HomeMy WebLinkAbout16400 (23) : ` ' �� CITY OF DIAMOND BAR �
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
- T_,� , 21660 E.Copley Drive Suitc 190
'4 (909)86Q3195 Fax(909)861-3117 PRESS
� ��'"�"� BUILDING PERMIT APPLICATION FIRMLY
N JOBSITE
a ADDRESS 22518 LARK SPRING TER aPP�icar�pry PERMIT ��n(� P/C
o DATE U�10712001 NUMBER 9J�� #
$ ISSUE ,�� iJITYPE OCC
APN LOT TRACT__ DATE CONST. GROUP
0 owNeR _TALBOT.NORMAN
p ADDRESS 22518 LARK SPRING TERRACE ZONING SETBACKS
gCI7v DIAMOND B ziP 91765 TE�. 909-860-653 FRONT Rw n
APPLICANT �etClerk InC TEL. 8S�'�TT� REAR U_
� SIDE/SIDE STREET RW ❑___
� CONTRACTOR �nquest management group SIDE �
ADDRESS 26741 orto a arkwa suite e- —
� CITY foothill ranch ZIP 926'�� TEL. ��B PROPOSED USE
o ARCWENG/
W DESIGNER_ NO.DWEL. NO. NO.
a ADDRESS
= CITY Z�p �� UNITS STORIES BEDROOMS
�
� DESCFiIPTIf�N SQ.FT. FACTOR PSF ADJ.AREANALUATION
O OWNER•BUILDER DECLARATION SFR/ADD/REM <AP68> <V8IU8�
� 1 HEREHY AfFIRM UNDER PEN/LLTY OF PERIURV THAT i AM EXEMPT FROM THE CONfflACTORS LI� G2f09B/C8f{10ft �YM e�',�� �V'a�(J8�
W CENSEUWFOHTHEFOLLOWINGRFASON(SEC.7037.SBUSINESSANOPROFESSIONSCOOE:ANYCITYOR (n A,,
WV COUNTYWryICHREWIRE3APERMfTTOCONSTRUCT,ALTER,IMGROVE,DEMOLISH,ORREPqIRANVSTRUC- W pgj10/DBCIf �ly�'d�' �VaIUA�
TURE,PqIOR TO ITS ISSUANCE,ALSO HEOUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNE� W
� STATEMENT THA7 HE OR SHE IS LICENSED PUIi5UAN7 70 THE PROYISIONS OF TIfE CONiFlACTORS LI� ^. `r
� CENSE UlW(CHAFTEfl e(COMMENCIN�WITH SECTION 7a00)OF DIVISION 3 0F THE BUSMESSAND PRO� � POOUSPB �tV Aay <Y�IUA�
fESSbNSCODE�OR7HATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTNEALL[GEDE%EMP- � A,,
TION.ANVVKKATIONOFSECTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof <HiBa� SVaIUA�
� A CMl PENALTY OF NOT MORE THAN FIVE HUN�RED DOLLARS(SSCO)J: p� �f
� ❑I,ASOWNEROFTNEPFODEATV,ORMVENPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, Ll Cammercial P./�le`�]�! Cy$�(Je� �
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDEU OR OFFEHED FOR Sf�LE(SEC.7o4s,BUSI� J
� NESS AND PqOFESSIOIVS CO�E:7HE CON7RAC70F5 LICENSE LAW OOES NOT APPLY'f0 AN owNER oF C�('Qa� GV'L�lle�
PqpPFATYVYFiOBUILDSORIMPROVESTHEREON,ANDWHO�0E3SUCHWOPKHIMSELFORHERSELFOR �
Q 7HF10UCHHISORHEROWNEMPLOYEES,PflOVIDEDTHAT5UC411MPROVFMENT$ARENOTINTENDE�OR m
Q OPFEREDWRSALEIF,HOWEVEP,THEBUIL�INGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- <APBay CVaIUA�/
� 'TION,YHE OWNER�BUILOER WILL HAVE THE BURDEN OF 7HOVING THAT HE OR SHE 01�NOT BUILD OR /�,. y`dlUe
IMPROVE FOR THE PURPOSE OF SAL�. [ri Aa�j S �
❑I,AS ONT7ER OF 7HE PflOPF.HTY,AM E%CLUSIVEIY CANTRACTING WfTH LICENSE�CONTRACTORS
� TO CONSTRUC7 THE PR0.IECT(SEC.701i,@USINESS AND PFOFESSIONS CA�e:7NE CONTRAC70R5 Lb Velualion 198.00 ADJ.AREA__
= CENSEUWDOESNOTAPPLYTOANONTJEROFAPftOPEHTVWHOBUILO50RIMPROVESTiEREON,ANb -- ------
F YYFIOCONTRACT9FOR9UCHPROJECTSWITMAGONiflRCTOR(S)LICENSEDPURSUPNTiOTMEGONTRAG pUANTITY DESCRIPTION FEE
Y 7OHSLICENSELAW.).
Qn I AM EXEMGT UNDER SEC. .___B,8 P.G FOR 7MI5 PEASON Q
}� U
ZW1TE --- OWNER—..—___ _—_.—_'_'._'_' U
� LICENSED CONTRACTORS DECLARATION W
� W
I HEREBY AFFINAI UNDER PENALTY OF PEFUURY THAf I AM LICENSED UNDER PROVISIOYS OF C4ipp7EH x
�, Y(COMAIENCINGWITHSECI"ION7000)OFDiVISION30FTHE8USINESSAN�PROFES510NSCO0E,AN0 Z " �'� y, �, ! dJ���J
�L MYLICENSE IS IN FlILLFORCEAND EFFECT. m •,�e
d LICENSE CLArSS��r76 _-- uc.No. 529482 � � • ��� .�' `� ��� `�..��'.
v onrE O3107lGOO� __ CONTRACTOR , ° ' --_-_ 0. .C' ' eti '�V`'� .
w i
� WORKERS'CUMPENSATION DE .RATION�� Q
� I HEREBYAFfIRM t1N�Efl 7ENALTY OF PERIURY ONF OF TME FOLLOWING DECLARATIONS: Z
0 _IHAVEAN�WILLMAINTAiNACERTiFlGATEOFGONSENTTOSELF-INSUFEFOHWORKERS' _
� COAIPENSATION,AS PROVIDED 8V SECTION 3�0o OF THF LABOFl CO�E.FOR TNE PERFOPMANCE U
O OFTHEWORKFORWHICHTHISPERMITISISSUED. �
�L � IHAVEANOWIILlMINTAINNORKERS'CAMPENSATIONINSURANCE,ASREQUIREDBYSECTION
Q J7000FTXELA�RCODE,FORTNEPERWRMMICEOFTHEWORKFOFWHICHTHISPERMITIS
_ ISSUE�.MV WORKERS'CAMPENSATION INSURANCE CARFIEH AND PO!ICV NUMBER ARE: CONSTRUCTION ______..,._. _
"""'-_'_"'" _-_'-"'_...__'
> �aRR,ER. no carrier PLAN REVIEW
----- _._..-
---- — -�---
Z ra1CYNUMBER ------....—.__..._.. ELECTRIC
Q -._._..---- ----- �
�- `� Sf�
� (MLSSEGT/xiNEEONCTBEmPAPI.ETE�CFT1-I�PERAYIIS�ORONEMN�DREDDOLLAFi4(E70D)ORLE.S51 PLUMBING _.__.'____.____ O ,�V
"....____._
Z 1 CERTIFY TNAT IN THE PF.RFORMANCE OF THF WOPY,FOR WHICH T'IS PERMIT IS ISSl1E0,1 MECHANICAL _,...,__.__ � � Y.
--- ---......—,-- ��.J�• rs
CJ� SHALE.NOT EMFLOV ANY PEfl50N INANY MANNER SO TO ECO E SUBJECTTO TH[ �
(n WOFKERS'COMPENSATIONLAWSOFCALIFORNIA,AN G ET TIFISh10ULDBECYME INSPECTIONFEE .__ ��...5_�.�'�.S
� SU&IECTTDTHE WORKEflS'CAMPENSATION PP,OVI N F . FTHE L4BOP �� _-. ----' - �
� CADE,ISHALLFOHTHWITHCOMVIYWIT4/THO, __ ISSUANCE _
: ^C�-• ...._-..._...__
p DATE:_O�'�7rzon� APPLICAN2 _.._"'_.____ SMIP � ! k"�•�� /-� '�r,- ��`
- --��,:r.:'_.—��-�1\..--i�l-,�... __._...._.—._..___"_'—_
Wr -.,v�
-'� WARNING:FAIWHETUSECUREWOflKEHS'COMPENSATIONC VERAG[1541NLl�WFUL.ANOSHALL6E ENERGYP/C _•...____.,,___„ _
J SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFIh ONEHUNORED7HOUSANU � �l�J�
_ . ,r.
LL DOLLARS(S1oo.000),INADDITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROV;bEDFORIli ENERGYPERMIT 1.=!P..j� _�' ( �����-�}���}
J SECTION3708 Of hIE LABOR CODE,IN7ERESL ANDATTOHNEY'S FEES. �' �� � -� "'
¢ RETENTION FEE: __ . _. .. ..--,------...- -
- -
O CONSTRLICTIONLENDINGAGENCY PRE-ALTFEE: �-- . �
�y, . , .__...----- .__..--� '--
� � I XEREBV AFFIFlM UND[P PENALTY OF PERJUflV THATTHEFE IS ACANSTItUCTION LENOING AGENCY �vu'AC� �--•% . ���' �
._"""__'_—.
z FOR THE PEFFORMANCE OFTHE WORK FOR WHICHTHIS PERMITIS ISSUED(SEC.3�57,CIV.CJ. ��Ar> � —��
L4 ._"'.._—y�,, '.—_.-___."'.— �_'__ �
� LCNDER'SNAME__..._-'—_"'".,.__"—_____'_'_- �O{f1AY�
<$tP88t> ------------....._. .---
1_ LENDER'SA[mRESS_�C�..,> p�.�......_.._""'_'
��.nr �
� TOTAL FEES
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFOPMATION IS�HRECT.
W I AGREE TO COMPLV WITH P1L CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUIL�ING
� CONSTRUCTION,ANU HERE6YAl1THOR12E PEPR[SENTATIVFS OFTHIS COUNTY TO FNTEH UPON THE
Z ABUVEMENTIONED PROPERTV FOR INSPECTION PUHPOSES. ,
� COMMENTS..___ __..__,___ __
� NetClerk In ' ._._ — ------ ----
m PERMITTF.E NAME(P �
� � �' o3�o�rzoo� ---- ----------
� SIGNATUREOFPE ^�" ., �Al'E --"'--- -'— ' —
_ � RECPT.NO. , � e PAID 8Y ___r Y_�VALIDATION__�__
~ �—���WHITE—De ertment Co YELLOW�inance Co PINK—Assessor Co GOLDENROo--File Co GREEN— licant's Co
P PY� PY. PY, PY� APP PY
` - ,.. _ _ _
_
�, , , � � �
, � : �
� , ,
� � € i
i i I ,
, t
— ' y � i � � i i —
i
. � , � I ; ; ; j ,
,� � , , � ; , i � � ,
r�,� � i �
� � .
� �
I
�
��, ,
. � .
�
.. . . . � , . . . . . . i . . . .
�
, �� 1 : � ' I i � �
�- �.�� , � _— , � � I
i
�
z#� � . , +_ _ __ _ i i
;..
�= i I i ' I i
,
� �, r � � � � � i i �
� I
���� ' I I ,_ , ; _ � � � j ' ' � � , � � � !
_.
+ �. �,��� I � I � �
� ,
i ; ,
��"� ` i_ � , � i ' z
�� ; � � ; , � � "� � � � , � i � j ,
t ' � #4� � { �� � � �� i � . . I` � �
h � i "� ) ( � � �� .I � � � �'I � {
. � � _ �'. ,. � ,' ' .. t
� , � I � , I � , ; 6
#
- ��� � � � �
� +
.
i
, �
i� I i
r�r 7 ; ... , � ' _ . ,
�, - _ __ J y _ _ I �
; ��� f_ _ I ' {: '. j i � i i i , i
�_�; � r__
� � ii ��� � I4 . �. I '. I , �
� '_, �.�i m ' �� � ,. i ;�i I � '� j�(� � � i � �. i � � � i ' � �
r ,£k. ' . . '., . i . � � .
ri. , • , , . . . , , ,
:: , . - I i � . i .
i
� �`t}&f �:,�' ! i �.... � � I_.....J _,......; _ t - i i ,,���� ! � I I ! , i �
f
E
m� e , j i ! � � �i I I � � , i , �
�
I ' i ' � ,R ,
_. F -. . . ; � , . � j �
_ ' r
`� a,'�. . . I_ �_ .___ :......... . . ... _ t
, i
� � _ i.. .j � � � , �
7 � I, , 9� k�.
r ( i � �
I � I � x it
p t L. I � ..s.
� t � _ _ i � ( S 4. U �k
i �� - " � �4 � ��, �1 � �J � �
1 #
� �
l�k. f. I ` � 1 1 I. � � -� �.
� � � '�,. I ��M 7� ��.
,: p� 3 ..I _ . .. i - - .,. . ` a �- �'
�4 �, , -� , . .: c i � � . ,.. ��
.. . _...,,.r_ .... .....�,. «..,._._...,.. ..�..,...,._. .I�.... .. ...... .. . _..�, , _ .�..' . ... ,.. ...... ..... ...,......., .._.,.....- . . .... ... . ..,.... . , .,......, . .._..
� �