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HomeMy WebLinkAbout10738 � � - CTTY OF DIAMOND BAR ' ' • �� COMMUNITY DEVELOPMENT DEPARTMENT .,.w 21660 E Coplcy Drive Suite 190 � PRESS �_..... (909)860-3195 Faz(909)861-3117 '�' BUILDING PERMIT APPLICATION FI RM LY y JOBSITE ,/ �, �/� �f APPUCATION �J PERMR P/C o ADDRESSO����i� E1G���� .�J�t,d�-f'J � DATE � / NUMBEf� N c� ISSUE TYPE OCC APN OT TRA�T DATE CONST. GROUP � � OWNER �/�- i i Jy� , � ADDR 5 ZONING SEiBACKS � . B CI �ZI TEL. REAR RW p g APPLICANT TE�• SIDE/SIDESTREET RW p' � CONTRACTOR �� 1 Inn SIDE ❑ ADDRESS PROPOSEDUSE t ��lil7Ll.J. o RCH/ENG/ AU, A 91789� TE �' � DESIGNER N0.DWEL NO. NO. n. ADDRESS UNITS STORIES - BEDROOMS � CITY 21P TEL c�i� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION , � . OWNER-BCILDEfl DECLARATION SFR/ADD/REM - ' 0 p I HEREBV AFi1WA UNDER VENILTY OF VERAIRV THAT 1 AA1 EXEYPT FNOY THE CONTMCTORS L4 Qareqe/Cerport � - - � W CENSEUWFORiHEidlOWRIONEEASON(SEC70.1i.6BU51NES5ANDPROFE551QVSO0DE:/WVGITYOR (n U ODUMYWHIpiREONRESAFEiUARTOCCNSTRUCT,ALTERIMPROVE.DEMOLISM.ORiiEWWiANYSTRUG W PBfIOIDBCk ' ' ' � TURE,PR10R TO ITS ISSUMlCE,AL50 REOUIRES T11E MVLICANT FOiI SUCF1 PERMIT TO FILE A SIONEG W STATEMENT TINT NE OR SHE IS LICENSED PURSUKfT TO TME iNOVISIONS OF ME CONiRAGfORS LF ' . � CENSE LAW I�PTER�(COMMENCWO WI7H SECTION 7000)OFDIVISqN]OF iHE BUSINESS AND PR6 u' POOVSpB ' � � � � � � FESSIONS CmE)Ofi THAT HE OR SHE IS EXEMPT iHEREiROAI ilNO THE BASIS FOH THE ILLEOEO D(EMP• TION.ANYVIOUTIONOFSECTION70�1.6BYANV�OVLK'.ANTFOqAGERYITSU6)ECTSTHEAiOIICANiTO Z qe.p�} � � ACMIPENALTV OF IqTMORE TH.W FNE HIX�DRED DOLURS(f50o�.g � 04��M�EROFTHEPROOERTV,ORMVEMPLOVEESMIITHWAOESASTHEIRSOIECOYPENSATICN, 0 CpmmBfClel � � YALL DO iHE N'ORK N1D THE STRUG'TURE IS NOT WTENDED Oq OFFENED FOR SALE(SEG 70W,BUSf J NESS AND VROFESSIDNS OOOE:TME CONTMCTORS LICENSE UW OOES NOTAVPLY TO AN OWNEN OF N iROVERiY1M�OBUIIDSOR41iROVESTHEREON.ANDIN�ODOE55UQ1WONKHIMSEIFDNHERSELFOH = ' � � � THROUCJIMISORHERO'MIEMPLOYEES,iROVIOEDTHAT5UC1fUAPROVEMENTSMENOTWTENDEDON m . . OFiEREO FOi14ALE IF,HONIFVE0.IME BIA.DN�OR MDiYJVEYEMISSOI�WITHIN ONE YFAROFOdAPLE• Z 71ON,T1E OWNER6UILDEH NALL NAVE THE BURDEN OF VROVINO T/UT ME OR S11E DD NOT BUILD Oil MPHOVE FOR THE PURPOSE OF SALE1 01,AS OWNEN OF TIE PROPEHTY,AM E%CLUSIYELY CONTMCTNO YATH LICENSED CONTMCTOR3 , Q TO CONSTHUCT TME PRQIECT(SEG.7oN,BUSINESS AND iROFES510N5 CODE TNE OOFlrRACT0R4 LF V81118I(Of1 ADJ.AREA " W CENSEUWDOESNOTAPP�YTOANOWNEROFAPROPERiYWHOBUTASORIMPROVEST/EREON,AH� � WIbCONTRACTSfORSUCH0110JECTSWITNACONTfUCTOR(S�UCENSEOPURSUMfTTOh1ECOHTRAG ou.wnrr DESCRIPTION FEE � TO(LS LICENSE UW.). Q O 1 AA1 pfEMPT UN�EiI SEG ' B.i P.G FOR THIS REA,.ON � � V u' DATE OVMER � � UCENSED CONTRACTOAS DECLARATION W IXEREBYAFfIRMUNDERPENAUYOFPEfWRYTHAilAA/LICEN;EOUNDERPROVI510NSOFCNMTEII � �CyCyT�(/ � � d Y(OO�wiENpNOWITHSECT10N700010F0(VISIONiOFiHE8U51NE45MIDPf10FES510NSGO0E,MID Z � W LICENSE S R!FULL FORCE/WD E�fECT. m _ ' ' , \., ' - .. . ' � I�CENSE SS , LIC.NO. j , �j UATE � CONTRACTOR � W . � WORKERS'COMPENSATION DECLARATION � � V � IHEREBVAFFIPMUNDEROENALTYOFPERIURYONEOfTHEFOLlO1NNfiDECLApATI0N5: Z �� � � _IMAVEANDWIILAIANTAAlACERTIFlCATEOiCONSEMTOSEIFaNSUHEFORWOfY(E(IS' � Cd/0EN5ATqN.ASVROVIDE0BY6EC770N17ooOFTMEIABORCODE,FORiHEPEHFORYANCE 'U OF THE WOR1C FOR N711d1 THIS PER41T IS ISSUFA. � G _I HAVE AND VALL MAINTAPI WOFKERS COMPENSA710N WSUMNCE,AS RE�UIRED BY SECTION Q �7a0 Oi THE II.BOR COOE,FOR THE PERFOHMANLE OF iHE WORK fOR WHICH THl4 iERMIi IS � ISSUED.MY WORKEFS COYPENSATIDN INSURANCE CARRIER AND POLICYNUABERARf: CONSTRUCTION � CARRIER PLAN REVIEW � ra�cYNu►�eER ELECTRIC (IwssECllONr�IDnqreEm.ilFiIDOPnEVEiIMi6waoNEH.�o(iEoOottu�Sp+oqoalEss} PLUMBING C� 8 1 GERTIFY TMAT N THE PERFORMANGE OF THE N'ORK FOR WHIp1 TT11S PEHMIT IS ISSUEO,I MECHANICAL ' CJ SHALLNOTEMPLOYANYVERSON NANYMANNERSOASTOBECOMESUBJECTTOTHE � WORlCERS'CO�IPENSATIOHUWSOFCALIFORNU�INDAQREETMATIFIS/IOUIOBEC011E INSPECTIONFEE � ' `- 6UBJECTTOTHEWORKERS'COMPENSATIONGRONSIONSOFSECTION77000FTHEtABOR ^ + '` � cooc,i s FonnNnn�eourtr win�nasc�v�/s�g�us./^ ISSUANCE pOATE:� aPPLICANT. (./AC.1'�X�i SMIP �1E r _ � WANIINO:F/UIURETO EQIREWORKERS'COMPENSATIONCOVERA6EISUNUWM.,ANOSHiW.BE ENERGYP/C 6U&IEGTANEMPLOYERTOCPMtNALiENALTIESIWDCMlfM1ESU7TOONEMUNDREDTHOUSAlA ENERGYPERMIT `E'. � OOlU1RS(f100,000�,NADD1T10NTOTNEC0.5TOFCOMPEN5AT10N,OMU�ESASPPOVIDEDFOfiIN - - - J SECTION�70lOFTHEIABOFiCODE,IMEREST,ANDATTORNEY9FEES. RETENTIONFEE: � � ^ O CONSTRUCTION LENDING AGENCY PRE•AlT FEE � IHEREBVAFFlIWUNDERFENALiYOFPEfWRYTHATTMEREISACON5T11UCT10NlENDINUAOENCY � Z FON THE VEHFORYANC£OF TNE WORK POR NApCH TIi15 iENMIT IS ISSUW(SEG]OW,pK G.} . W � lENOER'9 NM�E � � LEHDER'9�DORE55 � � ICERTIFVTMATIHAVEREADiH14AV7UG1T10NANOSTATETUTTHEABOVENFORMATIONISOORRECT. TOTAL FEES � p`�3 �Cl� � IAGRfETOCOMFLYWITNALLGTYANDCOUHTYORDWANCESANOSTA7EUWSREUTINQTOBUL�INf] ' � CONSTRUCTION,ANOHEREBVAUi/10RIZEREPRESENTATNESOFTHISCOUNTYTOEMERU00NTHE � - ABOVE�ENTIONEO GROiERTY FOR W 37E�TION RIRPOSE3. COMMENTS � J � m ' � iE1M1ITTEE NAYE(GRIM� , l/� . y SWNATUREOFPERWTTEE OA E � RECPT.NO. PAID BY VALIDA - WHITE—Department Copy.YELLOW—Finance Copy,P�NK—Aseessor Copy.GOLDENROD—fib Capy,GR EN—Applk.ant's Copy . i �tMw'n:S!a'ares�vd.•M.:H�., vw.n;�..,ryM;:a'�.r.�ev��� n.v'.'�;'sd. »+ � �.a� r.. !' �!'^tsn'�,rotrK . f:"R'+:�;�1'7s�,±•:;'�;�;��vwy°�, .J"��Te�:..�.M..,,,.�:',�.nt^_ -�., -:a7"',''fl;:��,,�,:�s�,y.,•�.^ .r��:�y•,..n1,,,3�.• . . • � - , cirv, or-�n�A�or���a�R ��,���:-���,1�� - . '`� , . ; � , •.� ; .�::�., ,,..,� .:-�- ::v�_�:'.f..i��;_lr�t,�c,:� ,: . - _ �:'_ .....'�; . .� IP�lSPECTIOP�D RE�QRD�;:,Y� ;,,, �",;;E; "`:.� _ .� ,,-:�:�'. , + .,,��i�:_��� �f.�,:� , ��;�; _:��t� `..� -�,. 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