Loading...
HomeMy WebLinkAbout13230 (14) CITY OF DIAMOND BAR �----�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES %'"�� ' � ,� . 2166�E.Copley Drive Suite 190 �� � (909)860-3195 Fax(909)861-3117 � �.�-��' PRESS ���9�° BUII,DING PERMIT APPLICATION t`"`� FIRMLY d DDRIESS � L ��� F���� y' DATEICATION NUMBER ��s-`>�`�" #/C 0 � APN LO' ISSUE ,'1 TYPE OCC DATE t`�"' � ?��('� "I CONST. GROUP p OWNER '�' __ ADDRES 3 �� ZONING SETBACKS � CITY E < 21P �� TEL. , REART RW _ CUl — APPLICAN"f TEL. SIDE/SIDE STREET RW CJ � CONTRACTOR C, SIDE Cl_____ � ADDRESS � CITY ZIP � f TEL. � PROPOSED USE oARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. a ADDRESS _. UNITS uTORIES _ BEDROOMS y CI7Y ZIF TEL._ u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUIL�ER DECLAHATION SFR/ADDlREM O � I HER�Y AFFlRM UNDER PENALN OF PERJURY THqT I AM EXEMPT FROM THE CONTRACTORS ll• Ge�dJB/C2fPOh W CENSELAWFONTHEFOIIOWINGREASIXJ(SEC.7N1SAl1SINESSAN�PROFE5510N5CODE:ANVCINON (n � COUNTYWHICHqEOUIRESAPERMItTOC�ISTqUGT,lLLTER,IMGRO`/E.OEMOLISH,ORREPAIRANYSTRUC- W P8t10/DeCk � TURE.PRIOA TO 1T8 ISSl1ANCE,ALSO RE�UIRES iHE APPLICANT FDR SUCH PEHMIT TO FILE A SIGNED W � STATEMEN7 7HAT HE OR SME IS�ICENSED PURSUAN7 70 TME PROVIS;ONS OF THE CON7RACTORS LI- � — CENSE LAW(CHAPTER B(COMMENC!NG WITH SECTION 7aa0)OF OIVISION 9 OF THE BUSINESS AND FRO- POOUSPB FESS�ONS CODE)Ofl TMAT HE OR SME IS EXEMPT THEftEFflOM AN�THE BASIS FOfl TME ALLEGED F.XEMP- TION.ANYVIOLATKKJOFSECTION7091.6BVANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICAN7T0 Z Re-Roof � A CIVILPENALTY OF IVOT MOflE TMAN FIVE MUNDRE�OOLLARS(5500).1: p f71,A30NRlEROFTHEPROPERN,ORMYEMPLOVEESWITHWAGC-SASTHEIFlSOLECOMPENSATIO�, L� COfilf118fdel ' Z WILL DD THE WORK MN�'iNE SiHI1CTlIRE IS N07 INTENDED OA OFFERED FOF SALE(SEC.70aa,BUSI- J NE39A7�PROFESSIONS CO�E:TNE CCNTRACTORS LICENSE LAW�CES NOT APPLY TO AN OWNER OF � PflOPERNWHOBUILDSORIMPROVESTHENEIXJ,AN�4h1000ESSLICHWORKHIMSELFOqHERSELFOR � � THRIXI6HHI90RHERONMEMPLOYEES,PqOVIDE�THA75UCHIMPROVEMENT9ARENOTIN7ENDE00fl � � OFFEREDiORSALE.IF,HOWEYER,T1EBUl01NOORIMPROVEMENTIS50LDWRHINONFV[AROFCOMPIE� _ Z TION,7HF.OWNER�BUILDEF WILL HAVE THE BURDEN OF PHOVIM1G THAT NE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPQSE OF SpLE). � w C71.ASOWNEROFTMEPFOPERTI;MIEXCLUSIYELVCAPITRACTINGWITMIJGENSEDCONTHACTORS � TO CANSTfiUCT THE PFl0.IECT(SEC.7014,9t1SINESS AND PROGESSIONS CODF.:THE CONTRACTORS LI- VaIU9lI0f1 .._._—_..._ADJ.AREA___,___ ___ i W CENSELRWDOESNOTAPPLYTOANOWNEROFAPROPERTYWMOBUIL0.50RIMPROVESTHEREON,AND � F WFiDCONTRRCTS(ORSUCHPROJEC7SWI7HAWNTRACTOR(S)LICENSEDPURSUANTTOTHECOMRAC QUANTITY DESCRIPTION FEE Y TOfi5 LICENSE UW.�. ¢ ❑IAM EXEMPT UNDER SEC. 9.8 P.C.FOH THIS flEA50N Q � - --- ---- U LL � I DATE_ OWNER WZ —_— --.._....--." i � LICENuED CONTRACTORS DECLARATION � INEPEBYAFFIflMUNDERPENALTYOFPERJURYTHA7tAMLICENSEDUNDE{iPROVISIONSUFCfiAPT[R � J� /' � ( p_ 9(COMMENCIN3 WITH SECTION 7a0D�OF DIVISION 30F THE eIISINESS AND PROFE5510Y5 CqfJE,ANO Z 6 � ?< AIY UCENSE I6 M FULL FO(10EAND EFFECT. ,��� LLJ /J , rS�� � � d UCENSE CLASS . `/ LIC.NO. ���d � � �Y�--�-�--'---=_'- � h' J V DATE_.�_=�I—�'_�- CONTftACTOR�1] _ a �� W � WORKERS'COMPENSA710N UFCL4RATION Q � I HEREBY AfFIRM UNDER PENALTY DF PERJURY ONE OF THE FOLLOWI�G DECLAPATIONS: U N Z Q � _I HAVEAND WILL MIIINTAIN A CEfi�IFICATE DF CANSI'NT TO SEIF-INSUHE FOR WOflKERS' 2 CtkAPENSATION.A9PROVIDEDBY5ECT10N3'lOOOFTNEfABORCODE,FORTHEPERFORMANCE U Q yOF THE WORK FOR WHICH THIS PF.FlMIT IS�SSl1ED. � O ✓i _ _ w J_I HPVEAND WILI MAINTA�N N'ORKEP.S'CAMPENSA710N INSUHANCE,AS HEQUIRED 9V SEC?!DN Q37000FTHELABORCODE.FORTHFPERFOFA9ANCEOFTHEWORKFORWHICHTHISPERMITIS � ISSUED.MY WORKERSiCOMPENSRTION INS RANCE CFRHIEfl AN�POIICY NUMBER ARE. CONSTRUCTION .....,.__,.__.. '__""""_-___ y CARRIER� � �� �____.. PLANREVIFW ___ .� � , -- --- --'-- --- O POLICYNUMBER___ � ELECTRIC � . � _.,._.. - -'_--"'_ _'..—. ._ � (IFiISSECi1CNNE�NOiBE�P+IPLEfEDOF7F�PEPA4fI5FOpONEHUNDFEDDJUAFlSIS700)ORLES51. PLUM6ING _ '_.._.__..� W � ..'`" yi -_ ,Z I CERTIFYTHAT IN THE PERFOHMANCE OFTHE WORK FOP WHICH THIS PERMIT IS ISSUED.I MECHANICAL .,�}�_____ . _ (;3 SH0.lLNOTEMPLOVANVGEfi50NINANYMANNERSOASTOBECOMESIJBJECTTO7HC � WORKERS'COMPEN3ATIONlAW50FCALIfbRNIA,ANUAGREETNRTIFISHOUL�BECOME INSPECTIONFEE �.k______.._'•�`-�-'�-����-�, ���`��• S SU&lE iTOTHEWOHKEFS'COMPENSATIONPROVISIONSOFSECTION37000FiHELABOR �— C` „,"4. -f ',• --__ � � /y� CADE SHALLF flTHW17HCOMPLYWITM fiOVI510N5. ISSUANCE _ .._,_ � '� �� ,.� .. � Q / � �— SMIP �� � �`� DATE. S Q �PPLICANT. 1 ,�` . �.,..� ..— Q --�..._...-::: _'__.__—"__ W � ENERGY P/C '��'��' , ,, WARNINO:FAILUFETOSECUREWORKERS'COMPENSATIONCOVERAGF:ISUNfAWFUL,AND � ��'� -'-'-" "- , . ...."___ . • +r ,�•�•• .�.'_'_"____..��._.._._ �y SU9JECTANEMPLOYFRTOCRIMINALPENALTIESANDCIYILFINESUPTOONEHUNDREDTIi0U5AN� ENERGV PERMIT � `y' ' DOlLARS(5700.000),INMDITIONTOTH[COSTOFCOMPfNSATION,DAMAGESASPRUVIUF.D4'OPM ��� �� -�-------��-- ---- .r-1 SECTION 37080F THE IA�OR CA�E.INTEREST,AN�ATTORNEY'S FEES. �°'��-`�"'� � RETEN710N FEE: ,�`^!,� �`"'' __..._,.._—_ _ .- � CONSTRUCTION LENDING AGENCY `%:a `� _ _ _ _______ PRE-ALTFEE: t�• _Z�'e�____ '��: - - � IHEflEBVAFFlRMUNDEFlPENFLTVOFPEHJURYTHATTHEftEISACONSTflUCTIQYLfN011:GAGENCY _ _ _�:✓'________ ___,_,_ _ FOR THE PEFlFOHMANCE OF THE WORK FOR WHICH THIS PFRMIT IS ISSl1E0(SEG 3a97,CIV.C.). W -___._�_-__.____...__ —.__--__'— ""__""'_"' � LENDEF'S NAME___ . ___ _'_ _""'__ __ H lENDEH'SAO�RE55_"'_____"'--_'---"_""'"___""_""'___'""'--"'" �'` wI CEflTiF'!THAT I HAVE READ THIS APPLIC�TION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. Tl/TAL r EES ��s� ` � � IAGqEETOCOMPLYWI7HALLCITYANDCA:IMYORDINANCESANDSTATEIAWSFlFLATINGTOBUILDING � GONSTHUCTION,AND HEREUY RUTHOf71LE REPflESENTATIV S OF THIS COUNTV TO F.NTEp UGUN THE Z A00VE•MENTIONED PFlOPERN f-0F INS CiION PURPOS COM ENTS o �.'..�._( � ��_�.. (fJ `*�', _J`-��' ( _�`'� l,.�/�-�'-1�-��__ _ --- � ¢ PEflMITTEEN � f f5 °� "-"------ [/) ��� 6 �y - _.. � SIONAYURE OF PER �1TEE DATE = RECPT.NO._�___--PAID BY VALIDATIO � __ ~ WHITE—Department Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Flie Copy.GREEN—Appliranfs Copy r. _.. ._ ..._... _.__, . ; _._LL _. . . _ . �..� i -, i ; � , I ,. ,SSS F , '. ', � , ; ..j ...'.. i I . .� I . .. .�. ,r... �"�s� � , i I i j I . I � � � , � ' � . ' . , � � x .. �tTP ' . � 4 � � � I f I � ; ' �� . ' ( , i i ' { �F�� I I .' � � .. � ' I ' I , : � � � I ..� � . � . - I �1 j I I� �, ! � { , (�.e � � . ' 1 j � . I ! , . { i . 1 .. ��� � � , ' ' � I � ' . � � I � � � � � i � . . � . � �� �� � ' i � � I..._ . � . � . �� . { � , . ��'�. l_ � �.._ ' .I �i i ...e. � � , ' � I' 1 j ' � i ' � � � � ' ' � I , , , ���� j , �� , � � � _ F �� ; i � , i � ' i i , ; ' � I � ��v � j � ,j � i ' � I _ - � � � � � � � � � i ';, � � �_,_j, ( i � ! � F.i �� �� . ,..-.� ' : i I .:. . _ ' . �}� ; ' � i ' i �Y I I � � s.��'F � I � ' � �-"e 3. � I � ����@" � i _I � � . � ' � � `xdEy ( � � �� � � � � � � f� �.�� P. ' I � I , I - � €h6' � ` i I . "� 1� �,.� i r ° i "�. , � � � : i� i ��� � � � � . � � - . I � ° � I �t �� t �i I �r '�. �' . - , � ' � � ' "� 3`� � - i r � i � t � i � i{ i '� I I r � � i 1 '`� � � ' 1 [i��� 3 "I i 'l.U� �t� _ r ..� , i � . i . � - , - , : 9 > � I � I _ . i i '' i � i j e,y � - [ . t 'ki=t� �t J F � 1 `� 5 1�� I, Y, _ i ( j�3� I i I ) _ . � � i } � g � � � g � .:'i��� t_ i � � }j = i ' I � . '` � � ' _ ' i � '-� ¢�: � � �_ � � . �C : f t , - . .. . ' _ I .� i : �.A. 4 � �..... 3_ ka'�, , � � . � �:: z«�' �1 <'a, . '. I i' '.."_ ,-- . �. I.. �,�f .�._...�... I I . �k t ' r � I � a ..�� ��. �� . ' , �. i � f � . . C s � . � : � : . I � � I . f i � x � � � � � _ Y .�' . � , � . i � I � i � � � ( � ' � � � 1 � ( � .. ��'� . . ! I � ; � . ; i , ' ' , � , �.>� - ,•�� i � � • ' � � , . ; ( , j ' I � � � � � j � j �' � ' � , , i ( . : � ! � � I� I . f i . i i . . , f.1�: � i � , I i i . � �� , ` ��r� i ; . ; f.. _i _ _ . . , — � �;: i i I � a i i i � i , , ; , I ; � . � � � , , . E � , , � � ; � , � , � � � � k � I i �� _ �� 4 . � - � �__�` _ _ � . . � [ ,.s� � �.. E �1Y} , ,'. . � -;. i. ...... �.. , I s" ���� 4 ��. � .. I I I � ' i j � 1 . � � � ��� �� �y����, . � i . � ; � � � - � � ;�, � �� � j x ���� I � :�.� �. _ k � , j . ,�� a� �af' � �� ', I .r+ �, ' ( � . � � . � -�. r�9�`Y9 1 ;�a .,,f, 4�F , ' t 'I , � i t ,i I = : i_�, I ' � i " � � xt�'3c.Zi � �.�� � �� '� �� � �� � a� �� i � i ' � 1 i�����p�� r �� , � .Y, p ; � . :_: '� r ,� , j � �� - . . ���� ,g{ : �r`yT ..�? .''I 1 � I . � w . . • i . �'. � 5�y¢ ) �. � ��' �' .� ] � I_ I .I ' � � _ � �ff �� XJ f Y`t 4��Y ¢ ` -- Et . ..� � .'2 , ) � I ' F£�k, � , _ , . ' � . , , . ��r4 .. . i . .-� ..._.�e....,___.. _... . .... . .,.�_...._. ...._.. ._._.......t 1 '4 ._.,..�..... ...r__ ........�....,. ..:...... ............., � . l .,.�.lW. _1.,.. .. .._... �......_"'__ _... . � 1