Loading...
HomeMy WebLinkAbout13968 �_ ��_� CITY OF DIAMOND BAR DEPARTMENT OF COMMI7NITY&DBVELOPMENT SERVICES _ 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 �" PRE$S �'� �UILDING PERNIIT APPLICATION ` FIRMLY , o� JOBSITE `. � ��� , DATECATION��� 1 NUMB R!��� #/C ADDRESS �) � ISSUE NPE OCC APN _ LOT___ TRACT DATE CONST. GROUP °e OWNER O " o AD ESS ZONING SETBA�KS W CI ZI TEL. FRONT RW ❑ gREAR ❑ _ AP I _ TEL. SIDE/SIDE STREET RW ❑ � CONTRACT . SIDE ❑ o CDDRE S ' " Z�P Y , TE ' pROPOSED USE o ARCW G/ - DESIGNER �il NO.DWEL. NO. NO. a ADORESS � CIIY ZIP TEL. UNITS STORIES BEDROOMS �n tn DESCRIPTiON SQ.FT. FACTOR PSF ADJ.ARErWALUATION � OWNEfl-BUILOEFi DECLARATION SFR/RDD/REM O p- I HEREBY AFFIAM UNDEft PENALTY OF PERIURY THAT i AM EXEMPT fROM THE CONTMCTORS ll- Gfl�d98/GB!(JOfI CENSELAWfORTHEFOILOWINGHEASON(SEC.7o3t.59lJSMFSSANOPRO:E$SIOtiS('A6E�ANVCITYOfl . (j� -z- COUNTYWHICNREWIRESAPERMITYOCON6TRl1C7,ALTER�MPROVE,�EMQtJSH,ORREPAIpANYSTFiUC- �{J PyYi6/DBCIC W- NRE,PflIOR TO ITS ISSUANCE.ALSO REQUIflES THE AP?UCANT fOR SUCH PERMIT TO FILE A SIGNED � - STA7EMENT THAT HE OR SHE IS UCENSED?URSUANT TO 1?ic'PROVISIONS OF THE CONiPACTORS l I- �-' CENSELAW�CHAPT£R9(CAMMENCINGWITHSECTION�000)OFDIVISiON30F?HEBUSINESSAICDPRO- � Pa0USP2 '�: FESSpNSCOOE)ORPHATHEORSNEISE%EMPTTHEREFROMAN9THEBASISFORTHEALLEGEDEXEMP• (� V TION.ANYVIOLA7KKJOFSEC710N7031.58VANYAPPLiCANTFORAFERMiTSU&lECT57HEAPPUCAN7T0 Z R8-Rcaf � ACIV�LPEN�T'OFNOTMORETHANFNEHUNOREDOOLLARS�f5CA).): - �_ O�.ASOYMEROFiHEPROPERTY,ORtdYEMPLOYEE3WITHWAGESASTMEIRSOLECAMPENSATION, CommBfCial - � WILL00 THE WOAK,AN�TT1E STRUCTURE IS N071NTENDEO OR OFPERED FOR 5RLE(SEC.70M,BUSI- .�J�.---I NESS AN�PqOFE5S1ON5 COOE:7HE CCMRACTOFS LICENSE lAW DOES NOT A?PLV TO AN OWNER OF � PR�PEfiTY Wt109UILDS OR IMPROVES THEflEON,ANC WHO DDfS 3UCH WOqK HIMS`:LF OR HERSELF OH � fL- THFlOUGNIi�50RHERO1YtiEMPLOYEES,PHOV�EDlH0.T5UCMIMPFOVEMEN:s'ARENO7'INTEMDEDOR � Q OfFERE0WR5ALE_IFHOWEVERiHEBUIl01NQORIMPitOVEMEJTISSCLDWITHINU`4EY'e{tROFCONFLE- __ - --Z- TION,THE OWNER-BUII.DEfl WILL NAyE TNE BURDEN OF PqOVING TFiAT H.E CR SHE�IO NOT BUIIA OF - - - � I.MPROYE WRR1E PUP.POSE OF SALE). - - ,� w ❑I.RSOWNEtiOFTHEPROPERTY.R&1EXCLUSIVELY:ANiF41CTIUGiMTHLIC.ENS�iCO4TRACTOftS �. TO CONSTRUCT TN£PROJECT�6'cG lOtd,BUSMESS At1A PROFESSIONS CODE TME C�VTiL1CTORS L- -V3itF8;i0n ADJ.AREA_ LL1. CENSEUWDOESNOTAPPLYTOANOWNERCFAPROAER7YWHOBN�DSOP.IMPROVESTHEftEON,AND - -- WHOCOMMCTS FOR SUCH FF.OJECTS W1T-I.;CONTRAGTOR(S)LICENSED PURSUIiNTTO THF Ca4TR4G f"' ioAsucENs��.nw.). QURNTlTY DESCRIPTION FEE � Y J .__ � ❑i Mt IXEMPT UNDER 3EC. o.d P.C.FOR TN'S REASON �:,- - � � —__ � LL"- DATE OWNER � QW y � LICEPlSEO CONTRAC�CRS DECIRRATIQN �W� e -�- I NEAEBYAFFIHM UN�EP.PENALTY OF?ERJUHY TN.hT!P_�,7 UC'eNSED UNOER PROViSiONo OF CHA?TER ��— - � (_-: 8(COMMENCMKiWfTHSeCTION)Ca]jOFCiYi51QN30FTHE5USINE ANDPR c,�BlQ$CC�E,l�\� j�� - - � }� MYIICENSE i51.N PJ �ORCEA��i;EFFECT. '� ; � � ldJ:� . _ ! / . �" ../ ( b �- UCENSE CLA&S LIC.NO._ . f -F'- DATE 1 CO�JTRACTOR � - .�_ WORlCEAS'CtSMPENSATIOIV DECLARATION f �,r ; `��- �! . .�'_ IHEHEBVAtLIAA1UYDERPEtd.4LTYOFP'cP.!URYONF_O.-'THE"rGLLOWMGDECLA5.�7fAN. �P � z -�_ __.IHRVEAliDWILtMRINTA1PiP.CEPTI=ICAT`eOFCAN3[NT70S'eLF-IVSUR FORV/OFji(ER' _ � � COM?ENSAYION,AS PROl90E�SY SECTION 3]00 OF TNE 1P.80R GOUE, OF TriE P FlM OF TNE V`IORK FOR WHICM T:i15 PEPAtIT IS ISSUEU. Q � F `IHRYEANOWILLMAiNTAINWORKERS' MPENSATIOYINSUPANCE,AS,jiE�Ui9EDBY5EC�? ' - .Q37000FTHeil$OR E.FOR EPE ANCEOFTH[WCA ORW}11C'iTH:5PE9U1Tl � - �_ ISSUEO.M R Efl5' MPEN ATIOtJ I E/F IER LIC �UMeER A ^' �CON TPUCTION a, caaaiEa - 1.-- - � t � � PLA REviEw -.�'. POLiCYqUl.�Efl ' l : . . , _- � EL TflIC _ . . C. Q-. (IFASSEC7I�NNE�NOTBEOOtJREIE�OFTiEPFS?ldTtSfOROPlEHU!dJFlEDOCLWiS� OOIORL 1 UMBING .�..a��_�..� �� �.. �.- ICERTIFYTW�TINTHEPERFORMANCEO.?H • KF WHICHTHISPE�MITISISSU MECHANICAL _ .._C�T; SHPILKpT f.\NPLOYANY PEfl50N IN ANY -4Erl S 5 TO BECAME SJBJECTTO TN.E I -tq' WORKERS'CGhPENSATIONLAWSOF IFORNI .�qGqEETHATIFISHCULDO'cCOME \ - WSPECTIONFEE - ,r s�y{�__ --_� Sl1&IECTTOTHE S' NSTIOY VISIONSOFSEC'ION3l0oOF R e��'�� �� � ,� �E� F H CC 1Y WI SE PROVI ISSUANCE - �. �_ 1 x - ._ .=�; � _ --p, DA " APPLICA . v SMIP �I��I�'��,�,_•;_��-����Ta � "'��. WAFlNING:fA1WflETOS CUREWOflKERS'COMPENSATfONCOVE AGEI5UNtAWFUL,ANDSNALLdE ' e`NER(3YP/C �TI!S'j`�R- - i- .'' �" � -J _T.. f.. _.___— .�' SU&IECTANEMPLOYERTOCNIMi;lALPENALTIESANDCIVILFINESUPTOONEHU\DREDTHOUSAND ENERGYPERMIT " DOLLARS(Stao.00o),INADDIT�ONTOTHECOSTOFCOMPENSA710N.OAMAGESASPROVIDEDFORIN J:--. SECTION37060FTric'UeORCO�E,INTEREST,ANDATfOftNEV'SFEES. RETENTIONFEE: �' — �� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: - O- -Q-._ IHEflEBVAFFIRMUNDERPENALTVOFPERJIJRYTHATTHFRFISACOkSTqUCTIONLENDINGAGENCV - FORTHE PERFORMANCE OFTNE WORK FOR WNICH 7H4S GEFl>AITIS ISSUED(SEC.3oal,CIV.C.). Z" W_. LENOEHSNAME_______ �- .F- LEN�ERSADDflESS _ �-�_�- ICEflTIFYTHATIHAVEflEADTHISAPPUCATIONANOSTATETHATTHEABOVEINFORMATIONISCORFECi. T�TA�FEES - _� �(�J W' IAGqEETOCAMPLVN7THALlCITYANDCOUNTYOR�INANf.ESANOSTATELAWSFEIATfIJGTOBUIL0ING � ��- CONS CTION,M:DHEREBYAUTHORIZEFEPRESENTATIVESOFTHISCOUNTVTOENTERUPONTI{E - - Z_ ENTIONW PFOFERTY FOH IN/�ECf ON PURPOSG C`JMMENTS � � � '�. ��-�l1 --- --- - � m�- MITT A/AE(PRIDIT) Q- iT >f'k � N I DRTE — REGPT.NO. � PAID BY - VALI�ATION ~ WHITE—Oepartme y,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD--File Copy.GREEN—ApplicanYs Copy � r.a , .:.._ _ . _ _. — � � o � � � � �� ;������� ����� � � _ � � — �_ � ����������� ������§ ' � � � �� � �� °�,a r�� � �� I � 3 � � �� +�� � ; 5 t�.��� �'�, ,� � i i _ .', _ � _- � �'�� i ' � I �. - � a i �€r�4t�x -�`����; .€` . � � - ,� �'g�� ��� � . �: � � : � � � �s � �. s � � n ,�J� t :� � _ � �. �� � � � ��: a 3� � � i � � si � - � �2€''��rt-.a�,� f:{�3� �{ i _ ' i = . ' 1 ' � � � � 3 �� �� . 'i�� �, .�','�- �� � � s^� � . .: ' - I _ E "_ '_ i " _ ' _ � > � i 5 ��.a�. ."�.�,.��.. E_.,� .. � , � ry�, - I . : � > � � E ._ t1v' ..... ; I I . ' CA i I � i ' � � ��.�:, j • � . I �: ; , k � . I � i _ ; , . ; ! j � � '� � _ t ,' ,, � ; . i ; �._.. � � _.1 i '' __'a ' s - � �,. . , . . , , , _ � . ?. .i :. : { ;� ; ' ; E �� � �� � . , I I � �� � ( . � � ` - F � ; ' � �� �I � ; � 7 � ; ; ; � � � i 3 I I , � i 1 � t ( i i � i i � �'4'3 ? . 3 � . � �.. � ,. �:. � .. ' . 7. � 3 � �'�F� ;" . . ., � i j_ E , t 7 � i j� ' ' �' �� . � i _' . � �.. € 1 ! � .�. . I 7 I �t- " ; � . i i- � 1. V : ': i ( - 1 I I � . E � I i . -{- , _ L � _ t � . � � ��€ -F--- _ ' e - ! +o '� x�. � � � ' � t S�'�,°�� '[- - �€js: � � " 4'�• � � ` I C` �.�. �Y� r � � � �. �- � ' ! �._ r ._ �,� �� � �'i �. � s ,: � !. � F 1� . 1 � `� � �� . s " - � �� a i ! `, t � a. � �� � � ' `" �� �� { � . . �:.. � � -:� _ + �'�` t "_� � �"x` : �- �- ._ � � � _ ' . i ; __ i � � � �"� : ; � �� � i i � . , � , �� au� � � � � 1 � , _ . _. Y' , ; , ,_ _ . -.� w._� - �. -i � : . ,�i ! r '. (. : . , � i� -- _. E . . � , E y—, �z= � _ � — — — . , . , . - , w � � : ; � : r- ; � y . �. ' � � : f . . '_ • i:=. ; : , ���' . . ! � : , ' i t i �• . �:'. � �- � �' _ � �.I f �� � i � ' �` � ' � , �( � �.' ! ' �i � � v',.. I ��.. 3: ��. ( � _ 1 � , I � . � • "� I -- 4 �t � -,i ;—� Y-- TM�.�. ' ,�E � . j F �E :� � f{ � , - i i t �.. : . F I �� � 1 �� �. F�. f �- . .i � 3 � � � . t _ �, I ��. . ' � � � � i � � � f_ ��. i i£ F � a _ I ' �. � �; i � i � � __ E ( � r � � i � � F � I � � ; s; � i ""1.- � � I �1 � �� i '� � �� � . i - i-�� , i � �; � , � ' � � ' ' � ;� �; ; ` . � � ; . : _ , , � �� _ h_ _�__ r_r_.___.n_ __._ _ ,_---.. ._e � _, . __ , , .�._.a_._. _ __..._.......__......._. .�. .�,.__.., ..... ._ _...._.. . , �._, __.__....,.. ....e x.:- , . �. . .. I �`E