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HomeMy WebLinkAbout05-314(7) ^ �.�_ CITY OF DIAMOND BAR DEPARTMENT OF COMNIUNITY&DEVELOPMENT SERVICES 21825 Copiey Drive,Diamond Bar,CA 91765 _� �_...... (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS -'9N' BUILDING PERNIIT APPLICATION FIRMLY y�, JOBSITE APPLICATION a ADDRESS PERMIT p/� o DATE 3O iSt>��f O NUMBER p ��' ��� �) � ISSUE TYPE OCC °-° APN LOT TRACT DATE p OWNER ' r"G N�w•G5 CONST. V�IJ�(L GROUP - - " ADDRESS '3:% D Qi 'Sv�� ZONING SETBACKS ��� ��"' �«`"~Or'• `�' V�� p�� �L ySR:Gt�I L w FRONT �ub�IG....��._s1 v..RW"S '��'y!�p j Z CITY �SC� K�cS�. ZIP�� TEL. ly t�a7-�. � APPLICANT TEL. REAR p ¢ SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE p ADDRESS n e' r � � O PROPOSED USE �SelXe�[�..1 1''1�J I�� -'Y6.,r�.. �,, CIN ZIP TEL. l ��dL�W w.S w ARCH/ENG/ r 1 z DESIGNER �Z 1`IK �sR�rJEtl.� l P.D• " : `)O� �S11PlQ�r_/, w NO.DWEL. NO. NO. a ADDRESS 131 SnivovwTsi.� �c! S.,te I�n � UNITS STORIES BEDROOMS � CITY ._.�2 v ikt ZIP��1'1 TEL. cfW�l.Q�l-Ndop � DESCRIPTION SQ.FT: FACTOR PSF ADJ.AREANAIUATION O OWNER-BUILDER DECLARATION SFR/ADD/REM C��f9� p I HEREBV AFFIRM UNDER PENAIN OF PE0.NRY THAT 1 AM EXEMPT FROM THE CAMfiACTOHS ll- (3afeg9/C8lPOd � W CENSEUWFORTHEFOLIOWINQRGASON(SEC.703i.68U51NE5SANDPPOFESS�ONSCODE:ANYCINOR (n U COUNiyyh{iCHRE�UIRESAPERMITTOCONSTRUCT,ALTEFl,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC W � W NRE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPUCANT FOR SUCH PERMIT TO FllE A SIONED W Palio/Deck ' � STATEMEM THAT HE OR SHE IS 110EN5E0 PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI• � � CENSE LAW(CHAPTEfl e(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- PooUSpa � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOflTHEALLEGEDEXEMP- (� V TION.ANYVIOUTIONOFSECTION7031.58YANYAPPUCMIrFORAPERMITSUBJECTSTHEAPPUCANTTO Z Re-Roaf ��V� A CIVIL PENALiY OF NOT MORE THAN FIVE HUNDRED OOLLAHS(5500).): � OI,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHfYAGESASTHEIR50LECOMPENSATiON, � Commercial Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFPERED FOR SAI.E(SEG�7041,BUSF J - � NESS AND PROFESSIONS CODE:iHE CONTRACTORS UCENSE LAW DOES NOT APPLY TO AN OWNER OF � PqOPERTY WHO BUILDS OR IMPROVES THEflEON,AtJD WHO�OES SUCH WORK HIMSEIFOR HERSELF Oq � THHOUGHH�SORHEqOWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENfSARENOTINTENDEDOR m � OFFEREOFORSALEIF,HOWEVEF�THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE . Z TION,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVIN6 THAT HE OR SHE DID NOT BUItD OR � IMPROVEFORTHEPUqPOSEOFSALE). W ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELYCAMRACTINGWITHLICENSEDCONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC,7044,BUSINESS AND PROFESSIONS CODE:THE COMMCTOqS ll- V81UH1I011 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANONT7EROFAPROPERTYWHOBUILDSORIMPROVESTNEREON,ANO � WFIOCONTRACTSFORSUCHPROJECTSWiTHACONTflACTOR(S)LICENSEOPURSUANTTOTHECOMRAG QUANTITY DESCRIPTION Y TORS UCENSE LAW.). PEE � O 1 AM EXEMPT UNDER SEC. 8.6 P.0.FOR THIS REASON Q � U u. � DATE OWNER F- � W F, LICENSED CONTRACTORS DECLARATION W � 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDEq PflOVIS10NS OF CHAPTER � � 9�COMMENCINGWITHSECTION7000)OFDIVISION30FTHEBUSINESSANOPROFESSIONSCADE,AND Z ��� MY LICENSE IS IN FULL FORCEAND EFfECL m � UCENSE CLASS�� LIC.NO. V�.�J /(� � U DATE_� A �i CONTRACTOR.�2.� S d W � WORKERS'COMPENSATION DECLARATION a � I HEREBYAFFIfiM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: Z Z _IHAVEANDWILLMAMTAINACERTIFICATEOFCONSENTTOSELFdNSUREFORWORKERS' _ �.. ¢ COMPENSATION,ASPROVIDEDBYSECTION37000FTHELABORCADE,FORTHEPERFORMANCE W ��, Q OFTHEWORKFORWHICHTHISPERMITISISSUED. � '�.. QW _IHAVEANDN7LLMAIMAINWORKERS'COMPENSATIONINSURANCE,ASREQUIREDBYSECTION �� 37000FTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKPoflWHICHTHISPERMITIS '�, J ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMOERARE: CONSTRUCTION i j CARRIER PtAN REVIEW � 0 POLICYNUMBEfl � Z ELECTRIC � a (iHISS[C1pNNE�NOTBEOJMPLEfmOFl1-EPERMflISFORONEMR�DFiED00UAf15(5100)ORLESS} PLUMBING � Z 1 CERTIFY iHAT INTHE PEHFOflMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL � (3 SHALL NOT EMPIOY ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TOTHE I � WORKERS'COMPENSATIONLAWSOFCALIFORNIAANDAGREETHATIPISHOULDBECAME INSPECTIONFEE � � SUBJECTTO THE WORKERS'COMPENSATION PROYISIONS OF SECTION 37o00f iHE tABOR ( = CODE,ISHALLFORTHWITHCOMPIYWITHTHOSEPROVI510NS. ISSUANCE j � k p DATE: APPUCANT: SMIP J WARNING:fAILURETOSECUREWORKERS'COMPENSATIONCAVEflAGEiSUNIAWFUL,MIDSHALlBE ENERGYPlC � SUBJECTANEMPLOYERTOCRIMINALPENAL7IESANDCMLFINESUPTOONEHUNDREDTHWSAND ENERGYPEAMIT DOLLARS(f100.00D).IN ADDITION TO THE COST OF CAMPENSATION,DAMAQES AS PROVI�ED FOR IN J SECTION370BOFTHELABORCODE,MTEREST,ANDATTORNEY'SfEES. F p� RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � IHEfiEBYAFFIRMUNDEHPENALNOFPERJURYTHATTHEflEISACONSTPUCTiONLENDINOAGENCY I€ POR THE PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.CJ. Z W I; � LENDER'S NAME r F- IENDEWSADORESS � W ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECt TOTAL FEES ��,� C � ��O � � IAGREETOCAMPLYWITHAILCRYANDCOUNTYORDINANCESANDSTATEIAWSREUTINOTOBUIIDING ' CANSTRUCTION,ANOHEREBYAUTHORIZEREPRESEMATIVESOFTHISCOUNiYTOENTERUPONTHE ��� � ��� ABOVE•MEMIONED PROPERTY FOR INSPECTION PURPOSES. y 0 COMMENTS �'�G-�'�R ���.�`� �(�e�-��L�.� �iI j �'�P�G -�r2.'� ��C� -"'rC�r'PIC"��7�•�l''SLQ� - �S �JE�-P-�1� � ¢ PERMITTEENAME(PRIDlT) � � C� `� SIGNATUREOFPERMITTEE DATE �� � � � RECPT.NO. PA�D BY VALIDATION � S � wuirc—ne..��...e.,e r.....,vci i nw—c�..e..,..,r.....,ov.iv—e....,,..�...n......n_ro nc.�onn eu_n__.....,��.� �?