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+�. [_� h � C
� 2a�P��-=-�.T 1n�1�l�-�-_�n...?
m PER EENAIAE(PRINT)
v_¢i �,,.Qy,.y.t�%� !� • �lp.'..•A-A�\. +���l `"c[ � • . � /��'i A� �" �ept,� �
= SIGNATUfiE OF PERMITTEE OATE
RECPi N0.•-� }�"� PAI�BY= ���-� VALIDATION _
~" WH17E—Oepanment Copy.YELLOW—Flnance Copy.PINK—Assessor Copy,GOLDENROD--File Copy.GREEN—ApplicanPs Copy
A � .� ,..; �_— � � � ,. �.. � � �_ �_ I�.j_..�.. _ i �_.� _ . i .._ � � ,_...i_ � .. , �
, . �. i ' ! =� � � � � ?�: . �� � .�;� � � _ � i ' i : �. � i �. . ( ;j�
,
m.� + �. I �,� , ; l
� I <: � I � � � I �, �� l i : I' - � �
, � �� � �.I + �� �: _ a I � , � - �_ i _ , 1 � �- � � �
� . ° ' E � ��. � � : � . � ; , � , _ , � � ; _�: ; � � C'- r � ,
,
� � � . ; ,i � � ;;, ;� � , � ; � �; ; , _ � � � �
, ,�: i i � .
.: - .... . ; �' � ' :� � � � � 1. _ � •a. , I i.
i j� ,: ; I i. � I � i I � � � I; I' `I. I ; I` _ `
_i � �
� � � � �_ � � _� � I ! f '.i -
�_ � i T; i � � �,: � I , � ' ' f � I
> i � { �) � � i i �: I �[ i� � �..� � ' �� �� ���; �� i
, ,
_ . � � ��� �" � � � ���� � �� ' j� i i i I , �: � � I � �
� � �
� I sl � � , � � � i � � ` I , ! �
� - - �- - a : � � ; � i .. � � i ,
j � � � , i � � � ' �! , � I
i ' 1 � ; � �� � � � � I i �. � ' � i �
i � � fll�� .� , � I 1 ., , ,, l , , i � � : � . � i ' ' � I I
1� a� ; 1 , ' � � i, i � r I :� I , � i
G
IU�G Q IO���' � � � I_;�" _I �'� f. i I•�. i�� _P � , �". i � . ' � � _� i
� � � , i �a�u�z el� ���i I ��i.��c�1 i I�� i. ;r�� �,: � ; i i j I ''i � ' E
� I � z��, ¢ wi Iz� � � i I � ' I � I I I �
� I z — �7 � u z � I ' : i ' � � i
� � irt .rr� o,alo w m c9 Ioi ��z �a .r i. �cn i�l � a,. i I ,; ; I � , f i , i ' I
t- rn ii o �. m� c�l I z�' a�o(s- � z ri a�z �I I � i � �.,_ � ' '
� f I i ` � I + I I ��
� �2 . . rn r- � �c ,� � a�il,u � f i � . � r
'� �A� �� y [[ � S S JI�'�- zl �IZI="� � W� ��. ~'LL''c11liF�- OEa'Oli��� � i � �::I ' � :� I � � ` � I
.�
�. � ' Q s � C;Iv�CIGiz ��L7 Z n �b < � � ��
, �: � �� ��a �O m�2 I `7I.w � �'� ,4 ���' �r.r � y, i I i ; ;
�'�� � Q�dILLlillf �.IiLI�ICO J,�I(� fJ J J J..P U J C� J ��J CL� �j I ,. . I ' ' . _ .'.
F;. `"' � p�Q .�.�vi�lu;��i ¢��iLiai:���IO CIC3i��O�ZIz �,��_��r"w w`7� : � .� . i_. j � .�i . . - E I
. �- � rizl�.� ��_ � z;2•u o�z;o o c� �. �:i_'�I� �' � , � i - � ` •i !
.: "' u_��I� .� ��u. � ��w�a � �lu.-�la. �� U��':��� 7 a� u.. L 0�,�., ...- , � -� '
� �--�-1-- �- ` -.f-... , �
a,. �-.� _1--��;_`--�=-� �-_ ��"�_' �-- � �--- ;:-i�---jL+ i � i i j: J � � � .� i l
� -+-- i' � � , I
.-� �: r� l � � � .I�� ; ' � I' �, . .i � { ' '�.�f �
���51. e ' j �I � I .-I��' '� � i I � I - I � Y � - �f I .I
� � � � - � L ' I �, �. � I I � � I i ( i 1 i� .� � + � _ �. ` �. ( !
.. � "" ..I. � i; � �, � � ��� ' �i �-i 1 3 � I� � � � � �� _ f �� �
� - � i� I h j! I �I� i I: , �I . i I � � � { i - I
, ;'r �. �: � � � � l . �.,� ; i ; , , , ; : k ''; � j � � , ;'
�,. I ,� I' I � ' I �: I i � .;; ,. , � � i
•: � � :� I � I' �t I �� ' i I i . ' i
,
� i;
� _ � I '� I_ � L�- ,�-1�� ,� -� � i .� I ,
r:,� ��i�: � �. �� ; � ��� � �.�.. i� �; I �� �, ��_� � I ..�� � i�_
�� � � . ; �1-.� � � .. , �_" i � �
c' ' � �� � ti � i�� � � � ;� ��� � 1i � . j � ��� � � �
� - � � � �� � —-
, � �- i �
�.' �' � ' ( ' � i � � i ' � , I i
` i ;� o
, �
` �
�
y: �� z zI I I� a l� �'U ��� ��,� c�� � I i � � ( �. I, ; i I I� �
� � �F- �i�l I ,,ui i z � t, � z w �I o.�" � ' t;�^.� r„ I � � �Y(fS !
V-� � m�� z��- � .� - ---a '�Ci z a [
.��y S I� W C E j!FI- Z' ¢ HIU�`�'C fli G��r[.� 4� �Y J l t-��.::I���I� �. � I � , I�) i
�� [J" J I� W �EQ ','L�y l:Jj4 1i1: ��'��G^�J tn � Z JIi�i7.�IF-iU � � , �Q I
�L ¢ U � c � w�W c > w .� �i I � z .'¢ �-. z�¢iw �: �.5� � ����� 'I- s_-
U�O � ¢ O u�;x c��. ���Y �u o.'�!�I cn ,�, '¢- h I_. O ui .� �...�'� i g��ca.;
;.� +rz a {v� � caixx#-lw�g� � a ¢, � a � c� x .u'a � I:.'..( �-- �,,
' m` >: � � a wl� �,ti c�3,i7 'S . _..e ��' r. a.'¢i� J 'j;r' � � 'n.u;
; a
t-I� :Ti �: I J i a;�.C��
O � F-,O � J � �i�IO� I-' �'� d�Gu �i ( i
�" � ' � u.t t-� � ��� tu �10 t7'I4 O c�10�� �e �•[ii ¢!ua LLi w�¢ �:zIL`Z i , !.t]W
_
�. � ��, tn�ii W�CS:Ul f- ��CL �i. Q 6'� � t�I 6:.1 'S 14J ��(� cn i!� L3 l� ti ty�ti i � �' � UJ[!� ..,...,::.....,. � ,-_..-,.-
��:..�___l�.1_._�.�._ _...._;:�.._ _ _.��_.�_ :_. .._.�._..__._. . A. ��.:.