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HomeMy WebLinkAbout11290 (5) __._.._._.__ ._ .. ... __ --- -- --.._..--- .._.._.. . _._ ..-- - CITY OF DIAMOND BAR COMMUNfCY DEVELOPMENT DEPARTMENT -:..0 • 21660E.Copley DrivcSuitc!90 PRESS (909)86Q3195 Fax(909)861•3117 '�''� BUILDING PERMITAPPLICATION FIRMLY o ADDRESS i�Z I lJ/�'►��C.i1.0�� (/� � APPLICATION PERMIT //�� P/C DATE NUMBER� JI � ` � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP � �OWNER , ADDRESS ZONING SETBACKS � CITY ZIP TEL R�R RW . ❑ APPLICANT TEL. SIDE/SIDE STREET RW ❑ CONTRACTOR .� /7'lC^� SIDE ❑ ADDRES � PROPOSED USE �!�_ H -/� � CITY ZI rd TEL �` � ARCHlE G/ ` — � DESIGNER NO.DWEL NO. NO. ADDRESS UNITS STORIES 7/ BE�ROOMS.�_ � CITY 21P TEL � DESCRIPTION S�.FT. . FACTOR PSF ADJ.AREANALUATION N Q OWNER•Bl:ILOER OECLARATION SFWADD/REM � O p I HEREBv AiFlRM W�OER PENALTV OF PEMIRV TNAT 1 A/A E%EYPT FRdA TNE[DNTMCTOqS U• G918Q4�C8fpOR W GENSEUwFORiHEFOLL01aINC+REASONI5E4Ta71.6BU3NESSANDPilOFE55qN5CO0E:ANYd7YOR (n U COUNTYWMCHqE0URE5ADERURTOCONSTRUCT,ALTE0.MPR0VE.DEMOl15N.OHREPAIRANYSTNUC- �jJ PB��� � � TURE,PRIOR TO RS ISSUANCE,A150 REGUIRES THE APMIGNT FOR SUC/I PEfWR TO i1LE A S�GNED w STATEMENT TFUT NE OH SNE IS IICEN5E0 VURSUANT TO T11E PHOV510N5 OF TF�E CONTMCTORS ll• � CFNSE UW�CHAPTER 0(COMMENCINO VnTN SECTION 7000)OF OMSIDN]OF 7ME BUSINE55 FND iH0- ^ POOVSpB fE55qNS CODE)OR TW�7 HE OH SHE�5 E%EMPT THEAEfROM AND iME BASIS FOR TME ALLEOED fxE4P• TION.ANVVqLATIONOFSECT10N70�1.68YANYA7PLICANTFORAPERMiTSUBJECTS7MEMPlICANTTO z Re-Rool � A CML PENh�TIf pF NOT E10fiE THAN FNE HUNORED DOLURS(f50�1.1: � OI��WNEROFTMEVROPERTl.ORMYEMPLOYEESN7THWAGESASTHEiRSOLECOUPENSll710N. O COmfflBfClel N'ILL 00 iNE MIORK,AN�TNE STRUCiURE IS NOi INTEHOED OR OFFEAEO fOfi S�LE(SEC.7DN,BU51• J NE55 AND FROFESSIONS LOOE:THE CONTMCTOi15l10EN5E UW DO[S NOT AYVLY TO/JJ qVNER OF � ViqVEH7YW1pBUILD50RWVROVESTHEREON.MIDNMODOE55UCHN'ORKHIMSELFORHERSfLFOR a ' (= TMqOUGHMI50RMERONNEUPLOYEES,VRON�CDTHAT5UCJ11YPNOYEMEMSARENOTMEIAEDOR m . QOiFERE�L�SALEIF,110WEYE�tTNE�LD7ICORMPROVEA�EHT650l�WRHNONEYEAROFCpA0.E• Z TqN.TME OMMER�UILDER MnLL NAVE TME BUIiDEN OF VROVWO iw�T NE Ofl SHE DD NOT BU¢D Oi1 � N/PiqVEFORTIIEVUPVOSEOF81LLE1 O 4�ONMEfl OF THE PROPERT`�AM EXCLUSNELY CONTMCTNO WRN IICENSED CONTMCTORS Q TO CONSTRULT iHE PRQIECT(SEC.70�L Bu51NE55 AND PROFESSION3 CODE:7HE CONTRAG70R5 LI• V81U8[i0f1 ADJ.AREA ' � W CENSEIAWDOESNOTAOVLYTOANOWNEROFAVROPERTYYApBUL�90RWPi1�VE4THEREON.AND � MnqCONifUCTSFORSUp1PRO,7ECTSVATNA00NTMCTOR�S�LICENSEDVURSUANiTOTH[COHTMG ounrm�v DESCRIPTION FEE � � TOqSUCENSEUw} 0 O IMI IXEMPTUNDEH SEC. B.i P.C.FOR iHlS REASON � U � � u" DATE OVMER � � . W F UCENSED CONTRACTORS DECLARATtON w ', ' � , � (NEREBYAFFIRMUNDEAPENA�TVOfPER1URYTMAiIAMIICEN5E0UN0ERPROV1510NSOFCHAPTER .V . - (y 0(COYYENGwO NniH SECTION 7000)OF DMSION 7 OF TNE BUSINESSAND VROFESSiDNS CODE,AND z YY LICF,MjE j;J1 iUll FORCE ANO EFFECT. 0 LICENSE CUl S �~ V J , LIC.N0. �� �/ � . �j DATE • �' CONTMCTOR�/ �.A)L�LIA� � W . ,.J - � WORKERS'COMPENSATION DECLARATION U , �O T •�� N INERE FIRYUN�ERiENALT/OFPER1UMdJEOFTHEFOLLON�NODECUMTqNS: G �G� O �� N - Q � _IHAYE/JANnLL�NTAN1ACEfifIFICATEOFCONSENTTOSELFRISUREFOHWOfU(EflS' S � (� O ,Zb � CqAPEN3ATICN.ASOROVIDE08YSEC710N77DCOFTMELABOqO00E.FORTIIEVERFORWNCE W OF iHE YXNiN fDR MM111CH iW 5 PERAIIT IS ISSUEO. � C w _IHAYEANDVnLLMA1HTAWWOPofERS'CqAPEN5AT10NRI5UfiANCE,IlSRE0�1iNEDBY9ECT�ON Q �7DOOFiMEVeORCOOE.FORhiEGERiOiWANCEOFTHEWOFMFORNM17ICHTHISPERMRS A 65UED.W CE FENSATION 6UFW�CE ENM�'.IGOl�L1'NWBERME: CONSTAUCTION � CARRIER C � �:5��:5� PUW REVIEW ' � va�cr ER�J C�� ELECTRIC 0 (IfasSECTnNNE��q7BEoo6ptEIFDOFMaEaMtGiC(iU+EVtI�d�DOOLLARSRtaojORlFssl PL z ICEiRIFYTNATN1711EPERiON1ANCEOFiHENOfiKfORWH10/TMISVERM1i15i55UED.1 C-CHANICAL ('J SHALLHOTEUPLOYANYFER50NNANYMiWNERSOASTOBECOMESUBJECTTOTHE N NKIRNERS'COMPENSATIDNUW50FGlJFORNI^/WOAGRE TMATIFISIIOIIDBECOAIE E SVBJE TOTHEW'ORKERS'Cd�PEN oRpVISiONS EC710N77000FTHELA80N � Ocao swu� nr�nnrnco�r� in� sEr h ISSUANCE p DATE: L3 �pAVPUCA . SMIP W ENERGY P/C WARN11q:F11LUNETOSECUflEWOfYCERS'COMPENSA COVERACEISUNUWM.ANDSMALLBE (—y 6UBJEC?ANEMPLOYER70CRIYIWLLFENALTIESANDCMLFINESUPTOONEMUN�REDTMOUSANO ENERGYPERMIT Dq1AR5(t100,000).N ADOITION TO iME WST OF COM7ENSATqN,DAMACES AS GPdJIDED FOii IN � 6ECilON]7010F7NEl�BONO00E,M7ERE5T,MID�TTORNEY'SFEES. � RETEMIONFEE: a CONSTRUCTION LENDING AGENCY PRE•ALT FEE: O 0. 1 NEREBY AFFIRM UNOER VENALTY OF VE WUflY TIMT TMERE IS A CdNSTRUCTION IENOwO AOENCY z FOR TNE VEPFONYIVIC£OF iME WO(1K fOR W/lldl THIS PERMI715155UED ISEG 7�7.CIV.G.4 , W � LENOER'S WWE . . � lEN0ER5ADORE55 . . ' wICERTIFYTHATIIUVEREADTHISM%.ICAiIDNIWDSTAiETHATiNEABOVENFORMATIONISCORiIECT. TOTAL FEES t Q IACREETOCOMPLYN7TFIAl.LCRYANDCOUNTYORD�NANCESINDSTAiEUWSRELATWOTOBl1LDIN0 . CON57RUGT10N.AND MEREBYAUT110W 2E REiRESEMATIVES OF T45 COUNTY TO EMER UPON 1HE S� �BOVE.YE iONEO OROGERTY FOR IH57ERqN VURPOSES. , COMMENTS � �+ �.,v� _ m PE Nq Q � N � [n SqlN PE Tf D�TE � flECPi.N0. 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