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HomeMy WebLinkAbout13-682 _��`_ CTTY OF DIAMO?�ID BAR � � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES , � 21810 Copley Drive,Diamond Bar,CA 91765 , (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 � PRESS `�''"'. SUIL,DING PERMIT APPLICATION FIRMLY � JOBSITE Q ADDRESS I(O�� �C�nYI'ZP kY1dI� � APPLICATION. � � PERMIT 13� Q�/ P/C o DATE NUMBER ����� `r APN LOT TRACT DATE ` � CONST. �� GROUP p OWNEF Ec�c, Ho p ADDRESS_ �b77 BcL�Y�2� Kno�� �2a ZONING SETBACKS FRONT Z CITY 7i o.nc��� r[' ZIP�p,� TEL��.-(,�14 79Y1 RW O❑ o APPLICANT 5'Yr���n Sc.l���crtf TEL.95\-Z�11-b27L S DEISIDE STREET RW p m CONTF�ACTOR A�K�exl• CA��e11i(�¢� P�v M�rw SIDE � � ADDRESS�g95 [`�,X`o C�;��-# � � CITY �v tr�0. 1�4r�� ZIP�1 TEL(�7�c 38�-S}�2 PROPOSED USE w ARCWENG/ z DESIGNER � ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS cn � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREHY AFFlRM UNOER PET7AlTY OF�ERAIRV THA1 I AA1 EXEMCT FROM 7HE COMfRACTORS L4 Garage%Carport �W CFNSEUwFORTHEFOILOWINaPEA50N(SEC.7wf.SeV51NE55M1�PROFE5510N5CO0E/JIYCITYOR (n � U COUNTYWliICF1qEWIRESAFER!AITTOCONSTiiUCi,ALTE0.UAPROV�DEMOUSH,ORREPNHMlYSTRUC W W TUNE,PHIOq TO RS ISSU/WCE,ALSO REOUIRES iHE ACPUCANi WR SUCH PERMfI'�TO FlLE A SIOHED W PatiaJDeck � STA7EMENT TNAT HE OR SHE IS UCENSED PUHSUAM TO iHE PROVISIONS OF THE CONfMCTORS LF � CENSE UW(QUPTER Y(COMMENCIN�WRH SECTbN 7000)Of UIVISION�OF THE BUSWESS AND PR0. ' � PooVSpa � � FESSpN5CA0E)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEOEDE%EMP• C7 V TqN.ANYVIOUTIONOF5ECT10N7o]1.59YMfYAPPLICANTFORAPEM11T5UeJEC1'STiEAVP�ICANTTO Z Re-Roof A C1VIL VENALTV OF NOT AIORE h1AN FIVE HUNDRED OOL1M5(i50D�.}. � ❑t�aMNEROFiHE�ROPEHiY,ORMYEMPLOYEESWRHfVAGESllSTHEIRSOLECOMPENSATION, � COI11rtIBlClel Z MALL DO THE N'ORI(AND THE STRUC7URE IS NOT IMENOED.OR OFFERED FOR S/�LE(9EC.TOK'8�31- J � NESS AND PROFESSIONS COOE:THE CONiMCTORS LICENSE UW DOES NOTMPIY 70 AH ONMER OF � — FROPERIYNM1IO6UIL0.SOFIMOROVESTNEREON,AlIOWM1iODOE55UCHWOFKHiMSELFOpHEHSEIFOR Q TMROUGH HIS OR HER ONT!EMP:OYEFS,7fiOVIDED 7HAT SUpi IMPROVpi1ENJ5AHE NOT PRENDED OR m u1 OFFFAED FbR SALE IF,HOWEVER 1HE BUIlDINO OR MPROVEMENf IS SOLD WRHW ONE YEAROFCOMPIE- ' 0 TION,THE OYMER�BUILDER WILL HAVE THE BUFDEN OF PROVING 7}UT HE OR SHE�IO NOT BUILD OR Z WPROVEFOR7HEPURPOSEOFSAL�; - = 04ASOWNEROFTHEPROPERfY,AAIEXQUSNELYCOMMCTWO'MTHLICENSEDCOHT{iAGfOfLS W [[ TO CONSTRUCT THE PRQIEC7(SEC.70��,BUS�NE55 M!0 PROFESSIONS CODE iHE COMMCTOR9 U- V31U9tlOfl S S ADJ.AREA W CENSE UW DOES NOTMVLY TOAN ONMER OFA PHOVERTY WHO 9UIlD5 OH IMPROVES 7HEREON,AND � NRIOCONTMCT5FOR5UCHPRUIECTSWfiHACONTRACTOfi�S)LICFNSEDPURSUAHfTOTHECOHfRAG (��f(��Y DESCRIPTION FEE � Y TORS UCENSE UW.�. Q ❑I.W E%EMVT UNOER SEC. B.8 F.C.FOq THIS REASON Q ?�. U — OATE � OWNER ? � z cU � LICENSED CONTRACTORS DECLARATION W � � ._ 1 HEREBY AFFIRRI UNDER PENAL�Y OF PERJUifI MA'IAM IICENSED UNDER VRONSbNS Of CFUFTER d Y(COIAM�NCPICi W17H SECT.ION T000)OF DIVISICW]OF THE BUSINESS ANO FROFESSIONS COOE,ANO Z T X "MY IICENSE LS IN FiAL FORCE AHD EFFECi. � � Ur,ENSG c ss C co �,�.No. q Z 81d-�9 � " E � � V OATE Z '� 13 . CONTRACTORpm�-i"�b_� p1� � - W � WORKERS'COMPENSATION DECLARATION a � I MEREBY AFFlHM UNOER PENAITY OF PEiWM UNE OF 7HE FOLlOJ11NG DECIMATIONS: Z O I HAVE/�ND WILL MAIN7AIN A GEH(IFIGTE OF CONSF.M T�D SELF-INSVRE FOF NOAI(ERS ¢ '� COMFENSATION,ti5 FROVI��BY SECTON J100 OF THE U90R COD�FOR THE PERFOFMNJCE U Q OF THE WOR%FOH VAiICH THIS PERMIT IS ISSUED. � � � . � _IIMVEANOWILLMAIMAINWORKERB'COMPENSATIONINSUMNC�ASREIXIIREUBVSECTION Q J70o OF THE IADOH COOE,FOq THE VERFORMANCE OF THE WOFK FOR WHIQi THIS PERMfi IS J ISSUED.MY VIORI(ERS'COMPENSATION INSURANCE CAARIER AND POIICY NUMBERARE: CONSTRUCTION _ __ � CARRIER PLAN REVIEW Zaa icr NutaaEa ELECTRIC �— ^ -- ¢ -- w (nis�cnonN�rureEoor.stEtIDOFnfaar.trbcbaonEra�+�Octlu�sRtm)oa�ss} PLUMBtNG - — - r O . Z I CER7IFY THAT M TTiE PERFORAUNCE OF THE WOHI(FOR WHICH iHIS PERMIT LS ISSUED,I MECHANICAL C� SHNl NO7 EMPLOY ANY GESi50H W/J1Y IAANNEFI SO AS TO BECOAIE SUBJECT TO THE, ' -- " � WORKER5COMFENSATqNUM50fCALIFOqNItiANDAGREE7HATIFI51i0UlD8ECGME INSPECTIONFEE = SU&IECT TO 7HE wUfIXEflS'cOMPENSAT�ON VROV�51oN5 0F 5ECT10N]700 0F 7HE LABOR — cooE i sw�u wRrr�wirn coraa�r wina niosE vqohs�or+s. ISSUANCE O p OATE APPLICANP. �SMIP � W J WARNINO:FAM1LHE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUI�AHD SMALL BE ENERGY�P/C J � SU&JECT AN EMPIOYER 70 CRIMINAL CENALTIES AND CMl FlNES UP 70 ONE HUNDRED TFIIXISANU ENERGY PEFMIT DOLUAS(S1oo,Doo),W�DD1770N TO THE COS"f OF COMPENSA710N,OAMAGES AS PROVI�ED Fbp IN � J SECTION]70!OF TiE IABOH CODt WTERESi AND ATTOfUlEYS FEES. � �� w RETEFITION FEE: O CONSTRUCTION LENDING AGENCY PRE-AlT FEE _ � t HEREBY AFFlRM UNDER PENlLLTY OF PERNqY TH/IT 7HERE 19 ACONSTRVI.'TION LENOWO AdENCY a- FOH THE FERFOqMANCE OF 7HE WoqK FOR WHICH 7HIS PER/AR IS ISSUED(SEC.7oW,GV.C.} Z W � LENDER's NA7AE � . � � ' H LENDEASA�DRESS � wICERTIFYTIATIHAVEREADTiI9APFlJCATIONANOSTATETHATTiEABOVEWFORAlAT10NISCORqECT. TOTAL FEES � Z� � � 1 AGREE TO COMP�Y N7TH ALLCRV M10 CW1RY OFDINANCES AND STATE UNS REU1TiNO TO BUGDINO _� � CONSTAUCTION,ANDHEREBYAUfHOqIZEREPFESENTATNE50F7HI5COUNTYTOEHTERUPONTHE Z A80VEAIENf1DNED PROFERTY FOR INSPECfIDN PURPO"ES. COMMENTS � �? 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