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HomeMy WebLinkAbout10298 1 - CITY OF DIAMOND BAR ���� COMMUNITY DEVELOPMENT DEPARTMENT t� � 2I660 E.Copley Drive Suite 190 (909)E60-3195 Faz(909)861•3I17 PRESS �'""� BUILDING PERMITAPPLICATIQN FIRMLY r ���TE APPUCATION 1 PERMIT 1��f p/C o ADDRESS �g�c Ct7G.Cl�1�/C.90 L� DATE � NUMBEF�i���� � OCC � APN LOT _ TRACT��iS��� DATE CONST. GROUP p OWNER �' �- v�:c �,C, � p ADDRESS � �C�L y�O ZONING SETBACKS � CITY {�O�t�t!f�/ ZIP�+TEL.j��I�`S/fj.3't FRONT qyy p APPLICANT TEL. flEAR p zd SIDE/SIDE STREET RW ❑ a� CONTRACTOR �L��G SIDE p ADDRESS � CITY ZIP TEL PROPOSEDUSE ��'"��r✓G- o ARCWENG/ DESIGNER �i7 NO.DWEL NO. NO. N ADDRESS UNITS 3 STORIES BEDROOMS � CfTY ZIP TEL. m cn DESCRIPTION SO.FT: FACTOR PSF ADJ.AREANALUATION p� ONMER-BI:ILDER OECLAAATION SFR/ADDlREM O p I HEREBY AFFIRM UNDER VE WLLTY OF PEiWAY THAT 1 AM E%EMVT FROM T1E LONiRAGfORS L4 � Gef89B/CeIpOR W CENSEUWFORIMEFOU.OWWaREASON(SEC.70.7f.SBU5NE55ANDVHOFE55lON5CODE:IWYUTYOR U COUNTYNMIC/iREWIqESAVERIAITTOCONSTRUCi,ALTER�AVROVE.OEMOL151lOqREPA1RANYSTAUC. W W TURE.Vf110R TO RS ISSUMILE ALSO REOUIRES THE/VPIICANT FOR SUCH PEPoAIT TO FllE A SICNEO W PetiOlDBtk � � BTATEGEM TN�T NE OR SHE l4 UCENSEO OURSUANT TO TH[VROVISIONS OF TNE CONTRACTORS LI� � . . . � CENSE UW(G1A77ER Y(COMYENCPIO WITH SECTqN 7000)OF DNISqN]OF TME BUSiNE55AND PRD� POOVSpB . FESSIONSCOOE)ORTFUTNEORSHEISE%EMPTTHER[FRpAANDTHE&ISISFOR7HEALLEOEDEXENP• (� TqN.ANYVIOLATIONOF8ECT10H7o]1.SBYANVAVPUCANTFORA►ERYI75U&1ECTSTNEMPLIG/NtTO Z Re-Roof � ACML GENALTY OF NO7 MOiiE T1AN i1VE MMDRED DOlURS�{500�.�: � OLASOMMEROFTHEVRO�ERTY,ORMYEMPLOYEESWITHWAGESASiHEIRSOLECDMPENSATION, � COmrtIBfClel Z 1Mll 00 THE WORK.IvrD THE STRUCiURE t5 NOT INTENOED OR OffERED FOR SALE(SEC.7a�,BuSi• J N NE55 AND VROFESSIONS COOE:TNE CONTRACTORS LICENSE UW DOES NOT APvIY TO AN OWNER OF � OHOPERTY VAq BULDS OR IMVROVESTHEREOµ/ND WHO DOES SUCH WORN MIMSELF OA XEHSELF Oq Q iHROUGHHISORHEROWNEUPLOVEES,PROViOEDiHATSUp1WPROVEMEMSMEHOTWTENDEDOR m � OFFEREDFOi13ALE1F,HONEYER7NEBULDM100RMPROVEMENiISSOIDWITHWONEYEAROFCOMP�. Z TION,TNE OWNER�BVILDER WILL f1AYE iME BUROEN OF PROVwO TMA7 ME OR SME OiD NOT BUILD OR WPfqVEFORTHE7URPO5EOFSALE} W OIASONMEROFTHEiRDPERTY./J.IE%QUSNELVCONTMCTNaYATHLILENSFDCONTMCTORS � TO CONSTRUCT THE PR0.IECT(SEC.701�.BUSINE55 AND iIiOFESSION3 CODE:TME CONiRACTORB L4 VBIuB�1M ADJ.AREA L11 CENSEUWDOESNOTACPLVTOANONMEROFAOR07ERT'VAIOBVILDSORWPROVE4TMEREp/.MID L NMOCONiMCTSFORSUCHPiqlECfSWIT1A00ffTRACTOR(5)I�CENSEDPUR5t1ANTTOTiECONTMG ourwnTv DESCFiIPTION �E f- TORS LICENSE UW). � OI/AIEI(EMPiUPDERSEC. 6.lV.C.FORTWSREASON Q 3 �¢' LL DATE ��y OWNER 1 F- 0 • W F LICENSED CONTRACTORS ECLAFlATION W � INEREBYAiFYVAUNDERiENµTYOFiERA1RYl1UTIMILILENSEDUNDERVf10VISIONSOFCHAPTER d ��COMMENCM70 WITH SECTqN 70001 OF DNiS�ON 70F THE BUSINESS M!0 VROFESSIONS COOE.AND Z 1/ � X A/Y 110EN5E IS W FULL fORCE M10 E�FECT. m LLl � IICENSE CUSS LIC.NO, j V DATE CONTRACiOR d W � WORKERS'COMPENSATION DECLARATION Q � IHEREBVAFFlRMUN�ERPENALTYOFOEfUURYONEOFiHEfOIIOWINODECUMT10N5: Z 0 _IHAYEINDWILLMAWTAINACERTIi1CAiEOFCOHSEHTTOSELF-INSUREFORYA7HKER5' a G = Q C061PENSATqN,ASPRDVIDEDBYSECTON77000F7HELA80qC00E,FOi1THEPERFORM�NCE �U Q Oi THG WORK FOq WMIGf 1M15 PERMiT IS ISSUED. � � _IHAVEMIDWILLLUIMANWORKENS'CdIPEN5AT10NIN5URANCE,A5RE0UIREDBYSECTION Q ]7oo0FTHELABORCODE,FORTMEPERFORAIANCEOFTHEWORKFORWHIGITMISVERMITIS � ISSVED.WNCMKERS'COMPENSATIONWSURANCECARRIERANDVOLICYNUMBERME: CONSTRUCTION � UNRiEN PLAN REVIEW �0 POIIGYNUABER ELE� p (MsSEcfnNr�NoiBE0.Af�FTmOfTIEVEaAfrsfOaONEw�OtED�ou/Yi5M1+00I0RtE551 �, Z I CEHTIFY THAT TI THE VERiORA1ANCE OF 7HE WORK FOfl WHIp1 TMS VERYR IS ISSUED,I MECHANICAL r (7 SMALLNOTEYPIOYANYPER50NWANYMANNERSOA5T08ECOAlESU&IECTTOTNE i•� a�_,; (q NOPo(ERS'COAIPENSATIONlAW50FCAl1FOqNtAANDACREETNATIFISMIXILDB[CONE INSPECTIONFEE �� � I� S SUBJECTTOTI1EWOqKERS'tdAPENSATIONOROV15iONSOFSECTiON]7ooOFTMEMBOR .� ��� COOE,15/411FORT/MlITHCOMPLYVATMhq6E7R0'JISi0N5. ISSUANCE � , � 0 P p DATE: AFPLICANT: SMIP / � WMMNO:FALUHETOSEWREWOf1KER5'C0IAPENS�TIONCOVERAGEISUNL1IWFULIIWSHALLBE ENERGYPlC �� ' ` � SUBIECTFHEMP�OYERTOCWNMALPENALTIESIWDpNLFWESUPTOONEMUlARED7110USAND ENERGYPERMIT DOLLARS(f 100.000�H/DDITION TO TNE COST OF WMPENSA7qN,UIVAAGES AS VROVIOED fOR IN J SECTION�70lOFTHEIABORCOOE,NTEREST,ANDATfORNEY'SFEES ` W RETENTION FEE: _ 4 CONSTRUCTION LENDING AGENCY PRE•ALT FEE: � O � � INEREBYFFFViMUNDERiENALTYOFPEIWRYTMATTNEREISACONSTHUCTIONLENONGAGENCY Z fOR THE VERiORMANCE OF ME WOi+I(iON WHIG1 THiS VERMIT IS ISSUED ISEG 70Y7.CN.4�. W � IENDER'S NUAE � IENDER'SADORE55 � TOTAL FEES � ICERTiFVTHATIH►VEREADMISAPGLIGTIONANDSTATETNATTHEABOVEWFORYATIONISCpRR[CL �� W IACREETOCCMPLYWITHMLCRyANDCOUNTVOPDPIANCESANOSTATEUNSPEUTNOTOBULDINC � / � CONSTi1UCTION,A�HEREBYAUT�pii1ZEPEPRESEHTA7NE50FTw5CWN7YTOEMEHUPONTHE S�. ABOVE•YENTIONEDVROVEHTYiORWSPECTqNIURPO5E5. 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