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HomeMy WebLinkAbout12224 CITY OF DIAMOND BAR '� � ' --l� -- DEPARTMENT OF COMMUNITY&DEVELOPMBNT SERVICES � . 21660 E.Copley Drive Suite 190 �"� � (909)860-3195 Faac(909)861-3117 PRESS ���'a�°� � BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE APPLICATIO���� � PERMIT ADDRES .2�3 Ga C� � �S DATE�.(�T$ NUMBER � �i � ISSUE '� t IYPE OCC APN LOT TRACT_ DATE CONST. GROUP p OWNER "' � p ADDRES � ZONING SETBACKS w' FRONT RW C I__ � � CITY�.�� ZIP TEL. REAR �; ' APPLICANT TEL._ SIDE/SIQE STREET RW G � � CONTRACTO � Q �G SIDE n e ADDRESS�2L�a, S . � o CITYH���� I �TEL.l��� .. PROPOSED USE p� G ' '�'�c - � o ARC � / - - -�..� � , �� ' W DESIGNER NO.DWEl. PJO. NO.� � a. ADDRESS UNITS STORIES ?-- BEDROOMS � CITY ZIP TEL. � � DESCRIPTION SQ.FT. FAC70R PSF ADJ.AREANALUATION �r OWNEF•BUILDER DECLARATION SFR/ADD/HEM O I HEREBV AFfIRM UNDER PENALTY OF PE0.tt1RY THAT I N.1 E%EAIPT FROM THE CONTRACTOqS Lt- G2fflJEICafPOft � W CENSEUWFOHTNEFOLLOWINfiREA50ry(SEC]o3t.56USINESSAIiDPROFESSIONSCOOE:ANYCINOR (n COUNTYVhIICHREOUIRESAPERMITTOCONSiRUCiALiEfl,fMPqOVE,DEMOLISH,ORAE7AlRANYSiAVC- W pdIi0/DBCk W TURE.PRIOR TO ITS�SSUANCE,AL50 REWIRES THE APPLICANT FOR SUGH PERMIT TO FILE A SIGN[� W r� STATE�.iENT THAT HE OR SHE IS LICENSED PUqSUANT 70 THE PHONSIONS OF TNE CONTRACTORS LI� � r � CEM5E UW(CHA7TEfl B(COMMENCINO WITM SECTION 7000j OF DIVISION 30F iME BUSIN�SS ANO PRO� POOI/Sp2 FES6qNSCODE)ORTHATHEORSHEISEXEMPTTHEiIEFROMAN07HEBA5�SFOpTHEAL�EGEDEXEMP- (� } TION.ANYVKKATIONOFSEGTION7o37.5BYANYMPUCANTFOftAPERMITSU&IECTSTMEAPPLICANTIO Z py�Roai ' � A CML PENALTY OF NOT MORE THMI FNE NUNDRE�DOLLARS(t600).): , � � ❑I,ASOWNENOFTNEPflOPERTY,ORMYEMPLOYEESWITHWAGE5A57NEIR50LECOMPENSAIlON. ❑ Commercial WILLOO 7HE WORK,AND TME STflUC7URE IS NOT INTENOED OF OFFEREO FOR SAIE�SfC.7044,Bl1Sl� J � NES3 AND PfiaE5510N5 WDE:THE GONTIiACTONS LICENSE UW�OES NOT A oLY?O AN OWNEH OF . � ; PFpAERTY WI108U1LD5 OR IMFROVE6TiEREON,AND WHO DOES 6UCH WOqK HIMSEIF OR HERS0.F OR Q THROUQHHISORHEHOWNBAPLOYEES,PROYIDEDTHATSUCHIMPROVEMENTSpHENOTINTENOEDOR m P QOfiERWFORSA�EIF,NOWEVEF4THEBUILDINGORIMPROVEMENTiS50LDWITHINONEYEAflUFCAMPLE- ( z TqN,THE OWNER�BUILDER WILL HAYE THE BURDEN OF PROVING THAT HE OFl SHE DID NOT OUIID OR � IMPROVEFOR7HEPURPOSE�SALE} ? 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(] m S 0 LICENSE CLASS Lic.ND._�1_L�'-b � I j I U DATE P CONTRACTOR_ W -�� .��� ,i./r4�� k a i a Y � ORKEHS'COMPENSATION DECLARATION � � Q � � IHEqEB�AFFIRMUNDERPENALIYOFPERJURVONEOFTHF.FOUAWINGDECLARATION4 � � Q � � 111AVEANDWILLMAINTAINACERTIfICATEOFCONSENTTOSELF-INSUREFOHWONKEFS' = h � �COMPENSATqN.ASGROVIDEDBYSEC710N37000FTHELABORCWE.FORTHEPERFORMANCE �U OFiHE WOFK FOR WMICH THIS PF.fiMIT IS ISSUED, � /� t: W �I HAVE AND WILLMAINTAIN WORKERS'COhiPENSATION IhSl1RANCE.AS REOl11RED BV SECTIOM 7 � Q 37000FTHELA90RCODE.FORiHEPERFORMANCEOFTHEWORKFORWHIGHTMISPERM1T15 --^ _-I�� 7 - k ISSUED.MYWURKEflS'COMPENSA7KMJlNSURANCECARRIEFlANDPDLIGYNUMBFRAR'e: CONSTRUCTION f C s" j cnaaien__. '� - ------- PLAN RFVIEW ------ --.-- - ZvaicvNUMe� " - ---� ElECTRlC ----- -------.. .._- 4 a ^- '' ' Q (n{ss[craNr��rioree�oaFn+rEw.nrswnawE�n�Euoo�w+s�sia)oFl�Ess). PLUMBING -----.---- ----- —_._._ Z I CERTIFY THAT MTHE PERFORMANCE OF TME WOqK FOP WHICH THIS PERMIT IS ISSUED,1 MECHANICAL _._____ _..,.__ I (� SHALLNOTEMPLOYANYPEFlSONINANYMANNERSOASTOBf:COMESUBJECTTOTfIE /� p,.�� I N WONNERS'COMPENSATIONLAWSOFCALIFORNI�.AN[IAGREETHATIFI5HOl1LOBECO�dE INSPECTIONFEE __.__._ / �Z..5L { = 9UBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37W OF TNE LABOR - i --_ /✓--L " � COOE,I HALLFORTHWITHCOlRPLVWITNTHOSEPHOVISIONS. ISSUANCE O .• ' I SMIP � p DATE: APPLICANT: ' __' ._'_ __.'._." __-__ _- + � ENERGY P/C ---.----,-- -.---,-. --- J WARNING:FAIL RCTOSECUREWORKERS'COMPENSRTIONCOVERAGEISUNLAWFUL,ANOSHALLBF. i �y SUBJECTAN EM7LOVER TOCFIMiNAL FENAL7IESAND CIVlL FINES UP TOONE HUNOREU THOUSAND ENERGY PERMIT ` DOLLAfIS(51o0,o001,INMDITIONTOTHECOSTOFCOMPENSATION,DAMAG[SASPROVIDEOFORIN ----�� �---�-- - ----- ��--- 4 � SECTIDN37080FTHF.LABORCOUE,IN7EREST.ANDA770RNEY'SFEES. 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