIANCE 'U Q OFTHEWORKFORWHICHTHISPERMITISISSUE�. � � _INAVEANDWILLMAINTAINWORKERS'CAMPENSATIONINSUPANCE.ASREQUIIy�OBYSEC7KKi Q 3TooOFTHELA80RCODE.FORTHEPERFORMANCEOFTHEWORKFORWH�CHTHISPERM1T15 ISSUEO.A1V WORKERS'COMPENSATION INSURANCE CARNIEP ANO POLICY Nt1M9ER ARE� CONSTRUCTION J - j CARFIEH PLAN REVIEW � � POLICY NUMBER ELECTRIC . � Q 0 (IFiLSSEC7ICNNE�NOTBE00MPLE7EDOFh1EPERAMISFORqVEHIMY)FEDDOlUiRS(SiaDlCfiLESS). PLUMBING Z I CERTIFYTHAT INTHE PERFOHMANCEOFTHE WOflK FOR WHICH THIS PERMR IS ISSUED.I MECHANICAL (,�} SHALLNOT EMP�OY ANY PEHSON IN ANV MANNER 50 AS TO BECOME SUB.ECT TO THE Uj WOFKERS'COMPENSATION IAWS OF CALIFORNIA AN�AGREE TMAT IF I SHOUL�BECOME INSPECTION FEE � ? SUBJECTTOTIiEWORNERS'CAMPENSATIONPROVISIONSOFSECTIONe7000FTHEl�1BOR -- , � CADE.ISHALLFORTHWI7HCOMPLYWITHTHOSE OYISIDNS. ISSUANCE � ���,g.� ��.�- p �ATE:Q/�"�` APPLICANT: SMIP _'__ J WARNING FAILURE TO SECURE WORKERS'COMPENSA710N COVERAGE IS UNUWFUL,qND SHALL BE ENERGY PIC Q1 [� � SUBJECTANEMPLOYENTOCRIMINILLPENALTIESANDC!VILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT y���I'� � � �'T� DOLIARS(Si OO.00D).IN AODITION TO THE COST OF COMPENSATION.OAMAGES AS PROVIpED FOF IN ¢ SECTION 3TOB OF TNE IABOR CA�E,iNTEREST,ANDATTORNEYS FEES. RETENTION FEE: ' d CONSTRUCTION LENDING AGENCY pRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENAIN OF PERJURY THATTHERE IS A CONSTRUCTION LENDING AGENCY ___ FOR TNE PER WFMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.300'),CIV.C.�. Z w — � LENDEF'S NNAE ..,.. .. ... � . .. . . ,.. . I- LENDER'SADDRESS _ w ICERTIFY7HATIMAVEflEPDTHISAPPLICATIONANDSTATETHATTHEIIBOVEINFORMAT10NI5CORflECT. TOTAL FEES a3. I� ~ � 1 AGREE TO COMPLY WIrH ALLCT'AND CAUNTV ORDINANCES AN�STATE LAWS RELATING TO BUILOING � CONSTRUCTION,ANDHEREBYAUTHOflIZEREPRESENTpT�yESOFTHISCOUNTVNENTERUPONTHE Z A80VE-MENTIONEDPROVERTVFORINSPECT�ONPURPOSES. COMMENTS � � � -._ .... .. .. .. . .. . ... m PERMITTEE NAME IPRINn � j � . � SIONATURE OF PERMITTEE �ATE ' = R6CPT.NO- PAID 8V VALIDATI ~ WHITE—DaOartment Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—Fila Copy.GREEN—ApqicanYs Copy ' _,.,..,.,_,�,....,,��,a.�.,.....,,,.�-.,..w...�-..,,.�.z�,,,....a,..-..-„-..�,c�....».,..,a,,,.«.,�,.....�..._..,.��...�.»�s:-�u�..�,.��-._....- - ,r,-:—,,,�.;r., ,„,=•=,x...�.�,,:... ,„.� . .-...,.. ,b.,;.,,,.�- , k , ...,.:.�:.a� .,..,,c-. . %..a .. .. ., .��,Y.nr, , . ..,. ,.�„.. . v:�sw r. .... .;,s::p, ti'^�t . . . .. . . . . . ., '��'�. ,""�.!w�'..y :Ja.q�c ,� ^ � . . . ., ' `'r,-, �r,°. 5 x:, . , .,. , ;M,y,yc.,v . 4e1� iI� D'I�1Ai�AiJ�MlJ ��P� &4Yw�rG4r Y i49CV R1���A"t� � - . . . � s e � � �. - , �k �..� ��:a'ci....�. . ` ■ p � :�: :. ._ ,_...:_....., i . • . . �. � O . .�,. .n . ...... . .� . � . , ., ..... . .� .. ... _ ' _ .. .... . . . . � '.. SET BACK ::. -� � ; FLC��R JQlST ' I .. ., . ___.._.. . ,; --- — -�---------- -+--------- ----- FTGS/FOFiMS/STEEL ' :."�:.;: T: FHA�iEQMTS .., , . . , . _. - -- -------__ _ -�------------ ---- ,���� - -�.� ELECYRIC GROUND - . t I �)NbER !=LOOR DUCT � •� � '�`�` '� � � �--*-r-----�:----�----=�--- �- -;:°=,'-=;== +- ,---.� GROUND�'LtJMBING � � UiVDER r-LddR;-CG��i!DUIT ,. k,,.;, � ..• �_ �—�—_• , , . �y.,;r � SI..AB GRADE - -- ._-- _. �.FI(�EPLACE�(�UfVQATI�ON I ' ''�•, ...i -1------ TcMP POWER -- --- I � ' FIREPLACE BC�ID BFARP ' ,A+,;:`• ..�'f,i: �� � .. -.-1-=-------- — --- — �= •------ ______ WaTER SERV'IC�E� • .., � - < ,.,,. .-�--- M1D H7. S�f�N�,�'t��h. 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