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HomeMy WebLinkAbout05-314(1) ��_� CITY tpF llJ[AMOND TiAR DEPARTMENT OF COMMUIVITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 92765 ��9�i' (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS BUILDING PERMIT APPLICATION FIRMLY j JOBSITE APPUCATION PERMIT P/C ¢ ADDRESS o DATE 'JD tTu�nC_ O NUMBER # �`'� �i�- `) , °-° APN L07 I TRACT ISSUE 7Yp� ` f � DATE CONST. V�fJ Q GROUP -t J-� o OWNER o ' vw.e5 �p ADDRESS �i '`G� +�� v�t� LONING SETBACKS ���N`,N"'���t���S� �i�aq2N �ieec� � Z CITY CoStc- QS�. ZIP 9�ab TEL. 14 �12 ~ $ AEART � pW ' ,� ❑ p APPUCANT TEI. ❑ Z SIDElSIDE STREET q�11/ p ¢ CONTRACTOR SIDE � � ADDRESS A � o CITY ZIP TEL. PROPOSEDUSE Q���dit��,Ir1a.I HvIE� tZ.w.�IA., pw� , ��,; �y w ARCH/ENG/ � � z DESIGNER �Z}'I IC �R j!J lLS ��lJ•L' 11 ✓GrP,C NO.DWEL. NO. nw., ADDRESS 1�1 TNtJo ��—,u,w `(�j� SVt loo NO. � CITY T(t,��� Z�p . UNITS STORlES BEDROOMS Ra.b1"1 TEL. p� OWNER-BUILDER DECLARATION DESCRIPTION SQ,FT; FACTOR PSF ADJ,AREANALUATION O SFR/ADD/AEM �� f��� 1 HEREBY AFFIRM UNDER PENAITY Of pERJURV 7HAT i AM EXEMPT FROM THE CONTMCTOpS LI- G0�898/COIPOrt W CENSEUWFOATHEFOLLOWlN6AEASONjSEC.)p7).5BUSINESSANDPAOFESSIOMSCppE:ANyCITYOA (n UZ, COUNTYWHICHRE�UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DE�IOLISH.ORqEPA1RANYSTRUG W � � NRE,PflIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICpNT FOR SUCH PERMITTO FII.E A SIGNED W Patio/Deck OSTATEI,IENT THAT HE OR SHE IS UCENSED pURSUANT TO THE PPOVISIONS OF THE CONTRqCTORS LI- CENSE LAW(CHAP7ER e(COMMENCING 1V�TH SECTION 70a0)OF DIVISION 3 OFTHE BUSINESS AND PR0. �'�' POOUSp3 FESSIONSCOpE)OA7HA7HEOASHEISEXEMP7THEAFFAOMAND7HE8A5lSFOA7HEALLEOEDEXEMP- (� V TION.ANYVIOLATIONOFSECTION7o31.5BYANYAPpLICANTFORAPERMITSUBJECTSTHEAPPUCANTTO Z Re-Roof ���.�„ � ACNIIPENAINOFNOTMORETtWJPNEHUNDRED00LLAR5(5500)J: Q ❑I,ASOWNEqOFTHEPFlbPEH7Y,ORIAYEMP�OYEESWI7HY�pGESASTHEIR50LECOMPENSATION, � Commercial Z WILL DO THE WORK,ANU THE STRUCTURE IS NOT MTBNDED OA OFPEflED FOq SAIE(SEC,�7011,BU51- .J ' N NESS AND PqOFESSIONS CODE;THE CANTAACTOAS UCENSE U+SY DOES N07 A➢PLY TO AN OWNEA OF ? PROPERiY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WOPK HIMSEIf OR HERSELF OR � THROU6HHISORHEROWNEMPIOYEES,PROVIDEDTHATSUCHiMPROVEMEMSARENOTINTENDE00R m Q OFFEflEOFOqSALEif,HOWEVEfi,THE8UILDIN60fltAfPROVEMENTISSOLDWfTHINONEYEAROFCAMPCE- z, TION,THE OWNER-BUILDER WILL HAVE THE BUR�EN OF PNOVINCt THAT HE OR SHE DID NOT BUILD OR � IMPROVEFOqiHEPURPOSEOFSALE). W ❑I.ASOWNEROFTHEPROPERTV,AMEXClUSNEi,YCOMRACTINOWITHLICENSFOCONTPACTORS � TO CONSTRUGT THE PRQIECT(SEC.7044,BUSINESS ANO PROFESSIONS CODE:THE CONTMCTORS U- V81UallOfl ADJ.AqEA � CENSELiW�0ES7V07APPlYTOMlOWNEROFAPROPERTYWHOBUILDSOqIMPROVES7HEqEON,ANO � � WFIOCONlRACTSFORSUCHPROJECTSWITHACONTFACTOR(S)UCENSEDPURSUANTTOTHECONTRAG qUANTITY DESCRIPTION FEE � x TORS IJCENSE IAW.). � �I AM EXEMPT UNDER SEC. 8.d P.C.FOR THIS REASON Q � U �'i' DpTE OWNFR ►�— � I.ICENSED CONTAACTOAS DECLARATlON � � 1 HEREBYAFFIRM UNDER PENALTY Of PERJURY THAT IAM LICENSED UNDER PHOVISIONS OF CHAPTER � p„ B(COMMENGNG WITH SECTION 7oa0j OF DNISION 30P THE BUSINE55 AND PROFESSIONS CADE,AND Z � MY UCENSE IS IN FlILL FORCEANO EfFECL m � L�CENSE CL/qSS LIC.NO. D��� I��Q �`� � wDATE_�• f � CONTRACTOR���_� 1L�� Ft,pinv� pJ. � WORKERS'COMPENSATION bECLARATION � � I HEREBVAFFIRM UNDEfl PENALTY OF PERJURY ONE OFiHE FOLLOWING DECLAMTIONS: V .� � Z � _tHAVEAMDWtLLMAIN7AINACER7IFICATEOFCONSEMTOSELF•lMSUFEFORWORKEflS' ¢ 2 COMPENSATION,ASPROVIDEDBYSECTION37o00FTHELABORCODE,FORTHEPEHFORMANCE U OFTHE WORK FOR WHICH THIS PERMIT IS ISSUEO. � � F _IHAVEANDWILLMAINTAINWORKERS'CAMPENSATIONINSURANCE,pSREOUIREDBY5ECT10N Q 37000FTHELABORCOOE,iOqTNEPEHFORMANCEOFTHEWORKWRWHICHTHISPERMiTIS , � ISSUED.MY WORKERS'COMPENSATIOiJ INSURANCE CARRIER AND POLICY NUMBEfl ARE: CONSTFUCTION �, CARRIER PLAN REVIEW � POLICYNUMBER ELECTRIC � (I1�IISSECf10NNE�t�78ECnr9'l.ETEDOF7}EpEWXl15p7i3pNE}A1N)FlEDOpIA{14(f10D)OALESS} PLUMBING Z ICERTIFYTHATINTHEPERFOPMANCEOFTHEWORKKORWHICHTHISPERMITISISSUED,I MECHANICAL C7 SHAII NOT EMPLOYANY PERSON IN ANY MANNER SOqS TO BECAME SUBJECTTOTHE � WORKERS'COMPENSATIONLAWSOFCALIFORNIAMIDAOPFETHATIFISHOULDBECOME INSPECTIONFEE �„_ SUBJEC7T07HFWOAlCERS'COMPElJSA710NPAOVI510NSOFSEC710N37000FTHEtA80R = CODE,ISHALLFORTHWITHCOMPIYWIiHTNOSEPHOVISIONS. ISSUANCE � p DATE: APPLICANT; SMIP � WA8NIN6:FAILURE 70 SECUflE WORKERS'COMPENSATiON CAVERAQE IS UNLAWFUt,AND SHAtLBE ENEHGY P!C � � SUBJECTANEMPLOYERTOCRIMINALPENAITIESANDCIVILFiNESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT JDOLLARS{S70o,o00).IN A�DITION TO THE CQST OF COMPENSA710N,bAMACaES AS PROVIDED KOp IN SECTION37080FTNELABORCODE,INTEREST,ANDATTORNEV'SFEES. w RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � INEAEBYAFF7RMUMDEAPENALTYOFPEAJUAY7NAi7HEflE75ACON5TAUGTlONLENDANOAGEMCY fOR THE PERFORMANCE OF THE WORK W R WHICN THIS PERMIT IS ISSUED(SEC.3097,CN.C.). Z LtJ � LENDER'SNAME F-- LENDEfl'SADDpESS �� W ICERTiFYTHATiHAVEREADTHISAPPIICATIONANOSTA7ETHATTHEABOVEiNFORMATIONISCARRECT. TOTAL FEES �� 0 ��' �� p. iAGRE6TOCOMPLYWITHALLCITYANDCOUNTYORDINANCESANDSTATEUWSpELATiNGTOBUILDIN6 � CONSTRUCTION,ANDHEREBYAUTFlOA)ZEAEPflE5EN7ATNESOFTHISCOUN7Y70EMERUPOMTNE ��'���f �, � � �.�. � z ABOVEMENTIONEDpqOPERTYFORiNSPECTiONPURPOSES. COMMENTS ��� ����G� '�`a'� �`������„�,."'� � �a��G �� � +�����c�'�i r PI c�1r o� �14-C�� cs5'.�►4��ll ¢ PERMITTEENAME(PRIl7T) . . [/� � � SIGNATUREOFPERMITTEE DATE �y �ry � RECPT.NO.��°�j PAID BY _5������r,li VpIJDAT)ON WHITE—DepaAment Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy