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HomeMy WebLinkAbout15520 (222) ■ ti-. ��� _ CITY OF DIAMOND BAR � DEPARTMENT OF COMMiJNITY&DEVELOPMBNT SERVICES 21660 E.Copley Drive Suite 190 " (909)860-3195 Fax(909)861-3117 PRESS �����°�\ BUILDING PERMIT APPLICATION FIRMLY v DDRESS •���V ��v C���i�i4l_ Cj iZ. P�+ �=,�h�317(yy DATE CATION X J I � PERMIT IS�`,' �lC U NUMBER � ISSUE G� �/ l �r ` J TYPE OCC APN LOT TRACT DATE 0 � V'� CONST. GROUP p OWNER �Z7AV�!7 f"1 iYe'�l�R� p ADDRESS �2^v c7 Cs ' 'i�i-- �l��. ZONING SETBACKS W CITY U1+4 Q �+�i. �/�t ZIP�TEL. ��`� b�•`fc�, FRONT RW ❑ � APPLICANT ��J'ii?T I�1���4N.4�"v'1 TEL. �t fi�•'•fo REAR ❑ � SIDEJSIDE STREET RW ❑ � CONTRACTOR SIDE � � ADDRESS CI7Y ZIP TEL. PROPOSED USE o ARCWENG/ z DESIGNER — w NO.DWEL. NO. NO. n_ ADDRESS � CITY ZIP TEL. UNITS STORIES _ BEDROOMS � v� DE5CRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNEfl-BUiLDER DECLARATION SFR/ADD!FiEM O 1 HEREBY AFFIRN UNDER PENALTY OF PERIURY iNAT I AM EXEAIPT FPOM THE CONTRACTORS LI� G8f89BK'i8fG1011 W CENSEUWFORlHFFOLLOWINGREASON(SEC.lo31.5BU51NE55ANDPROFES510NSCODE:ANYC:TYOR (n U GWMYYyMIC1iHEWIRESAPERMITTOGONSTRJCT,ALTER,IMPFOVEDEMOLISH.ORqEPPIRANYSTRUC� W patio/Deck � NqE.PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPUCAN7 FOR SUCH PERMIT TO FILE A SIGNFA W STATEMENT TFIAT HE OR SHE IS UCENSED PUflSUANT TD TME PHOVISIONS OF TME CONTRACTORS U� � CENSE LAW ICFN7TEH 9(COMMENCING WITH SECTION 70W)OF DIVISION 3 OF THE BUSINESS AND PRO- LL' POOUSpB FESSIONSCODE)OHTHATHEORSHEISEXEMPTTHEREFROMANDiHEBR515FORTHEALLEGEDEXEMP� (� TION.ANYVKKl.TqNOFSECTION7031.5BYAMYAPPLICANTFORAPERMITSU9JECT5THEAPPLICANTTO z Re-Roof � A CML PENALTY OF NOT MORETHAN FNE HUNDRm DOLURS(5500).): � ❑I,ASONMEROFTHEPROPEHTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, Q COfIIfTIBfCl21 WILL 00 THE WORK,AND TFIE STRUCTURE IS NOT INTENDED OR OFFEREO FOfl SALE(SEC.7044,BU51� J � NESSAND PROFESSIONS WOE:THECANTAACTORS LICENSE LAW DOES NOTAPPLYTO ANOWNEF OF � PROPERTY NRIO BUILDS OH IMPROVES THEREON,ANO VYF10 DOES SUCH WORKHIMSELF OR HERSELF OR � THROUGHHISORHEHOWNEMPLOVEES.PROYIOEDTHATSUCHIMPROVEMENTSAqENOTINTENDEDOR m OOFFENEDFORSILLEIF,NOWEVER'M�BUILUIN60RIMPROVEMENTISSOLDWITHINONEYEAHOFCD6APLE� Z TION,THE OWNEN-BUILDER WILL HAVE TNE BUADEN OF PqOVING THR1 HE GR SHE�IO NOT BUILO OR = IMPROVE FOR THE PURPOSE OF SALE). �1,AS ONTlER OFTHE PROPER7V.AM EXCLUSIYELY CANTRACTING W ITH UCENSED CONTRACTOqS Q TO STRUCT THE PRWECT(SEC,toM,BUSINESS AND PROFESSqNS CCDE:THE CONTRACTORS ll� VBI11821011 ADJ.AREA L.L� GENSEUWDOESNOTAPPLYTOIWONMEROFAPROPLRTYriHOBUILD50RIMPROVESTMEREON,AND - Z NRiOCONTRACT5FOR5UCHPflQ1ECT5WITHACONTRACTOq�S�LICENSWPURSUANiTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORSLICENSELAW.�. � ,7 I AM EKEMPY UNDER SEC. F3.H P G FOR THIS REASOhl J � o a 3 � . � � DATE ��' � OWNER U 0 w �Q LICENSED CON7RACTORS DECLARATION w 2 1 HEREBV AFFIRAI UN�ER PENA;.TY OF PERIURV TNAT I AM LICENSED UNOEF PROVISIONS OF CHAP'fER � � B(COMMENCINOWITHSECTKKJ7oCaJOFDNIS�ONaOFTHEBU51NES5PNDPROFESSIONSCODE.AUD Z X MY UCENSE IS IN NLL FORCE AND EFFECT. m LLI � � IICENSE CLASS _ LIC.NO. � � J V DATE CONTRACTOR_____,___,___ a W � WORKERS'COMPENSATIONDECLARATION Q ' „'�-�,.� -� ���� � � IHEREBYAFFlRMUkDERPENALTYDFPEfiIURVONECFTHEFOLtOWINGOECUIRATIONS. � � N Q �4'f't-�'J'�'' ��! �� �y'r"�y` '� � __IHAVEANDWILLMAINTAINACERTIFICATEOFCONSEhTTOSELG�INSUPEFORWORKERS' _ — CAfAPENSATION,IIS PROYiDEO BY SECTiON 37000F THE LABOS COOE,FDR T4+E PERFORMANCF. U Q OFTHE WORK:OR WHICM TNIS GERMIT IS ISSUED. � � � I HAYE AND WILL AAAINTAIN WORKERS'COMPENSATION!NSL'FANCE.AS REOUIRED 3`/SECTION Q 37ooOFTNELABORWDE,FORTHEPERFORMANCEO:�FIEWORKFORWHICHTHISPEPMIT;S ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND PO.ICV NVMBER AqE� CONSTRUC7ION J j cr�aRien ___ FLAN REVIEW ___ __ ZroucrkuMeeq . -------------� ELECTRIC ------- — — 4 O (iWSSECiqNNE�N'JTBcOOMR_ETEDOFhEPEPIvYPISii�RONE!-AJnDP.EDDCLLARS(f700�ORLESS;. PLUMBING ___.,_.,_,_ __,_ W ��Z I CERTIFV THAT IN THE PERFOflMANCE OF THE�kOFiK FOR WMiGH Tri15?ERMIT IS ISSUE7,1 MECHANICAL ____.__,_ �j SHALLNOTEMPLOYANYPEflSONINAIVYMANNER50A5T08ECOMESUBJECTTOTNE � WORKERS'COMPENSATIONUlW50FCAL!FORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE ___ ` J � Sll&IECTTOTHEWOfiKERS'COM?ENSFTIONPFlOVi510N50FSECT10N37COOFTH'eLA80R 's'�' � COOE,ISNALI.FORTHW�?HCOMPLYWITriTF10SE�aovisious. ISSUANCE _____ � SMIP p OATE:_____ APPLIGAM: __ __ ___ ---- �-- J WARNINGFAIWHETOSECUREWORKERS'COMPENSATIONCAVERAGEISUNLAWFUL.AN�SHALLBE ENERGVP/C ___._ y�SyL���l �j _ �`�� �Yy y!y � SU&IECTAN EMPLOYEN TO CRIMINAL PENALTIES AND CIVIL FI!:ES UP TOONE HUNDqED THOlJSAND ENERGY PEFMIT •n' `���,F{' 'LA�R` r DOLLARS(51ao,oao�.INADDITIONTOTHECDSTOFCOAIPENSATION,OAMAGESASGROV!DEDF051N --�'5��;`e ���A�g,'a�-�jv x J SECTION9TOBOFTHELABOflCODE,INTEREST,ANDATTOPNE`."SFEES. ,4 dTRF � RETENTION FEE: ., ♦A�av a�,'��f e d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: —��1�'�'�"��`��3 �� v O � IHEREBVAFFIRMUNDERPE�YALTYOFPERJURViHATTHEREISACQNSTiiUCTIONLENDINGAGENCV a- FOR TNE PERFORMANCE OF'fHE WORK FOR WHICH THIS AERMIT IS ISSUED(SEC.�OB'],CIV.C.?. �—�-- Z W __ —_— � LENDER'SNAME ___.._ ___ --___.___ 1— LENOER'SADDNESS _ _.________.._ W1 CERTIFV THAT I HAVE READ THIS APPLICATION AND STA'E THATTHE ABOYE INFORMATION IS CORRECT. TOTAL S�E ES � I AGFEE TO COMPLV W1TH ALL GITY ANO CAUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING � CONSTqUCTION.AND HEREBVAV7HORIZE REPftESENTAi1YE50F THIS COUNTV TO ENTER VPON THE // ZABOVEMENTIONED PROPERTV FOR INSP'eCTION PURPQSES. COMMENTS ____ ` /� � �,/ ��p� _ /�t V L�_ M � L r�«•!"ZR _- "'_'_" m PERMITTEE E(PRIN �� � . �L � _ � 'L� D� --- — --� —"�[ -- � SIGNATU E OF PERMIT7EE OATE ��(�� ( = RECPT.NO. �„f ' PAID BY ___ VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROo--File Copy,GREEN—ApplicanCs Copy .-_..r.M1.R�:..a�..,,w .�...........-_..��_�_._..__..__.....----'._....-- . . . . .. . .... . . . .. . . , . ' .. . .. . . � . . . . .. . ,,. . . . � . ...r . .. ' . � ' .. �:'�N�"�� ..i. �.;T:�n i. 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