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HomeMy WebLinkAbout17086 (17) �` CTIY OF DIAMOND BAR i r�EP�1RTMENTOF COMMUNTTY&DEVELOPMENT 5ERVICES EXPlRED � � __,��21825 E.Copley Drive (909)860.3195Fax(909)861-3117 JUN 18 2pp2_ PREss `%�� BUILDiNG PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION p � PERMIT � P/C o ADDRESS �-�. qTE_ � 1 NUMBER t� � APN LOT TRACT ' �SSUE TYPE CC � —�— DATE � � �� CONST. GROUP p OWNE�rYI/l LL'G o ADDRESS �ZONING SETBACKS z CITY ZIP TEL FRONT RW ❑ g APPUCANT TEL. REAR ❑ SIDE/SIDE STREET RW O � CONTRACTOR '��r.E�10 SIDE ❑ o ADDRESS r2 PR�POSED USE ' orrr t^ _ A-� ziP�3T _ 7 � �, w ARCWENG! � DESIGNER N0.DWEL NO. 1 y NO. n. ADDRESS UNITS STORIES BEDRQOMS � CITY ZIP TEL. N cn DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATI�N p� OWNER•BUILDER DECIARATION SFRlADDiAEM O p I HEREBYAFFlRM UNDER FENALTY OF FEfiIUHY T�NT 1 AM E%EMPT FROM 7ME CONTMCiOqSll• G0f8gB/CBfpOR W CENSEUWFORTHEFOl10WINOPEA50N(SEC.70.77.60USINESSMIOFROFE5510NSCODE:M1YpTYOR (� U �p{p(TyW}�Ip�REOUIRESAPERMRTOCONSTRUGT,AL7ERIMPflOVE,OEMOL15H.ORflEPNRANYSTRUC• W patio/Dack � TUFiE PRIOR TO RS ISSUANCE,A150 REOUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED W � STATEMENT TUT HE OR SHE IS LICENSED PURSUANT TO THE PRONSiONS OF TNE CONTRACTORS LI� � � GENSEUW(CHAGTER9(CDMMENqNOWITM5ECT10N7000)OFDIVISION�OFTHEBUSINESSANOVFO- POOVSpB FESSIONS CODE�OR THA7 HE OH SHE IS EXEMPi THEREFROAI/W D TME 6ASI5 FOR iHE ALLEGED E%EMP- � TION.ANVVIOIATqNOFSECilON7a71.5BYANYAPPLIC11MiOHAOERMIT5U0JECT5TME�PPUCANiTO Z Ra-Aoof � AGVILYENALTYOFNOTMORETHANFNEMUNDflEDDOLURS�{50o�.): � ❑I,ASOKNEROfTHEPROPERtY,ORAIVEMPLOVEESWITHWACE5A5THE�R50LECDAIPENSATION, 0 CommBfCi01 WILL 00 THE WORK,ANO TNE SiRUCTUHE IS NOT IN7ENOED OR OFFERE�FOR SALE(SEQ 7a1,BU56 J � NESS AND PROFESSIONS CODE:THE CONTPACTORS IICENSE UW OOES NOTAPPLV TO AN OWNEfl OF � iROPEHfY WHO BUILDS OR IMPROVES THEREDN,AND WNO DOES SUCH WORKNIMSELF OR HERSELF OR Q 7HROUGHHISORHEHOWNEAIPLOYEES,itiQY�OEDTMATSUCHIMPROVEMEMSARENOTINTENDEDOR m QOFFEREOFORSAIEIF,f10WEVE0.TMEBUlDINGON11AvpOVEMEMI550LDWITMNDNEYEAROFCdAPIE• Z T�ON.TH[fWMEH�BUi40ER MALL NAVE THE BURDEN OF PROVW(3 THAT HE OR SHE OiD NOT BUItD OR = WPROVE iOR THE VUflP0.5E OF SALEI. w OI.ASOWNEROFTHEPROCERiY,AME%CLUSNELYfANTqACTW6WITNUCENSEDCONTMCTORS (r TO CONSTRUCT THE PflQ1ECT(SE4 70N,BUSINESS RND CHOiESSIONS CDDE:THE COMRACiOHS U- Vd�U8110t1 ADJ.AREA W CENSEUWDOESNOi�PPLYTOANOWNEROFAPROPERTYWMOBUILD50RIMPROVESTMEREON.AN� � WVIOCOMMCTSFOqSUCHDR0.IECTSNnTHACANTMCTOR�S�UCENSEDPUNSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE Y TORSLICENSEUW.�. 0 ❑IAM EXEA/PT UNDER SEC. B.8 P.C.iOR THIS REASON U � � � LL OATE OMMER f' Z W � LICENSED CONTRACTORS DECLARATION W � IHEREBYAFFIRMUNDERVENAL7YOFFERJURYTNATIAAIUCENSEDUNDERDRONSIONSOFCHADTER � d Y�COMMENCNOWtTT13EGT10N700o)OF�MSIONJOFTHEBUSINESSANDPROFESSiONSCADE.ANO Z ►IY LICENSE IS W FULL FORCE AND EFFECT. . m � UCENSECLpASS � �/G ��c.No. ��3 U.2.p � V �ATE /�/U' O� �CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION a � IHEREBYIiF�INAIUNDERiENALTVOFFERIUMONEOF7HEFOLLOWwCDECLARATqNS: � y Q � �IHAVEANDWiLLMAINTAINACERTIFICATEOF07N5ENTTOSELF-INSUREFORWORKERS' S � COMVENSATION.IISPNOVIOEDBVSECTI0N77000F7MELABORCOOE.FORTMEPERFOW.IMlGE W OF TNE WORK FOR WHIp17H15 CERM�T IS ISSUED. � � �I HAVEAND WILLMNNTAIN M/OfU(ERS'L0IAPENSATION INSUiUNCE,AS REOURED BV SECTION 4� 87000FTHELABORCOOE.iORTNEGERFORMANCEOFTHEWOPKWHWHICHTH�SPERMITIS U^SUED.MYWORIfERS'COMPENSATbNINSUiIANCECARPoERANDPOLICYNUMBERARE: CONSTRUCT�ON � CARRIER PLAN REVIEW � voucrrauMeEA ELECTRIC — � (THSSECiIONA£mN07BEC�iE7EDOFTEPEPMT6FORONEHUOREDWIURSpt00�ORLESS} PLUMBING Z I CERTIFYMAT W TNE PENFORMANCE OFiHE W�RK FOR WN�CH 7HIS 7ERAIIT IS ISSUEO,I MECHANICAL U' SHALLNOTEMPLOYANYPERSONINANYMM'NERSDASTDBECOMESUBJECTiOTNE � WORKERS'COMVENSATqNLAW50FCALIFONNI0.AND11CFEETNATIFISNIXILDOECOAIE INSPECTIONFEE SUBJECTTOTHEWORKERS'C0IAPENSATIONPflON5qN50F5ECT10N77000FTHEv�sOR S cooe.isH.uivoan'w�rHcan�rwin�n�ose ohsar+s./J _/ ISSUANCE �'p DATE:,��'�b�6�APPLICAM: � ��l—A�..f Ll:c SMIP � ENERGY P/C WARNING:FAILURE TO SECURE WORKERS'COMPENSA710N COYERAGE IS UNUwFUL,ANO SMALL BE �y SU&IECTANEMPLOVERTOCRIMpIALVENALTIESANOCMLFiNESUPTODNEHUNORED7HOU5AN0 ENERGYPERMIT DOIURS(f 100,000).N FDOIiION TO TME C0.5TOF fAMPENSATION,OMU�ES AS PROVIDEC FOR IN ¢ SEC7�ON�7aeOFTHEIAeORCOOE,NTEREST,ANDAl70R�EY5FEES RETENTIONFEE: nW.. CONSTRUCTION LENDING AGENCV pRE•ALT FEE: � IHEREBVAFFIRMUNOERPENALTYOFPERRIRYTHATTHEREISACANSTfiUC710NLENDINGAGENCY FORTHE PERFORMANCE DF TNE W�P1C FOR WMiCN iHiS iER1AlT IS�SSUED(SEC.7ov7,CIv G). � � LENDER'SNAME � LENDERSAOONE55 � ICERTIFYTHAi1HAVEREADTHISAPPLICATIqJANOSTATETHATTHEA80VEINFORA/A7pNISWRRECT. TOTAL FEES . �,Q(t,, JO W IAGREETOCOMP�YN7THALLCRYANDCOVNTYOfiDiNANCE5ANO5TATELAWSRELATW6TOBlJILDIN6 n' CONSTRUCTION.ANDHEHEBYAUTMON�ZEflEPRE5EN7A71VE50FiHISCOU1RYi0EME1iUPONTHE Z /IBOVE�MENTIONEDGROGERTYFONIN57ECTIONPURPOSES. COMMENTS _ ����A,�� y �A rcaum u au+n ^/ � • �-/ K.� ��0.�O� � 5�6NATUR � PERMITTEE DATE � RECPT.�O. PAIO BY � VALIDATION WHITE—Department Copy,YELLOW—Finanee Copy,PINK—AssessorCopy,GOLDENROD—File Copy.GREEN—Apqicant's Copy r .,.,y. .-.<,a...�, �,, v . .::r. �r.:...• �,:.;.r.�.,' N ti� , ',1� „!�� i �'v.-�L :L. . . �.�,. ro- • .. ��� . � �r � .. ...,.. . � . .-., . 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DRYWALL NAILING DEDICATIOt�S SEWER r FINAL ENG. SEPTIC TANK LAP�DSCAPE/IRRIC. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZOP�ING FINAL CONST. FIRE OEPT. FIPJAL • FIPJAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENEPGY � , .....,,.�_�...,.-.::.._......_ _ i' r?�`1� `�I-S� � ' . �_.__ —� .:+�..=;x .. r�. ,,.V_.._...�.._a.�__.-- - -- �- COMnn�N-rs�d�{�.�C�S����b t�-D�c��S_S_.�'�-��_,���- . , SEPTIC TANK SIZE SEEP PIT/U SIZE !�_� � F�f�' I��,�I I � , _. , .a ; � , � j . �