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HomeMy WebLinkAbout17137 (19) �\ CITY OF DIAMOND BAR � , ; DEPARTMENT OF COIvIIvIUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive ' � (949)860-3195 Fax(909)861-3117 PRESS �'%�� BUILDINGPERIMITAPPLICATION FIRMLY o DDRIESS`3aso F}/�W�C(�Q-Qa3� APPUCATION p� 'q 0 PERMIT � I2 P/C DATE NUMBER �� 7t � APN LOT TRACT �SSUE q TYPE CC ��-�- DATE 1 �� CONST. GROUP p OWNER N 7���7 7E-'� p ADDR S � il LJUC� ZONING SETBACKS z CITY ZIP Ql{Q TEL. - 0 /'{-' FRONT RW ❑ o APPLICANT TEL. �� -� 7 SID SIDE STREET RW O � CONTRACT SIDE o ADDR SS� t� CITY ZIP X1 TEL. � i�l 1 PROPOSEDUSE�O.�NAIc��NS�'!4-� 8 '1��C.Oi� Y� o ARCH/ENG/ S.b P�F' 1 ` DESIGNER � NO.OWEL. � N0. o? NO. (C, �2 3 a ADDRESS UNITS S70RIES BEDROOMS � CITY ZIP TEL � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDEF DECLP.RATION SFRIADO/REM O p I HEREBY AFFlPM UNDER PENALTY OF GERJURV THAT I AM EXEMaT iROM THE CONTMCTORS LI• G3290/C2fp0A W CENSEUWFOR7HEFOLLOWINGREASON�SEC.7o71.58USMESSANDDROFE55'ONSCOOE:ANVCITVOR (n C� COUNTYWMICHflEOUIRESA�ERMITTOODN57RUCT,AITER.IMPROYE,OEMOLISM,ORflEPA1RA4Y3TRUP W patio/Deck � TURE,VRqR TO RS ISSUANCE.ILL50 NEOUIPES THE AVCLICANT FOR SUCM DL'WA�T TO FILE A SiGNED w STATEMENT T}L1T NE ON SME IS UCENSED PURSVANT t0 THE PROYISIONS OF THE CdiTMCTOR3 LI• � CENSE UW(p1APTER 0(COAIMENCMO WITH SECTION 70CA)OF ONISIQN 70F THE BUSINESSAND FR0. � Pool/Spa FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM MD THE BASiS FOFl TMG ALLEGED E%EMP• � TION.ANYVIDLATIONOFSECTION70]I.5BYANYAFPIICANTFOqAPERMIT5U0.1ECT5THEAPPLICANTTO Z Re-R001 �,,,� A CINL 7EN�LTY OF HOT MORE THAN FfVE HUNORED DOlU�S(f5oo�.} , � ❑I.ASOWNEROFiHEPROVERTV.OHMYEMPLOVEESWITHWAGE5l15TMEIRSOIECOMPENSATqN, � Commerciat Z MALL DO THE WORI(,AN�THE STRUCTURE IS NOT INTENOED OR OiFERE'J FOR SALE(SEC.70��,BU51� J � NESSANOPROFESSIONSCODE:THECON7MCTOf1SUCENSEUWDOESNOTA7PLYTOANOWNEROF � PROVERTY W1p BUMS OR MPROVES TNEREON,ANO W1/0 DOES SUCN WORK Ni1AS[lF OR HEHSELF OR Q TNRIXICHNISORMERONTIEMPLOYEES,VROYID£DTHATSIJCMIMPPOVEMENTSARENOTWTENOEDOR m QOLFEREOfOqSIlE.IF,/qWEyERTHEBUILDINGORIMPqOVEAIEMISSqDWIiHiYOM1[VERROFCOMi�E- Z TION,THE ONRJER-BVILOEF WiLL HAVE ME BURDEN OF PROVIN6 THAT HE OR SHE D�D NOi BUILD OR = DAOROVE FORTME PUHVOSE OF S�LEJ. w OI.ASONMEflOFTHEVROPERTY,MAEXCIUSNELYfANTiUCTINCWITNUCENSEDCANTRACTORS [[ TO CONSTRUCi THE Pfi�JECT(SEC.70��.BUSINESS AN7 PROFE5510N5 CODE:iNE CPYTiUCTORS L6 V8�U2liOf1 �D � A0.1.AREA W CENSEUWDOESNOTAPPLYTOANON'NEROFAPROPEHTYYnqBUI�pSONIAIPROVESTHEREON.AND � NTqCAN7MCT5FOR5UpIPRQ1ECT5YATNACONTRACTOR(S�LICENSEDPURiUANTTpTMECONTMG QUANTITY DESCRIPTION FEE X TOPS UCENSE UW.). � Q ❑I/UA FXEIAPT UNDER SEC. B.i P.G FOR THiS REASON Q 3 � � ¢ OATE OWnEH U Z W � LICENSED CONTRACTORS DECLAAATtON w IHEREBYAFFIRMUNDERPENALTYOFVENJUftViMATIAMLICENSEDUNDENPFOVISqNSOFCMA7TEq � � 9�COMIAENCRMWITMSECTION7000)OFDNi510N�OFINEBU51NE54AN7DROFE55ioN5CODE,A.4D Z �� MY IICENSE IS M FULL FpRCE I�NO EiFECL � � UCENSE CLASS tIC.NO. J V DATE CONTRACTOR a W � YlORKERS'COMPENSATION DECLARATION ' � ¢ � 1HEREBVAFFIRMUNDEqDENALTYOFPE0.IURYONEOFTNEFOLLON",NGDECLAMTqNS: U Cn Q � �INAVEANDV/ILlA1AIN7AINACERTIFICATEOFCONSENTTOSELF.INSUPEFORKC1iiKERS' _ COIdPENSATION.AS PROViOED BY SECTON�1o00F TME UBOR COOE,FOR?HE PERFORMANCE w OF THE WORK FOR WHICH 7MIS VERMIT IS ISSUED. � � W �IHAYEANOWILLMNHTAINWORNERS'COMPENSATIDNINSUMNCE,ASREO'JIREDBYSECTION I� /�T O 97DOOFTHEL�BORCODE,LOqTHEDERFORMANCEOFiHEWORKFORWHICHTHISVERMIiIS I�OI '7)V ISSUED.MYWORKERS'OOMPE,��y�r 10NiN5UFLWCECARR'�EHM1DFOliCYM1M6[RME: CONS7RUCTION L I� (/ j CMRIER��—�. `Ji11D � pLAN REVIEW Z POLICYNt1610Ea r�c���O�' �`p �17�1 - __ ELECTRIC Q Q (tr6sEcrloNNEmraTBEmbaErEncFnEPEan+tsro�a:[r+LwrilDDclufU�i�oota+tEssl PLUMBING z I CERTIFY THAT IN iME PERFORMAVCE OF THE WORK FOR WNICH THIS OERMIT IS ISSUEO,I MECHANICAL C'} SHALLNOTEAIPLOYANVDE0.iONINANYMANNER50ASTO8ECOMLSUBJECTTOTME � WORKERS'COMVENSATIONUWSOFCALiFORNIqANDACR[ETHATIFISHWLDB[COME INSPECTIONFEE � S $U&IECTTOTHENbRKERS'COMPENSATION7 VISIONSOFSELilONJ7oQOFiHEU80R CODE,C�SMALL FORTMVITN COMPIV W R N ISSUANCE � 0 �� 7"�� .� 1:��� SMIP • IO p DATE: APPLICANT. _ - W ENERGY P/C J WMNING;fAILURE TO SECURE WOHKERS'COMPENSATION CAYERAGE IS UNUWFUL.A�D SHALL BE � SUBJECTANEMPLOYfRTOCRIM14AL0EN/�L71E5ANOCMLFwESUPTOONENUNOFE0TNIX15AND ENERGYPERMIT OOLlAFiS�5100.OW).W ADDITION TO TNE COST OF COMFENSATKK7.DAMAGES AS PROYIDED FOR IN ..'�J SECTION71oeOFTHEUBORCODE.INTEREST,ANDATTORNEr5FEE5. RETENTIONFEE: � � � CONSTRUCTION LENDING AGENCY pRE�ALT FEE: � IHEREBYAFFIRMUNOERGENALTYOFVEPJURI'TNAiTHEREISACONST�UCTIONIENDINOACENCY FOR TME PE RFORMANCE OF TNE WORK FOR WHi01 TM�S VERMIT IS ISSUED�SEC.7D97,CIV.G). Z W � LEdDERSNAME F� IENDEq'SAD�RE55 W ICERTIfYTHATIHAVEflEADTHiSAPP�ICATIONAYDSTATETNATTHGAEfOVEU:FOR4ATqNISCORflECi TOTAL FEES `�O� .� O a, I�GNEETOCOMPLYWITHhLICIT/ANDCOVN7YOR�INANLESAN�STAIEUWSREUTIN6TOBUM1DING � CONSTRUCTION,ANDNERE8YAU71KIRIZEREPRESENTATIVESOFTNISCOUNTVTOENTERl1PONTHE Z �BOVE�MENTqNED OPERTYFORWSPECTIONVURPOSES. ' COMMENTS � � m pERMI NNAE(PRI � � � ¢ S�Cs�.K. �--��1-0� cn � SIGNATUREOFVERMI EE DATE � �. RECPT.NO. _PAI�BY VALIDATION WHITE—Department Copy.YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy , . . „ - . , ,�: . . -� ..,�,.. . . . ... ..._ - . A� , ._... _ _ .... _ . , ,. , . .. ��i . Ir?' ;�i`1.�?i�'3`.'�, i��:-.�=; t S'�_.�r'G-\_+..._��i�• �i;:�r a:�...^'i..F _...__.�._ . 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