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HomeMy WebLinkAbout10516 (5) , CITY OF DIAMOND BAR P� ��t� ��p,��FO COMMUNITY DEVELOPMENT DEPARTMENT �C�' e (,909�}860-3 95 Fa�x(409)861-3117 ��1Q�� PRESS �'""� BUILDING PERMITAPPLICATION FIRMLY � �QSeT� APPLICATION PERMIT %'-�+� PJC o ADORESS DATE ' � NUMBER� r r � ISSUE TYPE OCC APN LOT T CT DA7E CONST. GROUP p OWNER "' ADORESS � ZONING SETBACKS G � z CIIY ZIP TEL. FRONT AW ❑ g APPLIC T TEL. REAR ❑ SIDEISIDE STREET RW ❑ � CONTRACTOR �� -/Y 4fI'ss.+�T SlDE ❑ Q ADDRE � Ct1Y �Q�'//�i1� ZIP TEL. PAOPOSED USE u�. AFCWENG! � DESIGNER NO.DWEI. (' NO. NO. � ADdRESS UNITS � STORIES 2-r BE�ROOMS�_ � CIIY ZIP TEL. � c� DESCRIPTION SQ.Ff, FACTOR PSF ADJ.AREANALUATION � OVYNER-BL:ILDER DECLAflATION SFR/ADDhiEM O Q I HENEBY AFFIRM IW�EF PEN�LTY OF PFMIRY THAT 1 All El(EMPT FROM 7HE CONTIUCTOp$l4 G8f89B/CB�Of� W CEN�UWFOflTMEfOLLOWINGFlER50N(SEC.7oJ1.5flUS�NE5SNIOPPOFESSKNJSCODE:M11'CITYON (,() COUNTYWHIp/HIEqU1RE5APERMITTOCONSTRUCT./�LTER,IMVROYE.0610LISH.OHREPAIRANYSTPoJC• �(f W TUHE,PRIOR TO RS ISEU�NCE.AI.S'O RCWIRES TME MPUGWT F011 SUCH PERYIT TO i1�E A$�p�D W PahOIDBG( . � ST�T�MFM TMAT HE OR SME IS LICENSED WJRSUANT TO TNE RimV1510NS OF 7NE CONTAACTDRS L4 � i � CENSE lAW�CMIIVTER 9(COWIENGING MH7H SECTpN 7m0)OF DIVISION 9 OF THE BUSWESS ANO PiO- POOUSp9 � FE93qN9CODE}pqTHATHEOH5HE15E%EYGTTHEREFHOMANDTHEBASISFORTHEALLEGEDE%EMP• (� TION,ANYVKKATqNOF5ECT10N7031.5BVANYAPPLICANTFORAPERY1T5U8JECTSIHEMPLICANTTO Z p9-Rpp} I � A CML PEWiLTY OF NOT MOi1E TNAN FNE HUNOF�DOIURSlS5a0),I: � ❑I.A90NMEROFTHEPROPERTY.O(iMYEYVLOVEE5W17NW�GE5A5THEIR50LEWYPFN5AT10N, � COIf1111BfG18I VAII DO TNE N�OiiK.MA 7HE SiRUCTURE IS NOT INTENDE�ON OFPERED KOF SnLE(SEG.70M,BUSF J y NESB AHO P110FESSWNS CODE TNE CONTRACTOR9 LICENSE WV DOES NOT APPLY 70 AN ONMER OF � , PROPEiiTYWN08UCDSORIYPROVES7l1EREON,MIDNMODOESSUq/WORKHIYSELFORHEFISELFOq � iNf10UCiNMISNiNERONME�LOVEES,PHOV1DE07N11T5UCHWPNOVEYENTSMENOTINlENDEppq m � OFFEflEDFORSILLEIF,FIO'NEVER7MEBUILDINGORNAPROYEYENTISSOIDWRHINONEVEAROFC(AJPLE Z TION,THE OWNERAUItDER WILL H11VE THE BURDEN OF PROYNNi hUT HE OR 9ME DID NOT BUItD Oii F � WPHOYEFOR/NEPl1fiPOSEOFSAI�. � ❑I,A90NMEqOiiHEPROPENTV,MIE%0.USNELYCONiRACTW�WITHLICENSEDCONTMCTORS (,W'[ 10 CONSTPUCT iHE PI�JECT(SEC.7DM,BUSINESS ANO PROFESSIOeLS CODE:7HE CONT9ACTOµ5l4 V8hJ8�10i1 AQI.AREA W CENSE lAW OOES NOT/�PPLY TO�N OWNER OF A PR�ERTY NTiO W ILDS Oq IMPROY�S THEREON,Aryp � 1M�OCOM1IT�'L1CiSFORSIKFlPRQ/ECTSNITHACONTRACTORjS)LICENSEDPUiL�UANtTOTMECONTMb OUANTITY DESCRIPT7ON �E � TORSLICENSEIAVI.�. t ❑1 AM E%EAIP7 UNDER SEC. B.8 P.C.FOR Tl1151iEA50N 4 � 3 U � LL 2 DAiE ONMER V � W F„ LICENSED CONTI3ACTORS DECU1AA710N W � �MEHE9Y AFFIPy�JOER VENALTV OF PERRINV iHAT IAId LICENSEO 11NDER PROVISIONS OF CHAVTER � p� •(COIWENCMIfi WITH SECTION 7000)OF pIVI510N 3 0F ME BUSINE55 MlO PROFESSpNS 000E,/Y� Z � MY UCENSE IS W FULL F E AND EFFECT. m � LICENSE CU '� LIC.NO.� � jJ U DATE COHTMCTOP f a W � � WORKERS'COMP€NSAT10 LARATION � .Il.�e � / a ���R..� � 1 NERE9Y 114 UNOER PENALTT OF PEf WPV ONE Of TME FOLlO`N�NG OEOJ.IUTqNS: Z /� /� t.r fra..� � _I/UVEANDWILLIANNTAMACERTIFlCATEOFCUNSEHTTOSELHNSUREF'ORNqRKERS' _ �ppIPEN5AT10N,A5PHOV�EDBYSECTIOM]�o00FTHEtABORCWE.FORIMEPERiORAAANCE �U Q OF TME YYDRN FOR MMKH THIS PERMIT IS ISSUED. ,� � r ��+5 W a _I HAVE 11tA WILL MI1p1TAM7'NORKERS'COUPENSATION INSUMNCE,AS REOUIpED BY SECTqN Q a7000pTh1ELABOiiWOE.fORTHEPERFORAIWCEOFTHEN'ORKWRWHIqi1HISPEWRIS ISSUED.MY YIORiC S'WMPENSAiION C�URMiCE CMWFR A/m PpLICY M1Ag1ER ARE: CON'u"TRUCTION 4 � �p ? c,�RRIER -. �1''L' � �1 �Li'•'f- PLAM REVIEW � °°��""iuun�-��i►/C � '-�� ELECTR�C € (M65Ecf�oMtE�hoTBEWtREr�oFnEPEwu�rs7�waJEH►�mt,wsls+UAaxLE�S} PLUMBINCa y' , i ' � O � � Z iCEqT�FVTHATNTHEPEPFOPM1INCEOFTMEWORKFORWHMAITHI5PE1WIT65155UED,1 MECHANICAL � C} SMALLND7EMPLOYANYPEFSCMWM7YMANNERSO�STOBEC011ESUBJECTTOTHE � WORKFRS'LONPRIS�710NLAWSOFCALifORN1/�ANDAGAEETHATIFISMOULDBECOME INSPECTIONFEE SU&IECTTOTHEWOPoSERS'COMPENSA NSKKJSOFSECT1QNataoOFiHEtABOq �j CODE. F rHcornvtv ovisaus. ISSUANCE I_ II��_� 7 O � Q pATE: �APPLICAMr: SMIP � ENERGY PJC WARWN6:i�&.URETOSEWPEWORKE0.5'COYPENSI�TIONCOYE SUMLAWFUL�ANOSHhIi.BE �y SlffiIECTAN E1W�OYEHTO CRNRU�L PEWILTIES MlD CML FINES U ONE HUNDRED TI/OUSAND ENERGY PERNpT pOLLAR3({7 oa,o0p�,IN ADDITION TO THE COST OF C04PENSATION,Dr1M�GE5 AS PROVIDED FOR IN ¢ SECTION970EOFTf/ELF9�NO00E.�NTEREST,ANDATTORNEY'SFEES. REjENTIONFEE: - � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HE(tEBV AFFIRM UNDER PENALTY OF PEMINY THAT THERE IS ACONSTRUCTtON LENORu3 AGENCV z WR THE PENFORIWICE OF 171E WORK WH WNI(7f 7HI3 PERMIT I5ISSUED�SEC.70Y7,CIV.C.�. I W � � IENDEN'S NMIE { F" LENUEPSADDRE55 � q ICE11i�FYTNAT�H,WEREADT115�OVlIG7pNM10STATETlUTTNEABOVEWFOfOAAT10NISCORRECT. 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