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HomeMy WebLinkAbout12263 (6) - - ---- -- -..... ... . ._.. ... --�.______.... CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT :,. ' 21660 E.Copley Drive Suite l90 PRESS (909)8643195 Faz(909)861-3117 '^"� BUILDING PERMITAPPLICATION FIRMLY JOBSRE •� APPLICATION � o ADDRESS � • � � � OATE �� NUMB R � A� � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNE��"7�XJ�- "' ADDRESS �!�_ ZONING SETBACKS � �LL' CfTY � ZIP TEL. REAR Rw ❑ APPUCANT fl l �� TEL �'ZC>/S��k � SIDE/SI�E STflEET RW �O � CONTRACTOR •�- � , ✓I. SIDE ❑ ! �"7 � � f U � CITY E. r`Y_C ZIP� , TEL 5r7 9_�� ` PROPOSED USE T � o - _ �,c�-�t-�-t.rr�� 3c� vn,c.rv�, wa ARCH/ENG/ _ . . b DESIGNER NO.DWEL NO. NO. a ADDRESS UNITS STORIES • BEDROOMS � CITY ZIP TEL � DESCFiIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BI:tLDER DECLARATION SFR/ADD�AEM O p 1 NEREBY AFFIfIM UNDER iENALTY OF PERIURY TIUT 1 MI EXEMPT FROY THE COHTMCTOftS L4 G8fB9B/C81p011 W CENSEUWfORTHEFOLLOWINGREA50N(SEC.70.71.6BUSWESSMIDVROFESSIONSCODE.PM'CfTYOR (n - U COUNiYWFi1f71RE0UIRE5AGERMITTOCONSTRUCT.ALTE0.1MPIbVE.DEYOLISH.OiIiIEPAIRANYSTRUG W Patiol0eck � TUNE VNqR TO RS ISSUANCE.A150 RE�IJIRES iHE APVLH'JWT FOH SUCH iEPMIT TO FILE A SIGNED W � S7ATEVEM TUR ME OR SHE IS UCENSED PURSUIIR TO T1E OHO'NSIONS OF 1ME CONTRACTOf79 L4 � � CENSE UW(CFIAPiERf(CdAA1ENCMO MA7/1 SECTION 7000)OF�INSiON]OF THE BUS�NE55 MA GR0. u" POOVSpB FESSIONS COOEI�TFNT HE OR SHE IS EXEMPT iHEREFilOu AND THL BA515 FOR TME ALLEOED EXEMF TION.ANYVIOLATIONOFSECTIONM]1.6BYANVMPLIGNiFORAFERMITSUOJECTSTMEAPFUCANTiO Z pe•Roal � A qVIL VENALTY OF/pT MORE 71UW ME MUN�RED DdUARS(iSu01): � OI��WNEROFTHEVROPENTY.ORMYEAIVLOYEE5Vn7MWAGESASTNEIRSOIECOMPENSATION, � CORITBfCiel � MALL DO THE YYOfYf.AND THE STRUC7UHE IS NOT WTENDED OR OFFERED FOR 6�LE(SEG 70N.BU54 J y NE55 AND P110FESSIOHS CODE.THE CONTMCTORS LICFNSE UW DOES NOT APiLY TO AN OMMER OF ? PRODEHT`IM'HO BUlUS OR W PROVES TNEPEON,MA W/p DOES SUC/I NOHK HIMSELFOR NERSfLF OR � THNOUf`JINISORNEROWNEUPLOYEES,CNOVOEDTNATSUCHWPROVEYEMSAREN071N7EHDEDOR C� . . W OFFEREOFORSKEF.HOWEVERIHEBULDWGORMPRDVFMEMISSOLDWITFtlNONGYEAqOFCOMPLE- � TION,7ME 01tt1ER�BUILDER WILL HAVE iHE BUROEN OF►PONNO T1NT HE OR SNE DO NOT BUtLD Oit Z IMPROVEFqiTHE%1RPOSEOFSALF} Q= OI�SOwNEROFiMEPROPERT'I.AME%ttUSiVELYCOMMCTNOWITHLIGEN5EDO0NfMCiORS TO WNSTRUGT iTIE PRQIECT(SEG 7M1,6USINESS I�NO PROfE5510N4 WDE:TME CDNiRAC70HS L4 �/filU8li0�1 � ADJ.AHEA W CENSEUWDOESNOTAPPLYTOANOVINEROFAPROVEHTYWN06UIlD50RIMVfiDVES7MEREON,AND � MM1�OCONTRACTSFORSUp1PRO,)ECTSWITNACONTMCTOR(5)LICENSEDPURSUANTTOTHECONTRAC au,wnrr DESCRIPTION FEE - � TORSUCENSEUw). �J � OIMIEXE�PTUNDfRSEC. B.1P.GFORTHISREASON Q � V -•- � � �ATE OWNER V ..... • � . . . , . - .. .. Z W �4 L�CENSED CONTRACTORS DECLARATION W LL I NEREBVAFFIRM UNDER PEWLLTY OF 7ER1UR`I THAT I M1 LILENSED UNDER ORONStlNS OF CHAPTEA �, d Y(COMA1ENdNOWITH9ECT10N7000)OFpVI510N]OFTHEBUS�NEYSANDFHOFFSSi0N5CO0E,AND Z X MY LICENSE IS N MLFOHCE I�NO EFFECT. UJ Lj�/7�3 � � LICENSE CU155 ` LIC.NO. � V OATf� / `� cONTRACTOfi a . W ' � WORKERS'COMPENSATION DECLARATION bf3 ` Q � IMEREBYI1FfIRA1UNDERPEN/LTYOFiEM/HYONEOFTXEfOLt01MN6DECLAM710N5: V `" a � _IIUVEANOVnLLMANTAINAGERTiFICA7EOFCONSEMTOSElFaNSUREiORWUIiKERS' S � COMVENSATION,ASPiIOVIDE08YSECTIONl7ooOFTMEIABORCODE,FORTIIEPERFORM/!KF W p' OF THE WORK FOii MMICM TN�S PERMIT IS�SSUED. � W _IMAVEIWOWILLIAANTAINWORKERSCOMPENSATqNINSUMNCE.ASREOUIREDBYSECT10N O l70o OF h1E LABOR COOE,Fqi THE VERFORMANCE OF THE WOPo(FOR MI/11CH TMIS OERNIT IS �� '�O ISSUEO.MYNpRKERS'COMaFNSAT WSURANCECARWERANDPOIICYNUABERARE: CONSTRUCTION � U jGAFiRIER PUW REVIEW � POLICYNUMBER � ELECTRIG � (nassEcno�+H[mNo7eEoor.aFrmocnfvEw.riswaa�eKroaEnOcuuisR+mla��ssl PLUMBING Z �CERTIFYTM�TWTFIEVERFORYANGEOFTHEN9PKFORWHIp1iM5iERMIi6155UED,1 b1ECHANICAL (7 SM�ILNOTEMVLOYN7YVENSONINANYMANNERSOASiOBECOME5U8JEGTTOTME y VIORKERSCOMPENSATIDNUWSOFCALIFORNiI�ANUAOHEETMATIFISNOIADBECO/dE EE SUBJECT TO TNE WORKERS'WYPENSATqN VROYISIDNS OF SECTbN]7000F THE LABOR Qcooe,i ruu soa rH eoua�r wm��oaovis s. SSUANCE � �.c� p DATE: �APPLIGWT: SMIP ,O V W ENERGY P/C WARHI :f/ULURETOSEWRE WOfiKE115'COMPENSATION COVERAGE IS V11J1WFUL.AND SHALLBE �y SUBJEGTANEMPLOYERTOCRu1INALVENALTIESANDCMLFWESUPTOONEMINDREDTFqUSAND ENERGYPERMIT OOLURS(f�D0,000�NADDITqN TOTME fAST OF COMVEN5AT10N,DAYAGES AS VHOVDEO FOR W � SECTION]70eOF7HElABOACOOE,WTEHEST,AND�TfORNEY'SFEE4. RETENTIONFEE' , d CONSTRUCTION LENDINCa AGENCY PRE-ALT FEE: �'� '� O � INEREBVAFfIRMI,HDEAVENALT'OFVE0.1URVTHA7THEHEISACONSTRUC710NLENDw4►OENCN FOR iNE PERFOFMANCE OF TME WORK FOR Yv1pd1 iHiS VERYIT IS ISSUED(SEC.]oY7,dV.CJ. � � LENOfR'SN/WE � LENOER9AOORE55 W ICERTIFYTHA7IHAVERFADTHi4APPl1UlTqNA/DSTATETHATT/EABOVEWFON4ATqNISCORRECT. TOTAL FEES � d IAGREETOCOMPLYWI7F1Ai1CrtYANDCOIMTYORDPLWGES/ND6TATEUwSFEUTNaTOBULDINC CONS7RUCTION,AND MEREBV AUTlqHIIE REPNESEHTATIVES OF T1uS COUNiYTO EMER UPON TNE S�. ��E VRDVER7Y fOR WSP CTqN wr�vose . COMMENTS ' � � � � �a � y � � G 1 Vj lqNAlURE OF PERAIITTEE f � � RECPT.NO. PAID BY VALIDATION . 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