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HomeMy WebLinkAbout12551 (13) � � !� CITY OF DIAMOND BAR ' i DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �,�`' _ 21660 E.Copley Drive Suite 190 W PRESS ���rw BUII,DING PERMTr APPLICATION FIRMLY o ADDR'ESS��i(J� ����C DATE CATION���.-�J�.�� NUMBER L� #lC �'��v l �d ISSUE TYPE OCC °��-° APN 9 ��T �RACT���� DATE ������ ���CONST. ` GROUP LL OWNER °F � ���,� `���� ADDRESS Io ��'G�� ZONING SETBACKS o CITY 1L�M i�I ZIP TEL. ��' Q"' REORT RW � o APPLICAN'f TEL. SIDEJSIDE STREET RW �7 � CONTRACTOR �Cs�C. Pf�l� � �� SIDE _ ❑ � CIT`f�.�IA�� l.�.l��.,5 ZIP EL.� PROPOSED USE R w ARCWENG/ WDESIGNER NO.DWEL NO. . a ADDRESS UNITS STORIES BEDftOOMS � � CITY ZIP TEL. `� `y DESCflIPTION SQ.FT FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDEF DECLARATION SFR/ADD/REM � o -� I HEPEBY AFFlRM UNOER PENALTV QF PERtt1RY THAT I AM IXEMPT FRO!A THE CONTRACTOflS LI- -_ � GdfaJB/C8fP0�[ -W- CENSELAWPoR7HEFOLLOWINGREASON(SEC.70.91.SBUSINESSANOPflOFESSIONSCODE:ANYCITYOR � U� COUMryWHICMflEWIflESAPERMITTOCON5TRl1CT,ALTER,�MPROVE,DEMOLiSH,ORftEPAIHMlYS7AUC- . W PdIiO/DBCk -W--: TURE,PRIDfl 70 ITS ISSUANCE,AL50 flHH1�fiE5 THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNED :� _� STAIEIAENT THAT HE OH 6HE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONiRACTORS Lk .0_. CENSE LAW(CMMTER e(WAtMENCING WITH SECTIOY�Wo)OF DIVISION 30F THE BUSME33AND PRO- U' POOVSPB g . F fESS�ONSCODE)OH7HATHEORSHEISEXEMPTTHEPEFROMANOTHEBASISPoHTHEALLEGEDEKEMP- - (� V TION.ANYVIOLATIONOFSECTION7031.59YANYAPPLICANTFORAPERMITSU&lECTSTHEAPPLICPNiTO -Z Re-Foof . -�_ ACIVILPENAITYOFNOTAVJREhIANFIVEHUNOflED00WflS(35oo�.):- _0_ ❑I,ASOWNEROFTHEPROPEHTY.ORMYEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSAnON, � � CommerCial " .Z= Wlll DO THE WOq1C,AND THE ST0.UCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oa4,BUSI�. ,J NESS AND PROFESSIONS CODE:THE CONTRACTOAS LICENSE UW DOES NOT APPLY TO AN OWNER OF -�- PflOPERTYWF108UILDSORIMPROVESTHEREON,MJDWHODOE55UCHWORKHIMSELFORHERSELFOR -- _ -=�-�� TNHOUGHHIS�RHEHOWNEMPLOYEES,CRON�EOTHATSUCHIMPROVEMENTSARENOTINTENDEDOFi --m �O;: OFFERED FOflSALE IF,HOWEVER7}1C-BUIlAl4G ORIMPROVEMEH(IS SOtD WIYHIN ONEYEAR OF COMPLE -.�_. -TqN,THE OWNER�BUIIDER WILL F1AVE THE BURDEN OF PPOVINO T}tAT HE OR SHE DID NOT OUIIA Oft- - .� IMPR6VE WRTNE PURPOSE OF SALE). - ❑I,ASOWNEROFTHEPflOPEFlTl;AAtEXCLU5IVELVCOYTMCY1NGWiTHIICENSEDCONTRACTDflS` -'Q�-�. :TO CON5TRUCT THE PROJECT(SEC.7044,BUSINE55 AND PROFESSIIXJS COOE:THE COMqACTORS LI-- � V3Il18fI0f1 ADJ.AflEA - +W`- -CENSEUWOOESNOTAPPLYTOANOWNEROFAPROPERNWHOBUILOSOFiMPfiOVESTHEREON.l�YD -- -_. -Wf!OCONTMCTSWflSUCHPfiOJECTSWITHACONTRACTOR(S)UCENSEDPURSUANTTOTHECONTFiAG -- -QUANT�TY DESCRIPTION � FEE - -~. 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B.L P.C.fOR THIS REASON , � �- � � � �.�LL" .DATE `� � OYVNER - U Z W ;�i� IICENSEDCONTRACTORSDECLARATION - `: �j � - ;�-=' I XEflEBY RFFIRM UiVDER PENAITY OF P'eRJU.iY T1iFT ItiA LICENS'cD WDER PftOViSICtiS 0F Cl41PTEP _. �� _ ��= e(�MAIENCINGWiiHSECTION7oDoJOFDIVI510N30FTHEBUSINE55AN6PPOFE55!ONSCODE.AND - Z ' -- MY tICENSE IS iN FULL WRCE AND EFFECL y� .y : m _�: L�CENSE CL{ASS�`���� � L�C.NO. ���(yf�/ l v`s i�} % j . -_V_ DATE L��4�1"`�T, _ _ CONTRACTOR-C7.LsO N T 1 N I } a k W'- � -�' WOflKERS'COMPENSATION DECLARATION - -� - .�, Q � �> U .�-. -IHEREBYAFFIqMUNDEHPENALTVOFPERIURYONEOFTHEWLLOWMGDECLARA710N5: ' � �0- _IHAYEANDWILLMAINTAIYACERTIFICATEOFCANSEMTOSELFIN5UREFORWORKERS' � � � . � ;-�`_ WMPENSATIOY,ASVROVI�E�BYSECT10N37000FTNELABORCODE,FORTHEPEHf-0RMANCE '' �U - OFTHkWORKFORWHICHTHISPERMITI51S3UED. , � �. -W- I HAVE AND WILL MAINTAIN VfONKEHS'COMPENS0.TION INSUFMCE.AS flE�U1RED BY SECTION - /'��'� �y. c� '�.- 37000FTHELABORCODE,FORTHEPEFiFORMANCEOFTHEWORKFORWHICHTHiSPERMITIS 7(7 p =�' ISSUED.MY WORKERS'COMPENSATION INSURANCE CAHfl1ER ANO POLICY NUMBEFARE: CONS 6�/7 G J""�7- � R�j� cARRiEq � - . PLAN REVIEW I I I Z.�. �-�� POLICYNUM9ER ELECTRIC :;:Z:.. . —____ _ .____— _ �: ;�_�: (nussEcrae7r��rioiae�rIDOFn�aErun,t�sroRc��r+u'��oeuaAsfstw)oa�[ss� PIUMBING '�.z-- ICERTIFYTMATINTHEPEFFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED,I - -MECHANICA� � --;(�- SHALLNOTEMPLOYANYPEflSONINANYMANNER50A5?06ECaMESUFUECTTOiHE . . . . :�-- WORKEH6'COMPENSATIONIAWSOFCALIFORIviqANDAGREETHATIFISHOULDBECAME I FEE _ __.__ . `�_ SL�&1ECTTOTHEWOPKERS'COMPENSATIONPROVISIONSOFS[CTION370aOFTHELABOP �3�/'�o - _�_ CO�E,�1I SH/1ALL FOflTHWITH COMPIY WI THOSE PPOVISIONS. e ISSUANCE �l � ��![ t�i ��j�/y�� �v �..W, �ATE:�� APPLICANT. ���%�"= MIP �- J- W�RNINGFAILURETOSECUREWORKEHS'GOMPENSATIONCOVERp6EISUNLAWFUL,ANOSHAIIUE ENERGYP/C �.J, ��—y -SU6JECTAN EMPLOVERTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNOREU THOUSANO - ENERGY P (T - OOLLAflS(f700,000).IN ADDITION TO THE COST Of O�MPENSATION,DAMAGES AS PROVIDED FOR IN /q �__¢:_ SECTION37080FTHE LABOR COOE,INTEREST,AND ATTOflNE1"5 FEES. ENTION FEE: 0 D v `:�-�_ CONSTRUCTION LENDING AGENCY PREALT FEE: �0= -��-�. IHEREBYAFFIflMUNDEflPENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLENDINGAGENCY -�' FOHTMEPERWRMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED(SEC.309�,CIV.C.). - . i:Z: W_ LEN�ER'S NAME - - _��'. .':1--:-. IENDER'SADDRESS — - /� ['�� ICERTIFY7HATIHAVERFJ�DTHISAPPLICATIONANDSTATETHATTHEA90VEMFORMATIONISCAFIRECT : TOTAL FQUJ' J y� �{�y�x � �/J � � (/�..� IAGREETOCAMPLYWITHALLCRYANDCAl1NTVORDINANCESANOSTATELAWSREIATINGTOBUILDiNG ��� t.� t,r vvtiv x )t � CANSTRUCTION,ANOHEREBVAUTHORIZEPEPRESENTATNESOFTMISCOUNNTOENTEflUPONTHE � ��� �.Z ABOVE-MENTIONEDPROPERTYFORINSPECTbNPURPOSES.. , � CO /'���TA*�{(�*m�j/�jy - ��Y�IYYIYL�I�Y�'l7Y'��_'___'_ . _—_ —_ � �f Cl C. 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