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HomeMy WebLinkAbout10313 . . ._._.� . .. . . _-_�. ...-.'-'--- o �r---�----�: :.-' .--'-. -'. ..'.- -'�- '- '--�-.-' . ..- - -�- C1TY OF DIAMOND BAR �� � COMMUNITY DEVELOPMENT DEPARTMENT :,•d 21660 E.Copley Drive Suite 190 . PRESS (909)860-3195 Fax(909)861-3117 ' ^"^", BUILDINGPERMITAPPLICATION FIRMLY oy JOBSITE ,�{'�,.��^� ���� -.T?_+��a�v APPLICATIO PERMff J� 1 p/C ADDRESS.Q�w "' �� DATE NUMBER V� k � APN LOTT_ TRACT � ISSUE TYPE OCC � / � � DATE CONST. GROUP p aWNER - ADDRESS u� �� L 20NING SETBACKS Z CITY NO ZIP�17X!�TEL R�p RW p� g APPLICANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR L��LC�'!�G I� SIDE ❑ � ADDRESS PROPOSED USE U� � CITY ZIP TEL o ARCH/ENG/ �, � � � � DESIGNER NO.DWEL _. NO. , NO.� a ADDRESS UNITS STORIES ' BEDROOMS � CI1V ZIP ' TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BI:�LDER DECLARATION SFR/ADD/REM O • p I HfNEBY AFFIRM UHDER PENALTY Of PEMXiV THAT I AM E%EMPT fR01A THE CONTMMORS L4 GBfaqB/CBfpOft W LENSEUWFORTMEFOLLOWIN�RE/�SONlSEG70.7I.6BUSINESSAND7ROFESSi0N5000E:M('/GITYOR (n U COIMTYWMpfRE0URE5AFERMRTOCd75TRUCT.ALTERMPROVE.OE�70115N.ORREpVPAM/STRUG `W P8ti0lDBtk �V7ImE.VW Wi TO RS ISSUIWCE.AL50 REWIRES ME�vVIICANi FON SUCM iERMIT TO F0.E�SiGNED STATE4EM THAi NE Oq SNE IS UCENSED PURSUAHT TO THE PRONSIONS OF THE CONTqACTOpS lF � CENSEUN�(UUV7ERYfIXMIMENCN6M7TM5ECTqN7000�OFDIV45qN]OFTMEBUSINESSAlWVRO� n POOVSpB iE55lON5C00EI��THEORSHEISE%EMP77MEREF1104AIATNEBASISFOfiiHEALlEOEDEXENV• v � TION..WYVIOLATIONOFSECT�ON7071.6BYANVA7VLICANiFORAPERAUTSIJBlECTSTXEMPII['�111TT0 Z Re-Rool �,,,� A CML VEw1LTY OF HOT YORE T1UN iNE 1M1INOAED 001UR51{500),): � OlA50WNEAOF7HEPiiOPER7V.ORYYEMPLOVEE51M7MWAGE5A5THE�RSOLECOYPEKSATION, 0 L`p�pmBfCl81 MALL DO iNE MlONK AND THE STRl/CTURE IS NOT INTENOED OR OfFERED fOR SALE(SEG 70r�,0U51- J Hf55 AND iAOFESSIONS COOE:T1E CONTRAROiiS LICENSE Uw OOES NOT�PP�V TO Ml OWNER OF � ViqPERTYNMOBU0.DSORMPROyESTMEREON,IWDN?p00E55UCf1wORKNINSELFOHNERSEIFOq � ' � THROUCHN150RHEROVN1fMPLOYEES,VPONDEDTIIATSUCHYADROVEMEMSARENOTWTE�DEDOR m 0 OfFEREDFORSALEIF,/10YhYERTMEBV4DwGOHMVROYEMEMI550lDWIT1aNONEYEANOFOOMPLE• Z T10N,THE OwNER�BUILDER MnLLlUVE iHE BURDEN OF PROV4q THAi 11E OR SNE OD MOT BUttD OR = MVROVE FOq THE PURPOSE�F 9ALEl � O 4 A`+��ER OF THE PROPEFrtV.AM EXC�USIVELY COHTMCTNa WITM L�CENSFD CONTRACTORS � To CONSTRUCf TNE VRO.IELT(SEG 7Wl BU51NES5 ANO PfqFE5510NS CODE:7NE CONTRACTOPS U• VeluYllOfl AQI.AREA W CENSEUWDOESNOTMPLVTOANONNE110FAPROPERTVM'FqBUM1D90HIMPRpVEST�EREOH,AHD � NM1IOCONTMCfSFOR5UC11VNWECf4NA7HA00NTMCiOR(5)LICENSEOVURSUIINTTOiMECONTMG pUANTITY DESCRIPTION FEE � TOfiSLICEHSEUW} � OI�E%EM7TUNDEHSEC. & P.C.FOiliN13PEASON � 3 � . � � o�re ^ � ovmea � V . • . • Fa UCENSED CONTRACTORS DECLARA N W 2 IMEREBYAFFIRMUNOERPENALttOfVEfWRYiMAT1ANUCENSEDUNDEHPRON510NSOFCHAP7ER Vr _ � p. �(COA�MENdH0IMT11 SEC710N)Ooo)OF DMSION]OF TNE BUSINESS M/D PROFESSiONS CODE.AND Z X YY LICENSE IS N MLFORCEAN�EFFECT. m LLl � LICENSE CLASS UC.NO. j V DATE CONTRACTOR � W _ � WORKEFS'COMPENSATION OECLMATION Q � IHEREBVAiFlRMUNOERVENALTVOFVE0.RIMONEOFTHEFOILOWINC�EMfU7K1N5: Z Q � _111AHEANDWRl1aAMlTAINACERTIFICATEOFCCYlSENTT06ElFaNSUR6FORWON(fR5 = T COMVEHSATqN,AgpROV10EDBVSEC710N]7ooOFTMELABORC00E.FORTHEPERFORYANCE U Q OF TME WORK FOit WHCH 1M13 PFMIIT IS ISSUED. � � �IW.VEINDVNLLIAA4fTA1NWOiiKERSCOMVENSATIDNMSURANCE,ASPEOUIREDBYSECTqN . /t�/ � ]700 OF TME UBOR LOOE FOR TME PERFORMMlGE OF iME WOHK FON MR11df THS iERMR IS � L 3�� � ISSUEO.W NWIKERS'COMPENSATION MSUiLWCE GRRIER AND POLILY IM.�BEA�E CONSTRUCTION O�• � dRNER PLANREVIEW _3l,T`�`� . � vacY Nu►�eER ELECTRIC 0 �sEcrnrar�rqteEati.pterIDofnfven,�refrnaEHrd�nOat�sR�aqattrss} PLUMBING Z ICERTIFYTHATWTHEVENFOHMANCEOFTHEWOFKFOIiYMIQ1iHI5VEPo.11T1565VED.l MECHANICAL MA,�� �OOQ C7 SHALL NOi EMPLOY ANY VERSON N ANC MANHER 50 AS TO BECOME SUBIECT TO T1E " � WORKERSCOAIVFHSAiONLAW50fCALFORNIA�AOREE7MATIFISIqULDBECOME INSPECTIONFEE ' S SUBJEGT TO TME NqHKERS'COMPENSATION VROVISbN90F SECT10N]70a OF iHE LABOR � cao�,i sww.conTirvnn�eaav�r win�rNosE naowsa�s. ISSUANCE � $MIP �. p pATE: APPLICANT: � ENERGY P/C ' WAPNINfI FAILURE TO SEd111E WDRNERS'COMPENSATION COYERAGE IS IMANlFUL.AND SMALL BE � LU&1ECfANEMP�OYERTOCii1AINALVENALTIESANDCMLFWESUPTOONEMUNDREDT/1WSAND ENERGYPEqM1T DOILA/i5(f�0o.000�MlADDITbN TO TME COSTOF COMPENSATION,DFIMGES AS PHOVDED FOR IN � SECTION 770�OF TNE UBOR COOE,INTERES7/NOATTORNEY'9 iEES RETENTION FEE: n"'�. CONSTRUCTION LEND�NG AGENCY ppE-ALT FEE " "' � IHEREBYAFFIRYUNDERPENALTYOFPERM1IRYTNATTHERE�SAOONS7RUMIONLENDINO�CENC/ fpi T11E iERFORMNICE OF 71�E WORK FOR NMIG1 T115 PEfMUT IS ISSUED(SEG 7oa7,dV.G). •� � IENOERS W1ME , /� M� � IENDEN'S�DDRESS .I /I%�„ ^�, 7 W ICERTIFYiHATINAYEREAUTM1511PPLICJITqNM93T11TE7TNTTNEABOVENFOHMATqNISCORRECL TOTAL FEES � �• � 1 AOREE TO COYPLY WiTN ALL GTY ANO CWNTV ONDiNN10E5/ND 6TATE UwS HEU71N0 TO BULAINU �} CONSTRUCTION,/UO NEREBY AUT/qR11E HEPRESEN7AilYES OF THIS COIM�Y TO ENTER UPON iME ABOVE�MEMiiG1ED PROPERTY iOH INSVECTION PVRPOSES. 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