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. COMMENTS
0 � .
a PERMI M1E(VRI �
�
N �� siaN� FE OF P I E TE RECPT.NO.�,'���'""^�� PAID BY c��+ =J � VAL�DATION -
H �
WHITE—Depanment Copy,YELLOW—Finance Copy.PINK—Assessor GoPy,GOLDENROD—Flle Capy,GREEN—Applfcanfs Copy
�. �. ._
� ; 1� � � �"�"�" � T ,��"� i z
� � I i � r � � ' I � E I - � �� , -�_--��..� � � I ,;. j .;� �
� � , , �. a _ � � � � � !
� � 1`� ;i �� , - � i f i f � �
; � � � i - �, _ -j i�' I I � ��, �
� '� - � ' I �. , �
�
, a ������ � �� � , - � � � � i , ; � , ; ����=1 ��: �
a � i � � !
i: a : i � °� � , , � I � ' � � ` �
� � � , �
i , � �: , � ; I� �--f '-�=- -i- � - I � ' �` ( � � �� �1 i
, 1 � �
� � .= I � � � f:: � � .i � i i i � � - < I 'I j ;,
�
� � � i-- � � �' � � � ; � i I �''• ! ;; - i�
� � :I � � , � �;' 1 � , ;� ` � � '! � i ; J; ! ; I �' ^''; ' I
�
' � � ��i�'�� `i , ' ; ' ' � � �; ( , � i � � i I � � ; i ,. � ;
�
� � � � �� � a � �� � � .i t= I � i ,'Q � I � i I ' r,� � ' I �
�. � � o � c4 � � i : �.7 Iz; � � � � ,t� , I , � �
� :j I �
� � lac; -, zw � � �; 2 �,, � i ` � � i� I-' I � � �� �
�;,� � ' cc cc�o o :a W1� � � z��lz G"' N a �ic�lzir-'�� ' � � i ;� � •i ( � . I , � ,.
�- r=iu�:
c� ��� ��lo w m �,� � ��� ����i�i ��� zl w d�z ������I a � � ' � ; I C � `:
�.'$aj .. pl� �f��Ulv C ni��`J C�I'� ��w Z �S CIC. �- ��Z �� u+�: F_; I I . � � � ' �
� `)" . ' �'� 2 � ¢ � `�I�,�' � =�xl`� �il`�`�"�h��j:��u o ° '�i�,�- �' I I I ' I ; . I ! I i I
.` LL LL CL G I 'i G `� �' a I Q- � .d�
:. . � � ...Q,�O � m �I U �'I� � J I_1 J U` � :17.F- J I s�i f- �I� ( . I .��. ..1 . � . I.....,. � � 1
�� � � ,� i z z��l¢ ��,�~i.�Z w,.Zi-' Z Q�t� Giu.. O:� � �iQlw,W;> ui ' � �. � � � � . .� . ... � _ .I � �
�- cC w ui a. a I I
� u. o!.- o C��o:w�u.�� Z z cc! �w.zi i .� � ( � � I.. _ (
� � �c LL ,�;� u u � <c � n m c[ ,� p. c�. a G o u. � O i.��w i=i o I.0 � i
�'- ...�_ L.l � � � L�._ �L_. ' .
; �
� � --f —r-�— � --f— � — , —+--_� — � --�—� —� ; f I,;; j `I � i
� � �
~:- � � � � � � ' ; f � i i � � � i �i `.� _ �, ,� � � ''
i I � i � t � ' I� �
� (` (
f�5 w I � � {. � �
� , ,+ I' ; { i I I.
� � i � � � � ,: � � ; !° � , ; �
�� � � ' :i � � � f � �' � � � � � , ' � � � i
� I: � a i: i � ,
i � ' �': � ( , � t � � � � ! � ��� � '� � (
o ' � , I
; � ' � , , � � � � � � � � I
.. _ '
� ��_i � �_7_.y_ I i � � � .--� �� �- - � � ( �' � � � i � � ��
' " I �
;
�--- � � i; , ; �. � �. � F � �� ; I ► � ; � E i ; , ; i
� � �i _ � f� � I � ;� , �_ � � i � ., , !
� ��''- �--�--I-�—�-- i � +�'�. ' � � � ; ; i
� ' � i �� � � �; �
I � ¢ i. I I I ( ' ��' � I ( i ` ...
i ' ' , �:_ I � � � � 1'�.. { �', ( i
� o � � ! � � {� � ,� I � i � f u� ;
� I� �im �� � � IU ��z�w �b�I.� � � I� � � N�
07 p g 1 U' t-. z� .- F., � [o rv
r �T I_ � {'-�•.�I FI�Q J ...� ' � �..��i '. -{/� I � � .
:.:�.I'Cr� ¢ � w >I F- '��h-i(J�� o] C] 1- r z(Lr!m; : F- � i I � : Y N -�
,`; � C7I� p � �IQ � uJldlttll7i� ���I-V; � '�zk� J�IG9�f- U�2t. � � , ��.�.
Y�¢ t> ¢,� w ut �' > w��i�' i �'� !� � � I, �
c,� p IocGicnac� o =�wlai� -'- rnt- � , ss- rs- �Iw w �� u , �H,
�, �v> z � F I � zic�: I s ,
mu zE, c. Q zlzi= w a � U �. c. x .u �a � �a;
c7 °-�� a�w I� ��u�: c� t7 I c7�s �I�I.� ''� u-. h�n�s. ¢� � .J � �-�I�� ��� �� � �� ��� F=���.�.:
F- CS W 0����.g-�O eZ O "�I�,�iO �-�- �l0..tu .n � E�4 E. -I�. � d,u.l�.
; ' W � �I1��,��;0 � C Q o�o�x � `� w [� wIw w �¢Iz Iz z zI I � �Iwcn�,
v, � w c, v; F- � cr u � s rr ¢�ua w��:U n cn��u5 i:7 I:i L� ��._�::a..�.1.._ ,__..:.P .. _. _. a.. .:��J��__.:L..._.:...:_: _T.:e.�:__�_.__....�