HomeMy WebLinkAbout10231 - CITY OF DIAMOND BAR COMMUNTfY DEVELOPMENT DEPARTMENT 21660 E.Copley Drive Suite 190 (909)860�3195 Fax(909)861•3117 PRESS '""'� BUII.DING PERMIT APPLICATION FI RM LY < DDRESS 2- I S, h APPLICATION 7`C,�j� PERMR � �� p � I� p DATE ��'� �NUMBER N g ISSUE TyPE p�C APN LOT TRACT DATE ' ' CONST. GROUP p OWNER ls O t_ QO "" ADDRESS—_'�2oO v�1ow, F'�-�1►.t_Q1ud 20NING SETBACKS � � CITY � ZIP�l1'164- TEL.gb°► `�-84 38oZ, FRONT RW ❑ � APPLICANT } S t�.JG�R TEL,�i�A4z-Xv�y- SIDEJSIDE STREFT RW O CONTRACTOR �L� l SIDE ❑ p� ADDRESS I 4-�c{-� f�,'L�S�f-P-�� C'r � CITY1/r4�i�s_ ZIP�1,�fio1 TEL � 3 PROPOSEDUSE �A1GlI1�A.1T S��►�1 (�f�L�O o ARCWENG! /I —ll�t.�_r��N T�..D � DESIGNER ,/�t � S F�r. NO.DWEL NO. NO. ADDRESS 1e'1 W._�AIAM A r=-�2n4 , • � CfTY,.(3u� le.�,...� ZIP��]IEL _ UNITS STORIES BEDROOMS cn DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION � OWNER•B�ILDER DECLARATION � SFWADD/REM O p I MEREBY AFFtRM UNDER VEtULTY OF PERA/RY T11AT 1 AH E%EMPT FROM 7HE LONfRAGTORS LL � G.re�6K.•�1pOR � CENSEUWFOfl7HEFOLLOWNOHEASON�5EG7071.68U5ME55ANOPROFE5510NSCODf:MlYpTYON COUHiYNMIp1REOUIRESAVER/AITTOCONSTRUCT,KTEiIMVROVEDEA10U5FtORREVAIRANYSTRUC• W PBIiOlD9dc NRE,CRIOR N RS ISSUM/CE ALSO REWIRES THE AVPLIGWT FOR SUCH VERMIT TO i1LE A SIGNEO W BTATEMENT 71UT HE OR SME IS LICENSED VURSUANT TO THE iROVIS10N5 OF THE CONTRACTORS LI• � CENSE Uw(CMAPTER Y�CdAYENCwfi NATH SECTiON 7000)OF DMSION 7 OF TME BUSk1E55AND PRO- V' POOVSP9 ' iES510N5WDE)ORiHATMEORSHEISEMEMPT7HEREFiqAIANDTHEBA:.ISiORTMEALIFOEDEXEMP• C7 TION.AHYVIOIATqNOF6EGT10N70]1.SBYANYAGPIICANTFOHAiERYITSVBJEGT5h1E11PPUG/NiTO Z Re-Roof F ACMLVENKT70FNDTMOHETWWFNEMINDREODOlUR5�f5o0�.�: OIASOMMEROFTHEPROPERTY,ORYYEMPLOYEESWIiHWA0E5ASiHEIRSOLECOMPENSATION, ❑ Commereial � �' YVILL DO THE WORK.MiD 1HE SiRUCiURE IS HOT INTENOED OR OFLERED FOR SALE(SEC.7W�,BU51- J ' � NE55 AND ViiOFE55�ON5 COOE:TME CONTRACTORS LICENSE Uw OOES NO7�VVLY TO MI OWNER OF � OROVENTYMII/OBULDSOiIIGVROVESTIIEREON,MJDYF1000E55UC/1YYORNHIMSELFORHERSELFqi - � [C T1i10U0HHISORMER01M1EMPLOVEES,PRONOEDiNATSUCHWPROVEMEMSAREHOTWTEHDE00R m � OFFENEDiORSALEtF,FqNEYER7MEBULOwGORMPROVEMEMI55OlDVnTMx10NEYEAROFCOMPIE• Z TION,TNE OwNEHAUILDER WiLI MAVE iME BURDEN OF PfiOViq iMA7 ME OR SNE 00 NOT BUIID OR W PiqVE FOF THE VURPOSE OF SALE} w OlA50WNEROFTHEPRDPERT:N.IEXCLUSNELYCOHTMCTNONrtTHL10ENSEDLONTMCT00.4 Q TO CONSTRUCT THE PRO.IECT(SEG 70�t.BUSINE55 AND GHOFESSIONS CODE�TME CONTR�CTORS L4 V61U�Ii011�CJ(O O C� AQl.AREA � W CENSEUWDOESNOTAPOLYTOANOWNEROFAFROOERTYW�pBU4D50RIMPROVES7HEFEON,AND • � W1qCONTMCT3iDR5UCHPp0.1ECfSWIT1AODNTMCTOR(S�LICENSEDPURSUMlTTOIHECOHfMG QUANTITY DESCRIPTION �E � TORSLICENSELAWJ. ' 0 O I AM IXEMPi UNOER SEC. 6.{V.G FOR TMIS REASON � � � DATE OWNER • . t-� � .. Z W � UCENSED CONTRACTORS DECLAFiAT10N ' W IMEREBYAGFIR4UNOERPENALTYOFiERA1RYiHATIA1AlICENSEDUNOERVROVI510NSOFCHAOTER V. . . � � �(COMMENCMIO WIiH SECTION 70001aF DMSION]OF THE BUSMESS AND PROFESSIONS COOE,AND Z �� MY LICENSE IS N FULL FORCE MID E�fECL m � UCENSE CLASS LIC.NO. �J V DATE CONTRACTOR R W � � WORKERS'CDMPENSATION DECLAHATION � � IMEREB�hiF'IRMUNDERVENAITYOFiE0.1URY0NEOFTHEiOILOYAN(;OECLARATqNS: Z . � _IHAVEANDNnLIYANTMHAtEATI�ICATEOFCONSENTTOSELFJNSUREFORWO(i(ERS' _ COMPENSA7qN,ASPROVIDEDBYSECTION]7ooOFTHEUBORC00E.FORTHEPERFORMANCE `U Q OF 7NE WORK FOR WHIGI7MIS PERMIT IS ISSUEO. � _I NAVE AND NnLL YAMTAIN WORKERS COAIPENSATION pJSUR/NCE,�4 REOUIRED BY SECTIOH 0 ]70o OFTFIE LABOR OOOE,FOil T/E PERFOfLAANCE OF iHE WORK FOR Yn1ICMTHtS PERMIT 19 ^� � ISSUED.MYWORNERS'COMGENSATIONWSURANCEGRRIEHANOPOIIGYNUMBEHME: CONSTFlUCTION ' • / . � uawea PLAN REVIEW � � 0Z POIICYNUMBER ELECTRIC � Q p (���+���T��Tm���������R+�la+�ssl PLUMBINO � Z I CERTIFV THAT N THE PERFORAIANCE OF THE WORK FOR WMICH MIS PERMITIS ISSUED.1 MECHANICAL (�} SNALI NOi EMPLOV AN'/VERSON W IM'YANNER SOA4 TO BECdAE SUBJECTTO7ME y WORKERS CdAVEN5A7qN Uw50F CAUFORMti ANDACREE TMAT IF I SHDULD BECOUE iNSPECTION FEE � S SUBJfGTTOTMEWORKERS'COMPENSATqNPROV15iON50FSECTICN77000FTHELABOR COOE,ISMALLFORMWITHGOMPLYWIMTIqSEFROV1510N5. ISSUANCE . � ' 0 j p DATE: APPLICANT: � SMIP � J /^ �� � ENERGY PIC WARNIHG FAILURE TO SE WPE MIOAKENS COMVENSAiION COVERAOE IS UNUwFUI,AND SM�LL BE � SUBJECTANEMPIOYERTOCRYNALVEIIALTIES�NOCMLFHESUPTOONEMUNDREDiM0U5AHD ENERGYPERMIT � DOILMS(f 100,000�,W ADDrt10N TO ME COST OF COMPENSATqN,DAIMCES AS VROVIDED FOR W �l SECTION]70lOfTHEIABOfiCOOE.INTEREST.IiNDATTOfWEVSFEES. RETENTIONFEE: � � / � q� CONS7HUCTION LENDING AGENCY �"' � PRE•ALT FEE: � IHEREBYAFFlRIAUNpERVENALTYOFPERIURYTHATTHEREISACONSTRUCT10NlENDWOAOENCY iORTHE PERfOR1AANCE OF THE MIORK FOR WMtlI7H15 PERMITIS ISSUEO(SEC.�oY7,dV.C.�. � � IENDER4NALE C IENDER'S 11DORE55 � � ICERTIFViNATIFNVEREII)T/15110PLICATIONANDSTATETMATTIEIBOVENFqdMATIDNISWHRECL TOTAL FEES . p� IAf3REETOCOMPLYNI7NALLCITYAHOGOIMTYORDiwWCESFNDSTA1EUwSNEUTNOTOBULDINO � � S� CONSTRUCTId{AND MEREBY AUTl10RIZE REPRESENTATIVES OF THIS COIMTY TO EMER UPON TNE ��//�� (,^L /( � J�� /y� ��� , ABOVE�IEMIONEDiROVER7YFOqINSVECTqNPURPOSES. COMMENTS 7 V�J� • �- '•�!O `�Y'� � � ON � m PERYITTE n � � Z� � N a rune ov vewn OAT � RECPT.N0. PPJD BY VAL�DATION - . WMITE—�epenmant Copy.YELLOW—Finanw Capy.PINK—Asasseor Copy.GOLDENfiOD—Fik Copy,GREEN—App4yn a C•apy / . _ � 'k7_ :s,r.�: +�q::e;�:�^:.H:.T„K'�.'.tir.:_:+..'+ . ,"•.i't':t�. . . . . . , . .,�.•, _��, .ri :l�Y',i..,;'r:. ' � l;'YGi�.,:::..•.i:•.;'.•a_ :i�;�" ~~;°". . ..'�'....1�.+��.r.�..�:.+(.v..p•.,.f..,,..e.(.-... . . .�. ..�.,'.�'_ - . � . , . ... Y. CITY. OF DIAf��n!D.E3/�R� c�:',, ; �� -'`� r� �, - - �. ., �,':`�; _. _ . :.... , INSPECTIO(�! REC�F�D' :�r ::.,;:';`�': . , . '�:: ..� .- .�,.'^.r.. , .. i:.. ... 7:rr!. 7F: _ • 'l�k• :�.�c�'rJc �p ' I�rVn= . �)►.�'l� t`�1���lf :•; � iI r+�k-7���''�C1.�.►!I :t c ���� - ; ��ti�1�a�e,�r��1={�;� �I � �� ,,, _ � .��.�..�_._____����.�.__.._.. .,_ _.�'�'�____.. _.---- --.�...:.._1�.,. _ - •.__.Y:_..._� .:...�_ ._ � _... _ _._ - - . .,� . 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