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HomeMy WebLinkAbout10498 i � 'Y�P ) - CITY UF DIAMOND BAR � 1 COMMUNITX DEVELOPMENT DEPARTMENT i .,,.,� 216fi0 E.Copley Drive Suite 190 PRE.�+�J+ ! (909)860-3195�ax(909)8G1-3117 t ""°� BUILDINGPERMITAPPLICAT[ON FIRMLY 1 � � JOBSITE ���/� �.l APPLICATION � G�J PERMIT /� J P/C < ADDRES s/'=�c1".' �LC� �l�Jl1� �C�� �✓ 6 { V G i p � DATE � � NUMBER # r.� ISSUE NPE OCC , APN LOT T_ TRAC7 DATE CONST. GROUP � p OWNER ; . ,. �-• �� �L V ADDRESS �Z-`6�� (�3\_04)�;cj ZONING SETBACKS i w �` � 7� �� 7' FRONT RW ❑ y Z CITY ` lt:l�'�.Ui � ?i ZIP��] TEL. �1� 1 a� - � APPLICANT �.i 1<'..� TEL.' l i� S's'Ci3 REAR [�____ � � — SIDEISIDE STREET RW i l ; ¢ CONTRACTQ�i� �� �L(.`L��( l: - `'�-R:'-���L1 C.,� SIDE ❑ ADDRESS �� L�• v1.�1; 0 4��j ! �,. • �c. f PROPOSED USE � � � CITY�LC�t?L<Ch.. ZIP � � ��c7fEL�{ \: L\�,'S C�. t o ARCH/ENG/ --- z DESIGNER NO.DWEL. NO. NO. � � ADDRESS UNITS STORIES BE�ROOMS � � CITY ZIP, TEL._ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION s � OWNER-BL'IIDER DECLARATION SFR/ADD/REM �� p I HEREBV AFFIRM UNDER PENAl1Y OF PERJURV TNAT I AM EXf.MPT FROM THE CONTHACTORS LI� � Garage/Carport W CENSELAWFORTHEFOIIOWINGREA50N(SEC.�D31.5811SINESSANOPROFE5510N5CA�E:ANYqNOR i U COUNTVWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,�EIAOLISH,ORREPAIRANVS7Pl1C- �J,J patio/Deck . W TURE.PRIOR TO ITS ISSl1ANCE.AL50 REQUIRES THE APPLICANT FOR Sl1CH PEflMIT TO FILE A SIGNED W y � STATEMENT THAY HE OR SHE IS LICENSED PURSUANT TO T4�E PflOVIS10N5 OF THE CONTRACTOfiS ll� � � CENSE LAW(CHAPTER 9(COMMENC!NG WITH SECTION 7000)OF�IVISION 3 OF THE BUSINE55 AN�PRD� u' POOVSpa FESSIONSCqDE)ORTHATHEOftSHEISE%[MPTTHF.fiEfROMANDTHEBASISFOflTHEALLEOEDEXEMP� (!f � TION.ANYVIOLATIONOFSECTION7037.58VANYAPPLICAMfbPAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof �CIVIL PENALTY OF NOT MORE THAN flVE HUNDRED DDLLARS(E500)J: Y � ❑I.ASONMEROFTHEPROPERN,OflMVEMPLOVEESWITHWAGESA57HEIR50LECOMPENSATION, 0 Camffl6fCifl1 � Z WILl00 THE WORK.ANO THE STflUCiURF IS NOT INTENDEO OR OFFERE.�FOR SME�SEC.704a,BUSI� J NESS AND PqOFE551aNS CODE'.THE CONTRACTOflS IICENSE lAW DOES NOT APPLY TO AN OWNER OF = D N PROPERTYWHOBUIlD50RIMPROVESiHEREON,ANDWMO�0E5511CHWORKHIMSELfOPNERS[LFOR � W THROUGHHISORMEROWNEMPLOYLES,PROVIDEDTHATSUCMIMPROY[MENTSARENOTINTENDEOOR . m OFFEREO FORSALE.IF,NOWEVER,THE BUILDING OR IMPROVEMENT IS SOL�WI7HIN ON[YEANOFCAMPLE� } Z� TION,THF.OWNER-BUILDER WII.L MAVE THE BURDEN OF PROVING TMAT HE OF SME DID NOT BUILD OP � IMPflOVEFORTHEPUpPObEOFSALE). W C]I.RSOWNEflOFTHEPFOPERTY,AMEXClU51VELYCANTHACTINGWITHLIGEN3EUCONTRACTOH5 �}�, � TO CONSTRUCT THE PROJECT(SEC.7044,BUSINESS AND Pf70FES510NS CODE:TME CONTRACTONS LI� VeI118�1Of1 ________ ADJ.AREA _ C W' CENSELAWDOESNOTAPPLYTOANOWNEHOfAPHOPEFlTYWH09UIL�50RIMPROVE5THEREON.ANO �� WHOCONTRACTSFORSUCVI7ROJECTSWITHACANTRACTOfi(S)LICENSEDPURSUANTTOTHF.CONTRAP �UANTITY DESCRIP710N FEE � Y TORS LICLNSE LAW.�. '--' � I i I AM EXEMPT UNDER SEC._ 8.8 C.C.FOR THIS REASON � � � �: Q 7 �' —_—"' __"_ _—__ —_— p � UATE _., OWNF.R'_"'_ ""__"' Z � � LICENSED CONTRACTORS DECLARATION ;� W OC I HEREBV AFFIRM UNDER P[NALTY OF PEfiJURY THAT I AM LICENSE�UNOER PROVISIqNS OF CHAPTER � � 9(COMMENCINGWITHSECTION7oIX1�OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND : Z p � W, AIY LICENSE IS IN F111.L FORCE AN�EFFECT. m y�L� �,�` �- �`+'�,_`�,�� y � � 110ENSE CLA55�� LIC.NO.!CJ��}-��-/� � ' l� ��(� �� � V OATE� � r�' GONTRAGTOR��1 Q. CZ l.�Ct\'L'd_ ', d W '��) a� WORKERS'COMPENSATION DECI.ARATION f���� e� -� j � ✓ � I HENEBYAFFIRM 11NDER PENALTY OF PERJUftY ONE OF THF.fOLLOWiN6 DEGARATIONS: � N 7 � I 41AVE ANO WILL MAINTAIN A C[HTI�ICATE OF CONSF:NT TO SELF�INSURE FOR NlORKERS' ` a COMPENSATION,ASPROYIDE�DYSECTION37000FiMELA90HCA0E,FORTMEPERFOqMpNCF _ G OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED. } � ��. W 1 HAVE AND WILL MAINTAIN WOAKERS'COMPENSPTION INSUfiANCE,AS REOUIRED�Y SECTION � Q 77000FTHELABQRCADE,FOfiTHEPfHFORMANCEOFTHEWORKFORWHICHTHISPEflM1T15 � � ISSUE�.MV WOBKERS'COMPENSATION�NSURANCE CARFIEP AND PDLICV NUMOER AFE� CONSTRUCTION _. ___,____ __ � r� i �g j CARRIGN..__ 1�' �.Z..rj'/ �_i-:�'t� i PIAN REVIEW -'-- --�„"—'._�_ N 0� POUCYNUMBEq � � 'i�` �1 � � EIECTRIC C.-�._�l�"���__—"_.— ` Q .— � 0 (IFSSSEGTpNNEEDNOTBEWM0.ETE�OF7HEPEWJlTIStOfiCf1EM1N�FiED00lLi�FiS(E1a01�LE5S} P� BING�� _.,_ � Z 1 CEFi7�FV THAT IN 7HE AERFORMANCE OF THE WORK FO(i WHICN THIS PERMIT IS ISSl1Eq I MECHANICAL + C!3, SHALL NOT EMPLOY ANY P[FSON N�NY MANNER SDAS TO BECOME SUBJECT TO THE WORKERS'COMPENSATIONLr1WSOFCALIFORNIA,ANUAGf3EETHATIFISNOUI.D8EC0 E (� INSPECTIONFEE j � SUBJECTTOTF!EWORKERS'COMPENSATIO fiOVISION50FSECTlO 37004�THE ORt t � -- . — � `COD,ISH LL qORfMWRHCOMPLVWI H09 PROVISIONS. [ !i �SSUANCE _,_____, p DATE: �1�APPUCANT:��--"L'� ,.'.'��C=�" .� SMIP �__'_' A�,'s�'�r,.� '������,�•i _'�_ _ � W ENERGY P/C _.___ ��°'- �� � J WAPNIN�IUR TO5ECUREWOflKEflS'COMPENSATIONCAVERAGEISUNIAWFUL,ANDSHRLLBE LL SU&IECTANEMP�OYER70CRIMINAI.VENALTIESAN�CIVILFINESl1PTOONEHUNURE01HOU5AND ENERGYPERMIT � DOLIARS({loo,OW�,IN A�OITION TO THE GOST OF COMPENSATION.DAMAGES AS PROVIDED FON IN �-- ---------- ---- � � SECTION37080FTHELABOHCODE,WTEREST,nNDATTORNEY'SFEES. P � . RETENTION FEE: _..__.:�u�� �i ��? � �� R.' ,�9T-1�,� j d CONSTRUCTIONLENDINGAGENCY PRE-ALTFEE� ____._ O� � � 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTpUCTION�EN�ING AGENCV __ q FOFTHE P[flFOPMANCE OF THE WORK FOH WNICH THIS PERMIT IS ISSUEO(SEC.3og7,CIV.C.�. Z � W —__ � LENDER'SNAME___ _,__ �.___ _ _ F_ LENDER'SADORE55_,,. '� � -- ---- ----- r, � W ICEflTIFYTHATIHAVEqEADTHISAPPLICATIONANDSTATETHATTHEA80VEINFOFMATIONISCORRECT. TO�AL FEES 1j•� � p_ I AGREE TO CAMPLY WIiH ALL CITV AND GOUNTY Ofi01NANCESlWD STATE UWS REIATING TO6UILDING � CANSTflUCTION.AND NEREBV AUTHORIZE flEPRESENTATIVES OF THIS COUNTYTD F.NTER UPON THE Z ABOVE�MENTIONED VROPERTV FOq IN5PECTION PL1RP0 l l� COMMENTS.�, � � 1�(1'�C��C�)�J`. C�ti� -- ---- --- '� m pERMITTEE NAME(PRINT) —7 � _ , _ ¢ � v C. � l v� _ � � 5 ITTEE —_— TE ' � � RECP7.NO. PAID BY VALIDATIO WHITE—Depanment Copy.YELLOW—Finance Copy.PINK—Assessor Copy.GOLDENROD—File Copy,QREEN—ApPlicanfs Copy � -��--_ �T'..�._._._. .. _�.. I �-. ��!T T � Gs�cnctnupt7 <� � mitn � � �S"�o -r� � �,--3 ,n���m r,�v+ !ZIz z ��e m !n ;rt 77 ��� .t 2 n�17 rn r- lr m,� ( � � D O Q�O'.. 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