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HomeMy WebLinkAbout10293 CITY OF DIAMOND BAR -/� �� COMMUNITY DEVELOPMENT DEPARTMENT .,.� 21660 E.Copley Drive Suite 190 PRESS (909)86Q3195 Fax(909)861-3117 ""'� BUILDING PERMIT APPLICATION , FIRMLY QN ��� �ag0 APPLICATION PERMIT P/C ADDRESS y GO�.O!'�/,q�ti0 CN DATE � NUMBE ' � N � APN LOT TRACT �I�S'.�r ISSUE TYPE OCC DA7E CONST. GROUP �j OWNER !�%h17' r.�t' �`74 p ADDRESS � L3�X ��C ZONING SETHACKS � CITY � �G�►Jti1 21P TEL.„ REAR Rw ❑ APPLICANT TEL. SI�EJSIDE STREET RW ❑ � CONTRACT�R �LC%!'`�tIL SIDE ❑ o ADDRESS Vy,.����w� CITY ZIP TEL PROPOSED USE o ARCH/ENG/ � DESIGNER N0.DWEL 7 NO. NO. ADDRESS UNITS �7 STORIES BEDROOMS � CITY 21P TEL. � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION d OWNER-BI:ILDER DECU+RATION SFR/ADD/REM O p 1 HEREBV AFFlRM W�DER PENALTV OF PERAIM TUT I AM EXEUPT FROM THE COMMCTORS L4 G6f8AH�C8fpOR W CENSEUWFOqT/1EfOlLOMANGREA50N{SEC.70.tt.68U5R1E5SAN0VNOfES510N5COOE:Mf/CiTYOR (n CJ COUMf'/WNICHREOURESAiERMRtOCONSTRUCT,ALTERIMPRpYE,pEMOUSM,ORRERURANYSTRUG W Patiolpeck � TURE,PR10R TO RS ISSU+WCE,AL50 REWIRES TN6 AVPUCANT FOR SVdI pERA/1T 70 FILE A SICNED w STATEMENT iHAT NE OR SME IS IILENSED WRSUMIT TO TNE PR�NSIONS OF TME CONTMCfOR5 L4 S CENSE LAW(G/WTER i(C041MENCINO YATH SECTqN 7D00�OF OIVISION]OF TNE BUSiNE55 AHD VRS � POOVSpB ' � YiE55qNSCOOE)ORTHATNfORSHEtSf%EIIPT7HFaEFqOAIANDTMEBA515FOp7MEALLECEDEI([IAP. V TION.ANYV�OI/iTIDNOFSELTION7WI.SBYANYAiiIIGNiFOfiAPEW.�ITSUBJECTSTNEAPPLIGNTTO ^L RB•ROO� A CML PENALTY OF NOT IAORE iTLW iNE MINDRED OOLURS IfSoo).�: � 04ASOWNEROFTHEDROOERN,OR4VEMPLOVEESWIlMWAGESIISTNEIRSd.ECOMPEN5AT10N, � COf11rtIBIL181 y N�IL DO iNE WORIL AHD THE STRt1C7URE 6 NOT IMENOED OR OFiERE�FOR S�LE(SEG.7W�.Bu56 J N HE55 AND Fi10FF55iON5 COOE:iHE CONTMCTORS UCENSE Uw OOES NOT AOP�V TO M!OWNEq OF = VpODERTY WNO BUILDS OR W PROVES 711ER[ON.AND WNO DOES StKH MIORK HIMSELF OF ME0.5ELFOq � THNOUGIIHISORMERONIIEMPLOVEES.PROYIDEDTMA75Up7�MPROVEMEMSMEHOTMEIIDEDOR � 0 OFiERE�fOHSKEIF,FqWEVER7NEBULDWCORMPiiOVEMEMI550lDWrt1aNONEYEA110FCOMPLE• Z TqN,iME O�NNEqbU1L0ER MIILL NAVE TME BURDEN OF pROVN1�THAT NE Oii SNE DD NOT BUILD Oq = qAFROVEid1TMEPUFPO5EOF6hLE7. O 4 AS OtN+ER OF TNE PMPERTY,M/E%CLUSIVELY CqlTMCTN6 WITH LICENSED CONTMCTORS � TO CONSTRUCT THE PROIECT(SEC.70��.6US�NESS I�ND Vi70FE5S10NS CODE:TME(�TFAC7ORS L4 V81U81id1 ADJ.AREA � GENSEUWDOESNOTAPPL�iOANON'NEROFAFROPEqTYMR10BUI1D90RIMPqOVE97T1EHEON,ANO 1N�OCOMMCTSFOASUCHPROJECTSVAM�CONTRI�CTOi1�5)UCENSEDPUqSUANiTOTHECONTMG QUANTITY DESCRIPTION FEE � TO0.5 LKENSE IAW} O O I AM f%EAIPT UNDER SEC. B. D.G.FOR TW3 REASON J � �=" DATE OWNER < • Z � LICENSED CONTRACTORS U-C ION � I HEREBV AFflRM UNOER PENAITV OG GERRIRY T11AT I M1 UCENSED IRAEN PROVI510N5 OFCHAP7ER - ,^,.' - p„ ��CO�MIENpN�WIiH3ELTION700o�OFDM5�ON70FTNEBU51NE55ANOPHOFE5510N5fADE,AND z 'Vvrr % � � 4Y UCENSE IS N FULL FOi10EM/�FFFECL m � " � LICENSE CLASS UC.N0. j V DATE CONTRJICTOR � 06 WORKERS'COMPENSATION DECLAHATION � � INENEBYAFFlRMUNOERiENALTVO[VE0.RIPYWEOFTNEFOUDIMN6DEqAM7qN5: � � _I/NVEANDWilLWM7AINACERTIFIGTEOFCONSEMTOSEiFaNSUqEFOqWORKERS' CpAPENSATqN,A9 Vi101MED BY SECTION 710o OF THE LABOR CODF,FOR iHE PERFOMI►NCE OF THE WOiUf iOR WHIC11 iHIS VERui715155UED. C w _IMAVEMIDWILLMAulTNNWORKERS'COM7ENSATqNIN5URAIJCE,ASNEWIRED8Y5EGTqN Q �7000FTHELAtiORCOD[,iORTHEPERFORMANCEOFTNEWORKiORYn1Ip/Ti15PERMRi3 ISSUEO.W YNiU(ERS'OOMPENS�TION MSURANCE CARPoEAANO POLICY NUMBER ME: CONSTRUCTION j CAMIEN PLAN PEVIEW � PDLIC�NUMBEA ELECTR i � r w (11655ECiCNNE�NOTBE00M;ETmOFMPERAfi6Poti0NEN.1lyiEDDOtlARSRiO�OHLFS61 UMBING �� Z ICERTIFY7WUWMEFERFOqMANCEOFTMEWO(iKFOfINMIp1TM5PERMIT6155UED.1 MECHANICAL U_` SH�LLNOTEMPLOYANY7ERSONNANYMANNEqSOASTOBECOYESU&1ECTTOTHE � YVON1cERSCOuvENSATqNUW50FGLLIFORN��ANDAGREETNA7IFISNOULDBECOUE INSPECTIONFEE SUBJEGT TO TME WORKERS'COAAPENSATqN YROVISiONS OF SEGTION�70o OF THE UBON s OOOE.ISHAiLFOHTHWITICpAPLYWITHTHOSEPROY15lOf15. ISSUANCE I':,�J iG R'� : �� O V �W�.�i n WTE: APPUCANT: SMIP � ENERGY P/C WAANINO:FA4URE TO SECURE YYORKEHS'COMVENSATqN COVEMGE�5 UNUIMFUL.AND SHALL BE �(� LL SUBJECTANEMP�OYERTOCPIMNA�iEN/LiIESFNOCNRFINESUPTO0NEMINDREOTN�USFNO ENERGYPERMIT �� � �IYY� DOLURS(t1o0,000�,W ADDrt10H i0 THE GOST OF WYPENSATION,DAYAGES AS PIiOViDED FOR M � SECTqN]70lOFTMEUBORCODE.NTERESLIUOATfORNEV5fEE5. RETENTIONFEE: �W CONSTRUCTION LENOIN�AGENCY PRE-ALT FEE: � INEPEBYAFFlfWUJDERVEN/LLTYOFiEMJi1YT1UTTMENEISACONSiRUCTIdiIFN�WOAGENCY FOR TNE PERFORMANCE OF ME WORK PoR WH1CM 7Tn5 iEHY1T IS ISSVED(SEC.]oit,pV.C.J. � � IENOERSNAME � IENDER'SADORESS W� TOTAL FEES �} ICEpTiFYiHATINAVEREADTNiSAPPLICATqNIwD3iATETN�iTY1EABOVEMFOi7YATqNISCORRECT. I� � IAGREETOCOYPLYWRNN1CIiYANOCOUNTYORDwM10ESM105tATEUWSNEIATNa70BU0.DING � GONSiFUCT10N,ANpMERE81'�lJi/qfiIIEREVNESENTATryE50FT/qSCOUNTYTOENTENUFONTHE . . ABOVE�IAENTIONEO VAOPEATY FOR WSPECiION PUN'OSES. COMMENTS � �C� C,'-roR��GI3�h�'�' m _ rEaan�euuE roa�m ���'�_ u_6i C� y qMAIUREOFPE OATE t � RECPT.NO. PAID BY VALJDATION WHITE—Dapartment Gopy.YELLOW—Finance Copy,PINK—Aea�asar Copy.GOLDENROD—Fik Copy,GREEN—Ayplk�M'�Copy . . .. .. ............. ....._ . - - . ,.. _ . � . . .. . .. .,_.,_,.- ..... ; .. .. �. . .,. . . , ,. , ,,...,.;...,.:....., ,•�- . . �� •...� , , ,•�.i.,� .. , . . .. , . . , .,_:s.:,.:.., ...,..,�..,-• .;:,-....:... ,,,. .,,n�:�.:. ,.w,., . . . . . . • ,_ .•�r.: � . � .. V �`` ciTv.OF DIAP�90F�"D G�:F� :'.'. � �.:' ��:��: - ' ' � , . � . � ''� �'� RdSPECil0��1 F=cE�Gf:D ; ' .. , .' , , .__'.: : �. . . . , ,:. , . �r'i: � _� _. .. I�k-`l�� ��'I�._ k �"_.._...�---'�- �r �,6�;1.� ;;f�- - ,;f ►�w i:�:.l�� �j^��:I�.c,°,r��;��:: , -. �r ��,,p_., �r .,;� ��,��. Cc� J _ �. ---[�-'�---r-(_- -- ----- -.. -••-- ----- � /� _ ai_r•: _ � . ..� - _"�'_ " _ .r____L�- .' � _ ' .. 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