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HomeMy WebLinkAbout11041 (5) i�' - C1TY OF DIAMOND BAR COMMUNTfY DEVELOPMENT DEPARTMENT <,. 21660 E.Copley Drive Suite 190 � PRESS (909)860-3195 Fau(909)86I•3117 �''^''� B UILDING PERMIT APPLICATION FIR M LY � JOBSffE APPLICATIO -� PERMR I � P/C , o ADDRESS -_ 2532 OAK KNOLT, DKIV-" DATE NUMBEq r� � APN LOT_�4 TRACT 47851 ISSUE TYPE OCC DATE CONST. GROUP p OWNER DT_Ar10ND BAR AST PARTN .RS � "" ADDRESS ZONING SETHACKS � CI7Y Torrance ZIP TEL.3 - - 9 FRONT Rw ❑ APPUCANT Kicha d Gould TEL. G�m�p abov REAR ❑ � SIDE/SI�E STREET > RW ❑ a� CONTRACTOR T. ..C_ F.ntPrt�ri���� 3nr_ SIDE ❑ � ADDRESS ;:ir•�P a� nwnar ��^ , �,y�, . � CITY ZIP TEL PROPOSED USE :VP_F' . ,_'� .P �.�y -'e;- �F� e o AFiCFVENG/ • • . � DESIGNER R_ l:rni l rl �. ��.�.p.0�gt•e g NO.DWEL �• NO. ,. NO. ADDflESS ^•d:�te c^ aw�e� UNITS 1 STORIES ��'� BEDROOMS 5 � CITIf ZIP TEL. � DESCRIPTION SO.FT. FACTOR PSF A J. REANALUATION � � OWNER•B�ILDER pECU1AATION SFFUADD/REM 1 � O . 0 I HEREBY AiFIR1I WOER VENAL7Y OF VERAIRV TINT I AA1 E%EMFT FROM THE COHTMCTORS L4 G8f8pBKiBfpOR W CENSEUWFORiHEFOLLOwwdREA50N(SEG70.71.6BUSMESS+wDPHOfESS10NSCODE:ANVCRYOR (n � COl,F1TYMMICHPEOUIRESAVERIAITTOCONSTRUCiKTERMPROVE.DEAlOLISH.ORREPNflANYSifHlC• �1 1 . 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B.l P.G FOq iM15 REASON Q �� �• 3 c� .. . � u" DATE OKNER V �Q UCENSED COPITRACTORS DECLARATION W [L IMEREBYAFFIflYUNOERPENALTYpFiEit1URYTNTIAMLICFNSEDUNDEHVNOV1310HSOFCNAFTER Vr . . p„ ��COMMENCNO VYITN SEC110N 7000�OF OIVIS�ON]Oi TME BUSINESSANO FHOFESSIONS COOE,MID Z , ,� �L MY IILENSE IS N FULL FORCE NID EFFECT. m � uc�secuss �s uc.►+o. ?23670 � �- V DATE CONTMCTOR .i_C_C_ �.'1''_' � W � WORKERS'COMPENSATION DECLARATION � = U N IHERFBYAFFlPAIUNDEHVEHALTYOfDE0.R1RYONEOFTMEFOLLOWiNODE0.�NAT�ONS: N Q � �iHAVEANDMIILLLUNTNNAGERTIFICAiEOFCONSENfT06ELF-INSUREFORVVOiL(fR5 S COMPENSATION,AS VRO�nDED BY SECTION 770o OF 7NE UeOR COOE,FOR THE PERFORYANCE �U OF TME WORK fqi YVIIICII THiS PEflMii IS ISSVEO. � C - Qv IHAVEANDWILLMAMNNWORNERS'OdAPEN5AT10NINSURANCE.A5RE0UREDBVSECiION // }+/�( O ]70o OF iNE LABOR COOE FON ME PERFORMANCE OF iHE WORK fORYVHICM TMS PENMR IS �� �u � ISSUED.W Y/ORKERS'COAIFENSATqN INSUiWJCE GARR�EN M1D POLIGY NUMBER ARE: CONSTRUCTION � r� 1 • � GhRRiER Rs�'fn�-m� Cn--np:i�^+-;nn PLANREVIEW � � POLICYNWBEH [�T9��;1��5�iLG ELECTRIC 0 (T16sEcnONrE�tareEmr.FtFtIDaFnevEra.�rsi�aoN[MroriEooalNLSpirolantFssl PLUM8ING �/� �. Z ICERiIFYTHA7WTHE0EAfOR/lM10EOFTMEWORKFORWNiC11TMI5VERUITISBSUED.I MECHANICAL ` �./D� � C7 5+44L HOT EMPLOYANY VERSON N ANY MMINEH SO AS TO BECOME SU&IECi TO TnE N WORNERSCW.�PENSAiqNU�OFCALIFOiUJIAANOAGRfETMATICISIqlA08ECOME �INSPECTIONFEE S SUBJECTTOTMEWORKERS'COMVEMSATIONifiOVI5qN50F5EGT10N]7ooOFT11E1/BOR COOE,I S'W1 FORTIM/iTH GOMPLY NnT1 THDSE PROVISIONS. 1SSUNJCE � � SMIP DATE: APPLICANT: �W WAIWIHO:FAIUIRGTOSEp1REWORKERS'GdIVENSAT10NCOVENA�EISUMAWF7IL.�N0511ALL8E 'ENERGYP/C � SUBJECTANEM7LOYERTOCRIMMAL/ENN.TIESANOCMLFINESUPTOONEIUNOFEDTqUSANO ENERGYPEFMIT DOUM,,(it W,00o),NADqT10N TO TME COS70F CqA0EN5�710N.DAAIAGES�5 VROVIDED FON W �J /�/] ¢ SECTIDN]70!OF THE LJIBOH COOE,NTEREST,AND ATTORNEY'$FFES ' RETENTION FEE: � /�O• L' `� � CONSTRUCTION LEN�ING AGENCY PRE-ALT FEE: � IMER[BYAPFIRYUHUERPEN/LTYOFOE0.IUMTIUTTHENEISACONSTRUCTIONLENONOACENCY iOq TNE FERFORMANCE OF iME WORI(FOR NMIC117NIS YERMIT IS ISSUEO(SEG 70Y7.CIV.G.� � LENDfR'SNAME � � IENDER'SADORE54 �I � ICERTIFYiIUTINAYFREADi11tSAPPLIGTIONANOSTATETUTTHEABOV[WFONWTqN13[OMECL TOTAL FEES , •�� � IAGREEiOCOMPLYWIMALIGIIYANDCIX1NttORDPlANCESANOSTATEU�NEUTPI6TOBUILDING V � CONS7RUCT10N,/1CHEREBY�UfIqiIIiEREDFE5EN7ATNE50FT1U5COUMYTOENfERUVON7NE ABOVE�4EMIONED PNOPERTY FOH W SPECTqN 7URiOSES. 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