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HomeMy WebLinkAbout16300 (20) ���� � �,,,;,,,� 1,� CITY OF DIAMOND BAR /��..,�3'�'��'� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ,�� W 21660 E.Copley Drive Suite 190 (909)860-3195 Faic(909)861-3117 PRESS "�'�"� BUII.DING PERMIT APPLICATION FIRMLY _ o� JOBSITE / � APPLICATION • � � � PERMIT � P/G-�"� ADDRESS ��` �` ���� �'*���c-"L � . DATE NUMBER # , � DATEE '!i f � T�'PE OCC APN T TRACT CONST. GROUP p OWNER LL ADDRESS �'/L. ZONING SETBACKS 0 � CITY �//�� • '� ZIP� TEL. L+ FRONT RW ❑ APPLICANT TEL. REAR ❑ SIDE/SIQE STREET RW ❑ aQl CONTFiACTOR l7� SI�E ❑ Q CI'fY !G`.�L'� ZIP �S TEL. �jJ��lL� PROPOSED USE !�L'� � �%h ARCWENGI DESIGNEFi NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. cr� cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFlRM UNDER PENRLTY OF AERJURV hIAT 1 AM EXEMPT PROM THE CON7RACTORS Lb Gflrdge/C3fpoA W CENSEUWFOq7HEFOlLOWMGREASON(SEC.703158USINESSAN�PROFESSIONSCADE:ANYCINop � WUNTYWHICHREOUIRESAPERMIT7000NSTRUCT,ALTER,IMPROVE,DEMOUSH,ORREPAIRANVS?RUC� W W 7URE,PRpR TO ITS ISSUANCE,K50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FlLE A SIGNE� W Patio/0eck � STATEMENT 7HAT HE OR SHE 19 LICENSED PURSUANT To THE PHOVISIONS OF THE CONTRACTORS L4 CENSE LAW�CHAPTER 9(COMMENqNO WITH SECTION 1000)OF OIVISION 30F THE BUSINESS AND PRO� � POOVSPd FESSqNSCOOE)ORTHATHEORSHEISEXEMPTTHEHEFHOMANDTMEBASISFORTHEALLEQE�EXEMP- (� TION.ANYVIOLATIONOFSF.CTION7031.58VANYAPPLICANTFORAPERMITSU&IECTSTNEAPPLICANTTO Z Re-Roof F, A CINL PENALN OF NOT MORF.THqN FIVE HUN�REO DOLlARS(SSoo),I: � ❑t.ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COmmercial - YALL 00 THE WOqK,AND 7HE STRl1CTURE IS NOT INTENOFO OR OFFEREO FOR SALE(SEC.7odl BUSI- � � NESS AND PqOFESSIONS CODE:THE CANTRACTORS l'.CENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUILQS OR MPROVES THEREON,AND WHO DOES SUCH WORN HIMSELF Op HERSELF Ofl � THfKIUGHHI50RHEROMMEMPLOYEES,PROVIDEDTHATSUCHIMnROVEMENTSARENOTINTENDEDOfl m QOFFEREDFORS/iLE.IF,HOWEVERTHEBUILDINODRIMPROVE/.1BITISSOLDWRHINONEVEAROFCOMPLE- Z TKKJ,THE OWNER�8UILIJER VAIL HAVE T4E BURDEN OF PROVING THAL HE OF SHE DID NOT BUILD OH � IMPROYE FOFl THE PURPOSE OF SILLE). ly,� ❑I,A59M/NEROFTHEPFlOPERTY,AMEXCWSNELVCONiRACTINGWI7HUCENSEDCONTRACTORS (� TO CONSTRUCT THE PROJECT�SEC.7olr,BUSINESS At�O PROFESSIONS COOE:THE CONTRACTORS LI� V3ludtion ADJ.AREA W CENSEUWDOESNOTAPPLYTOMIOWNEROFAPROPERNWHOBUILDSORIMPROVESTHEftEON,AND — - �L y/�pCpNTqACTSftlRSUCHPROJECTSWITHACONTWICTOR�S;LIC�NSEDPURSUANT70iHECONTqAG OUANTITY DESCRIPTION FEE � TORS LICENSE UW). ❑I M/EkEMPT UNDER SEC. B.8 P.C.FOR THIS REASON J O V 3 � u" DATE _ OWNER_ U � w � LICENSE�CONTRACTORS DECLARATION � � 1 HEREBYAFFIRAI UN�ER PENALTV OF PERIURV THAT I AM LICENSED UNDeR PROVISIONS OF CHAPTER � /�.p.� � D(OOMMENCINONITNSECTION)000)OFDIVISION3OFTH[BUSINESSANDPROFESSIONSCODE,AND Z �� �'I, � MV UCENSE IS iN FULL FORCEAND EFFECL _ — � LICENSE CLASS �'�� �j m y / LIC.NO.��`f O� �,/}� � � UATE 3��/'�C.�! CGNTRACTOR��j[��_ a. W � N10RKERS'COMPENSATION DECLAAATION Q � �HEREBY AFFIRM UNDER PENALTV O�PEitJURY ONE OF THE FOLLOWING DECLARATIONS: Z � _I HAVE :LMAINTAIN ACERTIFICATE OF CONSENTTO SELF-INSUR'c FOR WORKERS' 2 ' Q NSATION,AS PROVIOEO 91'SF.CTION 37�M OF THE LA90R CODE,FOR THE PERFORMANCE `U THE WORK FOR WHICH THIS PEPMIT IS ISSUEU. � � � _IHAVE/VdDWILLMAINLAINWORKERS'GOMPEYSATIO INS ANCE,ASREQU�REDBVSECTION 0 37000F?HE fi E,FORTHEPER . N FT WORKPORWHICHTHISPERMITIS ISSUED.MV f1K "COMP SpTbN S Al� RANOPOLICYNUMBEPARE: CONSTRUCTION � CM1ARIER ;T��.s � PLAN REVIEW z POLICVNUMBER ��u'G-L��G' [LECTRIC � �" � {r��ssccrnarv��noraEoa.+Rt�ooFn��wxr�sra;aue waoaeo ioo�oa�tssF PLUMBING r a � I CERTIFY THAT IN THE PERfORMFNCE OF THE WOFK FOR H THIS P MI ISSUEO,1 MECHANICAL (�} SHALLNOTEIAPLOVANYPERSdNINANVIAANNER S E O JECT OTHE (n VVORNERS'CpdPENSATiON LAWSOF CALIFOPN PND AT. HOU BECOME INSPECTION FEE r SUBJECT TO THE WORKERS'COMPENSATION P F 5 C 370o HE LNBOR � CODE,ISHALLFORTHWITHCOMPLVWI'iHTH EP �SSUANCE w O L .r— p OATE:��cC�,�APPLICANT. SMIP J WARNING:FAIIURE'.'O SECURE WORKEFiS'CAMPENSATI c:OVER E FUL,AND SHALL BE ENERCaY P!C �y SU&IECTANEMPLOVERTOCRIMINAIPENALTIESANDCMI 'PTOONEHUNOREDTHOUSAND ENERGYPEAMIT OOLLARS(S'OO.U00).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN � SECTION37o60FTF.EIABORCOOE,INTEREST,ANDATTUFNEY'SFEES. RETENTIONFEE: _ � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENALTV OF PERJURY THATTHERE IS ACONSTRUCTION LENOING AGENCY FOR THE PERFORMANCE OF h1E WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3097,CN.C.). Z W � �ENOER'SNAME !— LENOER'ShDORE55 _ � TOTAL FEES � ICERTIFYTHATIHAVEFEADTHISAPPLICATIONANOSTATETHATTHEABOVEINFORMATIONISCARRECT. W I AGREE TO COMPLV WI7H ALL CIN AND COUNTY INANCES AND STATE L4WS REU7ING TO BUILDING � CONSTRUCTION,ANDHEREBYAUT ER S NTATIVESOFTHISCOUNTYTOENTERUPONTHE ZABOVE-MENiIONED PROPER NS ION RPOSES. COMMENTS � /� J � ¢m PEflMITTEE AM I �� � Q/ /.i Cn / � SIGNA7UREOFP MffTE DATE = RECPT.NO. 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