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HomeMy WebLinkAbout16796 (42) G— � �� CITY OF DIAMOND BAR �� � DEPARTMENT OF CO:vIIvIUNITY R,DEVELOPMENT SERVICES i �` 2(825E.CopleyDrive � (909)860-3195 Fax(909)861-3117 P ESS ��h� BUILDING PERMIT APPLICATION FIR M LY oJOBSITE APPLICATION PERMIT P!C ADDRESS��d�O G� •GT DATE� • O NUMBER�_ N � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER p ADDRE S �' ZONING SETE3ACKS z CI ZIPg TEL� � � FRONT RW ❑ � APPLICANT TEL. REAR p �� SIDE/SIDE STREEi RW O CONTRACTO SIDE p � ADDRESS � CIT",����_�jy ZIP TEL PROPOSED US o ARCWENG/ � O�S•'B•� Z DESIGNER w NO.DWEL. NO. NO. ' n. ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER•BUILDEH DECLARATION SFR/ADDlREM O p 1 HEREBV AFFIRAI UNOER VENALTV OF PERAIRY TNAT I AA1 E%EMPT FROM TNE CONTRACTORS ll• Gyfeg(i/C21pOfI W CENSEUwFORTMEfOUOWINGREA50N(SEC.7Wt.SB'JSINESSANOGROFESSIONSCODE:ANYqTYOR (n U �p{JNryyA11CHRE0URE5APERMRT�WNSTFUCT,ALTER�MOROVE.DEMOLISH.OitHECAIRANVSTRUC• W W TURE,PRqR TO RS ISSUANCE,AL50 REOUIRES THE APPLICANi FOfI SUGH YERuIT TO FILE A SIGNED w F'atio/peCk STATEMENT THAT HE OR SHE IS LICENSED PURSUMlT TO THE PROVISIONS OF TlIE CONTMCTORS ll. � CENSE UW(f]IAPTEN i(OOAl1AENCINa VnTH SECTqN 700��OF DIVISION]OF TNE BUSiNESS�ND PRO- LL' POOVSp1 0 FE5510NSCODnO�TUTHEOR5MEI5ExE1APTTHEREFROAIAN7TMEBA515FORTHGAIIECEDEXEMa� (� V TION.IINV VIOIATION OF SECTION 70�1.6 BYANYAOP�ICANT FOR�PERM?SUBIECTS THE APPIICANT T0 Z Fle•Raof A CML iENALTY OF NOT MORE THAN FNE XUNDRED DOlURS(f5oo�): Z~ ❑LASG+mEROFTHEVROPER7Y,ORMrEMaLOYEESYnTMWAGESASTMEIFlSOLECOMPEN5A7qN, ❑ YVILL DO TME WORK,ANU Th�E STRUCTUFiE IS NO7 M7ENDEU OR OFFERED fOR SAIE(SEQ 7WI,BU51� J COmm0roi01 N NESS IWD GROFESSIONS CODE:THE CONTRALTORS LICENSF lAW DOCS NOTAVPIY 70 AN OWNER OF GROVERTYWM08UM1DSORIMPROYESTNEREON.INONM000[SSUCMWORKHIMSELFORNERSELiOR � wiHROUCJ/NI50RHEROWNE4�LOYEES.PROVIOEDTHATSUCHtlAoppyE�[NTS�RENOTNTENDEDOfi m Q OFFEREDFOfiSILLEIF,110WEVERTMEBULDINGOR9APROVFIAENTISSOIDWITMINON[YEAROFCOM�LE� Z TION.iHE OWN[R�BUILDER W:LL HAVE TNE BVFlDCN OF PROVINC THAT ME OR SHE DID HOT BUqp OA = pAPROYE FOR TH[PURPOSE OF SALEI uJ ❑I�OWNEROFiNEPR07ERiY,AME%ClUSNELYCONTMCTWGWIiMLICENSEDCONTMCTORS [L i0 CDNSTHUCi 7ME VRO.IECT�SEG 70N,BUSINESS AND Pf10FE5510NS CODE:THE CONTRACTOAS U� V01U01iOf1 ADJ.AREA W CENSEUWOOESNO7APVLYTOANOWNEROFAPROPERiYW/qBURDSORPAPROVESTMEREON.AND � WHOCONTMCTSFORSUd1PR0UECT5VATHACONTMCTOR(S�LICENSEDPl1R5UAHTTOTH[CONTRAU QUANTITY DESCRIPTION FEE Y TORSLICENSEUWJ. ¢ O I AA1 EXEMPT UNDER SEC. B.i P.C.LOR THIS HE�SON Q 70 V � � DATE OVdNER U Z W � LICENSED CONTFiACTORS DECLARATION w � IHEREBY�FFIRMUNDERPfNAITYOF7E0.7URYiFUTINAUCENSEDUNOERPflONSIONSOfCMAVTFR � d C(COMMENCWGNATHSECTION7000)OFDM510N70FTHEBUSINESSANDPROFE5510NSCODE,AND Z !C MYLKENSEt51NFU1FORCEINDEFFECT. m �LLI � � 110EN5E ClASS L�C.NO.� ���"�� � V DATE� .CONTRACTOR��f����yrl►lyr� a .� lil �� ' —_�s � WORKERS'COMPENSATION DECLARATION a NIHEREBYIIFFIRAIUNDEROEWLLTVOFiER1URVONEOFTHEFOILOW'NGOEQAMTIONS: z � Q 0 _IHAVEANDWILLMAMTAINACERTIi1CATEOFLpNSENTiOSELF�NSUREFORM/ORKERS' _ Q COMPENS�TqN,A5 PROViOED BY SEGTON 770o OF TnE LABOR COCE,FOn TME VERFOwAu10E W O OF THE WORN fOR WHICH THIS PERMIT IS ISSUED. � �I MAVE AND WILL MAMTA:N WON(ERS'CO6IPFNSATION INSURANCE,AS PEOUIRED BY SECTION Q �70a OF TNE LABOR COOE,FOiI THE PERfORMANCL OF TME WORK FON WMICM THIS GEN.aT IS , �J/��� J ISSUED.MYN9RK CONPENS�TqNINSVP NCECARR'CR�NO70LICYKUMOER/JIE: CONSTRUCTION ((J �- j CAARIER �� PLAN REVIEW ' � POLICYNUMO[R� .1� ���� ELECTRIC � (IFaS5EC17CNNEmNDTBECCMLETEDOFhECERMT6FC(i0NE1Al�DF1EDDOl1/fi5K��1��� PLUMDING Z ICERTIFVTHATN7HEPEFFORMANCEOFTHEWDRKFORWHICHiHiSPERAUTI5155UED.l �1ECHANICAL (} SHALL NOT EMPLOV ANY VERSON IN ANY MANNER 50 AS TO BEC0IAE SUOJEL7 TO THE N NORKERS'fA1A0EN5ATpNUWSOFCALtFORNI.IANDAGREETHATIFISHOU�DBECOIAE INSPECTIONFEE S SV&IECTTOTMEVJORNERS'C061PENS�TqNPROVISiON50FSfCTqN]7000FiHELA80R ' cooe.i s`uu vonrtnnn+con��r Nnni Trase vRovisions. ISSUANCE z. �a O p OATE: APPIICANT: SMIP � O J WAiiNINQ.fA1LURETO5EWf1EWORKERS'COMPENSATqNCOVFMCEISUNLAWFULANDSMAL�BE ENERGYP/C � SU&IECTMIEMPLOYERTOCitIMiNALPENA:TIESANDCMLFINESUPTOONEHUNDFEDTIqU5AN0 ENERGYPERMIT DOlLARS(f700.000).W ADDITIONTO TME COST OF CAMPENS�TpN.DAMAGES AS PROV:DED FOR IN ¢ 5[CTION970lOFTHEUBORCODE,NTEPEST,ANOATTOFNEYSFEES. FlETENTIONFEE: �l ,OD aW.. CONSTRUCTION LENDING AGENCV pFiE•ALT FEE: O Q INEREBYAFFIRMUNOERVENALTYOFVERJURYTIUTIHEREISACONSTRUCTIONLENDiNCAGENL7 �- FOR TME VERFORMMKE OF TME WORI (�fi 'HIGM T1n5 VE i7jyM 5155UEO(SEC.]ov1,CIV.C). � Y�.�i-f LEN�ER'S NueE i ir+�!i �. LENDER'S�COR[55 � TOTAL FEES 30 w 1 CERTIfY MAT I HAVE NEAD iH15 APPLICATION AND ST�TE TMAT THE ABOVE PlFOR1A�TION IS fARRECL I��I.• � IAGREE70CAMDLYN7TMALLCI7VANDCOUNTVORDiNANCE5AND5TATEUWSREUTINGTOBUROING � V, CONSTRUCTION.ANDHEREBVAUTHORIZEREPR[SENTATNESOFiMI5CWN7YTOENIEHUPONTHE � Z ABOVE�AENtqN[DPROVE NFORWSGECibNPUFPOSES. COMMENTS � _ m PERAUTTEENAUE(Pp Q . N �/ 1 � SiGNA7UftE P MiTTEE —FD �E� � RECPT.�O. � ` � PAID BY � � ALIDATION WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor CoDY.GOLDENROD—File Capy.GREEN—Appl�canl's CoDY . •. ... .. .. �- .. ;..:i' r':. ... .�.��.•.-.r...._ __. . . .. /. v� ♦ . �(. � . . . . .... . � � 'Y � � . .. .. . . . � ... .... . . ......_ �........-w�..-..�r. 1..1 . . . l�.. ,v . .. � t . .. . .. � . . .. � . . . . .. . . r:, v��°: QI' e`^�''�f`.�:��1':l7 t�' l�^'.� if�fii•,-L::Gi�' F�-CE'�f�i� ._____.—__��__^..---------------.._...._.. ___._ . .__---...........---- --- -- �--�-------------____ ._.–--�-- .__.__�_ �___.__. �. 1►'��,�=�`Cl�.l►�; r:}`:E_ �►�F-'�ca-�;'re;:, i� E=i:y�:.�.��tc 1e. �is� �=. Ii�F=i:.!_.c;Cef:t . .. _..---- --.... . ....--�------.. ._ ... _ . ...... . _ _. _ _. _.._.___....._..._ . . . SET 6ACf: � � I . �' � � ! 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