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HomeMy WebLinkAbout12-1318 (14) CITY OF DIAMOND BAR -�---�F� — DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � I 21810 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS '�^', BUILDING PERMIT APPLICATION FIRMLY o DDRESS �LJ� S• ���{��I�� �� ���J� DATECATION jO � � Z NUMBERL-��I� �,C / � DA EE D � �� TYPE �D 1 OCC APN LOT ' TRACT CONST. GROUP p OWNER Cl�I��I2C7N o ADDRESS � DO v� Gn1Y � Q�. ZONING SETBACKS Z cirv SAN P.�lN�Da�I ZIP 5��, TEL. ZS 1 3] ] FRONT p�/y p � APPLICANT TEL. REAR p � SIDE/SIDE STREET RW ❑ z � CONTRACTOR i�l�A,IE k�ER.� I1�1�- SIDE ❑ ADDRESS SZ81 COMY�'1/)lJ�l.� /��I . � CITY R.3£rll�A4�L1C ZIP 9(�b2� TEL �.�fdo-Ib79 PROPOSED USE w ARCWENG/ z DESIGNER WA��'PIiYL.Q1l INC • w � NO.DWEL. NO. NO. a ADDRESS 1�'IGI�� ��� Pr•�. � CITY ,�Kv�_✓� ([_ ZIP Y UNITS STORIES BEDROOMS [�bZi TEL.71`f�Zfd�S7 �n DESCAIPTION SC1.FT. FACTOR PSF ADJ.AREA/VALUATION p� OWNER•BUILDER DECLARATION SFWADD/REM O p I MER�Y AFFlRM UNOEA PENALTV OF PER0.IRY THAT I AM E%EMVT FROM TME CANTMCTOL75 LL GaragelCarpoR W CENSEUWFORiHEFOILOWW6REA$ON(SEC.70.71.SBUSWESSANDPROFESSIONSCOOEANYCITYOR (n U CWNfYM?11CHREWIRESAP6UUTTOCONSTRUCT,AITER�PROVE.DEMOI.ISM,ORREPNRANYSTPUG w 7URE,PR10R TD RS ISSUANCE,ALSO REWIRE9 THE APPLIGANi FOR SUCH PEAMIT TO FlLE A SIONED w P8110/DBGk � STATEMENT hUT HE OR SHE IS LICENSED PUHSUANT 70 TME PROVLSIONS OF THE CONTRACTORS LL � , � CENSE UW(CHAPTER e�COMMENCWO WITN SECTION]000)OF OIVISION 7 OF THE 9USINESS M!D PR6 PooVSpa 0 FESSqNS COD�OR THAT HE OR SHE IS E%EMPTTHEREFROM AND THE BA515 FOR THE ALLE6ED E%EMP- C7 V TION.ANYVIOLA7IONOFSECilON703t.SBVANYAFPLiCANTFORAPEM/RSU&IECTSTHEAPPLICANTTO Z RB-ROOI A CNR.PENALTY OF NOT MORE THAN FlVE HUNDRED DOLLAHS(f5ao).): � ❑l��N�NEROFTIEPROVERTY,ORA7YENPLOYEE9WITHIVAGESASTHEIR50LECOMPEN5A710H, � Commercial � z MnLL Do Tl1E WOFlI(MlD TiE STRUCTURE IS NOT INTENDED Oq OFFERED FOR SALE(SEC.7ou,BU51� J � NESS AND PROFESSIONS CODE THE CONTRAGTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � . PROPERTV W1i0 BU0.0.4 OR IMPNOVES THEREON,AND WHO OOES SUG1 WORK HUASELF OR HERSELF OR w TWiOUCH HIS OR HER ON?l EAIttOYEES,7ROVIDED RiAT SUqI W PROVpJENTS AAE NOT MTEMpED OR m . Q OFFERFDFORSALEIF,HOWEVER7NEBU4DWOOi11MFROVEMENTtSSOtDWfTMNONEVEAqOFCOMPLE• Z 710N,THE OWNER�BUILAER WILL IUVE 7HE WFDEN OF PROVPId THA7 ME OR SHE DID NOT BUIID OR � IMPROVE FOH 7HE PURPoSE OF SALE} w ❑I,AS OWNER OFTHE PROPEHTY.AAI E%0.USNELV CANTMCTMU WfTH 110EN5ED CONTRACTORS Q TO CONSTpUC7 THE PR0.IECT(SEC.)a�.BUSINE55 AND PROFESSIONS CODE:iHE CONTRACTORS Ll- V81Ua�lOf1 ADJ.ARE{i W CENSE UW DOE9 NOT APVIV TO AN OWNER OFA PROPERTY WFIO BUM1A9 OR IMPROYES THEREON,AND � WHOCAMRACTSFORSUCHPRQlECTSWITHACAMRACTOR�S)LICENSEDWRSUANTTOTHECONTiUC QUANTITY DESCRIPTION FEE . TORS LICENSE UW.). � O I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U - � OATE OWlvER F— Z U � UCENSED CONTRACTORS DECLARATION W � � I HEREBV AFFIqM UNDER PENALTV OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CiIAPTER � � Y(COMMENCIN(i WITH SECTION 7000)OF DMSION 7 0F THE BVSINESS AND PROFE551GNS CODE,MW Z X�� MY UCENSE IS W FIA.L FORCE AND EFFEI:T, m u� /� -+ � LICENSECLASS Cf„�C��O�C'.TT LIC.NO.3 � . j Lj DATE S� CONTRACTOR d . - - W � WORKERS'COMPENSATION DEC N Q � . � 1 MEREBY AFFIpN UNDER PENAITY OF VERIURV ONE OF 7HE FOLLOW WG DECLAHAT�NS: z � _I NAVE AND WILL A7AIMAW A CERTIFICATE OF CANSEM TO SELFNSURE FOR WOR)(EA5 T ^ � COAIGENSATION,A4 PROVIDED BY SECTION]70o OF THE LABOR CODE.FOR THE PEAFORMANLE �U � Q OF TNE WORK FOR NTi1CH THIS PERMIT IS ISSUED. - � ' � w �1 NAVE AND WILL YNNiA1N WOqKERS'COMPENSATqN INSURANCE,AS REOUIRED BV SECilON O J7000F THE UBOR CODE.FOR THE VERFORMMICE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MV WORI(EAS'COM➢ENSATION IN$URANCE CMRIER AND POIICY NUMBER ARE: CONSTRUCTION jCAARIER F��261.. INC . E,�j. 1 PLAN REVIEW _ �•Z(� 0 POLICY NUMBER [9�4 U 7 Z Z� ELECTRIC Z ¢ p 0*���+N-'�mr�o'rBEcan�.ErmaFnEa�r.r�sia+a+Erax��ocu.�uMmloa�ss� PLUMBING � , _ w Z 1 CERTIFV THAT M THE PERFORAIANCE OF THE WOfM FOR WMICH THIS PERMIT IS ISSUED,1 MECHANICAI � CJ SHN1 NOT EAIPLOV ANV PERSON W ANY lAANNER SOAS TO BECOME SU&IECT TO TNE � WORKERS COAIPENSA710N UWS OF GLLIFORN10.�ND AGREE��r�i sr+o�xn eecor,�e � INSPECTION FEE _ = SU&IECTTOTMEWOHKERS'COM7ENSATIDNPROVISIONSOF CTION37o00FTHEUBOR caoE,i srwu wRr�nni coMa�v vnni nwsE pqo�sro . ISSUANCE O � p On�: ,�'OS-/L nPrucnwr: SMIP d 7 CJ w J WARNIN4 FA6LRE TO SECURE WORKERS' P SATION RAGE IS UNUWFU�AND SHALL BE ENERGY P/C � SU&IECTAN EMPLOYER 7o CRIM WAL PENAL7IE AHD CML S UP TO ONE HUNORED THOUSANO ENERGY PERMIT DOlUA9(f100.000�IH ADOIT7UN TOTHE CAST OF COMPENSATION,OAMAf3E5 AS PROVIDED FOR IN J SECTION 370E OF TiE LABOR CODE,PITERE3T,/✓ID ATfORNEVS FEES. � ¢ RETENTION FEE: OCONSTRUCTION LENDING AGENCY pRE-ALT�F�E/E:'+� � r r O Q 1 HER�Y AFFlRM UNDER PENALTY Of PERIURV THAT TFiERE IS ACONSTRUCTION IENOVW AOQ/CY �L�/�y � � �- FOR THE PERFORMANCE OF THE WOPo(FOfl WHIC71 THIS PERMIT IS ISSUED(SEC.]OY7.CIV.C.). ��1 - Z w , � LENDER's NAA1E . . F— LENDERSAODRE53 /7 w 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STA7ETIiAT h1EA80VE MFOqMAT10N IS CORHECT. TOTAL FE ES . \����f � I AGREE TO COMttY N77H ALL G7V M1D COUN7Y OROWANCES AND S7A7E UWS fiEU7WO TO&1RDIN[i . � � � CONSTRUCTION,AND HEREBV AUTHORIZE REPfiESENTATNES OF THI$CWNTY TO EHiER UPON THE . Z ABOVE-MENTKXJE�PHOPERTY FOR INSPECTION VURPQSES , COMMENTS � J � m FERMITfEE NA1AE(VWNT� ' Q N N SIONA7UqE OF PERMI7TEE DA7E � RECPT.NO. 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DR'f�TlALL M1fAILiPJG i DEDICATlONS --------__._------- --------------------------..._ - ----- SEWER ,FINAL ENG. ' ----- _----..---�----------------- --------- -�- -- --- - -------- SEPTICTANK LANDSCAPEIIRRIG. ` ' SEEP P1T/L.L --- ------ - ------' OhJ SITE IN1PS.-- ----�---- GAS AIR TEST FINAI ZOf�lING FINAL CONST. FIRE DEPT.FINAL FINAL FIE.�,TING ��HEALTH DEPT.FINAL FINAL ELECTRIC � �QEV.FEES PAID FfNAL PLUMBING I ENERGY FINAL PLANING FINALE�JGIMEERING � � �'m ,� ' COMMEPJTS �, ' �2� % ,� �y SEPTICTANKSIZE SEEP PIT/U SIZE 4 ,.