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HomeMy WebLinkAbout10451 �. .�. :. . ._.�. ._. M... __. _.___ _ -, ,. _, { � " CTTY OF DIAMUND BAR COMMUNITY DEV"EI�OPIvI�N'1'DEPARTMEIVT .K•,C 21660 E.Copley Drive Suite 190 PRESS+ (909)860-3195 Fax(909)$b1=3117 �"""' BUILDING PERMI'C APPLICATION FIRM LY _. � .,_ . „ ,._4_ ,,. � JOBSRE ' g� b� t�: APPUCATION PERfN17 �`����, P/C o ADDRESS 22800 HIT.,ZDN fIE�D #Z4 _ DATE NUMBER # $ . .., issu� � � rvP� occ � APN�� LOT ,SRC1T� • DATE `� � CONST. GROUP OWNER • • O ADDRESS C o Y' �nSiVe � ZbNING SETBACKS 0 W CI'fY ZIP TEL. ` „ O REART RW ❑ � APPLICANT L� S�edetl rE� !909) 597-7734 SIDE/SIDE STREET RW ❑ � GONTRACTOJ� � �ghtin�, INc. ' ' SIDE �_ ❑ � 15�'�a1�'�TL1�c1�718 � �; .'; ADDRE3S PROPOSED USE 0 CITY � 21P TEL_ 4 wo ARCH/ENG! n/a z� DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. i. c�n DESCRIPTION SQ.FI: FACTOR PSF ADJ.AREANALUATION p� OWNER-BCI�DER DECLARATION SFR/ADD/FIEM O I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT�AM EXEAIPT FFOM TF�E CONTR;�C70RS LF GaragalCarport W CENSEUWFORTHEFOLLOWINdREASON(SECJo91.5BUSINESSANDPHOFESSI6NSCObEiANYCITY'OR (n U COUNNWHICHREdUIRESAPERMITTOCANSTqUCLALTER.IMPROYE,DEM041SH.ORf1EPAIpANYSTROG W Patio/Dadc Z TUFE,PH�OR TO 1TS ISSUANCE,ASO RE�UIRES THE APPCICAN'Y KOR SUCM PERMIT TO FIC6 A SIONED � STATEMENT TH0.T HE Oq SHE IS LICENSED PURSUANT TO THE pROVI510N5 OF THE CpNTRq�'fORS U- � � CENSELAWCHAPTERB(CDMMENCIN(3411TH3ECTION70otiOF01V1SION30FTNE9USINESS'ANDPqO. LL' POOUSpB �„ . , „�� __: � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEFEFROMANDTH@BASISFOR7HEALlEQEDE%EMP (' � - V T{ON.ANYYIOLATIONOFSECTION7031.58YANYAPPLICANT'FORpPERIMT�5U8JEC75TH�APP�ICAM'TO Z Re-Roof ACIVILPENA�TY OF NOT MORE THAN FlVE HUNORED DOLLAR§(fkoD).): -�� ` ^`-"�� ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITNWAO@SA&THEIRgOLECOMP�N$A710N, Q � Commerciai WIIL DO THE WORK,ANO THE STRUCTURE IS NOT IMENDED OR OFPERED FOR SALE(SEG 7064,�B1J56 J � NESS AND PROfESSIONS CODE:THE CANTRACTORS LICENSE lAW DOES NOTAPPLY 70 AN OWNER OF � PROPERTY WHO BUILDS OR IMPROVES TNEREON,AND WHO DOES SUGH WORK HIM$ELF OR H�qSELF OR CC THROUGHNISORNEROWNEMPtOVEES,PROVIDE0THA75UCNIMP{tOVEM�N'f5�A{7ENOTINT NDEO"OR m QOFFEREDFORSAI.E.IF,HOV/EVER,7FiE8UILDINC.ORIMPRdVEb1EN"1'ISSOWWITHINONEVEpI�OFCAMpL& TION,THE OWNER�BUILDEii WILL HAVE THE BUROEN OF PNOVING THAT NE OR SNE 010 NCST BUICO;OR = IMPROVE FOR THE PURPO6E OF SAIE�. �- � -�� . .���'"'4.!!� _W ❑I,ASOWNEFiOF7HEPROPERN,AMEXCLUSIVELYCONTqACTINQ,WITHLICENSEDCONTRACTORS � TO CAN5TRUCT THE PR0.IECT"(SEQ 7odl,BUSINE55 AND PHOFESSIDN$CADE:'fHE CONiRACTOqS U- V81U8Ii0n ADJ.AREA W CENSELAWOOESNOTAPPLY7pANOWNEROFAPROPERTYWHbBU1LDSORIMPpOVk57N�AE0N,AN0 � NAiOCONTFiACTSFOFl5UCH7HOJECT$WITHACON7FACTOR(5)UCENSEDPUR5UANTTOTHECONTR'AG QUAN7ITY DESCRIPTION FEE � TORSLICEN5ELAW.�. . �...�:�:'::�..��� J 1 Electrical Pedestal (C,han e � ❑I AM EXEIAP7 UNDER SEC. B.&P.0.FOR TNIS REASON Q g � � U � LL' OATE OWNER ..�-� U Z W � UCENSED CONTRACTORS DECLARATION ' W � I HEREBYAFFIRM UNDER PEN0.LTY OF PERJURV THAT IAM UCENSEO UNOEF VROVISIONS OF CHAPTEH � � 9(COMMENCING WITH 3ECiKKJ 700D)OF OIVISION 3 OF THE BUSINESS ANp PROf�SSION3 COOE.AND Z X� MY LICENSE IS IN NLL FORCE AND EFFECT. m - 0 UCENSE CIASS C�O uc.r,o. �2g594 = V pATE CONTRACTOR � - - � �- a W . .,.....,., ,..:_.... ....:,.:, r.;. � WORKERS'COMPENSATION DECLARATION � Q � INEflEBYAFFIRMUNDEfiPENALTYOFPERJURYONEOFTHEF04LOWINGDECUIRATIONS: Z Z _—IHAYEANOWILLMAINTAINACERTIFICATEOFCONSENT705ELFdN5l1REFORWOFACERS' 2 ¢ COMPENSATION,AS PROVIDE�BV SECTION 3700 0F THE lABbR COOE,F0t7�HE PERFORMNICE W � OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO. � � � _I HAVE AN�Wlll MAINTAIN WOHKERS'CAIAPENSATIQN INSURANCE.AS REOUIRED BY SECTION � 37000FTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKf-0RN/H�CHTHISPERMRIS J ISSUEO.MY 1NOpKERS'CAMPENSA710N�NSURANCE CARRIER AND POL�CY NUMBER ARE: CONSTRUCTION j CARRIER '��nt CCflT�X',TL-'a'�7-OT1 PLAN REVIEW �. Z aoucv NUMBER � 6 � 7—O2 ELECTRIC�} �i� �...---� ¢ � (MISSECTIONNE�NOTBEODMF'LEfEDOFThEPEPAYi1SFORIXJEFIUW(tED00LLNiSiS�00)ORLESS), � �L�ING Z i CERTIFY 7HAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C7 SHALL NOT EMPLOY ANY PERSON IN 0.NY MANNER 50 AS TO BECOME SUBJECT TO THE - y WORNERS'COMPENSATION LAWS OG CAUFORNfA;AN AGqEE a7 iF f sNOtri'�9ECOME� MSPECTION FEE = SU&IECTTOTHEWORKERS'CAMPENSATIONPROV SQF CTION3�oo FTHEUBOR / �..P- cao ISHALL HWI7HCOMPLYWiTH omsio ISSUAN� � �`T p ^--_.m:,,....-_.� p �ATE:,���APPLICANT: SMIP __ J WARNINGFAILURETOSEWREWORKENS'COMPENSATION ERAGE�SUNUlW0.1L,ANDSNALLBE ENERGYPlC � SU&lEC7AN EMPLOYER TO CRIMINILL PENALTIES AND CIVII FINES UP 700NE HUNDREO THWSAND ENERGY PERMIT DOLLAflS(S7oo,o00).IN/��ITION TO iHE COSTOF COMPENSATION.DAMADES AS PROVIDED FOR IN � SECTIDN37oeOFTHE�ABORWDE,IN7ERE5T,AN0ATTORNEY'SFEES. � � RETENTIONFEE; O � CON5TRUCTION LENDING AGENCY pRE-n�T FEE: � 1 HEPEBY AFFIRM UNDEq PENAITY OF PERJURV THAT THERE IS A CONSTRUCT�ON LENDINa A(iENCY FORTHE PERFOfiMANCE OFTFIE WORK FOR WHICH TNIS PERMIT IS ISSUEO(SEC.3oW,C�V.C.}, � W � LENDER'S NAME � � � � � � � - � !— LENDER'SADDRESS � TOTAL FEES . �� ��__ ... � 1 CERTIfY THAT I HAVE READTMISAPPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. ' W �AOREE TO COMOLV WITH ALL CITY,WD COUNTV ORDINANCESAND STATE UWS RELATING TO BUIIDING "' � CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTqTIVESOFTHISCOUN7VTOENTERUPONTHE - � � � � ABOVEMENTpNED PROPERTY FOR INSPEGTION PUHPOSES. � - � - . COMMENTS � : . ....... . . ...._.. ,, ,... .. � y � m d PERMITTE E(PRINT) s � P � (n SIONATUNE F PERMI D E ���'�y�+C.' PAIO BY .--�'�'^'^"�� 6 ��VALIDATION .� . � RECPT.NO. �-�".^' � WHITE—Department Copy,YELLOW—F(nence Copy,PINK—Assaesor Copy.GOlOENHOn—Fle Copy,OFiEEN—Appilcant's Copy �. .. . ,.... ,.... _ . , , . .., .. _ Gil'Y O�.[39A�NiC�I�C1 13�4�i � � � ..� ` ,�� ,; , , .. 4:,.� �9,m . ,. E��' . � �6'������v1 ��G��1'�� , !i c, {;.;i•t �-.' �u�4�.L'.�,,. :� � , �.C: ;� �. iY�:r � S S a � .� �.. . _...,� ., � ..:.,:> ., >.. , ` ■ � s ._... ,. . �...,. , �:; -== �_::<. �...:,:�.::� , , ___. ._.. SET�ACK' , . _ i FLOQf?Jt"3lS�" �. . _.. 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