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HomeMy WebLinkAbout10268 �-� CITY OF DIAMOND BAR " r COMMUNITY DEVELOPMENT DEPARTMENT 21660 E.Coplcy Drive Suite 190 . , PRESS (909)860-3195 Fax(909)861-3117 '�', BUILDINGPERhfITAPPLICATION FIRMLY a ADDRESS��� G��G'RI C, APP��CATION � , PEHMIT ��`A p/C p DATE �j NUMBER ti� k � APN LOT TRACT ISSUE r�TYpE OCC DATE CONST. GROUP p OWNER ' C TC� -�' ADDRESS � o ba ZONING SETHACKS Z CITY �.�!^}CJi'U�`� ZIP d.l TEL. R�RT RW O g APPLICANT TEL. � SIDFJSIDE STREET RW ❑ CONTRACTOR �� �l� SIDE ❑ � AD�RESS CffY ZIP TEL PROPOSEO USE 8 AflCH/ENG/ • , � DESIGNER NO.DWEL NO.:. •:. , � , O. . ADDRESS UNITS - ' � STOHIES�� ' �EDR MS � CI7Y ZIP TEL � cn DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� ONMER-Bl.'ILDER DECLARATION SFR/ADDIREM O p 1 HEPEBY PFFIRM UHDEN PENALTY OF PERAIRY THAT 1 AIA EXEMPT FRpA 7HE COHTRACT00.S L4 Gs����rt . � � W CFNSEUWFORTHEFOLLOWW�REASdJ(SEC.7m1.6BUSNE5SAN0ViqFE5510N5LY�0E:ANYCfTYOR (n U COUNiYWHiO1RE0UIRESAPEPMiTTOCONSTRUCL/LLTERM�OROVE.pEY0U5H2OqpEPAMMIYSTRUG W PBIiQ�DlCJ( � ' � _� TURE,PRqR TO RS ISSUANCE.AL50 REWIRES TNE APPLICAM FOR Sl/C//PERNR TO FILE A SICNED W STATEMENT TU7 ME OR SF1E IS 110ENSED iU0.RVANT TO hIE PROVUKNS OF TNE CONTMCiOR9 Lti .� LENSE UW(CHAVTER Y(COMYENClNiMA7N SECTION 7000)OF DIVISqN]OF TME BUSINE55/ND PNO- V" POOVSpi FESSqN5C00EJOHTHATHEOtISHEISEXEMPTTMEREFROMANOTHE8A515FORTMEALLEOEDEXEMP• (ry 710N.ANYVIOLATqNOFSECTIOH7071.lBY�MlA7VLICJIMfOAAPERMiTSUBJECTSiHEMPLICMlTTO z Re-Roof � ACMLVENKTYOF NOT YORE 71UN FNE IUNDRED DOLURS�i5m).�: � 04A+OWNEROLTHEVRDPERTY,OHMVfMPLOvfESWITHWAQE51lSTHE1RSOLECOUPENSATION, Cpmme�GBl WiLL DO THE WORK N�D THE Sitk1CTURE IS NOT MENOFD OR OFLERED FOR SILE(SEC.701�,BU51• � N NESS MO GROFESSIONS OOOE:711E CONTIIACTOR4 LICENSE UW DOES NOT MPLY TO AN OWNER OF ? 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Z 0 W � LICENSED CONTRACTORS DE AT N W IHEREBVAFFIRAIUNDERPENALTYOFPE0.AJHYTIATIAMLICENSFDUNDERPROVISqNSOFCHAPTER Ur p„ Y(OO/AMENpNON7M5ECT10N70Do)OFDMS�ONiOF1HEBU5INESSNOVFlOFE5410N5COOE,AND Z X MYLICENSEISNfUILFORCEANOEFFEGT. m 11J Q LICENSE CUSS LIC.NO. � V DATE CONTMCTOR d W � WORKERS'COMPENSATION DECLARATION � � I HEREBYA[tIRAI UNDER VENALlY OF VEHIUFN ONE OFTHE FOLLONnN�DECLAM.770N5: Z , � � _IHAVENOlMLL1MWITNNACERTIFILATEOFO0N5EMTOSElFdNSUR[iORWOfi1(ERS 2 ODGPENSAiqN,A3PA0VIDE0BYSECTION77000FTHEUB0fiC00E,FORTNEPERFORIAMICE W Q OFTNE WORK FOR WHiC11TH15 PERAIIT IS ISSUED. � W �111�VE MA YALL WUIYTAN WORKEilS'COMPENSATION INSURANCE,I15 HEWIRED BY SECf10N � / � ]700 OF THE LABOA COOE.FOH THE VERFORYANCE OF THE WORK iOR WHIp17T115 VER4R IS /1.� F�! � ISSUEO.WWORKERS'CdAPENS�TqNINSURANCEGRF�ERM1000LICVNUYBERME: CONSTRUCTION 1 >>(J � CMRIER PLAN REVIEW Z ���BEp ELECTRIC d 0 (�1aS5ECTIdtlNE�NDTBE00MRE7IDOF11EPENMT6FOROt�EHUrqimOd113iSRtao�OfitFS61 PLUMBING Fn•, 'z�. Z ICEFTIFYhUTNTHEPERFOi1MANCEOFiHEVYORKFORK411CHTH15PERMITISI55UE0,1 MECHANICAL C"�� `.%�� ��"' J� ('J SHALLNOTEMPLO`/ANYVERSONWANYYANNERSOA5T08ECOM[SU&IECTTOME y WOPoCERS'COMVENSATIONUw50FCAUFORNIAANDAOREET/u71FI5MDULDBECOME �NSPECTIONFEE � S SUBJECTTOTNEWORKERS'COMVENSATqNPi10V�5qN50FSEttqNl7ooOFTNELABOR � _ tOOE.I 5HM1 FOiiT1VA7M[dAPLY NnTH TMOSE VROVISiONS. ISSUANCE � SMIP p DATE: APPLICMfT. � ENERGY P!C WARNINQ FARURE TO SE WRE WORICE0.S'COMVENSATION COVERAGE IS UN.ANRUL,AN�S WLLL BE � SUBIECTANEMVLOYERTOCRM1iNALVENALTIESMACMLiNfSUPTOONEHUNDREDilqU5A1q ENERGYPERMIT DOlAMS(f t 00,000�.N ADOITION TO TNE COST OF COMPENSAiqN,DAAIACES AS PROVIDED F011 W J SECTiON]7o00FTMEtABOqCODE,WiEREST,ANDA7TORNEY'9FEEA RETENTONFEE: /'1 � /'7 OCONSTRUCTION LENDING AGENCY pRE-ALT FEE: r' � IMEREBVAFFl/WUNCERPENALT/OFPEiWRYT1uTTNE11EI5ACON5TtiUCT10HLENDw0A0ENCY � � FOR TME 7ERFOR�AANCE OF iME WORK iORNrt11p/TMS PENAIT IS ISSUED(SEG.]oa7,pV.G�. � � IENDER'S NAME ' � LENDER'4/iDORE55 w� TOTAL FEES � 1 CERTIFY THAT 1 MAVE READ TMIS APPL1CATqN AHD STATE THATTHE ABOYE NFOfIMA710N IS CORRCC7. p„ I AOREE TO COMPIY YVITH ALL UTY AND COUNTY ORDINANCES AND STATE UW5 REUTNO TO BU0.�IN0 � CONSTPl1CT10N,ANOHEREBVAl7i110RRERE7RESENTATNE50FTHISOOUNTYTOEHTERUVONME ABOVEJAEHTqNEO PROVER7Y FOQ MSPEC7qN 7URPOSES. COMMENTS � l��• �--9�`� ,��k)1�l�T m 6 iEW.aTiEENAYE(PNNT) j. 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