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HomeMy WebLinkAboutNo Permit Number (45) CITY OF DIAMOND BAR �� --�� -- DEPARTMENT OF COMMUNITY&.DEVELOPMENT SERVICES � 21660 fi.Copley Drive Suiu 190 � - � (909)860-3195 Fax(909)861-3117 PR E$$ ��'�� BUII.DING PERMTT APPLICATTON FIRMLY � JOBSfTE ,� APPLICATION f Q `j C] PERMfT a !I P/C o ADDRESS ' � > DATE � ( � NUMBER �J k � , ISSUE 7YPE OCC APN LOT AC DATE '' ' CONST. • �• GROUP p OWNER � ADD S ' ZONING SETBACKS �'�' C , ZI TEL , FRONT RW ❑ g APPUCANT T � REAR p � - SIDE/SIOE STREET RW ❑ CONTRACT � SIDE ❑ � ADDR � PROPOSED USE � CfTY Z � TEL � ARC G/ � ��G�i�� DESIGNER N0.DWEL. NO. NO. ADDRESS UNITS STOFiIES BEDROOMS � CITY ZIP TEI.. y DESCRIPTION SQ.FT.'• FACTOR PSF ADJ.AREANALUATION p� OWNER-BUIL�ER DECLAHATION SFWADD,'REM O p I XEREBV AfF1R1A UNDER VEIUITY OF PE0.AIRY T1uT I IIJ F%E4Pi FRdA THE CONTRACTORS U• Gdfep9/CafpOA lU CEHSEUWFORiHEfOLLOYYHGREIISAH�5EG70.71.68U5WE55ANOCROFE55lON5CO0E:ANVC�TYOR (n � f.OU!liYWHKy1REO111RE5APEMIRTOCONSTRUCf.AlTER7APqOVEDEMOlJ51tOANEPAIRANY57RUG W PatiaDeck �� - �� - � � TURE,PIiIOR TO RS 65UANCE,�LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO fILE A S�GNE7 W 6TATEMEM iHAT ME OR SME IS UGENSED PURSUANT TO THE VfiDV1510N5 OF TME COHTRACTORS lb � � CENSEUW(C7IADTERY�Cd.IYCNCWON1iN5ECTIDN7000)OFDIVISION70FTNEBUS!NESSAN'�GRO• � 'POOVSP3 FESSIONSCODE�ORiTUTHEOR5HE19EXEMPTiMEREFROMANDiHEBA515FOFiTHEALIEGEDE%[A1P••, TION.ANYYIIXATIDNOFSECTION707t.6BYAHYAPVLICANiFORI1PEH1AIT5lAJECT57T1EMPLIGNTTO z qe-poof � ACMLpFNAl7YOFNOTLIORETHANFNEVNNDREDDOLLAH51l500),): � � OL�SON'NEROFTHEPROPERT:ORMYEMPLOYEESWITMWaGE5n5MEIRSOIECOMPENSATqN, � CUllmeftl0l ' MMl DO THE WORIC AND THE SiRUCiURE l5 Wt IMENOED OR OFFEHED fOR SALE(SEC.7o4.BU51. J � NESS A/O PROFESSIONS CODE:THE CONTMCTORS IICEHSE UW DOES NOT APPLY TO/N OWNER OF ? VHOiEAfYMF10BUlDSORMPROVESTMEREON.ANDM710DOE55UCHYVOFlKMIuS[LFORHERSELFOq m - (X iTd10UGHHI50HHEROWNEMPtOYEES,PRDViDmTMATSUCHMPROVEAIEMSARENOiM7ENDFDOR �L1 pF�qE'pfpq5/LEF,IqWEVER7MEBURDVqORIMPROVEMINT1550lDWRMNONEYEMOFLOMPLE� � �TION.7HE O�MNER�BUIIDER VALL NAVE THE BURDCN OF PROVWO THAT HE di SNE OIO NOT BUItD OR W PROVE FOR T11E GUPPOSE OF 6ALE). �y,� ❑LASOMMEROFiHEGROPERf1:M1E%CLUSMELI'CONTRACENOWRHIICENSEDCONTMCTOR3 � TO COHSTPAlCT TIE PFiOJER(SEC.7ou.BUS�NE55 Ml0 VROLESSIpNS COOE:iHE CdJTMC70R5 L4 V81Uatipl ADJ.AREA � CF115EUWOOESN0TIIPPLYMANONT�EROFAPROPEfl7VYR108UILDSOHpAPiqYESTNEAEON.ANO N11000NTRACTSFONSUCHVR0.IECTSVAIHACONTMCfOR(SJLICENSEOPU0.:UAMTOTHECONTMG pUMlTI7Y DESCRiPTIOV FEE � TORS UGENSE UW} OIMIIXEAIPTUNDfR4EC. O.iV.C.FORTHI5RCA50N J V I( k t � � p►TE OWNEF V ~ W , ^ . LIC[NSED CONTRACTORS DECIARATION W " i'; ' � IHEREHV�FFIRYUNDERPENALTYOFOEftA/MiHA71AMLKENSEUUNDERVROVI5�ON50FCH�PTER � s �(COI.�/ENCl10N'ITMSEGilON7aao)OFOMS�ON70FiNEBU5iNE541WDPROFES510N5CODE,AND Z "L W LICENSE IS N FUl FORC 4D EFFECT. m �1... LICENSE 5 � IIC.NO. �� j �� pATE CONTMCTO�i t a . Ti � WORKERS'COMPENSATION D[CLAFiATION Q N IHEREBYAFFIRUUNpERVENALTYOFVE0.1URVONEOF1HEfOLLDWINGOECIARATIONS: U � z Q � _IMAVEANDWILLtWNTAMACERTIFlCATEOFCOHSEMTOSELF.INSL'HEFORWOHKERS S � COMPfNSAiION,�9PROV10ED8Y5EC7lON7raoOFTHE4BORCODE,FORTHEPERFOiWANCE W OF iHE WORK FON NMCN THIS VERMIT IS�SSUED. � 0 1 HAVE IJD WILL I.WMAN WdiKERS'COMVENSATION W SUMNCE.RS NEOUINED BY SECTION � i7o00FMLUBORO00E,FORTMEiERFOFVAANCEOFTiEWOFKFORWNICH7Hi5FEiW1715 t$SUEp.W Wp OENSATION INSUw/�cc�,�RRiER ANU POLICY NIIAlDER ARE: CONSTRUGTION � GRPoER � �I M � /- GCe`�I� PLAN REVIEW � roucrt�uuaca —� ELECT ',l7 0 QH65ECi1drN[mN0T8@a1.RETIDOFTEPERMTBPoHWEIAf�F1ED001L�1iSR•oc10RlE�} BNI G T.": h �''-w a:�i 1J' Z ICERTIiYTH�iNiMEFERFOiWnNCEOFhIErioRKFOAYAiip17HI5PERMiTI5I55UE0,1 MECHANICAL () SNN.LNOTEMPLOYANVVE0.50NINANYMM'NERSOASTOBECONESU&1ECTTOiME � YIORKERSCOMoENSATI0NUW50FCALIFORNI,�ANO�GREETMATIF15110UlDBECOIAC INSP IONFEE S SUBJECTTOTN[WORKERS'CO�.�PENSA7qN PROVISIONS OF SECTON]70o OF TME LAeOP C�U �"�f1(1 � �E.ISNALLFO(tTMViNCd.�PLVWrtH SEVaO'NSqNS. �;��. S$UA �"� � n �`' ��_ `�a� �P��„M:��f�'�T � ., 1p OA7E: " .. . . � ENERGYPlC CI . il::....J.'�:.�)_ , � WAqN11W:FALURE TO SECURE KORKERS COMPENSA7qN COVERAGE iS UNUWFUL,ANO SHALL BE ,�i , � �. , , � SLBJECiM1EMPL01'EHTOCRIMPLLLPEWLLTIESANOCMLFWESUVTOONENUNOREDTf0U5AND EN[RGYPERMIT;U �������''L�:.i.=_. � DOLURS ltt 00,000),N/DOIT70N TO THE COST OF CDlJPENSATION.DARUGES AS VROVNEU FOR IN J SEGT�ON770lOF1HELABORCODE,HTEflEST,ANDATTORNEY'SFEES. - RETENTIONFEE: Q a CONSTRUCTION LENDINGAGENCY PRE•ALT FEE: � INERCBYAFFIRAIUNDERiENALTYDF�ERRIRVTHATTHEREISACONSTPUCTION�ENDINaAGENCY ' � Z fOF 7HE PERFOMVNCE OF THE wOFiK FOR WnKN 7Mi5 YE W.�IT IS ISSUED�SEC.7ov7,dV.C.). W � LENDEH'S NAYE C LENDER'S1IDDRE55 /� ��.y W I CERTIFY TMAT 1 F/R/E READ THIS MPLICA710N IlNO STATE TMAT iHE ABOVE NFORlAAT1011 i5 COMECL TOTAL F EES CLJ+� � ,Ol p., IACREETOCddPLYWITMALLCrt`IMACOUNTYOROW�NCES�NDSTATEUWSNEUTiN�TOBUIlDINO � CONSTRUCTqN.MIDHEREBYAUTIOAREREPqESEHTATfVE50FTHI5COUNi'/TOENTERUPONTHE Z ABOVEa^1EM10NEDPROVERTYFORINSPECTIONWNPO5E5. COMMENTS � � � ` � • � m iEflY N WNT) Q � � y B w�7VRE PERMIT7EE D iE � R[CPT.NO. PAID BY ✓ VALIDATION WHITE-0opertment Copy,YELLOW—Finance Copy,PINK—Asaessar Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy , .. .. . . .. . .. .. . . , ., _ . ,.. . . , . . . , . . „ . . . . ,. . . � . . . . , ... . . . . . . , � � � � � � �� -=�- � � � � CITY �F DIAMOND;BAR , ., „., ,., ._•i\�,1 ,, , .��:, .�=.�,::1NSPECTIO�d RECORD �; : . �:::,�: : � " '�!►'.�-���������. 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