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HomeMy WebLinkAbout13769 � . __._ -ti.____,___._..�_ . _...., ;......._.,..,�,,.:_ .s... _ -�______..._:_._._.�.�_.. ,..t.: _ . .----- ��� CITY OF DIAMOND BAR DEPARTMENT O�COMMUNTfY 8t DEVBLOPMENT SERVICES � , 21660 E.Copley Drive Suite 190 (909)8603195Fax(909)8b1-311T � PRESS `'^�'� BUII.DING PERMIT APPLICATION FIRMLY 4 DDRESS 1 �, �� �E�D�{c � �t--.� ��v >- APPLICATIO ,r PERMIT P/C o DATE NUMBER 1t $ ISSUE NPE pCC APN LOT TRACT pATE CONST. GROUP � OWNER �/�} A ADDRESS Zrt� Z e- �- ZONING SETBACKS CITY TJ I 'Y2S 21P TEL. FRONT RW ❑ APPUCANT �T� C I l�"t TEL. REAR p SIDE/SIDE STREET RW ❑ CONTRACTOR � F-t 1 0 .l Nt�_ SIDE p ADORESS�� �7C S��D� � w g CITY "b t f�S ZIP TEL l""1 . PROPOSED USE O f.(�n'3 I s � � L- m.-r ��rr �--�iii ARCFVENG/ —�— 1K[�t/ / �� ADD ESS N O.D W E L. N D. � NO. CITY ZIP TEL UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.ARE/WALUATION � OWNER•BUILDER DECLARATION SFR/AOD/REM p 1 HEREBV AFF1q1A UNDER PENALIV OF iEiWRY TFIAT I AAA E%EMM FRaM 71iE CON7MC7pR3 41• G8f6g8/CBfp011 (L CQISEIAWFOR7NEFOLIOWINGREA80N�SEC.7091.68VSINESSMIOPROFESSIONSCODE:ANYCIIYOR (f� OOUNiYMRiICHRE0URE5APERMRTO00fJSTqUCT,/1LTER,9APROYE.CEMOIISH,ORHEPAIRMIyRTAUC• 'W patio/Deck 7URE.PRIOR iD ITS 159UANGE,ALSO REOtJIRES THE 11PPL1CANi FOR SUCH PERMIT 70 FILE A fI4NE� � BTATEMENT T4tT ME OR 8XE IS UCENSED PURSUMfr 70 THE PFOYISIONS OF THE CONTFlACTOR6 LI• CENSE UW(CHAPTEN Y(CqAMENCINO WITH BECTqN 7000)OF�NISION 30F TNE BUSINESSANO Vlq- V"' POOVSpe FESSpNS000�OpTFihTHEOR9HE18EXEMPTTHEREFROMANOTHElASISFOFTMEALLEOE�6XEMP• (�f 710N.MIYVqLATpNOFSECT10N7D91.SBYANVAPPLICANTiORAPERAlIT6U91ECTSTMEADPLIGNTTO z R0-Fi001 - �� r AdVIL/ENALTYOFPDTMOfiETXANFNENUJDREDDOLLMS�{Ga0).)� � � OI,ASONMEROFTHEDROPERT;ORMYEMPLOVEESYNiNWA0E511S7HE1RSOLECOMPENSATION, COTIIIB�CIBI MALL DO iME WOi11(AND TNE 9TRUCNRE IS NOT INTEND6D OR OFFERED FOR 6ALE�6EG 7oM,BUSI- ,Q � NF55 ANC PROFE5810N5 COOE:THE CONTRACTORS LICEN9E LAW DOES NOT APFLY TO AN OWNER OF . � VIiOPERTY N1F10 WILD30i1 MIPROVES TfEREON,AHD NMO DOE9 BUCN MlORK FNMSEI.F Ofl MERSELF OR � iHi1OUGHHISORHENOWNBdPLOYEE9,►ROYIDmTHATSUGNIMPROVEMBffSARENOTIMTEIVDEDOR m OFFEiIED infl SALE.Ii,110M�EYER 71fE BUILDINOOR IMPROVEMENT IS SOLD WRNIN ONEYEAppf CC7MP{E- i10N,iNE OWNER�UILDER YYILL N11YE 711E OUHDEN OF YqOYINU THAT HE OR SHE DID IhJi 9lNLD OR IMPROVE FOti TFIE R1RP0.5E OF Sµ,E�. � O L�3 UN�NER OF THE PHOPERTY,JW E%CLUSIVEI.Y CONTR�CTINO WITH IICENSED CONTAACTORS � 10 O�N,STRUCT 7ME PROJECT(SEC.76N,BUSINESS M1D PROFESSIONS COUE.?HE CONTIIACTOfL:U- VelU9tlOn ADJ.AREA CENSE UW DDES NOTAPPLY TO Ml OMME9 OF APROPERTY WHO BUIlDS OR 14�VpOVE9 TMEREqV,AND wHom,rtancTsransucHoawEcrswirH�oartiucroa�s>��coasBoauaswwrror�carrruc- pUANTITY DESCRIPTION FEE � roas uc�cE uw.�. ❑t Mi E%EMPT UNDEfl 8EC. B.�P.C.FOR TFIIS REASON U � � DATE OWNER _' U ����[[[ IICEN5E0 CONTFiACTORS DECIARATION W � I NEREBV AFFlRAt IM�ER PENALTV OF PERIURY 1HAT IAM LICFNSEO UNDER PROV1510NS OF CHAPTEN � Y(001AMENCpMa WITH BECTION 7000)OF DIVISIDN J OF T1E BUSINESS ANO PROFESSIONS CO�E,AND � � MY L10EN8E 16 Nl RILL PoRCE AND EFFECT. m 0 LICENSE CLASS ( r J 1 LIC.I�b.^_f 9 3 fl / v � � o�'rE �? �,-S Z� � � corarancToa� I�� f'—'] a t WORKERS'COMPENSATION DECLARATION � yI MEREBYAFFIRM UNDER iENALTY OF PERIURY qiE CF THE FOLIOWING�ECLIIRATIONS: Z � _tHAVEANDSMLLMAMTAINACERTIfICATEOFCONSENTTOBELFdNSUREFORWORKERS' _ COGPENSATION.AS PROVIOEO 6V SECTION 3700[iF THE LABOq CaOE,FOR TNE VERFOquANCE W � OF THE WOqK FOq NhiICH TMS PENAIIT IS 755UED. � �t MAYE AN6 YiILL MWNTAIN WORKEHS'COM7ENSATIO�i INSURANCE,Il5 HEQUIREO 9V SECTION � Q 97o00FTXEUIBORWOE,GOR7HEP'cRWRMANCEOFThIEWORKWqWHtdiTNISPERMITIS I CONSTRl1C71ON � � ISSUED.MV WORNERS'O(O'MPENSATION IN9URANCE CARR�ER AND POLICY NUMeER ARE� rj CARRIER ,/TfAT� �i.(./�l 1� pLAN qEVIEW `Q POLICV INMBER ��}c�'1 a"��„ 9._._ — e�ECTR�c < , � Q1iBSFCIIONNE�N0IBCCAA�PLF�FDOFTI#PERNTI6fORONEM1CYiEDDOl1PFS(5�W)ORLESSF PLUMBING Z I CEr7TIFYIHAT INTI{E PERFORMANCE OF THE WDRK FOR WNICN THIS PERA1171515SUED.1 MECHANICAL (� 6HALl NOT EMpLOY ANY PEHSON W ANY AAANNER SO/LS TO BEODME SlJ&IECT TO THE (q MIOIiKERS'COM�ENSATIONLAN50FGLLIFORNIA.ANDAGREETHATIi1SHOUlDBECOAAE INSPECTIONFEE SUBJECT TO THE WORKERS'COAIPENSATION OROVISIONS OF SECTION e�OD OF hIE LA6bR -f'j COOE,I SHAL�FORfHWITH COMPLY WITH THOSE PROV15KNVS. ISSUANCE (. p DATE:�� APPLICANT. � r►. 1 •� SMIP ���� � ENERGY P!C WMNING:F1IRURE TO SECURE WORNERS'f:OMPENSATIdJ COVERAGE IS UNUVlFUL,ANO SNALLBE S SU6IECTANEMPLOVEfiTOCRIMPIAL7ENALTIESANDCI4ILFINESUPTODNEHUNDqEDTNOUSAND ENERGYPERMIT DOLLARS(5100,000),M ADOITqN TO THE COST OF COMPENSATqN,OAMAGES A6 PRON�ED FOR IN (1 � BEC71ON970sOFT1ELABORCOOE,INTERE57,ANDAT70RNEYSFEES. RETENTIONFEE: ��I� q �� e��� w `r..T_�'„—e-..��! c� CONSTRUCTION LENDING AGENCY PRE•ALT FEE: � 1 HEREBV AFFIRIA UNOER VENALTY OF PERJURY TNA7 THERE IS ACONSTRUC710N 1.6NDING AOENCY ' � � ' t�a '� .'7-J x�E'��'+- FORTHE GERFORMANCE OF 151E WORN FOR WHICH 7HIS PENMIT IS ISSUEO(SEC.70B1,QV.C.). � ' �. ' . . � , .' 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