Loading...
HomeMy WebLinkAbout10952 - 23427 ROBIN BROOK (2) � � 4 � CITY OF DIAMOND BAR �J��i��„,�.� COMMUNITY DEVFLOPMENT DEPARTMIiNT � 2166O E.Coplcy Drivc Suite l90 f' ,,,y�,,:.., (909)R60-3195['ux(90I)861-3I17 ��� � �_ ��u� PRESS � _ BU1LDlNG ' MiTAAPI,ICATTON FIRMLY � o��r JOBSITE �^� �� �_ ��r�a APPLtCATION NUMB R � ��PlC � ADDRESS I DATE � o�o ISSUE�� TYPE � # OCC------ ' � APN______, L T TRA T_ � DATE �' pOWNER w < �___..,---___.--- ..----------- __ CONST._ GROUP � � /r� � .c �. --- , ADDRESS 71 L y r7` ,- , ZONlNG SETSACKS � o -' _. F_i . . . z CITY� ��L __^ ZIP TEL.,__ FRONT RW -� ! o` APPLI NT --- 7E1.�---L REAR __ ---...---- 's -- ------._...._---�--- J -.. .. .--- ----- ! Z - ` SIDE/SIDE STREET RW ; I_____.___ � � CONTRACTOR � -- — SIDE -__--,------------,. � ADDRESS ���L— �� ~ . — - �- � :� � -�-�'- re�i".�_y � , � CITY w. �cy �ZIP.� L TEL.�IO Z�;7 PROPOSED USE o�._�k�;�%•• C o r� f ,J j„i�r.../.� ° w ARCH/ENG/ � � L � - ___�.___� k 0 z DESIGNER ��--.--- q��`-`�f��' � NO.DWEL. NO. ua�. ADDRESS_.__._.._ ----- --------- N0. , ��. ��-" ---'--'-' UNITS STORIES __ BEDROOMS p � CITY.__ ZIP ------ TEL. ---- --- _..-----_._ � ---- - � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATlON � � OWNER-BI;ILDER DECLARAI"ION O SFR/ADD/REM � p I HEREHY AFFIHM UNJEFi VF:NALIV OF PEIiJURY THAT I AM F%kMVi FRO!A TI{L CONTfiACTUfiS 11- GafdJB/CBfPOR W CF.NS[tAWFOflTHEFCLLOWINGqEA50N�5[C.1o31.tiBl1SIYESSANDPROFE55:ON5CUDE.A�Y(:ITYON (� � C-� COUN�YW!!IC!lRCQIIIACSAPCA.N77TCCO4STRL'CT.ALTER.1`.fP1?nVC,I)FM1;OLrSM,t).RRFPAL4ANYSTR'JC� (ll R W TURE,f'flIOR TO ITF ISSUANCE,AI SO fif(]UIRf_S TH[A�PLICANT FOR SUq{yf:fIM1T TO FILE A SICN[p �ai10/�@Ck ' STATEMFNT THA7 H[Oq SHE IS LICENSED PUHSUANI"TO 11!E PftOVISIONS OF THE CONTRACTOHS LI- W--- � � CENSE LAW(CHAP fF:fi 9((:OMMFNCING WRH ScCTION 7000)OF DiV15�(]N 30F fil[yU51NC55 ANU PflO� u' PooVSpa � "�' �F:;SIUNSCODE)OFTHATHEORSFIEISEXEMPiIfiERCfqOMANDTHEBAS15FORTHeALLEGEUEXEh1P- (� y � TION.A4vV1(iLATIUi�UI�SECIlON7C:11.59Y�1YAP?I!CANTFOHAPENMITSUfiJ�CTETHEA�PLICAVT'O € V A CIVIL PENALN OF NO7 MOHF 1I IAN fIVL f IUNun[o�oLLARS(55ai).): Z F1e-R001 �y 4Y' �p'� 4 F- P � ❑I,ASOWNEROtTH[PROPERN,ORMYEMPLOYEESVJII'HVdA�ESASTHFIRSOLECOMPEN5ATl0�. O COffIR10fC18I � Z WlLL DO THE WGNX,ANU 7Hf.S'IRiJCiilfiF!.S NO'IVTENDED OR OFFEREU r OR;ALE(SE(:.�n44,(3USI- J � Nk:SSANONFlbfCSSiONSCODE.THECO�THMGIn�i511GLN5ELAWDOcSNOTAPPLYTOANOWNEHOF = '-�- PFOPER fV WI IO BUILUS OR IMPi70VES TNEREON,AN�WI10 L)Of�S Sllf.li WORK HIMS[LF Ofl HERSELF Oq .' p_,' iHRqUGHHISOflHEftOWNEMPLOVEES,PIiDVf�EDiHATEUCHIMPROVEMENTSAHENOfMTCNUEUGH L� � �L CfFfRE:�FORSAIC.IF,HOWEVERTHEBUILDINGORIMPfiOVtMfNiISSOLUWITMINONEYEAROFCOMPLF.- j0 TIOY,THE WdNER-OUILUER WILI fIAVF TH[611F�EN OF PROVI�G illA�HI�OR SHC:f11D NOT BtJILD OR �, IMPfioVt FOFl THE PURI'OSE OF SALF), uJ p1.A$OWN[flOFTHC�PROPER7Y,AMEXG!USIVELYf,ONIfiAGTINGWITHLICENSEDCOMRACTOF75 - �y� i (S iCi CON57pUCT THE PROJECT(SEC.7041.[SUSINf.SS AND PROFE5510N5 CDUI'THF GDNThiAGTOtiSll- � VOIIIafI0f1 _/ `�� ADJ.AREA L1.1 CFNSELAWDOF.SNOTAPPLYTOANOWNE4i01=AI�ROP[iTTYWH06UILDSORIMPROVESTHE(7f.ON,AN� ---------.__._____..._..___,_,_, � WHOCOtiTR�GTSFOR5UG41P1iOJ[CTSWITHACONTRACTOFi(u)IiCFNSLDPURSIIANTTOTHECO4TqAP OUANTITY DESCRIPTION �I FEE Y 7oliStICENSELAW.). � � :-,I AM EXEMPT UNOER SEG __.__. __. _ti.&P.0 FOfl THIS REASON q ° _. U y � — -- ----------..._ ---- I OC � OA7e _OWhER___.___- ` }- `� � � LICENSED CUN7HACTORS DECLAAATION � t Q W � IIIEFlE9YAFFIRMUNDERPENALTVOFPEN.IIIRYTHATIAMLICEY5�0UkDCqPROVISIONSOFCHAPTER � � � J�COMMF:NCINCWITI75ECTION70W�OF7IVISIONiOF111EUUSINESSANDPROFES510N5CODE.AND Z __,_ � �X MY LICENSE IS IN FULL FORCf:AND[�F[CT. .m � LICENSE CLASS_ [. " ,_�j . .._ LIC.NO. � � - _ _ '.._-__ . . � U DATF ..��{/'- 5�..__ GCNTRAC70R _._ ___`_ '�i�C,.,�+- d E W � � WORKEftS'COMP[NSATtON DECLARATION J - --- G a A � 1 HEHEUYn��IIiM UNIIFR PENAL7Y O"r PF"liJUHY ONE OFTNE FOLLOLYI,tiG DFGLA71A1'IONS: U � � z Z ____, II{�y[ANUWIII.MAINT/11NACtRlIFIGA�FOFCONSENTTOSELF�INSURF.FORWOHKEfiS' a 'r 4 COMPENSATION,AS PROVIDED BV SFCTION 3/aoOf THE LABOR COD'c,FOH 7HE Pf�fi�ORMq16CE (� y OF 711`t WOf7K FOR WHiCH THIS YF(iMl f IS ISSUEO. W R � � A QW _IHAVeANDWILLM0.I.YTA',NWORKEHS'C(:M.VF�\SATIOYINSUAANCE,ASREQUIRFDlV5fC710N s�ouOFTHELA80RCU[)C,fOHTHEPEHFOIUdANC[OfTHfWOPKFOHWHICHTHISVEHM�TIS i �� ISSt1ED.lAYWORKf:RtiCOMPE4SATIONINSURANCECARRIERANUPULICVNUMOERARF.: CONSTRUCT�ON 7� �� � J � _._. � CARR)ER_'_'' ' -� ...__._._ PLANREVIEW :� --- ---- - -- ....----. , � POIICVNUlABEH____ _ .__._ .- -._.. I ELECTRIC � 4 -- .-------- u� 0 (fHSSECIh�NNF.CDNOT6ECON�F'LETEDO'rTViCPFItAUTISFOppVEHUWHEUDOLU�RS(St00�ORlESSj PLUMBING ___ . _ L27 - _ �; Z I CERTIFY7HAT IN fHC PERFOftMANCE O�II IE Wp17K fOR V.'HICH THIS P'eHMIT IS ISSUf.II,I MLCHANICAL . 4� C� SHA��.NOT EAIPLOY HNY PCRSOti INANY MANNCt�SOAS TO P[CO CTTOTI{E �� ���-'���-' '"-- , �/J WORKEHS'C.O�UPENSATfO.M L�N'S Of CAl7tOFlNlA,A!J'D GAEE� 1 IF I tilV l/ iL(;OMF INSPECTION FFE �� = SUBJECTTOTI{FWOFtKI'HS'CO.UPENSATN��P OV• .�VSOk CTION 0 HEIA[lOH � � / �--- ; CO/pE ISHAIIfO/HTHWITHCOMPLYWI(HTII ' ROVISIO , I ISSUANCE fS �� O •%/�(�•./ _ _ � $M�� '_"""'_'_"_ -- _ __ � p f1ATE:.___ APPLICANT. p W ' ' ___' '__ '_"' " ENEHGY P/C � J WAFlNIN(3:fAILURETOSECUREWORKEHS'Cq EN ATIONCAVf.f1AG SUNLAWFULAN�SIIhLLAF � � _J _ � SUBJECTANEMVIOYI=RTOCRIMINALPENALIIESAYDCIVILFINESU�OONF,HUNUHEDTHOUSAND ENERGYPERMIT DOLI,ARS(E1o0,00a),IN AUOITION TOTHE COSf OF CONPENSATION,OAMAGES AS VNOVI�k D FOH IN .-- J SECTION 3lo6OF 11IE I ACiOft CODE,INTEHEST,ANU A1 fORNEY'S FEES. ------- --'" � ,_ RET[NTION FEE: _ _.________________� ,I. �_ i OCONS7RUCTION LENDiNG AGENCY PRE-ALT FEE: ._. .. __ � � IHEH613YAFfIRMUNDEqPFNnITYOt PCRJURVTHATTH6R61SnCON51f�UCTIONLEND:NGAGENCY � �OR THC P[F7FORMANCE Of I HF.WONK fOfl WHICH THIS PERNII 15 IS5l1C:)(SLC.3097,CIV.C). - -� -- - -� � Z -_ W _._. �- '--' - ' � lCNOEH'SNAME__ "'_' H LENOERSAODRESS - "'_ _ _ "_ __'__ -'__ '_-__. _.""____.". . ._ ' -- � � _...._.. � W 1 CEii(IFV�IIqT I HAVE REAU lfi;y9CPPl.I(:ATI NANO STATETHAT flll-AiiOVC,\F()GIMATION IS CORFECT, TOTA� �EES ^ ��C!- �y � IAGREETOCOMViY ITNAIIC�YANDCO IYORpI:JAN(:ESAN�STATELAWSRELATING'f08111IflING N CONSTAl7C.TION,l1 11F.RCl3yfqt17HORllk: P NTAT!VE^un�IHI:;C(N1NlYlUElrTERUPO.VTHE � � ABOVE�ME i0�'. PROf+E �Y FOR IN (:7'I urarosrs. „ - . : COMMENTS � - - '-- � / -----.'.--- i m ' -' - /- - �--... ._ �% - -- � -- .. .,__... _ � AE ENnMf q. ' (° � " /� �q - . ._. _ _' —___ ___ ' __ _. �.G�C�✓S'�s� /�—���[ . - - Uj SIGNA UF F MITT[E � DATE � ' ^ ------- - --- � � R[CPT.NO. .�__ pqiD BY VALIDATION_._ .._ ,_ � WHITE—Depadment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplicanPs Copy � e _. __.�_.� _ _,_ _.... ___.._ _.,.._ ._ _ __ _. ---- _._ . , -- - - .- - �-_ � _ � � _.; �-_-- _.� ( ,. � i I , I ; I � ' I { ���.e � i �� � . f j I � i - � . '; i �, ' '.� i i i I i � i I . � ( , � i I I . �� . � I � � � � � ' � ( � ( ' � ' � � � ' I '� � ' , ij = i � � � � I � l i l I I ; � ! , I � � � � , � ; i � i ; � I � i � ' ' ' � � � � ��� i � � i ' I � ' � j � � � � f I � ; i � ' ; � I I � ' I i ' : ( ' ' I i � ' i i � I � I � _ �_� ! ,_ ' { I i � � _ �_..!. I �- _ � � _ � , � � i � � � � j � � i . i � i i � I �� i k ! a ; I � � � ; ' � I ' � i ; ' � ' � �� � ' 1 , k I ' ` - , ' �'�t' I � : ' � � i , � i ' � �i I I ' I � - �4�.. I i ; i 1 I ; I � � � ' j � � � i i i ? : �. , i i . j � , �,� � I � � i i � � � � i i � . , ; i ( ' ; ? �t������,-_t -- t. � � I f--�.- � � i � } � ' � ' I I ! I ! � ��� � '-- � ! � i � � ( i ! I � i I ' �� ' ; I � � w ' � � ' . � ' � i � �! ' i � ' i .� �� �1' : ; , � ; i � � � � � i i � � ; � � �' � 1 #r'�� I '�-.;�n r�-.ai`�� I. .� � I . ; � i �.�;I I � ' ; ! , i � � ' I ' '� i � . � �rs� ( ��;,� � � r._�i �`�' i IC `� - �'�I "r: r ' � � � , � � . � I � `-`' `�j n� � �i i "� - � � rr `t' u {I r i i i ; ' � � r �- � rti��i:' ( :- .S' t�7 'r' I�' �(k��C]1 i� (�u Gt 1.� �ti :� i`.. N-�`r - � : . ; � - j _ i ' � `I . �� { (�, � � �� � : � � . I i ' : I � �. , � �� t,�I '"1 ( t c^ .. � i t � . i_ � ?�—a u,� > , � �z 1 �� � I C3<1� .� , �p- �F i��r `�. `_ � a� �. � !_ ,�� r�t i i �� �� i � 1 I � i *^�' € �. �f� �i r1 ,_1 � J � � s � � ' �� I i � . I I � �� � f 1� �� P � �f i � �- � c � � �. � � � �?� I � i � r - y,. ���. ; ') i�� II k� i�' C7 v l. Li �L r . : � ,,, �iI 'i ra r �. � � � � i,r s'� . a�9 ' ��� � '' ' -.�1 ' - —,. � ��� i � i � � � : ; � � � �� ���� I '....� ' _ � i- _ -� -�_ { i � f i � 4 �• Er� ��' ' , I � i � i i ' ' � ! ; I ' � ' ��" # }�t .�' � , i /j I � � � . , I . i . � 3 i . ' i �i � 'i ��; � ; r � °f i ' !, I I i � f . � � I � � ' , , I � ' I ` ' l , . � �.�� '� � ' I � ' � ! ' � i . '. i �" � �: � i � ! , � �) i r���� , 1 ; � � , , , _ � � _ -� i—; � - ._ � I ° f '-_ _} _i : I i I f ' �, � � I_ � �- [ I i ' I ��� j j �,,��4 i � � ! � i I � ' i ;\ I — ( -- '� ---- -..... � l__� , _. . . , I , _ � � , , � ' _. , ; ' , t �. I _ { i j i ` E I ' i � i � �r- ' ? � �� �� :i � ��ri� � '� � I I + ; � � ' ��a' E �� n' u� �i I� i � , � ( '' ,i � i i " � 5� � I (rr E ; � i (�:, � � .� �, ci` � �� � ,) ( I,�,� r ���� � � � � � ! i 1 � �-j � d a�. � J j tq 111 � � � �y.'$ .� i. i . ',uz � � i �_ �-�� i� � j .� � � i ���.W � �" �. � i ''� I t �� (.5 r ; I E ^ 1 � � ��.�_� j` .% ri .�;I,�I ' ii�4� ` � �,� � ..i �� �' {,' } �,,� I ( �i � ��` .� i L�i � _ I ��,, L � � ' ( , iI , �I- 4, , � � [ � � u. ��1 ' 1 �t���n L ( i._C.+ � �., 'C.�� ' t<.�.� I� - ��t . -,� „ - - � � _..,.g __....._� _......._.._.. .. __ 1__..-._�a�._._._.__...._.__......_.._,._,____�__` I , , ' .�._.i.... .... . _ __.._. . __ i ._.a__, .t.. (m�_ � � ___ ...: .._a:.�_ ,_:. , ___1_.