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HomeMy WebLinkAbout10105 - C1TY OF DIAMOND BAR. � COMMUNITY DEVELOPMENT DEPARTMENT :.. ' 21660 E Coplcy Drive Suite l90 • PRESS (909)860�3195 Fax(909)861-3117 �'""', BUILDING PERMITAPPLICATTON FIRMLY y�, JOBSITE APPUCATION ��r PERMR P/C o ADDRESS ��� S . g � N DATE �!l// / NUMBER � N �7 /D� � ISSUE TYpE OCC APN LOT TRACT DATE CONST. GROUP • °C OWNER O � ADDRESS ZONING SEBACKS � CITY 21P TEL REAR RW ❑ APPLICANT TEL. SIDFJSIDE STREET RW ❑ � CONTRACTOR_D �S �FLf L�u►�l' SIDE ❑ o ADDRESS$Mn SOM�R5�7 � ��..GG S��N , c�rr PAR�1N,o�A.rr ZIP TEL. PROPOSEDUSE o ARCH/ENG/ . DESIGNER � ��►-�a � ' NO.DWEL NO. NO. . ..- a ADDRESS 7-n� � l. 1--(��_ �iZ�3 N CITY �� i3l�i.7�. ZIP�Q�Z.TEL.�I&�g4-'L��Uu. UNfTS STORIES �BEDROOMS cn DESCRIPTION SO.F1: FACTOR PSF ADJ.AREAlVALUATION p� OWNER-BI:ILDER DECLARATION SFWADD/REM O � I NEREBY AFFIRY UNDER GENALTI'OF PERRIRY THAT 1 AM El(EMPT FROM iME CONTMCTORS l4 GelBQeK.eryOR W CENSEUWFOFiTHEfOLLOWINGREASON(SEC.7071.6BUSWESSMACHOFESSION9CODEANYCITYOR (n U COUNTYNMICFIREOUIRESAVERMIiTOCONSTRUCT.KTERM�PROVE.DENOLISH,ORRERURANVS7fiUG W PatlolDetk � � TUR�OR1di TO RS ISSUANCE,ALSO REOUIRES iHE APGLICANT FOH SUd1 VERYIT TO FILE A SIGNEp W . � ETATEMENT TU1T HE OR SHE IS LJCENSED PUR6UANT TO 1ME PIIOVISIONS OF 7ME CONTMCTpRg�F LL � GENSE UW(GWTER 0(COMYENCN6 WITH SEC7IDN 7000)OF DIVISqN 7 OF iHE BUSINESS AND ORO� POOVSpA FESSIONSCOOEI��THEOH511EISE%EMPTTFIEREFPOAAN/OTHEBASISFOHTMEALLEOFDE%Ew• (� TIDN.ANYVqLAT1ONOF5ECilON70.71.6BYANV�PPLIGNTFORAPERWTSUBJECT5TME11PP�ICAHTTO Z pe-Rool � ACIVIL VENAITY OF NOT YORE 7HAN FIVE HUtJDREO DOLURS(i50o).): � OlA50WNEROFTHEPRODERT`/.ORAIYEMP�OVEESWITHWAGESAS7HEIRSOIECOMGENSATpN. � (�`pmmefCi91 � � M7Ll DO TNE MIORK ANO TME STPUCTURE i5 NOT 4lTENOED OR OFFEFED fOR SALE(SEG 70u,BUSb J N NE55 ANO VROFESSqNS CODE:711E CONTMC70R5 UCENSE UW OOES NO7 MPLY TO AN OWHEN OF j , , . PROPERTY MIFq BUILDS OR w1PROVES THEFEON.AND WNO DOES SUCN Nqi1N HiYSELF Oi1 NERSELF OR � THROIKHNISORMEROW1iEMPLOYEES.ORONOEOTHATSUGIMPROVEMENiSARENOTMENUEDOR m � OFFEREDfORSn1EIF,110WEYER7MEBNLpNOORIMVROVEMINT1550LDWfTKNONE1ENiOFCaMPIE• � � Z TION,THE OWNER�BULDER WiLL NAVE TME BUPDEN OF PROVIN4 71UT XE OR SME D�D NOT BVILD ON = MVROVEFORiMEPURPOSEOF5ALE1. . �l�ONNER OF THE VROPERTY,AY E%CLUSNELY CON7MCi1N0 WTTH LICENSED CONTRACTDRS � TO CONSTRUC'f TME VROJECT(SEG 7ou.BUSINE54 AND VROFESSqNS COOE:7NE CONiMCTOR4 LI� VeIUB�IOfI� / � AQ1.AFiFA - W CENSEUWDDESNOTAOPLYTOAN0IVNEROFAVROPERTYN?100UKDSORMP110VESTHEREON.7W0 � M7qCOMMCTSFORSUCMCROJECT9WIhIACONTMC70R(5)LICENSEDCURSUAN7MiMEWNTiIAG QUANTI DESCRIPTION � FEE � � TOfi5l10EN5E IAW.} � O I Au EXE4FT UN�ER SEC. B.t V.C.FORTHIS REASON Q L � 3 c' � � DATE OWHER U Z W 4 LICENSED CONTRACTORS DECLAAATION W K INEHEBYAFFWMUNDERVENILLTYOFPERRIRYTHATIAMLICENSEDUNOERVROVISqNSOFCHAGTER � � 0(COWENCnxiWRMSECT10N7000)OiDM510N70FMEBUSINE54AN0VROiE5S10N5LO0E.M1D Z �� MYLICENSEtSWFULLFORGEANDEFFECT. m � LICENSE CLASS LIC.NO. ��l V DATE � CONTAACTOH a W � WORKERS'COMPENSATION DECLAFiAT10N NI HEREBY I1fiIPA1 UNDER VENAL7Y OF PERNRY ONE OF THE FOLLON7N�DECUlMT10N5: Z � � _INAVEAlJD1MLl►UMTNNACERTIFICATEOFCONSENTTOSElFaN5U11[FORW�OW(ERS' _ COMGENSATqN,ASPRONDEDBYSECTON77ooOFTMELABORCOOE,FONTMEPERPoAMANGE w � OF 7HE WORI(FOiI WHICFI TMIS PERMIT 15155UED. � _I NAVE AND MnLL 1MMNN MIORNERS'COMPENSATqN INSURANCE,AS REOUIRED BV SECTION /+/ Q ]700 0f THE LABOR COOE,FOR iHE PERFOWd+1NGE OF T1E WORK iOR NM171C/i iN15 PEtWlT13 V J ISSUED.AIYNORKERS'COMPENSATpNp15URMIGEGARWENANDPOIICYMJMBENARE: CONSTRUCTION 1 p � cu+RIER _ _ PLAN REVIEW � 0 POIICYNUMBER ELECTRIC o �nassEcrcN��wreeaa.�rmaFnercwwrswAorErunr�000ukisR+�laat¢ssl. PLUMBING Z ICERTLLYTNATNTHEVERFORIAANCEOFTMEWONNFONWHN]/TNISOERAIITBLSSUE�,I MECHANICAL (S 51uLLNOTEIAPLOYANVPERSONINANVAI�MIERSOASMBECOMESUBJECTTOTHE y WOHNERSCdIPENSATIONLAWSOFCALIFORHIA�NDACHEETHATIF15/qlXCOECOME INSPECTIONFEE � � � S SUBJECTTOTHEWORI(ERS'COMPENSA7qNPRONSiONSOFSEG7qN770oOFTHEUBOR �, cooe,i stuu vartmwirn coMa�r wm+nase vnohsans. ISSUANCE O p WTE: APP��C,WT: SMIP �. � � ENERGY P/C +"�, ,► WAfWINO:FIULURE TO SEp1RE WORKERS GOMFENSATqN COVERAGE IS UNUWFUL.ANO SHALI BE � bUBJECfANEMPIOYERTOCRYNALVEtU1TtESANDCMIFNESUPTOONENUNDFmT11WS/Wp ENERGYPERMIT � OOLLMS If 100.0001.W ADOITION TO THE COST OF COMPENS�iION.DAMAGES AS PRONDED FOR W � 6ECT1DMl7aOfTNEU1BORCOOE.IN7ERE5T,ANDATfORNEY5FEE3. � � q�ENT1ONFEE: � - � OCONSTRUCTION LENDING AGENCY PqE-ALT FEE _ - . � IMEREBV►Gi1R611110ERVENAITYOF0E0..UHYT/UTTHEFELSAfDNSTRUCT10NlENDWOAGENCV • � FOA iNE FERFOR4ANCE OF 711E WORN fOR WMIC11 THiS VERu1T IS ISSUED(SEC.]oY7,pV.C.�. � � LE�IDfR'SNu.�E � � � LENDEHS►DORESS � ICERTIFYTUTIMAVERFJVDT/ISAPPIIGITqNANDSTATEiHATT1E11BOVEWFORVATqNISCORqECT. TOTA�.._FEES 1 � IAGREETOCOMPLVYA7NALLCT'IWGCOUN7YORDINANLESMIOSTATEUWSREUTPIGTOBU4DING ' . � CONSTRUCTION,ANDMEREBYAUf/qWZEHEPRESENTA7IVESOFiNISCOUNTYTOEHTERUPONTNE '�� � n`�.� '� � ABOVE•NENTqNEDVROPERiYFORWSPECTIONNIRPOSES. '� �J�,.�o�a •-•� o . 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