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HomeMy WebLinkAbout14558 i ' � , � � _� __� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY dt DEVELOPMENT SERVICES I _ W y 21660 E.Coploy Drive Sirite 19� _. (904)860-3195 Fea(909)861-3117 PRESS ' �"�' � BUILDING PERMIT APPLICATION FIRMLY ! a DDR'ESS �"1 �S� �JeS 1T ILIU ��' ' r APPLICATION ' � PERMR P/C i � � SS E TYPE ER� i pCC ', i � APN LOT RACT DATE CONST. GROUP j p OWNER o ADDRESS (P ZONING SEfBACKS � CITY d ZIP ��7 TE � t + REAR RW p � APPLICANT���(1}�r��1 GlK3 t�EL id '-1 11 SIDFJSIQE STREET RW ❑ j � CONTRAC�O C SIDE ❑ g CRY 5— `a• ZIP Z ' TE 3��1�)S,__l.�i� PROPOSED US€ � ARCHJENG/ � DE5IGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q ONRJER-BWLDER DECLARATION �p�ppD/REM � O I HEPEBY AFFlqU Ul�ER PEN�1.N OF PERNRY 7HAT 1 Ml EXEIAPT FROIM1 THE OONTMCTORS it- GarepB/C81pOrt � L{I CEt�6EUNNFnRTMEFOLLOM�NCiRF�150N(SEC.7v31.5BU51t1E55M1DPibFES51ONSC00E:ANYGTYOR (f� . �J COUMYMM�d11iEOlAFESAPEFWRTOCONSTRUCT,PLTERkAPROVE,DEY0U5N.ORREPA7RANY5TRUC- w Z IlME,PWOfi 1t71T8 ISSUANCE,KSO pEp1lRES 7HE MPLIGAN�i FOq SUQi PERYIT TO FILE A SIONED Pa1i0/�BCk ��L BTAIEMENT TMAT HE OR SHE IS LICENSED PUqSUANT TO hIE PROVI510N5 OF iHE CONTMCTOR9 LI• W GENSE UW(GiAPiER Y(COYYENCM(i YVITIi SELTION 70WJ OF DIVISIDN 3 OF THE BLI3MESS�N�PqO. u' POOU$p8 FES8IDNSCODE�01iTiATHEORSHEISIXEYPTTHEREFRONNWTNE8A31SfORTHEALLEO�E%EMP• (� TqN.ANY VIOlAT10N OF SECTIqJ 700t.5 BYANY APPLICAM FOR A iEN111T SIAlECTS THE APPLICAMTO Z pe-Roof � A pVLL PENAL7Y OF NOT MOiIE iHM!FIVE HIXJDREO 00LUR5(i4n0).): � 04�aNNEqOF7HEPROPERTI'.ORNVEYPLOYEESNA7HWAGES►S7HEIRSOLECWIPENSATIai, ❑ �mmercial - YALI DO THE WOPo(AtA hIE 3TRUCTUqE I5 NOT IMEN�ED OR OFFEPEU WR SALE(SEC.7oN,BUSi- J lE64/J0 PROFES.410NS COOE:TME CONfRACTORSIICENSE UW OOES NOT AVPL.Y TO AN OWNEq OF = � PNOAEHTYY17iD0UMDSORIMPROVE37HEqEON,MDMRqDOESSUCHNK)RKNIySE(,iORNERSELFOR � 2 THIidIOMMI80RHENOWNEMPLOYEES.PROVIDEDiHAT3UC11WiFOVEMENTSAHENOTMiEfAEDOtt m �O OFFEf�PoR3KEIF,HONiEVERMENAtDIN(iOi1�WROVEMENTIS50LDNTfHNONEYEAROFCOMR.E• HO EVE � TION.�HE ON�MER�BUILDER WILL HAVE THE BURDEN OF PROVttM TXAT HE OR SNE D�NOT BUILD Di4 MIFipVE PoR 7ME PURPDSE OF LLLE]. ❑4 A4 M1RI�N OF7HE PROPEiiIY,AM E%CUISNELV WNTMCENO N7f1i LICEN3ED C�NTMCTORB � N WNSTR4GTiHE PROUECT I�C.7ou,BUSINE55 MID PROFESSIONS CODE:THE CONTPACTORS LI- ValuetiOn ADJ.AREA W CE)15EUWDOESNDTAPP{,YTOANONMEROFAPROPERlVW1108UMD30RMPROVEBTHEHEON,AND � wN000r+rFwcTswnsua+PAwecrsvnm�caarsuctonts���risEov�su�rrtron+EcoNrruc pUANTITY OESCRIPTION �E � TORSLICAISEUW.). �I AM D(EIIPT UHDER SEQ B.d i.Q FOR THIS REASON � U � 011TE ONMER � � LICENSED CONTRACTORS DECLARATION W J � W 1 MEl�9YAFFIRN IXAER PENKTY OF PENUNY THAT I AM LICENSEO UIY�ER PROVISIONS OF CH�PTER S i(COIMIENCNIO NTTH SECTION 70d1)OF DMSION 3 0F THE BUSINESS ANO PROFESSIONS CO�E,AND Z � � MY IICENBE IS W FU1 FORCE MIO EFFECT. a,A � � � UCENSE qJ1SS ��G~J�I' LIC.NO.� +�� � � U DATE CONTMCTOR 0 W = WORKERS'COMPENSATfON DECLARATiON " Q � IHEREB'/AFFIRMUF�ENVENALTYOFPEiWRYONEOFTMEFOLIOWINGDE TIONS: v . � �IIUVE.WWNIMAIVTAMACEHTIFlCATEOFCONSENTTOSELF-� UREPoqWORKERS' _ " _ . G�DMPENS�TpH,AS PROV�EO BY SECTION 37000F TME I�BOR E.FOfl THE VER w OF THE WORK FOR NM1iNXi THIS PERMiT IS ISSUED. � �, _I HAYE Mq W1LL IMMAM WORKEFIS'COMPENSATqN INSURANCE,AS REOUIRED BY Q 71G00F THE IABOR COOE PoR THE PEflPoRA1FNCE OF THE WORK WR WHICN ERMR IS 4 153UED.W (ER3'WMOEN$ATK1N INSURANCE C RIER AND POLICV N EPARE: ONSTRUCTION jG�aiqEq /� � � P N REVIEW Z ����-N—� ECTRIC Q 0 (n�ssEcnor+�wreEaor,st�oFn�a�rsFonnor�M�vo �s+ro)oa�ss� . PIUMBING W i cermFr nuT M n+e renr�rvce oF nie wonK wn wHkx n�u veFwrt ss i , MECHANICAI SHALLNOi EMPLOV ANY vER50N M!ANY YANNEN SO AS TO BE�E SU&IECT TO THE - . '!ir``s�'as (q NVRKERS'COMPENSATqNtAW5OfG41FOANIA,MlDAGREETHATIFISY/OULOBECDME INSPECTIONFEE - S SUBJECT TO THE W�DHKERS'COAAPENSATION PROVISIONS OF SECTpN]700 OF THE UBOp ' + -- cooe.isw�uFORnrvnrnco�.�Rrwi n�oseanowsan. ISSUANCE ! � � ^ '�`r1� �{.�-1�aL��A SMIP . p DATE: APPLICANT: �t ( � WARWNO:FA0.URETOSEWi�WOPo(ERS'C�MPENSATpNCOVEFUGEISUNLAwFlA.,ANDbHALLBE ENERGYP/C K'�{05 r ��' �y SIJB,IECTANEMPLOVERTOCNfiAMALPENALTIESMACMIFINE5l1VTDGINEHUI�AflED7}iWSNlD ENEFGYPERMIT i DOLLAR9�f100.0o�),WApDIT10NTOTHECOSTOFC04PEN5AT10N,0AM110E5ASPROYIDEOfORIN _, _ � SECTpN 37M OF THE LABOR CODE,M�ITENEST,AND ATTORNEYB FEES. RETENTION FEE: �� 7� Te i+ ` y��v•�A-.--�:' �� O CONSTRUCTION LENDINOA(iENCY PRE-ALTFEE: ��-TII��,+AY'��--T E-'""�""_"��� � INERE9VAFFIRMIRiUERPENILLTYOFPEFtA1RYTMATTNERE�SACIXd57AUCTiONLENDIN6A0ENCY Z FOfl THE PEAlORYANCE OF 7ME WORK W R WHICH THIS PERMIT IS ISSUED(SEC.90D1,GV.C.). L!] � LENDEH'S NNAE � IENDERSAIXlRE53 � ICERTIfYTfMiIIiJNEREADTMSMPLICAT10N1�NDSTA7ETUT7HEABOVFMiORM�TqNISCORRECT. 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