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HomeMy WebLinkAbout10448 �� ��[� EXPlRE[3 CITY OF DIAMQND,BAR � COMMUNITY DEVELOPM�NT DEPARTM � q hiT .,,,.,W 21660 E.Copley Drive Suite 190 ��+� O � L�OO (909)860-3195 Fax(904)861-3117 PRESS """'� BUILDING PERMIT APPLICATION FIRMLY . . .... � JOBSITE "` °" � ' �. ' APPLICATION PE�IMiT ,� P/C -� ADDRESS 22886 HIL�N T3EAD #1153 � �� # o DATE r- NUMBER �� � APN LOT TRACT �SSUE - IYPE OCC p OWNER Diamond Bar TenxLis Club H.p.A. DATE CONST. GROIDP p ADDRESS C O C�Y ive Property Mgt. PO Box 00 ZONING SETBACKS gCITY ey ZIP TEL. - 8 FRONT RW O APPLICANT � TEL.�����3 REAR ❑ SIDEISIDE STREET RW ❑ � CONTRACTOR � �-9�1t].ricT� �t1C. SIDE ❑ ADDRESS 15'I�$� Sierra Bonita Lan� � CITY GY171'1� Z�p 91710 TEL. �9O9) 597-7734 PROPOSED USE w ARCH/ENG/ z DESIGNER Tl/C � ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS cn cn DESCRIPTION SQ.FI'. FACTOR PSF ADJ.AREANALUATION p� OWNER-BCILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIq1A UNDER PENALTV OF PERJURY THAT I AA1 EXEMPT FROM TffE CONTRACTORS LI� G8l8(J6/C8�(30h W CENSELAWFORTHEFOLLOWINGREASON(SEC.1031.58U51NESSANOPROFESSIONSCODE:ANVCITVOR (n U COUNTYWHICHREQUIRESAPERMITTOCONS7RUCT,AL7EF.IMPROVE,DEMOLISH,ORREPNRANYSTqUG W TURE,PRIOR 7D ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED W PatioJDeck .� STATEMENT TFIAT HE OR SHE IS LICENSED PUqSUANT 70 7HE PROVISIONS OF THE CONTRACTORS-U� � � CENSE LAW(CNAPTER 9 iCDMMENCING WiTH SECTION 7a00)OF pIVISION 3 OF THE BUSINESS AND PtiO• POOUSpB � FESSIONSCODEIORTHATHEORSHEfSEXEMPTTHEfiEFROMANDTHEBA5ISFORTNEALLEGEDO(EMP• (� TION.NNVVIOLATIONOFSECTiON7o3t.5BYANYAPPUCANTFORAPEAMITSU&IECTSTHEAPPLICANTTO z Re-Roof A CIVIL PENALTY OF NOT MORE TNAN FIVE HUN�RE�DOLIApS(45U0�.):�'-' � OI,ASOWNEROFTHEPROPEqTI,ORMVEMPLOYEESWITHWAGESA3THEIRSOLECqMGENSATION, � COtI1RIBfCIHi ' ' Z WILI DO THE WORN,AND THE STRUCTURE IS NOT INTENOEO OR OFFERED FOR SALE(SEC.7044,BUSI- J � NE55 AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW�pES NOT APPLY TO AN OWNER OF = PROPER7Y WHO BUIIDS Oq IMPROVES THEREON,AND WHO DOES SUCH WORN HIMSELF,OR�HER$ELP OR � iHfiOUGHHISOHHEROWN�EMPLOYEES.PROVIDED7HATSUCHTMPROVEMENTSARENOTWTENDEDOR C� OOFFEREDF4fi5ALE.IF,HOWEVER,hIEBl11LDMaORIA1PROVEMEN7'ISSOIDWRHINONEVEAAOFL�CIAPLE� Z TION,THE OWNER•BU�LDER WILL HAVE THE BURDEN oF PqOVING THAT HE OR SHE DID NOT BVILD Oti = IAAPROVE FOR THE PURPOSE OF SALE�. ' : W ❑I,AS OWNER OF THE PROPEATV,AM EXCLUSNEI.V CONTRACTINQ WITH LICEN3E0 CONTRACTORS � TO CONSTRUCT h1E PROJECT(8EC.7044,BUSINESS AND PROFE$SIONS COOE:hiE CANTflACTORS LI� V0IU8I1011 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEflOFAPftOPERTYWHpBUIl�50RIMPflOVESTHEREbN,ANO -- � NMOCONTqACTSFORSUCHPROJECTSWITHACONIAACTOR(S)LICENSE�PURSUANTTOTHECONTflAG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). OO I AM E%EMPT UNDER SEC. B.E P.C.FORTHIS REASON Q � Electrical Pedest�7. � V LL' DA7E OWNER F- O W ��[ UCENSED CONTRACTORS DECLARATION w CL !HEREBY AFFIRM UNOER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAGTER � d 9(COMMENCINGWITHSECTION700��OFDIVISION30FTHEBUSINESSMI�PROFESSIONSCODE,AND Z 'X MV UCENSE IS IN FULI FORCE AND EFFECT, m � LICENSE CLASS+�� LIC.NO. 72JFi"� � V UATE CONTRACTOR � � - � � d W a=�' WORKERS'COMPENSATION OECLARATION a � 1 HEREBYAFFlRM UNOER FENALTY OF PERJURY ONE DF THE FOLLOWING�ECLARATIONS: Z Z _IHAVEANDWILIMAINTAINACERTIFICATEOFCONSENTTOSELFJNSUREFORWO{U(ERS' _ ¢ COMPENSATION,AS PROVIDED BY SECTION 37ao Of THE IABOR CODE,FOR THE PERFOqMANCE U Q OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED. � F _i HAVE AND WILL MNNTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BY SECTION Q 37000F THE LABOR CODE,FOFTHE PEFiFORMMICE OF THE WORK FOFl WHICH THI6 PERMITIS ISSUED.MY WORKERS'COMGENSATION IN3URANCE CARRIER AND POIJCV NUMBER AFiE: CONSTRUCTION J } CARqIER ��1T�iqPPLVC�TTCx,i PLAN REVIEW POLICYNUMBER WN96Fi279[11-(1� � -^�' z '`e��ecr�a��~�, '�-�,' � (I}iISSECTqNNE�NOTBE00MPLEfE00FTfPEWMISFORONENUNDiiEDDOLLf�AS(t700JORL�6G P�U TMBIV��� Z �CEflTIFY THAT IN THE PEflFORMANCE OF THE WDR1(FOR WHICH THIS PERMIT IS ISSUE�,I MEGHANICAL �-`"'� L;} SHALLNOT EMPLOYANY PERSON IN 0.NY MANNER SOAS 70 BECAME SUBJECT TO TNE � WORKENS'COMPENSATION�AWS OF CALIFORNIA,A AGREE T T�F I SHOULD BECOME INSPECTION FEE � SUBJECTTOTHE FKERS'COMPENSATIONPRO ONSOFS TION3700 THELABOR �-'��� /^' „�.- OCAOE,I ALLF WITHCOMPLYWITHT{�pD ROVISION ISSU.�ANC�i �.? �' p DATE: � /APPLICANT: ' .�-"""�' �SMIP W J WARNING�FAILLIRE TO SECURE WORKERS'COAAPENSATION ERAGE IS UNLAWFUL,AND SHAL�BE ENERGY P/C � SU&IECT AN EAAPLOVERTO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE F0.INORED THOUSAND ENERGY PERMIT DOLLARS(S1o0,oDa).IN ADORION TO THE COST OF COAIPENSATION.DAMAOES AS PROVIDEO FOR IN � SEGTION 3�ae OF THE LABOH COOE,INTEREST,AND ATT4RNEY'S FEES. � o� RETENTION FEE: OCONSTFUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIPMUN�ERPENALNOFPER/URYTHATTHEREISACONSTflUCT10NLENDINGAGENCY "�� FOR THE PERWRMANCE OFTHE WOPK FOR WHICHTHIS PERMIT I51$SUEO(SEC.3087,CIV.CJ. Z W � LENDER'S NAME � � F- LENDER'SAODRE55_ � ��-��� ...�.... . . , , �� W ICERTIFYTHATIHAVEREADTHISAPPIICATIONANDSTATETMAT7HEA60VEMFORMATIONISCORRECi TOTALFEES �� ' ��� d 1 AGFiEE TO COMPLY WI7H ALL CITY AND CAUNTV ORDINANCES ANO STATE IAWS PELATING TO BUILDING � . .. � CONS7qUCTION,AND HEREBYAUTHORIZE REPRESENTATNES OF THIS COUN'rV TO ENTER UPON THE � � �� ��� � AeOVEMENTIONED PFOPERTY FOR INSPECTION PURPOSES. COMMENTS � � O J i � �'�'�' ��� ¢ PERMI EE E IP � I. ;I � � I � SIONA7 RE OF P EE DA +� ��-�. �.�� F RECPT.NO. �-���.°��� pAl�BV�� � 7 �,VALIDATION WHI7E—Department Copy,YELLOW—Finance Copy,P�NK—Assessor Copy,GOLDENROD—File Copy,GREEN—AppllcanPs Copy I ... .::. �. .�... Y ,�.-.��. -.. � . . . . .. - . -. . '.:�; ' '* „', . „ � ., „ .. . , . .� . . . ,. .. „p �.�� ... „ ':� . ,�f' �.rF ..', ..a:� .� � r . '.. ...... R r. . . . .,. . . .... , .. . _w � �¢''� � k: + , V,rd'6 7 �:`4IN ��0YY1 �� �A�1 .rid��' §,�1 P ! .� � � y . ..�r�np� p�.r�y� q�g� .. . 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FtC?EJC��i EtE�TRIC ___... ; . : � ROt1G'�GRADING , _ 4�OUGFi PLUiUIHING ___ , . FINiSH GRAD{NG ; , :, ` ._� :.�..-J-.. F� . . .._ : . .. .... —" ' .._. _,�.._ s�sc���vE�,Tu��-�s� _ . _ , . �oo��[�ECTR.rc ,. -- -- ---- — ------ �xa� ��r�isic�a�� _ __. ;_ �c�c�t F�Nc�r�G; � ...; -----_ _. ����z en�s�+�a�ic�n�- � ; �oc�L�in��,t� __ ._ _ �.: � __._ � �E�L68�G 1!�lSULATI�N � —`� C3FF 8i7�iMPS: . , C3FtYWd�,LLNAIl..i�1C � --_ DEDBCA'f€�3�IS _. � SEYI�ER _ . � . , .. ____ . __ _ FI�dAL ENG. — -- _ , ----.. S�PTIC�'ANK ';; -::-_...�_ . _- . �..'' ` LANDSCAPEIPRRIC�: , _ , � SEEP P1T1L.L. __ . ,�.;. , - _._'_ .` '' ON Sl�E I�APS. ---- , _,_ _ - -- -- C-;AS AIR�EST i �iNA�.ZdiViNG __ ;.;. ,, ---- — -� F�I�AL�Ot�ST. _ _.. _ _. _ I Fl�tE QEF'T.FINAL . _ `, �lNAL HEATIFJG _ _._._.._ ._ _.__. _ �.HEALTH DEPT. FINAL. Fit�iAL ELEC�fttC _ __.___ __. __ J.��; DIEU. FEES PAlD , . . :-; ,.. --- ---- •. 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