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HomeMy WebLinkAbout15914 (664) � � CITY OF DIAMOND BAR �'""�' -J��'-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �/' w 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)8613117 � PRESS �`'��" BUILDING PERMIT APPLICATION FIRMLY � JOBSITE } APPLICATION (� 9 1 PERMIT P!C 0 ADDRESS��Ja�r b �'• LQJJC?°�t'�LE�'I� .L��- DATE � 4 �1 � NUMBER� . � p � APN LQT TRACT �SSUE f � TYPE OCC ¢ DATE � �i r/� ��� ' CONST. GROUP p OWNER Se��tCs �i•°Y! p ADDRESe��C� L• 1li�.'-�UG�`77f Q� ZONING SETBACKS �y CITY � 1g+'F'I�- ZIP �' ` TEL..�s.°f'asZ�SS�I REART RW ❑ g APPLICANT TEL. SIDEISlCE STREET RW � � CONTRACTOR f��M.S�I�.fS •�/,tJL LT� SIDE � � ADDR�i^ ` ���".L�E2�/t,;/� t�L�SiiN�� J��C� o CITY �/�'Fi�S/� ZIP 2 � TEI. PROPOSED USE .0 �E � � �+ ARCH/ENG/ �S Cf,�a%�SAx •� i,�5' /C .a z DESIGNER �y � — NO.DWEL. N�. NO. a. ADDRESS � CITY ZIP TEL. UNITS STORIES l BEDROOMS � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBV AFFIRM UNDER PENAL?V OF PERIURV THAT I AM EXEMPT FROM THE C9NiRACTOR3 ll- GBfa JB/CH�Oft W CENSELAWFORTiEFOILOWINGFEA50N(SEC.7o31.58V51NEu5ANDPROF'c55!ONSCODE:ANYCfTYOR (f� _ C,7 CpUNTYSYHICHREOUIRESAPERMfrTOCONSTRUCT,ALTER,iMPROVE.�EM�LISH,ORREPAIRANYSiRUC- Z NHE,PRIOR TO ITS ISSUMICE,ALSO REW IRES THE APPLICANT FOR SUCH PERMIT TO FIiE A SIGNED W PatiO/D6Ck STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISiONS OF THE CONiRACTORS ll- � CENSE LAW(CHAPTER D(C061MENCING WITH SECTION 7o0D)OF�IYISION 3 OF THE BUSINE55 AND PRO- u' POOVSpB FSSSqNSCODE)ORT1iATHEORSHEISE%EMPTTHEilEFROMANDTHEBASISFOR?HEALLEGEDE%EIAP- (� V TION.ANVVIOLATIONO:SECTION7031.SB�ANYAPPLICANTFORAPERMITSU&1ECTS?HEAPPLICANT'O Z Fjp-p00� � ACMLPENILLTYOFNOTMOqETHANFlVEHUN�REDDOLLAR5�f5oo�.j: � �I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITiiWAGESPSTHEIRSOLECOMPENSAiION, 0 Lommercial WILL DO THE WOAKµ�THE STRUC1iJRE IS NOT IMTEN�ED OR OFFFRE�FOR SALE(SEC.7046,BU51- J— � NE55AND iROFES510N5 CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF = PROPERN NhlO BUILOS OR lMPROVES THEREON,AND VYNO DOES SUCH WORK HIMSELF OR HEFiSELF OR Q TriROUGH HIS OP HER ONM EAIPLOVEES.PpOVIDm THAT SUCH IMPROVEMENTS AHE NOT INTENDED OR m L1�1 OFFEREDPDRSALE If,HOWEVERTMEBUILDINGOqIMPROVEMEMI550LDWITMNONEYEAqOFCOMPLE- Z TION,THE OWNER-BUIIDER NqLL HAVE THE BURDEN OF PROVING TNRT HE OA SHE OID NOT 2UIL�OR I = IMPROVE FOR THE PUflPOSE OF SAI.E). (ya CI,AECWNEROFTHEPROPERTY,AMEX�'AUSIVELYGONTFACTINGNR?HLICEYSEDCON7RqCTORS { � TO CANSTftUCT THE PqOJECT(SEC.�OM,B1151NE55 AN�PFiCFE55i0iU5 CU.^.F_.THE CONTRACTORS'.I� VBIUflIi011 �_(L'-�'`� ADJ.AREA____. 4J CENSEUWDOESNOTRPPLVTOANOWNEROFAPqOPERTYWH06UILDSORIlAPqOVESTiiEP.EON,AND -- �� W/IOCONTRACTSFORSUCkPA0.1ECT5W1?HACON7qAC70R(5)LICEIJSEDPURSJANTTOTHECON,'RAG QUANTI�N DESCRIPTION FEE Y TORSIJCENSELAW.). _ Q J � C7 I AM EXEMFT VNDER SEC. ____,_��__8 8 P.C.FOR THIS P.EASON Q � __ W � _'_ " OATE_ OWNEp_"____'___' __ (�I Z � LICENSED CONTRACTORS DECLARATION W~ � �HEREBYAFFIRtA UNDER PENAL7V OF PERiURY THA71 AM IICENS'c3:1�DER PROV:5:0!15 OF ChqATER �I a, Y(COMMENCIN6WITHSECTKKJ7000�OFDMSION90F?HEBUSINESSAVDP(i4FESSIGhSCODE,AtJD Z`___ _ X MY IIGENSE IS IN FULL FORCE hND EFFECT � `V �A E�E�L�,—'��__ CONTRAC7q�j�Lj..,y��I�G� _'� a�r � w I----� � WORKFRo CON,PSNSF4TION DECLARATION —�� = Ui---- y t HEREBV AFFIRM UNGeR PENALTY OF PE�JURY ONE OFTHc FO'�,.L.OWING DF.C�IRA'lOtiS: cn z, ¢;- - O I HAVEANOl41LL MqINTAIkACFRTIFICATE OF COYSENTTO SELF-�N6URE FOR WORKERS' _ aOOMPENSATION,ASPROYI�EDBVSECTION3TOOOFTMEIABORGODE,FORTMEPERrOftMANtE W�____ OFTHE WCFiK FCR WN�CH iH15 PEPMIT'�SISSU'cU. � � _INAVETkOWILL0.�AiF'!A!'�WORKEAS':AMPENSAT!CNINSI:RANCE,ASREQUIREJDVSECTiON � ' ft [[[------��� (\ � 3lW OF THE UF.GR CO�F,FOR"HE PERFOAMA\C::Of iHE WOFK rOR WHiCH THIS PEflMiT 1S � �y.�/ ,� U Iu5UE0.ARY WORY'cA5'G..MPEhS CN INSAUHANCt C0.Ra:cR AN�PG�IC�P:UM6Eq ARE. CON JTP,UCTION _ � L j CARRIER����r_^�/�!/ ___^_�f ____ _ . PIAPJ REVIEW _. _ _ � � POUCYNUMOER��J Y'iG_�ii_�L���.�_ i ELECTRIC __________ � �irsssE,^ncav;u�nrro?ee�e�nc�'n!e�w�rr�swaa�Huwa[000unns�six�oa�cs;�. PLUMBING f3 -------- ----- — Z 1 CERTIFV T>IAT INT1iF PERFOAMANCE Of THc WCFlI(FOR4VHICH THIS PcRMITlS I.SSUe7,1 ��ECHANICAL __ _ ___.__ L'] SHRLLI�NJTEihPLOYANVPER50NiNANYMAN�:EftSO0.ST0?ECOMESt:9JECTTOTHE N WOl6C[q5'COM?ENSA7!ONIA'NSOFCALIFORN�AANCAGF.EFT4ATIFISNOUL.CBECOUE � INSPECTIONFEE ____—-_ _ SU&lE,^.'fT0T4EVlnRKERS'CDMPENSATIO Vla"IONSOFSE N]]OCCF �FLABOR --� ►= I ISSUANCE � CADE.I SHALLFOrihlWl'i H COMPLY WI'.1i E f'flOViSIONS. --- —'_—'—__'_ _'_'___�j.�.y_ Q �'���--�e� -. .. sM�� � . �)t� p DATE: A'PLICANT __— __ __-- ."_"'----.'-- ' — � YJAFNIkG:FA1LURETOSECURF.VVOaNERS'COMPENSATIONCOVERAGEISUNLAWFV:.,AN�SFAILBE ENERGY?!C _______.__,_ ____ _ ` SU9JECTANENPLOYERTOCRIMINAIPENALTIESANOCIVILFMF.SUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(t!W,000),IN AD�ITION TO THE COS'OF COSAPENSTTION,DpMA(�ES AS PROVIDED FOR IN J SECTION37080FTFIELABOHCODE,IN?EREST,ANOATfORNEV'SFEES. RETENTIONFEE: Q __ _._.._______ _ pw.. CONSTRUCTION L[NDING AGENCY PRE-ALT FEE: p -----�------ � I HEREBY AFFIHhS UNOEH PF.NALTV OF PERJU9�THAT THERE�5 ACONSTFUCTION LENDING AGEhCV _____ FOR TNE PERFORMANCE OF THE WORN FOR W FiICH TMIS PERM�i IS ISSUED(SEC.9o97,GIV C.) Z W — � LENDER'S NAME ___,__ F_ LEN�ERSAODRE55____ � ICERTIFYTHATiHAVEREADTHISAPPUCATIONANDSTATETHl1Th:EA00VFIN'rURMAT10Ni5CORRECT. TCTAL FEES � � � . W IAGREE TO COM?LV WRH ALL Cf'Y AND CAUN7V ORDINANCES AN�STA7E LAWS RELA7ING TO BUILDING � CONSTRUCTICN,A\'J HEREBYAUTHORIZE P.EPRES'cN7ATIYES OF THIS COUN7V TO ENTER UPON THF ZABOVE-MENTANED FHOPERTV GOFS INSPECTION GURPOSES. Q COMMENTS_ � m — Q PERMI--�.INT "__'__ cn � /'v�:�f Q� � 51 URF OF PEA DATE � = RECPT.NO. _PAID BY VALIDATION � WHITE—DeDartment Copy.YELLOW—finan�Copy.PINK—Assessor Copy,GOLDENRO ile Copy,GREEN—Appli Ys Copy _. . , .. . � . . " '.t: . . ., , � ., x_ '�, .� , k�_ �. , u..E ., �. .. , . ,� . .. . .. , . . 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