Loading...
HomeMy WebLinkAbout05-314(11) ^ � CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES _ 21825 Copley Drive,Diamond Bar,CA 91765 � w (909)839-7020 Fax(909)861-3117 Building Inspection Hotlioe(909)839-7027 PRESS ���'9�'� � BUII,DING PERMIT APPLICATION _ FIRMLY � JOBSITE APPLICI�TIO PERMIT P/C �r o ADDRESS DATE ����C'�� NUMBER #�-�� ' ��� > � ISSUE TYPE OCC APN LOT �� TRACT DATE_ CONST. GROUP p OWNER C�d� E � ` ADDRESS ���� ��`W��� � � �t6��- ZONING SETBACKS ��� ` � � Z CITY�,t�`�"�'1te CVEtv.�„-va��_ ZIP �� TEL.��Q��"�•� ��a�� FRONT �tl� ���`��a� �Ea�t R� ��° � . � APPUCANT TEL REAR ❑ o SIDElSIDE STREET RW O ¢ CONTRACTOR SIDE O o ADDRESS PROPOSED USE � ������� �t!^~"°-a�S CITY ZIP TEL. w ARCH/ENG/ z DESIGNER ��'�� ��� ' ���� NO.DWEL. NO. NO. a ADDRESS ��� [�+J6�drt��C"t t ���T�• � UNITS �� STORIES� �-�` BEDROOMS �� � cirY ��-�a��� ziP 4 �`�.. TE�.� ��� � • • DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION OOWNER•BUILDERDECLARATION SFR/ADD/REM ��{��f,g p 1 HEREBY AFPIRM UNDEfl PENAITY OF PERIURY THAT 1 AM EXEMPT FROM THE COYTRACTORS LI- Gflf89B/C2IPOd ���� � � � � W CENSEUWFORTHEFOLLOWIN/3REASON(SEC.7031.68USINESSANDPROFESSIONSCODE:ANYCITYOR (n , ZCOUNTY4YHICHflEQUIRESAPERMITTOCONSTflUCT,AITER.IMPROVE,DEMOlISH,ORREPAiRM1Y5TqU4 W P8110/DBCiC ��,� . . W NRE,PRIOR TO ITS ISSUANCE,ALSO flEQUIRES THE APPLICANT FOR SUCH PEflMiT TO FIIE A SIGNED W � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE VROVISIONS OF THE CONTflACTORS LI- � CENSE LAW(CHAPiEfl B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PR0- LL' PooUSpa . � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP• (,�} � V TION.ANYVIOLATIONOFSECTION7031.6BYANYAPPLICANiFOflAPERMITSUBJECTSTHEAPPIICANTTO z Re-Root A CML PENALTY OF NOT MORE THAN FNE HUNDRED DOLLAfiS(5500).): Z ❑I,ASOWNEROFTHEPROPERiY,ORMYEMPLOYEESWI7HYlAOESASTHEIflSOLECOMPENSATION, � Commercial . — WILL DO THE WORK AND THE STflUCNRE IS NOT INTENDEO OR OPFEflED FOR SALE(SEC.�7044,BU51- J NESS AND PROFESSIONS CODE:THE CONiRACTORS LICENSEIAW DOES NOT APPLY 70 AN OWNER OF � � � PROPERTYWFIOBURDSORIMPROVESTHEREON,ANOWHODOESSUCHWORKHIMSELFORHERSELPOR = - � � THROU(iHHiSORHEflOWNEMPLOYEES,PROViDEDTHATSUCHIMPROVEMEMSAREN071NTENDEUOR m� � 0 OFFEREDFORSALEIFHOWEVER,THEBUItAINOORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE- . Z TION,THE OWNER-BUIIDEfl WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUItD OR � IMPROVE FORTHE PURPOSE OF SAIE). O 1,AS OWNER OF THE PROPERTV,AM EXCLUSIVEIY CONTMCTINO W(TH IiCENSED CONTRACTOPS � TO CONSTRUCT THE PROJECT(SEC.7044,BUSINESS AND PROFESSIONS CODE:THE CONiRACTORS L4 � V011131I011 ADJ.AREA �� W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND � NTIOCONTRACTSf'ORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE � � � � � � TORSLICENSELAW.). � � ❑IAM EXEMPTUNDERSEC. 8.3 P.C.FORTHIS REASON U � � LL' DATE OWNER E"' . Z W � LICENSED CONTRACTORS DECLARATION �j � I HEREBYAFFIRM UNDER PENALTY OF PERJURV THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER � . . p_ 9(COMMENCINO WfTH SECTION 7000)OF DIVISION 30FTHE BUSINESSAND PROFESSIONS CODE,AND Z �� X MV UCENSE IS IN FULL FORCE ANO EFFECL LLI �pi m � UCENSE CLASS � LIC.NO. ��'�'��`��"��� � � V DATE� �' ' ..� CONTRACTOR���1�=�-Lty�� ��'�.�P�f6w�'Y �- W � WORKERS'COMPENSATION DECLARATION Q � I HEREBYAFfIRM UNDER PENALTY OF PERIURY ONE OFTHE FOILOWINO DECLARATIONS: U � � Z Q 0 _IHAVEANOWILLMA�NTAINACEflTiFICATEOFCONSENTTOSELF-INSUqEFORWORKERS' _ COMPENSATION,ASPROVIOEDBYSECTION37000FTHELABORCODE,FORTHEPERFORMANCE U � ¢ OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � 0 W _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSUHANCE,ASREQUIREDBVSECTION Q 37000FTHElABORCODE,FORTNEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSUED.MY WORKERS'COMPENSATION INSURANCE CARPIER AND POIiCY NUMBERARE: CONSTRUCTION ' J j cAqRiEq PLAN REVIEW Z PaICYNUMeER ELECTflIC ¢ (fHISSECiIONNE�NOTBE00AW.ETEDOF7HEPEfUM�SFORONEIiU�DF1mDOLLARS(S10U)ORLESS} PLUMBING 0 z I CERTIFYTHAT INTHE PERFOPMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL (3 SHALLNOTEMPLOYANYPEq50NiNANYMANNERSOASTOBECOMESUBJECTTOTHE � WORKERS'COMPENSATION LAWS OF CALIFOftNIAAND AaREETHAT IF 1 SHOULD BECOME INSPECTION FEE SUBJEC7 TO THE WbRKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR � CADE,I SHAII FORTHYl�TH COMPIV W17H THOSE PROVISIONS. ISSUANCE � SMIP p DATE: APPLICANT. . . J ENERGY P/C WARNINO:FAIIURETU SECURE WORKERS'COMPENSATION COVERAOE IS UNLAWFUL,AND SHALL BE � SUBJECTANEMPLOY[RTOCHIMINALPENALTIESANDCNIIFINESUPTOONEHUNOREDTHOUSAND ENERGYPERMIT DOLLAFS(5100,000),IN AODITION TO THE COST OF CAMPENSATION,DAMA6ES AS PROVIDED FOR IN � SECTION37080FTHELABORCODE,INTEREST,ANDATfORNE1"SFEES. ' RETENTIONFEE: , � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THATTHERE IS ACONSTRUCTION LENDIN6 A(iENCY n- fORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30H7,CIV.C.). � Z W S LENDER'S NAME � f— LENDER'SADDRESS � ICERTIF1'THATIHAVEREADTH�SAPPLICATIONANDSTATETHATTHEA60VEINFORMATIONISCARRECT. TOTAL FEES w IAOREETOCOMPLYWITHALLCITYANDCOUNTYORDINANCESANOSTATELAWSflEUTIN0T08UIlOING � CONSTRUCTION,ANOHEREBYAVTHORIZEREPflESENTATIVESOFTHISCOUNTYTOENTERUPONTHE � ZABOVE-MENTIONED PROPERTY FOR INSPECTtUN PURPOSES. COMMENTS �� � J � m PERMITfEE NAME(PRINn � Q � � SIONANREOFPERMITfEE DATE � �� = RECPT.NO. PAID BY UALIDATION