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HomeMy WebLinkAbout17815 (19) . . .. _ __ �___ ___- ._. _ � _ . �` CiTY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)661-3117 PRE$$ �� BUILDINGPERMITAPPLICATION , FIRMLY � JOBSITE /O � , APPLICATION L.� 1_�� PERMIT (n Q(S P/C o ADDRESS U I Cr��VI FYV ,l"� DATE �� l NUMBER � V N # a� .ISSUE TYPE OCC APN L T � � TRACT .5-2-2 �J? DATE CONST. GROUP p OWNER „�i�u�i���Sa �ZNni '.�4^ L i n " ADDR SS �� . ZONING SETBACKS z CITY � �o►t r ZIP � L TEL�°�31�-�d2/ FRONT RW ❑ g APPLICANT ! ` TEL�c���.-�s/ REAR ❑ � � "'�-r SIDE/SIDE STREEf RW O CONTRACTOR I'- � SIDE p ADDRE S � � CITY C� ZIP 2�2� 7EL�' o -� / PROPOSED USE '�'�' w ARCWENG/ 0. ADDR SS �N�C '� ' `v>a • . NO.DWEL. NO. NO. C�-► UNITS STORIES BEDROOMS � CITYSriN ✓v� ZIP TEL +'-3 - � DESCRIPTION SO.Fi. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFFVADO/REM O p I HEREBY AFFliUI UNDER PENA�TY OF GERJUIiY THAT I AM EXEMPi FROM TXE CONiMCiORS l4 Garege/Caiport W CENSEUWFORTHEFq.LOWINOREA50NISEC.70.'1t.6BU5WESSMIOPROFES5lON5COOE:I�M'CI7VOR (n U COUNTYWMCHREOUIRESAPER�IRiOCON5iRl1CT,ALiER.IMPROVE,�EMOLISH.ORREPAIRANYSTRUG W Patio/Deck � TURE.iiUOR TO RS ISSUANCE,AL50 REOUIRES THE MPIICANT FOH SUCH PERMIT TO FILE A SIGNE� � 67ATEIAENT TH�T HE OR SHE IS LICENSEO PURSUANT TO THE PROY1510N5 OF THE COMMCTORS L4 w .� CENSE UW�CHAME�79(COI.�IAENpNO WRH SECfION T000)OF OIVISION]OF TME 8�15WE55 ANO Pf�. �- PooUSpa FESSIONSGOOEIORTHATHEDRSMEISEXEMPTTHEREFROM�NDTHE8AS13fORTNEAlLEOEDE%EMP• (� � TION.ANYVqLATqNOFSECT�ON7071.68YANYAPMIGNTFORAPEHMtTSU&lECTSTHEMPUCANTTO Z Ra-Roof A CML iENALTY OF NOT MORE T11AN FNE NUNDRED DOLURS�f5oo).)� Z ❑l��N�NEROFTHEPR07EH7Y.ORMYEM7L0YEESWITHW�GESASTHEIRSOIECDMPENSATqN. 0 COrt1I11BfC121 �' PIILL DO THE N'OHK,ANO THE STHUCTURE IS NOT INTENDED OR OFLEREO fOR SALE(SEC.7a�,BU51• J N NE55 ANO PROFESSIONS CODE:THE CONfMMORS UCENSE LAW DOES NOTAPP�,V i0 AN OWNER OF ? iROVEHiY WHO BUILOS Oq MIPROVES iHEREON.ANO WHO DOES SUCM WORK MiMSEIF OR HERSELF OR ft TtROUCHNI50RMEROVMEMPLOYEE3,Pi10VIDED?HATSUCHYdPROVEMEMSMENO7INTENOFAOR m �pOFiERWPoFSALE.If,HOWEVER,TNEBULDIN00R11APROVEMEMIS50lDWITHINONEYEAqOFCOM7lE- Z TION,TNE OY/NER-BURDER WILL HAVE TME BIIPOEN OG PRONNO TMAT HE OR SME DID NOT BURD Oli = MPiqVEFORTMEPURPOSEOF$ALEL O 4��ER OF THE PROPE�AU E%CLUSN0.V CONTMCTINO N1TH LICENSED CONTMCTORS Q 70 fANSiRUCT T/IE PROJECT(SEC.7D4,6USINE55 ANO PROFESSIONS COOE:THE CONiMCTOflS l4 V81110(IOfI A0.1.AREA W CENSEUWOOESNOTA7iLYTOANOMMEROFAPROVENiYWMOBUILD30R�.1PRWE3iMEREON.AND � Y1RqCONTiL1CTSFOHSUq1PRO.lECTSWITHACAN7MCTOR(S�IICENSEDVUR5UM1TT07HECONIMF QUANTITY DESCRIPTION FEE Y ?ORSUCENSEUW.� � O I AM E%EMPT UNDER SEC. B.i P.C.FOR iM15 REASON U O � � � OATE OwNER � Z � �Q LICENSED CONTRACTORS DECLA ION ' W CC I NEREBYAFFIHM UNDER PENALTV Of PE0.1UpY T1UT IAM UCENSEO UNOEN PROVISIONS OG CHI1PiEfl �r !f\ � L (L I(COMMENCINOVYffH5ECT10N7000)OFDIVISqN]OFTMEBUSINESSANDPHOFESSqNSCODE,MlD z Y� �" LLt MY LICENSE IS W FIAL iORCEAND EFFECL � � LICENSE CLASS LIC.NO. � F– � � J V DATE corrrancrori o- . _ _ . .. . _._ _ . w � WORKERS'COMPENSATION DECLAFATION � ¢ . � � IHEREBYAFFlRNUNDERVENALTYOFVE0.NRYONEOFt/1EFOLLOWINODECLAMTIDNS: v [� ,. ¢ � _INAVE�NDMA�LLWNTNNACERTIFICATEOFCONSEMMSElNNSUREFORWONtERS' � 2 � � . . � „ � , � • •. � COMPENSATION,ASPRONDEDBYSEC710N�7ooDFTHEUIBORCOOE.FORTMEPENFORMMICE W OF THE WORK FOR WMp1 THiS PEN.�IT IS ISSVEO. � . � , . d W �IHAVEIUIDWILLI.WMAINYlOFlIfERS'CqAPENSATqNINSUfUNCE.ASNEWIREDBYSECTION � QJ70oOFTHELABORCOOE.iORTMEPERFOfiMM10EOFTMEWORKFORWMICHh113PERM1715 � ISSUED.MYYYOPoCERS'COMPENSATqNINSUHANCECAHRIEHANDPOI�CYNUMBERME CONSTRUCTION � CMRIER PLAN REVIEW.. � vacr nun�aEn �•. .. � ' .- ELECTHIC � � � - � ' ' �1 a..� 0 (IH155[Cf10NNEmWTBEmhKE7FDOFTEPEW.�T6R7RONEMIK%iED00LLNi5�2t00)OIiLESSy. PLUMBING '�1 l}� Z ICERTIFYTHATINTNEPERFORMANCEOFTHEWORHFOAWNiCMTM15PERMITI5155UED,l MECHANICAL (J SHAtLNOT EIADLOYANY PERSON W ANV A/ANNER SOAS TO BECO�AE SU61EC7 TO TME N WORKENS'COMPENSA710NLAWSOFCAL60RNIAANOAGFEEiMATIFI5/qULDBECOME INSPECTIONFEE SUBJECTTO iME WOPo(ERS'COMPENSATION PRONSIONS OF SECTqN 77000F TME U�BOR � u -rj cooe,is�wi,FoanMnn�eoua�vwin+ HswNs. ISSUANCE - � �[^/�pZ � � SMIP . � � � p OATE: APPLICANT: _ w ENEfiGY P/C WMNIN@iMURETOSEWREWORKERS'CdAPENSATqNCAVE uE13UNUN�ULN�O3MALLBE �y SU0.IECTANEMPLOVERTOCW�INALPENALTESMIDqNLFINE PTOONEMUNDREDT11IX15AND ENERGYPERMIT OOLUAS(f 100.000).NI ADDITION TO TNE COSi OF COMPENSATION.DAMAGES AS PROVIDED FOR IN � SECTpN]TueOFiHELABORCOOE.INTEREST,ANDATfORNEYSFEE4. q�ENTIONFEE: d CONSTRUCTION LENDING AGENCY PREALT FEE: � IHEREBVALFIHMUNOERPENALTYOFOE0.IURVTHATTNEREISAGONSTRUCTIDNLENDWOAGENCY �-' FORTHEPERWNAANCEOFiHEWORKFORWMIpiTH15FERMiTI5135UED�5EG�0Y7,CIV,C.1. � � lENOER'S NAME � � LENOERSAWRE55 �� //�� ' � ��.O O � ILERTIFY7/UTIMINEREADMISMPL�CATIONi1NOSTATETNATTiEABOVEINFORAIAilON15CORRECL TOTAL FEES L,J� � � IAGREEMCOM7LYNATHALICRYANDCDUNTYORDiNANCESANDSTATEUYVSREUTWQTOBUILD�NG CONSTRUC710N.ANOHEREBYAUTl10RIZEHfPRESENTATNESOFTHISGOUNTYTDENiERUPONTHE , /"���0� ZAWVE-MENiIONE�FROPERTYFOqINSPECTiONPURPO5E5. COMMENTS �� � /\ �L��.. ` JCI * — J m ERM NnE1PHl Q ��{���,, 1 cn � lL S 1 � sicru7JREOFPEqr1 EE DA7E � pECPT.NO. PAtD BY VAUDATION WHI7E—Department Capy.YELLOW—Finanee Copy,PINK—Assessw Capy,GOLDENROD—File Copy,GREEN—ApplicaM's Copy .C�• `.;aNYF•4�tvE::t.°�v"f�¢•ek.lvrrlTd�G�`!5 ^" �� 'i��!�.�,Or, ..}` :t ':c . .:tt; •+;; �ti'' n�;',. - .-� '. ... �. — wy., . ,•Kn.+..,,,,,:'� � rw••: .� �... .�c .. ...... ... . . . , `S+, �r 1. :��;�. ��:' ',�� .f:i"Y�i . .� 2 4`' . . .. CIT'�' OF DIA�J30t3D B�R .. 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