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HomeMy WebLinkAbout15946 (17) CITY OF DIAMOND BAR - �� -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES i � si�o E.cop��y nri��s�c�i90 PRESS , (909)860-3195 Faz(909)861-3117 ��'�^�, BIN,DINGPERMITAPPLICATION "Classics" Plan 1 Model CR FIRMLY JOBSITE APPLICATION (� PERMIT P!C 0 ADDflESS 23551 Canyon VIStB Ct. DATE I � ��vl NUMBER / x � APN LOT 4 TRACT 52287 �SSUE TYPE OCC DATE CONST. GROUP � OWNER Pul}P H�me rnrr� ADDRESS 1$401 �/U❑ Karman AVe SU 200 ZONING SETBACKS Z CI7y Irvine ZIP 9261�e�. 9497974400 FRortr RW ❑ g APPLICANT TEL. REAR ❑ � SIDE/SIDE STREEf RW ❑ CONTRACTOR SIDE ❑ � ADDRESS ' PROPOSEDUSE SEWER LATERAL CITY ZIP TEL � ARCFUENG/ • DESIGNER NO.DWEL NO. NO. AODRESS UNITS STORIES BEDROOMS � CITY ZIP TEL � DESGRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � T OWNER-BUILDER DECLARkTION SFR/ADD/REM � � I HfREBV AFFlRIA UNDER OENALTY Oi PEiWRV THAT 1 A/A E%EMPT FROM THE CONTiUC7ORS L4 Gerage/Carport � Ll,1 CENSEUWFORTMEFOLLOWW�REIl50N(SEC.70.77.68USINESSANDVROFESSIONSCODE:ANYCITYOR (n �7 COI,NTyyYHIp1RE0UIRESAPEfiMRTOCONSTRUCi,ALTER��ROVE.DEAlOI.15V/.OiiREPA1RANYS7AUC, W PBth/DBCk �L7URE VHDR i0 R9 ISSUMICE,ALSO REWIRES THE APPLIGWT FOR SUp7 PERMIi TO FILE A SICNEO . W � CTATFMENT hWT NE OR SHE IS LICENSED NRSUMI7 M THE VROVISIONS OF THE CON7MCTORS ll• � CFNSEUW(OUPTERY(WMMENpNOWIiMSECTION7oo010FDM510N70FTME8USINE53ANOPRO• � PODUSp3 FE56qNS COO�OR TIN7 HE OR SHE IS E%ENPT THEPEFPAAI AND THE BASiS FOR THE ALLEGED E%EIAP• 7pN.ANYV10LAilONOFSECTION7a71.68YANYAP7L1CM7TFOqAVERMIT5U8JECT5TMEAPPLICANTTO Z Re-Roo1 � A pYIL VENALTY OF IqT MORE iNM�FNE HUNDRED DOLlMS psoo).k , � ❑I,ASOV.MEROFTMEVROPEFTY.ORMYEMPLOYEESWI7HWAGESASTHEIRSOLfCOMCENSATpN, 0 Canmercial . YALL 00 THE WOfIK ANO THE STRUCTURE IS HOT IMENDEOOR OGFERED fOR ShLE(SEC.7o1�.BU51- J Nf55/NO VROiE55�ON5 OOOE:TME GONTiUCTORS UCENSE UW DOES NOiAPPLY i0 M!OWNER OF � P{qPEq{yMT1pBULpSpiiIMPPOVESTHENEON.ANDWNODOE55UdIWOI�KHIMSELFORH[RSEIFOR = hWOUO/l HIS OR NEP pVN E1IPLOYEES,PPOVDEO hUT SUCM�AopOVEA1ENT5 ARE NOT MTENDm OR m � OFFERED�ORSALEIF,FqN�EVER7NE8UlDINOORIMPROVEMENT15901DN7TMNONEYEAROFCOMRE• � ` � ' � �T10N.7HE OWNERBUR.DEP MALL HAVE iHE BURDEN OF GpOVINO TMA7 NE OR SME��D NOi BVRD OR MVRDVE FOR TME VURPOSE OF SALE). ' O I,A9 OWNER OF iHE P{#OVEHiY,AL�E%CLUSNELY COMMCTWO NTTH LICENSEO CONiRACT00.4 TO CONSTRUGT TME►ROJECT(SEG.7oN.0u51NE55 N!D PNOPESSIONS GODE iHE CONTMCTORS lF Valuatbn ADJ.AREA CENSE UW DOE3 NOTAPPLY TO/W OWN[N OF A PPOPERtt NnU BU4.DS OF 11.1PfqVE3 THEHECN.AND WHOCONTMCT9Wfl5UCMVRQlECTSWI7MACOHTRACTOR(S�LICENSEOWRSUN7TTOTHECONTMG OUANTITY DESCRIPTION FEE � TOi1S UCENSE UW.). O IAM IXEMPTUNOEP SEC. 8.1 P.G.iOR THIS qFASON U u" DATE OWNER � � U LIC[NSED CONTRACTORS DECLARATION -� � w INEREBYAFFM.MUNDERVEN�LLTYOF7E0.1URYTHATIAMIICENSEOUNDERPRON510NSOFCHAPTEN Ur � �(COA�MENCINOWTiHSECT�17000)OFOMSION]OFTHEBIJSINE55MlDVROFESSiON5W0E.AND Z X W LICEHSE IS IN M.l FORCE AND EFFECT. m LU � � LICENSECIASS LIC.NO. j � p�7E CONTR4CTOR a W � WORKERS'COMPENSATION�ECLARATION -i U � I HEiIEBYAFFIRM UNDER VENALTY OF VERNNY ONE OF iHE FOLLON7NG DECLAfUT10N3: � � O ��IIU`/EANDNaLLMAMiAINACERTIFICATEOFO0N5[NTTOSELFdNSUREFORWOFKERS' 2 � COMPENSJITIOH,ASPROVIOEDBYSECTION�tOOOFhIEL�BdiCODE,FORTHEVERFOM��lICE W Of 7/1E W0�7K FOR WN�p1 TNLS PEiW IT IS ISSUED. � O �I MAVEAND W�LLMARR�IN YK7NCEA.'.'CAMPENS�TqH MSUF7ANCE,A9 REDUIRCD BY SECTqN d �70o OF T1E UBOR CODE.FOR ME PERFOtU.1ANCE OF THE N'ORK F�R WMiCH TMIS PERAIIT 15 � ISSUEO.WWORNERS'COIIVENSATIONMSURANCECAAFlIERANOPOLICYNUMBERME: CONSTRUCT�ON � �a� PLAN REVIEW � POLICYNUMBER ELECTRIC p �ssEcfia+rF�wreem�.a�oaFnEo[w.irtsrona+e�noaiw�sa+m�a��ssi PLUMBING \ / � Z ICERT1FYiMATNh1EPERFO�WMlCEOFTMEWORKFORWNiCHTFnSVFRui'fi5IS5UE0,1 MECHANICAL `���� �'� '�' " (�, SHALLNOTEAIPLOYANYPERSONNANY4ANN[RSOASTOBECOMESUBIECTTOTHE zJ � 1VORKERS'COb�FEN5AT10NLAW50FGL�FORNU.AN�ACREETMATIFI5HIXILDBECO�E INSPECTIONFEE � SVBJECT TO TH�1WR1(Ei15'COMPENSATION PROVI510N5 OF SECTqM]70o OF T11E UBOR �� �' cooE,i snuxFoannnn+CaaPtrwm�nase rnovisons. ISSUANCE � SMIP � � J p DA1E: APPL�CAM: � . ►+� ENERGY P/C C � �`D ' � WAPNIN4 FA0.URE TD SECUHE WORIfERS COMPENSATION COYENAGE�S UNLAWFIA.ANO SHALL BE L �/ � EU6IECTANEMPIOYEHTOCNIMMALPENhLT1E5ANOCMLF�NE5UP100NENUNDREDT110USAND EN[RGYPERMIT ���_����FL'I 1 pOlUfiS(St oo,000).N I�DDITION TO T/E COSTOF CO/APENSATqN,D��GES IS iPAVDEO iOR M \ Q SECT10N�70tOF1}IELABORCOOE,NTEflEST.MIUAnORNEYSFEES RETENTIONFEE: / r QW„ CONSTRUCTION LENDINGAGENCY PRE-ALT FEE: O � IMEREBVAFTIRMUNDERiENALTYOFVERJURYTHATTHEREISACONSTRUCTqNLENDINGAGENCY z iOF 7NE VfRFORMANCE OF THE WORK FOR WHIp1 THIS PERMIT IS ISSVED�SEG 70v1.CIV.G�. W � LENDER'S NAME . � LEHDERSIDOPE55 � ICERTIFYTHATIHAVEREADiMISAV�LILATIONANDSTATETHATTHEA80VEN�ORNA710N15COqRECT. 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