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HomeMy WebLinkAbout14193 J� _� - - . ..� — -i-- -- �...._.i� . ,-�, .� --.� - - •- - � � — . __`_-- ��c�•,r� �LD� �f� �� CITY OF DIAMOND BAR . DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVIC�ES � 21660 E.Copley Drive Suite 190 (909)860.3195 Faz(909)861-3117 PRESS "'�^', BUII.DING PERMTT APPLICATION FIRMLY } JOBSITE 2QQ3 S11VeT Hawk Drive 3UriTtS APPLICATION PERMITI �P/� o ADDRESS DATE ��22�99 NUMBERV I '�# o� 'ISSUE TYPE OC APN LOT TRACT 3�OZ6 OATE CONST. � GROU�-3&ti-1 °C QWNER O p ADDRESS i ver Hawk Drive zoNiN� SETBACKS FRONT _ �.,�,- c,,,, v� ..�RW Z cirrn�.n�� R ,� ZIP TE�,., � ❑ g APPUCANT �1•11• 1`+�1ari' TE�tSI��=�+=+��E`jl REAR O � SIDEISIDE STREET RW ❑ CONTRAC7Q�bII1��,Y and�,�g�� SIDE � ADDRESS L .i �at Same � CITY RrPa ZIP 29 82.1 TE�.7-14-579-371 PROPOSED USE o ARCH/ENG/ �z DESIGNER n]an NO.DWEL. NO, Hp. a ADDRESS � a a asaS oa Su�e�FI�4- � C��, UNITS 3 STORIES 2 BEDROOMS S22 Pl ri Cg,].a aa g ZiP�QZ TEL.$1�(. N DESCRIPTION SQ.Fl: FACTOR PSF ADJ.AREr1NALUATION O OWNER-BUILDER DECLAFATION SFR/ADD/REM p I HEREBY AFFlRM UNDER PENAL7Y OF PERNRV h1AT I AM EXEMP7 FROM THE CONTFUC70R5 LI- Gef096/CBfpOfl W CENSEUWFORTHEFOLLOWINGREASON(SECJ0.3t.5BU51NESSANDPROFE5510N5CADE:ANVGTYOR (n w�•� COUMVWHICMREWIRESAPERMRTOCONSTRUCT,ALTER,IMPHOVE,OEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck NRE,PRpR TO ITS ISSUANCE,AL50 RE�UIRES hIE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED w �` � STATE4ENT THAT HE OR SHE IS lJCENSED PURSUANT TO THE PqOVI510NS OF THE CONTRAC70R5 lb � CENSE UW(p1APTER Y(COMMENCINO WIh1 SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � PooUSpa FESSpNSCODE)ORTHATHEOfiSHEISE%EMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP- (!7 TqN.ANYVpLATIONOFSECTION7037.5BYANYAPPLICAN7FORAPEfiMI75U9JECT5THEAPPZICANT70 Z Re-Roat � A CIVIL PENALTY Of NpT MOqE 7TiMl FNE HUNDRED DOLLARS(i500).): � �I,tiSOWNEROFTHEPROGERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOIECQMPENSATtON, CORIRI6ICIHI � VIILL DO TIE WORK ANU TME STqUCTURE IS NOT INTENDED ON OFFERED fOR SALE(SEC.70M,BU51- � � HESS AND PROFESSIONS CODE:THE CONTMC70q5 LICENSE LAW DOES NOT APGLV TO AN OWNER UF PROPEHTY Mh10 BUILDS OR IMPAOVES THEREON,AND WHO DOES SUCN WORK HIMSELf OR HERSELf OR � Q � .er UTL Zt CC THHOUl3H HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUGi IMPROVEMENTS ARE NOT INTENDED OR m - � � ,OFFEREDFORS�LEIF,HOW�Eq7HEBUILDINGORIMPROVEMEN71S50LDWITHINONEYEAROFCAM%.E- Z 'TION.THE OWNERAUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DIO NOT BUILD OR = IMPROVEFORTHEPURPOSEOFSALE). � � W ❑I,tiSOWNEROFTHEPROPERTI;AMEXCLUSIVELYCON7MCTINGWfT1!!.ICENSEDCOMRACTORS — � TO CONSTHUCT iHE PROJECT(SEC.7ou,BUSINESS M10 PHOFESSIONS CAOE:THE CANTRACTORS LI- V01Uei10l1 Eq LL1 CENSE UW DOES NOTAPP�V TO AN ONTIER OF A PHOPERTY WHO BUILDS Oq 1;.1PROVES TiEREON,AND F WNOCONTiUCTSFOpSUCHPROJECTSWIiHACONfpACTOR(S)UCENSEDPURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE � Y TORS LICENSE LAW.). Q ❑I AM E%EMPT UNDER SEC. B.6 P.C.FOR THIS qEA50N Q 3 � � DATE OWNER- ¢ Z U F LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDEH PENALTV OF PENURV hIAT 1 MI LICENSED UNDER PROVISIONS OF CHAPTER � � 0(COAIMENCINO Wlhl SECTqN 7000)Oi OIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND z ��� MY LICENSE IS IN FULL FORCE AND EFFECT. m � LICENSE CUSS LIC.NO. � , V DATE CONTRACTOR d . . W /� � WORKERS'COMPENSATlON DECLARATION �(1—� � N ��,.J v � I HEREBYAFFIfUI UNDER PENALTY OF VERIUAV ONE OF THE FOLLOWING DECURATIONS: Z � L7 _I HAVE AND WILL MAIN7AIN A CERTIFICA7E OF CONSENT TO SELF-INSURE FOR WORKERS' _ ' ' ' ' , Q COIAPENSATION,AS PFOVIDEO BY SEC710N 370o OF THE LABOR COOE,FOR THE PERFORMANCE w Q OF THE WORK FOR WMICFI THIS PERMI71S9�SUED:•, , •� �: . • � , _ ` j ��[�/ !� . QW L1_I HAVE AHD WILL MAIHTAIN WORKERS'COMPENSATION INSUfUNCE.AS REOl11RED BY SECTION , �37DD OF 7HE LAPOR CODE,FOR lHE VERFORINANCE OF THE WOFK FOR WHICH 7H15 PERMI715 • � , , , ISSUED.MY WORKERS' MPENSATION INSURANCE'CARRIER MD POLICY NUMBER ARF. �+ ' CONSTRUCTION ' � �,/ jc�RaiEn PLAN REVIEW ZPOLICYNUMBER � ELECTRIC � ' � Q . � '.i . � (ffCSSfCfqNNE�NOTBEOC/+WlEfE00F71¢PERARISFORONEFIIR�DREDDRIAfiSR700)ORLESS�'; PLUMBING� � ...i . � " Z �CERTIFy 7HAT IN THE PERFORMANCE OF THE WOHK fOR WHICH THIS PENMIT IS ISSUED,I F MECHANICAL � ('3 SHALL NOT EMPLOV ANY PERSON IN ANV MANNER Sp AS�70 BECOME SU&lEC7 TO THE . c (q WORKERS'CAMPENSA710NUWSOPCNLIFORNIA,ANDAGREETHATIFISHOULDBECOME•�' - � � INSPECTIOMFEE ' " � ' SUBJEC7TOTHEWORKERS'fAMPENSATIONPROVISIONSOFSECTION37o00FTHELABOR �� (' '• '� � rj CADE,I SHALL FORTHWITM CAMPLY WI�,HOSE PROVISIONS. ISSUANCE b4 1��.�_.' ' � Cj G p DATE:_�APPLICANL� _�L_t�1/� V . N1'i� SMIP � w - fyS3YY' . J WARNIN�:FAILURE TO SECURE WORKERS'COMPENSA710N CAVERAGE IS UNUWFUL,M1D SHALLBE ENERGY P/C ^� n WI A!�f1A � SUBJECT AN EMPLOVER 70 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND �r �+ G ���.7 DOLLARS(f100.000),IN ADDI710N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOp IN ENERGY PE IT J SECTION 37ot OF MF UBOF CODE,INTEREST,AND ATTOqNEY'S FEES. �. 2 AETE�Urv�tEJ��T P.'�"1?TT'`J t'7 I _ � OCONSTRUCTION LENDING AGENCY PRE-A�T��'£�D��rr: t_:?` �:�``_ ! � ��� � I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUC7ION 1EN01NG AGENCY ` L � FOR THE PERWFMANCE OF THE WOHK F-0R WHICH 7HI5 PERMIT IS ISSUED(SEC.70G7,CIV.CJ. Z , W � LENOER'S NMIE F- LENOER'SAOOHESS � w 1 CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT iHE ABOYE INFORMATION IS CAqRECT, TOTA L F E E S , � I AGREE TO COMPLV WITH ALL CITV AND COUNTY OqDINANCES AND STA7E LAWS REUTING 70 BUILDING � CONSTRUCTION,AND NEREBV AUTHORIZE RE7FESENTATIVES OF THIS COUNTV 70 ENTER UPON THE Z ABOVE-MENTIONED PqOPERTY FOR NSPECTION PURPoSES. COMMENTS � � y � E � m PE EE NAME 1PR1/!T) ,` — �"'.`_—"� -� n /1 a CI f '� ► / N SION UREOFPERMITTEE DAT � � RECPT.NO. _ PAID BY VALIDATION I WHITE—Department Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOIDENROD--File Copy,GREEN—Applicant's Copy ( . . . 1 _ �.- •"_^ _. , . _ . ' � , � '� "' I' � ' � �:���f �f� ��/P�6�iI�f�1Q� ((��Q� 16�I�f�'[�c����6�! II�[���f�� 'D � �.�. '`+"`—""' . Q'A' °- � �������+ Q ��a^ p � .:aR o � qn , . a , r � r , a. . � -. f ��, +� � �,.,� .. . , , . . �. . -s, - �� �. 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