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HomeMy WebLinkAbout1673 MAPLE HILL RD (4) , . , 1�___ CITY OF DiAMOND BAR �' "—'^• � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� �� 21810 Copley Drive,Diamond Bar,CA 91765 � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS �'��'. SUILDING PERMIT APPLICATION FIRMLY � JOBSITE , -?i ` APPLICATI PERMIT P/C o ADDRESS J DATE � NUMBER_L�, '� # o� ISSUE /'/�j'Z TYPE OCC APN OT TRACT DATE�,_ / �J CONST. GROUP p OWNER " ADDRESS• ZONING SETBACKS Z CITY TEL. FRONT RW ❑ � � APPLICANT TEI. REAR ❑ � SIDE/SIDE STREET RW ❑ z Q CONTRACTOR SIDE ❑ Q ADDRESS PROPOSED USE � CITY �(t'A-CI�I'/J�/9 ZIP�� TE � w ARCH/ENG/ . I � z DESIGNER /��� - � ADDRESS NO.DWEL. �j �' NO. � CITY ZIP TEL. UNITS �� STORIES J BEDROOMS�, � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBV AFFlRM UNDER VENALT'OF VERAIRY 7HAT 1 AM E%EAIPT FROM THE CONTRACTORS Ll- G0f8 JOICalPO1� W CENSEUWFOR7HEFOlLOWINGREASON(SEC.7031.SBUSINESSANDFROFESSIONSCODEANYCRYOR (n U CIXJHfYWHICNqEWIRESAVERMITTOCONSTRULT,ALTER.UAPROVE,�EMOl15H2OHREPAIRANYSTqUG W Patio/Deck Z lURE.PRIOR TO RS ISSUANCE,AL50 REOUIpES TiE APPLICAHT FOR SUCH PERMIT TO FILE A SIGNED w STATEMENT 7HA7 HE OR SHE IS 110ENSED PURSUANi TO THE PRONSIONS OF THE CONTMCTORS LF w � CENSE UW(CHAP7ER 9(COMMENCING Wlhl SECTION 7000)OF DIVISION�OF THE BUSINESS AND PRO- � PooUSpa FESSpNS COO�OR THAT HE OR SHE IS EXEMPT THEREFROM AND iHE BA515 FOH THE ALLEOED El(EMP- � TION.ANYVIOLATIONOFSECTION7o�7.5BYANYAPPLICANTFORAPERMITSU&IECTS7HEMPUCANTTO Z RaRool A CML PEWJ.TV OF NOT MORE THAN FIVE HUNDRED OOLLMS(S50o).): ~ ❑I,ASOVMEROFTHEPROPERTV,ORMYEMPLOYEESWITHSVAGESASTHEIRSOLECOMPENSATION, � � � O Commercial - Z WILL 00 THE WORN,AND THE STRUCTURE IS NOT INTENOED.OR OFFERED FOR SALE(SEC.7ou,BU51- J � NESS AND VROFESSIONS CODE:THE CONTRACTORS UCENSE LAW DOES NO7 APPLY 70 AN OWNER OF � - PROPEHfY W/i0 BUILDS OH IMPROVES THEREON,M1D VM0 DOES SUCH WONN HIMSELF OR HERSELF OR [C THROUGH HIS OR HER OVfN EAI7LOVEES,PROVIDED 7HAT SUCH IMPROVEMENTSARE NOT INTENDED OR m QOFFEREDPDRSALEIF,FIOWEVERTMEBUItDINGORIMPROVEMENTI550LON7THINONEYEAROFCAMCLE Z TION,THE OWNER�6UILDER WILL HAVE TME BUROEN OF PROVING THAT HE OR SHE DID NOT 9UIlD OR � W PROVE FOR THE PURPOSE OF SALEJ. w OI,ASOWNEROFTHEPROPERTY,AMEXQUSNELYCANTRAC71N6WfTHLICENSEDCOHiRALTORS [[ TO CONSTRUCT THE PR0.IECT(SEC.7oN,BUSINE55 AND PROFESSIONS CODE:7HE CANfMCTORS L�- V81UailOfl ADJ.AREA W CENSE LAW DOES NOTAPPIY TO AN OWNER OFA PROPERTV WHO BUILDS OR IMPROVES 7HEREON,AND � NMOCOMRACTSFORSUCNPR0.IECTSWffFfACONTRAC70H(S)LICENSEDVURSUANTTOhiECONTRAG OUANTITY DESCRIPTION FEE � �Y 70RS LICENSE LAW.). � � ❑I AA1 EXEMPT UNDER SEC. B.8 P.C.FOR THIS RFASON Q � U ti � DATE OWNER � Z W :n 1"-1 � LICENSED CONTRACTORS DECLARATION w v vuu =-d � I HEREBY AFFIRM UNDER PENALTY OF PERJURY 71iAT IAM LICENSED UNDER PROVISIONS Of CHAPTEH � U � d 9(COMMENCINO WITH SECfION 7000)OF DIVISION J OF THE BUSINE55 ANO PROFESSIONS CODE,AND Z X GY LJCENSE IS IN FULL FORCE AND EFFECi � m - 0 0 • o � (N� LLI ^, - � _V'_ 0 IICENSE CLASS LIC.NO. v J (�MOV� PUOP � BP� VDATE corrrrucTo a W �C �o� . . � WORKERS'COMPENSATION DECIARATION -� Q = U � I HEREBV AFFIRM UNDER PENALT'OF PERIURY ONE OF 7HE FOLLOWING OECLARATIONS: ' � C!� Q � I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF•INSURE FOR WOFlKERS' _ � COMPENSA710N,AS PFOVIDED BV SEC710N J7oo OF THE UBOR CODE,FOR THE PERFORMANCE �U OF'IHE WORK FOR WHICH TiIS PERMIT IS ISSUED. � � w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSA7ION INSUMNCE.AS REOUIRED BY SECTION Q J7000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS � / ISSUEO.MY WORKEAS'COMPENSATION INSUfUNCE CARHIER AND POLICY NUMBER ME: CONSTRUCTION /( �I��_ j CAPRIER S I• T���� PLAN REVIEW ZPaICY NUMBER ELECTRIC ¢ � (IH65E(.'f1LY�NEIDNOTBECO1�ilfTEDOFIHEPERhi(SFORONEHUI�OREDOOLU0.S�St0UlORLESSl PLUMBING W Z 1 CERTIFY THAT IN THE PERFOf1MANCE OF THE WORI(FOH WHICH THIS GERMIT IS ISSUED,I MECHANICAL (,�} SHALL NOT EMFLOY ANY PERSON IN ANY M SO AS TO BECAME SUBJECT TO THE � WORKERS'COMPENSATtON UWS Oi CAl RNI/� D AGREE T1AT IF I ULD BECAME INSPECTION FEE � SUBJECT TO THE WOfiKERS'COMVENS N PROVI IONS OF 5 7o F THE UBOR � J �� CADE,I SHALL FORfHWlh1 C0IAPLY TMOSE P VISION ISSUANCE /� [� � 2 SMIP � ✓'�D p DATE: �/ APPLICANL _ J WARNING:FAIWRE TO SE(.URE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,ANO SHALL BE ENERGY P/C � SU&IEGTANEMPLOYERTOCRIMINAL7ENAL7IESPNOCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(f100.000),IN ADDITON TO THE COST OF COMPENSA710N,OMIAGES h5 PROVIDED FOR IN J SECTION 370!OF TiE LABOR CODE,IN7EREST,AND ATfORNEYS FEES. ' FIETENTION FEE: � Z Od 2 a CONSTRUCTION LENDING AGENCY pRE-AL�T FEE: -+ �. 1 HEREBY AFFlRM UNDER PENALTY OF PERIURY THAT THERE IS ACONSTRUCTION LENDINO AGENCY �!-Y S� � ,du f-0R TNE PERFORMANCE OF 7HE WORIC FOR WH�C71 THIS PERMIT IS ISSUED(SEC.70a7.GV.G). Z W � LENDER'S NMIE F- LENDER'SADDRESS � ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETiATTiEABOVEINFORMATIONISCORRECL TOTAL FEES ��J �( �^'�.� w IAGREETOCOMPLYWI7HALLCRYAN�CIXINTYORDINANCESANDSTATEUWSRElA7WGTOBUILDING ' � CONS7fiULTION,AND HEREBY Alfh10RIZE REPRESENTATNES OF 7HI5 COVNTY70 EMER UPON 7HE ZABOVE-MEMIONEO PR07ERTY FOR INSPECTION PURPOSES. COMMENTS 0 ' J i � m PERMITTEE NAME(PRIFIT) " Q . � i � SIGNANREOFPERMfTTEE DATE � _ . RECPT.NO. PAID BY 7 J VALIDATION ~ WHITE-De rtment Co YELLOW—Finance Co PINK—Assessor Co GOIDENROD—File � Pa PY. 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DR'f:nlALL NAILING i �i DEDICF�110N5 ---------------------- ----------- -------------------------- ;-------------------._---------. .....-------___-------- SEV�JER � --- -.__ I LFINAL ENG�_ _ _--- — ------- -- ------ -- ------------._ ----�--- __ _ ---- ------- -- - — .---- SEFTICTANK _ _ 1____ _ � LANDSCAPE!IRRIG___ _ __ _ _ _____ __ SEEP PIT,%L.L. i ON 51TE IMPS. 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