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HomeMy WebLinkAbout10932 (5) CITY OF DIAMOND BAR ' . � . COMMUNITY DEVELOPMENT DEPARTMENT � .:,. ' 21660E.CopleyDriveSuite190 PRESS (909)86Q1195 Fax(909)86l-3117 '�". BUILDINGPERMITAPPLICATION FIRMLY � JOBSITE APPLICATION , PERMfT o ADDRESS 2825 OAK KNOLL DRIVE oATe q NUMBER.�� 11__�� � APN LOT 44 TRACT 47851 ISSUE TYPE OC DATE CONST. GROUP p OWNER Diamond Bar East ar er , ADDRESS 3 0 Torrance BlVd. Ste. 3OO ZONING SEBACKS . � cmr Torrance ziP 90503 TE� 310-540-399 Faorrr � � ` ; aw o - � APPLICANT R1C ar GOu� TEL same Sb0 REAR ❑ SIDE/SIDE STREET- ` �� RW O CONTRACTOR J.C.C. Enterprises SIDE ❑ � ADDRESS same as owner � CITY ZIP TEL PROPOSEDUSE � New single family residence o ARCH/ENG! . ., z� DESIGNER R. Gould & Associates NO.DWEL � NO. � NO. � ADDRESS same as owner� UNITS 1 ` �STORIES 2 BEDROOMS 5 CITY ZIP TEL � DESCRIPTION SQ.FT. FACTOFi PSF ADJ.AREANALUATION � OONMER-BI:ILDERDECLAFlATION SFRlADD/REM �$ _� p 1 HEREBY AFFIRM U1DER VElULTY Oi VEiWRV THAT 1 AIA EXEMPT iRDY iHE tONTRACi00.5 L4 Gero � �� � W CENSEUN�FORiHEFOLLO'MNGREASON(SFC.70.t7.6BU5ME55ANDOROiE55�01JSCOOE:ANYGTVOq (n ���� � C� U WU1(TYWHICHREOUIRESAPEN.�RTOCONS7FUCT,FLTE0.�P��.OE40LISH,ORREPAIRANY67RU0 W�,� , G � 7URE.VRqN TO RS ISSUIWCE,ALSO R[WIf1E5 THE AVPtICANT FOR SUpI PERMIT TO F0.E A SiONED W ' � ' � STATEMENT TNATNE OR SHE IS LICENSEO YURSUANT TO iNE iROV�5qN5 OF i11E CONiMCTOR9 L4 , ; � CENSEUW(CHACTERi1C04YENCWOWIiM5ECT10N7000)OFDINSION]OFTHEBUSNIESSANOPHD� V" POOUSpi RD iE5510N5 COOE)OR iHAT ME OR SHE 19 E%EYPT THEREFfiOM AND T/1E BASIS FOfI TME 11LLEDE0 EI(EMV• TION.ANYV�OUlT10NOF3ECTION7071.6BYANYADPLICANTFd1AVERMITSUBIECT3TNEMPLCAlITTO z Re.Roo! �l �� � A CIViI iENALTV OF NOT IAORE THAN FNE HUI:ORED DOlURS�t5o01,): � Otti+^�NEROFTHEPf10PERTY.ONMYEMPLOYEESNnTNWA0ESA37HEIRSOIfCOYPENSATIDN, � Commercial - • � � NnLL DO iHE WOiYC/ND TME STRUGTUFE IS NOT w7ENDE0 OR OFFERED fOR SALE(SEG 701�.BU54 J N NESS ANO VROFE5510N5 COOE:THE C0IRIUGTORS UCENSE UW DOES NOT AFPLY TO AN OWNER OF, ' � �� �� . PROPEHfYYAiOBU�DSOqIMPROVESTIEREON,MAW/i000E55UR1WORKNIMSELFORMERSEIFOFi orch �� 133 Q THROUC,HNISORNEHOYMEMOLDYEEAPROVIDE07HATSUCHIYVROVE4ENTSMENOiMENDEDOR m . � OFFEREOFORSALEIF,YqM/EVER7NEBULDW40RM�ONOVEYENTISSOIDNrtTHNONEYEANOFCOMPIF• � Z TION.TME OWNER�UILDER W1LL HAVE TNE BURDEN OF VROVINO THA7 NE 01l SHE DD NOT BUttD OR . , MFROVE FOi1THE PURPOSE OF SALE} I' . • � O 4�DWNER OF THE PROPEHTY.NA E%CLt75NELY COHTMCTNG WR/I 110EN5ED OOHTMCT00.S W CENS�EUWDOESNOTAPP�YTOANONNEROFAGROPEA IMqBULDSO�NIMP„POVES�EREON,AHO4 VBIUB ADJ.AREA � � MM1�OCONTMCiSFORSUCHVRQIECTSNIMACONTMCfORI51LICENSEDPUNSVANTNTMECONTMP ounrmrv OESCRIPTION FEE � TORS LICENSE Uw.1. . � O IAM EXEMPT{1NDER SEC. B.i P.C.FOR iH15 REA.,ON � 3 � . u" DATE OWNER � � � � •,. W . .... ,'� . � LICENSED CONTRACTORS DECLARATION W � " .. � INEi1E8YAFFIRMUNDEHPENAL7YOfiERA1RYTMATIAMLICENSEDUNDEIIPROVI5�ON50FCHAPiER V. . � p„ �(C01.w1ENCINOWfTHSECTiON7o0o)OFDMSiOf!]OFTIIEBUSiNESSAHDVNOFE3S10NSCO0E,AND Z X UY UCENSE 61N Ml fORCE AND EfFECT. m • � � UCENSECU55� B ��.No. 223670 � �""' � w V DATE corirrucror+ T.G:C. Ent: a.' � � � �, w • � WORKERS'COMPENSATION DECLARATION � � I HEREBV AFFlRM UNDER PENAITY OF PE0.R1M ONE OF iHE FOIIAWiNG DECURATqNS: V `=' a � _IHAVEANOWLIYAWTAMACERTIi1CATEOFCONSENTTOSELF•MSUREFONYRHtKERS' _ � 4 � � CDuvENSATION.AS DRONOED BY SECTION]7m OF i/1E UBOFt CODE.FOR THE PERFORMANCE U Q � OF iHE WOi1K FOR WNICH iM14 PEH/AR IS ISSUED. � G V W ,�p�IHAYEMIDWILLtWMAWMKNLCERS'COVPENSATIONRISUWWCE,ASREOIAREDBYSEC710N Q ]7000FTHE UBOR COOE,FOR THE iERFOR4ANGE OF 7NE WONf f-0fl WHiCH TFUS CER11R IS ISSUED.MYNNFL(ERS'CdIPENSATqN INSUPANCE CARR�fR/ND VttIC`/NU4ABER ME: CONSTRUCTION � � Q 7 CARRIER PLAN REVIEW Z POLICY NL➢dBEN W 9(B ' ELECTRIC _ �- ¢ 0 �sEcnoN��rqieem.stEtEooFncvEaurs�rnar+e�ara+E000uu�p+mlattFssl PLUMBING Z IGERi1FYTMATNT}1EPERFORAIANCEOii11EWORKFORWMICHiFnSPERMITISISSUED.1 MECHANICAL �r (,'} SWLLLNOTEMPLOVAHYFERSONINANYNANNENSOASTOBECOMESUB.IECTTO7HE . .. . � YqRNERS'COMPENSATIONU�NSOFCALIFORNIA,ANDA6REETHATIFISHOULOBECOME INSPECTIONFEE '�� � SUBIECTTOTMEWONNERS'COAIPENSATIONPHOVISIONSOFSECTION]7000FTHELABOR - COOE,I SWLLL FOHTHMATH COMPLV WiTH T1105E PROVISiONS. ISSUANCE � � SMIP � p DATE: APRICMfT: � ENERGY P!C WARNiN6:FluIURE TO SECURE VNDRKERS COUPENSATION COVEfUGE IS UMAWFUL.AND S WLL BE , � SUBJECTANEMPLOYERTOCRNIINAI.OEWLLTIESNACMLFNESUPTOOHEMINOREO7H]USAND ENERGYPEFiM1T DO1111R5(f tao.0ao�,R!ADDITION TO TN[LOST OF COMPENSATqN,OA41AOE5 AS PROVDEO FOR W � SECTIOH770lOFiNEUBORGO0E,N7ERE5T,11NOATTORNEYSFEES. RETENTIONFEE: ��r� a CONSTRUCTION LENDING AGENCY PRE•ALT FEE: O Q IMEREBVAiFYWUNOERPENILLTYOFPERAIRYTIUTTNERE15ACON5iRUCT10NLENDu�AGENCY n- FORTHfiERiORAIANCEOiIHEYNDfiKiORYY111CH7H157EFMRI5155UED(SEGiDV7,CN.G). . . � �[ � � LENDER'SNAME ' � C IFNDEitSADORE55 � � ^ W ICER7iFYTMAiIMAVEREADTMSMPLICATIONAN�STATEiW1TTHEliBOVENFORMATqNISCqiRECT. T///y��/{'''��]�//'''��j�jy'''���t F /�J(I y � � � IACNEETOCOAIOLVWIh1ALLCRV/WOCIXINT'IONOwANCE3AI�STATElAWSREUTINOTOBULDIHO ����/�' d•f�� � � • CONSTRUCTId1lWD HEREBYAUTFqfUZE NEPRESENTATIVES OF TNIS COUHfY TO EHTER UPON T11E / . S� ABOVEi1EHTqNEDVROVEHiYFORINSPECTIONPVqPO5E5. CO ENTS - ` G � � � . J � � 6 YERA1177EE NAME(Pa� . . . . . N y ;BWNATYRFOFPEiiM1TTEE , - �.. Z DATE � _ �' � RECPT.NO. PND BY VAL10AT10 WHITE-0spaMnent Copy.YELLOW—Fin�nca Copy.PINK—As�esaor Copy,GOLDENROD—Flk Copy,GREEN—/�pplManCs Copy . . r�.,. �i.V1.YMC��l'm :'fw.�;.�.iN`�.�F:� .•�iF'�n. �:n+. {::.';::ti'l:;p^tti'. �ri,�r'�1P�'t�... �. -.�.i�.:"k":��..:"�..�'�:�,�..��Lr.�•-c;,.rr...r,.tr.• . . �-�•y.Y��.:,w.�r.�,.� ,�;.we.-�...:� ., r'�'!•bi •`� . - CITY_OF DI�`t�OfdD',�AF� . �''�� � �!�` � '� r_ .::;-. . _ INSPEC�IOh i�ECORD ; ;�;� � �. : , t ' - -. �, �' , .-; - -_' ,„�.� . � :; �,:. �:. �. � � � � �I�C�; f. � � 1D � �: 1 f� O�:i' , . ; ��r ���f C �,�� .0 � �� ;�►���i1�C�T�Il'�" �IR1-`�_ � �;l�ak .�';.bl'� '1tif-��!?�1� I �-��_...� l.� .�'�'� � _•:,:_,;s._ ----.�._.._ _ � _�.__ _�_....._____�:�::�;:: y._.�.._____ .._ -- .-......_ _,_._._..�._ ___ - - _ ..� _. SET BACK.,,_ __ , '. 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