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HomeMy WebLinkAbout10447 (5) ��� ,1 �pr � C1TY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT � .� : e 21660 E,Copley Drive Suite 190 ,. PRESS � (909)860-3195 Fax(909)861-3117 �" ��'""' BUILDINGPERMITAPPLICATION FIRMLY � � JOBSITE APPLICATION / PERMIT ��e P/C F o ADDRESS ?2775 TAUFrn7AV nRTvr? DATE �✓'���'`� NUMBER �� �# $ ISSUE�� -'—TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER Diamand Ear Termis ClUb H.O.Z1. ! ADDRESS C O CCT�jJYChGriSlV2 PY'c�KY'ty Mqt. PO BOX 400 ZONING SETBACKS p SCITY � ZIP��� TEL. 5 -��8 FRONT RW LJ — � APPLICANT � TEL.��3 FiEAR ❑ � SIDEISIDE STREET RW � oCONTRACTOR Z� �-ahting, INC. SIDE ❑ ADDRESS 15189 Siexra Bonita Lane PROPOSED USE � o ciTr C�ino ziP 91710 TE�. (909) 597-773 ; w ARCH/ENG/ P z DESIGNER_17f8 NO.DWEL. NO. NO. � a ADDRESS � � CITY ZIP TEL. UNITS STORIES BEDROOMS r � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ti Q OWNER-BI:ILDER DECLARATION SFRIADD/REM O I HEREBY AFFIRM UNDER PENALTV OF PERJURY THA71 AM E%E41D7 FRON 7HE CANTfUCTOqS IJ- G8l89B/CdfPOA W CENSELAWFORTHEFOILOWIN6REASON(SEC.7037.5BUSINESSANDPROFESSIONSCODE:ANYCIiVOR (n � U COUMYNhI1CHRE�UIqESAPERMITTOCONSTRUCT,AI.TER,MPqOYE,�EMOLISH,OflHEVA1pPNV5iHUC• W patio/Deck ` W TURE,PRIOF TO ITS ISSUANCE,AL50 REWIRES THE APPLICANT FOP SUCH PERAlITTO FILE A SIGNED [� � SiATEMEfiT THAT HE OR SHE IS UCENSED PURSUANT TO THE PFiOVISIONS OF THE CONTHACTOHS ll- f? � CENSELAW(CFUP7EN81�MENCINIiWITMSECTION70oo)OFDIVISION3DP7HEBUSINESSANDPHO- LL POOVSpfl FESSIONS CODE)OH 7HAT HE OR SHE IS ENEMP7THEREFROM IW�TFIE BASIS FOR h1E ALLEGEO EXEMP• i � TION.ANVVIOUTIONOFSECTION7071.SBYANVIIPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Flaof S; A CIVIL PENAL7Y OF NOT MORE THNi FIVE HUNDREO OOLLARS(5500).): �� ZOI,ASOWNEROFTHEPqOGERTY,ORMVEAIPLOVEESWIhIWAGESASTHEIR50LECOMPENSATiON. O COrtImBfCi31 � WILL DO 7NE WORK,AND THE 57(iUCiURE IS NOT IN7ENDED OR OFFEREO FOR SALE(SEC,7a4,BU51- J I': NE55 M!0 PROFESSIONS CO�E:THE CONTRRCTORS LICENSE LAW DOES NOT pPPLV TO AN OWNEROF � PROPEFl7vWHOBl11LD50RiMDROVES7HEREON,ANOWHODOESSUCHWORNHIMSELFORHERSELFOR = '� � TNROUGHH160HHEROYMEMPLOYEES,PROVIDEOTNATSUCHIAIPROVEMENTSARENOTIN7ENDEDDR m �' QOFFEREDFORSRLE.IF,MOWEYERn1E8UR.DINGORIMPROVEMENTI330LDN77HINONEYEAROFCOMPLE• '� � 710N,iHE OWNEN�BUILOER WILL HAVE THE BURDEN OF PROVING 7HAT HE OR 9HE�i�NOT 6UILD OR t. � IMPROVE FORTHE PURPOSEOf SALE). � U I,AS OWNER OF TME PROVERTY,AM EIfCU131VELV CON7flAC71Nd N7TH LICENSED CONTRACTORS � TO CON5TRUCT 7HE PH0.IECT(SEC.70�0,BUSINE55 AND PROFESSIONS CODE:TME CONTRACTONS LI• V31u8fiOf1 ADJ.AREA_ y� W CENSELAWDOE3NOTAPPLYTOANOWNEROFAPROPERTYWHOBUILOSORIMPROVESTHEREON,AND p � YlT1000MRACTSFORSUCHPROJECTSWITHACANIMCTOR(S)IICENSE�PURSUANTTOTHECONTMC- (aUANTITY DESCRIPTION FEE �� � TORS LICENSE UWJ. X � O I AM EXEMPT UNDER SEC._ 8.S P.C.FOH THIS REASON U � e Electrica.l Panel �� LL � DATE OWNER V Z W � LICENSED CANTRACTORS DECLARATION W � Q � 2 I HEREBV AFFIRM 11NDER PENALTY OF VEfiJURY THAT IAM LICENSE�UNDER PROVISIONSOF CHAPTER Ve + d 9(COMMENCINGWITHSECTION700nJOFDIVISION30FTHE8U51NE5SANDPROFESSIONSCODE,AND Z � X MY LICENSE IS IN FULL FORCE M1D EFFECT. m W II � LICENSECUISS C�O LIC.NO. �I .�S�Q j � ~ DATE ���G�a7 CONTRACTOH a y}� W Y; [� WORKERS'COMPENSATION DECLARATfON � `� = U �" � I HEREBY AFFIRM UNDER PENAL7V OF PERJURY ONE OFTHE fOLLOWWG DECLARATIONS: Z i! `� a ^ � _IH/WEANOWILIMAINTAINACERTIFICATEOFCONSENTT03ElF-IN9UREFOHWORKERS' _ � � CAMPFNSATION,AS PROVIDED BV SECTKKJ 87000FTHE UBOR CODE.FOHTHE PERFONMANCE �U a; OF THE WORK FOR WMICH THI3 PERMIT IS ISSUED. � S _I HAYE AND WILI MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SFCTIDN � 37000FTHE LABOR CODE.FOH THE PERFORMANCE OF THE WORK FOR WHICH TNIS PER/AIT IS ISSUED.MV WORNEAS'COMPENSA710N INSUHANCE CARRIERAND POLICY NUMBERME: CONSTRUCTION . � CAFRIEH ��nt CQi�7F'1�S3t10ri PLAN REVIEW �� � vW:d� r G ,7 ;'� Z POLICV NUMBER ELECTRICf' C.�' �" � Q - .w.,.r.s � ��sseciar+NE�rarse��EooFn�vEa�rrawaor+EM�moou�wsgim�ow�. PLUMBING � i Z I CERTIFV THAT IN THE PERFOPMANCE OF THE WORK FOR WHICH THIS PERIAIi IS ISSUED,I MECHANICAI � (,�} SHALL NOT EMPLOY ANY PEFSON iN ANV MANNER SO AS 70 BECOME SUBJEC7 TO 7HE ; (/� WORKERS'CAMPENSATION LAWS OF CALIFORNIF,AN AGREE T IF 1 SHOULD BECOME INSPECTION FEE � , .�'3`�:: ,�-.^ ; ? SUBJE 70THE RKERS'COMPENSATIONPRO NSOFS �Wi77W THEIABOR �7„�+ � � �,,, � cpoe �F I�y�F1CAMPLYWITH visioru "I550'RNEE: t�� �� !��; ` O ""_- i� s'� - ia,::;a;i;. p DATE: �0 �PPLICANT. �' S�".� -- W ENERGY P/C � J WARNIN6:FAILURE TO SECUFE VlORKEHS'C0IAPFNSATION C01 AGE ISUNUWFIIL,AND SHALL BE t �,Y t � SUBIECTANEMPLOYEflTOCRIMINALPENALTIES/WDCIVII.FIN' PTOONEHUNDRE�7Fi0USIWU ENEFiGYPERMIT �A���� / de � DOLLARS�fi00,W0�,INADDIiIONTO7HECO5TOFCOMPENS�TpN,�AMAGESPSPflOVIDEDFORIN �—� �� � � SECTION97080FTHEUBORCODE,INTEREST,ANDATTORNEYSFEES. —f��a�� FiETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � O 3 � IHEREBVAFFIq1AUN0ERPENALT'OFPER1l1HVTHATTHEREISACONSTf81C710NLENDINGAGENCY FOR THE PERFORMPNCE OF 7HE WORK FOR WHICH THIS PERIAIT IS I55UED(SEC.3oD7.CIV.CJ. � W � LENDER'SNAME �y C LENDER'SAUDRESS 'd � TOTAL FEES ���r'� � � � ICERTIFYTNATIHAVEREADTHISAPPLICATIONANDSTATETHRTTHEABOVEINFORMATqNISCANRECL ��,.� �� � IACiREETOCAMPLYWITHALlC1iYANDCOUNTYORDINANCESPNDSTATEIAWSRELATINGTOBNLDINO ✓ d � CONS7RUCTION,ANDHEHEBYAUTHORREREPRESENTAiIVESOF7HI5COUN7V70ENTERUPONTHE � Z ABOVE•MENTIONEDPROPERTYFORINSPEGTIONPURPOSES. 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