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HomeMy WebLinkAbout14989 � � CITY OF DIAMOND BAR ��J�- -� DEPARTMENT OF COMMUNITY 8r.DEVELOPMENT SERVICES `!"—'� , ♦ „ 216b0 E.Copley Drive Suite 190 � (909)860-3195 Fax(909)861-3117 PRESS ����„�°� BL7II.DING PERMTT APPLICATION FIRMLY � JOBSITE �� "1 i_^� � � ' �� APPLICATION-�j '�']� !A� PERMIT / "�' P/C o ADDRESSk �«<� DATE �� tt� ���� NUMBER� # � ISSUE �^� NPE OCC APN L T TRACT DATE_�- I�CONST. GROUP p OWNER � LL ADDRESS ZODlING SEfBACKS � ClTY _ TEL. FRONT RW � APPLICANT L. REAR '� SIDE/SIDE STREET RW 7 � CONTRACTOR 6 Q �t . SIDE ❑ ADDRESS c C � PROPOSED USE T � St!"r � �� � CITY ZILPj��7-��,,,,T .��-� J w ARC J / G(�- w .�•-1 �,� 7�j v' � �- z DESIGNER � NO.DWEL. NO. c NO. � ADDRESS UNITS STORIES �^���� BEDROOMS = CITY ZIP TEL. � DESCAIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SFR/ADDIREM O 0 I NER�V AFFIRM UNOER PENAITY OF PEFUURV THAT I AM E%EMP?FRDM THE CANTRAC?ORS LI- � CgfB(J&�CBfpOII W CENSELAWFORiHEFOLLOW�NGREA50N(SEG.1031.5BUSINESSANOPAOFE55pN5COCE:ANYCITYOR _ U COUMYWWCHREWIRESAPEflMRTOCONSTRUGT,ALTER,IMPROVE,OEMOLISH,ORfiEPAIRANVSTRUG W patio/Deck WYURE,PRIOR TO ITS ISSUANCE,ALSO REOUTAES THE APPLICANT FOR Sl1CH PERMIT 70 FiLE A 51GNED � STATEMENT THAT HE OR SHE IS IiCENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI• � CENSE lAW(CNAPTER B(COFAMENCING WITH SECTION 7000)OF DIV!SION 3 OFTHE BUSINESS AND PRO- � POOUS�^.8 FESSIONSCODE)ORINATHEORSHEISEXEMPTTNEREFqOMANDTHEBA515FONTHEALLEGE�JE%EMP- (� TION.ANYVIOUTIONOFSECTION7o31.5BVANVAPPLICANTFORAPERMIT5U6JEC?STHEAPPLICANTTO z Re-Roof � AqVll PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS�S5a0?J: � �I,ASOWNEROFiHEPROPEHTV.ORMYEMPLOYEE5INTNWAGESASiHEIRSOLF.COMPENSATION. O COR11112fC181 WILL DO THE WORK,AN�TME STRUCTURE IS NOT INTENDED OR OFFERE7 FOR SALE(SEC.7044,BU51- J — NE55 NND PROFESSIONS COOE:THE CANTRACTORS IICENSE LAW OOES NOT APPLY Tb AN OWNER OF N PqOPERTYWFIOBUILU50RIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR = � THROUGHHISORHEflOWNEMPIOVEES,PROYlOEOTHATSUCHIMPROVEMENTSAqENO'IN7ENDEDOR m QOFFEREDFORSALE.IF,FIOWEVERTMEBUILDINGORIMPROVEMENTISSOtDWITHINONEVEAROFCAMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR � IMPROVE FOR THE PURPOSE OF SAL�. ❑I,AS OWNER OF THE PFW PERT;AM E%GUISIVFI.V CON i RACTING NlITH LICENSED CANTRACTORS Q TO CANSIiAJCT lHE PR0.IECT(SEC.7043,BUSINESS AND PROPESSIONS GODE:hiF.CONTRACTORS LI� VBIIIflt� � ADJ.AflEA W CENSEi.AWDOESNOTAPPLYTOANOWNEROFAPftOPEH1YWHOBU1LO50RIMPROVESTMEREON,AND � WHOCONTRACTSFOpSUCHPROJECTSWITHACANTRACTOR(S)LICENSEDPUFSUPNiTOTHECONTRAC� �UANTITY �ESCRIPTION FEE � TORSLICENSELAW.). J O �I Nd EXEMPT UNDER SEC.__, _ _B.H D.C.FOR'HIS REASO� U �i _ _—_ _'—___—...______— � � DATE ONTER f" Z —_— — —__ W � LICENSED CONTFACTORS DECL4RATION �j � I HEREBYAFFIRM UNOEH PENALTV OF PERJJRV THAT 1 AM:.ICENSEC UMDEP.PROVISIONS OF CHATER � � 8(COMME4CINOWITHSEC?ION7000)OFDIVISION3OFTHE9USINES£lWOPROF'eSSIONSCODE,AND Z __ MV LIGENSE IS W FULL FOFiGE hIJD zFFECT. � 9 �} � � � � UCENSE CLASS �� • LIC.NO.�` � � � � � J V DATE ��� CCNTRAI:TOR s a W � WORKERS'COMPENSATION DECLA IU, Q� � U � IHEREB�RfFIqMGNDERPENALT'OFPERIURYOYEOF'F!EFO-_LCN': -CIARATioRs: z 0 I HAVE AND WILL MAINTA�N A CERTIF!CATE OF CCNSENTTO SE:F-INSLIRE FOR WORKEaS' _� � C'AAlPEN5ATION,ASPHC)YIDEDBYSEC�ION3%OOOFTHELABORCODE,FORTHEPF4FORMANCE ��_ OF WORK FOR WHICY,THIS PERMIT�5 ISSUED. � _. � I HA4EAND WILI.MAINTNN WORN[RS':.JMPENSATION IN�LIRANCE.AS H'c�UIWEp 8V SEC710N f Q 3�W OF THE LAHUR CCDE,FOR T11E PERFORMANCt OF TH'e WORK FOR WHICH THIS FEPMiT IS --— ---- — �SSUEO.MYWD E�R'G7MV/�EJNSATIONyN5u9pNf.EGAR �.7ANDPOLICYNIIM�EflAflF CqNSTRUCTION � �� jcnRaiEa____���JL.___��-- ------- PLAN REVIEW ----.---.----- z70LICY NUMBEri ��� _��__— . � ELECTRIC ___________— ___ Q � (iHISS�CfiONNEE�INOT0E�4PLEfFJOF'f11EPEC0.tlTIS�ORONeHIMDf,EDCOlLPAS(570alORLESs�. I PLUMBING 1 L � _--_ d• �M Z ICERTIFYTHATINTHEPEF1FORMANCEOFT}fEWOP.KFOFwH�CHiHISPERMITI51S5liE�,i MECHANICAL ._. _ (�J SHA:LNOTEMPlOYA4YVERSONINANYMANNER50A5iOBECAMESUH!ECT'OTME � WORKERS'COMVENSATIOtdtAWSOFCALIFORNIA.ENDAGREETMATIF�SHOUL�BF.COME INSPECTIONFEE __ 1'�(�(� � SUdI' TOTHEWORKERS'(:O�AP'cNSA?ION?ROVtS NSOFSECTIOt�! POF'HElA80F �SS�JAhJC.E _� r� � �9iiall �— � � c hALLFOR,nTh'.'rVITHGOMPLVWITHTFOSEP iSION£. -- � ' ,.,� -1� � �Z- 6'94' SMIP __ _ t�( l pDATE:_ ' APPLIGP.NT. . _ ...'_.. _' ----'— ,.- -.:�. • ` y, � _ __' �y" —y7 i..� 3�'' J ENERGV P/C ._.. �� +� �^��� '�.` J WARNING:FAIIURETOSECUFEWORKERS'COMPENSA710 VERA UNLAWfl1L,ANDSNAILBE p,�J��•� � SU&IEC7ANEMPLOVERTOCRIMINALPENALTIFSANDC:V_FINESUPTOONEHUPUREDTHOUSAN� FNERGYPERMIT _���� w"'�"9 � � J� DOLLAfiS�f 100,oCe�.IN ADDITION TO THF COST Of COMPENSAiION,DAMAGES AS PFOVIDED FOR IN � SECTION37060FlHELA80RGODE,�NTERE5T,A4DPTTO�NEY'SFEES. RETENTIONFEE: __ d CONSTRUCTION LENDING AGENCY PRE-AlT FEE: ..___,_.__._.—__ . 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