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HomeMy WebLinkAbout10558 CTfY OF DIAMOND BAR � , � ��p/� COMMUNffY DEVELOPMENT DEPARTME�� �C% , �O .,.W 21660 E.Copley Drive Sni[e 190 �J PRESS BUILDINGPERMI�TAPPLICATION jo�� FIRMLY %,�� � JQBSITE ,� �J APPIICATION '�� � � RERMIT /rJs4^� P/C o ADORESS /Z�°�� t7�V�-�� DATE ' NUMBER '�U 8 c� ISSUE TYPE OCC APN lOT TRACT OATE CANST. GROUP °� OWNER�'�� UI�I��N�4P,�' " ADDRESS '� i 20NING SETBACKS � C� _ �� .� � ., FRONT RW ❑ APPL�CANT 7�, �"� / REAR ❑ ! SIOE/SIDE STREEf RW ❑ � CONTRACTQR C�'��Cf � SIOE ❑ oADDR�SS ' 't� � s �F��/��- l/v.S' L ciTM rT"��J X� Z�Q TEL PROPOSED USE • t. o ARCFVENG/ „� � DESIGNER NiD.DWEL. NO. N�. ADORESS UNIT3 STORIES �BEDROOMS � CtTY ZIP TEL. v' DESCRIPTION SQ.Ff. FACTOR PSF ApJ.AREqNALUATIQN � � ONMER-BI:ILDER DECLARATION �q/qpDlREM O Q 1 NEREBY AFFlPY UNDEH PENALTY OF PERAIRY hUT 1 Mt EXEMPT fRdA THE CONTRACTOQS lb GBfBBB/Ci8fp0ll (JJ CENSELAY/FOHiHEFOLLOWINOREA50N(SEG.70.71.6BUSWESSANDVf�FE3310N3CODE:AMVGITYOR ((� C.7 �UMTYVMICHREOl11RESAPERMITTOCONSTRUCT,ALTER.MWROVE.OEMOUSM.ORf7EOMJfiNJY57iNG W Pario?Decic � NFrc,PIUOq TO ITS ISSUMICE.AL50 9EWIiifS THE APPIICANT FOR SUCH PEqN1T TO RLE A 51(�N�O � STATEYENT iHAT HE OR SHE IS LICENSED PUASUAMT TO TNE VROVISIONS OF THE CONTRACTOiL4 U� � CENSE LAW(CHAPTER 91���M111M SECi10M 7UM)oF OIVISqN 7 OF 7FIE BUSWE55 MID PR6 � PooUSpa - FESSIORJS COD�Oil THAT HE OR SHE IS E%EMPT TMEREFR04 AND THE BASIS FO(iTHE ALLE6E0 EXFYP• V TION.ANY VIOLATqN OF 9ECTIOPI T0.91.6 BYAHY MPLICANT FOR 11 PERYIT SUBJECTS TF�APPLICAM TO Z {�g.flppf r A CML PENAL7Y OF NOT NOfiE THAN FrvE Fa1f�RED DOLLARS(Ko0).): � ❑4ASOWNEROFTHEPROPEFTY,dINYEMDLOYEESWITNWAGESASTHEIRSOLECd1PENSATION, � (,`pmTBfCiel Will DO THE WORK,ANO THE STNUCTURE IS NOT IMENDED OR OFFEHED WA SALE(SEC.toN.BUSI- J WE38 MD pqpFESSIpNfi COOE:THE CONTAIICTORS LICENSE LAW DOES NOT APPLY N A!1 Oy�NER OF N PROPERTYMM1IOBUk�SORMdPpqVESTHEREON.A�NMO0�ES5l1CNNADflKHWSELFORNENSELFOP � � Q 7FiqOUd1 HIS OFl HENONM EYRLOYEES,PROVtOED THAT SUpI IMIPROVEMENTS MiE NOT NTENOEU Oq m Q OFFEREUFOR&1LEIF,FIONIEVERIMEBUkDIN60RNAPROVEMkMI550LDW17}IINONEYEAHOFCOYVLE• �� Z 710N,TiE OWNERAl11LOEA MIILL HAVE THE BURDEN OF PROVIM6 THAT HE OR SHE DID NOT BUIID Oq WPAOVE FOR 711E PUHP�f75E OF SAIE). I � ❑I,ASOWNEHOFTHEPROPERfI:ANE%CLUSNELVCONTRAGTWGWlfHLICFlISE�COHTMCTOflS TO CONSTRUCT THE PRQIECT(SEC.704/.BUS'NESS AND PROFESS10N5 ODOE:TME CONTNACTOPfi LI- VelU8t10n ADJ.AREA W CEN6EUWOOESNOTAPPLVTOANOWNEROFAVROPEflNMM1iDBU1LD50RMMROVE5T1E1�ON,AND � MINOWNTRACTSFORSUCHPROJECTSWITHACONfRACTOR(SILICENSEOPUNSUANTTOiHECONTRAG p�qry�7y DESCRIPTION FEE � TORS LICENSE IAW.�. ❑1 AM E%EMM IINDER SEC. B.1 P.4 FOR TH13 REA.40N U � � V" OATE ONR�EH V � LICENSEO CONTRACTORS DECLARATION � � � w I NEREBV AFFIlHA UNDER PHlAL7Y OF PERXIRV THAT I AM LICENSED Ut�ER PRON310N8 OF GUPTER Vr � 0(CAMMENCING WRH SECTION 7a06)OF OIVISION 3 OF THE BUSME55 MiD PROFESSqNS CD�E,AND Z X MY UCENSE IS IN FULL FORCE AND EF�ECT. m � ������U� t"3 ��.�. �-� ��t�� � V DATE�� � CONTfiACTOt�t W � WORKERS COMPENSATION DECLAFIATION a � 1 HEPEBV AFFIRM UI�EP PENALiY OF PEIWHY ONE OF T1�FOLLOwING OECLAMTIONS: U � Q � _IH�VE�NOWILIMMNTAINACERTIFlCATEOFCON3ENTTOSELF�IN3t1REPoRN�OPoCERS y �' COMPENS�TIdJ,A50ROVIDEDBV3ECTION9700DFTHELABOROD�E,WRTHEPERFORIIANCE C) OF TNE WORK FOR WMICH TM�B PERMIT 19 ISSUED. � � � _IH�VEANDWILLWMTAN7N�ORKER5C01.1PEN6ATIONINSUWWCE,ASREWI0.EDBVSECTqN d L=-; Q� 370o OF THE U.BOR CODE,FOR TME PER WRMIINCE OF 7HE WORN FON YVNIp1 THIS PERMIT IS s./ ISSUED.MY N'ORNERS'COMpENS��N INSURANCE CARRIER ANU POLICV M/MBER JU1E: ONSTRU jCARRIER PU.N REVIEW Z POLICVNUMBER ELECTR�C 4 � (fF#sSECfoqtf�HoiBE�MFLET�CFTEVEW�rtsaoFouElalAqiE000ulfi5tZ10�oRLE5s1 PLUMBING Z 1 CER7IFV THAT Ml THE 7ERFORIIANCE OF 7HE WOR1(FOA WHICN THIS PERMIT IS ISSUED,I MECHANICAL �j" SHAL�NOT EMPLOYANY PEPSON IN ANV MANNER SO AS TO BECOME SUBJECJ,TO THE � (n WORKERS'CONPENSATqNLAW50FCALIfONNIA,ANDAGHEETHATIFIS BECOME INSPECTtONFEE . ? SUBJECTTO THE N10RKER5'C0�17ENSATION PROVI$�Qt15 Of SECTI�1 77 OF THE UBOR /5 •�� E�� Wq7HWITry COMPLY WITH 11705E PR25VISIONS. � N� APPLICANP. �1� .� � � p DATE: � ENERGV P/C WM� :FAILUR TO SEWRE WORI(ERS'WMPENSATIDN COVEP 1.5 MAN�FLL.ANO SNMLBE � SUBJEC7ANEMPL01'ERTOCPIMMALPENQTIESANDCMlFWESU TO EHUNDREDi}1IX15ANU ENERGYPERMIT Yt� p0�UR5({1a0,000),W AODRION TO THE COST OF COMPENS�TION. ES AS PROYIDED FOp IN � SECTION 7/oe OF THE LA60i7 COUE,NlTEREST.AND ATfORNEV'S FE . RETENTION FEE: a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBY AFFIRM IFIDER PENALTY OF PEFWRY THhT THERE I8 A CONSTRUCTION LENDMO AGENCY 1 1 1� �} � � FOH THE PERfOR1A1�NCE OF 1NE WORK FOR WHItli TH�4 PEipA1715155UE0(SEC.309'7.CIV.C.�. . ���' Z �. . � W � LENDER'SFUYE H LENOER'SMORESS WICEHTIFYTHATINAVERE�07HiSAPVLIGTIONANDSTATETHATTHEABOVEINWRM�TqNISCORRECT. TOTAL FEES �� �y IAOREETOWNPLVVA�t1ALLCRY/�NOCWNTVORDWANCESANOST�TEUM�SFELATINGT09UILDING ��� �� CONSTi#JLiION,MA HEPEBY AURIORIZE REPRESENTIITIVES OF THIS CAUNTY TO EMER UPON 1HE � ABOVE�IIENTqN�PHOPERlYFORINSVECT10NPURPOSES. 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