Loading...
HomeMy WebLinkAbout14261 (19) �� CITY OF DIAMOND BAR � DEPARTMENT OF COMMIJNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)86Q3193 Fax(909)861-3117 PRESS � ��N' � BUQ.DING PERMIT APPLICATION FIRMLY � JOBSITE ��^� � �/�1 ��� � /A K Qf\!� DATEICATION � �- �� NUMBER' v �!C Q ADDRESS J � i''t �V � ISSUE TYPE OCC APN OT TRACT DATE CONST. GROUP � OWNER ��j�tlY� _ _ ADDRESS�3 i'Zp ��r�IT b� ZONING SETBACKS Z CITY D!�'�'1(�m �i� ZIP TEL. REART RW f�7 � APPLICANT TEI. SIOElSI�E STREET RW ❑ a� CONTRACTOR (OJy . SIOE ❑ cC ADDRESS +% ' a'' `OpOSm USE L�p ' !y) � a CIN 'C�' A ZIP�J 77a1 TEL � s1 � ARCH/ENG/ DESIGNER NO.DWEL. N0. � NO. ApDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER�ECLARATION SFR/ADDIREM OQQ I HE/1E8Y AFFlM U1DER PENAITV OF PE0.IUNY THAT 1 MI E7(HAPT FHOM THE CON7RAC70R5 LI� G8/8y8/COfpoA Ll,I CENSEUWFORTHEFOLLOWINOREASON�SEC.7037.6BUSINESSANOPFOFESSIONSCOOEANYCITVOF (f� CJ OIXMffYWWpIREOlFRESAPEIiWTTOCONSTRUCT,KTERIMPPOVE,DEMOUSM,ORREMIRPNYSTRUG W patio/Dock Z iVRE,RRpil TO ITS ISSUMlCE,AL50 RECX11RE5 THE APPLICANT FOR SUCH PERYIT TO FIL6 A SIGMED �� STATFlIENT TFU11 NE OR SHE IS LICENSkU PURSUMlT TO TME PROYISIONS OF(�1E CONTRACTORS U- W CE115�tAW(CHAPfEH Y(COMNENCWO WITH SECTION lOW)OF OIVISpN 3 OF THE BUSMESS AND PRO� � PooVSpa FESfilONSCdOE�OpTHATHEOR5MEI5F%E�PTTMENEFROIJAN07NEB�S�SFOPTHEALLEGEDE%FNP• (� 2 TION.ANYVIOL/�TIONOFSECtION7a1t.68YANVMPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO z Re-Roof J� b� � ACIVILCEN�LNOFNOTM�RETHANFNEMINDREDOOLLARS(i500J.)� O �4��ENOFTMEPROPER�I;ORMVEMPLOYEESWIMWAGESASTHEIR50tECOMPENSATION, 0 COfTImerCi81 - Z WILl00 THE WON(,N�TTIE STRUCTURE IS N�T INTENDED OR OFFERED FOR SALE(SEC.70U,BU51� J y 11�5$NiD PROFESSIONS CODE:TME CONTR�CTORS UCENSE l�W DOES NOT�PPIY TO AN OYlNER OP � PROPEHfY WHp 9VpDS 09 NIPROVES THEREOH,AND WHO DOES SUp7 WORK HIMSEIF OR HERSELF OR (t TMNOUGHMISOqHENONMEM7lOYEES,FimV�EDTHATSUCH@IvqpyEMENTSMENOTINTENUEDO(i m W OFFEREOFORSALE.�F.FIOMIEYER7MEBLNlDIN60RIMPqpVEMBQfISSqDVATMINONEVE/�ROiWRIPL6 Z TIOl,TiE OMMERiVRDER YIILL HAVE THE BUR�EN OF PfiOViNO TNAT HE Ofl SHE DID NOT BUIfD OP = MIPROVE FONTHE PURPO6E OF SKE). O 1,/S OWNER OF T/E PROPERiY,M1 E%CLUSNELV COHTRACTINO WITM IiCENSE�CONTRACTORS �'` � TOODNSTHUCT 7HE PRO.IECT(SEC.70N,BU5INESS ANO PROFESSIONS CODE;THE CONTRACTOPS LI- g1118t1 ���[.o ApJ.AREA CEN9f UW DOE4NOTMPIYTOANONMEROFAPROPER'fYVM1iOBUILD50R 11APqOVESTHEREON,ANO MRqWNTMCTSFOIiSUG1PRQ1ECT5WfiTiIICOHfMCTOR(5)LICENSEDPURSUMlTTO?HECo11TMG OUANTITV DESCRIPTION FEE � ibAS UCEMSE U�W.I. �AM E%EMPT IRIDER SEC. B.8 P.C.FOR THIS REASON Q U LL � ta�t7e owr+E V � LICENSED CONTRACTORS DECLARATION —� � w IMEREBYAFF'INYUNDERPEH�LTYOFPERtt1RYTF1ATiAMIICENSEDUNDERPROVISqNSOFCHAPTER � � 0(COMlIENCRiO WITH SECTION 70oP)OF D��SION�OF THE BUSINE55 AND PROFESSIOfJS CODE,AND Z X MYLICENSE IS M7 FUAlFORCE N70 EFFECT. � LICENSE CLASS^�w C�'�+�� LIC.NO. Z C.� �� v a�re l 1— 3—� coriTrucToa�' . �J� `C�C o? � WORKERS COMPENSATION DECLARATION '3 l' � U � IHEREBYAFFlPMINAERPENAITVOFPERRIRYONEOFTHEFOLLOWIN6DECLAMTKKJS: (� a O 1l/�VEMIDWILLFWNTMNACENTIFICATEOFCONSENTTOSELF-INSUHEFORMAflKERS' _ CU4PENSATION,AS PitOVIDEO 6Y SEC110N 7700 OF THE UBOR CODE,FOR THF VERFORMANCE U a OFTY�WORKFOqVMICNTHISPERMiTI5155UE0. � 0 �_I F1�VEAMD WiLLMARfTA1N WORKER6'COMPENSATION IN3URANCE,AS REW�RED BY SECTION n 37000FTNELA80HCOOE.FOPIMEPERFORMPNCEOGTNEWORKWflWHICHTHISPERMI7I5 ISSUED.WWDRI(EA5'COMOENSATIONINSUFUNCEGRRIERANOPOIICYNVMBENAflE: CONSTRUCTION �Z F � 4 � C1IRPoEN P�(�f3E�/��4�/ 4 4'+ � VOLILW NUMBER ELECTRIC �� r�-��-•'v- � �ssEcnonr�mNor[+�ca,�tEtmoF�pEw�ts�atar�Manr�ooaurtsR��)a+��l PLUMBING W MECHANICAL �A1��� '�i1QO � 1 CERTIFYITUT INTFIE PERFORM+wCE OF TNE WORK FOR WNlqi THIS PERMIT IS ISSVED,I SH/J.L NOT EMPLOV M1V PERSON W ANY MANNER SO AS TO BECOME SUBJECT TO THE U (/� N'OPI(EPS'LOMPENSATIONUWSOFCAL�FOFNIA,ANOA6FEETHAiIFISHWLDBECOME INSPECTIONFEE 6UBJECTTOTHEVJOHKEP.S'CQAIPENSATIONPROVISIONSOF CTION3lo00FTHEUBOF cwe.isNw.co�mm�n�cor�v�rwminasePRovisiora. ISSUANCE ''� Y�FI3J':�Ar'`��r�AR � p DATE: t1-3-��Q APPLICANT: ��1—�I�'•��_ SMIP �3LLTTTD��=J�?`:TlSA�":'T'� � � ENERGY P/C WARNINCf:F�0.UPE N SECURE WORKERS'COMPENSATION COYERAOE IS UNLAY/FUL,AND SHALL BE � SUBAECTANBAPLOVEHTOCPoMWALPENALTIESANDCIVILfWESUPi00NEMUNORE0T1KK1SAND ENERGYPERMIT OOLL�RS(ilao.000�.IN ADDI710N TO 7NE CQST Of CpMPENSATION,�AMIIOES AS VROVIOEO FOR IN � SECTION 37oe OFTHE LABOR COOE,INiEREST,�NU ATTORNEY'S FEES. F{ElENTION FEE: pW., � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � O ¢ IHEREBYAFFI0.MUNDERPENALTYOFDERJURYTHATTHEREISACbHSTRl1CTIONLFNOINGAGENCY �- WHTHEPENWRIAANCEOFTNEWOHKFORWH�CNTM�SPENMITISISSUED(SEC.3oo�,CIV.C.�. Z W � lENOEWSNAME F— LENDER'SADORESS � ICERTIFVTUTIMAVEREADTHI3APPlICATIONANDSTATETMATTMEABOVEMlFORMATIONISCOFRECL TOTML FEES � d 1 AGFiEE TO GOMPLV WITH ALL CiTY ANO COUNN O{qINANCE3 AND STATE LAWS REUTING TO BUILDINO � CONSTRUCTION.AN�NEREBVAUTMDqIZEREPRESENTATIVE50F7H�SCOUNTYTOENTERUPONTHE ABOVE-MENTIONED PROPEf�TY FOH INSPECTION PURPOSES. COMMENTS � � ev� D""� � _ m PER4ITTEENAME(PRINn � ' �f i r .-�9 � SIONANREOFF ITfEE DATE � RECPT.NO. PAID BY VAIJDATIQN WHITE--DepaAment Copy,YELLOW�inance Copy,PW K—Asaessa Copy,GOLDENROD—File Copy,GREEN—AppliranPs Copy i "" �.,. "' iY�. ��i, Y": r. r..w^ � s�.`» ,a, , >.. . ... , . . ., , �e . . ... „N..'^�i �.�,�". �.,�����' , , -�;ai� s � .�� .. . . _ ?�`'..^ ,<.;*� ..,. ........ . .:... . .... .. .. . .. . . ._ . . , . .. . _ ; -. ,. , ,. � . . � _ .._ ..._ ' � .._ � . : . ; . . .._....._.. .._.,_ ...�.._ . ..._ ._ .. .. _._ __ _ ._ _ _,_ .. ... ._ ._. ......., , - r ... - ' �. �# ., ' .. ..... ._.._ ..__ _ . . .._ _.._.._ ... . ... . ........... . ._ ....___ _. . . _ .. .. . . , ,. , , � . . .... ,.., ' � ... _ .- ..:... �. . s N .. . . . ,_.. . _...... ..._... .......... ._.._.. . ._....,....._.._ -_._�_...._.._.. ._.___.___'._ ...�_..,... . ..._...._._..._._,..._._......,_ ._...._._.._.. . , . � , .J.,\ ... ..... .: ! � . . , .".,. � , � .. .'........ .. ___� ._ _ _ .. ... . .....q...... . .. . ' . _. ..... ...__.. ...._. ._ ...._....._ ...._. .. . ....... ...... _ . R... � I , . 1 1 e �... / � .f t� �� /'� . . . .�_... .. ... . ...... ', ' _ ... t -... ., .... t i . * .�I � : ���'n'",��, ` : �-1�,- , _..� , , , �. - < _ . i __ __. �.o,�. J'� ...._. . _.. _ . _. ...... � ,- .� . r_., �. � ... _ . , �., � , a _.. . . ,�,.—. ..., ... . ::.. r ' . ,i., , ;,..-.` .,.� �,. . .., , �.. . . . .: � .-� . .. ........ .. .._ .. ..... .......... } .,. � .-. '. �.. . , . - ..__.... .... j . . .. . . . ....._...___._ ._._. . ...._ .......... _ . ........._ 3 :. . �; ' ' � '' � �� ..._ _. _... - .___ ... . _.. ............� � .. .. .._... ........ ..... ... ... _._.. _..._ .:: . , ._ _ .. . _ ._... i �..:-. . :.. - . .... ,_. _;., : � , . .. .._.... .... .. ........._,._..._....... ......._ ...._..._.... . . . _. _.. _. ....,._.. . . . .... ... ......... .. i _ ._ _._. . ._...... � ..._.. .._..... _ . . ._ ... _. � .. : . . E , � . ._..._ ,... _..� ......_._. . ..._..._...� ._.........__ ._. ....... .....,.._ . . .... . .. .. .. . .. . .. .. ... __.. .. _ ...... .. .._... ..... . . .. __ .. � . �,,�,-�/���,�; . : _ . � . � � . . , , _ � _ _ � . . _: _ � . :' ... ..��.. ... ."_� _ . ". � ... . 3 ... . ... ...... .. .... ... ...... ..._.. . . _.. . .......... . ............. ..a i�/ � � '� . ...... ...... ...... .... 1 " `e!�--n ' • M v � � � � ! LL.1�P�� ti � � ..... . .... .... ....... ... .".. .. . ... ... ...... ..._. _ . .. ....... . . . ._... .. ... ...... ... ........ .._.. . .. ._ I .......... � -._ . .... . .. . . ... . .. .. ...... .__... .......... ...._... _....._.._ ......._ . . _.... . . ...._.. ..... _ .... .._ .... .. . ... _..... _.. __.. _... . . . . _.._....� ......... .._.. ..._ ._ ......... ..._............ .. .. ......._....... . .. .. ...,. ......... ....... ...... . .._ ..... ..,........_. .........._,........,. _.......... ....._. . ;.,,....�.. . . ... . ................._.,..,....... .._.._..... ...,.. ............._ .. . . .._...... .... .. .... ...._..... ......... .. .... ..............,......_.. .. ...,..... ..._.... ._.......... ......... .. � ._ . .. . ._.. ........ ......... .......... ........ .._._.... . . . ...... . ...... .._._ _ _. ....... � ....... ....... ..... . _. .................. . . . . � .. ... ._... .. . ........ ... . ...... ... .. ... ._.__. . ...._. ...... ..._... ........ .. ..._.... .. ....... ..... .... ..._.... .... ........ ......_ . ......... � . _a... . . . :.. ..... . � :�:.. . '�: ' ' �.. .. ... . . ..... .... .. ... ........ ....... .. .. ._.... . ..._ .... .. ......_ . .. _. .. �...... ....... ........ _. . _.... .. ......_...... . . ... . . . .._.. . .... ; 1 I _ . � .. .. _ ._ _ , _ ._ _ . . . . _ _._ __ . _ � s` . ._. .. _.,......... .. . _... .. .. ...... .. _.... . . ... .... ...... . .. ._._ .. . .. _.. . .. ._ . ...... .... .. � ' ....... . ......w.__.__. _,...... .. .. ... ........._ _...._. .. _..... ... . . ..._._,.. _._._.. ......... ....... . ..._ .. � i I