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HomeMy WebLinkAbout10141 - CTI'Y OE DIAMOND BAR COMMUNTfY DEVELOPMENT DEPARTMENT �. ;,.� 21660 E.Copley Drive Suite 190 PRESS (909)860.3195 Fax(909)861-3117 '""'� RUfLDINGPERMITAPPLICATION FIRMLY '':�f DDRESS d-�`� �+�� ��1�--2� 5. (��-� ;� DATE CATION 2..�� � NUMBER `O� �/C "�t +�--- '� ISSUE TYPE OCC �' APN__,_,T LOT TRA� _ DATE CONST. GROUP pF OWNER ��y`-'4� � �-� �` ADDRESS�' --'`����� U 20NING SETBACKS o'. � z CITY I F'L�F�(j (�i(1((,. ZIP_ _ TEL. �SCoI n�� FRONT RW ❑ o:' APPLICAN7 n 'r�2i InIAR-�C-ati! TEL��:L h.'��S 3� .,� S DE/SIDE STREET RW ❑ � CONTRACTOR L•'L� r0(LR-�`-'° �t`�(aZ Fa SIDE fl Q_ ADDR SS �1 �+�s �.l_ i(S�. = �-,--- O CIN - ZIP�'�«� �.. 7EL...��i%� ��1a:f-Y,`!`3I + PROPOSED USE l���- `�"'�"1' � �S i I i�G— S f�S a; U-/.►aS R1 .. T � c. � L" cs.;e c. w ARCH/ENG/ f,n!!;;/1eC, r .'t� � 6-C,R1 � CI)i`t Z DESIGNER ' NO.DWEL. NO. N . a, ADDRESS -• UNITS_ � STORIES �'"�'" BEDROOMS� �; CITY ZIP TEi.. � �ESCRIPT�ON SQ.FT. FACTOR PSF ADJ.AREANALUATION O. OWNER-BI:ILDER DECLARATION SFWADD/REM � [], 1 HEREBY AFFIRM UNDER PENALTY OF PERJIIRY TNAT I AM EXEMPT FROM THE CONTRRCTOqS LI� GAMJB/Cd�Otf W- CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.58USIHESSANOPROFESSIONSCq�E:ANYCI7YOR J(n U CAl1NNWHICHNEOl11RESAPERAIITTOCONSTRl1CT,ALTER.IMPROVE,�[MOUSM.ORREPAIPANYSTFUG •�� W patiolDeck Z` TUHE,PNIOR TO ITS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOft SUCH PEflMiT TO FiLE�SIGNED W 57ATEMENT hIAT HE Oq SHE�5 LICENSED Pl1R5l1ANT TO TNE PROVISIONS OF THE CONTqACTORS LI. �� W �, CENBE LAW(CNAPT[R B(COMMENCINO WITH SECTION 7a00)OF DIVISION 3 OF THE BUSINESS AND PRO- ' V" POOUSp3 FESSIONSCq�E)OH7HATHEORSHEISEXEMPTTHEFEFROMANDTHEBASISFORTHEALLEGE�E7(EMP• '�(� VTION.ANYYIOIpTIONOFSECTION70S1.5BYMlYAPPLICANTFORAPEHMITSU&lECYSTHERPPLICANTTO '� Z Fjg-R00f � � AGVILPENALTYOFNOTAfOAETNANFIVEHl1NORE0OOLLARS(f5ao).)� ; Q o: ❑I,ASONMEROFTMEPROPEflTV,ORMYEMPLOYEESWITHWA6ESASTHEIRSOLECOMPENSATION, CORIR1BfCi81 Z. WILL pp THE WOqK,AND THE STRIICTURE IS NOT INTENOED OR OFFERF�FOR SALE(SEC.)oea,Bl1SL � J NE55 AND PROFESSIONS CODE:THE CONTRACTORS IICENSE LAW�OES NOT APPLV TO AN OWNER OF �'� PfiOPENTVNMOBUILD50HIMPROVESTHEREON,ANDWHODOE55UCHWORKHIMSELFORHERSELFOR � � �{ 7HflOUGHH�50RHEROWNEMVLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTIN7EN0EDOq `m u1'- OFFEREDFORSALE.IF,NOWFVER,THEBUILDINGORIMPROVEHIENTISSOLDWITHINONEVEAqOFCAMPLE� 0�% TtON,iHE OWNEfl-BUILDEfl WILL HAVE TME BUROEN OF PqOVMG THAT MF.OR SHE DID NOT BUILD OR �; IA�PROVE FOR THE PURPOSE OF SALE�. ❑I,AS OYMER OF THE PROPERTV.AM EXCLUSIVELY fqNTRACTM�WITH LICENSED CONTRACTORS /� �, TO CANSTHUCT THE PROJECT(SEC.7044,BUSINE55 AND PROFESSIONS GbDE:THE CONTR0.CTOH5 LI� V3II18(IOfI ��i CJti_'�"� ADJ.AREA_ W GENSEUWDOESNOTAPPLYTOANOWNEFOFAPROPERT'WMOBUI4DSORIMPROVESTHEREON,AND �' WHOCANTRACTSFORSUCHPflOJECTSWIiHACANTRACTOR(S�LICENSEDPl1RSUANTT07HECONTRAG QunNriTv DESCRIPTION FEE � TOR$LIGENSE UWJ. �. 0 U 1 AM EXEMPT UNDER SEC._____.. ____B.8 P.a FOR 7NI5 REASON , U � � _ _,_ _—_' _— . � �' �FTE OWNEfl__ ___ _ f' Z.. W �Q, LICENSED CONTRACTORS DECLARATION W CL'� 1 NEHEBV AFFIRIJ,UNDER PENALTY OF PERJURY THRT I AM IICENSED UNDER PROVISIONS Of CHAPTEfl � ��' B(COMMENCING WITH SEC110N 7000)OF DIV�SION 30F THE BUSINESS AND PROFES610NS COOE,AND Z IdY LICENSE IS M NLL FOflCEANO EFFECT. m ^� � � UCENSE CLASS �--�y _._LIC.NO. � I �4' � � ` �j DATE �I��""�, �' ��` _._ CONTRACTOR��F\���?_�.P3 a ll.f A �� WpRKERS'COMPENSATION DECLARATION ,1�%'L.��! � -� �(f,. CJ � V � IHERE6VAFFIRIAUN�ERVENALTVOFPERJUHYONEOFTHEFOLLOWMGOECLAMTpNS: ` r � v ' Q 0 �INAVEANDWILLMAINTAINACC-RTIFICATEOFCONSENiTOSELF-INSUREFOqWORKERS' _ COIAPENS�TION,AS PROVI�ED DY SECTION 37000F THE IABOR CODE.FOR TME PERFORMANCE U ¢ OF THE WOHK FOR WHICM THIS P[RMIT IS ISSUED. � � W 1 HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS NE�UIRED BY SECTKKJ Q A39oa OF TME LA60F CODE,FOR THE PERFORMANCE OF THE WORK FOR WHK:F1 THIS PERMIT IS ISSUEO.MY W�RKERS'COMPENSATION INSURANCE CARRIER AND POUCYNUMBENARE: CONS7RUCTION _ ___. �( � � ¢ CARRIER_._..�����• �t'� � PLAN REVIEW �r > — --- � POLICY NUMBER__._�.W U �l�lf t�' _ r �_� � ELECTRIC .Q (INU^SECTKWNEmNDTBECOMPLE7E00FTHEPERhYfISFOR�NEHIML%i[ODOf1AAS�51C0)ORLE55? P�UMBING _ Z 1 CERTIFY TH�T INTHE PERFORMANCE OF YHE WORK FOR WHICH THIS 7ERMIT IS�SSUED,I MECHANICAL (' SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SOAS TO BECOME SU&IECTTOTHE �/] WORKERS'COMPENSATIONtAW50FCRLIFORNIA,ANOAOREETHATIFISHOULDBECOME INSPECTION FEE ___ ��x`°'s� '°F r SU&IECT TO THE WORKERS'COMPENSATION 7ROVISIONS OF SECTION 37000F THE LABOR � CA�E.I SIIALL FORTHWITH COMPLY WIT rMose raovisioNs. ISSUANCE __ =Q 0 onrE:4�_.�f"�Z�� APPLICANT �L t;t?..i_���J(L f1-�`U`� = SMIP ---_. w ENERGY P/C J WARNINp:FAILURETOSECUAEWORKERS'COMPENSATIONCAVERAGEISUNtAWNL,ANOSHPILBE ---- � LL SU6IECTANEAIPLOYERTOCqIMWALPENALTIESANOCIVILFINESUPTOONEHUN�REDTHOUSAN� ENERGYPERMIT ' d � + DOLLARS(f100.o00).IN ADDITION TO7HE COSTOF COMPENSATION,DAMAGES AS PROV:DE�FOR IN --�-- � SECTION37aeOF7HELABORCO�E.INTEREST.ANDATrOHNEN5FEE5. RETENTIONFEE: ___ a CONSTFUCTION LENDING AGENCY PRE-ALT FEE: � I HERFBYAFFIRM UNDEfl PENALTY OF PERJUflY THAT 7HERE IS A CONSTflUCTION LENDING AGENCY n- FORTHE PERFORMANCE OF THE WOPK FOR WHICH THIS PEflA11T IS ISSUED(SEC.7097,CIV.G), Z W � LENDER'S NAME, _ — _ F-- LENDER'SADDflE53 _ __ � ICEflTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHA7THEA8OVEINFORIAAT10NISCaRHECT. TOTAL FEES ` W IAGHEETOCOMPLYWITHALLCITYANDCOUNTVOROINANCESPNOSTATEUWSiiELATINGTOBUILDING � CONSTiiUCT10N,ANDHEFEB�AUTHORIZEREPRESENTAiIVESOFTHISCWNTVTOENTERl1PON7NE ///��� (J y� � q80VEdAENT10NEDPROPERTYFOflINSPEGTIDNPUflPO5E5. � �J ! � /. ��IV/C�� �/✓�� Z COMMENTS �_ c+�. 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