HomeMy WebLinkAbout17654 (10) �` . CTTY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860.3195 Fax(909)861-3117 PRESS "%:�` BUILDING PERMIT APPLICATION FIRMLY � JOBSITE � � APPLICATION � O� PERMIT /C o AODRESS DATE NUMBER�� M � APN LOT TRACT ISSUE ` TYPE OCC DATE CONST. GROUP p OWNER ��L.C/[�C����L� ADDRESS ZONING SETBACKS Z ��TM �� FRONT RW O g APPLICANT TEL. AEAR O SIDE/SIDE STREET RW O � CONTRACTOR SIDE O � ADDRESS PROPOSED USE � CITY IP o ARCH/ENG/ �'Yt+�t.` �!2 (�� z DESIGNER NO.DWEL NO. NO. d ADDRESS ��-�a��J UNITS STORIES BEDROOMS � CITY ZIP TEL. / � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER•BUILDER DECLARAT�ON SFR/ADD/REM O W CENSEIAWFOH7HEFOLIOWINOPEA50N(SEG7N 68USINE 9ANOP OFESSIONSW�DE�.�C mOR Garage/CarpoR V CWNTYNMICHNEOUIRESAGER/AITTOCDNS7RlICT,ALTER,IMDROVE,�EMOLISKdAREVAIH�NYSTNl1G � � TURE,PRqR TO RS ISSUMICE,1LL50 REWIRES THE MttICANT FOR SUC11 PERMIT TO FILE A SIGNEO w Patio/Deck � STATEMENT TFUR HE OR SHE IS LICENSED PURSUANT t0 THE PROVISIONS OF TME CONTMCTORS L4 .� CENSE UW(C11APiER C I�MMENCINO WIiN SECTION 7000)OF DIVISION 1 OF iME BUSINESS AND PHO� LL PooVSpa fE55qN5CO0E)ORTHATHEORSHEtSE%EMPTTHEREFROMANDTME8ASi5FORTHEALLEGEDE%EMP• (� VTqN.ANYYIOI�TIONOFSECTIONTO]1.6BYANYADPLICMlfFORAVERMITSUBJECiSTMEMPLIC/WTTO Z Re•Rool AGNL VENALTY OF NOT MORE TMAN FIVF MUNORED OOLURS(f50o).); � ❑lASONNEROFTHEPROPERTY,ORIAVEMP�OYEESWITHWAGESA57HEIR50LFCOMPEN5A710N, � CpmlllerC(91 ' � Z WILL DO THE WORK,ANO THE STRUCTURE IS NOT IMENDED OR OFFERED FOR SALE(SEC.70��,BUSI• J � NESS AND PROFESSIONS OOOE:THE CONTMCTORS IICENSE L�W DOES NOT AVPLY TO AN OWNEH OF ? GR07ERN W/q BUILDS OR IMPROVES THEREON,AN�WHO DOES SUCH WOHN HIIASEIF OR HERSELF OR CL 7HROUGHNISOFHERONNFIAPLOYEES,FROVIOEDTHATSUWIAIPROVEMENTSARENOTYJTENDEDOR CO W OFFEREOFORSPLEIF,110VlEVER7HEBUiIDINGOHIIAPROVEIAEMIS50lDMATHiNONEYEAROFCOMPIE� 0 TION,hIE OWNER�BUILDER WILL HAVE THE BUHDEN OF PROVINO THAT ME OR SHE DID NOT BU4D OF Z IMFROVEFORTNEiUHP0.5EOF5ALE� = O�ASOYVNEROFTMEPflOPEHiY.AMEXCLU5IVELVGOMRACTPoGWITMLICENSEDCONTRACTORS Q TD CONSTNUCT 1NE PR0.)ECT(SEG 7DN.&1SINE55 AND PROFESSIONS CO�E:THE CONTMCTORS U• ValUOl(0� ADJ.AREA W CENSEUWDOESNOTMPLYTOANOWNEROFAFROPEHTYWHOBUILOSORIMPROVESTHEREON.AN� � W/qCONTMCT5fOR5UCH7RQIECTSMiTHACANTiUCTOR(S)LICENSEOPURSUMJTTOh1ECONTMG OUANTITY DESCRIPTION FEE � TORS LICENSE UW). � OIAMEXEMPTUNDERSEC. B.tC.C.FOFTHISREA50N U �S � LL DATE OWNER �, V F IICENSED CONTRACTORS DECLARATION i j � INEREBVAFFIRMUNDENFENALTVOFGE0.IU{iYTHATIAAlLICENSEDUNDERDROVISIONSOFCHAPTER V. � 9�COMAIENCW6WRHSECTION7000)OFDMSION�OFTHEBUSINESSANDPROFESSIONSCOOE.AND Z �� MYIICENSE IS W FULL CEAND EFFECT. m /, �'M � IICENSE CLASS � LIC.N0. � J �� �" ~ -DATF/� CONTMC70R � a W � / J � r Q ERS'COMPENSATION D ATION Q � IHEREBYAFFlPMUNDERPENAl7YOFGE0.IURVONEOFTHEiOUOWINQDECLAMTqNS: V f� Q O _IHAVEANDWILLIMNTNNAGERTIfICATEOFCON5EN7TO5ELF�INSUREFORMlOR1cER5' _ � COMPENSATqN,ASVNOVIOEDBVSECTI0N7/000FTHEUBORWOE.FORTHEPERFORMMICE U Q OFTHEWOPKFORNMICHh11SPEWAiTI51S5UED. � � I IMYE AND WILL MAIMAIN WORKERS'COIAPENSATqN MSURANCE,AS HEWIqED BY SECTION Q �7000FiHELABORCODEFORTHEPERFORMANCEOFTHEWOHNFORWHIp1THI5DERM1T15 SUED.MYWORKERS' ENSATqNINSURANCECARRIERANDVOLICYNUMBERARE: CONSTRUCTION jc�Aaiea _ PLAN REVIEW Z roucvN eEa ELECTRIC ¢ 0 �nusEcnor+ noree n+��oFnerewertawnor��ooaLwsa�mloa�ss�. PLUMBING � , Z I CERTiFY T11AT W THE PERFORMANCE OF THE WORK FOR N71id1 THIS PERMIT IS ISSUED,1 MECHANICAL (J SNALLNOT E�APLOV ANY VERSON W ANY AIANNER SOAS TO 6ECOME SUBJECT TO iME � NqRKERS'COAIPFNSATIONUWSOFGL�FORMA,AND�GREETIUTIFISHOt1LDBECOME INSPECT�ONFEE S SVB.IECTTOTNEWORKERS'COMPENSATIONCROVISIONSOFSECTION�70oOFTNEUBOR ISSUANCE C �. CODE,I SHALL FORTFM'�iM COMPLY VATH TF105E PROVISIONS. � SMIP p DATE: APPLICANT: � ENERGY P!C WAFNINO:FA0.URE TO SEWRE WORKERS'COMPENSP.TION COVERAGE IS UNUWFUL,AN�SHALLBE � SIAJECTANEMPLOVEHTOCRIMWALPENALTIESANOCMIFWESUPTOONEHUNOREDiHWSANO ENERGYPEHMIT OOLURS(5100,000),IN AODITION TOTHE C0.5T OF COMPENSATKKJ,OAMACES AS PROVIDED fOR IN J SECTION77oeOFTMELABORCODE,INTERE57MJOATTORNEY'SFEES. RETENTIONFEE: � Q oW., CONSTRUCTION LENDING AGENCY PRE•AlT FEE: � IHEREBYAiFIqMUNOERPENALTYOfPERJURVTMATTHEREISACON5T13UCTIONLEN0INCACENCY FOH iHE GERFORAIANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.30a7,CIV.C.�. � � LENDFR'S�WAE � LENDERSA�DRES /� ` wICERTIFYTHA IHA EADTF SAP ATIONMIDSTATETHATTME�BOVENFORAIATIONISCONPECL TOTAL FEES 1�5�,/ � IAGREETO MP TNKL TV COUNTYORDINANCESAN�STATELAWSRELATN�TOBURDIN6 � CONSTRUCTI , HEREBV ORREREPRESENT�TNESOFTHISCOUNTYTOENiERUVONTXE ABOVE-MENT GROGER fiINSPECTqNOUflPOSES. COMMENTS O J � � P EEN E RINT) � UR F I DA c � RECPT. . PAID BY VALIDATION WHITE—Departmen[Capy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Fila Capy,GREEN—Applicant's Copy ::f.' � � ! .. .��•' . .��t� � . . . ..,. .�� t .?ct. ,,y:.,".r• .. _ {.;wf:�}'? � , � � ..G�•'v�S� \,':i � . �,s.'. � ..� .,..� . �!T r' rf' c�i�►f�G�i�}Q S��f� . 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QRYVVALL NAILING ^ DEDICATIONS � SEbVER �(� D ��.1�..�� FINAL ENG. � SEPTIC TANK �TANDSCAPE/IRRIG. � SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAI.CONST. ! . F!RE DEPT.FINA! FINRL HEATIP�G � HEALTH DEPT. FINAL FINAL ELECTRIC � DEV. FEES PAID FINAL PLUMBING � ENERGY ' --- ---- �`�...��'� ,_t,;� �'fi l€.t��_,.., .-'.._.�_„ ! . cor�r,nENrs ' SEPTIC TANK SIZE SEEP PIT/U 51ZE _..._.�. .._..__.._._._..� ��w� � I i r��� — , "��� --� . _ , i , . ` � . � . - , � . __ .___..,_..____ ___.._.__.__._.a . � ___._ . .