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HomeMy WebLinkAbout05-314(10) ^ _!�_ CITY OF DIAMOND BAR IF � DEPARTMENT OF CONIMUNITY&DEVELOPMENT SERVICES � : w , 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Brrilding Inspection Hotline(909)839-7027 pRESS °�' � BUII.DING PERMIT APPLICATION �IRMLY o� JOBSITE APPLICATION PERMIT P/C � ADDFiESS DATE ���'���� NUMBER p °��- ��� �� °-° APN LOT �� �� ISSUE � TRACT DATE ONST. ��� GROUP � ��� 0 ow�vE� ��c���� � �t� -f� . `-�• ADDRESS ���� ��"���� �"°�. �i � ZONING SETBACKS o � ' FRONT �C p�Fl���I �� R �g�� z CIN CQ ZIP TEL.�$��gi �°�•� 4 � W . A APPLICANT TEL, REAR ❑ Z SIDE/SIDE STREET RW p ¢ CONTRACTOR SIbE ❑ o CDDRESS ZIP TEL. PROPOSED USE �S� . � ��i~^ �� w ARCH/ENG/ — z DESIGNER ��'�"G� � ��f�Cm'. � �����`1 - w � NO.DWEL �� NO. � ►�p, � ADDRESS � t ��v� � �- �� � � UNITS STORIES ��M BEDROOMS � CITY "�lX 4t�RP�,. ZIP TEL. ���� �^° � cn DESCRIPTION SQ.FT: FACTOR PSF ADJ.AREANALUATION O OWNER-BUILDER DECLARATION SFR/ADD/REM �� ��� I HEREBY AFfIRM UNDEfl PENALN Of PER.IURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI• G8l8g8IC8fP0(l "���t, W CENSEUWFOATHEFOLLOWINOAEASON(SEC.7031.68USINESSANDPROFESSbNSCODE:ANYCIryOR (n C� COUNTYWHICHREW�RESAPERMITTOCONSTflUCT,ALTER,IMPROVE,DEMOLISH,ORREPNRANYSTRUG W �g � TURE,PpIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICqNT FOR SUCH PEflM1T TO FIIE A SIGNED W. Patfo/Deck � d � STATEMENT THAT HE OR SHE IS LICENSEO PUflSUANT TO THE PflOVi510NS OF THE WMRAC70q5 LI- � � CENSE LAW(CHAPTER 9(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOVSP2 VfES510NSCODE)OATHA7HEOASHEISEXEMPT7NEREFROMANDTHEBASISFOflTHEALLEOEDEXEMP- (�} TION.ANYVIOLATIOtiOFSECTION7o3L68YANVAPPLICANTFORAPERM�T5U0JECTSTHEAPPLICANTTO Z Re-Rooi A CIYIL PENALTY OF NOT MORE TFIM!FIVE HUNDRED DOILARS(S50oj.): � Q QI,ASOWNEqOFTHEPROPERiY,ORMYEMPLOYEESWiTHYJAGE5A57HE1RS01ECOMPENSATiON, � Commerctaf . — Z WILL DO THE WORK,ANO THE STflUCTURE IS NOT INTENDED Op OPPEREO FOR SALE(SEC.�704t,BU51• J � NESSAND PqOFE3SIONS CODE:THE CANTRACTORS UCENSE.LqW DOES NOT APPLY TO AN OWNBfl OF = pROP6RTYNTiOBU1lO50RiMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHEflSELFOR � � CC 7HROUGHHISORHEROWNEMPLOYEES,PROVIDEOTHATSUCHIMPROVEMENT3AflENOTINTENDE00R m � OFFEflEOfORSAtEIFHOWEVE�THEBiNLbINIiORIMPAOVEMENTlSSOtDWtTHtNONEYEAROFCOMPlE Z TION,THE OWNEH�BUILOER WILL HAVE THE BURDEN OF PROVIN6 TNAT HE OR SHE DID NOT BUitD OR = IMPROVEFORTHEPUPPOSEOFSAIE). W DI,ASOWNEROFTHEPROPEHIY,AMEXCA.USNELYCONTflACTINGWfTHLICENSEDCONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.7044,BUSINESS AND PROFESSIONS CODE:THE CONTMCTORS LI- V81lIflI10l1 ADJ.AREA W CEMSEiAWOOESN07AhPtYTOANOWNEROFAPAOPEATYWNOBUIl0.SOA1MPAOVESTHEREON,AND � WHOCONTRqCTSFORSUCHPR0.IECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONiRAG QUANTITY DESCRIPTION FEE � Y TORSUCENSELAW.). � q 1 AM EXEMP7 UNDER S�C. 0.&P.C.FOR THIS pEASON Q" � V u' DATE owNER U � W � UCENSED CONTRACTORS DECLARATION w � I HEREBYAFFIRM UNOER PENALTY OF PERJURYTHAT IAA1lICENSED UNDER PROVISIONS OF CHAPTER � d e(COMMENCINOWITHSECTWN7000)OFDIVISfON30FTHE8USINESSAMOPflOFESS10N5CODE,AND Z � � IAY UCENSE IS IN FUII FOFCE AND EFPECT. gy��, ay�"�q�� m d LICENSE CLASS R✓' IIC.NO. � °° 6'°" j. V DATE €L� � ��� CONTRACTOR a -� -- W � WORKERS'COMPENSA710N DECLARATION Q � IHEREBVAFPIRMUNDERPENALTYOFPERJUHYONEOFTHEFOLIOWINGDECUHATiONS: Z � � Z _IHAVEANON7LLMAfNTNNACERTIFICAT60FCON5EMTO5ELFdNSUAEFOHWOAKERS' _ ¢ COMPENSATION,ASPROVIOEDBYSECTIONa7000FTHELA80RCODE,FORTHEPERFORMANCE W � OFTHE WOflK FOR WHICH THIS PERMIT IS ISSUED. � 0 � _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSUHhNCE,ASqEWIqEDBVSECTiON �Q 37000FTHELA80flCODE,FOflTHEPEflWFMANCEOfTHHWORKfORWHtCHTHISPERMt71S ISSUED.MY WORKERS'COMPENSATION�NSURANCE CARRIER AND POLICY NUMBEHARE: CONSTRUCTION j CARRIER PLAN REVIEW 0 Pd.rCY MUMBEA z ELECTHIC Q 0 (fH1SSEC7KWNE�ND78EWMFtEtEDOF'MEPFfiI�YltSWHONEMR�DRE0D01U3iS(5100)ORLFSS) PLUMBING Z 1 CERTIfYTHAT INTHE PEHFORMANCE OF THE WOflK FOR WHICHTHIS PERMIT IS ISSUED,I MECHANICAL C�3 SHALL NOT EMPIOY ANY PERSON IN ANY MANNEfl SO pS TO BECAME SU&IECt 70 THE � WOqKERS'CqMPENSATIONIAWSOFCALIFORNIAANDAGREETHATIFISHOULDBECOME INSPEC710N FEE � SUBJECT70THEWORKERS'COMPENSA710NPROYISIONSOFSECTION37000FTHELABOR � CODE,1 Sl1ALL FOFiiHWITH COMPLY WITN THOSE PFOVISIONS. ISSUANCE � SMIP p DATE: APPLICANT: J WARNINO:FAICURE TO SECURE WORKERS'CAMPEWSA7f04 COYEAAGE IS UNLAWFUl,AND SHALL BE ENERGY PIC � SUBJECTANEMPLOYER70CRIMINALPENALTIESANbCMLfWESUPTOONENUNDR&DTHWSAND ENERGYPERMIT DOLLARS(S7 W,000),IN ADDITION TO THE COST OF rAMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION37080fTHELA80RCODE,INTEflEST,ANDATTORNEY'SFEES. � RETENTIONFEE: OCONSTRUCTiON LENDtNG AGENCY PRE-ALT FEE: � IHEREBVAFFIHMtMDEAPENALTYOFPERJUAY7HATTHEAE�SACANSTRUCTIONLENDINGAGENCY �- FORTHE PERFORMAtJCE OFTHE WORK FOR WHICH THIS PERMITIS ISSUED(SEC.30e7,CIV.CJ. � Z W � LENDER'S NAME ... F— IENDER'SADDPESS . W ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETIIATTHEABOVEINFOFMATIONISCARpECT. TOTAL FEES'����� �'�•�" . � IAGREETOCAMPLYWITHALLCRYANDCOUNTYORDINANC@SANDSTATEIAWSRELATINGT08UILDIN6 � CONSTRUGTKN7,ANDHEREBYAUTHOAIZEAEPRESENTATI4ESOFTHISCAUNTYTOENTERUpONTHE � y�� ,y�� � �� z ABOVE-MENTpNEDPROPEflNFORINSP&CTIONPURPOSES. COMMENTS ��'� �]J"�tQO�� Y'� �'S�F� �J�r�� � 0 j �1(9�� �C �.1�t m PERMITTEE NAME(PRIPfn � � . Q � N SIONATUR@ OP PERM(TTEE OATE ���� � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Ffnance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GFEEN—AppllcanYs Copy