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HomeMy WebLinkAbout15973 (22) -- . . _ ` f� C[TY OF DIAMOND BAR - i DEPARTMENT OF COMMUMTY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 (909)860-3195 Faz(909)861-3117 PRE$$ ��ti�'� BUII.DING PERMIT APPLICATION FI RMLY � JOBSITE Q � APPLICATION n � J�/� PERMfT /C o ADDRESS � '��`n� �'�- r • DATE L � ��/' NUMBER x • � ISSUE TYPE OCC APN LOT TRACT DATE � � D CONST. GROUP � OWNER a '� LL ADDRESS C (l� r 20NING SETBACKS w CI71f ZIP TEL��I�'��fSti FRONT RW ❑ � APPUCANT ' Mu��n TEL. l n-�SC-K73� SIDEJSIDE STREEf RW ❑ � CONTRACTOR SIDE ❑ g ADDRESS PROP.OSED USE CfTY = ZIP G 1�,[1�. TEL. Q'- 7 Y � ARCFUENG/ j� ' _ � DESIGNER ,r�C � �� NO.DWEL NO. NO. ADDR SS � � UNITS STORIES BEDROOMS N CI7Y � ZIP�Z TEL.-I�Y �r30-1v11. y �ESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECIARATION SFR/ADDIFiEM O p I HEiIEBY AFflfiA UN�EN PENALTY OF PERR1qY TMAT I MI EI(EM7T Ff10M THE CO"lTMCTORS U• GB�ege/CO�pOR lll CENSEUWFORTHEfOLLOWMI0RF�ISON�5EC.7mt.68U5wE55ANDVROfESSION5CO0E:ANVdTYOR (n SJ OOUNiYWN10/HE0U11iE5APERAIRTOODNSTf1UCT,ALTERMPROVE,DE�OI.ISH.ORREVNRANVSTAUC� W PaUo/Deck - Z TUi1E.PiWR TO RS ISSUANCE.ALSO REOUIRES TNE APPLICMIT FOR SUCM VERMIT TO flLE A 51GNED �i� 6TATEMEM T11AT NE OR SIiE t5 LJCENSED WRSUMfT TD iHE Pfi0YI510N5 OF THE CANTMCTORS lb W � CENSEUW�WMTER/�COMMENCWOWI7HSECT70N7000�OFDIV13qN70FTHEBU51NE55ANDPFO• u" POOUSpe iES5qN5 CODE)OA TW1T NE Ofi SNE IS E%EMPT 7HEREFROAI Ml�THE Bti515 FOR TH[ALLEGED E%EA1P• TION.l1N'IVIOlAT10NOFSECTqN7071.6BYANYAPPIN',ANTFOR�PEHMiTSUB1ECT5TNEAPPLILANTTO Z qg•ROOI � A CML iENAL7Y OF H�T MORE TNAN FIVE HUN�RED DOLLA0.S(i5af).Y � 04��WNEROFTFIiPROOERTV.ORA1VfMVLOYEESWITHWACESA5TME1q50LECOAIPFNSATION, 0 (`,pmfilOfClel � 1MLL 00 THE WWtK,AND THE STRUCTURE IS NOT IHTENDED OR OFFERED FOR SA:E(SEG 70u.BUSI� J N NE55 AHO Gi10FE55qN5 COCE:Tl7[CONTRACTORS 4CENSE LAW OOES NOT AOVLY TO AN OWNEN OF ? PROPERTY N?q BU0.D3 OR MPROVES iHERE01(MIO MfMO DOES SUC11 YVORKHIMSELF OR MERSELF OR �� iHROUGHM90FiHEROMMEA1PlOYEES,VR0V9EDTNATSUdIWPROVEYENTSAAENOTMENOEDOF m lL OFFEAEDiOR5ALE6,NOWEVERTfEBULDIN00fiMDROVEMEMI550lDWITIqNONEYEAROFCqAPLE � TtlN,T11E OwNERbUILDER WILL IUVE TNE BURDEN OF PROVw6 T1uT ME OR 6ME DIO NOT BURD OR � 61PiqVE FON TME VURPOSE OF SPLE} W OI�+�NNEROFTHEPROPEHiY,M1EXCLUSNELYCONIMCTNGWRHLICENSEDCONTtUCTORS ['C TO CONSTRUCi TME►R61EGT(9EG 70H.BU9INESS IWD FROFESSIONS CCDE:THE WNTMC70H5 LI• �ldIUBIiIXI_ ADJ.AHEA �1J CENSEUIWDOE9NOTMPLYTO/WOWNEROFAYROOERTYWFIDBULDSORIMPROVESMEREON.ANO , Z YFqCDNfMCT9F011511CHPRO,IECfSVnTHACONTMCTOR(5)L�CENSEDPURSUIWTTOTHECONTMG OUANTITY DESCRIPTION FEE � Tp15 LICEM.^.E UW I. O I AM IXEMPT UfAER SEC. B.i D.C.GOR TMIS REA50N � ' 3 � � � DA7E ONNER V � LICENSED CONTRACTORS DECV+RATION � � W �I HEREBYAFFIRIA WDER PENALTY OF VERIUAV THAT I IW LICENSED UNDER DROV1510NS OF CMAPTEF Vr � f(COMMENCNOWIT115ECTIONTooD70FOIN5lON90FiNEBUSMESSAN�PROFE55qN5CO0E,M9 Z X W LIGENSE IS IN FULL FORCE AND EFFECL m /'� 1 I � LICEN"ECUSS� LIC.NO. � � L 7 �j wh � corrrrUcron �� �� a � WORKEflS'COMPENSATIONDECLAFATION + a _, , = U � 1 HER[6YAfF.lUJ UNDER PENALTV OF VERNRY ONEOF iHE fOLLOLri40 DECUMTIONS: � ' -� N Q � � � � _I/NVEANDMaIIIMNTNNAGERTIFICATEOFCONSEMTOSELFiNSUREFORKOFKERS' 2 � ' -- " � �� ' ' �- � ' -� � �— CpMPETI$ATION,/SPHOYIO[OBYSECTION71000FTMELABORCOOE,FOfiTMEPENFOMIANCE W OFTNE WORK FOR WHipi TMIS CERIAIT SISSUED. � � �I HAVE AND V/iLL WAMTACI YKMNERS'COMPENSATION INSUMNCE,AS REOViRED BY SECTION � 77aoOF1HEU�BORCOOE.FOR7MEVERFOfUW10EOFTHEWOPKFORrvMiCHTH15PERMITIS I ��� _ � 65UEO.W/y-ro RKEHS'COMPENSATIONI UMNCEGRRIE ANDPOIICYNUAIBERME: CONSTRUCTION '� � uawEa`"�� � � W PUW REVIEW � 1 � iOLICYNUABEN ������ ELECTRIC � � �1 0 �nassccio+ra[mr+rneEm.s�rmoFnfr�rs�or+et►+u��oouuis�s+ao�ar+�ss� PLUM6ING �� �5V • Z 1 CERTIFY hu7 M THE PEAFOfIMANCE OF TME WORK FON WHiCH iM15 PERu1T IS ISSUED,1 MECHANICAL � (�' SH�LLNO7EMPLOYANYVERSONINMrvYA1:NERSOASTOBECOMESU0JEC7iOTNE � V/ORKER�COMVENSATqNUw50FCAL�FORNIAN+DAOREE7MATIFISHOULDBECOME INSPECT�ONFEE S SU&lECTTDTFIEIMOR7cER5'COMPENSAT70NiROY15�0.N50FSECT�ON]�ooOFTNEIABOR , eoo,i s romxMn+wr.�v�r��11��TT ose vHowsa�s. ISSUataCE ��:n+ (1 Cl 7� � � �SMIP �- ---.+iT+ ` r��• p DATE: a- � APPLICAI���-��.� � ENERGY P/C D1A WARNINO:FAWI7ET SEGIIREYARKFRS'COMPENSATIONCOVEMGEISUNUWFU�ANOSMILLLBE � SUBJECTANEAIPLOYERTOCiiIN:NALVENAlTiESANDCMLflNESUPT00NEM1NDREDi1K7USAND EM1ERGYPERMIT �1J�nrNG AND OOLLA0.5(tt00.0o0).M111DDITION TO THE COST OF CAMOENSATION.DAAIAGES AS PROVIDEO FOR PI � SECTION]7oeOF111ELABORCODE.INTERGST,AND�7TORNEYSFEEi pE7E�lONFEE: O CONSTFUCTION LENDING AGENGY pRE•ALT FEE: — z � INfRLBYICFIPUWJDERVENAL7YOFPE0.NRYTHA7THEREISACONSTRUCiIONLENOWO�CENCY ' � n- iOR T11E DERLORMANCE OF TNE WCKiK iOR VMICHTN�S 7EWAIT IS ISSUED(SEC.70G7,CN.G�. � � LENDEiK NMaE C LFNDERSAOOHE55 � ILEfl11FYTfUT11U1YEREADTiISAPPLIGTIONANDSTATE7MATT1EA80VEM�OR/AAT10NI5CORRECL TOTAL FEES ' J, 1 AGREE TO COMPLY NATi ALL CT'AND WUfTY OROINAHCES AND STATE UWS REUTM6 70 BULDINQ CONSiRUCTION.AND MEREBY AUi170RIZE REPRESENTATNES OF iHl3 COUFlTY TO EMER UFON iHE ,//'�J/�f � /�BOVE•WEN710NEDPflOPER7YFOAWSPECT10N7URPO5E5. 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