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HomeMy WebLinkAbout10155 (5) ! - � - CITY OF DIAMOND BAR - '%'" � �! COMMUNITY DEVELOPMENT DEPARTMENT �:- i Zit�o E.cop��Y�;��su;u iso `i"- PRESS � (904)86Q3195 Fax(909)861-3117 r� '+"' EUILDINGPERMITAPPLICATION ' / FIRMLY o ADDRE �-��"!'7 �,J�lTi.`{ W47 APPLICATION /i4 ,�,� PERMIT P/C �„ �S� DATE �V I NUMBER � 1t � � APN LOT � TRACT DA EE CONST. GROUP p OWtdER � P o ADDRESS �}�iC) T�]M4�N C�'t-- i��1�1�i S� �c+� ZONING SETBACKS Z CITY '�MA�.��L ZIP� TEL. FRONT RW ❑ 8 APPLICANT �d�k C� s.c�,sd'S TEL. REAR D � SIDE/SIDE STREEf RW ❑ CONTRACTaR �6v�-T Ca�e"iC.Q7 S SIOE O Q ADDRES �i'�-- �"�ev.✓� f �+ff,"�t4-7/ ��ll,t/T$ � CITY S.V ZIP� TEL.�- t'� PROPOSED USE � >t�- W aRcwENa, A-ssc�, z DESIGNER � +-� � ADDRESS ' :►Il.,4.► v � � NO.DWEL NO. NO. y CITY�L�tr.wct. ZIP��� TEL.'�p hL�3+i'Y� UNITS STORIES BEDROOMS � DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION � OWNER-BI:ILOER DECLAAATION $�ADfllREM O 0 1 HEHEBY AFflNM UNDER PENAUY OF OEM/RY 7HAT 1 AA1 E%EYPT fRdA 1{IE CONfPACTORS LI- �gre�e� W CENSEUWFOi1h1EFd.LOWMlCAEASON(SEG.703t.5BU5tlNES51.N�PPOFES6bNSO0DE:ANYCINOR (J� � U pqJNTYWHIp1pE0UIRE5APEHIARTOCONSTPUCT.ALTEi�p.1PROVE.DEM�LISIi.ORREMiRANV57FUG W P8f�0/UBCk W TI1RE,PqIpN TO RS 155UANCE,ALSO REIXIIRES TI�APPIICANT fOfl SUCFI PERYIIT TO FILE�SIGNED W � STA7EYENT 1H11i HE QR SHE IS UCENSED PUFtSUMlT TO iNE PRDVISIONS OF CONTMCTORS LI- CEN&E LAW(d1AVTEH i 1����TM SECTpN 7m0)OF DIVISqN a BU&N1E88�ND Pi� u' P�P FE:SIONSCWE�ORTHATHEOiiSHEISEXE1dPtTHEREFiqMANO COH7HEALLEOEOEXEUV• (rJ VTION.ANY�/10L�TqNOfSEC�IONT091.5BY►MIAPP�IGNTF�i 1TSl1flJECT5THE11PPLIf•ANT70 Z {jq-{jpp+ � A CML VENALiV OF NOT 110PE 7HAN FNE MBdOREO 1.): � OI.ASOWNEROFTHEPROPERTY,ORMYEMPIOY 17NWAOE9ASTHEIqSOLECOMPENSATION, O (`,q}��fC181 MM3.90 THE WORK,JMI�THE STRUCTUNE IS NOT ED OR OFFERED FOq SALE(SEC.7oN,BU51- J NE63 ANO PROFE6SION8 CODE:TNE CONTR� LICENSE LAW DOES NOT APPLV TO A!1 OWNEP OF �'—n PROPERTVlN108U1LD50R47PqOVESTXE .ANOWNOOOESSl1Cl1WDRKNIYSELFOflMERSELfOfl m Q THAOAIONNI50RMEROWNEYPLOYEE$ EDT4tT5UCHWPNOYEElEMS�RENOTINTENO��OR QOFFEqEOfORSKEIF,FIOWEVER7HE ORMiPROVEYEM155(JLDWITTYNONEYEAH�OOMPLE- � TION,TIiE OWNER-BUILDEq MALL THE BURDEN OF PqOVMIfi 7HAT HE OR SHE D�0 NO7 BURO OR � WPPOVE FOii TME PURPOSE OF 6 ❑I.1150VMEflOFTHEP ENf1;J4AEXCLUSIVELYWNTP�CTMOWITNIJCENSEDCAHTMCiOR3 Q TO WNS7PUC7 TNE C (SEC.lOM,BUSINESS Ml0 PPOFESSKKIS OODE:THE OOMMCTOHS l}- VeiUet{(Ml �" ADJ.AREA W CENSEUWOOESHOT VTOANOWNEHOF�PROPERT'WFWBU�LDSORMPPOVESTHEREON.IWD � wNpca�rrucrs UqIPpOJECTSVATHACONTMCTOR(5)UCENSEDWRSUANTTOTHECONfRAP QUANTI7Y DESCRIPTION FEE roas ucEr+sE � ❑1 M1 IXEMOT UNDER SEF B.�P.C.FOR THIS REASQN U Q � DATE OWNER V U.1 �s{ LICENSEO CONTRACTORS DECLARATION w ¢ I XEHEBY�FiIfM1 UN�ER PENALTY OF PERNIRY TWU l AM LICENSED UfW ER PROVI510N5 0F CF4�PTER � � Y(R]IY�ENCING WITN SECTIOH 70001�OIVISpN 3 OF TNE BUSINES9 ANO PROFESSpNS CODE,M�Q � ��� MY L�CEN9E W^M FUIL Po MlU EFFEC7. � 0 LICENSE CUSS L1C.NO. � � j v wrE corrrw�croa a w � WORKERS'COMPENSATION OECLA.RATION � N I HEREbY AfFIRN IF�IDER PENPLTY OF FEMJRY ONE OF TNE RDLIOWING OECLAMTpNS: � , { � Q # 0 �_�IUVEANpWILLN�ITAINACERiIFICATEOFCONSENTT03ELF•INSUFEfORVYONKER3' 2 � C04vEN5IRION,AS PROVIDEO BY SECTION�7oU OF 7HE UBOfl CODE.FOR TNE PERFOflMNICE � � �TNE WOfOC iOR MMK]7 TM45 P£SW.IT IS 455UET/. � � W t INVE/W�WILI MAINTAM WORKER5'COMPENSATION INSUHANCE.AS REOUIRED BY 3ECTION Q �OF iHE LABOR COOE.FOR THE iEPFOMW7CE OF THE V70RK PoR YMICH 7HIS PERYR IS �j� ISSUED.MV NONCERS'00�1A+PENSATpN INSUMNCE CA�RPoER M1D POLICY MIMBERARE: CONSTRUCTION ,g! ��w� y CARNiEA S1�AJ'�t� ��lQN� �[ 'J . r :- . J�� �. �� � z POLICY NUMBEH �#1,.�� (�` EL 1a1C d Q Q (iF�43EcnoNrE�ra'reEm6�LEf�oFnEVEw.ri6tbqd�Mx�o�+�ootiMs�� opL68�. PLUMBINCa � ICERTIFYTHATMITHEPENFOAWNCEOFiXEM'OiMfOAWHICH 6FWITISISSUED.1 MECHANICAL I (�} SHALL NOT ENP�OV ANY PERSON W�NY MANNER 50 AS T E SU&IELT TO iME (/� WONKERS'COMPENSATIONUM/SOFCFLIFOFNtAANO EE TIFISHOUL08ECOME INSPECTION FEE -� �' + �`� '�} SUBIECT70TMEWOflKEqS'C04PENSATIONPimVIS SOF TqN77000FTHELA80R .fT Yrc. j O cooE cormm�nmcor.�virw�n+n+osev hS . ISSUANCE ° OOE . p D11iE: � _ APPLICANT: SMIP � � ENERGY P/C _��D���J WApNINO:FNLURETOSE REN�OWfERS'COYPENSATIdlCOVEPAGEISUNUWFlR,M�SNAl1.BE yi � �� �,�� � � SUBJECT AN ENPLOYEH TO 17i111MJ�L PENAL�IES M1D CML FINES UP TO ONE XUlANED TNWS�wD ENEAGY PERMIT OOlLAR3�f1a0,0o0�,W AODITION TOTHECOSTOf COLIPENSATION.DiWAGE5115 PROVIDED FOR IN aSECTION37aOGTHEUBORCOOE.OITEREST,ANDATfORNEYSFEES. 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