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HomeMy WebLinkAbout10234 (5) C[TY OF DIAMOND BAR /� COMMUNTT'Y DEVELOPMENT DEPARTMENT _ 21660 E.Copley Drive Suite 190 (909)8G43195 Faz(909)861-3]l7 PRESS BUILDING PERMIT APPLICATION FIRMLY � A�I� �� f3 DATE CATION � ERMIT 1C NUMBER O # �_ TRACT �E OCC ISSUE � APN LOT� DATE CONST. GROUP p OWNER LL ADDRESS ZONING SETBACKS 0 � C�1�' ZIP TEt. FRONT RW ❑ APPLiCANT TE�, REAR � � SiDFJSIDE STREET RW ❑ CONTRACTOR C� S��S SIDE � � ADORF,y�S.� �u`� CITY IDr7'w�..<< 71p�'p� 7�L PRQPOSED USE oARCH/ENG/ z DESIGNER W NO.DWEL / NO. NO. �a ADDRESS UNffS STORIES � CITY Z�p ��, BEDRdOMS�_ N DESCRIPTION SQ.FT. FACTOR PSF AW.AREANAlUA710N o OWNER-91;IlDER DECLARATION SFWADO/REM Q I MEREBV�FFIRIA U�Eq PENALN OF pEiWpY TFU1T I M1 ENEMPT Fi1pM TFiE OpryTRAC70F5 Lt- W CENSEUWFON7HEFOlLOWN�REASON�gEC.7031.5BUSWESSAMDPROFESSIONSCWEANYC1TYDq � �re���R CJ PWNfYWHIGIRFdIIMESAPERA11T7000N5THUC'f,ALTEH.MIPROVE�UE110lISH,ORREP4WANY9TNUG PetINOBf�( W NRE,PqqH TO�TS ISSUANCE,1LL50 REO�J�qE9 THE�PRICMiT GOR SWi PEtW1T TO FILE A SIONEp W � � ST�TEYENT TU7 HE Op SHE IS LICENSF�PVRSUMlT TO TFIE P�VISIONS OF TME CONTRACTOR4 lF .�, CfKSE lAW(CNqPTER 9(COM4ENCW(i WITH SECTKIN 7000J Of DIVIfiqM 3 0f TME BU5WES5 AND Pip. � POOU$PA I � FE9810MbWDE�OR�MATHEOR5ME13E%EMPTTHEREFROyANpTMEBAS�SWRTHEALlEOEDEXEMP- � TION.AMY VIOLATIOlI OF SECTION 7 W 1.6 BY�HV APpUf,AHJ FOR A PERYIT SUgJEGTS THE APPLICNli Tp Z �.A�pf � ACMLPENAL7VOFNOTMORETHANFNEF�{/I(UREDDOLLARS(f5m).): � 0 OI,ASOWNEAOF7XEPROPERTV.ORMVEMP�pyEESWITNWAGESAST/�ppSp�ECpyOENSAiqry, Q COTR1BfCiel Z MIILL 00 THE WORK,µp T}1E STAUCNFlE IS NOT INiEN�EO ON OFFEFED FpR SILE(SEC.7W,8US1. J N NES9 AND PRDFESS�ONS COUE:THE CONiqA07pRs��CENSE UW DOES N07 AV%Y TO,W pWNER OG PNGPERNVAI�BUILDBORYPROVESTIEREON,ANONMOOOESSUCNWONI(NILLSEt.FOqMERSELFOq � W THiKKMHHI50qNEqOWNEMPLOYEES,PqpV�DE�TFUTSUCMIMPROYEMENTSARENOTNTEMDEDOq m 0 OFFEREOIaRSALEIF.1bWEVEf�7HEBULOYJGOqWPR01rEMENii550LDW17fiINONEYEAROFCOYP�.E- Z T10N.7ME ONR/ERAUItDER M/ILL HAVE THE BURDEN oF PROVM�Ct THAT HE OFI SHE OO NOT BUIID Oq = MIPRWEfORTFIEPUflPO8EOF5ALEy W ❑I.AS ONTIER Oi rHE�ROPERTV,A1A E7(CLUSNECY CONlILtCiNMa WITI�CICENSEQ COMTMC70AS (r TO OONSTRUC7 iHE PFGIECT(SEC.70aa,BUSINE55 AND PROFESSIONS GODE:TME COIiTRAC70q5 U- V81118110l1 qpJ.qaEq � CENSE lAW DOES NOT MPLV TO AN ONMER OF A PROP[RTY WFIp BUMS OR IMPFq1lES 1Ti�qEON,AN� 1N�OCaNTMCfSFQqSIKMVpOJECTSWITHACOHfRACTOR(S�UCENSEOPUp$UAMTOINECONTRAG pUAMTITY DESCRIPTION TOilS 4CENSE LAW), �E 0 ❑I/JI EXEMVT UNDER SEC. 8.8 P.C.FOH THIS REASON a � U LL DATE OWryER 6 z V � LICENSEU CO.NTRACTORS DECURATION W � I HFREBYAfFIRN UNDEq VENALTY OF PEAJUAY TMAT 1AM LICENSEO UNDER PqOY15qN50F CMAPTER � � s(OOEVIENCMO WRH SFCTION�um�pF DIVISIOq 3�TME BUSMIESSIND PpOFE9yqry5 CODE,NA Z V.1 �L������ CE�jI�1M EFFECi, m � LICENSE�}S 'L IIC.NO.�_ � v o�re S I/ coNTrucroa a w � / WOAKERS'COMPENSATION DEClAAAT10N a _ � � N 1 HEFEyrA�FIRAI UNDER PENALTY OF PEfU1RV WE OF iHE WLLpN7Nf3 DEa11qATpNS: V C � r N � Z � � V IMAVEANDWILIAUMTIIINACEfifIf�TEOFCOHSENTipSELF•INSUREPORWOfiKERS' a CqIPENSAiION,AS PqONOFO BY SECnON 37oD OF 7HE1,1BOp CppE FOH TNE PERPoRAUINCE U OF hIE WORK iOR Nh11CH THIS VERMIT IS ISSUEO. � t � � � O , � _�.1 WIVE Mq VRLL M11MTI1M NK]iMERS'COYVENSATpry INSUPAP/CE,AS qEIX7�REp gy 9fQ7pp� Q 3700 OF 7NE L\BOp CODE,FOqTHE PEPipRM�YVCE OF THE WORK Fpp MMlql T}{t5 PEFUAIT IS lSSUEO.MYM�[t�(£R$'L�pM➢FHSATpNINS�A�URRIERAND➢tlL�CYNUMBER�qE: CONSTRUCTION i j CARHtEq UC+��K1%J�/�/�� / PtAN REVIEW � POLICYNUNBER,e/� ,Iry_L '�� Zd ELECTRIC � (fF6SEC1ONnf�No7eEW4PCEl�oFhEPEwfsroRouEM�o0.1N+sMODlaalfS4f PLUM81 W Z 1 CER7IFY7M�,t pt T71E PERFOPoUANCE OF 7HE NORY FOq WNICH 1HIS PEH417�ISSVfD.l M CHANI � CJ 9HAllNOTEM%.DYANYPENSONWINYMMINENSOASTOBE(nItESU9JE�77oiNE (n WOfqCEq5Cd�PEN5AT10NL�W50F �ORNI�,I1NDApqEETMATIFI5H0UL�BECOME INSPECTIONFEE ��- `-��'1 � SUBJECT 70 THE NqHKEFS'COMP TION PROVISlONS OF SECTqry 9700 OF TN[LABOR OODE, SFULL THCOMPLY ThpSEPROVISIONS. ISSUANCE o � p a.re: t /'�' S� nvapnrrr: sM�r w � WAtRIIlM FA0..UPE TO SECURE N�OP�fEA9'�pMVEN5ATI0N(3�VEMOE IS UNUWF1q,AMD 51U1LL 9E EMERGY PIC � SUB.IECT�N EMPLOYEH TO CRIMW�I.PEH�lLT1E3 AND CM�FWES UP TO dJ�MJNOq6D 7NW SMl� ENERGY PERMIT •±�r '" � DDLLAHS Ii100.0Eo�.W 11p�RION TO THE COSTOF CqAPEN5ATION,0�1A�GE5 AS PRpypED FOR IN $ECTION�7MOFiF1ELAgOqOppE.WTEPEST,�NO�T'f�NVEY4FEE5. RETENTIONFEE: � 0 CONS7RUCTIDN LENDING AGENCY pRE-AL7 FEE � � 1HEREBVAFFIRYlM1�EqPEN�LTYOFPEfWNYTMl1TTMEREISACONSTRUCTIONLENOKIOAGENCV FOR TNE iERiOPoiANCE OF TME WONK Poq N?NCN THIS PEiNAIT IS ISSUED(SEC.]OV7,CIV.C.). � � IEtDERS NAME � LENDER'SADDRESS �� "� iwa�Eroo�oTi.�iDir�"'EvnprHF'a°Lc'�rver+o�uT�onoTiww�siNosr�"r°EuwsREIAATWG'TO�DRIG TOTAL FEES tJ � a CONSTfiUCT10N,AApHEREBYAUTIK�RIZEREPREBENTATIyESOFTHISCOUNTyTOEMERUPONTHE �i AB�VE NTIONED PROPEN7Y FORINSPECTqN DURPOSES. � COMMENTS J d , !'....I � .z ��;n� � n ewuemwnn < y Cn F DATE � HECPT.FIO. _PAIO BY VALIOATION � b WHITE-0epsrtman!Copy,YELLOW—Finu�ce Copy,PINK—Awasa Copy,GOLDENROD--Fik Copy,apEEN—qppllnM�$rqpy _ _ � , , z�.l`�"'� � �'il��l���'•_ai� �/��? �����'�,a��i° .�.E,��>�''�� ' } �_ }' t ! - .v __. _ _-_._- o ��T�HC6. � _ I I ; �Lv.�R JvlS� a �i CS.;/rOf,'"tP�iS�i�EL �-._� f � I i=N�1 r,E Q;.S�S _�__�. `_.__�____._ _ _-•-. - -------- --;-___ . �L�C�itiC GfjOUf�O I � i UitiD�H FLQ�R DUCT i � � i -; � -1 -_-- t�„t;U�yU r LU,.'- .-. - ` � � I ._UIviDEFi F"LCOe�CU :(�Uil �----' � �'�417s''(� � _ _�._. __ ___- _ . --- _ _ -------------- ' ^ � , � ! 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