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HomeMy WebLinkAbout10797 i - CITY OF DIAMOND BAR • COMMUNITY DEVELOPMENT DEPARTMENT r� ,,,� 21660 E.Copley Drive Suite 190 . 1 PRESS (909)860-3195 Pax(909)861•3117 4'^"� BUILDWGPERMITAPPLICATION ' FIRMLY o DDRI SS /�ZZ ��� ���W p ti DATE CATION ;?j� �� NUMBEF`� I � M� � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP o OWNER �uj> Ian,n v'iaA .�-tvn-E�vO " AODRESS,16�'Z � ��%t�� �u�W �n-'' ZONING SEfBACKS 1RED B CITY �. !3�4-rt • 21P�i � TEL.9 G/ •7 r�S6 g FRONT RW ❑ g APPLICANT �u�'� AN7 V I h n ►�tw. TEL.-�!cl'�o ��9 REAA O SIDE/51DE STREET ❑ � CONTRACTOR SIDE ❑ � ADDRESS 'PROPOSED USE� ���E � �-S '��/G � �S ' CITY ZIP TEL E . o w � t o ARCWENG/ / �vo ,o � IJS � DESIGNER NO.DWEL / N0. NO. . ADDRESS UNITS � STORIES Z' BEDROOMS S � C�7y ZIP TEL N DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER•BCILDER DECLARATION SFFlADDlREM O p I NEREBY AFFIRM UNOEN PENALT!OF VEIWRY 7HAT I AM E%EMP7 filOM THE CONTRACiOH3 l4 Gere�B/C�l�pn W CENSEUWFORTHEFOLLOWMW REAS�N(SEC.7W1.6BUSINESSANOVROFESSiONSCDDE:ANYdTYOR (n U COUNTYWHIOIREIXIIRESAVERMRTOCONSiRUGLK?ERMPfqVE,DEMOl15H2ORRERURANYSTRUC• W PBtIQIDBCIC ' u� TUFE,PRqR TO RS 65UANCE.AL50 REOUIPES iHE APPLICANT FOR SUC11 PEMUT TO FlLE A SICNED W � STATE4EM THATHE OR SHE IS LICENSm PUftSUFNT i0 TME YRW�SIpJS OF 111E CONTFAL10R8 lF � , , � CEN9E UW(CHADTER�(COYMENGNO VATN SECTION 7000)OF D�V�SION]OF THE BUSINE54 AND PRb � POOIISpB fE5510N5 COOE)OR THAT NE 00.511E IS EXEYP7 iHENEfROM IW 0 iNE BASIS FOR THE ALLFOED EXEMV• TqN.ANYVqIAi�d10FSECT10N70��.68YANYAPPLMJWTiORAPERMIT6U&lEGTSiHEAPPL�CANTTO qe-Roof �O �,,,� A CML VENAI.iV OF NOT MORE 7HIN FNE HUNORED DOILARS(f50Dl.k � ❑L��WNEROFTHEPROPERiY,ORMYEMPLOYEESVnTMWAOESASTMEIR50lECOA1PENSATION, O CpRlfnBfClBI WILL p0 THE WOfLC M/D iHE STRUCTURE 45 NOT WiENDED OR OFFEREO GON 6ALE�SEG 7o1r,BU51. _,1 HE53IlO VROFESSIONS CODE:TIE CONTiUCTONS LICENSE LAw DOE9 NOT APXY TO AN bWHER OC � PpOGERfYMAfOBURD40ii/APIqVESTHEREON.MIDWNODOE55Ud/M/DRNHIA15ElFORHER5ElF01i � � � TNRIXJG//IYS OH NER ONTI EMPLOYEES.PROV�DED THAT SUCM IMPROVEI/ENTS ME HO7 HTENDED OR � � � • � L11 OLFEREDFORSALEF,IqWEVER7MEBUlpN�ORIMFROVEMEHTISSdDN'ITHHONEYEAROFOOYPIE� � � ' Z 710N,1HE OwNER�BUR➢ER YVILL MAVE TME BURDEq OF PROVIND TNT HE OH SI1E pD HOT BIMD Oil , MPROVE FOR iHE PUflPOSEOF SALE7. W ❑l��N'NENOF7HEVROPERTT.MIE%CLUSNEL�LOH�MCTIN(1M17HLICENSEDCOHTMGTOR3 �o � TO CONSTRUCT THE PRO,IECT(SEG 7oa1.BUSME55 AND PROFfSSION4 COCE iNE CONTRACTORS U� lI118110f1 AOJ.AREA � CENSEUWDOE4NOTAP7LVTDAHOYVNEROFAGROPER7YWMOBULDSORMVROYESiXEREON.AND NT1000�RRACi3FORSUCH7H0UECTSN7THACON7MCTOR(SJL�CENSEDWRSUANTTOTMECOHTRAC pUANTITY DESCRIPTION FEE � � TORS LICENSE U�N�1. �J O 1 AA1 EXE1dVT UNDER SEC. � &�PA FOR iM15 REASON Q ' � 3 � u' DATE '2q � � OWNER �LL� V . . . Z W � UCENSED CONTRACTORS OECLARATION W � IHERE9Y�FiIRMUNOENPENALiYOFPEfUURVTINTIWLICEN5WUN0EHVROVISiONSOFCHADTER V. � p„ ��C0114ENCWa N77N SECTION 7a0o1�DIVISIDN 7 OF THE BVSINE55 MID PROFESSi0H4 CODE,AND Z `L 4Y LIGENSE IS N FULLFOHCEAND EFFECT. m � UCENSECL45S UC.NO. � 1--� �j DATE CONTRACTOR � O• W � WORKERS'COMPENSATION DECLAAATION � � INEREBYIIFFIRMUNDER7ENALTYOFVEFWRYONEOFiNEiOLIDWPlODECLAMTIOHS: U �' a � _INAVE/NDYnLLMANTAINACERTIFIG7EOFCON5EM705ELHN5UREFORWORKEI4S' 2 COMPENSI1TqN,ASPAOVIDEDBYBECT�ON77000FTHEtI�RCOOEFORTNEVERFOiYAFNCE W OF THE WORK FOR WHICM TMI.4 PERYIT IS ISSUEO. � . O Q _INAVEIWDYnLLMAOiTAINWORI(ER50UA7ENSATIONINSURANCE,�3REOUIREDBYSECTION /' '�, �7000FTYIELABORCODEFOfiTHEPEAFOfUA/NCEOFiHEYYOH1fiORVlHICHTHtSVE�T15 1 � ISSUFD.IAVWORKERS'COMOENSA7qNW5URANCEGRRIERANDPOLICYHUMBEHME: CONSTRUCTION � - > cwacn PLAN REVIEW.... Z raicrNuweER ELECTRIC ¢ p (n�sEenor+��r+otBEadw�ErmoFnErEnxrswaorEM�rn�aootWtsR+rolOa�. 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AGNEETIATIFISHOIADBECOME INSPECTIONFEE � S SU&lECTTOTHEN'�NERS'COAIPENSATIONPq SOFSECTION77000FTHELABOR �SSUMICE "II� ��� � COOE,ISHMLFOi171/WITHCdAPLYWITHT1105 SIONS. / Y�� � 2 4 Ma.ic+wr, L..,V� D'�C>!L� SM�P p DATE: W ENERGY P/C WARMN@FAlLUf1ETOSEWAEVAfiKERS'OOMPENYATIONCOVERAGEISV WFUL.�WDSMALLBE � 6UB.IECTiVIEMPLOVERTOCRIMINALVENALTIESANDCMLFWESUPTOONEMUNDIIEUTlIOUSNA ENERGYPERMIT DOUA0.S Ii100.0001.N ADDITION TO THE COST OF CDMPENSA7qN.DAAUGES AS FRCMOED FOA IN ¢ BECTqN]7aOFTMELABORCOOE,WTEREST,AND�TTOFNEY'4FEf5. � RETENTIONFEE: - a CONSTRUCTION LENDiNG AGENCY PRE•ALT FEE: � INEREBVAFFIHMUNDERPENALTYOFiER1UMTIWTiHERE15ACON5TRUCTIONlEN01NOAGENCY � ' Z FOR TME VERiORMANCE OF 711E WOf1K fOR V+�CM TFuS PERAAIT IS ISSUED�SEC.700/.pK C.} W � LEIUER'S NAME " � LENOER'SAOONE54 � � ICEpTIFYiNAi111AVERFJ�D7MI5MVLICATIONANDStATE7HATiNEI�BOVENFORA1ATqNISCORqECT, TOTAL FEES � � � . � O � IAlii1EETOCOMPLYNTTIIALLCT'ANDCOUNTYOAD�NANCESMIOSTATEUN�SRELATWUTOBULOIN6 � CONSTPUCTION,RND NEREBY AUTMORIIE REiRE5EH7AT1VE9 OF?Ni5 COUNTY TO EMER UPON TME , S�. 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