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HomeMy WebLinkAbout17276 cITY oF DYAMOND BAR �''' ------�"�' - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � I I 21825 E.Copley Drive (9Q9)860-3195 Fax(909)861-3117 PRESS `"'%v«�"' BUILDINGPER1bIITAPPLICATIION FIRMLY � JOBSITE 1118 Cle horn APPLICATION { PERMIT �J P/C o ADDRESS_ g DATE `� I� ' NUMBER � ` �� # g ISSUE TYPE OCC APN LOT TRACT DATE �� � � CONST. GROUP p OWNER Cimarron Oaks I HOA o ADDRESS �7S W ������]l R�Y� #�,�(�, ZONING SETBACKS z CITY (,'��g���k_ ZIP A171 i TFL3�A-�],O� FRONT RW C � APPLICANT TEL. REAR ❑ z SIDE/SIDE STREET RW ❑ ¢ , CONTRACTOR Roval Roof O. SIDE ❑ ADDRESS���,,� n...<.... c,.. � CITY ZIP��, TEL.� PROPOSED USE '�e�� ��� j���,�.����� ������_ w 'ARC� �z pESIGNER 7692 NO.DWEL. . NO. a' ADDRESS cn UNITS STORIES BEDROOMS � CITY ZIP TEL. �- � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION p� OWNER-BUILDEfi DECLARATICN SFRlADD/REM O p 1 HEREBY AFFIRM UNDEfl PENALTY OF PEflJURY THAT I AM EXEMPT FROM THE CONTHAC70RS LI- Gd�BJB/CafPOfi W CENSELAWFORhIEFOLLOWINGREASON(SEC,7031.58USINESSANDPROFESSIONSCODE:ANYCITYOR (� U' COUNNWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,�EMOLISH,ORREPAIRANYSiRUC- W, TUqE.PRIOR TD Iis ISSUANCE,ALSO RE�UIRES THE APPLICAN7 FOR SUCH PERMIT TO fIL:A SIGNED W PatiO/DBCk � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO�HE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTER 9(CAMMENCING WITH SECTION 7000)OF�IVISION 3 OF THE BUSINESSAN�PRO- � PooUSpa � �FESSIONSCADE)DRTHATHEOPSHEISEXEMPTTHEREFqOMANDTHEBA515FORTHEAILEGEDEXEMP- (� V TION.ANYVIOLATIONOFSEC710N7o31.5BYANYAPPLICANTFOqAPEftMITS'JBJECTSiHEAPPLICANTTO 'Z R0-R001 � .A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDREO DOLLAFS(55oa).): ❑4ASOWNEROFTHEPROPERTY,ORh1YEMPLOYEESWITH:W.4GESASTHEIRSOLECOMPENSATION, COrt1ff19fCiel Z�',�, WILL DO THE WORK AND THE STRIJCTUflE IS NOT INTEN�ED 6R OFFERED FOR SALE(SEC.7044,BU51� �J �'.� NESS AN�PROFESSIONS CODE:THE COMRACTORS LICENSE LAW�OES NOT APPLY 70 AN OWNER OF �'.PROPERTYWH09UILDSORIMPROVESTH=REON.AN�WHODOESSIJCHWORKHIMSELFORHERSELFOR � � '. THROUGHHISORHEROWNEMPLOYEES,7ROVI�EOTHATSUCkIMPROVEMENTSARENOTINTENDE�OR m Q�� OFFERF�FORSALE.IF,HOWEVER,THEBUILOINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z,', TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PFOVIN�'I1AT HE OR SHE DID NOT BUILD OR _,' IMPROVEFORTHEPUflPOSEOFSAL�. �,�J. ' ❑4ASpWNEROFiHEPFOPEFN,AMEXCWSNELYCONTRACTINGWITHLICENSEDCONTRACTORS Q. To CONSTRUCT THE PROJECi(SEC.7044,BUSINESS ANO PROFESSIONS CO�E:THE CONTHACTORS LI- Valuation ADJ.AREA LLJ�, �CENSELAWDOESNOTAPPLYTOANOWNEROFA?HOPER7YWHOBUILDSORIMPPOVESiHEREON,AND _�. WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)L'CENSEOPURSUANTTOTHECONTRAG FEE ~ TORSLICENSELAW.�. QUANTIN DESCR�PTION Y' 0 ❑I AM EXEMPT UNDER SEC. B.&P.C.FORTHIS flEA50N Q � J � �ATE OWNER � Z U � LICENSE�CONTRACTORS DECLARATION � ¢ � 1 HEREBYAFFlRlA UNDER PENALTV Of PERJURY THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER � � 9�COMMENCINGWITHSECTION�000)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCO�E.AND z 'X MY LICENSE IS IN FULL FORCE AN�EFFECT, m � LICENSECLASS�jl1 T_TTn LIC.NO. /.�JllG7 . � �� . 9 1T1� =f "7� . V DATE CONTRAGTOR a W - - ya o0 0. � � WORKERS'COMPENSATION DECLARATION Q � IHEREBVAFFIRMUNDERPENALTYDFPERJURVONEOFTHEf-0LLOWI�UGDECLAqATIONS:' U � Z Z _IHAVEANDWILLMAINTAINAGERTIFICATEOFCONSENiTOSELFdNSUREFOflWORKEFS' _ 4 COMPENSATION,AS PROVIDED BYSECTION 370o OFTHE LABOR CODE,fOR THE PERFORMANCE U Q OFTHEWORKFOflWHICHTHISPERMITISI551JED. � QI HAVE AND WILL MAINTAISJ WORKERS'COMPENSATION INSUflANCE,AS REQUIRED BY SECTION ,�.�y ��,� �„ Q. XXXa7ooOF7HELABORCO�E,FORiHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS p�� -Y•� ISSUED.MYWDRKERS'COMPENSATIONINSUPANCECARRIE3ANDPOLICYNl1MBEFARE: CONSTRUCTION J � CARRIER��$gr�n��T���0��1 PLAN REVIEW ZPOUCYNUMeEa ELECTPIC � ¢ a @iI55EG�KKJN�NOTBE�OMPLEfEDOFhiEPERMRISWRONEHUIJOREDDOLLARS(5100;�ORL6S). PLUMBING W Z I CERTIFYTHAi INTHE PERFORMPNCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL G_'3 SHALLI�TEMPI.OVANVPERSONINANYMANNER5DA5TOBECOME5U8.;ECTTOTHE � WOFKERS'COMPENSATIONLAWSOFCALL=ORNIA,ANDAGREE7HATIFISMOUI�BECOME INSPECTIONFEE � = SUBJECiTOTHEWOPKERS'COMPENSATIONPROVISIONSOFSECTION37400F7HELP80P CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE 0 ��'� p DATE: APPLICANT: SMIP '�7 7 Z � S�_= J � WARNING:FAIIURE TO SECUftE WORKEFS'COMPENSATION COVERAGE IS 11NLAW�UL,AND SHAIL BE ENERGY P/C J �, SU6JECiANEMPLOYERTOCRIMINALPENALTIESANDCiVILFINESUP700NEHUNOFiEOTHOl1SAN0 ENERGYPERMIT ' J' DOLLARS�§100,000),INADDITIONTOTHECOSTOFCOMPENSATION,�AMAGESASPRWIDEDFORIN ' SECTION 3�080F THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES, " �, RETENTION FEE: O CONSTFUCTION LENOING AGENCY PRE-ALT FEE: � ���. IHEFEBYAFFIFMl1N0ERPENALTVOFPEFJURVTHATiHEFEISACONSTRUCTIONLENDINGAGENCV FORTHE PERFORb7ANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.309�,QV.C.). � Z W � LENDER'SNAME I-'- LENDER'SADORESS 2� � ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEA30VEINFORMATIONISCORRECT. TOTAL FEES ` w IAGREETOCON�PLVWITHALLCITVANDCOUNiVORDiNANCE5AND6TA7EL4WSFiELATINGTO8UILDING � � CONSTRUC710N,AND HERE�Y AUTHOAIZE REPRESENTATIVES OF THIS COVNTY TO ENTEft UPON TF7E Z ABOVE-MENilONEOPflOPERTYFORINSPEC710NPURPO5E5. 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