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HomeMy WebLinkAbout11360 �XPIRED � CITY OF DIAMOND BAR I I I � G COMMUNI'I'YllEVELOPMFNTDEPAR'1'MENT OCT Q � 1000 Ilf 21G60 E.Coplcy Drivc tiuite 190 PRE�� OU))860-3195 Fax(9D9)SCI-3117 �� •'��", I3UILUINGYERM["1'APPLiCATION FfRMLY ;Y: JOBSITE a/� �� � I - �� ECATION �,. NUMBI R n ��c"� #/C_._._ ;o ADDRESS_ OC �� I 1...� '�.4�. _ �.-y..��.}�_ _ m ISSUE � 8 �� TYPE OCC .-- APN_.__ L� T __ ��iA�CeT �,__.__ DATE _,_.....__.,., _.CONST. _, GROUP __ pOWNER � -� _y����-.r�j.-�-i � ---- ADDRE S ' 1 ' . C-c;_�<Q.�,J(F-t-- •#__� ZONING SETBACKS ------ - W . FRONT _ __ RW Cl_-_ —._ � CITY • ..�i'� __ Z.IP T L. - - REAR — �' APPLICANT __ �JL:" ✓' -. TEL. ` �� r� ,. z ��� _� ____. _- ----- SIDE/SIDESTREET___ __.__. 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FACTOR PSF ADJ.AREANALUATION � -- ��� OWNER-f3UII.DER DFCLARATION SFFUADD/RFM O — .p I HEREBY AFFIRM UN�EH VtNAL�Y Of PERJLIflY 1'11A1 I AN�EXEMPT FROM THE CONTRACTORS LI- G3fdAe�Cefp011 W CF.NSfLAW�OfiTHFFOI.I.OYJINGHEA50N(SEC.7J31.58USMESSANDPROFES510NSCCHJ[�AYYCIfYOH (� ._____._____ _ ZCOUNTYYdhI1GHRE�UIRESAP[flMITTt�CUi�Si!iUf,!,ALTI':R,INPFlOVE,DEMOV�FI,ONRE?AIRANYSTftJC- W Patio/Deck w TURE,PRIOR TO ITE ISSUANC[,AI.`O REOU�HES i11E APPLICANT FOR SL'CH PERMIT TO FILC A SIGNED � __ STATEN.GNI'THA'f HE UH SHE IS LICENSED PURSUANT TO THf PROVISI(AV.`i OF TI I(:CON'I'H�GTOHS LI� �� CENSE LAW�CHAPTER 9(COVMENCING WITH 5[(:TION�OnO)Of DIVISION 3 OF THE OUSINESSAND f'HO- V" P001/Sa2 __ O FF.SuIONSCOD[�UR'(FIATHEDHFf1EI5E%EMPTTHEREFROIAAN�THFBA315F0(1THEAI.LCCEDEXEN.P� � V TION.ANYVIOLATIONOFSECTION7C31.SBYANYAPPLIGANTI�ORAVEFiMITSU[3.IFCT3?H�APPLICANTTO Z Re-Heot _ _! _� � ACIVIL PENAL7Y OF NOT MOH!:THAN FNF.I-IIIYDREU UOLLARS(fGPJ),): --' O LJI,ASOWNEHOFTHEPROPERTV,ORA7V[MPIOY:�fSNlITIIWAGCSASTH[IfiSULEGO:7PENSAT�Y. � COR1�110fC12I Z WILL DO TY.E WORK,AND TH[SfRUCIUR!:IS NO'f INT[NUED OH OFFERED�OR SALE(SEC.7044,9USI� �) -_—_t. -. �_-.7 NL'SS ANf)P(iUFE5510N5 CODE:7'HE CONif.ACTORS LICENS[t AW f70C:ti NU T AI�VLY i0 A4ONMEP.OF � � PFOP[RTYYlHOBUIL�SORiMPROVESIHeiiI:ON,A1vDYhIO00E55ilCkIWOf7KhI1M,5ELFOR4iER5ELFUR m _ [[ THIIOUGHHIiDR11EHOWN[M7LOYEkS,VHOVIDE�7H�T5L'CHIMPROVEMENTSARFNOTINTENU[b041 � w UFFENFDFORSN_E.IF,HOWEVERTHEOUILOINGURIM!'!iUVEMENlI550Lf]WITHI�tiUNFYF.AROFCOMPLE� 0 TION.THe OYJNER�Bl11LDF.R WII.L h�AVk TFIF.[3UH�fN(1F PHOVINO'fllAi IIE OR SHE DID NOT BUILD Oft --"--- �' Z IMPROVL F"0t77Hf PUR�OSE OF SALE�. _ ^I,ASOWNEROFTHEPFOPERTY,AIdF.XCLUSNCI.VCONI'HAGTINGWI711LICCNSfUGO":TFiACTORS --'-'- - W � TO WNSTRUCT TNF f'ROJECT(5[C.]n4d,PUSINE55 ANO PROFESSIONS CODE:THE CON7RACTORS LI- V81U2�i0f1 _,.,,. ,___.. _, ADJ.AREA.____,,._ ' W CENSELAWDOfSNO7APPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROV[SItIF.HF.ON,ANU S WHOCONTRAGTSFORSUCHPROJ�f.TSWIT,HACONI'f?ACfOIi(S)LICF.:NSEUPUHSUMITTOTHECONTRAC- QUANTITY DE,iCRIPTION FEE ~ TOf15 LICFNS[IAW.). - � IIIAMCX�M7TUNf)ERSEC._._....... 8.8P.C.fORTHISREASON I Q � . ... .._.._ ' ___"-_ � ."'_ ..... ......._.-._.......... .'_-- W � DATE - "- " ----� --_'......._. OVVN[ii_____ -__........_._._- . � � LICCNSED CONTRACTORS DECLARATION -� _ � IHf:lt[BYAFFIRMUN��fiPfYAITYtifPf.FIJU%aYTI1A71MALICENSEDUA'DERPROVIS;ONSOFCHAPTFR � �. (L 9(COMMENCING VJITH SECTION%(100)O��IVI510N 3 0f TH[Bll.IN�SS PN[)Pfl(JFt551UNS G0�[,ANU z _ ' X MYLICENSFISINfUILFUfiCf-ANDEFFtCT. m /; ' W . . r (�.�l,. � '�.r {�+.,.� .�/� - '.+ ' � UCENSEC S ..�� LIC.NO. 0.� ° rl.G�l �I/Z1Z��71 l..Cit..J' ..-. - • .f ... -... � � . c� �j r. J i' U DATE_.�J.2� �-�_.._.__.._...___.___ CONTRACTOR � d �- —_ f __ W _ � WOHKERS'COMPENSAI'ION D[CLARATION � _ _ —� � i � � IfIEREBYAFFIRAIUN�ERPENAL7YOFPEHJURYONEOFTHEFOLLOW:NG�ECLARATIO:�S: - — J � __.. . IHAVEANDWILLMAINTAINACERTIFlCATEOFGONSENT705ELF�INSUREFORWORKf:ftS' � ¢ CON�PENSATIOV.ASPROVIDEDBVSECTION3/OOOFTHF.lA90RC0[1f.,fOR'fHLPEHFOF7MANCE __- .- ! ., OF THE WORK FOR WHICH THIS PERM171S ISSUED. � — ' '""__ _ F I HAVL AM7 WI:.L MAIN IAIh WORKERS'(:O.Y.PENSA710N�VSUI'IANCF-,A`1'I[OU:NED 13Y SfCTION � _'__ Q� 370UOF'!11[IARDHCOU[,fOftiHF.PFR�URMANCCOF'll{k:WORKI"0(1YlH�f:!1lIIISPERMITIS ISSU[�.IdY NfOHK F75'CO�)1 P[1JSATION INSURANCC:CARF:Itii ANU VOI.ICY til1M(3ERARE: C.ONSTRUCTION - _ ._ ... _ .. j cnrini�n �,6'-7 C .c.�f`Yl�� _ PLAN RL=VI[W --- -.....---. - �-_- � - ----._..... ' � ��sEcnauNf�Eouor���o Fn+�a��iswa�..... -..---- ELF.CTRIC _ ' Z - - �---- . .._ ..---........--- ----._..._....... . Q _... . ..�y. Q. =Hw�naeoaxiansl5»n)oni.rssl. PLUMBING ._..._.._....------- -...---...._----- � ./� w PdECHANICAL z I CEII7IFYTHAT INTHE f'ERFORMANC-CF THE WORK FOFl WHICHTHIS PfFtMI'f IS ISSUEU,l ..._._.._____ .... . _._._..__- -___._ (} SIIAI.I.NOTCMPLOVANVP[.�SONINANVMANkCliSOASIOfl[C0.19CS110J[CTTOTI!E � WO�KEFS'CONPENSATIONLAWuOFCALIFORNIA,AYDAGREETHATIFISHOL'LDBECOM[ �NSPECTIONFEL _,.. ......._.... � S110.1CCTT0 TIIE WOi1KEHS'CO!1.'�'CNSAf�V4 PROVISANS nf�FC710V 3]OOUF Tllc!MOR ISSUANC[ .......-----. ._. -......-.......__. -...----.-.— � CDUF,I SHALL FORTHWITH COMPLY Y�ITH THOS[f'ROVISIONS. � SMII' � �ATE... .. APPLICANT. . __"_" ........_._.._. ..__..._. _'____. ._'_ . Y'4 � . ..._..-..__ _ . . .. ....___._.._..._...... ._......_.._-_ � W ENERGY P!C . . . ' � J WAfiNING�fAII.Uf7f.TOS[CUN�WORKERS'COA7('[KSAfIONCOVFfiAGEISUNLAWFUL.ANDSHALLf7E ----' ------'--�- '- LL SUBJECTANEMPLOVERTOCRIMINALPENAltIESANDGIVILFINESUPTOONEHUNDflEDTHOUSAN� ENEfiGYPERMIT ___.. DOLLARS�E�o0.aa1).iNADDITIONTOTHECOSTOFCOUPENSATION,�AMAGESASPPOVIOf�f(JHIN ""-"' " -" '--""'" � SEC710Ni'�o6U�THC:LABORCODE,INTEREST.ANDATTORNEY'SFEES. FlETENTIONFEE: ____._.. _ .....__. . __ ._...___._.....'___ W CONSTRUCTION LFNDING AGENCY PRE-ALT FC-E: . _....����.'�. . d� -----..........------ � � IIiERE9YAFFIRMUNDERVC.NAl7YUfVLIiJU�1VTHA:"1'Iiflti�ISA(:(7NSTfiUGIIOYLEN�INGAGENCY � FORTHEPERFORM�NCEOFIHEYI()I;KFORYVIIIf:Iff1115PtHMITI5155UFD�5F.C900'l,CIV.C.). � �� � � ZW _-'_""_-___.... ... ... ......._......... .. ..._-__...._ -�- � LE'NUFR'S NAMG._-_"_'__" -._. __ .. ..__-"_'_"_'-__. . ...._ !- LENDEfl'SA�UI'tESS "�'-' "- -"'-"'-- '—" � WICERTIFYTIIATIIIMEfiF.PA)iI115APt'LICATIONANDSTATETIIATTHEADOVEIVFOR4f�TIONiscoa�rc-r.� TOTAL FEES � } r�� . � IAGREETO(X�.4IPLYWITHALLCITVAN�JCO:INTYORDINANC[SAA�.`3TATf1AWSfif:LAI1Nf.IOf1UILUING � � (:ONSTHUGTION,ANDlII:RC:HYAU7H0111%f.flt'.Pf1iSI:NTAl1VF50F�iiI5Cn1;NTYTOFNTERUPOY'THE A60VE�MENTIOYEO PROPEHfY fOR INSVECTION PU POSES. � (s GOMMENTS_ Z r __.._ .. .__. ... --- !- � i , : !� �/ ��� ._...---..._. . _..----.. ...._ .._._.-..--- - � �.1__�._G: --��_ _.__. ---.. . m P R ENAME(�RIYT1 .. . .._ .._.....__'._ . . ._.__._..... ... ¢ ,,.. � _ �3 r, ----- ... ._.: �- cn � ' 1..�/ - - „- _.. ..... ._.. . _. _. -- ---........ m ---.. _ _ � ' : - � SIG ATUREOf e fRMITTE • ATE: � Y��-G�.�.. 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