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HomeMy WebLinkAbout10003 CITY OF DIAMOND BAR ��-- COMMUNTTY DEVELOPMENT DEPARTMENT r � . 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 '�'� BUII DING PERMITAPPLICATIONI FIRMLY � JOBSITE APPUCATIO PERMtT /��3 #!C AODRESS � DATE NUMBER e� ISSUE TYPE OCC APN LOT � TRACT DATE CONST. GHOUP p OWNER ,���lY!C S ADDRESS +� C � ZONING SETBACKS � CITY ZIP�TEF;�O" FROPfT RW ❑ APPLICANT '�'�L TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ CONTRACTOR I .C. SIDE ❑ 0 A�R PROPOSED USE CITY ZIP��.TEL. 5� -C/-,��"� Z DESIGNER, �� �V�� �C N��G- Np,DWEL. NO. NO. d AODRESS a� Lb"T:�v i/'rui. UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTIQN SQ.FT. FACTOR PSF ADJ,AREA/VAlUAT1pN p� OWNER-Bt;ItAER DECLARATION SFWAQDfREM O 1 HEREBY AFFIiNA IN�EP PENILTY OF PE0.AINV TNAT I A4 EYFIIPT FROY 7HE CONfPACTOpS L6 .����� W CENSELAWPDR7HEFq.1.01NINGFE�SON(SEC.7ait.5BU5WE55AN�PHOFE55IONSCO�E:ANYCI7YOR (n V COUNTYMRi1QINEIX11iiESAPEAYITTOCOMSTf1UCT.AL7EFlIlIPfiOVE.DEYOLISM�ONRfF1JRAMVSTfA1G W PBtb109C1t � TUNE,PRqR TO fT&IS6UANCE.ALSO REOUWES THE APPLICqNT FOR Sllp1 PEfYIT TO FllE A SIONEO W .� 67ATFJAENT 7HAT HE OR SHE IS LICENSEO PURSUMR TO 7HE PFOViS1ON5 OG TNE CONiRACTOp3 LI- � CENSfUW(CNAPTER61�����THSECSION70WIDFD1Vl^alON30FTHE8ilSWESSMIDPHP LL PooUSpa FESSpNSCO0�0i17HA7HEOR3HEISEXEMPTiNEREFROMANDTHEBlSISFOPTMEALL60fiDEl�YP� � TION.ANV VIOLATKYI OF SECTION 10�1.5 6YANY APPLICANT FON A PEfd11T SU9JEGTS THE APPLICA/fT TO Z {�ROOf � A CML PENALiY OF NOT MORE THAN FNE HUNDRED DOLLARS(t50o)J: � ��ASOWNEAOFTHEPPOPERTY,UqMYE�PIDYEESVATNWAGE5A5iHEIR50LECORIPENSATION, O COrtIlIIBfCIHI yALI,p0 THE WOqI(AI�THE$TRUCTUHE IS NOT NiENDED OR OFFEREO FOii S�LE(SEC.7011,BU51- J NE54 AND PROFESSIONS CODE:THE CONTRACTONS UCENSE LAN!UQES NOT APPIY T�AN O�VNEq pf N PR�D6pTYWND8URD50Rd.1VROVE3711EREON.ANDWNODOE55UdiYYDqKWMSELFORHEfiSELFOii � 2 iHiqUGH HIS OR HEfl OMM EMPLOYEES,PROVIDED hIAT SUqI IMPROVFYENTS ME NDi MIT6NOE�OR m QOFFEPEDFDNSKEIF.NON�EVE�iTHEBUILDINGONNAPi10VEMENTI3301D1N1THWONEYfi�flOFCOMPLE Z TION,TNE OWNER-BU�LOER WILL H�VE TME BUROEN OF PFOVINp THI.T HE OW SHE DID NOT BUIID OR � wvnovE Fqi rNE auarosE oc sM.el. W ❑I.AS 01�MER OF THE PROPBHTV,AN E%CU1SNElV CONTRAGTM!(i WITH IICENSED CONTHAC70A8 TO CONSTNl1CT THE PRO.IECT(SEG.70H.BUSINE55 AND PROFE5510N5 CODE 7HE CONTRACiOHS Lb V81u9t1011 ADJ.AREA W CEN9EUWDOESNOTAPPLYTO�l10WNEROFAPROPEHTVWFIOBUMDSORYPQDVESTHEREON,MID � YMOLO�iTiUCT5FOR5l1tl7PiiO.IECTSN77HACONTMCTOR(5)LICENSEDPURSU��OiHECONTR�G QUANTITY DESCRIPTION FEE � TORS UCENSE LAW.). J 1 0 ❑1 FM E%EMPT UNDEH SEC. 8.8 P.C.FORTHIS REA..dN � � � ¢ ! 2 �u � DATE OwNER �` Z W G � LICENSED CONTRACTORS DECLARATION W '� � I HENF�YAFFIRM UNUEH PB�I�LTY OF VE0.IURY TIUT 1 NA IICFNSED UNDER PNOVISIOHS OF CMMTEH � � n � � 9(CO/WENCY/OWI7HSEC7�ON70C��OFDIVISIONJOFTHEBUSINE38M1DPROfESS�ON4CODE.ANO � �ax x� W UCENSE IS W FUU.FORCE ANO EFFECT. m . � UCENSE CUSS � 'I - ��c.rm. ��Z�� � Z ,,�,L a. .!;; � VDATE CONfRACTdi #LR� a W � � � WOHKERS'COMPENSATION DECLARATION Q � I HEPE9YAFFIPM IAiDER PENiiLTY OF PE0.RIRY ONE OG TME FOLLOW�NO UEQAMT10N5: U �' � Q f ��J G IHAVEANDWILLIMMITAM�CEflTIFICATEOFCONSENTTOSELi-INSUREFWIYMDRKERS' r � �1IIPENSATqN,ABPROVIDEDBYSEC710N91a00F7HEUeOH�DE,iORTHEPERFORNANCE U I DIf.1 . KIG�.S ' OFTHEWORKFORWHICHTNISPEXMITIS�SSUED. � 1 (�,S �J✓� � W ���UyE Mlp WI��MAtNfAW WO(tl(ER5 COIAPEN4ATION INSUfUNCE,AS IiEQU10.E0 BY SECTqN Q31000FTHELABONCODE.PoflTNEPERWRIAANCEOFTHEWOPKfOflWM�Q7TMI5VERM1T15 J ISSUED.MY WORKER.'Cd.�P SIRION INSURANCE�1 R�EN AND POl1CV MNABER ARE: CONSTRUCTION a CAHRIEH ��1� �v�T �� PL4NREVIEW Zpa�c.�.eEn 22-�� � - �D i E�cra�c � � � (Ik15gEC�plN�hqTgEpoFPLE7�OFhEpEpuIf6R7qp�7EHl�ppplAfiSRtoqoqt�sy PLUMBING Z I CERTIFYTHAT W 111E PEFFONM�NCE OF THE WDRK FOR WHICF/iH15 VERMIT IS ISSUED,I MECHANICAL (�} SM,LLLNDTEMPLOYANYPEPSWlMANYMMlNERSOAST08ECOMESI�JECTTOTHE � YNOPoCEfl3'(�MPENSATpNUW50FGLLIFORNIA,ANDAGREE7HRTIFiSNOULDBECOME INSPECTIONFEE SUBJECT TO THE WORIfER3'COAAPENSATION PROVISIONS OF SECTION]7ao OF THE IABON � CODE.I SMALL FON7MWI7N LOMPLY WI7H TFK7SE PROVISIONS. ISSUANCE �� ����..� � o �T � a p DATE: APPLICANT SMIP s-A'�it1 �. � �•.:.�� j J ENERGY P/C � WAPNtHCi:FA0.URETOSEWREMIORKERS'COIAPEN4A7qA1COVEFAGEISUM:AwFI1l.M�OSFUlLBE � � SUBJEC7ANE4PLOVER�OCHIYINPLPEWLLTIESAN�CMLFINESUP700NEMUfAFEDTI�W3MA ENERGYPERMIT ppLUqS(Stpp,ppp�pA Ap�ITION i0 hIE CAST OF COAAPENSATION,DAIAAQES AS PROVIDED fOR IN � SECTlON 370!OF TNE UBOR WDE,MIIFREST,�NUATfORNEYS FEES. RETENTION FEE: CONSTRUCTION LENDING AGENCY PRE•ALT FEE: � IHEREbYAFFlR1AlMUEHPEWILTYOFPERNRYTN�TTMERE15ACONSTRUCTIONLENDMWAGENGY FOR lHE PERFOtiM�1NCE OF 1HE W�FlK FOR WHCH T/IIS OERMIT IS i55UED(SEC.3oW.CIV.C.�. Z W cZ IETOER'S NMAE r M- LFNDERSADOPES3 WI CERTIFY 1W�T 1 WNE REM THIS APPL�G�TIDN AND ST�TE TMT THE ABOVE INFORUATqN IS OORflECT. TOTAL FEES � 1 AOREE TO Cd1PLV NMH AL.L CITV ANO COUNTV ON��NANCES AND SUTE LAWS HELATING TO Bl11lDiNG CONST�ICTION.ML HEREBY AUTHORIZE REPPESENTIITIVE3 OF TMS COUNN TO ENTER UVON THE � AOpYE�NTqNEOPNOPERNFORINSPECTIONPUPPOSES. 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