Loading...
HomeMy WebLinkAbout13628 (14) �.� CITY OF DIAMOND BAR ,,; DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES --�''� � E.Copley 've Suite 190 � ��� a � - {909)861-3117 '� PRESS """" "�BFNG ERMIT APPLICATION FIRMLY p� JOBSITE �2� ry.�G��/�� DATECATION � � �--' q NUMBE� #/ ADDRESS r.n�v r-� � APN LCO�T�_ TRACT ISSUE TYPE OCC p OWNER V DATE CONST. GROUP o ADDF�ESS O�S N ZONING SETBACKS �W CITYUI4 ZIP T . REART RW o APPLICANT ���, TEL._ SIDE/SIDE STREET RW [I CONTRACT2R •D SIDE n � CITY � ZIP t Z EL. PROPOSED USE S��NtMI G S �Ac o ARCWENG/��� �� � DESIGNER ADDRESS . p }t NO.DWEL. O. NO. � C�n, � Z�P TE� UNITS STORIES BEDROOMS N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O 8 I HEREBY�FFIRM UNDER PENAL7V OF PER1UqV THAT I AM EXEMPT FROM THE CONTRACTORS LI� GBfdgB/C3fp01i CENSE lAW FOfl THE FOIIOWING REASON(SEC 7031 5 BUSMESS AN�PqOFE5510N5 CODE ANY CIN OR � r•ti:�h--•:-, -- •--.. , . . � �. W PatiolDeck � •��w . ..,. , , , . � PooUSpa •4 U "„ ' ` ' s. " � � fle-Roof � • . ,`,' ,1 , � ' , , " ' ' � Commercial N 1 � � � . ' � i� ' 1 • A 'V i . i. � � !•M.11.C•.1. .' ,^,"h'.'4', ' . � .V- .V . . m '. e-�. - ���a ,:. ,:� .. . . , � ... . . . V'� �� ..1•' . • ���V� � � • , W p.����::.�6•��f. � '•'�h .:.. .._: y �� . Z 'rt'A7•� .;�h1:�:x.�.'�i••h R. . . �.'.ti . „ � �.�. ... . . � IMPNOVE fORTHE PURPOSE OF SALE). � . - A�^�\-�^.�•-_ -': •�M:� • '��'�\" ti.5. \ '�\ , . � _ W !:e�ti����.n ��n��• '+ti�,•i:. ^ . �:�.� � , . Valuati �� ADJ.AREA TORSUCENSC,IAW), , �• .•.1•• ' � yg � �`O IAM E%EMPT UNDEH SEC. ' �h . � .____.8�8 PC,FOF THIS REP50 ANTITY D CRIPT ON .. FEE � ...��. � N a ✓ H V �' M 6 � ZDATE _--OWNER--_ _- '_ ___—"_— f C� �L ' ~ � 4 � Q -- W LICENSED CONTRAC,TORS DECLARATION -� � w IHEflEBV AFFIRM UNDER PENALTY OF PERIURY TNAT 1 AM LICENSED UhDER PROVISIONS UF CHAPTEH � ,rF � B(COMMENCINO WITH SECTKKJ 700D)OF�IVI610N 3 OFTHE BUSMESSAND PROI ESS'ONS CODE.AND Z - � ��� MY UCENSE IS IN FULL FOflCE AND EFFEGT m ' � /n J � LICENSE CfU1S5 ��� LIC.NO �-/��`� __ _ __ j V DATE____j��._. GONTRACTOR._ • _ , W � WORKERS'COMPENSATIQN UECLARATIUN (��[ �`s�i � N IHEflEBYAFfIRMUNDERPENIILfYOfPERJl1RYONEOFTMEFOLLOWINGUECIAFiAT10NS V � / � � � Z L �fl � d a � _IHAVEFtiDY✓iLLMhINTAINACERTIFICATEOFCANSFNT70SELF�INSJRFFORWORKEP5 = - CAMPENSATION,AS PHOVIDED BV SEC710N 3/ao OF THE LA9oft CA�E,GOR THE PFRFo�IAANCE U Q OF THE WORK FOR WHICH THIS PEHMIT IS ISSUED � W __I HA�E AND WILL MAIMAIN WORKEAS'COMPENS0.YIUN INSURANCE,AS REQU�FlED BV SECTION ���yyy ///��� � 37000FTMElABORCWE,FORTHEPERFORMANCEOFTHEWORKfOflWMICHTHISPEflM1T15 ���� r / ) � IS5UED.MY WORKERS'COMPENSATION IN9URANCE CARRIER ANU POLICV NUMBER ARE' CONSTFjUCTION � _ _ C/ > caqRien------ --------- -- PLAN REVIEW a �- - -- ----------- " z vo��crnuMeEs__ -.- ELECTRIC t � Q '- -------- �} - n �TFiA4SECfIQVNE�N0T9E(7�MPlEfEDOFT1�PEiUMS�OHONEH.MORE�IX7L1A0.S�S10�ORLESS� i PLUM8ING ,-_-- ----- - L..�I�_1 _ Z I CERTIFY TXAT INTHE VERFORMANCE OF 7FIE WORN FOR WHICH Tfi15 PERMI715ISSUED,I MECHANICAL ______ � _ ��] C u'�✓t (,�} SHA�LNOTEMPLOYANVPFRSONINANYMANYERSOASTOBECOMESUBJECTTOTHE '--i"'- - -i_--"- - (%� WORKERS'COMPENSATIONI.AWSOFCALIFORNIA,ANDAGREFTHATIFISHOUIO[7ECOMF INSPECTIONFEE �;,__�__ __ __ _ y�'y - SU&IECTTOIMEWORKtqS'COMPENSATIUNPHOYISIONSOF C110N37090FTNELABOR '... + ' , rl�y � CAOE,I SHAIl FORTFMITH COMPIY WITH S Pi V1510 I I$SUANCE ��y'---__ - V� O �.��/� ___"'_-__ " ._ 0 DATE. ✓�/`�-- APPLICANT '' ' _"'__' SMIP ____ __ ' _' "__"'" _ ( J WARNINO FAILURE TO SECURE WORKERS'C PENSATION COV AGE IS UNLAWFUL,ANO SHALL BE ENEHGY F/C __ _____. __ _ ___ _ � SU&IECTANEMPLDYERTOCRIMINALPEkALilESANDCIVILFIN- UPTDONENUNDRFDTHOUShND ENERGYPERMIT - - ���iJ� UOLLARS(5100,000),IN AODITION TO THE COST OF COMPENSATION.DAMA6ES AS PflOVIDED FOR IN 7.�y� J SECTION37oBOF7HELABORCODE,INTERES7,AN�ATTORNF.Y'SFEES Q RETENTION FEE: y�_ V`� OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: �__ ____ ____ _ � t NEflEeYAFFIRM UN�7ER PENALTY OF PERJUNY THRT THERE IS ACONSTRUGTION IENDING AGENCY � FOR TME PERFOflMANCE OF iH[WOIiK fOli WHICH iH15 PEPMIT IS ISSUED(SEC 9097,CIV C� --"--''- - Z �yJ -_-'"_—'__' __'_ � LENDER'SNAME ' __'_""_-'__ _ __'_'_"_ ___ 1=- IENDER'SAD�NESS________________,___________ p� w ICEflTIFYTHATIHAVEREAD7HISAPPI.ICATIONANDSTATETHATTHEABOVEM�ORMAIIONISCORAEC�. TOTAL FEES�_ �� d L� � �� y � � IAGREETOCAMPLYWITMALLGITYANOGOLINTYORDINANGESANDSTATELAWSHELATINGTOBUILDING � �I�Y, � CONSTRUCTION.ANDHEREBYAU�fIORIZFREPRESENTAiIVE50FTHISCUUNTYTOENTERUPONTHE Z ABOVE-MENTbNEDPROPERTYFORINSPECTIONPURPOSES I COM NTS r� �� --------- ------- —� M � m -- ��------- -- !� - - -�-- a VER E AM PRINn _ _ � 5�4•�I r�- � E OF P �ATE '-"'— —'--"'"-- -'- = FiECPT NO __�,__ PAID BY VALIDATION__. ~ WHITE-Department Copy,YELLOW--Finance Copy,PINK--Assessor Copy,GOLDENROD-Fiie Copy,GREEN-Applicanl's Copy ,�- t,. � iY' � � . � � �ry` . . ' � � � ' �. :, � ;} , � . , � U5 � .T;� ; . . � ,� a .; � � . �-- ,; � t_, � , . � ; _ � � - �i. � ' N � � ��� , ` . . � � � � ' � i - � . .� W `1 y � 4 �'J • � � � ? :{°` �y � V" Q.. ,� 3 i ,� ��� �� . � `�, � � � . , � ' `� : ",� , � � - � ��� ' � � . � � � �. � � � ,,. , j � �� ` � ,�, U� y � ( z i�'' � � -� r �i '�- �- �-' � �`-� � r' `�. �'� S � � � � � :s 9 � � � � . ; � � � . � _ �., � �� � - _._..___-�------------__._____-_---�--