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HomeMy WebLinkAbout10453 (5) — -- ._ _,...__._.�,,-a..._, .__�___�__...�;w..,._...�,,___. � � ���—�-._�.�_�..__.._._,,.,.�....���_� _..__��.;�_,r,.�._._._,,�.:�, " CITY OF DIAMOND BAR ., , COMMUNTfY 1>EV�I.O�Iyt81VT 1?EPAR't'ME1V"f" : 21660 E.Copley Drive Suite 190 , (909)860-3195 Fax(969)861-3117 PREsc '""'� BUII.DING PERMITAPPLICATION FIRML� ,,, � �.�� < DD E§S 22828 H2LTdN �'� �ry ' '� ' � APPLICATION PERMIT ���+'�u,�''� P/C p DA7E_ _„_ NUMBER '�� .� # °a APN LOT TRACT pAT� � �.L�°�C�'� riPE OCC o pyyNEq C70 Di�anond Bar T�nnis C1Ub H2O.A. CONST. GROUP " ADDRESS C O ensi�e Property Mgt. PO Bp�� 40 ZONING SETBACKS gCITY ��y ZIP �� TEL. — 8 FRONT RW ❑ APPLICANT TEL.����3 REAR ❑ � SIDFISIDE STREET RW ❑ � CONTRACTOR �n �- � 4 �. SIDE ❑ � ADDRESS 75'f$�Sierra Bon�.ta Tanr� � cirr a"�o ziP 91710 re�. (909) 597-77 4 PROPOSED USE w ARCFUENG/ z DESIGNER T1Ia w NO.DWEL. NO. NO. c� ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.F1' FqCTOR PSF ADJ.AREANALUATION � OWNER-BI;ILDER DECLARATION SFRIADD/REM O I HEREBV AFFIRM UNDER PENALN OF PERJURY THAT I AM E%EMPT FROM THE CbNTRAC70Rk LI- G,af89B/Gefp01Y nW CENSEUWFbRTHEFOLLOWWGREASON(SECJo31.58USINESSANDPROFES510NSCp0E:ANYCITVOR (f) U CIXINTYWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER.IIAPROVE,DEMOUSH,ORREPA(RANYSTRUG W Patio/peck Z NRE,VRIOq 70 ITS ISSUANCE,ALSO RE4UIRES THE APPLICqNT FOR SUCH PERMIT TO G7LE A SIGNED �� SiA7EMENT THAY HE OR SHE IS UCEN$E�PURSUAN7 TO THE PflOVISIONS OF 7HE pONTPoACTORS Lb W CENSE LAW(CHAPTER 9(CbMMENCMO'WITH SEC'fION 7000j OF DINSION s OF hIE'BUSINESS AryD'PCiO� �'`' PooVSpa FESSK)NSCODEIORTHATAEORSHE��SEKEMPTTHEREFFOMANOTHEBAS�SFOHTNEALLEQED�EXEMP• (� � TiON.ANYVIOI.ATIONOFSEC710N7o37.SBVANVAPPLICANiKORAPERMI7SU&IECTSTHEAPPUCAMYTp � R8•ROOf ACIYIL PENALTYOF NOT MORE THAN FIVE HUNOFED�OLIARS�5500}.j:� ' ' ' -' ��'� '' Q OI,ASOWNEROFTH�PROPfiRTY,OqMYEMPIOYEESWITNWAOESASTHEIRSOLECOMPENSATIpN, Q COry1I110lCi81 � WILL DO THE WOqK,AND THE STPUCTURE IS NOi IN7ENDED OR OFFERE�FOR SALE(SBC 706d,BUSI- �,J � NESS AND PROFESSIONS CODE:THE CONTRACTOHS LICENSE lAW�OES NOT APVLY TO AN OWNER OF PROPERTYWNOBUILDSORIMPROVESTHEREON,ANOWHO'OOESSUCHWORKHIAISELFORHERSELFOR � � TMROUGH H�S Oq HER OWN EMPLOVEES,PROVIDEO 7HATSUCH IIIIPROVEM�NTS AAE N071NTENpED tlR m pOFFEREDFORSALE.IF,FbWEVER'MEBUILDINGORIMPROVEMBJTISSOIDVlITHINONEYEAROFCQMPLE- Z TION,iHE OWNEF•9UILDEP WILL HAVE THE BURDEN�OF PROVINC 7HAT HE OR SHE DID NOT 9UIL0 OR _, IMVROVEFORTHEVURPOSEOFSALE). "" .w ❑I.AS OWNER OFTHE PROPERiY.AM E1(CLUSIVELYCONTRACTING WITH I.ICF,NSED CONTflACTORS (� TO CANSTRUCT THE PROJEC7(SEC.�044,9USINE56 ANp PROFESSIONS CA�E:TNE CONTRAC70RS ll- VBWatian _. ADJ.AREA W CENSELAWOOESNOTAPPLYTDANOWNEf10FAPROPER?V'WHO6UILOSORIMPFhOVESTHEHEON.AN� � WHOCqN7RACTSFORSUCHPR0.IECTSWITHACONTRACTOq(S�LICENSEDPURSUANTTOTHECANTflAC- �" roasucer+seuw.>. , , , QUANTITY � DESCRIPTION FEE Y � o ❑I AM E7CEMP7 UNDER SEC. B.&P.C.FOR THIS REASON � � � � LL DATE ONMEF U 2 W � LICENSED CONTRACTORS DECUIRATION W � IHEREBYAFFIRMUN�ERPENALTYOFPERJUHYTHATIAMLICENSEOUNDEPPROVISIONSOFCHAp7ER � . . _ � 9(COMMENCINGWITHSECTION7000)OFDIVISION30FTHEBUSINESSANDPROF�SSIONSCODE,AND Z. � ' �X� MY LICENSE�S IN FULL FORCE rWD EFFEC7, m lL) O UCENSE CLASSC1 O uc.No. 729594 = U DATE CONTRACTOR � � OJ. W � WORKERS'COMPENSAT70N DECLARATION� �� � � -��� ¢ � IHEREBYAFFlRMUNDERPENALTYOFPERJVflYONEOFTHEWLLOWWGDECLARATIONS: Z z ,IHAVEANDWILI.MAINTAINACERTIFtCATEOFCONSENTiO&ELF-INBUREFOPN/OqKERS' ' _ ¢ COMPENSATION,AS PROVIDE�BY SECiION 370o Of THE LABOR COpE,FOR THE PERFORMANCE �U Q OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED. � � W ,_I HAVE AND NALL MAINTAIN WORNERS'COMGENSATION INSURANCE,AS REQUIRED BY SECTION � 3�o0OF TME LABOR COpE,F'OR THE PERFORMANCE OP 7HE WORN fOR WHICH THIS FERMITIS ISSUED.MY WO EfiS'COMPENS 170N INSURANCE CARRIEA AND POLICY NUMBERARE: CONSTRUCTION ¢ �'`rsmnt �anper�satipn y CAFRIER PLAN REVIEW Z POLICYNUMBER WN96627901-f12 � ,"'�E��qi--�+ �,,,' _� Q �.,��s,�, � (IHLSSEC�N]NNE�N0T9ECUMft.EfE00FTl$PERM7ISFORONEHINDfi�OCUARS($7�OtiLESS} PIUMBING W Z I CERTIFY THAT IN THE PERFORMANCE OFTHE WORK FOR WFIICH THIS PERMIT IS ISSUEO,I MECHANICAL (.'3 SHAILNOTEMPIOYANY7Efl50NINANVMANNER50ASTOBECOMESUBJECTTOTHE � WOFKERS'COMGENSATIONLAWSOFDALIFOPNI -' �AGREETHATIF�SHOULD�BECOME - INSPECTIONFEE SUBJECTTOTHEWORKEflS'COMPENSATIONP ISION50 SECTION370 OFTHELA90R _r.w � DE, SHAU.F TH COMPLY WITH E PROVISI ISSU�NCE+^', ��° 0 � �] p �ATE: � 4^� APPLICANT. ��...� SH11P J WARNINO:FAILUAE?O SECURE WORKERS'COMPENSATION VERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C - � SUBJECTANFMROYERTOGRIMINALPENAITIESAN�CIVII.FINESUP700NEMUNDRE�THWSAHD ENERGYPERMIT DOILARS(St00,000),IN AODITION 70 THE COSTOFCOMPENSATWN,OAMAGES AS PROVIDED fOR IN � SECTION37080FTHELA80RCODE,IN7EREST,ANOATTORNEV'SFEES. RETENTIONFEE: i QCONSTRUC710N LENDING AGENCY PRE•ALT FEE y- - � s � IHEREBYAFfIRMUNDEFlPENALTYOfPEfiJURViHATTHEREiSACONSTRUC710NLENDINGAGENCY 4N � $w �� ...�a�r FOR THE PERiORMNJCE OF THE WORK WR WHICHTNIS PERAIIT IS ISSUEO(SEC.3oo7,CiV.C.). W � LENDEF'S NAME 1"– IENDER'SAODRE55 . ... , .�._� . — �+ . . ... . .. . . W ICEHTIFYTHA7IHAVEREAOTHISAPPLICATIONANDSTATETHM1TTHEABOVEINFORMATIONISCORPECT. TOTAL F�EJ � � � .: �� � � 1 AGREETO CONPLV WITH ALL CITY AND COUNTYOROINANCESAND STATE UWS RELATING TO BUILOING , � CONSTRUC710N,ANOHEHEBYAUTHOHIZEREPRESENTATIVE50FTHISCOUN7YTOEMERUPONTHE �-� � �� -� - � ... A90VE�MENTIONED PROPERTY FOR MSPECTION PURPOSES. COMMENTS a IARI2i' �' '�II�T m ' ¢ PEPMI E(PRI , . O) I!� 66 a�:�l _ / i � SI�NA REOFPER i E � E RECPT.NO.�� �>-:"'�� x � PAID BY��a'__�T� VALIDA7YON' WHITE—Department Copy,YELLOW—Finance Copy,PINK—Asseasor Copy,GOLDENROD—File Copy,GREEN—Applicant s Cbpy" . 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