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HomeMy WebLinkAbout16884 (32) , , --- �- --..._ _ _ . - -------- :...� /� •,;.�.. . :: , ,. . , , � _�� _ CITY OF DIAMOND BAR � �� i DEPARTMENT OF COMMUNITY,Bc DEVELOPMENT SERVICES i . ,� 21660 E.Copley Drive Suite 190 �/^�r-y�-�-� Z � , + ,; , ' (909)860-3195 Fax(909)861-3117 .,. . .. ,. r (I� 1 r� ., PRESS TM'. :�:BUII.DING PERMIT APPLICATION •. ', ' . � ..FI RMLY o� JOBSITE �� j C�ST(f/�lJ IJI�• DATE CATION t� D + NU 8 R v' v� x/C� -�� ADDRESS� " � ! � APN_P�T�7E��QME�CT �ZZC9� DATE �` � "�PE . OCC ISSU ONST. GROUP - � OWNER 4' ADDRESS VON KARrIEN STE.'" t ZONING SEfBACKS ' � CITY TRVTNF ZIPQ]�2 TEL.Q49-74,7-4 �REART _ _ RW � . APPUCANT ' TEL. SIDE/SIDE STREET RW ❑ � CONTAACTOR SAME � sioe ❑ � ADDRESS .� , •�--�;�,t_ , , ,. ; • CITY � ZIP TEL - PROPOSED USE � ARCFUENG/ Y1�/�.,� �� /-.. SS 9—/��SOG DESIGNER 1� I�1�-f (S7L17 NO.DWEL _ NO. ' NO. _ ADDRESS 4 UNITS= STORIES BEDROOMS ` � CITY � cn 7 'DESCRIPTION� Sa:FT. ACTOR PSF A0.1.AREANALUATION p� OWNER-BUILDERDECLARATION SFR/ADD/REM � �' O 8 I XEREBY AFFIfM1 UNDER PENIITY OF PEIWHY THAT 1 AM E%EMVT FF10M 7HE CONTMGTORS L�- " G3f8Q6/CflryOA � � CENSEUWFORiMEFqlOWMl3HE11SON(SEG7W1.68USNESSANOFROFESSqN3CODEANYCITYOR� (n , WUNfYWMIp11iEWWESAPERYRTOCDNSTRUCf,ALTERMViiOVEDEMOUSH,ORREPNRAN'fSTRUG W PdIlOIDOCk' � 7URE,PRqR TO RS ISSUANCE,KSO itEWIRES iHE APGLICANT FOH SUCH VERApTTO FILE A SIONED , W STATEMQfT hIAT HE OR SHE IS LICFNSED PURSUMIT TO tHE PFiOVI510N5 OF TNE CONTMCfORS L4� � CENSEUW(OUPTER Y([OAIMENClNO WIiH SECTION 1000)OF�IVISION]OF THEBUSMESS AND�NQ . � -'POOUSQa - -� � � . ' - � - - � � FESSIONS COD�OR THAT HE OR SHE IS El(EAIPT iNEREFHOM�NO ME BASIS FOR iHE ALLEOED E]fElA0.� TION.AHYVIOLIITIONOF6ECTION70]1.6BVAM/AiPUCiWTFO(7APERMITBUBJECTSTHEAPP�ICANTTp Z Ra-Roof - � • �- ��� ' ' �,,,, ACMLVENALTYOFNOTAIOHET/.wFIVEIIJNOREDD0.Wi51t5ooJ.Y •:, _ . , . � OI.ASOMNEROFTNEPROPERT`/,OFiMVEMPLOYEESNnTHWAOESASiHEIR50�ECOMPENSATION, � CORIII�BfC13I - � .. . . � � YALL DO iHE WORK AND THE STPAICTURE IS NOT INTENDED OR OFFERED FOR SALE(SEG 70N.BU54 i J � NE59 N10►iqFESSIONS CODE:7HE CONiMCTOH3 UGENSE Uw DOES NOT AFPLY TO AN OVMEA OF � � ( � VROPERT'W/1DBURDSORMPpOVE9THEHEON.ANUVMODOE58UCHNVNKHIMSELFORMERSEIFOR � t - . ._. � .OFF�ERE�DFOR�SALF.FIqWEVEil1HEEBULDW(iORNIPROVEMEIR'MISRSOI.OMWI7MINONEYEAROfCOMPLE � m C II� . -TION.iME 01VHER�BIMDER WILL WIVE THE BUROEN OF PROViNO 1TUT NE OR SHE DU NOT BUILD q1 �� � = WPROVEFOfl7HEVURPOSEOFSALE� �• W �I.0.40WNEROFiHEOliOPEHT'I,MIEXClUSNEIYCOHfiIACTNOYrtT11LICENSEDCONiMCTORS STO CONSTRIKT iHE VRQIECT(SEC.lOu,BUSINE54/W�PROiE5S10N5 COOE THE CONTMCTORS L6 VelU8t10f1 A J.AR � CENSEUWOOESNOTMVLYTOANONMEROFAPROPERTVWNOBUlD50RWPipYE47NEREON,ANO , rnaeartrucrswr�sucHvaaeersvnn+�arrtrUeronest��+seownsw�xrronieoorrrw�c QUANTITY....... DESCRiPTION � !.",'. . FEE Tais uCENse uw.). � O I AM E%EMPf UNOER SEC. B.�P.C.FOR iMIS NEASON Q •• '• \ S�' 1 � . _. .. . V _, . �. ._ . . ' � � : � �• ,.�,. W1E ' OWNER _ w ' -�:- ',r. .� ... ` � UCENSED CONTRACTORS DECLARATION —� f • ` � W IHEREBYDFFIRMVNDEAPENALTYOFPE0.IURYTFIATIAMIICENSEDUNOERPROVISKKJ50FpiMTER Z � � •(C04MIENCINOWfiFISECTIONioOo)OFOMSWN]OFTHEOUSINESSANDPROFESSIONSCOOE,�NO � � � MYUGENSEISWFULLFOtiCEANDEFFECT. m �� � � LICENSE CUSS � UC.NO. - � ��, � O . . DATE � COMMCTOR � ' •J✓ ... . ,t .� .. ... ._ - . '�" EXP.9—��—�� ���� HOMES 2 r : � � WO ERS MPENSATION DE � � � � yIHEREB �FGIMUNDERVENAI.TYOFPEfUURYONEOfTHEFOILOWINOOECLAMT10N5: z � TV � V � ��S NAVEANOWILLMAINTAINACEHTIFICATEOFCONSENTTOSE1FaN5UNEFORN'ORNERS' - S - �( �T". f�� -- - � - - . 7 OdAV£NSATIqI,AS PRqNDEO BY SEC710N 770o OF THE 1A00F CODE,PoH TNE DERtOM1ANCE W V" FIT/E WOFlK FOR WH1CHtH�S PERMIT IS ISSUED. � �^ C � MAVEANO Y/1LL MARRAIN WORKERS'COMDENSATpN INSURANCE,AS REOUIRED BY SECTIOFI Q �7000FiNELABORCOOEFORiHEPEPFCRMAtiCEOFTHEWORKFOHWHICHTHISVERM1T15 1 ('� - 0 ISSVED.IA'/WORKEHS'COM?FNBATqN WSURANCE CANUERAND POLICY MIMBERARE: CONSTRUCTION ` ��+O � Cn�wEA—��v��'��c �SP T��'Fr—��—c8 PLANREVIEW •� odicrt+uraeEn _ ELECTFIC � I • R n . 0 (fVi:ssEcilU+N�No�sEWM1Fl.EfE�OF7�EFEfMf6iaRONE1lR�Of1EDO0.1Af6R�a�0(+1E5s1 PLUMBING v• v• O Z ` ItERTtFY iHAT M T1E VERFORMANCE OF THE MIOpK FOH WHK]/THIS PERAIR IS LSSUEO.1 MECHANICAL � SWLLINOTEUPtAVANYiER50NINAN'lMAMIERSOA5T06ECOMESU&1EGTTOME (/� N'ORKERS'COMPENSATIONUWSOFCALIFORNIA,ANDAQREET/MTffIS110ULDBECOME INSPECTIONFEE . SU0.IECT TO THE WORNE0.5'COMPENSATION PROVISpNS OF SECTqN 370o OF THE UBOR ( caoe,�sH connrmrNwuv�rwminasernwisar�s. ISSUANCE o �3-2�-01 PULTE HOMES SMIP / � DATf: APPLICAMT. . / WAAN4N1:iALURETOSECUREWORKER3'COMPENSAiIONCOVERAGEISUNLAVJFU.,MIDSHALLBE ENERGYPIC ( � SUB.IECTANEMPLOYEHTOCRIMWALPENALTIESANDpNLFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT +� DOLLARS�ifoo.00O�NFDDITIONTOTNECOSTOFCOMPENSATION.DAMAOESASPROVqEDFORIN h /��/' � � J SEGt10N]7oeOFT1ElA00RCO0E,WTEREST,MlDAiTOiWEYSFEES. RETENTIONFEE: . �)� VJ O I CONSTRUCTtON LENDING AGENCY PRE-ALT FEE yr � INEREBVAFFlRMUNOERPENALTYOFPERlURYTHATT1iEREISACONSiPUCTIdJLENOPWACENCY ' ' "' � � ' " � / FOR THE PERFORMANCE OF ME WORK FOR WMICH THIS VEMIIT IS ISSUED(SEC.ioY7,CIV.C). .. . , O � ' NONE (PULTE) �- ' ,i � LENDER'S N�IAE � - ' . ' . . .C IENDER511DDRE55 /'� ,\ /� � . � ICERTIiYfNATINAVEREADIHISADPLICATIONANOSTATETMATTHEABOVEWFOWAATIONISCOFRECi TOTAL FEES • _'.-��,rn, I ; J.:, W IAGREETOCdAPLVWITHALI.CRVANOCOUNTYOROINANCEShNDSTATEUWSREUTINOTOBU6DINU ' � � CONSTRUCTION,/NDNEHEBVAUIY�ORRfREPNESENTATIVE50fTNI5COUNTYTOEHTERUPONiHE ' � �� v� S�. A80VEdAENTqNEOPROPERTYFOFINSPECTIONPURPO5E5. COMMENTS ' � � I• i� . � '� . . . _ _ . . . � � . = I m VERA1fTTEENAME(FNNT) - � . . - ji.� � c� ��S—�d / ,, , (n SIONA ERMI EE DATE �I ,� � • RECPT.NO. PAIDBY VALIDATION WHITE—Department COpy,YELLOW--Finenoa Copy,PINK—,Assessor Copy.GOLOENR0�10 Copy,GREEN—Applicant's Copy �1 � ... 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