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HomeMy WebLinkAbout14232 (19) . .� _ ._..._--� ---..._._.... . .. -- � _ . .. _ . - -- � CITY OF DIAMOND BAR � ' �^ -- �� � �-DEPARTMENT OF COMI�[UNITY&DEVELOPMENT SERVICES / 21660 E.Coplcy Drive Suiu 190 � � � � (909)860-3195 Fax(909)861-3117�j � ,. ;.;� . PRE$S � � 'TM', BUII.DING PERMIT A�PLICA'fION . " • ' FIRMLY Q ADDR SS- �I O Z� ��(,ty�L C�� l. APPLICATION f /L PERMfTI' 1 3 r P/C p DATE NUMBER � •�` if � APN LOT 3� TRA T �7 7� ISSUE TYPE � - OCC DATE � � CONST. GROUP � OWNER S �R r�Ll "' ADDRESS ✓ l 'I 1 / ZONING SETBACKS ' � CITY L � IP � -I�TEL FRONT, ', ' • RW ❑ APPLICANT TEL . �"' REAR ❑ � SIDE/SIDE STAEET _ RW ❑ CONTRACTOR��� cF7�LJN�� SIDE ❑ ADDRESS S�e," � CffY ZIP TEL PROPOSEO USE__ ' LR"N �� � ARCH/ENG/ • .. .... . DESIGNER Pi��I� �1�?O/lL� NO.DWEL. .NO. NO. � CITY E S ZIP TEL UNITS STORIES BEDROOMS tq - �n DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION � , OWNER•BUIIDER�ECLARATION SFR/ADDlREM �D O Z Q I NER�1/AFFIRM LND[fl VENKT/OF YEKAIRY iW1T I M1 E%EMPT iR01A THE CONTMCTORS ll- GereQB/GWpETf 1 � .] liJ CEHSELAWFORTHEfOILOWINOREASON(SEC.70.71.68USWESSMIDPROFESSIONSCOOE:ANYCITYOR (n ' 52 COIMTYMTM]1REOUIRESAVFAMRTOCON57AUCT.ALTERIMPROVE.DEMOLISH,ORREPAIRANYSTfiUC• w � � , ��y� � Z TL1RE.iR10R TO R4 ISSU�HCE.IL50 REWIRES TNE�PVLICANT FOR SUCH VERUR TO FlLE A SIGNCD -� �L 9TA7EMEM T}UT HE OR SME IS LKENSED PURSUNfT TO 7HE PRONSIONS OF iME CONTMCTORS LI- W . � � CENSEUW(pU0TEq0(COMM[NqNOVATHSECilON7000)OFDINSION]OFTHEBUSINESSFNDPqO- � PooVSpa � ' � � - FESSqNS CDDE)OR THAT ME OR SHE IS E%EUPi THEREFROIA M!D 7NE BASIS FOq T7E I�LLEOED E%EMP• TqN.Mf/VIOL/iT10NOF5ECT10N70.71.6BYANYAVPUCJUfiiD11�PEHMITSUBJECTSTXEAPPLICM7T70 Z Re-Roo1 ��' �,,,_ A CMC YENALTY OF NOT MOFiE TH/V!FNE HUNDRED DOLURS(f500�.}. � 04ASOWNEROFTHEVPOPERTY.OREIYEMGIOYEESNATHWAGESASTHEIHSOLECOMPENSAT�DN, � Cpmmertial - W�LL DO THE WOi1K AND iHE STRUCTURE IS NOT RlTFNDEO OR OFFERED FOR SALE(SEG 7oII,BU51• J ` ,� NE53 NIO VROFESSqNS COOE THE CON7MCfONS LICENSE UW DOES NOil1PPLv TO AN OWNER OF � P�.�_ ..�3 . , .,, VROPENT'/1N108UM1DSORMPROVESTMER[ON,NIDMM11000ESSUp/WORKWMSELFORHERSELFOR ' - � THROUGHMSORNEROYn1EMFLOYEES,iROYIDED7W�T3UGIMVROYEMEMS�RENOTMENDE00fi m QOFFEREDFORSAIEIF,NOWEYER711EBU�DWOOFiN1PROVEMENTISSOIDWfTHR10NLYEMOFCDMRE• ' 1;��' ! Z 'TqN,iME OWHER�BUIIDER VALL HAYE THE BURDEN OF FqOVINO TNAT NE Oq SHE DID NOT BNID Ofi , M7�FORTHE PURGOSE OF SALEL � W l��'NNEROFTIEOROPEHiY.AAIEI(CLUSNELYODffiAACiPqWrtHLICENSE�CDNTMCTOR3 [L � 1HUCTTNE iR0.1ECT(SEG 70N.BUSII:E44 AND GRO�ES510N5 CDDE:iHE CONTMCTOP9ll- VLIUBSIOKKI i � ADJ.AREA LL1 CFNSEUWDOESNOTAPPLYTDANONNEROFAPHOPERTYMMOBUILDSOREIPRDVESTNEREON,MlD � W1qCOMMCTSFORSUp1GRQ1ECi9N77HACONiMCTOR(S�UCENSEDPURSUNlTTOTNECONiMG OUANTITY DESCRIPTION, - Y tau uceNSE uw.l• • . }'. FEE � O I MI EXEMPT UNDER SEC. B.i P,Q FOR THIS PEASON Q , �•�� [ � • U LL' DATE ZX� OWNER ^ ¢ . � � - . , � LICENSED CONTRACTORS DECLARATION w � � � INEREBYAFFIRIIUIOERPENAI.TYOfPER1URYTHATIAMLICENSEDUNO[RPROVISiONSOFCIU➢TER rV .� , ' � -• �: '�, s ��0011uENClbWITHSECTION70o0)OFONiSqN]OfTNE&151NESSANDGROFESS�IXJSCOOE,AND Z X WLICENSEISNFULLFORCEAN FFFEC7. _' � LLl /�[� /n � LICENSE CU^S � UC.NO.�P T V/ � � _. ^t� DATE _ v CONTRACTOH • � d . Si , � WORKERS'COMPENSATION DECLARATtON ;-. ,_,- -••- , Q ,, .., , _ c � • . \ yINEREBYAFFlRMUN�ERPEN�LTYOfPERM1JNYONEDFTHEfOLLOWPIGDECLAMT10N5: Z � �INAVE/NDNAIIMANTAg1ACERTIi1CATFOFCONSEN7TO5ELF-INSUREFORWORKERS' = t � COMPENSATqN,J19 7ROVIDED BV SECTION�7000F T1E LABOR COOE,FOR iHE PERFOiiMNICE U OFTMEVYORKFORYVHIGITM15PERMtTi5155UED. � � •� � � �I XAVE AND WILL WIMUN WORKERS'OOA�PENSA710N INSURANCE,AS REWIRED BY SECTIDN i7o00F7HEU00RCODE,FORTHEPERWRMANCEOFTHEWOPofFORWHidiTHISPERMITIS I��S �� � ISSUED.MYNORNER50pAPENSATpNWSURANCECMAIERIWDPOIICYNUMBERME: CONSTflUCTION ^� f� ! 1 � CARRIER Ci��� PLAN REVIEIN ��� I�Y�� � vouc7�n�eEp �' � 3 ELECTRIC !SO�OU o �+ssEcm�rEmrate[oa.�rr[oaFn��n.r.sror�or��u�[noouu�sg+aolontessl P�Ul�1BING �5�t� Z 1 CERTIFYTHAT NTME PERfOM1ANCE OF 7HE WORK FDR WHICH TH6 CEfU.11T IS ISSUED.1 MECHANICAL I�I�Z� C,�} SMALLNOTEIA7LOYANYPE0.50NINANYYANNENSOAS70BECOMESUBJELTTOTHE � WORKERSWuvEN5AT10NUw50FCALIFORNU�ANOAGREETNATIFISN�UIDBECOAIE �NSPECTIONFEE S SUBJECTTO THE N10R1(ERS'COMPENSATION PRON510NS OF SECTION]700 0F ME 1A80q 000e i sw�u oarnwm�corav�r wm+n+ose vrw�nsia+s. , ISSUANCE Z�l�O � OAiE:�APPLICANT:�1��� r, �SMIP �w � ENERGY P/C ' •WARNIN�: AILURE OSEIXJREWOIL(ER9'COMPENSATIONCOVERAGEISUhLAWFUL SMALLBE SU&IECT 1W EMP�OYEH TO CRIAIINILL PENALTIES AND CMl FNES UP TO ONE MJNDRED THWSAND � 00.UR5(ilao.oa0j.N110DITIONTO7M[COSTOFCOMPEN511710N,OAMAGES�SPROYIOEDFORIN ENERGYPEFiM1T _ I9 7� •¢ SECTION�70EOfTHELABORC00E.NTEREST,ANDATfORNE`/'SFEES. � RETENTIONFEE: �t W oW.. 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