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HomeMy WebLinkAbout14228 (8) i , � �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SEFiV[CES �� , 21660 E.Coplcy Drive Suiu 190 (909)860-3195 Fax(909)861-3117. PRESS �y�� BUQ.DING PERMIT APPLICATION FIRMLY y J0851TE APPLICATION fp q PERMR r "� P/C o AD�flESS DATE �NUMBEFt M � ISSUE TYPE OCC APN LQT TRACT � DATE CONST. GROUP g OWNER \AlriM " ADDRES 7 ✓1 ZONING SETBACKS Z CITY IP TEL ' � R�R RW � � APPLICANT TEL SIDElSIDE STREET RW ❑ CONTRACTOR SIDE O � ADDRESS pROPOSED USE �J CITY ZIP TEL � ARCH�ENGI � DESIGNER NO.DWEL. NO. NO. . ADDHESS UNITS STORI BEDROOMS � CITY ZIP TEL N OESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION � Q ONMER•BUILDER DECURATION SFWADD/REM O p I NEREBYAFFIRM UNDER PENAL7V Of PFIWRV MAT I AM E%EAIPT FNOIJ THE CONTMLTORS L4 Gnrage/Carport � W CENSELAWWNiHEFOIlOWP7f1REASONf5EG7W1.68U5WE53ANDPROfE3510NSO00EANYqiYOR ' (n .� WUHTYVApGIpE0U11iE5APEMIRTOCONSTAUCf.KTE0.M�VR0YE,DEMOLISN,ORRED�IRANY57AUG `W Patio/Deck .. . 7URE,PRIDR TO RS 65UANCE./LSA REOUIRES TME A7PL�CANT FOR StK.M PEPMIT TO FILE A SI�NED ETATEMENT T1AT HE ql SHE IS UCENSED PUR.SUANT i0 THE PROVISIONS OF TNE CONTRACTOR3 l4 � CENSEUW(tl/A7TER0(COIAYENCHON7THSECTION7oo0)OFDMSION�OF7MEBUSINESSMlOPHO� u' POOVSpO iE55qN9000E)ORTNATHEORSMEISE%EMP7TiEAEFROMAND7NEBA5�SFOR1HEAlLEOEDEXEMP•� T10N.ANYVIOLAiCYIOFSECTIOH7D71.6BYANYAPVIICANTFORAiERMITbU0.)ECTSTMEM7L�CANTiO Z Re-Roof � ACMLPENALTVOFNOTMORE1YiMlFIVEHUNDfi[DDOlUFl51tb0D),): ' � O�.ASOM4IEROF7HEPp�PERT/.ORA/YEAI7LOYEESWI7MWAGE51lSTNE1HSOlECOMPEN5ATION, 0 CORiR1BfC18I � WN1 p0 iHE Yqi1N,M1D TNE SiRUC7URE IS NOT INTENOED OR OFFERE�FOR SALE(SEQ 70N,BUSI� J HESS/V�O OpOFESS10N4 CODE:iME CONiMCT00.5 LICENSE lAW DOES NO7APVLY TD AN OwNEq OF• � PHOGEfRYNT10BULD901iIMVROVESiMENEON./WDNHODOESSUCHYNORHHIMSELFORHERSELFOR � � Q TW1d1OHHISORHERONT/EMPLOYEE4,DqOVIDEOTHATSUCNIMVROVEMENf3MENOTINTEN0E00R CL� . L� ,OFfEREOFORSALEIF,YqN'EVERTHEBULDIIHSORMFROVEMENT4YSOlDWR1#NONEYEAROFCOMPIE• 'TION,THE OWNE�FBURDEa WiLL HA�E THE BURDEN OF DROVMO TNAT HL OR SHE DD NOT BUiID OR � YV W.WE FOR Tf1E PURVOSE OF&LLE7. 06�ON�NEROFTHEPROVE1tfY,M1EXCLUSNELVCONTNACTNOWITHLIGEN5E�00NfR11CT0(U TO CONSTMICT TNE PR61CCi(SFC.70N.9:151N[SS MID iROFF551ONS CODE:7NE COflTRACTONS LI• V2NdfI0f1 ADJ.AREA CENSE LAN'DOE9 NOT APPLY TO AN VlMCR OFAPROPEN7Y NTq BULDS ON IMPROVES iMERC-0N,AND VVIpCONTMCi4FOHSUCHVML[GTSwRHA00NTMCTOH(S�LICENSEOVURSUANf70T11EGON7MG QUANTITY DESCRIPTION FEE � TOHS UCEHSE UW.} O�NAE%E►�?TUNDEHSEG B.IP.C.FORTH15RG° U � / i} 3.T�� DATE OWNEA V . � �,�� � . 4 J � . . F LICENSED CONTRACTOFlS DECLARATION W . � IHEHEB'IAFFlRIJIAAERVENKttOFVERRIRY7HAfIAMUCENSEDUNOENPROVI5lON30FCHAPTER �r , , , S 0(COANIENCWOWRI/SECTION7oao1�DM5WN7UF71�EUUSMESSANDDROfESSqNSCODE,M10 Z Lti MY LIC[NSE L9 N FUl fORCEANO EFFECL � 0 � �.,_, LICENSE CU55 UC,NO. j , � �� conrw��croa a � WORKERS'COMPENSATION DECLAAATION 4 � IHEREBYAiFIfWUNDERPEN,LLTVOFDERIUPYONEOFTMEFOLLOWINGDECLAMTIONS: U �' a � ��HAVEAHOYALLAWN7M7ACCRTGICATEOFCONSEHTTOSELFJNSUREFORV.tlpICEqS' 2 � COMvfN5AT10N.A5DROVIDEDBVSEC710N7T�00F1NEU�BOfiLOOF.FORTHEPERFORMANCE U � OFINEWOW(FOfiVlHIq/TWSiERMITI5155UED. � G Q �I H�VE M70 W.LL LWMAW WOPKERS'COAIPENSA710N INSURINCE.h5 HEWIRED B7 SECTqN 7/p1pFTNEUBORCODE,F0117H"eGERFpRMANCEOFTHEWORKiORWF1ICHTH15iERA1R15 � . ISSUED.MYriOR10EA5'CdJPEN5A7qNIN5URANCECAHWERANDPOLICYNUMBERAlIE: CONSTflUCTION ? uqyER PLAN REVIEW � poucrNuue[q ELECTRIC � (R�55Ec71.71NEEDNo78E0d.HERDochEGEtM7sriMa+EHllailmDaL�'tsQtoo)ORLEssI PLUMDING � ICERTIFVTUTNi}IECERFOPAINlCEOFTMEY+OFiKFOfiV/HiCMTHISGERMIi1565UE0,1 MECHANICAL SMALL NOT EMPLOY M!Y PERP.ON NI ANY M�tNNER SO AS 10 BECOM"o SU�IECT 7D THE vJ WORKERS'COMVFN5AT10NlAWSOFCALIFIXWI�.ANO/�GREETNATIFIS�q�IDeECOME INSPECTIONFEE .�� y S SU&1ECTTOTNEWORKERSCOMVENSATqNPROV15lON50FSECT�ON170aOFiNEU80H ISSUANCE , 1 -- ex�i s�uu coan�wm�oouair win�nase vao�ns�s. � 0 SMIP 0 0��: �vv��curr: . w ENERGY P/C n�'*� � WARNIN6:FALURG TO 5[CURE M/ORKEHS'COh�PENSATqN CAYERAGE IS UNLAWRIL..�ND SwLLI BE SV6)ECiANEMPLOVERTOCR14PlALiFNl�LT1ESANDCMlFWESUPTO0NE11LY1DR[D71qU5ANo ENER6YPERMIT V��� DOL1AFt5�ff00.00o),N►DOmONTOTME COSYOFCOMPENSATION,OAMAGES AS PROVWEO FOR IN � 8EC7qN17oeOFT11EUBORCODE.NTEREST,ANOA7TORN[vSfEEi � RETENTIONFE _ _ �� TTr.�"_'� OCONSTRUCTIONLENDINGAGENCY PRE-ALTFEE: $u.�L.!]�I�(` ,L � IHEREBYAFi1NAUNDERPENALT/OFVERAIFVTMATTHEREI5AWN5iRUCT10NLENDW0A6ENCY ' ` dZ FOR T1E iCRPoiWANCE OF iHE WO�K FOR WHICH iH15 PEPIAIT IS ISSVEO(SEC]av7,CIV.C.). W .� LENOEN'SNM1E s � LEN�Ef1'SAODRE53 . WI GBRTFYTMAT i HAVE PEAD TH19 APPLICATION M10 STATE THAT iHEAWVE NFORMATqN iS CORR[CL 1 OTAL FEES � � � IA6REETOOWPLYW17M11LLCRVANDCOUNiYORDW�NCESANOST�TEUWSREUTiNGT08U0.D�N0 . . GONSTPUCTION,ANO NEREBv AUTHORIZE REPRESENTATNES OF THIS COUNT'TO ENTFR UDON THE S� 11BpVE. fTqN[DVROPERTYFdiINSPEGTIONPUR705ES. COMMENTS J � m CENARTEE [(PWNTJ � 4 1 n 6 /� N ____ha�� 1� � � SIGNA EOFPERMITTE6 A7E f � RECPT.NO. 1 PAID 8Y �VALIDATION WHITE-0epartment Cop�r,YELL —Finance Copy.PINK—Asaessor Copy,GOLDENROD—File Copy,GREEN—ApplicanCs Copy - ,., , .- " ' .Y . .. . . . .. , . ;�.r � , n.;<" , , . .,.�,.:,.. ,r, . �� . .. . , . . , • , . --j�) CITY OF DIr4M0I�lD,BAR , • :.,,;,•,.� : , , . _ -- r�,:;���'��.. . _ � iNSPECTIO��I�RECORD ';', , . . � � :.�: ;� �"' �f.Y';,6 . . . ., .. .. . . 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