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HomeMy WebLinkAbout10457 (5) �: , . , _... ._.�,,.,� ,—_.. _ _ ,_ y _ .__ _ .., .,_,_ ,._, _ _...,�� -, -- -- �- i �� XPI�ED CITY OF DIAMOND BAR � COMMUNITY DEV�LOPMENT DEPARTMENT T /� .;,,� 21660 E.Copley Drive Suite 190 0�� `� � LO�O pRESS (909)860-3195 Fax(909)8b1-3117 ��'�" BUILDING PERMIT APPLICATION FIRMLY c,i 22809 HTLTON, HEAD #550 ,.A- ,ai.. JOBSITE , . ,.,,w.� ...., APPUGATION PERMI�' � ' ^"''�P/C o ADDRESSD1ctIttOild B1Y Tef'iP1iS G`�1Ub�X�.c DATE NU�M�ER�"'��`� `� # c� ISSUE �f" o�,�,, ,� TYPE OCC APN LOT TRACT DATE --�'�,���� CONST. G R O U P °C OWNERI�iarrnnd �' Tentlis QUb H.O.A. 0 ADDRESS C o r'EY1217S1V2 PY' NI�. ZONING SETBACKS g cirr P•a• z�P 90241 TE�909 598-31$0 FRONt' Rw ❑ APPL�CANT 7E�.909 597—?�4 REAR ❑ ;.. SIDElSIDE STREET RW ❑ � CONTRACTOR �am �iahtit�Znc. SIDE ❑ � ADDRESS 151R9 Siarra Bonsta Lane � CIN Chino ZIP 91710 re�909 597-7734 PROPOSEDUSE oARCWENG/ � DESIGNER�fa Nf�.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS = CITY ZIP TEL. � DESCRIPTION SQ.FT: FACTOR PSF ADJ.AREANALUATION � OWNER-BCILDER DECLARATION SFR/ADDlREM O p 1 HEREBY AFFIR4A UNDER PENAITV OF PERJURY THAT I AM EXEMPT FROM THE QONTHACTORS LI� Gerege/CefpOrt W CENSELAWFOqTHEFOLLOWINGREASON(SEQ7091.SBUSINESSANOPROFESSIONSCdDE:ANVCITYOR (n U COUNTVWHICHREONRESAPEpMRTOCONSTFlUCT,ALTER,IIAPROVE,OEGOLISH,ORRED4�RANYStqUC. W patiolDeck Z TURE,PRIOR TO ITS ISSUANCE,AlSO q[-QUIRES THE APPLICANT FOR SUCH PERMIT?O kILE A SIGNEO STATEMENT THAT HE OR SHE IS UCENSEO PUR6UANT TO THE PROVI&IONS OF TH�CONiHACTORS CI� � CENSEUW(cHAPTER4(COMMENCIN�-WITHSECTION1DOo)OFpIV�SION30FTHEBU51NES5AT![l'PFi[.1� � POOI/Sp8 � FESSIONS cADE)OR THA7 HE OR SHE IS EXEMPTT}1EREFROM AND TME BASIS FOR THEALLEGED EXEMP• � TION.ANYVIOLATIONOFSECTION7031.SBYANVAPPLICPNTFORAPEPMITSU&IECI'STHEApPLICMITTO Z Re-Hoof � AqVILVENALNOFNDTMORETHANFIVEHUNDREDDOLtARS(3500).); � ❑I,ASOWNEROFTHEPROPER7V.ORMYEMPLOVEESWITHWAGESASTHEIRSOI,ECAMPENSATION, �O Commercial Z WILI DO THE WORK,AND THE STRUCTURE IS NOT MTENbE�OR OFFERED FOR SALE(SEC 1o44,'Bl1Sl- J NESS AN�PROGESSIONS CDDE:7HE CANTR4CTOR5 LICENSE LAW DOES NOT APPLV TO AN OWNER OF N PROPERTYWHOBUII�SORIMPROVES7HEREON,ANDWH600ES5UCHWORKHIMSELFONHERS�LFOR � pC THROUGHHISOAHEROWNbAPLOVEE3,PROYIDE�THATSUCHIMPROVEMENTSARENOTINTENDE00R m QOFFEREOFORSALE.IF,HOWEVERTREBUILDINGORIMPROVEMENTISSOLOWITHINONEYEAROFCbMPIE- 2 TION,THE OWNEH-BUILDER WILL MAVE THE 9UROEN OF PROVINd THAT HE OR SHE tlID NOT BUIID OR � IMPROVE FOR THE PURPOSE OF SAI.E). � ❑I,AS OWNER OF THE PROPEFTY.AM EXCLUSIVELV CONTRACTING WITH LICENSED CONTRAC,70RS -� To CANSTRUCT THE PROJECT(SEG To4A,BUSINE55 AND PROFESSIONS CA�E:THE CONTRACTORS LI� V81�8Si0f1 ADJ.AREA � W CENSE LAW DOES NOTAPP�V TO AN OWNEFl OFA PROPERTV WFIO BUILOS OR IMPROVES THEREON,ANO � WIiOCONTMCTSFORSUCHPqQ1ECTSWI7HACONTRACTOR(S)LICENSEDPURSUANTTOTHE;CONT'RAC QUANTITY DESCiiIPTION - FEE � oTORS LICEMSE LAWJ. /-���� O I AM EXEMPT UNDER SEC. B.8 P.G FORTMIS REASON Q �+u++y`- E�-2�r1C PE!CleStcZ � U � � DATE OWNER � Z W �c[ LICENSED CONTRACTORS DECLARATION W 2 I HEREBV AFFIRM UNDEFi PENALTY OF PERJURV THAT I AM LICENSE�UNOER PROVISiONS OF CHAP7ER � � � 9(COMMENCING WITH SECTION 7�00)OF DNISION 3 OF THE OUSINESSAND PROFESSIONS CODE,AND Z ��� MV LICENSE�S IN FULL FORCE AND EFFECL m 0 LICENSEGLASS c10 uc.r,o. 729594 = VDATE 6/19/97 CONTRACTOR � -� � a - W . ., ,,:._....,..,- � WORKERS'COMPENSRTION DECLARATION � Q � U � I HEREBY AFFIRM UNDER PENALTV OF PERJURY ONEOF THE FOLLOWING DECIARATIONS: z Q � IHAVEANDWILLMAINTAINACERTIFICATEOfCONSENTTOSELF-INSUREFORWOHKERS' _ COMPENSATION,ASPROVI�EDBYSECTION37ooOFTHELABORCO�E,FORTHEPEFlFORMANCE CJ 4 OF THE WORK FOR WHICH TNIS PERMIT IS ISSUED. � � w _I HAVE AND WIIL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION Q 370o OFTHE LA80R CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMITiS ISSUED.MV WORKERS'COMPENSA7ION INSURANCE CARRIER AND POIICV NUMBEH ARE: CONSTFUCTION J . . ..� CAPHIER �E�C�DCl� C.�T�S�.S�.'�,;.-tC�IS �,,.. P�,AN REN�EVJ s ZPOUCY NUMBER �966279����2 '`4.;�1 F(`��C ' � � ' � „�r ^' � a_ Q 0 (1HISSECIK.MINE�NOTBECOAAPLETEDOFTHEPERMffISFORONEHNJDREDDOU?AS(5100)ORLESu} PLUMBING _ Z I CEFTIFY THAT IN THE PERFORMANCE OF THE WDRK FOR WHICH THIS PERMIT IS iSSUED.I MECHANICAI �j' SHALLNO7EMPLOYANYPEPSONINANYMANNERSOAS708ECOMESU6JECTTOTHE � WORKERS'COMPENSATIONLAWSOFCALIFORNI0.ANDAGREETNATIFISHOUIDBECOME �NSPECTIONFEE � SUBJECT T07HE WORKERS'COMPENSATION PRO ISIONS DF SECTIO 3700 0F THE LA80fl !.-��� � .�.w• � CODE.I SHALL FORTHWITH COMPLY WITH THOS ROVISIONS. ISSUAAC�- O �.�._ G�'J _.5�,,.._,_._„s,. � p DATE: ,APPUCANT: t' . " "L .~ J WAFNINO:FAILURE TO SECURE WORKERS'COMPENSATION ERAGE IS UNLAWFUL,AN�SHALLBE ENERGY P/C �S,d��B �3� �—y SUBIEC7AN EMPLOYERTOCFIMINAL PENALTIESAND CIVJ �INES UP TOONE HUNDREO iHOUSAN� ENERCiY PERMIT DOLLAR9(5100.000).IN ADDITION TO THE COSTOF CAMPENSATION.DAMA6E5 AS PRDVIDED FOR�N _ � SECTION 3�OB Of THE LABOR COOE,�NTEAEST,ANO ATTORNEV'S FEES. . RETENTION FEE: a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS ACONSTRUCTION IEN�IN6 AGENCY FOR THE PERFORMANCE OF THE WORK FOR WNICH THIS PERIAIT IS ISSUED(SEC.30D7,C�V,C.). Z W � LENDER'S NAME - � F- LENDER'SAD�RESS . � TOTAL FEES ��r �� � 1 CERTIFV TNAT i HAVE REAO TNIS MPUCATION AN�STATETHAT THEABOVE INFOPMATION IS COpRECT. � 1 AGREETO COMPLV WITH ALL qTV AND COUNNORDINANCE3AFID STATE lAN'S RELATINQ TO BUIlDIN6 � . � � CpNSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE � � A60VEMENTIONEO PROPERTV FOR INSPECT�ON PURPOSES. COMMENTS - ' � � L>42/�-�j�" �cr�C Er��'►'�'� �, ,E � m PERMITT AME(VRIN � �r��~ � y 510 TU E OF p MIiTEE OATE ' �7� � � � n,, '� � ,;" RECPT.NO. ����"�d/=� PAID BY �...-�=-''��� ,�'1��1LIbA710N WHITE—Department Copy,YELLOW—Financa Copy,PINK—Assessor Copy.QOLDENROD—File Copy,QREEN—ApplicanCs Copy �i ., . ,. , ,, ,,. ,f,. •b: ,, ���� � ,„ ., , , ,,, � , , ,. ,: . ::•. . , .., .. ;�, , .. . , : , , r , . . , ,. .: ,:.... . .,. .. . . . . .. , .. , , . ����1` �''���'�� . .� . .. . , 3�P'. � Y ��', �u ��°.. v�R� � _�,'f f��,' �v �',�9{a' !�� ,"3�.Y'yp � . i ..S ' � ..:vb@"` ��� � ��"�,, .�F �Il�l�9C�NC� �/�F� � . ;,� , , . , . � ,,.� . � t. - � �����'i�� �����: .' � ���, A�a�A�,.r� ;.t i . '�;r�~` ■ • � � r � • o � ' � m ■ s �r :. .. .: . ._. ...._... .... _ . __. . _....._ ..._... . __ . :.� aET BAE:f€ .,. .,,, .. __ FLOOR J06ST :_ ,..:._. .. __ F1'G5/FOFtM5JS7EEl. , ' _ i FHA REQMTS _ ,,:,,,. _.... ;.. 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