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HomeMy WebLinkAbout13575 (1019) CITY OF DIAMOND BAR (�� J� , DEPARTMENT �\./ OF COMMUNITY d�DEVELOPMENT SERVICES 21b60 E.Copley Drivo Suite 190 (909)860-3195 Fax(909)861-3117 PRESS �'�^'� BUII.DING PERMIT APPLICATION FIRMLY � � JOBSITE APPLICATION PERMR P/C o ADDRESS I��C7 vAtl�.Y viy-rA ' DATE NUMBER ���-. M� $ ISSUE TYPE OCC APN LOT�Z TRACT 3`� �� DATE � ��+ ��� CONST. GROUP p OWNER � ADDRESS 20NING F O�CKS RW ❑ � CITY ZIP TEL REAR p APPLICANT TEL SIDE/SIDESTREET RW ❑ � CONTRACTOR �- G. I SIDE ❑ ADDRESS 5� ��ov T �R A F � Cm'._(Z4�R.tGE�,GAZip Z (r TEL71�•974•�"R PROPOSEDUSE N UNpEp_4 1 Vo.►D �R1P'1� � ARCFVENG/ � DESIGNER NO.DWEL. NO. NO. = CIO�D/RESS Z�P TEL. UNITS STORIES BEDROOMS � <n , DESCRIPTION S�.FL FACTOR PSF ADJ.AREANALUATION pC OWNER-BUILDER D[CLAAATION I SFRIADD/REM O ' p i NEr�r�cFla�a u+oEA v�n oF vErwnr nuT i tiu�cEuvT vaoM nie can�ucrons u- Garege/Car�oA W CEHSEUWFORT1tEFOlIbWINOREASON(SEC.70.71.SBVSINESSAN�PROfE5510N4CODE:ANYCIT'OR (n �� COIMTYNRACHRE0U1RE5APERMiTTOCONSTRUCT,ALiERIMPROVE.DEMOl1:.H.ORREPNRMlYS7FiUC• uf �Z NRE,VRqR TO RS ISSUANCE.ALSO REOUIHES TME APPLICANT fOR SUp7 PEFMIT TO FILE A SIGNED W PatiolDeck � STATEMEM THAT HE OR SME IS LICENSE�VURSU�WT TO TNE FRONSIONS OF TH[CONTMCTOHS LI• � � CENSE UW IC}UPTER Y(CdAMENCIN�N7TH SECTION 7oD0)OF DINSION]OF iHE BUSINESS AND PRO- POOUSpO FE6510NSCOOE�ORTI/ATHEORSNEISE%E/APTiNEREFROMAND111E8ASI5GOR7HEALLEGEDExEMP- (� TIOH.ANYVIOIAiIOHOFSECTION7071.60VN/YMPIICMlTFOflAPERMiTSUBJ[CTSTMEAPPUGNTTO Z Re-Root � ACtY1LFENIL7YOFNOTMORCTI4NMEHUNOREDDOlURS�isW1.1: I ^ ❑I,ASOYMEROFiHEPROPERiY,ORMYEMi1DYEE5WITHW.IGESAiTHCIR50lECOMPENSATqN, O COmTBrCId1 � � W!LL DO THE WORK M1D THE STRUCTURE IS NOT INTENOED OR OFFEREO FGR 5/LE�SEC.70N,BU54 J � NE55 MA PROFESSqN3 COOE:ME CON7MCTORS LICENSE UW DOES NOi AGPLV TO AN ONRIER OF ? iROPERTY NR10 BUMDS OR IMVROVES iMEREON.M!D VM110 DOES SUCH WORK HIAISELF Ofi HERSELF OR � TMROUGHWSORHEROWNEMGLOYEES,DROVIOEO7HAi5Utl111AVROVEMENTSARENOTWiEN�EDOR CL� � OFFEREDiORSALEIF.FION�EVERTI�EBURDT140liM�itOVEUENTI55IXDWtTHiNONEYEAfiOFCON0.E- , � TION.TNE OWHER-BUIIDER N'ILL HAVE TNE BURCEN OF pqpVMp{HAT HE OF SME D�U NOT BUIID pq MP{10VE fOHhl[PURPOSE OF SAIEL w Ot�OWNEROFTMEGROPER'Y,M1E%GUSNEIYLONTMCTWOVnTHUCENSEDCONTMCTOR3 � TO CONSTRUCTTNE YR0.IECT(SEG 7oa,BUSINE55AND VROFE55ION5 COLE:IME CON7RACTOHSII• ValU8ti00 ZO �OUC� ADJ.AREA CENSE UW DOES NOT AVVLY TO M7 OYVNEH OF A PROPERTY KTq BUttDS OR IIAPROVES THEREON,MA � �MqCDHTMCTSiORSUCMGR0.IECTSN1iHACONTMCTOR�57LICEhSEDPUPSUNRTOTHECONTMG QUANTIN DESCRIP710N �E � TOfiSUCENSEUW.I. , .. . _. , O I AA/E%EMPT U1AER SEC. B.a P.0.FOH THIS FEASON Q ' U V" WTE OWNER U J � LICENSED CONTRACTOFS DECLARATION � W Ct IHEREBYAFFIR71lR10ERPENALTYOFVEMIRYTHATIAMIICENSEDUN�EROttOVIS�ON50FCw�PTER � � •(COMMENCMIOWITHSECTION70a0)OFDMSION�OFTH�BUSiNESSAI:DPROFESSKK:SCODE,MID Z X W IICENSE IS R7 iLIL FOFiCEMtD EFFECT. I m L1J ^_1 .�7 r � UCENSE CUSS��LIC.NO. /O Z'7_�_ � �'j DATE � •11 �9� CIXITRACTOR�����nf(� , d � WORKERS'COMPENSATIONDECIARATtOV ��a'�,,'��{" � —� NIHEREBYAFFlRMWtDERVENALTYOFVERIURY04EOF7HEFOLLOY/INGDECUM'10N5: "' V Z � _IHAVE/UAWILLI.UINTAINACERTIFlCATEOFCONSEMTOSELF-INSUREFMWORKERS' $ Cp,IPENSIITqN,A5 FROVIDED BY SECTKKI Tao OF iHE IABOR CODE,FCRTHE VERFORMANCE �U Q 7MEWORKFORWHIp1iHISVEN.��TISI55UED. 'I � I HAVE AND WILL 1AAIM.APl WOPo(EFS'COlAPENSATioN W SUMNCE,AS REOUIRCD 9Y SECTION Q a7oa OFTHE LABOR COOE,fOR THE PERFORAIANCF OF THE WOPJ(F0�3 KMiW THiS PEN.�IT IS n L� ^'��� � 65UED.AIYV7JRl(ERbS'C�dAPEN5AT10NIN5URANCECANflIERANDVOUCYMIM9ERARE: CONSTRUCTION L II ! I � cuwiEA �f'"��L'uT��'�3�AC. P��i• �� PLAN REVIEW �_7.�Y � POLIC'(NUMBER GEi�D� '�i ZB7 Z� i .t��,! � --� �' / ELECTRIC p (na55Ecnor+NfFnNoiBEoo�.stFiFDocnEaaa.risrLN7ohElu�DR[U R+0% �e^,$) PLUMBING v',l'�, C��) .'C- � I CEHTIfY T1uT W THE PERFOR/AANCE OF THE Y+DRK FOR WnICH TN'S PERMIT IS ISSUED,I M[CHANICAL l ���y �`'1•�� L7 SHALLNOT E�PLOY ANY VERSON N INV M.WNLR SOAS TO BECOM[SU&tLCT TO TH[ � MlOHKE0.S'COMPENSATION UWS OF CA:IFORNIA MID�CPEE TNAT IF 1 SMOUID BECOME INSPECTION FEE ��,�� "`�,1't� S SUBIECTT07HEM/ORKERS'COMPEM'ATIONPROVISiON50FSECTION17000FTHEUBOR ,-� , � cooE�s�uu coan�ni cour�r vnn� sE v �v� ous ISSUANCE .t.�\` " .��J' ��� 0 o�re: S�U ��9 APPLICANT.�� h^ SMIP � �'.`>' :,_:-' �. ��C� � ENEHGY P/C + lt:,��,,.} WAANINO:FA Wi3E TO SECURE NUR1(ERS'COAIPENSATION COYERAGE IS UNL4WFIA,AND SHALL BE ('� r�� � SUBJECTANEMPLOVERTOCRIIAWALVENALTIESANOCMLFMESUPTOON[Hl1NOREDTHOU5AN0 ENERGYPERMIT ``����`�v OOlURS�SI OD,000),IN ADDITION TO THE COST OF COMPFNSATION,DNdAOES AS PROVmED KOR�N .r_t SECTqN770eOFiHELA00HCODE,w7ERE5T,ANDATTORNEY'SFEES � RETENTIONFEE: ���' � � /x� Q - a CONSTRUCTION LENDING AGENCY ', PR - LT F E: O � IHEREBVAFFlRMUNOERPENALTVOFPE0.NRVTHATTHEREISACONSTPUCTIONLEA�WGACENCY FOR ME OERFOiiMANCE OF THE YVORK FOR WHIp17M15 PERMIT IS�SSVCD(SCC.�097,CIV.G.). � � LENDER51dM�E �S LENDER'SADDRESS `� ICERTIFYTNATIHAVEREADT115APDLICATIONANOSTATETHA7TIEABOYEINGOR11ATqNISCORRECL TOTAL FEES y{� ! !/`1 w IAOREETOCOMPLYWITIALLCT'ANOCOUNiYOR01NANCE3MtO5TATEUN'SREUTINCTOBUILDINO �� 1✓IX�.J � CONSTHUCTION,ANO NEREBY AUlNOHIZE REPRESENTATiVES OF THIS CWNTY TO ENTER UPON THE Z ABOVE-MENTqNEDVROPENTVFORINSVECTIONVURPO5E5. 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