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HomeMy WebLinkAbout11388 (5) �xP���D � —/'T'""`�— CITY OP DIAMOND BAR � �~ I I COMMUN[TY DEVELOPMENT DEl'ARTMrNT p�T p 5 2000 II(` =..,w . 21660 Ei.Copley Drive Suite 190 PRESS � (909)8C0-3195 Fax(909)861-3117 � ,� "'':°"",� BUILDINGPERMITAPPLICATION ,, FIRMLY � � JOBSITE � r� '"7 � ��y��� \' APPLICATION PERMIT P/C o ADPRESS ��^�� r _�"" "y-"��7_�'� DATE `� � �� NUMBER���_ # � ` ISSUE TYPE OCC APN LOT TRACT _,. DATE CONST. GROUP � °C OWNE�C'�.�T, Clk��a1A � ------- �r ADDRES��i�1.�V�, ZONING SETBACKS i. � ---- -- � z cirv��r��. � ZIP`jC�- T�,�� FRDNT -�-- RW — �........_.� � APPLICANT TEL. REAR ,._____ �_:1 _ � Q SIDE/SIDE STREET--------- RW_.....----- ❑.----....._ `: dp`.�..�n -•-�-; SIDE _,__._,___._ L' ' Q CONTRACTOR r!�t-�.1�'Ci"`,�� "�A.���C�h7Y, __ _l.-- ! ADDRESS �?�����9?'�::t,'�'tLy�� � � CITY f����=.%t� ZIP E�-I�Z TEL`� ���.'jl PR�pOSED USE ,___ ' w ARCH/ENG/ ---- -�--------- < < `•: W DESIGNER - � i. NO.DWEL. NO. NO. n_ ADDRESS --------- UNITS STORIES BEDROOMS t' � CITY�---.--.�_ ZIP_.. TEL.---------- � - DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � i�. O OWNER-BCILDER DECLARATION SFR/ADD/REM ' i! p I HEREHY AFFIaM UNDER PENAITY OF PEFJURY THAT I AM EXEMPT FFOM THE CONTRACTORS LI- � Garage/Carpo�t ��' W CENSeLAWfUHffIcFOLI.OWINCH[�SOV�SEC.]o31.5AL1SINFSS0.NDPflOFESSIONSCODE:ANVCITYJR __ (' zI:Ol1N'lYWHICHRE�LiIflESAPERMITTOCONSTRL'CT,ALTEfl.IMPRGVE.DEM.OLISH.OflHEPNRNVYSTflUC- W PdfiO/O6CK �'' w TUHE,PRIOR TO ITe ISSUANCE,ALSO R[OUIl1[S THE AFf'LICANT FOR SUCH PERNIT TO FILE A SIGNED W __ _ _ _ �;_ STATEMENT TI IA'(IiE OH SHE IS LICENSEO PUFiSUANT TO THf.VIlOV1510Y5 Of 7 HE CONTRACTOFlS LI- �• � CENSE LAW(CHAPTER 9(COMMENCINO WITH SECTION 7000)OF OIVIS��N 3 OF THE�USWE55 ANU PHO- � PooUSpa {�; FESSIONSCO�F)OFlTFIAI'1{EOHSHf:ISEXEMPI'iIIEHEFR2UAN�TH[BASISfOFlTHF.ALLEG[DF%EMP- (� f�' � TION.ANYVIOLATIONOFSECTION7031.SOYANYAPPLICANT�ORAPERMITSURJ(:CTSI4!EA1'PUCANI'TO Z Re-Roaf j; � A CIVIL VENAITV(1F N��T IAOf7F THAN FNF HI1N[1fi[[]OOLLARS(5500).): — :; � L4ASOW4EfiOFTHEPHOPERTV.OHMYFMP!.OYfESWIIIIWACESMSTHFIIl50LEC0"AVE'NSATION, 0 Commercial 4, Z Wll.l.UO THG WQRK,AND THE STRUCil1RE IS NOT iNTEYDEO OR OFFEFED rOR SALe'(SEC.7J66,6U51� NESS AND PROFESSIONS GODE:1'I IE CON'R�CfURS I.ICCNSi:I.AW�U[S N()T APPL'/TO pN OW�Gii Of �. � PROP[RTYWHOBUILDSORIMPROVESTHEREON,AN�WHUUDESSUCHWOf7KHiM5�LfORHERS[L�OR � _ f � TIiHOUGHNI50FlHEFlOWNEMALOYEES,f�fiOVIC]EDTHATSUCHIMPFlOVEMENTSARENOTINTENDEDOR m C W OFFEREDFORSALE.IFHOWEVER,T11E6UILDINGORIMPROVE.MENTISSO:DWITHINONFVE'AHOFCOUPLE- S�' � TION.THE OWNER-RUII�Efl WILL HAVE TME BURDEN O:PftOV!NC TH�T HE OR 511E DID NOT BUILD OR ��� Z IMPROVEFORTHFPt1RV0.5FOF5ALF�. �` � �71,ASOWNEROFTHEPROPERTY,AMEXC�USIVELYCONTfiqCTINGWIfIILIGENSEUWNfHAG�OHS �' W (� f0 CONST�UCT THF:PROJECI'(SEC.%na4,A1151NfS5 AND PROFESSIONS COOE:THE CONTRACTORS LI- Vdlllatl0fl ADJ.AREA . ..._.__.______...,____.,.._ r� W CENSELAWDOESNDT�PPLYTOANONMf:ROFAPIIOP[FlTVWHOBUILDSORIMPflOVESTHEflEON,AND � WHOCONTt1ACTSFOflSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTH[CONTl7AC- QUANTIII' DESCRIPTION FEE '�� Y TORS UC[NSF LAW.1. I� � J �O O I AM�X[MP7'UNDER SEC.._.,...,.._..— B.&P.C.FOR THIS REASON U ,' � .___'.._.....'_—__._.. ............._" '_ � _ � � DAiE , OVlNER ' _"___..._._....__ ._..._....________— ——' U n Z W Q LICENSED CON7RACTORS DECLARATION W / r Lr IHEHEUVAFFIH41U4D[f1PfNALfvUfP[f7Jl1RYTHATIAMLICMSEDUNDERPROVI510Y50FC11AVTEH � � �/� ,�,�y,i�._a,.�.,�.p.. �� � 9(COMM[NCING WITH SECTION 7000)nF DIVIiION 30FTHf.BUSINtSSAND Pf10FE5SIONS CODE,AND Z vs'ea�y,+ X MY LICGNSF IS W LULL FOFiCC AND EFFECT. 4 � m ` � � LICENSE CLASS��� ,�._,_....._ LIC.NO. _��A��`�� �fi.,` � � VUAiE ����`�_.__ CON7HACTORi�YYf.LAY�CI-?•�+.� d w n � � WORKERS'COMPENSATION DECLARATION �^��' � ¢ � � \ U y � I HERLBV AFFlRM UNDER PENALTV OF PER.NRV ONF.O�THF fOLIOWING DECLARATIO4S: V Z � f.� JIHAVEANDWILIMAINTAINACEH�IFIChi[OFCANSfNTTOSELf-INSUREFORWORNER6' _ 'z COMPENSATION,ASPpOVIDEDBVSECIlON370oOF7NELAU0�7C0�[,fORTHEPERFORMANCE U t ¢ O�TH[WORK FOfl WHICH THIS PFHMIT IS ISSUED, � � O �W I HAVE AN�WILLlAAINTAIN WORKERS'GOMPFNSATIO.N INSUNANCE,AS fIF:Ol11pED 9Y SECTION Q 3700 OF 1'l1E LA60Ii GODf,FOR THE PERFORh1ANCE OF 1'h1E WOfiK fOH WNIGI I fFIIS PERMIT IS ISSUED.MYY,/�OFi�N�EFi�3'�CA,N�PEN�S TJIO�hINSUNANCEC�Ft�11ERANUPOLICYhUMB[(7ARG: CONSTflUCTION ______._._.._........___.._ Y j cnn�iEn ��l C�SU[`R'�� Kl�-`� _ `� PLANRFVIEW ....... ..................- t �+ 3 --- Z aoucvr+uMoer�...�.�� at7����1 .�(�v..---_---. �-- - ELECTRIC � t . ..�-- ......._..-............._.------._.....'--..-'........--------� � ¢ Q (iHi55ECTANNEEDNOTBEIXNdFLEiLUOFTHF:PFFIMfTISFORONFHUMJRFD0.YLAF5(5100)ORLES:). UMB�N� ____ � w I CGRTIFY THAT IN THE PERFORMANCE O�TH(WOHK�OR WHICH THIS P[flMI71S I55UED,1 MECHANICAL Z � Cj' ShWLLNti�[MPI.OYANYPERSONINANYMANNEHSOASTOg[COMLSUUJEC7"fOTHC. � WOFiK[RS'COMPENSATIONLAWSOFCALIfORNIA,AN�AGfiEETHATIFISHOULDBECOME INSPECTIONFEF �'�' j Sll[iJECT TO'f41E WDIiKEflS'COMPENSATION PROVI51(1NS UF SECT104 3]o00F THE LABOR � ¢ (:OIIE,I SIIALL F'URTHWRHCOMP�Y WITH THpSF PROVISIDNS. ISSUANCE > � O °",� 'o� .. t`�'�"� c--.,t� C. R p DATE: -S"'��J �... /aPPLICANT: • I�x�. ��"'A`'�^`d`�� ... SMIP w � ENERGY P/C � � �. . /p WARNINO:FAIWRETOSF.CUHFWORKEflS'COMPENSN710NCOVEHHGEISUNI.AWRIL,ANf1SHALLBE '�- -;�` ��-- -'-- � Sl19JECTANEMPLOYLRTOCRIMINALP[NALiI[aANOCIVILFINESUPTOONEHUNDREDTF10U5ANU ENERGYPERMIT ���� � �� �A�� UOLLAHS(E 100,OnD),IN AUDITION TO THE GOST Of(.'OUPI:NSATION,DAMAGES AS PROVIDED FOR IN —�-''--""-�-------"'-"------��- � SECTION3lO80F'f11ELA90RCODE,INTEHEST.ANUAIIORNFNSFCES. RETENTIONFEE: __._,_._ _.. _.... ...._..._.__......_ ..._.....-- ._. w CONSTRUCTION LGNUING AGENCY PRE-ALT FEE� � � 1HF.FlCFVAfFlflMUNDERPENnI.TVUfPERJURVTHATTHEREISAt:ONS1HUCTIONLL�.NDII:GAGCNCV $j. FOR THE PERFORMANCE O�7'Hc WORK FOR WHICH THIS PERMIT IS ISSU[�(SE(:,909],(AV.C.). � Ld.l � LENDER'SN�ME_..._—__._ —""—_.._._......."'__" -- — _ — _. _—...._... _... .....—._._..'___'__... __._._......_"_'—_'_'__'_ . � F— LENDFR'SADUHf:SS __..___._--...... — �— — � � ICERTIFYTHATIH�VERE�UiHISHPPLICATIONANDSTATETHAT'flItA30V[INFOHh1AI'IONISCOfifiFCT. TOTAL FEES „i w IAOREETOCOMVI.YWITHALLCITYANDCOUNTVOIIf)I.VANC,ESANOSTATELAWSREIATINGTOBUILDINC � CONSTRUCTION,A�f7HCHE�VAU(HOiIZEFEPRESENTATIVE50F11115COUNTVT01'.NTfIIUPc)NTHE z AE30VEMENTION[OPROPERTYFORIN&PLCI'IUNPIIR�USES. 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