Loading...
HomeMy WebLinkAbout11944 . /� CITY OF DIAMOND BAR ----��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �/ �W ,y 21660 E.Copley Drive Suibe 190 (909)860-3195 Fax(909)861-3117 PRESS ���"��°�� BUILDING PERMIT APPLICATION FIRMLY o ADDRESS ���f j'� •"l�� ����'� �� DATEICATION r�� ��� NU BER• "�#/C � c� ISSUE 7YPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER ��,�•i� _rr:r:�c.r�-� p ADDRESS �.�-`�C�� ��.�' t�L'7�-'-�� EZ--Rj� ZONING SETBACKS �g,' "��-�'"' FRONT RW fJ �W CITY�_. -� ZIP¢`,7�-:�TEL.�/.�-.�."' i ' �, REAR f�l APPLICANT �.c'-1�_ ��l:�yr�-,/.F�;-TEL. � ,'`�-L�' � SIDE/SIDE STREEf RW [� a� CONTRACTOR �'�= -' L�'.+�jt`�I�y SIDE fl ADDRESS i{�SI � 'C" 'r"E} ^E8`/�7 � CITY CY•"C s� 21P +_I TEL.��`3 � - �' , PROPOSED USE o ARCH/ENGI — — z� DESIGNER N0.DWEL, NO. NO. a ADDRESS UNI7S STORIES BEOROOMS � CI7Y ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER•BUIL�ER OECLARATION SFR/ADD/REM O p I MEHEBY AFFIRM UNDER PENALTY OF PERJURY THAT I NA EXEMPT FROM THE CANTRACTOflS I.I� G8f2g0/C8fP0lI W CENSELAWWRTHEFOLLOWIN6REASON(SEC.7o3�.58U51NES5ANDPROFE5510N5CODE:ANVCITYOR (n U �NTVWHICHqEWIRESqPEFMITTOCON57RUCT,AITER,IMPFiOVE,DEMOLISH,ORREPAIRANYSTRUG LI.I p8fi0/DeCk � iURE,PRIOR TO 17S ISSVANCE,ALSO REWIRES THE APPLICANT fOR SUCH PERMIT TO FILE A SIGNED w � S7ATEMEN�iHAT HE OR SHE IS�CENSED PURSUANT 70 7FiE PHOVI510N5 OF THE CONTRACTORS LI� � CENSE UW(CHAP7ER e(COMMENCING WITH SECTIOY 7000)OF DIVISION 30F THE BUSINESS AND PR6 V' POOUSPB FESSIONSCOOEJOflTHATHEORSNEiSEXEMPTTHEREFR�AAAN�TME8A515�OflTHCALLE6E0EXEMP• (3 TION.ANYVIOUTIONOFSECTON7o91.58VANYAPPLICANiFONAPERMITSU&IECTSTHEAAPLICANTTO Z Re-Roof � ACIVIL OENALTI OF NOT MORE THAN FNE HUNDRED DOILARS�S50D).): o f71,A50WNEflOFTHEPROPERTY,OflM�EMPLOYEESWITHWAGESASTHEIfl50LECOMPENSATION, � COfIIRIBfCIeI ' � N'ILL�O THE WORK PMD THE STfiUCTl1AE IS NOT INTENOED OR OFFERE�FOR SAL[(SEC 704<,BU51� _I � NE53 AND PROFESSIO�S'S CODE:THE CONTRAC70RS LICENSE LAW DDES Noi APPIY 70 AN OWNER OF � PROPERTYNM1f09UILDSORIMPROVESTNEREON,ANDNM1iODOE55l1CHWORKHIMSELFORHERSELFOq m � TMflOUGHXI50RNEflOWNEMPLOYEES,PROVIDEDiHATSUCHIMPflOVEMENTSARENOTIN7ENDF.00P Q OFFEAEDFORSALEIF,HOWEVERTMEBWLDINCORIMPROVEIAENTISSOLOWITHINONEYEAROFCOMPLE� Z TION,THE OWNER�BUILOER WIIL HRVE TME BUROEN Of PROVINO THAT HE OR 3HE DID NOT 8111LD OR = IMPROVE FOp THE PUHPOSE OF SALE). ❑1.AS OWNER OFTHE PROPERTY.AM E%CLUSIVELV CANTRACTING WITH LICENSED COMHACTORS � TO CONSTflUCT 7NE PqQ1ECT(SEC.7041,f1USINE55 AND PROFESSIONS CODE:THE CONTPACTORS ll� VflIU9IlOf1 ADJ.AREA____,.__ W CENSELAWOOESNOTRPPLYTOMlOYYNEROFAPROPEFTYWFIOBUILOSORIMPROVF.STMEREON,AN� F WFiOCONTMCTSFORSUGiPFiWECT6WITHhCONTRACTOR�S�UCENSEDPUPSUAkTTOTHECONTPAC- �UANTITY DESCRIPTION FEE � TONS LICENSE UW.). J 0 UTAIAEXEM7TUNDERSEC.��_ _9.8P.C.FORTHISRE0.50N U � — — CL LL' DA7E OWNEfi___—._.._.__—__--_'_'— � Z W � LICEN5E0 CONTRACTORS DECLARATION � � w I HEREBV AFFIMI UNDER PENALTV OF PERIUHY'fHAT I AM LICENSF.D UNUEN PROVISIONS OF CHAPTEA C_ � � � ',Y d 9(COPIMENqNO WITX SEGTION 7000)OF OIVISION 3 0F TME BUSINESS AND PRDFESSIONS CODE,AND � ' y� � �� ����� � ' F X MYIJCEN5EI51NFULLWRCEANOEFFECT. m d `/• ,-�,-/) ��� �{ " LLI � G � LICENSECLASS ����-� LIC.NO.��;_�__�_��__ � � —"_'_— J ... DA7E � /� `--' !r c� �� CONTRACiOR�'��,j W � WORKERS'COMPENSATION DECLARATION Q � U � IHEREBVAFFIRMUNDERPENALT'OFPERIURVONEOFTHEFOLLOWINGDECIAPATIONS: N Z � IHAVEANDWILLMAINTAINACEfi�IFICATEOFCONSENTTOSELF-INSUREPORWORKER5' _ � �CA�iPENSAT:0U,A5PROVIDEDBYBECTION37ouOFTNELRBORCJDE,FORhIEPERFORMANCE `U OF 7HE WORK FOR WHICH THIS PERAl1T IS ISSUE0. � � W _t H�VE AN�WILL kAINTAIN WOAKERS'COMPENSATION INSURANCE,AS flEOUIRED BY SECTION � � 37ooOFTHELA60RCODE,FOH7HEPERFORMANCEOFTHEWORKiORWHiCHiHISPERMl715 � ISSUED.MVWaRKERS'CORIPENSATIO INSUR0.NC CARHIERANDPOLICYNUMBERARE: CONSTRUCTION __.,,.____.. ..___.____— J �; � ;� "_ � CARRIER.�,�,1C� � '` _ C, _.....----- PLAN REVIEW _...-----....._.. ------- ` —-- � POLICYNUMBER A�n z`�C`1r1.,�4,��_�L�_�_�� ---._,_ ELECTRIC _....—_..�_ O (}�{���q.���rypTBENb1RE7Ep(yTlEPERtATI$FOfi0NEF41RDREDWI.lARS{510(IIORL[55) PLUMBING - _-_-- ` - Z I CEflTIFY TMAT IN THE PEHFORMANCE OF THE WOPN FOR WHICH THIS PERIAIT IS ISSUED,I MECHANICAL __.__ ________.---. � SHALLNUTEMPLOYANYPERSONINANYMANNERSOA5T06ECOMCSUBJECiT07HE �/j WORKERS'COMPENSATIONlAW30FCALIFORNIAhNDAGREETHATIFISHOUL�BECOME �NSPECTIONFEE _________ .,_______.. � SU&IECTTOTHEWORKERS'COAIPENSATION7fiOVI510N50f5ECTION3]OODFTMEIABOfl —_ _ . �qq,, L�� — � COOE,I SHALLFOfirM ITNLOMPLY WITNTFIOSE PROVI310N9. ISSUANCE _.____ — ..._��� O J,{�"/ ` �'\ DATE:j�.` � �+ APPLICANT � w SMIP ........�_—_'_'_' �— "._— '__ _— —_..___._._.__— — _._'—'___—__—____—' � EN&flGY P/C ---.---------— --- J WAflNING:FAILURE 705ECUFE WORKERS'COMPENSATION CAVERAGE IS UNL4WFUL,AND SHALL 9E �y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILfINESUPTOONEHUNDRf�THOLSAND ENERGYPERMIT _ __„ DOLLARS(ytoD,Doa),INAODITION70THECOSTOFCOMPENSRTION,DAM.AGESASPROVIDEDFORIN '---- --- � SECTION3)OBOF7HELABORCOOE.I4TEREST,AN�ATT�FiNEV'SF[E5. RETENTIONFEE: _ _._._—_._._.._--._ O CONSTRUCTION LENDING AGENCY PHE•ALT FEE:G""�1 RT• t"r -ry� . �;.,. --f"--_."-- . `---.-"--.�._..----- r � , � I HEREBV AFFIHM UN�ER PENALTY OF PEFJUHY THAT 7HERE IS A CANSTRUCTION LENDINO AGENCV . _ _��::.� �«�r __ _ FOH THE P[RFOPMANCE OF THE WORK FOP WHICH THIS PERAIIT IS ISSUED(SEC.309'].CIV.G). Z '____—.._. W � LENDERBNAME�'_'--- ""_ ___— ' ' ' ' ___"'_.��— F— LEN[lERSADDRESS "—__"'—'_'_—__.. .—'___"____' � W ICERTIFYTHATIMRVEREADTHISAPPLCATIONANDSTATETHATTHEABOVEINFORMATKKJISCARRECi TVTAL FEES � � IAGREETOCAMPLVWITHALLCITYANDCOUN7YOFlDINANCESANDSTPTELAWSHELPTINGTOBUILDIhG 1. CONSTRUCTION,AND HLRE6Y AUTHORIZE flEPRESENTA71VE5 OF l HIS COUNTY TO ENTEq UPON THE (/, " � ABOVE-MEIYTIONED PROVERTY FOFl INSPEC��ON PURPOSES. COMMENTS__�_�_�``s�--''_�����,� � '� .__— /`.�\,(� y/- �y,_ � ` � �/� Y 4.!°,-'��--"' �_ / � ��� �%d'0 �c-��--•��~r m PEHMITTFENAME(PRI � _ - a — a' � ---- ' ---- � SIONATUPEOFPERIAITfEE ���� � = RECPL NO. PAID BY � VALIDATION�_ ~ WHITE—DepeRment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy � ��s s ,. _.._ �_.. � ��� � _ ... _ ,� _. ._ �.. _ . �. � ' _... ��' . � ' � I �' I , I � � � ' I i yk � � j : i i. : � ( . i . . i k � + - � � � . � i I � ����� - i i � . � '_ � ., I � � ' . , . � . ' , I' �� � : ��". 1 . , � ; I 4 ' . � - ' i - i , _ i ! ... .i r � � I .. �3� i I � � ' ' I I I � ' � I ( ` . ; ' , ��� i - I � ' . ._ �, _ ', �. ' . � � � .) i I � � � ' I I I -. L ...... ...}-. '...{..__ ..{._ ... _ ' . � � � I i ! . ( . � I � � � I . ���� � � I, � : ; �. � � ��.zt I � � � . � i I � ! � � � I � I i - »i� { �'I 1 � i • i . � i _ � , � � j, ry ; i � I f ( ; i I . � ; i i �. -� --� ---�f - -- '— � � - � a � � i � I '� ! I ; I ; � C � ' � � � "�� � � ` i , M � i -� ; I � ; � i �, ; j ; ' ! , I E ,�� l; � , � ; j I I ' ���, ( ' ' I ' � ' ; �g � i ' ��.� � � � ' � , � ' �sE � � I I ( j i , i "� . . 'S .. .I� t I �� � _€x£5 : � r � � �, � � � a � �`�ti � ; r �I . I ) � r i ( sr � E � � i i � � � i � f i � si { : � i � # ; _ � - ' � • r� � �.j 1 ; � ; .�. � _ -r � ���„ � i- 4 � � ( . � . , a�, � � � �� _ (,�I�, E . :'� i' i_. � t - � '� i � � � G4" ,'�� .�� — � e t: . t f � � ` � �t b . � . . � . . . : , Y� ��_ry 1 � G �"� . . ��„ F.I� �� A �d ' ; � � ' 3 � .�L I: � � � � . i ( f •I it��. t f : = Y�'� I # " � � . : t .- ^;� «� �, 1 ` � � .�I,� � , I � 4 � � � "..�' f � I � , � ��� �,�� � �.!� _�-; .I r. � . i�.:i _. ..: � i � � � . k � � ; � I � . �t � � —`_ . _ . � ..i_ �. � L �.._��� , . i �. � _� ( .__ � ��— -� � - -- - j - � � � xe e �. - i � } ; i. , ' ' I ( � i i �� y� � I , ; � � � � � I � ' I � . . . � � � �'. k SI . . i � , � � j _ � . . . � k � , i ' � - , y�� �E�. .. , � ` I i � . 4 ' ' - . � _ I � : , � ��p� i � I � � � � J : . � I , _ � - � ' � � � ; � y �<, ., r � ' ,� ; � . . i � , _ � 1 � �� � , � , � . � ; ' � � I i � � �� ��p i . � � � II � I I � i � I ' . . �. � ' �� ! I f � ! _ � � '� : � �._. ;._ . , � I _ � I . . ' ' _ € �� � �--�i- � � i � �__. �'. ;..._�. , ._� = ; � � 1 �' � I d� � 7 � ' I. � � � � �i �. �'�`� ; �� , � i ? I � � � ! � � -E � � � � � , t ' ' ( � ;� ' ' ; � ' j , , ' , '� ' ' i i ' ! ; ; , , , , ; ' ; ; � . ' ; { �s` ' ' � ; t F# e. / 'L'��+y' . ' . � .�.. �_ ,. y...._.. �. - ... ., . .. _ . ,. ; ' i ���_ � �"9 �, ) 6 i � i � � .I..._�_ `�' � h�_ ��y, . � _ , � I _ I I _ , � . . � � �� t�ta#t �i.� '� �. S�'"� - �A. � . . . i . � ,• I i . � ( + I t � �;E f�x�d�k?. SX..£ t aq�� : E4 ' k . ".. � r' . . ( 1 , � ! - � h } � 1phF�}�#it �tsr' z� , � s y� � � � �� f . 1 � I � � . . � I � - � i l��P^'Sd3.�, k. �' � � � _ } Ra, - - 1�. i � � � j _ e�k �w�ro i 7 �, 7 } . �' � �� 7 .� � ` C'� � * ♦ -� �� � ' � g 1jp+sF�� �" fj ti � Y .:,{ � i � I .} � - � - i � i s µ. {}y �.#�.��4 y . t'_ � j� � . 3 ! 1 .� l� v� , i� � : I � � � , I €., + ; t : �- ,, � { � ��k�,�y f k. b , .�. � ,i �� ' I i�Y� . � i.. I ._ ��. t � I �� l� � >.-:-� � i . ....:. . ,..._..... ..... .. ........... ....._.,.. _. ...�... .... , ..... _.. -..,.I. .. .,._... ....,.<.. .. .:.._ . .i._,. . .... _ .,,. ..._.. .. �_ ..._,..,.,._e � F