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HomeMy WebLinkAbout15785 (22) .; � CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNTfY dc DEVELOPMENT SERVICES 21660 E.Caplcy Lhive 5uite 190 (909)860-3193 Fax(909)B61-3117 PRESS `*"� BUII.DING PERMIT APPLICATION FlRMLY a� JOBSITE � �. APPLICATION � — �1*1�PERM(T ���/C ADDRESS DATE U NUMBER � 155UE � + � TYPE OCC APN�_ OT TRACT DATE CONST. GROUP � OWNER O ADD SS ZONING SETBACKS B CITY ZIP TEL. - REART � ❑ APPLICANT TEL. SIDElSIDE STREET RW O CONTRACTOR SIDE ❑ g ADD SS � CITY ZI TEL. � PROPOSED USE � ARCWENG/ g DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. rn DESCRIPTION SQ.F7: FACTOR PSF ADJ.AREANALUATION Q OWNER•BUILDER DECLARATION SFFVADD/REM O NEREBY AiRqM tNiDER PEN�ILTY OF PERIURY TWR t IW EXEAIDT FIiOM TVIE CONTMCTOqS U- Gaf9gB/CBf�Ort COJS WFORTNEFOLLOWINOREABON(SEC.7o97.6BUSINE35ANOPROFESSqNSCODE:l1NYCITYOR (n OOUNTY 11EOUIRE9APEM1R7C)OON6Ti1UCiA�TEqp.IPqOVE,OEMOLISH,ORRFPAIHANYSTRl1C•. W patb/Dadc � TURE,� ITB tlSSUANCE,hL50 REOUIRES lNE APPLICANT FOR OUCH PERMiT TO FILE A SKiNm STATEMENT ME OR SIiE 19 LICENSED PURSUANT 70 TXE PROV1510N5 OF iHE CONTRACTORS tF CENSE LAW •(COMMENCINO WITN SECTION 7000j OF DIVISION]OF 7HE BUSINESS ANO PRO- � P��SpB FESSqN5W0E)OR 7lEORSHEISEXEMPT7NEREFROA,IMlUTNEBASISFOHTHEILLLEQEDEXEMP• (' TpN.ANYNOLATpNOF 7091.6BYANYMPLICANTFOAAVERMRBUBJECTS7HEMPLICMfTTO Z Re•Raof � ACML PENAL7Y OF NOT TIAN FNE HUN�RE��WlARS(t5m)): OLA.aNJEROF7ME RTY,ORMYEMPLOYEESWITNWAOESA6THEIRSOLECOMPENSA710N, COrt1111BfCIBI WILL DO 7}g YVORK,AND h1E URE IS NOT INTEND6�OR OFFERED FOR BALE(SEC.70u,BU51-' O NE59 AND PROFFSSIONS CODE:THE RACTORS LICENSE UW OOES NOT MPLY TO AN OWNER OF ? � �ROPEFRYYhqBUTASOR1YPipVEB EON,ANDMA1000E99UG1MIORKMIMSELFORXERSELFOR � TMROUOM YNS OR MEFi OMM EMPIDYEES,P VIDED 7HAT SUCN IMPROVEMENTSARE NOi WTENOED OR m OFFEAmwR&Y-EIF110WEVER7NE IMGNOVEMENTIBSOLDWITMNpJEYEAROFCUMFLE- TION,TNE OIMiER�BUNDER MIILL MAVE TNE BU N OF PAOW�Ki THAT HE Oq 8HE OW NOT BVIt�OR W PROVE FOR 111E VIIRPOSE OF 9ALE} OlABOWNEROFTHEPROPERTY,AAIE%CL CON7RACTN1fiWrtNLICENSFA00H�RAC70R3 � TD CONSTqUCf TME PiqJECT(BEC.tON,BUSINESS AN ROFESSIONS CODE:TME CONTMCTORS tl- YBIW�iOfl ADJ.AREA CENSE tAW DOES 1qTMPLV TOAN OWNEH OF APROPE BUIDS OR N1PFpVEB THEREON,AND WFIDCONilIAC18FORSUCfiPRQIECTSYVIINACONTMCTOR� SEDVUR6WWTT0IHECONTM6 QUANTITY DESCPoPTION FEE � 70R9 U�E tAW.� O IAM E%9/PT UNDER 6EC. B.i P.C.FOR TXIS HE�SaN Q U LL � OATE OMMER � � W UCENSED CONTRACTORS DECLARATION � � W 1 HEREBY AFFlRM UNDEq PENALTY OF PEINUiIY THAT I AM LICENSED UNOER PROVISION3 OF CHAPTER � �(OOMMENdIV�M/ITTI SECiION 7aao)OF OMSION 9 OFTFIE BUSINES&ANO PROFESSIIXJ5 COUE,AND Z � tlY LK�ENSE IS N FULL W C AND EFFECT. ��«� ��rz c,�.� � � � � ...rrY o���;�,n���vn�:q " � �' . LlILU?NG AND SAFE � WORKERS'COMPENSATION DECLARATION � � INEREBYAFFliU1 UNDER PENALTV OF PE0.IURV ONE OFh1E FOLLOWWO DECUIMTqNS: Z � �IiMVEANOri1LLMAP7TNNACERTIFlCATEOFCOpSEMTOBEIF•IN5UREFOfiWORKERS' a OOMP TqN.AS Pf10V10ED BY SECTION 5700 OF iNE UIBOR CODE,FOR THE 7ERFORMANCE W � �WORI(FOR YVIIICH TMIS PENMIT IS ISSUED. � I HAVE AND WILL AWNfAIN WORKEPS'COMPENSATION M6UFNNCE,AS REOUIREO BY BECTION }� Q a7ao OF iNE LABOR CODE,FOti TT1E PERPORMANCE OF THE WORK PoR WF1ICH TMIS PERMR IS C�I�/�' � U = ISSUED.MYWOi1KEq$0 PENSAT M`�N�1H CARHIERAN�POLICYNl1MBERARE: CONSTRUCTION � � �/ j cuiR�R ��`� PLANREYIEW �� �A � POL'ICYNUMBER t C �JSri�Y� ELECTRIC p (nasaEcrnrr�noree��oFnE�rsw�a+�r+unoncooala;sgiaoloq�ss} PLUMBING Z I CERTIFY h1AT IN THE PERFORMANCE OF TNE WORK FON WHip1 THIS PERr11T IS ISSUE0.1 MECHANICAL C�' SMALINOTEMPLOYANYVER50NN1ANYMANNERSOA5T08ECOMESUBJECTTOTHE (/� YYOFtlCEHS'COMPENSATIONIAWSOFCALIFONNIA,AN��OREETUTIFIBNOUL�BECOYE INSPECTIONFEE S BUBJECT TO THE WORI(ERS'OOGPENSATION GilOVI5lON40F SE ION 9700 OF 7HE LABOF coaE,�j l ��n+cour�rwi 7ePAowsaNs.�� ISSUANCE ` O � p��: ,�pp���• SMIP ���,/ !M(� �nnn _� WARNINO�FARUAE TO SECUNE WORKERS'COLIPENSATqN COVEMOE IS IINLAWFUL,AND SFULL BE ENERGY P/C � BUBJECTMJddPLOYERTOCRIMINALPENALTIESMI�CN1lFINESUPMONEHUNOREDTHIXI61WD ENERGYPERMIT �,DiAMUNDBAR � DOLLMS(i10o.000),IN ADDITION TO h1E COST OF CONPENSATION,OAMAOES AS PRONOE�FOR IN 7���f+�� 8EC710N27aOF7/7EUBofiCOOE,INTEREST.MVOATTORNEY'BFEE9. RETENTIONFEE: DING AND SAl'G1 I OCONSTRUCTION LENDING AGENCY PRE•ALT FEE: � IFIEflEBYAFFIRMUNOERPENALTYOFPERAIRYTHATTHEREISACONSTRl1CT10NLENDINOAOENCY FOR ME PERFOf WANCE OF 7HE WORK FOH YVHICH TFIIS VERMIT IS ISSUED�SEQ 9087,CIY.G�. � � LENUER'S W1ME F— lH�lOER'S1IDDRES9 � ICERTIFY?HATIHAVEREADTH�SAPPLICATIONM109TATET/IATTiE�BOVEWiORMATqNISCORRECL TOTAL FEES � � I M3REE M CAMVLY 1MTH ALL CfTI N!D COUNTY OROINANCES AND STATF UWS RELATINO TO BUILDING � CONSTRUCTIOfy AND NEREBV AUT1qfiQE REPRESENTA7IVE5 OF T7115 COl1Nh'TO FMEH UPON THE /1' Q=' E•MENTqN�P ERTYFORINSPECtIONYUHPOSES. COMMENTS yLP� ���� �� i U 9 r m PERM�TTEE NMIE(Gi�tT� , �, r---- /-5—� � ICi REOFPERMiTfEE CATE � RECPT.NO. 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