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HomeMy WebLinkAbout05-380 _��^ CITY OF DIAMOND BAIi � - � DEPARTMENT OF COMMUIVITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 I �w (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS BUII,DING PERMIT APPLICATION , FIRMLY 9�`� ��c�,, � � JOBSITE APPLICATIQN, � r � � PEFMtT P/C I o ADDfiESS DATE � � � NUMBER #��' ��� ' o ISSUE TYPE OCC °.° APN LOT TRACT DATE CONST, GROUP p OWNER _ " ADDRESS '{nqn �'(LiKCoI ���_,�.ri�� �o ZONING SETBACKS a FAONT RW ❑ oCIN �OS��.. MtS�. ZIP� TEL. '" REAR O q APPLICANT TE�-� SIDE/SIDE STREET RW C7 Q CONTRACTOR SIDE ❑ � ADDAESS PROPOSED USE i� ' G.. I � L �'- . � CITY ZIP TEL w APCH/ENG/ ��� S�Iai�-S�-t,�� �. z DESlGNER..Qh�-"� �IS�CrY �(LCkIT'C�LT�� NO.DWEL NO. NO. oW. ADDRESS�SS�S� �Ev►v� ,�.�.t<-� jZ2. Sa.tL a6o -� UNITS �� STORIES BEDROOMS � CITY �6�t v�tT C�Q ZIP�I$ TEL.j�4)�S-lS,�D � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER bECLARATION SFR/ADD/REM O p 1 HEREBY AFF�RM UNDER PENALTY OF PERNRY THAT 1 AM EXEMPT FROM 7NE CONTRACTOBS l4 G0f8g8/C8rp0�1 � W CENSEUWFORTHEFOLIOWINOREASON(SEC.70.71.68USINESSANDPROFESSIONSCODE:ANYCIiYOR (n . zCIXINTYWHICHRF�UIRESAPERMITTOCONSTRUCT,A[JEF,IMPROVE,DEMOlISH,ORREPAtRANYSTRUC- LLI PalioJDeck w TURE,PR10H TO 17S ISSUANCE,ALSO REQUIpE5 THE APPLICANT FOR SUCN PERIAIT TO FILE A SIGNED W � STATEMENT THAT HE Oq SNE IS LICENSED➢UASUANT 70 THE PROVISIONS OF THE CONTRACTORS LI• � CENSE LAW(CHMTER e(COMMENCINO YlITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. u' POOIISpB Q FESSbNSGODE�ORTHATHEORSHEISEXEMPTTHEREFROMANOTNE8A51SFORTHEALIEQEDEXEMP- (,�} U TION.ANYYIOlAT10NOFSECTiON7031.68YANYAPPLtCpNiFORAPERMITSt18JECTSTHEAPPLICANT70 Z pe-Aoof � ACMLPENALiVOFNO7MORETHANFNEHUNOREDDOLLARS(5500).): � ❑l,ASOWNEAOFTNEPROPEATY,ORMYEMPIOYEESWiTHYJAGESASTHE�RSOLECOMPENSATION, � COO7rtIBfClfll � � z WIIL 00 THE WORK,AND THE STRUCTURE IS NOT IMENDED OR OfFERED FOR SALE(SEC.70N,BU51- J �NESSAND PROFESSIONS CODE:THE COMRACTORS LICENSE LAW DOES NOT APPIV TO AN OWNEfl OF � PROPERTYYA108UILDSORIMPROVESTHEFEON,ANDWHObOESSUCHWORKHtMSELFOANEASELFOA � � THFIOU�HHISORHEROWNEMPIOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOq m LL1� OFFEAEDFOASALEIFHOWEYER,THEBUIIDINGORIMPROVEMINTI550LDWRHINONEYEAqOFCAMPLE- � TION,THE OWNEq-BUILDEfl WILL HAVE TNE BUqDEN OF PROVIN�THAT HE OR SHE DID NOT BUIID OR 'Z IMPROVEFORTHEPURPOSEOFSALE). � ❑1,ASOWNEROFTHEPfiOPEfiTKAMEXG.USNEtYCOMAACTI7JGWITHLlCENSEDCOMHACTORS � TO CONSTRUGT THE PROJECT(SEC,70M,BUSINESS AND PiiOFE5S10N5 CODE:THE CONTMCTORS ll- V81U8I10� ADJ.AREA W CENSEIAWDOESNOTAPPLYTOANOWNEROFAPROPERNWHOBURDSORIMPROVESiHEREON,AND � WhiOCONTRACTSFOR3UCHPROJECTSWITHACONTRACTOR(S)IiCENSEDPURSUANTTOTHECOMHAG qUANTITY DESCRIPTION FEE � � TORSIJCENSELAW.). J � O 1 AM EXEMPT UNDER SEC. B.8 P.C,FOR THIS REASON � � � � DATE OWNER V . Z W � LICENSED CONTRACTORS DECLARATION �j � 1 HEREBYAPFIRM UNDER PENALTV OF PERJUflY THAT 1 AM UCENSED UN�ER PROVISIONS OF CHAPTEP � � � p_, 9(COMMENCIMO W1T71 SECTWN 7000)OF DI41510N 3 0F THE BUSINESS AND PROFESSIONS CADE,AND Z X GY LICENSE IS IN FUII FORCEANO EFfECT. m � LICENSE CLASS � UC.NO. �0�3��-�v � ^ � F-- ` ! �C r�`�, � V pq7� X!1 O+�l`� CONTRAC70R�'y�[�5'�-��oe°'C W �T � WORKERS'COMPENSA710N DECLARATION a � U � I NEREBYAFFIRM UNDER PENALTY OF PEAJUAY ONE OFTHE FOLLOWING DECLARATIONS: Z Q � �IHAVEANDWILIMNNTAINACERTIPICATEOFCONSEMTOSELF-INSUREFORWOqKERS• T ¢ COMPENSATION,ASPROVIbEDBYSECTION37o00FTHElABOqCODE,fORTHEPEflfOfiMANCE W OFTHE WORK FOR WHICH TH�S PERMIT IS ISSVED. � 0 w _IHAVEANDWIILMAINTA�NWORKERS'CAMPENSATIONINSURANCE,ASREQVIREDBYSECTION Q 37000FTHELABOACADE,FORTHEPERWRMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSUED.MY WORKERS'COMPENSATION INSORANCE CARHIER AND POLICY NUMBERARE: CONSTRUCTION � CARRIER PLAN AEVIEW Z POLICYNUMBER ELECTRIC Q 0 {RNSSE(.'fIONNE�NOTBECOh7PLETEDOF'fl-EPEW�MT1SWFiONEMAR'DFaEDDOLIPAS(L100)ORLESS} PLUMBINC� Z 1 CERT�FY THAT IN TNE PEflFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �J SHALINOTEMPtOYANYPEASONINANYMANNER50A5TOBECAMESU&IECTTOTHE � WORKEflS'COMPENSATION lAWS OF CALIFORNIA,AND AOREETHAT IP I SHOUID BECAME INSPECTION FEE SU&IECT 70 THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR � CODE,ISHALLFORTHW�THCOMPIYWITH7HOSEPROVISIONS. ISSUANCE O SMIP p DATE: APPLtCANT: � J ENERGY P/C J WAqNlNO:FNWAETOSECUAEWORKERS'COMPENSATIONCAVERAGEISUNLAWPlIL,ANDSHALLBE � SUBJECTANEMPLOYERTOCRIMINAIP&NALTIESANDCNIIFINESUPTOONEHUNOqEOTHOUSANU ENERGYPERMIT DOLIARS(5700,OOn).�N ADDITION TO THE C0.5T OF CAMPENSATION,DAMAOES AS PROVIDED FOp IN � SECTION37080FTHELABOflCADE,rNzeREsr,avoarroaraErsFEFs. . RETEM710NFEE: w CONSTRUCTION LENDINC�AGENCY PRE-ALT FEE: a � IHEREBYAfFIRMUNDEHPENALTYOFPERJUqYTHATTHEREiSACONSTRUCTIONLENDINGAGENCY FOR THE PERFORMANCE OFTHE WORK W R WHICH THIS PEflM1T IS ISSUEO(SEC.3097,ClV.C.}. Z W � LENDER'S NAME F=- LENDEiYSADDRESS `�'� CP � �� � ICERTiFYTtiATIHAVEREADTNISAPPLlCATIONAND57ATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES���'���, w IAGHEETOCOMPLYWITHALLCRYANDCOUNTYOFDINANCESANUSTATELAWSRELATINGT09UI101N0 � CONSTRUCTION,ANOHEREBYAUTHORIZEPEPRESENTATIVESOFTHISCWNTYTOENTERUPONTHE � �� ��� Z AeOVE-MENTIONEDPROPERNFORINSPECTbNVURPOSES. COMMENTS G�-�-�U��;}��yrj�p� ��� ���� � �ik��G a�� '�rw' .c>►c �F c�.-� 9"P -'a � � m PERMITTEENAME(PflINn � Q � � SICNATUREOFPERMITTEE DATE � RECPT.NO. PAID BY VALIDATION H WHITE—Depadment Copy,YELLOW—Ffnance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—App!lcanYs Copy