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HomeMy WebLinkAbout05-314(6) ^ _�,�_ CITY OF DIAMOND BAR DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 ` (909)839-7020 Fax(909)861-311'1 Building Inspection Hotline(909)839-7027 PRESS ����"���� � BUII.DINGPERMITAPPLICATION FIRMLY ' �•s� � JOBSITE APPLICATION PERMIT P/C � o ADDRESS DATE 3a �uw.� aS NUMBER # �3�` �)�-- � ISSUE TYPE OCC APN LOT � L TRACT DATE CONST. �-NR GROUP Q'� v� p OWNER �rCOOIL�'ti� �b�.eS , �pADDRESS �'DQO ,gRiS'(�D I <i'fi 5v cl:� aa0 ZONING SETBACKS A�� °��� 'G'"^�"` �� Vi Ik..�. 5 G���,'c� o FRONT PI��-� 5��.P(a...�,�..v�43VW..Q.tc.S a.�, �i-1 Z CITY �rg� J'�t'�, ZIP a'Jb7�. TEL. u '� REAR � U ❑ o APPLICANT TEL. SIDEJSIDE STREET RW ❑ ¢ CONTRACTOR SIDE ❑ � ADDRESS PROP05EDUSE QeSiAC.��t�I FIuIk.-tG..w���rl L�O�bntiiw.�i.�ua� o C�7y ZIP TEL. w ARCH/ENG/ z DESIGNER � •��L�' N NO.DWEL. NO. NO. a ADDRESS 131 Sw1rJo�1q-i�rtJ � S�t�- (DD UNITS STORIES BEDROOMS � CIN �,(ZJivlL _ ZIP ga-bl? TEL. 9�iR^ ��.�^ �6 � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SFR/ADD/REM ��g��� O p 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT fROM THE CONTRACTORS LI• � Garage/Carport W CENSELAWFORTHEFOILOWINOREASON(SEC.7031.6BUSINESSANOPROFESSIONSCODE:ANYCITVOR ZCOUNfYWHICHflEWiRESAPERMITTOCONSTRUCT,AITER,IMPROVE,OEMOLISH,ORREPAIRANYSTRUP W P8110/DeCk w NRE,VRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT fOH SUCH PERMIT TO FILE A SIONED W � STATEMENT 7HAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTflACTORS ll- � CENSE LAW(CHAPTER B(COMMENCIN6 WITH SECTION 7000)OF DIVISION 3 0P THE BUSINESS AND PR0- �'�- PooVSpa 1..� FESSIONS CODE)OR THAT HE OR SHE IS EXEMPTTHEREFROM ANO THE BASIS FOR THE ALLEGED EXEMP- � TION.ANVVIOUTIONOFSECTION7031.6BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Root ���'�` � A CNIL 7ENALTY OF NOT MORE THAN FNE HUNDRED DOLLAHS(5500).): _ � ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHSNAGESASTHEIRSOLECOMPENSA710N, � COrtIRIBfCIHi Z WILL DO THE WORK,AND THE STHUCNRE IS NOT INTENDED OR OPPEREO FOR SALE(SEC.7044,BUSI- J NESS AND PROFESSIONS CODE:TNE CONTRACTORS IICENSE LAW UOES NOT APPLYTO AN OWNER OF � PROPEflTYVh10BUILDSORIMPROVESTHEREON,ANDVhiODOESSUCHWORKHIMSEIFORHERSELFOR m � THFIOUGHHISORHEROWNEMPIOYEES,VROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR QOFFEREDFORSALEIFHOWEVER,THEBUIIDIN�ORIMPROVEMENTISSOLDWtTHINONEYEAROFCOMPLE- z TION,THE OWNER-6UIlDEfl WILL HAVE THE BUROEN OF PROViNG THAT HE OR SHE DID NOT BUILD OR = IMPROVE FORTHE PURPOSE OF SALE). p 1,AS OWNER OF THE PROPEHTY,AM EXCLUSNELY CONTRACTIN6 WRH LICENSED CONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.7044,BUSINESS AND PROFESSIONS CODE:THE CONTflACTORS LI- V81U2�1Of1 ADJ.AREA W CENSELAWDOESNOTAPPIYTOANOWNEROFAPftOPERTYWHOBUIIOSORIMPROVESTHEqEON,AND � WFIOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPUflSUANTTOTHECONTRAG QUANTIN DESCRIPTION FEE Y TORS IJCENSE LAW.). J � ❑IAM EXEMPT UNDER SEC. B.8 P.C.FORTHIS REASON U O � � � DATE OWNER . U Z W � UCENSED CONTRACTORS DECLARATION J ` W �C I HEREBY AfFIRM UNDER PENAI.N OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER � � g(COMMENCING4YITHSECTION7o00)OFDIVISIONaOFTHE8U51NESSAN�PROFES510NSCADE,AND Z X MY LICENSE IS IN FULL FORCEAND EfFECT. m LLI Z � LICENSE CLASS LIC.NO. � ✓ � � U DATE� � O CONTflACTOR !U � n- W � WORKERS'COMPENSATION DECLARATION � � I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLlON7NG DECLARATIONS: U � Z Q 0 _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREPORWORKERS' _ ¢ CAMPENSATION,ASPROVIDEDBYSECTION37o00FTHELA80HCODE,FORTHEPERFORMANCE W OFTHE WORK FOR WHICH THIS PEFMIT IS ISSUED. � � w _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREOUIREDBYSECTION O 37o00FTHELABORCODE,FORTHEPEflFORMANCEOFTHEWORKWRWHICHTHISPERMITIS ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POL�CY NUMBERAflE: CONSTRUCTION j CARRIER PLAN REVIEW Z POIICY NUMBER ELECTRIC ¢ (i}flSSECIK7NNE�NDTBEOCf.IPIEfEDOF7FiEPEPo.IR�SFORONEfRR�DRE�DOIlAf�S(5�00)OR�ESS} PLUMBING 0 Z ICERTIFYTHATINTHEPERPORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED,I MECHANICAL �} St1ALLNOTEMPLOYANYPEfl50NINANYMANNERSOA5TO8ECAMESU&IECTTOTHE � WORKERS'COMPENSATIONLAWSOFCALIFORNIqANDAGREETHATIFISNOULDBECOME INSPECTIONFEE � SUBJECTTOTNEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR �SSUANCE � CODE,IStIALLFOHTHWIiHCOMPLYWiiHTHOSEPROVISIONS. O SMIP p DATE: APPUCANi: . � � ENERGY P!C WMNIN(3:FAiIURETO SECURE WORKERS'CAMPENSATION COVERAGE IS UNLAWFUI,AND SHALL BE � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDREOTHWSAND ENERGYPERMIT DOLLARS(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMA4E5 AS PROVIDED FOR IN J SECTION37080FTHELABORCODE,INTEREST,ANOATTORNEI"SfEES. RETENTIONFEE: � � W CONSTRUCTION LENDING AGENCY PRE-ALT FEE: a � i HEREBYAFPIRM UNDER PENALTY OF PERJURY THATTHEFiE IS ACANSTRUCTION I.EN�WG AQENCY . � FORTHE PERFORMNNCE OFTHE WORK WR WHICHTHIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z W � LENDER'SNAME F- LENDER'SA�DRESS � ICERTIFYTHATIHAVEREADTHISAPPUCATbNANDSTATETHATTHEA00VE1NFORMATIONiSCARRECT. TOTAL FEES ��� 1 �� � � W IAGREETOCAMPLYWITHALLCITYANDCOUNTYORDINANCESANDSTATEUWSREUTIN6TOBUILDIN6 � CONSTRUCTION,ANOHEREBYAUTHORIZEREPRESENTATIVESOFTHISCOUNTYTOEMEflUPONTHE yi. . ZABOVE-MENTIONED PROPERTY FOR INSPEC710N PURPOSES. COMMENTS �-K""�'t ���y�� r�'G '� OC'���"�T � � o '� �/c -��. P�R�C� •��sr PI�--�oS• `�1�� '��31y.�1�� _ —s m pERMITTEE NAME(PRINn � � Q � N SIGNANREOFPERMITfEE DATE RECPT.NO. PA�D BY ' VAIIDATiON I-=- WHITE—Deparlment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applfcant's Copy