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HomeMy WebLinkAbout05-314(5) �}„! CITY OF DIAMOND BAR DEPARTII�NT OF COMMUNITY&DEVELOPMENT SERVICES _ 21825 Copley Drive,Diamond Bar,CA 91765 :����`r'• (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS BiTII.DING PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION PERMIT P/C ` .� o ADDRESS DATE ��y�f 0 NUMBER #��• �J 1�}-- �� o ISSUE TYPE OCC °-° APN LOT I ,� TRACT DATE CONST. V N�L GROUP 'I �J' p OWNER 2.U0{2FiGtt� (�oi1'�GS p ADDRESS_�JOCIU (3�LiSTo� � 5v�5'� aOb ZONING SETBACKS l�ll �u1 � �G.ntO �Q U111$(se' S�i Z CIN �OSr0.. 3'(2S� ZIP� TEL.�714 N��'�,SZ6� FRONT �I�A� . $�15-Pl�.riNP►W �Q'�°-S �3�$ �( � APPLICANT TEL. REAR � p � SIDE/SIDE STREET RW ❑ z Q CONTRACTOR SIDE ❑ � ADDRESS , A � \ � CITY ZIP TEL. PROPOSEDUSE 2. i I fhVl��- �uht� '�" � w ARCWENG/� z DESIGNER Z P•O.G � � N l w , J NO.DWEL. NO. NO. a ADDRESS 1 N 1 1 �O STORIES � D�_t2��;.�DROOMS 26 � CIN SQ.Ji�t.-C. ZIP �1�L1`L TEL. �Ny- �I'y �D UNITS cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAIUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM �� ��� O p I HEREBY AFFIRM UNDER PENALiY OF PERNRY THAT I AA1 E%EAiPT FROM THE CONTRACTOHS LI• G8I8g0/C8lpOfl W CENSEtAWFORTHEFOLLOWINaREASON(SEC.7031.6BUSINESSANDVROFESSIONSCODE:ANYCIiYOR (n C> COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,AITEfl,IMPROVE,DEMOlJSH.OpREPA1RANYSTRUG � w NRE,PRIOR TO ITS ISSUANCE,ALSO REWIRES THE APPIiCANT FOR SUCH PERMITTO FlLE A SI6NED W Palfo/Deck � STATEMEM THAT HE OR SHE IS UCENSED PURSUANT TO TME PROVISIDNS OF THE CONTRACTORS ll- � � CENSE LAW(CHAPTER 9(COMMENCINa WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AMD PRO- POOUSpe 0 FESSIONSCODE)OflTHATHEORSHEISEXEMPTTHEREFROMANDTHE8A515FORTHEAlLE6E0EXEMP• C7 V TION.ANVVIOLATIONOFSECTION7o31.68YANYAPPLICANTFORAPEflMITSU&IECTSTHEAPPLICANTTO Z Re-Root ��'I� A CML PENALTY OF NO7 MORE THAN FIVE HUNDRED DOlLARS(S500j.): p ❑I,ASOWNEROPTHEPqOPERTY,ORMYEMPLOYEESWITHINAOESASTHEIRSOLECOMPENSATION, � COtOf118fC181 - Z WILL DO THE WORK,AND THE STflUCNRE IS NOT INTENDED Oq OFFEREO FOR SALE(SEC.7044,BUSI- J � NESS AND PROFESSIONS CODE:THE CANTflACTORS UCENSE lAW DOES NOTAPPtY TO AN OWNER OF ? PROPERN NR10 BURDS OR IMPROVES THEPEON,AND WHO DOES SUCH WORK H�MSEIF OR NERSELF OR � iHROU0HHI50RHEROWNEMPLOYEES,VROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m � OFFEREDWRSAIEIF,HOWEVER,THEBUILDINaORIMPROVEMENTISSOtDWIiHINONEYEAROFCOMPLE• Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVIN6 THAT HE OR SHE DID NOT BUIID OR = IMPROVEFORTHEPURPOSEOFSAL�. �,y� �I,ASOWNEROFTHEPROPERTY,AMEXCIUSIVEIYCANTflACTIN(iWfTHLiCENSEDCONTRACTORS � TO CONSTRUCT THE PR0.IECT(SECJ014,BUSINESS AND PROFESSIONS CODE:7HE CONtRACiOB5 Ll• V81110f100 ADJ.AREA W CENSEIAWDOESNOTAPPLYTOANOWNEROFAPROPER7YWi�lOBUIlD50RIMPROYESTHEREON,AND � WF�IOCONTpAC7SFORSUCHPROJECTSWITHACONTflACTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION PEE Y TORSLICENSEIAWJ. � O I AM EXEMPi UNDEfl SEC. 8.d P.C.FOR THIS REASON Q � U � � DATE OWNER U Z W � LICENSED CONTRACTOFS DECLARATION W � I HEREBYAFFIRM UNDER PENALTY OF PERJURV THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER � CL B(COMMENCIN6WITHSECTION7o00)OFDIVISION30FTHEBUSiNESSANDPROFE5510N5CODE,AND Z X AIY I.ICENSE IS IN Nll FORCE D EFFECT. m Lt.l � � � � LICENSE CLASS ���.No. 3�6 � U DATE � CONTRACTOR � �3 � W � WORKERS'COMPENSATION DECLARATION a � 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLIOWING DECURATIONS: Z Z _IHAVEANDWILLMAtNTAINACERTIFICATEOFCONSENTTOSEIFINSUREiORWORKERS' _ ¢ COMPENSATION,AS PHOVIDED BY SECTION 37000FTHE LABOR CODE,FOfl TNE PERFORMANCE W Q OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � � _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASpE�UIREDBYSECTION Q 37000FTHElABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ' J ISSUED.MY WORKERS'COMPENSATION INSURANCE CARHIER AND POLICY NUMBEHARE: CONSTRUCTION j CARqIER PLAN flEVIEW � POLICY NUMBER Z ELECTRIC ¢ (IF65SEC7pNNE�NOT8E00MPlEfEDOF7HEPERMf(ISFORQVEkiUhDFtEDDOLlARS(t10D]ORIESS} PLUMBING 0 Z I CERTIFY THAT IN THE PEHFOFiMANCE OF THE WORK FOR WH�CH THIS PEPMIT IS ISSUED,1 MECHANICAL �' SHALLNOTEMPLOYANYPERSONINANVMANNERSOASTOBECOMESUBJECTTOTHE � WORKERS'CAMPENSATIONIAWSOFCALIFORNIAANDAGREETHATIFISHOULDBECAME INSPECTIONFEE � SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37o00FTHELABOR . � CODE,ISHALLiORTHWiTHCOMPIYWITHTHOSEPROVI510NS. ISSUANCE � SMIP p DATE: APPLICANi: J WARNING:FAILURETOSECUREWORKERS'COMPENSATIONCAVEPAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C � SUBJECTANEMPIOYERTOCflIMINALPENALTIESANDCMLFINESUPTOONEHUNOREDTHOUSAND ENERGYPERMIT DOLURS(510D,000).IN AD�ITION TO THE COSi OF COMPENSATION,DAMAGES AS PROVI�ED WR IN � SECTION37080FTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. � RETENTIONFEE: a CONSTfiUCTION LENDING AGENCY PRE-ALT FEE: O � i HEREBYAFFIRM UNDER PENALN OF PERJUqY THATTHEflE IS ACONSTRUCTION LENDINO AGENCY iOR THE PEflFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30�'/,CIV.C.). Z W � LENDER'S N/JAE . F— LENDER'SADORESS �� � ICERTIFYTHATIHAVEHEADTHISMPUCATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES ���� ��O go � ��� W IAGREETOCOMGLYWITHALLCITYANDCOUNTYORDINANCESANDSTA7EUWSREUTIN6TOBUILDIN6 ' z� CONSTRUCTION,ANDHEREBYAUTHORI2EREPRESENTATIVESOFTHISCOUNTYTOEMERUPONTNE v .yy t�,.�� p� ,,y,� � � '�� ABOVE•MEMIONEDPROPERTYFORINSPECTIONPURPOSES. COMMENTS �r'Tr �'��-4,C���"1 W'�C �i��'��� � � '��,. � �,a�-�� c.xx;�l� ���a�exs� ��'�4ta1—�-3��(a�) Q PERMITTEE NAME(PRIP7n � I� 1 � � SNiNANREOFPEPMITfEE DATE '� < = RECPT.NO. PAID BY VALIDATION ~ WHITE—Deparlment Copy,YEILOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy I