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HomeMy WebLinkAbout13848 (17) - CITY OF DIAMOND BAR ��' COMMUN[TY DEVELOPMENT DEPARTMENT :,.� . 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 � ""' BUILDINGPERMITAPPLICAT[ON FIRMLY N J08SITE APPLICATION PERMIT J ���J Pl o ADDRESS 288� CRYSTAL RI?3GG ROAD _ DATE ��� ��NUMBERl.� !�q ✓�' � APN LOT 21 TRACT 478SO ISSUE TYPE OCC DATE CONST. GROUP o OWNER Jiamond Bar kTPSt T;i,C o ADDRESS 3480 TOTYaI10E L1V[I. St�. 3OO ZONING SETBACKS z cirv Torran.ce ziP 90503 re�.310-540-399 FRONT Rw ❑ p APPLICANT Rzeh�:rd Gould rE�.310-540-399 soersioEsrReer Rw ❑ mCONTRACTOR JCC Constructi.on SIDE � u � ADDRESS same 8S owner pq(�pOSEDUSE Nu,d_.SING�E rA`�iiJ�l' R.rSiDr.idCk, � CITY ZIP TEL. ,y� o ARCWENG/ �.TT.hC�:.�1) L•rRf.GE z� DESIGNER LL. Gou1d � LiSSOC. NO.DWEL. , NO. NO. a, ADDRESS_ sSmP a:; owz.er UNITS 1 STORIES � BEDROOMS � � CITY 21P TEL.__ � cn DESCFIIPTION SQ.FT. FACTOR PSF A J.AREANAL A N Q OWNER-BI:ILDER DECLARATION SFR/ADD/REM S i 1� O I HEREBV AFFIPAI UNDER PENALTV OF PERJURY THAT I AM EXEAIPT FPOM THE CANTRACTORS LI� / Garage/Carpori ;��� W� CENSELAWFORTHEFOLLOWIN6REASON(SEC.7o31.5BUSINESSANDPROFESSIONSCODE:ANYCINOR (n � C.�. COUNTYWHICHRE�UIfiESAPERMITTOCANSTHUCT,ALTER,IMPROYE,OEMOLISH,ORflEPA1RANY5TRl1G W Patio/Deck 7/ �' TUNE,PRIOR TO ITS ISSl/ANCE,ALSO qEQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W 1.'J!. � / STATEMENT THAY HE OR SHE IS IiCENSED PURSUM'T TO THE PROVISIONS OF TME CONTPACTOR9 LI• �, GENSE LAW(CMAPTER e(COMMENCING WITM SECTION 7000)OF OIYISION 3 OFTHE BUSINES5 PN�PRO� u' Po0USp0 O FESSIONSCO�E)ORTHATHEORSHEISEXEMPiTHEREFNOAIAN�THEBASISFORTMEALLEGEDEXEMP- � U TION.ANYVIOLATIONOFSECTION7031.SBYANVAPPLICMITFORAPEFMITSU&IECTSIHEAPPLICANTTO Z Re-Roof ' ACIVIL PENALT/OF NOT MORE THAN FNE HUNDRED DOLLARS(E500).): ZOI.ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, ❑ CORIfI1B�C10I WILL DD iNE WORK,AND THE STRUCTURE IS NOT INTENDEO OR OFFEFED FOR SRLE(SEC.)014,BUSI- J � PR�RTYPWHOBUSLOSOR MPROVESTHNEi1EDN,AN�LIYM0�0 SSU HEWORKHIMSEL ORNE SELFOR � ��1Cv:._' .�l.'.'. �� THROUGHHI60RHEROWNEMPIOVEES,PROVIDED7HAT&UCHIMPROVEMENTSARENOTINTEN�F�OH m (s� � W OFFEREDFORSN.E.IF,HOWEVER,THEBl11lOINGORIMPROVEMFNTISSOLDWITHINONEYFAROF�MPLE• POICh i' � � (/ �� TION.THE OWNER�BUILAER WILL HAVE THE 9URDEN OF PROVING THAT HE Ofl SHE 010 NOT BUILD OR z IMPqOVE FOR THE PURPOSE OF 3/�E�. W' L71,ASOWNEROFTIIEPROPEflTV,AME%CWSIVEIYCANTRACTINGWRHLICENSEDCONTRACTORS � � TO CONSTHUCT THE PR0.IECT ISEG 7044,BUSINE55 AND PROFES510N5 CADE:THE CONTRACTORS LI- VelUetiOn L J.pREA W CENSEIAWUDE3NOTAP�LVTOMIOWNEROFAPROPEflTYWHOBUILDSORIMPROVESTHEREON,ANO F VMOCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTOq(5)LICLNSEDPURSUANTTOTHECONTRAC• QUANTITY DESCRIPTION FEE TORS LICEN5E LAW.). J Q ❑1 M1 EXEMPT UNDEfl SEC. 8.8 P.G FOR THIS HEA;AN Q '�P� 3 — v_ ' > � � � OATE ___ 01YNER___..-- ---._—_.______— V . Z W �. LICENSED CONTRACTORS DECLARATION W , � � 1 HEFlEBY AFFIRM UNDEfi PENALTY OF PENJUfiY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER �e . � 9(CAMMENCING WITH SECTpN 7o0a)OF DIVISION 30F THE BUSINESS AND PROFESSIONS COOE,PND Z �X MY LICENSE IS IN FULL FONCEAND EFfECT. m """" " � LICEN5E CU155 � LIG.NO. �7 1 90 L j ~' �ATE CONTRACTOR__`�CC CGi7.utrUCC.I i� { ' W� —__ r/ f� t<y�r�F... :. �) i m! � WORKERS'COMPENSATIONDECLARATION [.-�t��� � U ;�TM;'<r.;' .- ;�•u.;i'-r,,,s;-�jsi�.°�g� a •---+ . ,,�-,;;; ,,,,; . � 1 HEREBY AFF�RM UNDEfl PENALTY OF PERJURV ONE OF TME FOLLOWINC�DECUHATIONS: � `� ;Ti? '.;Z':, ;� . 3�q"'v �'"' Uj , . .7t' ✓:�S'1�" `+.1'�..1.,, °�t:�.�"�L:4 i � IHAVEAN�WILLMAINTAINACEHTIFICATEOFGONSENTTOSELF�INSUREFOflWOflKEH3' _ C�AIPENSATION,ASPROVIDEDBVSEC71(MJ37000FTHELABORCWE.FORTHEPERFORMANCE U � OFTHEWORKFORWHICHTHISPERMRISISSUE0. � � � � v. W "1 HAVE IW�WILL MAINTAIN WORKER&'COMPENSATION INSURANCE,AS REQUIRED BV SECTION . � [j � /��' � . Q 3700 0F THE LABOH C00[,FDR THE PERFORMANCE OF THE WORK FOH WMICH THIS PERMR IS . ' . ��X `'"/ . ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE: CONSTRl1CTION +"`� � V 1 �"� J . j CAHRIER C,.1�_for:/�.�_�. Cn-:���e_�;�:.t_O_;� ���/�"""����---;;;J PLANREVIEW � �) ZPOLICV Nl1MBEF_..F�J�(i�'S I S�,i 7114 ��^`��` ; ; EIECTRIC ��t y� Q v � (iHISSECT%)NNE�NO78EOON.PLETFDOFIV�PERAYlISFORONEVRN�DREDOOLWiS(f�OoIOpLESSZ PLUMBING � �1 o- 1 T N Z ICERTIFYTHATINTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSl1E0.1 MECHANICAL t� � SHALLNOTEMPLOVANVPEflSONINANYMANNERSOASTOBECOMESUBJECTTOTHE . � WOfiKERS'COMPENSATIONLAWSOFCAf.IFORNIA,ANDAGREETHATIFISHIXILOBECOME INSPECTIONFEE ______,_ SIJAIECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION37000FTHElABOR L��� �� � COUE,tSHqLLfOflTHWITHCOMPLVWITHTH0.5EPROVI510N5. ISSUANCE ______ rJ .' � SMIP R p DATE: _ APPLICANT: /7J� I� J WARNINO:FAILUNE TO SECURE WORKERS'COMPEN5ATION CAVERAOE IS UNLAWFIIL,AND SHALL 6E ENERGY P/C �V��� LL SUBJECTAN EMPLOVER TO CRIMINAL PENIILTIES AND CIVIL FINES UP TOONE H�NORED THOl1SAND ENERGY PERMIT '� DOLURSIS100.00OI.INROD1710NTOTHEWSTOFCOMPENSATIDN,DMIAGESRSPROVIDEUFOR�N —� — � SECTION370B OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENT�ON FEE: pW„ CONSIAUCTION LENDING AGENCY PRE-ALT FEE: I � IHERE9VAFFIRMUNDERPENALTVOFPERIURVTHATTHEREISACONSTRUCTIONLENDINGAGENCY �;� d FOflTHEPERFORMANCEOFTHEWORKWRWHICHTHISVERMITISISSUED(SEC.3097,CIV.C.). W 1OQ�_1 '___ � LENDER'S NAME __ F_ LENDER'SAOORE55 _ � ,/_/���/iry �/�-J� W 1 CERTIFV THAT I HAVE READ THIS APPLICATION AND S7A7E iHFT THE A60VE INFOfiMATION IS CARRECL TOTAL FEES � ' P�"' , ��Y `�1 � � IA�REETOCOMPLVWITHALLCITYANOCOIJNTVO{mINANCESANDSTAiELAWSHEUTINGTOBUIL�ING � CONS7flUCTION,ANDNEREBYAUTHORI2EREPRESENTATIVE50FTHI5CWNTYTOEN7ENUPONTHE Z ABOVE�MEN710NED PROPERTV FOR INSPEC710N PURPOSES. (^1 COMMENTS_ 11` � /�h1o'3��� !�� ��i✓a�-: z.J.�:..�.'. m PERM�I7�7EE NAME(PRM7) iu.• .� 4 i 3 1".-. � � .!G:/'(��,� — + 1 a�,�' v� r''�' . ,1 t� �G%,�..�7'`,C•7 ��—r{-r_� � ��� � 1• , �� 1' `sFGN? RE PERMIT7EE DATE ,y � RECPT.NO. �:�')' PAIDBY�� VALIDATION � S ~ WHITE—Department Capy,YELLOW—Finance Copy.PINK—Assessor Copy.GOLDENROD--File Copy,GREEN—ApplicanPs Copy 9 :_.I _... i..__..:_�� i � �. � �_� � .i i ;.�.�..T.._.-�__ i; �;�p -a ol���'�i:(s�l�+,� g --� c��ci m �'cn , E 1� � I � . -' I I ; C' yi�n „�-n ���Icnrncn � c� rnicn � � �mc- Ir -��m tn i*1 �. i z,�!� z D �: m m � -r• x O O��OiO � 7� I I m ro ' ,� b n�a a ��m -v � � j ;c.�p a�o De'� a�� m n�-� ro I y � ,��� { ,:!' � � � j � S rlr�r�r�D � -� T,�� ��I�� �� �� iT�'��.'t7l�I'�'i�m � � '- ,� ��Ep � � b t���Sl ➢. n -� T T r�;:S I � � �9��`� zt D -�--� G i \�,c� i � i � �j=�� � � { �- �z.�-a i k-F E��z cn � n o�� c�i ry � � C�1 j c ii't���� ��� D� r z ✓�is�� � ��m O G� ,sl� � D In �:.? r-� �-: � �.^L. � rr � c;i-,� �m�r�zl, !z i��_ . i. I '�`Z � � � � � _ m_r G�. � c m m r �. i r c� � : ._ '') I ( � i � rD � m I � .s -s .n '- - frr . � rr:i . � �m�. 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