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HomeMy WebLinkAbout14166 (17) J -- . . . . . , . CITY OF DIAMOND BAR' '' ��",-° .' -'`-' r ��;;. � DEPARTMBNT OF COMMUNITY&DEYELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 (909)86a3195 Fax(909)861-3117._ PRESS �`- ' _ - �.BUILDING PERMIT APPLICATION . � - _ , , . FIRMLY: , ;r,;;-' . . � ,o D RESS �33 G���L� '�/~I��,S .L/¢�' APPUCATION � L PERMR �� P .?j " DATE ' NUMBER 1�_��, ± i � ' DATE _ _ . . .._ ...... .. _. . ',: .. -�- -- . APN LOT . TRACT _ . . .__.._ _ TYPE . , 1'. OCC - � � _ CONST. GROUP ' g OWNER GON / �� _-- (/ ,i - - , r ; i �` ADDRE S � L`" .S� � ' " : � ZONING SETBACKS � � ' . . _. _. _.._... �_ . . __ W CITY • �' ZIP TEL . , . .. � FRONT RW ❑ � APPUCANT . , TEL ' '- HEAR - _ � 0 SIDFJSIDE STREET RW O ' � �.. . . . ._ ... _ . . . . . . . .._ _ . ..- . .......... .. ' CONTRACTO � �+ � � .- ' SIDE 0 � ADDRESS/� - O � - - � -PROPOSED USE^` O—/ S�1/tGG--�i.�c—�cl� ��Sj ��f '._.g CRY / -ZIP TE �- � � � � ARCWENG/ . 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FESSqftS COOE)0(i TIu�T NE ORSItE i3 E%ENPTiHEFIEffiOY AHD ME BA419 FOR i/1E ALLEOED EXEW- TqKANYVI0LAT10HOF5ECf10N7W1.6BYANVlVPLICMIiiOHAYERMITSUBJECTBTXEMR�'AwT70 �� Z RB�R001 � A WC PENALN OF NOT AiOHE TIAN FNE M1NDRm DOUARS(t5oo).k ' , I , , � � O�ASOIVNEROFiHEPROFERTV,OHWENPLOYEESWITHWAGESASTMEIR50lFCOM7EN5AT10N. O �m�� _ . � WLL DO TlIE WOqIC ANO 1ME STPoJCiURE IS NOT N(TElAm Ofl OFFERED FOH SALE(SEG 70K BU54 J NE54 N10 PROFE5510NS OODE TNE CONTRACiORS IICENSE lAW DOES NOT AO�LV TO AN OwNER OF� � , i ., . , .. � . N iROYERTYMM1qBUlD90i1YVqOVESTMEFEON.MDW/qDOESSUtlIWOfLCWMSELFORHEflSEIFOA m � . ' -_"...._ .-iMil0U0MWSOFi/1ENOYMEYPLOYEES,PROVIDmT11ATSUGtIMPHOYEMEtrtSARENOTMENDEDOR. _'__"_ _'._____"____.___ _'__."___ __'�_."' '___._ .' __ _.__'__.__._.._.__. .... _ _ i OiFEiIEDFORSALEF,IrowFVE0.7ME8uLDv+60f1WONOVFLFMt450lDWrtwNd�EYEAROFCOMPIE- �'TIDN.i1�OIVHER-BUYDER VNL FNVE i}�BVHDFN OF PPOVYIO iTiAi HE Of16NE DOlpT BWLD OH �� : YPNDYEFORiHEPURPO5EOf8ALE1 . '- •. - . • ." , "� • ' . i � plA30YMEHOFTMEVROPEHfI:AYE7(CIUSNEIYCONTMCTWCiWfTNL10EN5FDGONTRACfORS .. . ��� TO OO/aSTRUCi 7HE PHWECT fSEG�Ou.BUS�HE55/�A PROiE55�ON5 CODE TtE COHTRACTOFlS LL Valuatian- . '_- AD.I.ARE/1 CFNSE UW OOES 110TMPlY tOAN OWNEROFA iHOPERtt WNO BUM.DS OH W iFiOYES iMEREGL AND 1 '. � v.woartw�crswnwaioaaEcrsxnrn�mrrtw�cro�slucorsm�uu�vrron�wnTw�c �UANTI7Y�'�, �DESCRIPTION . FEE� ,^ , i00.SUCfHSEWK} � � �' _. _ _ . _ .. . . _. ,. � OIIYE%ENPTIlDEHbEG. . . ..�. .&aP.GFORTMI5HFJ150N U . - ."`... ._ - - `. _' _ _ _ _ . . . . _ . . . � �- - -- . . . _ ,_ I�' . . . .. .........._.... .._ . . - - . . " � , a�� f�� .`. .� - . . '.' t -�.�� ' ' ��� Q - LL' DATE� OWi/ER U , _. _ __'_.. _ _ ._� __. .' _ � + - UCENSEDCON7flACTORSDECLARATION---.-.-_.,.._.'_..:.- .: W . ._._ . ... _.._......_._. - --.-.___._ ___. _. ._____-- --,--. - . � ..._ � INEREBYAfFYWUOERPENKTVOFFEfiK1RYiHAT1AA1L10ENSEDUNDENVROviSpN50FCHAiTER� Ur " . , . _ ' '. .•' : ' �(COUYENCIA N7TM SECTION l000)OF OrvWqN 70F THE BUS�NESS AND PNOFE5510NS tODE.AND Z W IJCENSE l5 N FULL fOfICE ANO EFFECT. m � . � . _...._. .__'_ _ _ . , . ._ . . . _ . . _.. . _.., '_. .". __ ....._. _ "..._ '_ � o � �- 6 �.No. .�T/0� � ; _t.- .. . _ _ '�. � �� ��� �w� � - � . WORI(ERS'COMPENSATION DECLARATION . . .._ � _.� . .. . .. . ... . ... . . ...._. _ . .._. .. ._. . . i ! � . . N IHEiiEBYAFFWYUlAERiEtULiYOFDEMIRVONEOfiMEfOLLDWINGDEC1AtUTqNS� . N Q � _INAVEMIOYALIIMNtAWALENfIFIGTEOFGONSENTTOSELHNSUREfORMURI(ER5 -. . _ ... _. _..' _.. ._'. . ' __ . . . .. ._ _ ._ - . � � � OOMPEHSA7qN,AS 7ROViDED BYSECTION J70o OF THE lABOl1 COOE,fOR THE PERFORIAM7CE W . Of iHE W W1K FOfi NRYCH iMl.4 PERMIT I9155UED. � . � � � - / .. .,. _ . ._ .. _. _ .._ . .. .. . ... .. , � Q �1 ryAyEµp IYyy WIyT/iW YpRI(ER5 COM7ENSATION WSUMNCE�`REOINNED BY SECiqN�. i7000GiHELABOtiCOOEFORyTWMEDERiOiUA�IwN+cC#E{O�FiHEYlORKFOAWMICHiM15PEWAlT13 J , j c�ar+,Ea �A!" ��L/`•V.l� Eaurov«icrwueEau�_....-- - - -coasTRucnoN .. • - - - PLAN REYIEW � ' ; . � ._.. �►+�+ � ' E�crwc - �: , � f , � � -Q (1F�6fCIt7HtEIDN0T6E0p.Fl£IFDOFTHEPFAATBPDRONEIUDOqED00LLui5iGtoo�0al6Sl PLUMBING ...._. . _ . .. .. . .. . _._. � . . . _.. __. . _ .. . . . .... . . . _.. . f Z ICENTIF/iW1iNiHEPERFORIAANCFOFiMENURKiORWMICHiHLSVEiW1TlSLSSUED,1 MECH�INICA� 1 " �ry SMMLlpTEMPLOYANYiERSCNIN/W'IMANNEHSOASTOBEOOMESUBJECTTOTHE � 'E . .(� ...WpWCE{t5'WYVfNSAipNUWSOFCALIFORN�I�NDAGtiEET/NTIF151qUD8E00ME"' - .INSPECTIONFEE. . ., � SUBJECiTOTM6NqRKERSWM�ENSAT woH SOi5ECT10N�7000fTNEUBON ISSUANCE �'SA T� �G s � , THCqWLYWI SE �. , .. . . _.._ ..__.._ . .-r .__. . _ .. _. ... ._. . � wrE: � waaurr. ' sMia - _ . _ _ . .... . , WAf W Wci FAIURE TO bECURE WORNERS'C0IAPENSATqN COVERAGE IS UMAwFUI.At0 SHAIl BE EMERGY P/C _ � W . . ._ . .. _._ . � SUBJECTMIEMPLOYFAtOLNiMwALPENALitESMIDGVILFM1E5Uii00HE1RAi6HEDilIOU+AND �ryEflGYPEflMIT �rvT�1 0 1,999 - -- . .- - - • DOLLARS(l100.0ooA N AOdT10N TO7HE CO6T OF GOMPENSAiION.DAMAGES AS PHOYIDED FOH W - � SECiqN370�OFTHELABOFtC00E.NTEREST,MmATTOfWEYBFEES 1 `) - . .. . . ,.. „� (�p .. . , RETENTION FEE:. o CONSTRUCTION IENDING AGENCY Pji A F (� F DIAM ND BAR � � IHEi1EBVAFiIWAUNOERVENAITYOFPE0.JURYTHATiHERELSA00N5TRUCT10NlFtiDYXiAGENGY ��-` - �3 ILDINGANDSAFET'I . . . ... . • �Z FORiME PEHiO�NrCE OF 7HE WOHK FOR WH�GI iM15 DERMIT IS ISSUED(5EG]OY7.LIV.G1. .. �. LLj . .. _.. .._ , . _.. .. ._' _' ' __ "' '.' .__ _ . .. ., .. ... __ ._ : . � IENDERSNAME ` . F- lF1DEH9ADDRESS . . __. ... ._... .__-___'_____.___... . _ ... ' � � ICER7IFYTHATIHAYEAfADTM1ISAVYLiG17pNANDSTATETINTTIEABOYENFOFUAATWNISWMECT. TOTAL FEES .. . : . .: ' � ' . � .� � IAGREETOCONPIYWfTHALLGINANDCa1N7rORDIWNCESANOSTATEUwSPEUTN610BUlDW(3 _ . .. � . �'� ��� . CONSTRUGTIW�IANDHEREBYAUi/10iYZEREPRESEN7ATrvESOFTWSCOUNi11TOENfEHUPON71fE . -'.__-- _._ ---_..____. . . - S� FnvRov�atr�or+wsvEctanwnroses. COMMENTS _ . ,. • - _ ��'�� .���/ - _.. -- . _ __ ._ . ._... � m pEA1IITTEE W1AIE IVtLNi). _ . . __. � ,�p - 4 Gp ' � N � uJ &IGNA7UREOFPERWTT ,. . _ . . , . ,DAiE _ _._ . RECPT.NO. PAID BY YAUDATION '' � WFi�TE—DepartmeM Copy.YELLOYV—Finance Copy,PINK—Asseasor Copy,GOLDENROD—Fi1e Copy.GREEN--Apd�canCs Copy Y � .. � � �.Y t �; t J 1 7 r t�r '.'l:1 �1_ I n.. �-_ .�,; � ?:L�C'd��it=:���'�"f�0= `- " '2 "� _ '�T[:S2 fi=: _zT i0 ,,f� Ti�::C' i ,TA:. �i' _ �TU. �:J 7Y�: =� 14f: ,n1..ti= J(."• t�le' f !,� i _ ¢ � na^ C>^. t ¢-� r_, pS� '.' 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