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HomeMy WebLinkAbout10581 ------ ---- --- -._. . _---�---- .._ __,_ . ._ __..____,._._,,,_... _---_,_..---- -- -- - E�CRf�i��_� - C1TY OF DIAMOND BAR ', "� ` ` , ' AU G �� l���t COMMUNTTY DEVELOPMENT DEPARTMENT .;,.� 21660 E.Copley Drive Suite 190, .; PRE$$ (909)86Q3195 Fax(909)861-3117'. ' ~"�'� BUILDING PERMIT APPLICATION FI R M LY o� JOBSITE �� APPUCATION„' � 3� � PERMIT• P/C��� v3D 'ADDRESS DATE NUMBER��_ M � ISSUE TYPE OCC . APN LOT TRACT DATE � CONST. GROUP p OWNER � C-�C� " ADORESS �� ! ZONING SETBACKS : �Z" CfTY •ZIP `�b TELZ-� FRONT " RW p g APPLICANT TEL. _. REAR ❑ � SIDE/SIDE STREET RW p � CONTRACTOR C2G ( SIDE p- ADDRESS PROPOSED USE � � CITI'L� I�C'1�1� ZIP�, ,TE'� ' Z' ' � DESIGNER 'C���d.�'f_301CL� I i _ _ � ADDRESS NO.DWEL NO. NO. • � CITY ZIP 7EL, UNITS STORIES �BEDROOMS N . OESCRIPTION SO.Ff. FACTOR PSF ADJ.AREANALUATION p� OWNEFi-BCILDER DECLARATION SFR/ADD/REM O p I NEREBY AfFIRA1 UNDER PENALiY OF VERAIRY THAT 1 MI E%EMPT FFiOM iNE CONTMCTORS l4' � G8fEQ8/Ca1pOR � � � � W GENSEUWFORiT1EiOlLOWNOPEA50NI�470.71.6BUSINESSANDVROFE5310NSt00E:ANYdTYOR (n C� COUNT7W1001REIX11RESAVER/AITTOCONSTRUCT,KTEH,MPfqVE.OEMOLISM,OHREVNRANVSTRUC• � W P8fI0ID0CII . . . • .... . . � TUi1E,PPoOR TO RS ISSUMlCE,A150 REOUIRES TME APVLICAMi FO{I SUQI iERMITTO FlLE A EI(iNED � STAiEYENT 7HAY ME OR SHE IS 110EN5E0 PURSUANT N THE VROVISIONS OF THE CONTMCTORS L4 W . . � CENSE lAW(CHAPTER�(CdAYENCINO WI711 SECTION 7000)OFDMSION�OF iHE BUSINESS AND GRO. LL' POOVS�2 . FESSIONS CODE)Oi1 TNAT HE OR SHE IS OfEMPT7HEREiPdA FNO THE BASIS iOR THE ALLE6ED E7fEYP. TION.AN'/VIOLATIONOfSECilON7Q�1.60YAN1'�PPLICNliFORAPERMITSUBJECT6TMEMMICANTTO � Z Ro-Raot � A CML iENKTY OF NOi MOiIE THAN fIVE MINORE�GOUMS(5500).k - � 04�.+`��EHOFTME7ROPERT`I.ORMYFMPLOYEESWIT1WAfiESASTMEIR50lECOMPENSATpf{ � COR1R1BfCl91 ' ' � � WIIL DO iHE WOHIC,N!D THE STRUCTURE IS NOT NI7ENDED p1 OfFEREO FOfI SALE(SEG 70I1,BUSF J � NESSAND PROFESSIONS OOOE:iNE CONTMCTORS UCENSE UW DOES NOT AFPLY TO AN ONMER OF � . . � ' pROPERTY NM110 BUILD30R YPRDVESTIIEREON,AND W11000E3 SUUI WORN W YSEIFOR ME0.SELF OR [L TMpOUGMHISORHEROWHEIAVLOYEEQVR�ViDED7HAT6Up/WPROVEUENTSAqENOTMENOEDM. . m � OFfEREDFOH9ALEIF,110WEVERiMEBULpNfiORIIAPRDVEMENTtSSOLDMATHNONEVEAAOFC01/PLE� � ' Z TIDN.7HE OWNEN�BULLDER 1MLL MAVE TNE BURDEN OF PROYINO THAT HE Oq 6HE WD NOT BUILD OR � MIPROVE FOR i/7E PUfiPOSE OF SALE► - '�i W OLASOVMEHOFTMEPf10PERfl;AAIEXCLUSNELYCONTMCTNOMrtTHLR:ENSE�CONTf1ACTOfiS . . . . � TO CONSTRUCT 1NE VROJECT(SEG)ON.BUSINESS AND PROFESSIONS COOE:7HE CONTMCTORS L4 VAluetlOfl AD.I.AREA � CENSE LAW DOES NOT AVttV TOAN ONMER OF A PROPERTY MRIO BUILDS OR MIVROVES THEREON.ANO � WIqCONTMCT9iOR4Ud10pOJECTSNfITNACONTMCTd1(S)LICENSEOVL70.5U�NTTOTMECONTRAG QUANTITY DESCRIPTION � ��FEE � � � � TOi1SL10EN5EUW.). . � O I AM IXE►�PT UNDEH SEG B.t P.C.FOR THIS qEA50N � u" DATE OWNER Z � UCENSED CONTRACTORS DECLARATION � INEREBYIIFFlRMUNDERPENALiYOFPEiWRVTHATIAAILICEN5E0UNDERPiqY1510N50FtMAPTER � � .. � � p� �(OOMMENCINO WITN SECTION 7000)OF DMSiON]OF TME BUSINESS ANO VROFESSIONS CODE,AND Z. X W LICENSE IS W FULL FORCE AND EFFECT. ' (� 0 UCENSE CUSS G-1�LIC.NO.��IOVf j V DATE S- 31-R�i � coKrr�croRXL��P�3i:CO. �; � _ w „ � WORKEHS'COMPENSATION DECLARATION S �,'��S � I HEREHV AFFlRM UJDER PENALTV OF PERIURY ONE OF iHE FOLLONnN6 DECUR+ITIONS: cn 3 S1G(._c[.�.� � 2 .:2-'0 � _IHAVEANDVALIMANTANACERTIFICATEOFCONSENTTOSELF-INSUREFORNONI(ER5 � Q CO1IVEN5AT10N,A30ROVDEO8V8ECT10Hf70oOFT1ElA80RCODE,iORiHEGENWiiYANCE OF TME W�OWC FOR MR11CH T1114 PERW T 61SSUED. � �INAVEANDWILLMAtl7TAINWOPo(ERS'COIAPENSATqNINSUHIWCE.ASI1EWIitFDBYSECfION � .� .. Q �70D Oi THE LABOR CODE FOH 1ME VERFORYANCE Of iHE WOR7C fOR WHldl Tl113 VEiWR IS •� ISSUEO.MVWORKERSL�DIAPENSATIONWSURANCECARRIERANDPOL`IC-V�NUA/BERME: CONSTRUCTION � GRRIER O �'1 � . LM!fi �L• v�'/ �� � fI I� � . � ppUpyMMBER � �2- • EIECTRIC . q ,20 � (ntssEcncwn�EmwieECd.RE�EooFTfCEaMtsinaoNE�+trtYiElnoalA0.aR�mloatF55� PLUMBING . Z ICERTIfYTMATWTHEPERFOiiMANCEOFTHENOPKFO(iWHICNTMISPERMITqIS5UE0,1 MECHANICAL (,�} SHFLL NOT EMPLOY ANY PERSON N M!Y MANNER SO AS TO BELOME SUBJECT TO THE � WORKERS'COMVENSATIDN UWS OF CALIFORNIA ta�E THATIF 13110U1D BECOME INSPECTION FEE - � �-� - S SUBIECTTOTHEWORICERS'COMDENSATIONi iSqNSOFSECT10N77000FiHEUBOR � '� �j�_� cao�,i swul coar�rvnn�canv�r wm�nas aohsaN , ISSUANCE � � � SMIP Z.O� p DAiE:7 39-�I7 APPLICMJT: � ENERGY P/C WAAMN6:fAILURETOSECUREW�ORKERSCdIPE ATIONCOVERAOEISUNUWFlA.ANDSWLLLBE , i"y 6UBJECTlJIE/APLOVENTOCRudWKiENALTIESANDCIVILFWE4U0TOONEHUNDREDTIqUSAND ENERGYPERMR _. �] � DOl1AR5(S1oo.000j,N l�DDITION TO THE COST Of COMPENSATqN,DA1M6E5/l4 PPOVIDED FOit IN _ � � �BECT1DN17oeOFTNELABORCOOE,NTEREST,ANDATTOiWEY9FEES. - RETENTIONFEE: � ��, J �� � � �� ` " nW. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � I HEREBY AFFlRM UNDER VENALiY OF PEfUURV TMAT TNERE IS A CONSTRUCTION LENOrM3 AOENCY �� ' Z FOfI iME PENFORA/ANCE OF 7HE WOPoC FORMMICH T/MS PERMIT IS ISSUED(SEG 10Y7.CIV.G�. � , W � LQ/DER'SNAME ' ' . • . . � LENDEH'SADORE55 '. �. . . . ._. . . . .. ... . ¢ ICERTIFYTHATIHAVEREADTHISAVPLIGTIONANDSTATETHATTHEABO'VEINFOMYA710NISWMECL TOTAL FEES - I ' � ,. / ��•�s, � IAOREET00011MYWIfHALLCITYANDCOUNTYOfiDINANCESANDSTATEU�MSREUnNOTOBUlDINO � � � � - � � � (� � � CONSTMICTION,AlOMEREBYAl1TNOR12EREPRESEMATNE3OFTWSCOUN7YTOEMERUPOHIHE ' '� , _ ' � ABOVE•IAENTIOHED ORODERTV FOR WSDECTqN VURVOSES. Q � COMMENTS � L. C`'ID�,I �' ; .. � ►ERWTTEENAME WW . . . . . . � . . .. � � �,` �. �, c� � a�.� i��' 7-31-`I7 ����� � � , ; ,,�,, �� N �BIONANIIEOFP ITiEE CATE . . . -- . . . .... '. ... E , �. � RECPT.NO. PAID BY �' � VAUOATION � .. ._ .. - YVFUTE—Department Copy,YELLOW—Finance Copy,PINK—Asasasa Copy.GOLDENROD—Flle Copy,GREEN—AppllcanCs Copy � � � i' � �t i � � . , :r�-,y'.`,g• . .r-.+.,xr.,':�n::•c�h r,r..r �:�v+.t..a .u. ,-.�u.z�i. ,�.. ... ... - � j' r� l ri�i•..� • � .. '^h,i 7�.ti'.:�,j�'hf wh11147�.":•�r��..12=�.a�n "'h,4k,���� ••rls.l+.!i... . . . . , .. 1'. . . �:c�.:�e.�. . �f'.��. � . CITY OF DIAN90ND�[3i4R�`%"'��'` r�{� , _�'�•�� lr� ,i� a�., J_ .�: .iYT[: '1) _.__ '��/�I, ��(�'r ^:"...;. . INSPECTIOI�! RECQRD �`'•��'`,'';`.:i`c:;;,�: � ..,;� �� ,.. . ,�,. , :��.� ;r_-_ . ,��•� ��� �� +,� ..., .. , 1,�?: ''.JJ.!','1:.'(L' .:I" . 1,;1_`. .I:i `'`. �c; t�lrll�.�.a^`C�►_A��i-L�"_t i��J�� K A� � �J.T.I� ,.- :1'�:, I �.C�J����� O �.�*�, 1! r�b '= :�•i� t�'����� .���,�.1����.. 'c;. 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