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HomeMy WebLinkAbout13335 �� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS � "9K'f BUILDING PERMTi'APPLICATION FIRMLY o ADDRIESS ���S �GlL/Z/AI A'L- LA�E_ DATE CATION � 7'�-� �NUMBER t�335 ��C issue J. �, � TVPe occ � � APN LOT TRACT __ DATE_ CONST. GROUP � p OWNER _1Y)/t �` /✓�/'�5 �"'�y�Z.i� s p ADDRESS �nj���uri..3„y `4ru.� ZON�NG SETBACKS � z CITY 'n�..w..d� Isoil, ZIP TEL. REART RW n f g APPLICANT �._ n'�c.Y( TEL.'ti4-g9 i-yLts SIDE/SIDE STREET RW LI_ Q � CONTRACTOR �MR�an e� I�QD t e�� SIDE 1 I_ _ � ADDRES "�(e� s• �Zp�L r y�c c�c-r k,� RLa)O �" O PROPOSED USE_ f�'�j�et� SJn 200� b� p CITY 7_IP L � rF�.. 7�9'����-� " � wo ARCH/ENG/ � -• �`�, j z DESIGNER L � ADDRESS�_�p � � NO.DWEL NO. NO. {: v� �I ��� �� UNITS STORfES BEDROOMS t � citv _,,��`4ef� ziP TEL.J�L_�ry, .� ------ - � DESCRIPTlON SQ.FT. FACTOR PSF ADJ.AREANALUATION � p� OWNER-BUILpER DFCLARATION SFR/ADD/REM � O p I HENE9Y AFFIRM UNDER VENPLTY OF PERIUHV THqT I AA1 E%EAIDT fROAI THE CO�TRACTORS LI- Ga�a98�Cafp�rt W CENSEUWFORiHEFOIIOWINGREASON(SEC.]0.91.SBU3INESSANUPflOFE5510NSGWE:ANVGITVOR �� � COUNiV VMICH REd11FiESA PERMITTO CONSTRUC7,ALTEN,IMPROVE,DEMOLISH,OF REPAIRAYV STFUG F iURE.PRIOR TO ITS ISSILWCE,AL50 RE�UIRES iHEAPPLICANT FOR SUCH PERMITTO fILEA SIGNED P2fi0/DBCI( � � STATEMENT 7HAT HE OR SNE IS LICENSE�PURSUANT i0 THE PROVISIONS OF THE CONTRqCTORS LI- "�� CENSE LAW(CHAPTER 8(COMMENCINQ WITH SECTION 7400)OF�NISION 30F THE BUSINE55 AND PRO� POOUSFI2 �• FESSIONSCOOE)ORTHATHEORSHEtSE%EMPiiHEFE�ROMAND7HE8A5i5FOR7HEM.lE3EDEXEMP- (� . U TION.ANVVIOLATIONOFSECTION7031.SBVANYAPVLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z He-Root � ACIViI VEN�LT'OF NOT MORE THAN FIVE HUN�RED OOLlAHS(5500).)� �, � ❑I,ASOWNEROFTHEPRpPERTV,ORMVF.MPLOYEESWITHV/AGESASTHEIRSDI.FCOMPENSATION, � COfI1mBfCiel — � S. WILL DO 1ME WOAK,AND THE STRUCTURE IS NOT INTEN�E�OR OFFERFO FOR SALE(SEC.7066,9U51� i.J { � N'cSS AND aROfESsiqYS CWE:THE CON7RAC7CHS LICENSE L4W�oES NO7 AP�I.Y 7o AN OVdNER OF � ` PHOPEflTYYVF109UILDSORIMPR04E57MEREON,AN�WNODOES&UCHWORKHIMSELFORHERSELFOR €m [+ d THROUGHN�SORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPflOVEMENTSAREptOTINTENDEDOR � W OFFEREDFORSAIE.�F,HOWEVER'�NEBU!ID:NGORIMPROVEMENTI550LDWlt'NINONEVEAROFCOUPLE- � TION,THE OWNEfl-BUfLDEfl WILL HAVE TNE BURD[N OF PROVMfi T7iA7'HE OR SHE�Ifl NOi BUILD OH Z IMPqOVEFORTNEPUqDOSEOFSPLE) 1 ` w C71,lSOWfYEROFTNEPROPEGiTY.NAE%ClU31VELYWNTRACI'IiJGWiTHLICENSEOCONI'RACTORS ! N � TO CANSTRUCT7HE PR0.IECT(SEC.7014.BUSMF.SS PND PROFESSIONS CADE�THC CON i RqC'fOflS ll• V8IU8I10.'7 � � "ADJ.AREA___, � W CENSEUW�OESNOTAPPLVTOANOWPJEROFApROPERTVWH09U1LD50HIMPROVESTHEREON,AND ' '- ' � NT%1CONTRACT9 FOR SUCM PRO.IECTS WI7H A CO4TRACTOR(S}LICENSED PUR5UMlT YO THE CONTRAC- Y roasuceNs[uw.�. QUANTI7Y OFSCRIPTION FEE � � I.IIAAIE%EMPYUNDER&'cC.__�____� _3.&P.C.FOf1THISRFASO4 .JQ � O JTL.�' 'S 4_ U ---`- ---....------- [L � � � � f QOATE ___OWNEFi """"".__"" __' U _" _— � � UCENSED CONTRACTORS�ECLARATION `� W � J � I HEPEBYAFFIRM UN�ER PENALTY OF 7EftJURYTHA7IAM UCENSE�UN�[R PFlOVIS!O4S OF CHAPTER ' � �[ a B(COMMENCINGWffHSECTION70W)CFDiV1510430FTHE9USINESSANDPROFE55!ONSCO�E,AYD Z _ t X W LICENSE IS IN FULL FOFiCE pNU EFFECT. m � � L�CENSE CLA55 !_�_ LIC.NO.��/���� j ! � /� � � w OATE `T�l.Q_��..7� C07JTMC70R�'4y.GL��QQ.L�?.dtS 4 — i � � � WORKE.RS'COMPEtJSATION�ECLARATION C��C,1'� U � � I � IHEREBYRFFIRMUNDENPENALTYOFPERJURYPJECFTHEFOLLOWIKGDEGLAP,ATIDNS: z � v�[ —'� ! � _IHAVEANDWI!LMAINTAINACER7IFICATEOFCONSENiTOSELF�INSUSiEFORWORKERS' _ Q COMPEIYSATION.AS PROVIDEO 6Y SECTION 370o OF THE LABOR CODE,FOR Thl[PENfOfiMANCE W S � � OFTHEWOHKFOAWHICHTHiSPEHMIY151S51/E0. � � � � W �IHAVEAN�WILIMAIMAiNW�RKERS'GOIAPENSATIUNINSUFANCE.ASRF:OUiRECBYSEC710t< ` � Q37000F7HE LRBOR CODE,FOA THE PERFORAIA�CE OF THE KORK FOH WHICry THIS FERMIT IS � I ,, /� � � ISSUED.MY WOflKEFS'CAN.PENSRiION INSI/f�ANCE CARPoER rWD POLIGV NUMdENARE: € coNsraucTioN ____ �, {.y,,�� __�,tJ�_�"�', �v � E j CAHPoFR�-��----,---.-.-. --- �c. � � PLAN REVIEW � lU —_ ! . .. ___ z POLICVNUMBEH�-�S'g�.�'�1q------- � ELECTRIL' � --------._..�,�. Q - -- 0 (IH65ECIpNN'cWNOTEE00h^P.E.TEUOFThEPERhAT6FOfiOJEMN�UiED00LLAR5(SiW�O�'iLESS) PLUMBING , _ �.,,;{r, __ • IAl ��'_"'_—'_'" i Z I CEflTIFV hIAT IN THE PERFOAMANCE OF THE WORK FOR WHICH THIS PEHMIT IS ISSUE�,I MECHANICAL �",}�� C;} SHAILNOT EMPLOY ANY PERSON IN.WY ASf�NNER SO AS TO B[CAME�UBJECT . I �(j WORKERS'COMPFNSATIONUWSOFCPLIFORNIA,ANOAGREETHqfIFISHU peEcorne�� INSPECTIONfEE _._ __. __ _ _ ; SUBJECTTO7HE WORKERS'COMPENSATION GFIOVISIONSOF SECTION 3700OF(!IE IAAON � � wo ISHN.LFOR7'IIWI�MCOMPLYWITMT105'?ROVISIONS. ISSUANCE __.__ .__.,___ _ __ ___ � _ �,. , O �y ' � ' , �r� Y �j,/ _,_..._ SMIP ------..._E.:",_-�_-T-��`'y �� � ��_.L� � p DATE:=l./,2�/'�'S'-- APPLICANY: .._..._ __ "_ _ I -- .— J WARNING AILURE�bSECUflEWORKERS'COMPENSATIONCOVERAGEISUNIAWFUL,ANDSHALLBE ENERGYPIC ._ _ • - .____.____ _ __.____ .. _, � � SUBJECTANEMPLOYEATOCRIMWALPENAL7IESAN�CIVI�FINESUPTOONEHUNOREOTHOUSANU ENERGYPERMlT y�'�.,—�—� � � �OLLAR5(5100.Wo),INMOITIONTOTMECOSTOFCOMPENSATION,�AMAGESASPROVIDEDFORIN - -� -- — � SECTION37080FTiELABORCADE,INTEREST,AI.DATTOPN[V'SFEES RETENTIONFEE: ___________„ _ ,__ x � FORTHEPkRIFORMANCEOFTFVOWORKFORWVHOIHTHSPFAMIA1515SF0(SEC.3ojDICN'�CGENCY PRE-ALTFEE: — --=_,_____...,___..��______�_ E � � �� c� ��rrr--�-..� w ——- --- -- -- -- -- � 3 LEND[(TS NAME ....'—__...._ "'"___" € ._ _..—_.. .._'—"'_'— _._'_— 4 H LENDERSAO�RESS .'__' _""__' __" & W ICEiiTIFYTHATIHAVEREAUTHISAPPLICATIONnkUS'fATETHATTHEABOVEiNFORMATIONISC-0RfiECT. TOT�IL FEES � � I AGREE TO CAMPLY WITH ALLCITY AN�CAUNN ORDM!NCES AN�STATE LAWS HELATING TO BUILDING p CANSTRUCTION,AND HEREBV AUTHOFlIZE REPR4SENTATIVES OFTHIS COLINTY TO ENTEP UPON THE q ZABOVE�MENTKKJED PROVERTY FOR INSPECTION PUflP05[5. � Q � , COMIAENTS,_, ,.. ..,,�, ------- —"-- -- — J "__. n _.m. _ _ � ---_ --- --- m � .--- --- _ _ � PE ' PRIM) � ""—�'_' —"_ _'—____ Q ` ���+ "_ � �b"���_�� —_� 'I� _ ( _ '——_— _ � r'luf'I�ATUHF.OFPE DATE � RECPT.NO. _• PAID BY _ .__,_VALIDATION __ WHITE—Department CoDY�YELLOW—Finance Copy,PINK—Asssssor Copy,GOLDENROD—File Copy.GREEN—ApplicanPs Copy . .... . _ ._ . _ . . _ . . _ _ . _. _._ . . . .. ��; � � � ' . . � . . , , , , ; � i ., � . � ! � � ' . , , ; • � . , . � . � - _ . !` • - . � _. , _ : . . . . , , _ _ . � _ ' .. ' � « - - , - , � . � , - �; .. � . i - , _. . ' _. _ � �• , : . . ' , - , ; . __ � . , , ., .. . 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