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HomeMy WebLinkAbout15200 - 1370 VALLEY VISTA (2) CITY OF DIAMOND BAR � -- DEPARTMENT OF COMMiJNITY dt D$VELOPMENT SERVICES 21660 E.Copley Ihi�e Suite t 90 (909)66a3195 Fax(909)661-3117 PRESS `'^�'� � BZJII.DING PERMTT APPLICATION FIRMLY y JOBSITE � . .1 APPLIC 11 PERMIT t P/C /'� o ADDRESS���0 VaI� V� 1 G Z l�J DATE � NUMBER/�_ s �v^�I� $ ISSUE� /1 7YPE ` ! OCC Fs APN LOT TRACT DATE `�' CONST. ^1� GROUP �� � OWNER ADDRESS �'?w 1^ ZONING SETBACKS � CITY ZIPqj(�(fQ TEL�I � .I FRONT RW ❑ APPLICANT f_/,��n g,�t��_ TEL. � REAR ❑ � SIDElSIDE STREET RW O CONTRACTOR 51DE ❑ 8 A C ES�G6 K �rOV C ZI g��3 TEL4�� 2�$�02s PROPOSED USE - �- C"'� � DE5IGNER �"br p�,�o1�'""S�S F�OV� NO.DWEL. NO. NO. ADDRESS r q �' � l � UNITS STORIES BEDROOMS � CITY� ZIP.��� TEL.�G��� y DE5CRIPTION SQ.FT. I�ACTOFt PSF A�J.AREANALLIATION � OWNER-BUILDERDECL4RAT10N SFR/A�D/REM IG ! Z G00 1 NER�Y AFFlRY UNDEP VENAL7Y OF PEHJURY 7HAT I AM EXEMPT FROM THE CONiMCTORS LI- GB�ABe/C9Rloft CENSELAWWA7HEFOLLOMI'NOREA90N1SEC.7031.6WSINE58ANDPROFESSIONSCODE:ANYCITVOR (n WUNTT1Ni1CN11EOlARESAPERMRTOCONSTNUGT.ALTE0.uN'R�YE,DEMOU51iORREPAINMIY6IAUP �J.I Pfl11Q�D0Ck TURE.P1ilOR M RS ISAIMICE,ALSO P60UIRE5IME AP7lICANT FOR BUCN PERMIT TO FILE A 81GNED W 8TA'FJAFM THAT HE qt BHE IS UCENSEC PURSUANT TO THE PHOV!SKKJS OF THE CONTMCTOpS LF CENSE LAW(WRP7ER 9(COMMEN(.1N(i WITIBECTION 7oCn)OF DIV1610N 9 OF TNE BUSINE55 ANO PRO-,, � POoUSpe iESSqNSCODE)ORTW�THEOFI9HEISEXEM7fTNEREFROAAANDTME8A9�SfOR7HEALlE�E�E%EM0. ; iqN.ANYYIOLA'IONOFSECf�ON7o3i.o9YANYAPPLIGNTFOPAPERA11TfUBJECTSTHE�GPIICAMTO Z pe-Root F ACMLPENKT40FNOTLbNETWWFIVEMk10RE0DOLLAR5�S60D1.k � OI.ASOWNEHOFTHEPRDPERT;ORMYEMPLOYEE8M1TNWAOESASTMEIRSOLEOOMPET1SATpN. O COmm6�ciel YVILI DO THE WORK.AND THE 9TRUC7URE IS Iq71NfEPWED OR OFFERED FOR SALE�SEC.70as,6U51- J � NE55 MID VNOFESSiONS O�OE:hIE CON7PACTOR4 LICENS[LAW DOES NOT IDPLY TO AN OMMEH OF = . pqpPEp7YyYFp BURp90R INPflOYE3 MEREfN,AN�WHO DOES SUCFi WORK WMSELFOR MERSELF OR � TIIFIOUGH HIS OR FIEROWN EMPIAYEES,PRONDED TMAT BUCM MIPflOVEMENT3 AflE NOT NTENOED OR m OFiEREL PDRBALE IF,IIOYVEVER 7NE B�INDINOOq IMPROVEMFM I380LD MIRHW ONE YEAR OFCOYPLE- � TqN,ifiE ONYWER-0VILDEN IYiCL Ii�VE 7HE BUADEN OF PflOVMHi h1AT HE aR BME OIp NOT BUILD OR tlAPROVE FOR TNE PUNG09E OF SALE7. W OI.MONMEROFTHEPROPERTI:AMEXCLU6NELYOONTMCTtt10WIPFILICENSEOCOMVLICTOR3 � TO OONSTRUCT 1HE PRp1ECT(SEG.7Wa�9USINE93/J70 Pl10fE9SION3 COLE;7HE CONTF�ACTORg LI- V81178i1011 ADJ.AREA � CENSEUWOOE8NOTAAPLYTOANONMEROFAGROPENTYWhIOBUlD50RI1JPROYE3THEREON.AND MfFp00NTMCTBPoRSUCHPRWEC7SWIh1ACOHTRACTDR(S�LIC[NSEDRIHSUANfT�TMEOONTM4 p�/WTITY DESCRI ION FEE � lOR5l10ENSEUIWJ. ^) ^ ❑1 AM E%EMPT UNDER BEC. B.�C,Q FOR THIS 11E�SON � �'+ �c U g � /� �=" DATE ONMEH � LICENSED CONTRACTORS DECLARATION W � IHEREBYAFFIqAIUNDERPENALTYOFPEiUURYTFIATIMA4�CEN5E�UN0ERPROVI6qN50FCHAFTER � � /(COMMENCWO 1MTN SECi1DN 7aoo)OF DIYISION]OP 7HE SUSiNE55 ANO iRUFES510N9 COOE,AN� Z V� MY UCENSE IS N M.L fORCE ANO EFFECT. m � LICENSEr1 S r� UC.NO. � �/���,.��� a � .� ppTE •, CONTMCTOR`yv�,�\� �M`CJ• WOf9KERS'COMPENSATION�ECU4AATION : � , � I NEAEBY AFFIRM UNOER PENALTY OF iER1URY ONE OF THE fOLLONnNG DECIAMT N5. O CA , i Q � _IMAVEANDWILLM�PITNN�CE��FICA7EOFCONSENTTOS�LFaNSUREFO RKERS' 2 _,� � ` p (�j ' ' � 001APEN6ATqN,1l5 PROVIDED BY SECTION 3700 OF THE UBDk CODE.FOR 7HE OF7MEWORKFORVRIN�ITHISPERMrt18183VEU. � � • �_IlNVEAND WILL M�MAW WORKER9'COMPENSATION INSURANCE,AS REOUIREO BY SECTIDN � � 97oo0i7NElABOROODE.FOHiNEPERfOAMANCEOFTHENlORNFQRWNIpITHISVERMIT " ISSUEO.MY WORKEAS'OOMPE ATIDN IN�':"�C@� FRIE�R A*!O POLICY NUMB R ME' CO STR TION , � CARRIER �o �' c�RS b'GG�� y.CF�+��eL r ��v R iEW � r�w��e�A — � � E�e ic •� � (RiIgSEGfqNNEIDNpTBEOp�FLE7PJpFhEPERMIT6PORONEMI�DOIED UMBING Z I CERTIFY T11AT W ME PERFORMANCE OF 7HF WDRH FOR WH�CH TH�S P�AAIT IS 159 D,1 MECHANICAL (,� SWi1 NOT EMVLOV.wV GE0.5oN W ANY MMINER 90 AS TO BECOME 6U EGf TO T � WORKERS'COMPENSATION 1AV18 0F GiLIFORNI.,ANU A0 AT IF I B COME INSPECTION FEE S SUBJEGTTOTHEWORIfERS'COMPENSATpNPROVI510N5 � CTIIdNN7)OOOFTHEUBOR oo�o//e,�.i s��H,u.�//roan+wini coua�v w�n+ osE n sar+ ISSUANCE � L�� �ppuC�T. SMIP DAiE: WARNINO:FAILURETOSECUHEWOHNENS'COMCENSATONfAVERAGEISUlB.AWFLL,IWDSMALLBE ENERGYP/C� �y SU&IECfANEMPIOYERTOCRIMINl1LPENALTIES�NDCIVILFINESUPTOONEMJNDREDTHOUSMlO ENERGYPERMIT � OOI.WiS(�7 W,000),IN ADDITION TO7HE COST OF COMGENSATpN,OAMAOES AS PROVIOED FOR IN J 6ECTWN770lOFTHEUiBORCODE,IMEFEST,ANDATTORNEY5FEE5. RETENTIONFEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 MEREBV AFFIRM UNOER OENALTY OF PERJURY 7HAT THEFE IS A CONSTRUCTION LENOINQ AGENCY FOR THE PERFOFlMANCE OF 1'ME WORN FOR WHICH THI6 PERMIT I&ISSUE�(SFC.iOW,CIV.CJ. Z W � LENDER'S NM1E � LENDERSAD�RESS � , � ICHRTIiVTNl1TINAV6R6ADTiISAPPUCATIDNANOSTATETHATTHEABOYEINFONAATIONIS00HRECT. TOTAL FEES � � I AfiREE TO COMPLV WITHALL CITY AND COUNTV ORDINMICESANO ST�TE UWB NEUTINO TO BUILDING 'L1 LUNSTNUCfION.ANOHERE07AUiliORIZE(iEPRESENTA71YE5OFTHISCOUNTYTOEMENUPONiHE � �M Q� �V S�, ABOVE-MEMIONEO PqOPERTV FOR IN57ECTION PUAP0.SE. CQMMENT !/V, 9,�,, �j S . �v IM� • Q PERNfTT E iPHll(� �w N W� � g OA7E � RECPT.NO. 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