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Home My WebLink About12701 (6) } . . . . . . .. . . . .� CITY C1F L7IAMOND BAR ��C3�� -- 17EPAEtTMEN"I'QF COMMUNITY 8c DEVELQPMEN't'3ERVTCES f� :� 21664�.Capley DriveSuite 190 t�as�o-s�s�sp��i.�ii� �� 0 9 2UO3 PRE�S :,;�°�� $u[t.nnv+��vta�r a�►�.Ic�TTaN FIRMLY �� .�OBSITE � � +��p �,g A,PPLICATION �y�p PERMIT t PIC �.�,�(/ �gLSRES3 .d�.+��`.-i—��-� �'f.--- t+Pt3�� DATE�'��.�+�'{}NUMB£�t I�� - f/� I � DATE�. ��•-"�..`T' f C3 CONST.� GRdl1P APN �QT i'RAC'f_ I p OWNER __ ,��`�� AFLIRESS "��r•-��^°"�-�6��.��,�^ ZONING FRflNT K� RW ❑ � CITY ��1� ZIP��,___f�TEL. � REAR p � APPUGAI+lT SL �,:� SIdE1SIi3E S7REET RW ._ ❑ d � CAN7RACTOR �1�'i�'-�`� SIDE � � AdDRESS� �� ,�� '� CITY_ Z1R TE�. I�R4PQSE0 U5E W P.RCHt�NG/ _- � PESIGNER NO.DWEL. M4 . � ��----- � ADdRESS UNITS � � CiTY ZIP_,, 'fEL. STDRIES BEDRQOMS �n DESCFiIPT10N SQ.FC. 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W �;�j��(��'('��Y�T�ATi � LENDEa'SNAME ,,,,_, �VA�.Lr�i�`Sl\'l,�i�47��Tk.Y' _ H LEM�EFY9pDDqE55 �.G �}- C r ICEH'<<FYTHATIFIRYEREPUTH45APPUCAT10NqN�5TATETHATTHEpBOVEINFORMATK7NI5CARqECT. `QTAL r�C� j j j"�� IA6HEETf?CpMPLYW3SHAI,LG"fYAN�CCXJMY07i�IrypNG�SAND$TATElAWSRELATINGTOBU3LpIWG J E �..�. � GY/NSt7�UC-tFON,ANDtiEFSFBYAttTI�IaRiGEHEPAEb"EM'ATIYES6F9'HISCCUMYTC}FNYERt&pNTie. lIF� ) � Z A60YE�MEMIONF�PRC7PERTY FOR INSPEGFION PUpPCtSE5.. f � � ________��t�?��4+P�`l�� 'I COMFAENTS � . .� � .. � � � .... ..... m PERkiR7'EENAMEiPRiNT} . Q _..... .... � � � � � SIGNATUPEa pp '�''�''�'� �—��`"'''��'�� 2� A RECPT.Ni?. -� PqIQ BY �r ..�;•� yqL�pAT30N ! +� WHiTE--Dapartment Cz�py,YEL4t7W—Finance Capy,PkNK—,0.sseSsor Gopy,GOLDENR(7D--File Copy,f3RF_�N--Applicanf's Capy °`��,`�`p'��^�:�,_, � � _ � � °�� - � �.i�� . S 4 .i i��.' . . . .. . � � � � � � � L s � ` i)C_i,�tti��6R t '., „�, . � � . . . 4��ilVtl.3�l�� .. 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OLASOVMEROFTHEPROPERTY.AMEXCLOSNELY TO W Z Q O W Z CONSTROCT THE PROJECT (SEC. 70K BOSINE55 h H pN1 SENSE LAWWESNOTAPPLYTOANOWNEROFAPROPE O J WHOWNNRACTSMRSOCH PRPIECTSWTHACONTRAC 7R IMPROVES THEREON, J 5 TOPSOCEN LAW). AND z PORSOANTTOTHECONTR.AG AM EXFIIPT UNDENSEC. FOR T HIS MILE OWNER v. z x w LICENSED CONTRACTORS DECLARATION I HEREBYAFFRM UNDER PENALTY OF PERJURY THAT I PM LICENSED UNDER PROVISIONS OF CHAPTER e (COAIMENCINO W1TH SECTKDN 7000) OF DIVISION 30FTHE BUSINESSAND PROFESSIONS CODE,AND UYUCENSE IS IN FULL FORCCEAND EFFECT UCENBE-5 LIQNO. WORKERS'COMPENSATION DECLARATION v.3 F I HEROYAFFIRM UNDER PENALTY OF PERIURYONE OFTHE FOLLOWING DECIARATN7NS_I HAVEAND WILLMAINTAIN ACERRFICATE OF CONSENTM SELF-INSURE FOR WORKERS COMFENMTKM.ASPROVIDEDHYSECTCN37COOFTHEVEORCODE,FORTHEPERFORMANCE OFTHE WOW(FOR WMCHTHS PERMIT IS ISSUED. I HAVE ANO WRLMAINTAIN VIOMEN/COMPENSATION INSURANCE AS REQUIRED BY SECTION amaOFTHE LABOR CODE, FORTHE PERFORMANCE OFTHE WORK FOR WHICHTHIS PERMITIS BELIED.MT V-PKFAS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBEFARE: POLICY (ReBSLCTIMr&EOrvorREmMPLETEDOFTHErwmsP,oRMEwwREDOOUARSR1DnoRL-sl.l CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHIM THIS PERMD IS BELIED.I SHALL NOT EMPLOV MY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TOTHE WOWETS'COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD BECOME SUBJECT TOTHE WORNEPS COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR NDE.I SHALL FORTHWITH COMPLY WIN THOSE PROVISIONS. DATE: APPLICANT: WARNMG FAILURE To SECURE WORKERS CCRMPENGATION COVERAGE IS UNIAWFUI.AND SHALL, BE SU BJECTAN EMPLOYERTOCRIMINALPENAME.A.mCIVI LFIN ESU PTOM EHUN DR EDTHOUSAN D WUMS IFDJ,OCOL IN ADDITION TO THE CJSTOF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 370.OF THE LABOR CODE.INTEREST ANDATTORNEYS FEES. CONSTRUCTION LENDWG AGENCY I HEREBYAFHRM UNDER PFNALN OF PERJURY THAT THERE IS ACCNSTHUCGICN LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH I'S PERMIT IS ISSUED(BEG 30.7. CN C.). LENDERSADDRE55 CERTIFY THAT I HAVE READ THIS APMCATKM'AND STATE THAT T NEABOVE INFORMAMN IS CORRECT.AGREEM COMPLY WRHALL CRY AND COUNLY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HERESY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE AVWENENTONM PROPERTY -aFOR INSPECTION PURPOSES. „pp PERMITTEENAME(PNNT) UMBER SSUE TYPE OCC ATE I'R'Z'A/S CONST GROU P ZONING seze�cKs RONT RW 0 EAR 0 IDFISIDE STREET RW O IDE 0 ROPOSED USE M4'IJW fA�I'/�;f�Y 1 ; 7 O.DWEL UIf N. 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