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HomeMy WebLinkAbout16446 (45) , �� CITY OF DIAMOND BAR x� - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES '�' ' � , 21660 E.Copley Drive Suite 190 ' �� � � (909)860-3195 Fax(909)861-3117 PRESS ��'��' � BUILDING PERMTI'APPLICATION FIRMLY o ADDRESS����I �' 0� ���Q� 1�� DATECATION� '� � � NUMBE #/C � - ISSUE TYPE OCC APN LOT TRACT_,____ DATE CONST. GROUP p OWNER C �I C7 L/ p ADDRESS��g,�I Cr. �.i o L D�j O S_ /� ZONING SETBACKS �w CITY���33M/u1rli) ('}�1_�ZIPy�7bs_ TE�tioy�g6/-al,� FRONT RW LJ APPLICANT/-�L�.eH �i�,y�7/L�cTa2( TE�.�:�/��rt%1�/�/) SDE/SIDESTREET RW CJ �¢ CONTRACTOR L'{ t�Yl � SIDE _ [�__ ADDRESS 1 �. Y�C� Lt � CiTYC?C�frL�C"J!1(� ZIP C�z�4 EL.(3if31S1�`C?i�i PROPOSEDUSE_ 0 ARCWENG/ - w DESIGNER _ __ N0.DWEL. N�. NO. n. ADDRESS � - UNITS __ STORIES BEDROOMS � CITY _ _ Z.IP TEL. -- cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECL4RATION SFR/ADD/REM O p I HEREBY�FFIRM UNDER PENALTV OF PERJURV THAT 1 AM EXEMPT FROM THE CONTRACTORS LI� Gefd9BlCflfpOfl �1J CENSEUWFOq7HEFOLLOWINGREA50N(SEC.7(Ai1.5BU51NE55ANDPROFES510N5CO�E:ANVCITVOR (n C.S COUNTYWFIICMREWIHESAPERMITTOCQNSTRl1CT,ALTER,IMPHOYE,�EMOLISH,ORflEPAIRANVSTRUC- � TURE,PRIOR TO�TS ISSUANCE,ALSO REQUIRES TNE APPLICANT FOR SUCH PERMIT TO FILE A SIONED W Pfl210/DBCk � STATEMENT iHAT HE Ofl SHE IS UCENSED PURSUANT TO THE PROVISiONS OF THE CONTRACTOflS ll� � CENSE LAri(CHAPTER 9(COMMENCING WITH SEC710N 7000)OF OIV!SION 30F THE 6USINE55 ANo PRo� POOUSpB FESSIONS�E)ORTHATHEOfiSHE1SE%EMPTT1iEREFROMAND'HEBASISFOfliHEALLEGEDE%EMf'- (!5 � TIpN./WYVIOLATKKJOF5ECT10N7031.5BYANYNPPLICAMFORAPEAMITS:IBJF:CTSTHEAPPLICANTTO Z Re-Roof � R CIVIL PEN/LLTY OF tiOT MORE THAN FlVE HUNDR[0�OLlARS(Y500).�: -- -- � III,ASONT1EROfTHEPROPERTV,ORMVEMPLOVEESWITHWh.^aE5lSTHEIRSULECOPAPENSAT:CN, COffIfflBfC181 W�LL DO THE WORK,AN�J THE STRUCTURF.IB NOT INTEM1DED OR OFFEFED FOR SALE(SEC 7C41,DUS�� O _,.�____ � N NE55 AN�PiiOFE5510N5 CODE:THE CANiRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNEn OF � VROPEPTY WHO 9UILD5 OR IMPROVES THEREON,AND NMO DOES SUCH WORK HIMSCLF OR t1ERSELF OR Q THROUQHHISORHEROWNEMPLOYEES,GHOVIDEDiHAT5I1G11MPROVEMENTSARENOTINTENDEDOfi m - — QOfFEREDFORSKEIF,FpWEVER7MEBUIL�INGORIMPRDYEMENTI550LOWITHINONEYEAROFCOAIPLE- � TION,THE OWNER�BUILAER WILL HAVE THE BURD[N OF PROVING THAT HE OR SHE Ui�NOT DUILD OR � IMPROVE FOR7HE PURPOSE OF SALE). (yJ L11,ASOWNEROFTMEPROPER7Y,AME%CWSIYELYCANTFlACTINGWITMLICENSEDCONTRACTOFlS — � TO CONSTRUCT hIE PRQIEC7(SEC.7044,�USINESS AND PROFESSIONS CODE THE CON7RACTORS IJ- V8I118f10� ADJ.AREA W CENSELAWOOESNOTAPPLYTOANOXRJEROFAPROPEMVW410�UIlDSOFlIMPqOVESTHEPEON,AND �--`��------- � WFIOCONfRACTSFOflSUCMPFOJECTSWITHAWNTRACTOR(S)LICENSFDPURS'J,WTTOTXECONTRAC� QUANTITY DESCRIP710N FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT 11N0Efl SEG B.8 A.C.FOR THIS RI:ASON � Q � U ----- --------�------ ----- ¢ � DATE� U`lMER_._________ � Z --_—_- W � LICENSED CONTRACTOHS DFCLARATION W -y—� � I HEREBYAFGIqA�UN�ER PENAL7V 01 P<R1URY THAT IAM LICENScU 11hUER PROVISIONS OF CHAP1'ER � —� �O T/9.�o �� n d 9COMMENCINGWITHSECTKKJ70000FDIVISION30F1H=_BUSINE&SANDPROrEESIONSGCDE,AND 7 w�� .s avt s.n X MY UCENSE IS IN FULL FOHCE AND EFFECT. � „ p_ __� — 0 UCENSE CLAS "��� LIG.N0. `ti�-����� � ``�� �,y,� � V DATE ^ .__C! I_.___ CONTftACTOR�dA�C�r�i_ ..�.Y.�.��.. .._ 0. W � WORKERS'COMPENSA710N DEGLARATION ¢ � I HEREBV AFFIHM UNDER PENPLTY OF PLRJURY ONE oF THE FOLLOWING OECt.ARR7roN5: z � IHAVEANDWILLMAINTARiAGEHTItICATFDtCONSENTT05[LF-INSUHF.FORWORKF.HS Z '7d- CO.IPENSATION,AS PA'v'V!DEO DV SECTION 3]CO OF1'kE LR80R CO�E,�OR THE 9ER�C!iA!ANCI: w OF TME WORK FOR WHICH tH13 YERMIi IS ISiUEO. � � � � _�HAVEANOWILLMAINTAINWOAKEfiS'COIAPFNSATIONINSURANCE,ASH[CkIIFl[UBVSFC�ION � 31000F7HELABOHCODE.FORTHF:PERFORI,I�NC[OFTMEWORKFOtiWhiICHTMiSPER�11i15 _ IfiSUEO.MY WpitKERS'COMPENSATION INSUf7ANC�CAHRIEH ANU POLICY tiJMtiER ARF� CONSTflUCTION __,_, _ ►�,a "__' j cnaPier�._����._4e��� _ PLANREVIEW ---------- ----------_- �,y z POLICYNUNBEN_�, ���� ��v �{ ELECTRIC '_.....'_'_"""'s' � (iW55FiT,IXVNc6�NnTGECQNPLE7EDOFTHEPE:.FMlSF�R(M'eNIMDRFDO[711N�9(5771)ORl'e5S? PLIJMBING `f-��� - �., -- ------..--------�--- � ICERTIFYTHATINTHEVEPFORMANCEOF7ReWORKFORWFIICH7HI5PERMRISI55UF.D.I MECHANICAL ____ _______ _____ ___ (�j SHALLNOfF.M�,OVANYPERSO4INANYMANNERSOASTODECOMESUBJEr,TTOTHE ) � WOFKERS'C(M�FENSATiON LAWS Of CALIFOHNIA,ANU AGREF TlIAT IF I SNGUI.D 13EC041[ INSPECTION FEE � - �s^ .-�!-�-//- '_ "_ __'_"_'__...c}.-Ir V V � Sll(iJECTTO THE WOHKFFi'CAMPENSATI�N PPOVISIONS OF SECTION 370C OF THE LAI30R ` � =~ - ---— CAOE,.�IS7HALLFOH VIWITNCOMPLYWIi4{�k105FPFlUVI510N5. �SSUANCE _ ,. •-- . �^ � 1 G �.._. , ' ♦ n� ....----.._,.. � o DATE: ~e G APPLICANT: 1'� ' `;L•�,,,jJLS-"y_`__`+_�__��.!.!1R:�. SMIP �__ �'..""'"_" '_ —�' { ..' _' � - I�AYj'� f f�, -- -� WAFlNING:FAII.Uf{ETOSECIJRFYJORKERS'COMPENSATICAICOVLRAGEiSUNLAWfUL,AN�SHOLLBE ENERGYP/C `� r�!JA J � A.'__—___''_" ""'_ � SUOJF.CTANEMPLOYERTOCflIMINAI.PENALTIESANDCIVILFINESUPTOONEHUN�REDTHOUS�ND ENERGYPERMIT � DOLLARS(Sl W,Coo�.I.N AD�ITION TOTHE GOST OF COMPENSATIC4,DAMAGES AS PROVIDED FOR IN ---- - ------��-�--�-��- -��--�- � SECTION37oeOF7HFLABORCa[7C,INfCftEST.ANDATTORNEI"SFEES. RETENTIONFEE: ___,________ d CONSTRUCTION LENDINGAGENCY �-"` ��� O PRE�ALT FEE: .----. ..--.----- '_""'-, � I HLF3E8Y AFFIRM UNDER PENALTV oF PFHJURV THATTHERE IS ACONSTiSUCT10N IENDING AGENCY n- FORTHEPEAFORAIMICEOFTHEWORKFOFWHICHTHISPERMITISISSUE�(SEC.3097,CIV.C.). -"-" "- --- --'- z w -----...------------------------- - � LEN�ER'SNFME"'__"'__'_'_ __—___—_"'--'_._._.,"__' "'—___"' 1_- LENDEfl'SADDRESS__.._.._..._ _...--_ - -"-_ � ICERTIFYTNATIHFVFREADTHISAPPLICA'fIONANDSTATEThIATTHERUOVEINFOHMAfIONISCORRLCT. TOTAL FEES � �r � � I AGREE TO COMPLY WITfi ALI.CITY AN�COUYTY OflDINANCES AND STATE LAW&REI.ATING TO BUILDING � CONSTRl1CTION,PND NEREBY AUIHORIZE NEVRESENTA'fIVFS OF THIS COl1NTY TO ENTER UPON THE ABOVEMENTIONF.D PR ERTY FOR INSPECi I N PUqPO5E5. —_ --_ - Z �� � �/�j j�, COMMFNTS___,._,_. .—__. � y�F •�f �?� 6� F � ���`_" "' _"' '" _ _ '—_"— _"___'___"__ � PERMITTEE' E INT) ca a,.� �� �, ,��� � �/ ---— --------- -_ ; ,i, r�.i � IGNATUR�OF PEflMI� OATE �� s RECPT.NO. ___PAID BY � _ _._ VALIDATION __ ~ WHITE-Department Copy,YELLOW--Finence Copy,PINK--Assessar Copy,GOLDENRO�File Copy,GREEN-Applicanfs Copy , , ; ' , : � ° . : ; � ' ' . , � ` , ` i � i � , , � � ! i , � ' ,,. � '- , � , � � ; . � j , i ! ; , ° — ; ' i I ':i , � l � , � ` � I _' j . ` , ;. _ .. � , I I � � i i � i . i i I r � � i � .�. , — . � j � — � � i � I ; 7 � i � � , ' � ; �� � : _ ;4 , I � � � � � � : I. � � - . . . �, . � ��. � � � , i , � Y I --.. - i t r . . . i � ` i ' � � , , ; � ' . ' , , , � ; , _. a. � � . 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