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HomeMy WebLinkAbout13325 � __��__ CITY QF DIAMOND BAR � DEPARTMENT OF COMMIJNITY&DEVELOPMENT SERVICES _ 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ����H�"�� BLJII.DING PERMTT APPLICATION FIRMLY } JOBSITE ��•��� �y���� APPLICATION PERMIT `�'/C o ADDRESS �� pATE '�I�� NUMBER ����`� # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER �. �I�l��-- " ADDRESS ����-� �CC%fc��} ZONING SETBACKS � FRONT RW ❑_. CITY AP Bf�-� ZIP��TEL. REAR ❑ APPLICANT TEL. SIDE/SIDE STREET RW O � CONTRACTOR /� �- SIDE ❑ ADDRESS ' L' ! � CITY � /4 cs' ZI�� TEL. ���;�� PROPOSED USE__�l� o ARCH/ENG/ DESIGNEfl y�j NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS �` CITY ziP TEL. ar tn DESCRIP7tON SQ.FT. FACTDR PSF ADJ.AREANALUATION Q: OWNER•BUILDER DECLARATION SFRlA�DJREM O: I HERE6Y AFFlRM UN�ER PENALTY OF PERlUHV THAT I AIA EXEMPT FROM THE COMWICTORS LI- GefaJB/Cflfport W. 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(]UANTITY DESCRIPTION` FEE ~�-�r TOHS UCENSE LAW.J. - � : _ ❑I AM EXEMPT UN�ER SEC B.8 P.C.FOR THIS REASON - � � ' �.� �'� '.L ��, ls � : � - - :bATE_ OY�NER__ � -... Z- � �4;_ -LICENSED CONTRACTORS DECIARATION W - - ¢;- IHEftEBVAFFIRMUN�EflPc'kAlttOr'PER-'URYTHATIhMLICEYSEDU:.DERPpOV!SIONSOFCHAPTc'R � �- 9(COMMENCINGWITHSEC�I(Nd7G-00)OFDIVISION30FiHE8USl:ESSAhDPFOFESS�NSCODE.AND z X.} 1AYLICENSE IS IN FllLL FORCEANO EFFECT. � . y,} C� Q ��" �y- LICENSECU4SS��� LIC.4U. �JC�s��7" --.. j V-;: DATE �"_.��-. CO�YTR4CTOR :�_ ��c.s�a_ �= d W �� �`- WOHKEFiS'COMPENSATIONDcCLARA710N � - �.: - ¢ j ��J'� �_� � IMEflEBYAFFiqMUNOERPENALNOFPERIURYONEOFTHEFOILOWINGDECtARATIONS: V �y Z O� __IHAVEANOYIILLMAINTAINACERTIFICATEOFCOh5chTTOSELFINSUREFORWORKEFS' Z +��--� COMPEW4ATIOM,AS PROVI�E�BY SECTION 3'!W OF THc'iA60R CCv'c FOH THE PEAf-0RMANCE W , _ OF 7HE WORK FOR tMrI1GHTHIS PEA�iT IS ISSUED. � 0'.. �` IMAVEANOWILLMNMAINWOqKEAS'COMP'cNSATIONiNSUMNCE.ASflEQUIFlEDBYSEC?ION Q'_ 97o00FTNELA90RCODE,FORT}IEPERFORMANCEOFTHEWOFXFORWHICHTHISP[RMITS - ISSUED.MY WOflH�E!RS'COMPENSATION INSUflPNCi CAflRIER AN�POUGY NUMBEfl ARE CONSTRUCTION j` cnAaiEa - r7-�L�) ^�.�- PLANREVIEW Z� aa�crwu�eEa '��1/ ELECTRIC C' � �( .__ . �. � � . ¢ (IfpSS�cna�NE�No'BE07MAFT�OF7FEPEPo.ittc"FOIlOrIEtIF[JREDOOIIiIti(51ao)ORLESS} PLUMBING �n� Zp �A y ■� _`f ��'� V� -- ICER71FY7HATINTHEPERFOftMMCEOF7HEWORKFORWHICNTHISPERMIiISISSUE�.1 MECHANICAL �JD L�'IC=+ `�� ��XhJ /�/IJ(� I (� SHAILNOiEMPLOYANYPERSONtNANYAIANNERSOA5T09ECAMESU&IECTTOTHE `sb - -- N-,_- WORKERS'COMPENSAiIONtAWSOFCALIfORYIA,FVOAGREETHATIF-ISHOULOBECOME " �NSPECTIONFEE ,__.__ �/�'� //� - �; SUBJECTTO TME WOflKERS'COMPENSATION PROVISIO4S OF SECTION 37000f THE 1A80A �SSUANCE �T��'�y - .,.�CC!-° �✓� GOD.ISHALLFORTHWITXGOMPLYWITH SEPR S. J �� �JC � � �r"'"C.i�'" SMIP - - p_.DATE: APPLICAM: __. � _ . - W�� ENERGYPIC - " �� ____ ___ .J: WARNINGFAILURETOSECUREYlORKERS'COMPENSATIONCOVEflAGEISUNtAW1'UL,ANDSHALLBE ,�F� � SUBJECTANEMPLOVER70CHIMINALPENALTIESANDCIVILFMESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT }'.' k �- . DOLLAFS(5700.000),INADOITION70THECOSTOFCAMPENSATION,DN.1qQE5ASPROV�OE�FORIN --� ---� J- SECT�ON 37a80F THE LABOR CODE,INTERE57 ANO ATTORNEV'S FEES. RETENTION FEE 4- W- Q.,: CONSTRUCTION LENDING RGENCY PRE-ALT FEE: �- �` ____ ___ � IHEREBYAFGIRMUNDEHPENALTYOFPERJl1NYTHATTHEREISACONSTRUCTIOYLENOWGAGENCY �"'i - FOH TNE PEflEORMANCE OFTHE WDPK FOR WHIGH TMIS PEflMIT IS ISSUEO(SEC.ao9l,GV.C.). � W � LENDEfl'SNAME____ F-� LEN[lFR'SA�DHESS __... __ � ICERTIFYTNATIHAVEflEADTHISAPPLICATIONANOSiATETHATTNEA9WEINFORMATiONISGORRECT. TOTAL FEES - W IAGREETOCAMPLYN7THALlGITYANOGOUNTYOFDINMlGESANOSTATELAWSRELATMGTOBUILDING - - � CANSTRUCTION,ANDHEflE6YAUTHORREREPRESENTqTIVE50FTh715COUNNTOENTEflUPONTHE - - � A60YE-h1ENYlONW PqOPEHN FOR INSPECTION PURPOSES. - - � COMMENTS_____ ___ ___ ____. _ � J � - m PERNITTEE N�M�PB�NT) --- - - d v� 1� � l-y'�- � - � SIONANflEOFPERMITTEE OA E -- � �- RECPT.NO. PAID BY VALIDATION WHITE—Deparfinent Copy,YELLOW—Fioance Copy,PINK—Assessor Copy.GOLDENROD--File Copy,GREEN—ApplicanYs Copy E �� ,�k�e �#�' �"'a I ! - " � '�, 3 �t �'€ Y� � � ,�' k � € i � _ � - . i � �,{"� �€ � - : i _ - � - #Y' ! . _ 3 � " � '� 3 ' ; J ' a �,�d��� . '- ,�� � �.. ''� _ �dt F ���., � � � "� - � � � .s� �'��' � - x ! k c- kt = � � . F - � 3 �' � � � � n � � - i i � � � � i � - `� y � t ��� � i ' : t � ' a"� z 3. I` i l � i � � � ., � � . ''�'� . ,.�..:€�� _ : '.�,.. � ^,1; ' I E i � � � � .�i ,; ..._. �.� . -. � , i � i � �,. , ✓ r , � �j : ° � ' � � ��.. � �-. � i i � � � �! 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