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HomeMy WebLinkAbout11141 ----�'=`�--- CTI'Y OF DIAMOND BAR •� COMMUNITY DEVELOPMEN'f DEPARTMENT `[" �; , -.,..� 21660 E.Copley Drive Suite 190 V (909)860-3195 Fax(909)861-3117 PRESS �'"""' BUILDING PERh4ITAPPLICATION FIRMLY } JOBSITE APPLICATION "� PERMIT p/� ,l./�j/1G) o ADDRESS� � , �- DATE NUMBER # ���� W ISSUE TYPE OCC APN LOT�-- TRACT DATE CONST. GROUP p OWNER �'��c'—� 'It�`��\�e>�'ICSL p ADDRESS`�-�`�'M� �.� t1�.j�-�., ZONING SETBACKS z CITY ,ZIP TEL. FRONT Ryy � � APPLICANT "t1 �TE � ' REAR n 7 z SIDE/SIDE STREET Ryy ❑ Q CONTRAC O ,LY�Q.-� SIDE � AD ,SS,� �'C" t'� � � CITY�C�C_`i��'C'>C_fl ZIP TEL. PROPOSED USE o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDRDOMS cn cn DESCRIPTION SQ.F1'. FACTOR P5F ADJ.AREANALUATION pC OWNER-BI;ILDER DECLAFATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRAC70RS LI- G8f8 0/Ce Dlt W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.5BU51NESSANDPROFESSiONSCODE:ANVCITVOF (n 9 � U COUNTYWHICHREOUIRESAPELiMITTOCANS'RUCT,ALTER.IMPROVE,�EMOLISH,ORREPAIRANVSTRUF Z TURE.Pp10R TO IT£ISSUANCE,ALSO REQUIRES THE APF+LICANT fOR SUCH pERMIT TO FILE A SIGNED W Patio/Deck � STATEMEN7 iHAT HE Ofl SH[IS LICENSEU PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U- � � CENSE LAW;CHAPTER 9(COMMENCING WITH SECTION 7000)OF�IVISIDN 3 0F THE BUSINESS AND PR0- POOUSpd �� � FESSIONSCODEIOR7HATHcOR5HEI5E%ENPTTHEREFROMANDTHEBASISFORTHEkLLEGEDEXEMP- (� 1 U TION.ANYVIOLATIONOFSECTION7031.56YANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO z Re-Roof '� ` ACIVILPENALTYOF NOT MORE THAN PIVE HUNDRED�OLLARS�$500).): � � � ❑I,ASOWNEfiOFTHEPfiOPERTKORMYEMPLOYEESWITHWAGESAS7HEiRSDLECAMPENSATION, ❑ CommefCiel l Z WILL DO THE WORK,AN�7HE STRUCTIiRE IS NOT WiFNDEO OR OFFEFEO FOR SALE(SEC.]044,BUSI� J J � NESS AN�PPOFeSSIONS CODE:THE COMRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNEP OF � PROPERTY WHO BUILOS OR IMPROVES THEREON,AN�WHO�OES SUCH WORK HIVASELF OR HERSELF Oq + � THflOUGHHI50RHEROWNEMPLOYEES,PROVIDE�THATSUCHIMPROVEMENTSARENOTiNTENDEDOR m w OFPEREDFORSALE.:F,HOWEVER,THEBUILDINGORIM?ROVEMENTISSOLDWITHINONEYEAROFCOMPLE- � TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF�ROVING THAT HE OR SHE OIO NOT BUItD OR Z IMPNOVEFORTHEPURPOSEOFSALE�. _ ❑I,ASOWNEROfTHEPROPER7Y,AME%CWSNELYCONTRACTINGWITHLICENSEDCONTRACTORS W � 70 CANSTRUCT iHE PROJECT(SEC.7a44,BUSINESS AND PROFESSIONS CO�E:iHE CONTRACTOHS LI- �Veltldti0ll ADJ.AREA W CENSELAWDOE540TAPPLYTOANOWNEROFAPROPERTVWHOBU�L�SORIMPROVESTHEREOtJ,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTNECONTFAC- QUANTITY DESCRIPTION FEE Y TORSLICENSELAW.J. Q ❑I AM E%EMPT UNDER SEC. 9.&P.C.FOR THIS REASON Q � U � � (7ATE OWNER F- Z W � LICENSED CONTRACTORS DECLARATION W 4 OC IHEREBVAFFIRNUNDERPENALTYOFPERJURVTHATIAMLICENSEDUNDERPROVISIONSOFCHAPTER � � 9�COMMENCINGWIT45ECTION7000)OFDIVISION30FiHEBUSINE55AN'JPROFESSIONSCODE,ANO Z 1X MY LICENSE IS IN FULLFORCEANO EFFECT, m � LICENSE CLA LIC.NO.���4 = U DA7E\��� � CONTRACTOF7}"� C, d W � WORKERS'COMPENSATION DECLARATION w�' ,a � IHEREBYAFFIRMUNDERPENALTYOFPERJURYONEOFTMEFOLLUWINGDECSFRATIONS�1�� z ZIHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTiOSELF-INSUREFORWORKEFS' ¢ fAMPENSATION,AS PROVIDED 6V SECTION 3]ao OFTHE LABOR CODE,FORTHE PERFORMANCE C� Q OFTHE WCR'{FOR WHICHTHIS PERMIT IS ISSUED. � w _I HAVE AND WILL MAINTAIN WORKERS'COh1PENSATION INSU3ANCE,AS RE�UIRED BY SECTION Q 3700 OF THE LABOR COOE,FOR'HE PEFFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 0 ISSUE�.1 WORKEFS' MPENSA SURANCEC RIERANDPO'�_ICYh'UMBERARE: CONSTRUCTION 4 J �Z1�,� �v+c�� j cAflRiER_ / PLANREVIEW t Z POLICY NUMBEA�lY ��,--.r ELECTRIC ¢ � (IHI56ECT10NNEmNOTBE�NPIETEDOFiHEPERNfTISFORONEHUrARE��OLLARS(E1ooJORLESS}. PLUMBING W Z 1 CERTIFY THAT IN THE PERFORkANCE OF THE WORK FOR WHICH iH15 PERMIT IS ISSUED,I MECHANICAL ('3 SHALLNOTEMPLOYANYPERSONWANYMANNERSOASTOBECOMESV&IECTTOTHE �/7 WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREETMAT IF I SHCULO BECOME INSPECTION FEE w SUBJECTTO THE WORKER5 COMPENSATION PROVISIONS OF SECTION 37ooOF THE LABOH � CODE.I SMAIL�ORTHWITH COMPLY WITH THOSE PROYISIONS. � ISSUANCE � � Q p DATE:\'\ � 1 APPLI N� SMIP L W J WARNING:FAILUflETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFtJL,ANDSHALLBE ENERGYP/C � SUBJECTAN EMPLOYER TO CR:MINAL PENALTIES AND CIYIL FINES UP TOONE HUNDREO TMOUSAN� ENERGY PERMIT DOLLARS(ElaO,oaa„IN ADDITION TO THE GOST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION37080FTHELABORCODE,INTEREST,AN�ATTORNEY'SFEES. RETENTIONFEE: OCONSTFiUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBYAFFIqM UNDEF PENAL7YOF PERJURV THAT THERE IS ACONSTFUCTION LENDMG AGENCV ZFOR THE PERFOFMANGE OFTFE WORK FOR WHICH THIS PERMIT IS ISSUED jSEC.3097,CIV.C.�. ' W � LENDER'S NAME !— LENDER'SADDRESS � /� w �CERTIFVTHATIHAVEREADTHISAPPI.ICA'�IONANOSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTf1L FEES � � IAGREETOCOMPLY\VITi1ALlCITVANDCOUNTYOR0INANCESANDSTATELAWSRELAiINGTOBUILDING ' � CONSTRUCiION,ANO HEREBY AUTHORIZE FEPRESENTATNES OF 7HIS COUNT'I TC ENTER UPON THE Z ABOVE-MENTIONED PROPERTV FOR INSPECTION Pl1RPOSES. COMMENTS � -�OC�..�V r-, 'CY1���e..�—, _ m TTEE El�4Ed (P� `' \^ ' . Cn `� \l � �.; . Uj SIGNATUREO PERM'�TTEE DATE /Q� � RECPT.NO, PAID BY VALIDATIO °4 WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy , .,:�: . .. ;,. ,, .. .. �i,A� i ...' . . ... . ... .. . .�. ... .�.. 'a. y. .. � � y - ,.�. �� - • : �.�.. -c�"� �. . > .. .,.�.;:,.a � .w�r F,;�-:CRP ,.'���t��.�w`;',rt"�.Y,1„ , � m�.*�- � . . . ... . , , . .. _., . �w' . ,, ... . . 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