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HomeMy WebLinkAbout10267 J�� CffY OF DIAMOND BAR � COMMUNITY DEVELOPMENT DEPARTMENT �� 21660 E Coplcy Drive Suite!90 . PRESS � (909)860-3195 Fax(909)86I•3117 �'^�'• BUILDING PERMITAPPLICATION FIRMLY N JOBSRE � � APPUCATION PERMR ����P] p/C � ADDRESS��S_ ��S7LQilC DATE�__��NUMBER.��(J11`16 L � � ISSUE TfPE � 7 OCC APN LOT TRACT��S� DATE CONST. GROUP. p OWNER � _//Uc� � p ADORESS b �_VG�(? ZONING SETBACKS z CI1Y¢�LtJN��/ ZIP�� TEL,�QG"y�_ FRONT RW D g APPLICA� TEL S DAE/SIDE STREET RW ❑ � CONTRACTOR SIDE ❑ o ADDRESS PROPOSED USE � � �G[, CITY ZIP TEL o ARCHlENG/ a � DESIGNER NO.DWEL NO. . ,_..::. .. O. ADDRESS UNITS STORIES � �EDROOMS � CITY ZIP TEL cNi� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION p� . . OWNER•B�ILDER DECLAFIATION SFR/ADD/REM O ' p 1 HEREBY 11FfIN1 UNDEP PENALTY OF PE0.RIRV TIU71 JJA E%EMPT FROA1 TNE CdlTMCTOfiS L4 GefBpBlCefport � W CENSEUWFOIITNEFOLLOWINOPEASONISEC.T0.71.6BUSiHESSANDVROFE55�ONSCOOE:ANYCITYOH (n U GOUNryWHICHRE0URE5AGE�RTOGONSTRUCT,ALTEiLMPRpVE,DEu0U5H2ORREPAWANVSlitl1C• W P8�101DBCk � 7URE.VRION TO RS 65UANCE,AL50 11EOUIflE9 iHE APPLIGINT FOR SUGM PERMIT TD FM1E A 51GNED W � STATEMENT TIAT HE OR SHE IS UCENSED%1RSUANT TO TIE P{i0VI5iON5 OF THE COHTMCTORS ll• LL . � CENSE UW(dUPiEN�(COMMENClW{YI7H SECTION 1000)OF DMSION 7 OF THE BV51NE55 AND PRO� POOUSp9 FESSqN5000E)OR1)UTHEDRSNEISE7(EMPTTHEHEFROMANDTNEBAS�SFORTHEALLEGEDfMEMP� � TION.AM'VbLAT10NOFSECT10NT7l1.6BYANVADPLIGHfFORAVENMITSUBIECTSTHEAPPl1CWiT0 z Re•Roo( � � , F, A CfYIL VENKTY OF HOT MORE T/UN F1VE FIUNDNED DOLURS�i5o0j.j: � O11150WNEROFTHEVROVERTV,ORYVE4vLOYEESM77MWAOE5A37NEIq50LECOu0EN5AT10H, � (`,pmTBrCial � � NALL DO iME WORK,ANO TF1E STRUGTUHE IS NOT IMENDEO OR OFiEHED FOR 6AlE(SEC.701�,BUSF J � NESS ANO GROFESSIONS COOE:TNE CONTMCTORS IICENSE UW�OES NOT��VLY i0 AN OwNER OF j . PRDGERTY YAID BUlAS Oq IMPROVES THEREON,ANO Y//q DOES SUpI WORN NIMSEIF OR NERSELFOR � THROUGIINISOqHEROWNEI/PLOYEES,VROVIOEDTUTSULMIMPROVEMENTSARENOTMENDEDOF m . � OFFEREOiOR5ALE1F,fIDWEVERTMEBUlDN00RMPiqVEMEMI55qDWITaNONEVEAAOFOOMPIE• • � Z TION,iHE OMNER�BUILDER WiLL NAVE TNE BURDEN OF GROVINO TNAT NE Ui SHE Dq NOT BUILD Oq = WPROVEFORTHEPURPOSEOFSALE�. O l�ONMER OF TME PHOPFRiV.M�E%CLUSNELV CONTMCTP�WITH LICENSED CONTMCTORS Q TO CONSTRUGT TME PNOJEGT ISEG la�,BUSINE55 ANO YROFESSIONS CODE:TME CONTRACTORS LI• VBIUB�IOn ADJ,AREJ1 W CENSEUWDOESNOTMPLYTOANON7JEROFAPROVERTYNM1pBUIIDSORMPROVESiHERfOµANO � W11000MMCiSiORSUG/OqqIECT9WIiNACONTMCTOR�S)I�CENSEDPURSUM/TTOTXE00NTMG QUANTITY DESCRIPTION FEE . � TORSLICENSEUW.j. �J �,` �•{' �t 0 O IAM EXEYPT UNOER SEC. B.l P.G FOR THIS REASON q ��+P7 �,��^.1r //� 3 � � "` . a �—`- o�re � owr+ea V � UCENSED CANTRACTORSD CLARA N W � INEREBYAFFIRYUPDERPENAITYOfiEfWHY7HAilAA1lICEN5E0UNO[(iPROYIS10N50fLHAGTER Vr p, �(MMYENCIHONn7H3EGT10N70oa�OFDMSqNlOFTHfBUSIHE55IWDiROFE55qN5C00E,ANO Z . �X YY LICENSE IS N FULL FORCE ANO EFFECL m � UCENSE CUSS UC.NO. j,,.1 V DATE CONTMCTOR a - W � WORKERS'COMPENSATION DECUIRATION � NIHENEBYAFFIRYUNOERVENALTYOFVEfiNfiYONEOFTMEfOILONM140ECURAT10N5: Z � _IHAVEANpWIl1MAIMAIHACERYtFKATEOFCOHSE1RT06ELF1HSUREFORNORKEitS = COMPENSA710N,113VRDVIOEOBYBECTIONJTOOOFTHELABOqCODE.FORTNEiENFORMANGE W OFTHE WOFlK iOR WHICHTNIS PERMIT 14155UED. � O �I HAVE A!ID VALL YAIMAN WO{U(ERS'LOIAPENSA710N W SURANLE,AS RE0111RE0 BY 9ECTIDH Q i7000FTF1El/4BONCODE,FORiHEPERFOiWANCEOFTHEWW7KFORWMd1TMISiERMRl9 l/ J ISSUED.A/YNORKERS'COMVENSATIONINSURANCEtARWE0.ANDVOLICYMXIBERME CONSTAUCTION Y�'. � CARRIER PLAN REVIEW � �a�'�+uMBER ELECTRIC o �rusEcrarrf�wreeadxtErmoFn�r�rswaor+eHuor�noaluisp�aoloatEss� PLUMBINO Z IGERTIFTIHATNTHEPENFORAIANCEOFTNEWOfiKFORWHICMiHiSVEMATI5L55UED,1 MECHANICAL C_'} &ULLNOTEMPLOVAHYPERSONWANVM�fNfR50A5TOBECOMESUBJERTO7HE y riOPo(ERS'COMPENSA710NLAw50FCAL�FOfiNI�ANDAaREETMA(IFISMWlL8E0p.�E INSPECTIONFEE L�� SUBJECTTOMEWORKERS'COMPENSATIONPROVISIONSOFSECi1DNS7ooOFTMEUIBOR V � s CO�E,1 SHALl FORMvNTM COY%,Y WITM TYIOSE VRDYISIONS. ISSUANCE � SMIP � p OATE: APPLIGNT: W ENERGY P!C � WAiWIN6:FALURETOSEWRE�NORKERS'COMPENSATIONGOYEMOEISUNUWFUI.AND5HAt10E � SUBIECTANEMVLOYFRTOGW4iNA�FENALTIESANOCMIiWESUPTOONENUNOREDTNOUSUA ENERGYPERMIT OOLLARS(f 100.000).N/�DOITION TO THE GOST OP COMPENSATIDN,DAMADES AS FNOVfOED Fpi IN ¢ SECTIDN�70eOFTHEIABORCODE.MTEAEST,ANDATfORNEYSFEES. RETENT�ONFEE' •� � 4 CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � INEFEBV�FFIRAILNDEROENAL7YOFVERJURYTW�TiMERE15�CON5TPUCTqNIENOPI4AGENCY � � FOR TNE PEAFONIAANCE OF TME WORK WR YVHid1 THIS PERMIT IS ISSUED(SEF 7oY7.GV.G�. � LEHDEiCS NAME Q�_ C LENDER9ADOfiE55 � 10EH71FYTUi1HAVEREADTHISMPLICATqNANDSTATETNATiHE/BOVENFORlAA7qNISLORRECT. TOTAL FEES . � IAONEET000IID�YN7THALLUiVAN�COUMYOR0INANCE5ANO5TATEUWSREUTIN6TOBUl01NC � COHS7RUCTION,N/D NEREBY IWTHOARE REPRESEMATNES OF iM5 COIMN i0 ENTER UPON i11E � �. ABDVELENTid1E0 0110DERTY fOR WSPECT�ON vUfiPO5E5. COMMENTS � � � �<� f;9��/ �c�3�erc'� m pERMITfEE NAI+E(VRINT) �^ � c�_n GJ �7 �/.1—�' � 610NANRE OF YE EE D�TE � � RECPT.N0. AID BY VALIDATION . -WHITE—Oapartment Capy,YELLOW—Finenca Coq,PINK—Assessa Copy,GOIDENROD—Fik Copy.GREEN—ApplbanPs Copy �.,w.�p,'- v�.rti:' � :�,t.r-.�,i•,...:,,4q••.•`.`.\a...'. .�, � :�" �'r. - . "x.. : . . . � . .:; , ",..e)' 'L�i, .. .a�.., c�a'1'•E• 'jiy':9".a': S.; �, • .. :�{: :'<i'�• �:•ib';,J.•.;ti.C{,;.. 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