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HomeMy WebLinkAbout16931 (42) �� CITY OF DIAMOND BAR � DEPARTMEM'OF COyfI�4UNITY�4:DEVELOPMEM SERVICES � � .*�,;�. 21825 E.Copley Drive ' /s�' (909)860-3t95Fax(909)861-3117 PRESS ��%::� BUILDING PER1�iIT APPLICATION FIRMLY o� JOBSITE i/��j���—��� A irn DATEICATION,r����� NUM�ER v��_ u/C ADDRESS lJ VI �� �.� ���I � ISSUE 1 nrPE occ APN LOT TRACT DATE CONST. GROUP p OWNER � ADDRESS ZONING SETE3ACKS Z CITY ZIP TEL. FRONT RW ❑ g APPLICANT TEL. REAR ❑ SIDE/SIDE STREET RW ❑ � CONTRACTOR O• ' - � c1 SIDE p � ADDRESS?Qbl (�.���L+�=�Y ��� pROPOSEDUSE .� o cirv LU 1��� zir��.:.TEL.�:��5">�,� w ARCH/ENG/ � DESIGNER a ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS N OESCFIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER�6UILDER DECLARATION SFFL'ADD�'R[M O p I HEREBY AFFIiU.I UNOER DENAItt OF PERNRY TNAT IAM EXEM�7 iHOAI THE CONTRACToas U� Garage/Corport W CENSEIAWFORTHEfOIIOWINOREA50N(SEC.70�7.5BUSINESSAN�VROFESS�ONSCODE.ANVLITYOR (n U pp�MT`(WHICHREWIFESAGERAn7TOCpJSTRUCT,ALTER.OAPROVE.DEA�0U5H2ORREOA:qA4V5TRUC• W Pafio/Deck w TURE.PPIOR TO ITS ISSUANCE.ALSO REOUIRES THE APCLICANT FOA SUCN FERMiT TO FILE A SIGNCD w STATEMENT THAT ME Ofi SNE IS LICENSED CURSUANT TO THE PRONSIqJS OF TME CONTRACTORS LI- � CENSE UW(GWTER Y(LOMMENCMC YnTM SCLTqN 7ooa)OF DIVISiON]OF THE BUSINE55 AND PRO� u' POOUSpe FE551ONSCODE)ORTH�THEORSnEISEXEMP7THCREFROMANDTnE8A5i5FORTnE�LLEG[DEx[MP• � � TION.ANY VIOLATION OF SECTION 70�1.5 BY ANY APV�ICANT FOfi�PERMIT SU&I[C75 TMF MPLICANT TD Z qe-Rocf A pVIL DENALTY OF NOT MORE TMAN FNE HUNDpED DOlURS(f;Col): � 04�:�'NNEROFTHEOROPEHTY.ORtAVEIAPLOVEESWITHWAGES,ISTHEIR50LECOMPCNSATAN, O CpmmBfC1.7I Z WILL DO 1ME WORN,AND THE STRUCTURE IS 1:OT INTENOED OR OFFERED LOR S�LE�SEC.70N,BU51. NESSANO PRDFESSiONS f.VOE:THE CONTqACTORSIICENSE LAW COES NOTAPP�Y 10/N OWNCP OF � CRpPERTY1NqBURD50RIMPROYESiHEREON,ANDWNO00E55Ud1WORKHIMSELFOFHERSELFOH � [L MROUGHMISORMEROWNEMPLOYEES,VROVIOEDTHATSUCHMPROVE4CNTSARENOIMTENOEDOR m w OFFEREDFORSALEIF,HPNEVER7HE0U�LOWGOHMPROVEMENTISSOIDWITHINONEYEAROFCOMF�E� � TNX1.TNE OWNER�BJILDER W�LL MAVE TNE BURDEN OF GROVtNC TMAT HE OR SHG O�D NOT BUILp 0�1 Z IMPPOYE FOfI TH[PURPOSE OF SALE4 �_ ❑�ASONM[ROFTNEPROVERTY.AME%CLUSIKLVCONT.LIGTINGW'�THIILENSEDCONTMCTORS TO CONSTqUCT THE VHOJECT ISEC.7al BUS'NESS AND VROFCSSIONS CODE:TN[CCNTRACTORS Lt� V01U31i011 AQ1.AqEA W CENSEUWDOESNOTAPPLYTONIOYMEROFAPROPERTYwHOBURD50NIMPROVESTMEREON.AND � Wr10CANTMCTSFORSUCIIPROJECTSWITHACONTRAC,'TOR(5)UCCNSEDCURSUA4TTOTNECONTfUG QUANTITY DESCFiIPTION FEE Y TORSUCENSEUN��. � ❑I MI E)IEIAPT UNDER SFC. 0.l D.C.fCA THIS REASON � ' OO � � DATE OwN[R V Z w � LICENS[D CONTRACTORS DECLARATION w IHEREBYAFFIRIAUNDERVENAL7VOFPER1URYiMA71�MLICENSEDUNDLRPROViSiONSOFCMAPTER Vr / -!lr\ -�` - ♦/�� d O(CpAMENCIN4 WITH 5ECT10N 70W)OF CNISION 70F TME B�I�CSSIW7 PRO�ESSiONS CODE,AY� Z � ` / X /AV LICENSE IS N FUIL FORGE AA'D EFFECT. L11 / �� m � LICENS[CLASS��5.(� UC.NO.�/������ ��,;L_,�� y�� j V DATE�J���1 COMRACTOR_L`r,11-�"�,`�+���-f a w � � WORKERS'COMPENSA710N DECLARATION a � IXEREBYAFFIRMUNOfRPENALT/OFVENURYONEOFTHEFOLLOYT.NGDECURATIONS: Z Q � _IHAVEANDWILLMAINTA:N�CERTIFICA7EOFCONSENTTOSELF-INSUREFORMrJRKERS' _ � COUPENSATqN,11SGROViDEDBYSECTION7�000FTHELALORCOOE,FORTHEPERLOR4ANCE U Q OFTNEN'OfiKiORVMICMTH157ERMITISISSUED. � � W _IHAVEAhDN".LLMAINTAW WOR1cER5'COAIPENSIITIONMSURANCE.�SPEOVIREDCYSECTION Q 7700 OF iHE LABOH COO[.FOH iHE FER�ORMhYCE OF TME WOPo(FOR WNICM THIS VEW.GT IS ' ISSUED.MYWORNERS'COA�PENSATqNINSUNWGEGRA',ERAN,D_V+OIICVNUMOERARE: CONSTRUCTION j CARiii[R_S#-�� �(�• �y_ PLANFEVIEW . Z �icvnuMo[n_� �,�;_1`1��-��� ELECTRIC ¢ � (IIdSSECfY1NNEmNDTE[Q7.7iEfFDOFhE�EMR6FORCfSHlltfiC000lUiLibtOC7pqlFSSI PLUM�iNG . - - - Z ICERTffYTHATINTHEPERFORNANCEOFTHEN'ORKiORWNICHTH15PERM:T154,SUED.I IAECHANICAL �"-'=� �-�' � • ••� ('J SMALL NOT ENPLOY ANV 7ERSON N ANY MnNNCR 50 AS TO BECO�E SUBILCT IOTHE ' " � WORNEFS'CONPENSATIONLA'NSOFLALIFORNII�,/W71.GREE7MATIFISMWLDBCLOME INS?ECTIONFEE � S SUOJECTTOTH[WORNEPS'COMPENSATqNDROV15qN50F5ECiqN770oOFTHEUBOR CODE I SHALL iORTMVATM COMPLY WITN TMOSE FRON510N5. ISSUANCE' _���r � n �n n' O � � p OATE:��_J,S;�_ APPLICANT: _ SMIP W � ENERGY P/C � WARNINC:FAILUR[TOSECUREWORKERS'COMPENSATIONCOVENAGEISUhUW�UL.ANDSHALLBE ��—y SUfiJEC1ANEMPIOVEHTOCFIAIWALPENALTICSMI�CNILfWE5UP700fvEHUN�REOTNOUSAND ENERGYPERMIT = ----�— DOLU�LS�f10o.000).NADDITONTOTHECOSTOFCOYPENSATION.DAMACESASPROY.DEDFORIN , �- � SEG710N]/OEOFTH[U[fORCODE.NTERE5T,M1DATiOqNEY'SFEES. RETENTIONFEE: ' a CONSTRUCTION LENDING AGENCY pRE-ALT FEE: O ' CC IHEREOVAFFIRAIUNDERPENALTVOL7F0.NRVTIUTTHEREISACd15TR�CTIONLFNDWGAGENCV d PoR THE PERFORAIANCE OF THE WOpK FOR wHid1TNIS VEkuIT IS ISSUED�5[C.]oal,CiY C.�. Z W � LEN�EiYS NAMC S' F=- LENDER'SA�DR[SS f c TOTAL FEES (A 7 J w I CEflTIFY THAT I NAVE READ THIS APPLICATION AND STATE TUT THE AOOVE P:FORAIAiqN IS CORRECT. d 1 AGREE TO COMPIY MATn ILLL CITY M:0 COVNTY O�DINA4CE5 AND STA1E UWS REUTINC TO BVILDINC CONSTRUCTiON.AND MER[BY�U7HORIZE RCPPCSCNTATIVES Of THIS COVNTY TO ENTER UPON TNE Z /�BpV--JII��ROPCRTYFOflINSPECTqNVUfiPO5C5. COMMENTS � � -����''A J m PERAIITTEE N �ICWHTI `.v ` � --�1„ ���tTP � l � — � SIGNATUHL P E /f � R[CPL NO. L __. 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