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HomeMy WebLinkAbout16041 . _ , . � - �� CITY OF DIAMOND BAR i DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � '��_`'` 21660 E.Copley DriVe Suiu 190 ` � (909)660-3195 Faa(909)861-3117 . PA E$S �'M'� BUQ.DING PERMiT APPLICATION . FlRMLY o ADDRIESS'Z-�SZ2. /�/00�J Cl�KF DATECATION I���, NUMB R `�L N� �g ISSUE TYPE OCC �- APN LOT TRACT DATE CONST. GROUP p OWNER _ 14.�4/L.�UA�A �"►4GolASoN o ADDRESS 7��',�7 IYlt9c�ti1l.�4 kis ' ZONING SETBACKS � CITY ZIP.�f7ln� TEL.90`i-syl-3013 FRONT RW ❑ APPLICA TEL. REAR ❑ � _ SIDE/51DESTREET RW ❑ CONTRACTOR�e/iA.�« r�-ta//s�s Swc SIDE ❑ � ADDRESS 3 f-'`3 s'a.0 u� .c,r ✓F CITY�Q 1fE..uvor� ZIP r1 /? TEL S2Z- � �j"// PROPOSED USE � ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. ' ADDRESS UNffS STORIES BEDROOMS � CITY ZIP TEL � cn DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANAWATION Q OWNER•BUILDER DECURATION SFRfADD/REM O p I HEREBY AFFIR►1 UNDER CEIUITY OF VEMJRY THA71 AM E%F4PT FROM THE CONTMCTORS LI� G8f8gB/CB�On � CBI"EUWFOi1THEfOLLOWN�REASOH(SEC7o71.6BU5WE5SANOPROFES5lON5CO0E:/NVpTYOi1 ' (n OIXMTYMMIp1REGUIRESAFERMITTOCONSTiIUCi,ALTERMPROVE.DEMOLISH,ORREPNRAM/3TRUG W patia/Deck Tl1RE,VRqR TO RS ISSUANCE./�150 I1EIX/1RES TME APPLIGN(f FOR SUCM VERMIT TO flLE A SIGNED w � 5TA7EMENT 7HAT ME OR SHE IS UGENSED WHSUM7T TO THE PROVISIONS OF TME CONiMCTORS U• CENSEUW(CFW'TER0ICOYYENCNOWITHSECTION700C1�WNSqN70FTXEBUS�NESSANOPR0. � �PooVSDa � ' iESSqNSO00E)diTHATHEORSHEISE%EYPTIHEREFROYANOTHEBASISFORTNEALLEGEDE7(EYP• C7 TION.AHYVIOLATpNOFbECT10N70.71.68VANVAPPLIGMFOH�PER1A1T5U8JECT5THEAP7LICAN7T0 Z (�0-ROOI F A C1VIL iENALTY OF NOT MORE THAN FNE HUNDRED OOLURS(isoo�.y � OL�SOWWEROFhiEPNOVERT;ORA/YEMvIOYEESYATHWAGESASTHEIfl90LE00MPENSATqH, � �mmerelat - IMLL DO iHE WORK,AND THE STRUCTURE IS NOT IHTENDW Oq OFFERED FOR SALE(SEG 7M1,BU51• J y NESS N7�FRDFESSIONS GODE:THE COHifUCTOi15 UCENSE UW WE5 NOT MRY 70 AN OWNER OF � VROPERTY MAq BUlDS OR NAPiqVES THEREON.AND MNOOOES SUGI NO�iN HIM50.F OR HERSELF OR Q THROUGHW90RMENOMMEWLOYEES,VRDVIOEDTUTSUdIWPROVEAIENTSARENOTMENDE�OR m . � OFFEf1WFORSALEIF.NOWEVER7I�EBU1.DWaORM7ROVEMFMBSOIDWITNMONEYFAROFC04DLE- TION.7HE OWNER�BUILDER W1LL HAVE THE BURDEN OF PROVPq iHAT HE OR 6HE OID NOT BUIID OR � MPROVE FOR TNE PURPOSE OF SALER O l AS OWNER OFTME PROPEHTY,AM IXCLUSNELY WN7MGtNa WfTT1 tICENSED COHTMCTOR3 ¢ 70 CONSTHUf.'f 7ME PHOJECT�SEG 70tr.BUSINE53 AND PROFESSIONS CODE:TME CONTPAC70RS ll• V81UaS10� ADJ.AREA lll CEMSELAWDDESNOiAPPLYNANOWNEROFAVROPERT`lYN10BULDSORIMPROVESTHEREON.AND �Z. yyrq�pMp/�C{gFOp5UCJ/VRd1ECTSVATHACONTRACTOP(5)LICEHSEDPUFiSUM/TTOTHECONTMG pUANTITY OESCRIPTION FEE � TOfiSLICENSEIAW). O I MI EXEMPT UNDER SEG B.1 i.G iOR THIS REASON Q 3 � � � DATE OWNER U � UCENSED CONTRACTORS DECIAAATION w � ,- , � IXEREBYAFflPMUNDERPENALTYOFiERR1RYlHATIAMLICENSEDUNDERPROVISIONSOFCHAPTER Ur ... ' '-""�� �(COhMENCVq WITH SELTION T00o)OF�IVISION]OF THE BUSwE55/W0 VROFE55i0NS C00E,AND Z W IICENSE IS N FULL F017CE AND EFFECT. m � LICENSECUSS C3 � ��.No. � 9`r�Z' J � OATE�����,j COMMCTOR �-F7� a WORKERS'COMPENSATION DECLARATION � NIHEREBVPFFIPoAUNDERPENALTYOFPERIURYON[OFTHEFOLIONnNGDECUMT10N5: Z � _IHAVEM'DWILLMAMTAMACERTIFlCATEOFWNSENTTOSELF�NSUqEFORMR7PXER5' _ CDA/PENSATION,ASVROVIOEDBYSECTION71000iTMEUBORCOOE,FOflTNEGERFORIAANCE W OF 711E WORK FOR WHICH THIg DERM7T IS ISSUED. � � _I HAVE MO WILL MAINTAPI WORKERS'COMPENSATION INSUMNCE,AS REOUIRED BY SECf10N dQ �7ooOFhIElA80RCO0Ei0(iTHEPERFOPMANCEOFTHEWORKFORWHILH7HISPER1AlT15 � ISSUE0.YYNVMCERS'COYPENSATqN�NSUW�NCEGRAiERANOVOLICYNUM�ERARE: CONSTRUCTION � uwwen L�rH iiZE Cu PUWFIEVIEW � Fd.ICYNUMBER �1I�A1 O 1 V)v�� ELECTRIC � �nusEcnwnFtnwreear.s3t�IDocnfvEvursanaxMtrnmmtu��sioo�a�tFss) PLUMBING I/I[.t) GLJq�EO►�'f Z 1 GER71FY7NAi W T/E PEFFORMANGE OF THE WORK iORYMICN THIS PERMIT IS t55UED,1 MECHANICAL U� SHAtLNOTEMPLOYANYYER50NM111'lYM�NNERSOASTOBECOMESI.BJECTTOTNE , � WOPo(ENS'COMPENSATIONUWSOFCALIFORNIA,MAAOREE7HATIFISHOUIDBECOME INSPECTIONFEE S SU&IECTTOTHEWOPo:ERS'COMPENSATIONPROVISqNSOfSECTqN�7WOFTHELA80R 000E,is�uticonnwnn�couv�rvnn�nas rAo�saus. ISSUANCE �� � f�T� ��,__--- SM�P p DATE:__� / APPLICANT. � _-____ . W ENERGY P/C WMMN�_FAILURE TO SECURE WORKERS'[OMVENSATIDN COVERAGE IS UNUWFIA.ANO SHILL 8E � SUOJECTANEMVLOVERTOCAIMWALVENALTIESANDCMIiWESUDTOONEHUNOREDT�K%15AND ENERGYPERMIT N � � �OO� OOLURS(f 100,000),N ADDf110N TO THE COST OF COMPENSATION,DIUMOES AS VROVIDED FOR IN ¢ SECTION07oeOF7MElABORCOOE,lITEREST,ANDAT70RNEYSFEES. RETENTIONFEE: a CONSTRUCTION LENDING AGENCY pqE-ALT FEE: 1 1 O � IMEREBYAFFlqAIUrWERiENAITYOFPERNflYTHATTHEREISACONSTIiUCTIONIfNDWGACENCY Z fORTHE iERFOqMANCE OF T11E WORK FOR WHICH THIS iERMIT IS ISSUEO(SEC.]oil,CIV.CJ. . W � IENDERS NNAE � IENOER5A0�RE55 t� ¢ ICERTIFIT/NTIHIIVEREADTHISAPPLMJITIONANDSTATETUTTHEABOVEWFOPMATIONISCORRECT. TOTAL FEES � �, `D W IAGREET000IA�LYWfT/11�1lCRYlWDCOUNTYORDINANCESM1057A7EUW5REUTINOTOBU0.0�rxI V � CONSTRUC'iION.ANDHEREBYAUTHOHREREVRESENTAT1VE50FT1U5COUNiYtOEMERUPONiHE � ABOVE-YENTIDNEDVROVERTYGORwSPECfIONVURPOSES. COMMENTS _ $Cl�T�lG��� ¢ PERA1t !NAA�E iRYT) I I '/Z7 /D/ N lil � URE OF PERMITiEE OAT , � � RECPT.N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Fhence Copy.PINK-Asseua Copy.GOLDENROD�-File Copy.GREEN-ApplicanCa Copy a ... i . ' .. . � . '?�.�. '^'�r.r: ,.r , �'�'' . . ' � � � � . ��' . � , . . ... �... , . :s' .J'w^;. �.M',r�..•�' ....� •1..«.,�. , , . ,A. , -• • r�\ CITY OF DIAMOND.:BAR, ,,,,..7., , ,.... � � _..�.�; . . II�SPECTIOf�'RECORD ��. � ., .l..���:r ;� �� �,� '; r ) , . � .. � '<« _ ..'� ...r_ � . �',.z_ �'. _ , .`. �.�i � ^,. .��.,. � .. , • . �,,,..� r�: �s � ��F/y,, r�=I' F�"1+� yy o)■.a�y;• �a�► i1�1A�,7{=�1 �y✓,11 +l� r . + '�°+�kc � -r I � �`��`/c '� .�i����..I•.�'^�,������i�� �ry'�"1�S�:1',�• . J.I+��w.����J � y ,i�V.�h���i".�J��.�vna�c�.aa �l���n .�aa"�������J�� .a. !SET BACK �,� i � �.�I � � ,; � . 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FEES PAID _ _ _.. - - , - - _ .-- -.- ------j � ���=!•�i�'�,�PLUP�181N3 - - -Q - - - - ENERGY . . ; _.;_ � ---- -----.._.. --- - ---- - - _.. ... . ' ��--- � �_--- --- ----�-- --- --_ _ - - - - _. ..�""""�'-r-•--:i,-"� .r ' ' - '�i:�i.._^_�:.� -� - �_.. - .;?"' !-`-,� �.� � �'- . , .. � --• ' ' -- - -•...� _ .._- , . - - -- � -- - �- -.. . - - --- -- . _... _.r_._. . . . ...... � , ( - - - -- '�-�---- ---- ._. _ ..._ _.._ _. ' I CO(�Pdf�NiS _ � � , , \� i -- - - - -- � � � � � , � � � � � �� � ------- -__ __-- ---- -- - - - - , � - -------- — ----- -- . _ _ ; , ! - , ; � .. . . . _ � { �; , � ,. ; �. �... �, I --- -" '---- -�� -- -- " ---- - - .. . � , i - .. .. . . ,� .1: ` . � i �^� _l� , .. ..-� ). -.'��'l\.�:� ...\!. .. . , , i � ' ' . . . . . . , ,. , _ i _ ' _ " " ._'__ 1 I . "_'_____ _"" "_ '_ . __. _. .. . . . � . 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