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HomeMy WebLinkAbout10785 CITY OF DIAMOND BAR , COMMUNTfY DEVELOPMENT DEPARTMENT 21660 E.Copley D[ive Suite 190 c��esasi9s Fax c�>s6�-s�i� PRESS "°"'°� BUILDWGPERMITAPPLICATION FIRMLY o� JOBSITE Z 2�,�� �r,4�,L'�� � � APPLICATION �� /f PERMIT � p/C ADDRESS pATE NUMBER �F � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP � OWNER � M'� ADDRESS 2 Z `!.� ZpNING SETBACKS . CITY ZIP�r{�r TEL. a'P " FRONT Ryy � ❑ APPLICANT TE�• SIDE/SIDE STREET RW ❑ CONTRACTOR LlNI� - e�.6 /.It. SIDE ❑ ADDRESS � CITY w- • ZIP '�('� TE 2— PROPOSEDUSE N1��� �� � ARCH/ENG! p DESICaNER NO.DWEL. NO. • NO. = CDDRESS ZIP TEL UNITS STORIE& BE�ROOMS m rn DESCRIPTION S�.FT. FACTOR PSF ADJ.AfiEANALUATION p� OWNER-BL'ILDER DECIARATION SFRlApD/REM O p 1 HEREBY AFfqM UNDER PENALTY OF PEMIRV THAT I AU E%EAIPT FROM THE CON�MCTORS l4 4�1 CENSEUWFOR7MEFq10WM�(iREASON(SEC.70J1.6BUSMESSANOVROFESSION9COOE:ANYCrtYOR (n �8n0���� 5y7 COUNTVWHIOIREOUIRESAPERAAITiDCONS71iUCT,ALiE0.�N��E,DE/ADUSN,ORREMIpANVBTpUC- W P���� � TURE,VRqR TO RS tSSUANCE,ALSO IIEWIRE9 7HE APPLICANT FOR SUCII PERIAIT TO FILE A 61GNED W fTATEMENT THAT HE Oq 8NE 16 LICFNBEO PURSUANT TO THE PROY1510N5 OF THE OONTMCTOR9 L4 CENSE LAW(pUPTEIIO(COYYEHCWO MA7N 6ECTION 1000)OF�IV1910N�OF 1HE BUSINE53 JWD PRO � PaO�Sps FESSIDNSCOOE)OfITFUTNEOReHEISEXEMPTTHEREFROMANDTiElIISISFORiYIEAlLEOEOEXEMP• (� TqN.ANY V10LATqN OF$ECTION 7091,6 BY ANV MPLIGNT FOR 11 YERMIT SUB.IECTE TIE MPLR'dNT T0 p�p� d � A qVIL PENALTY OF NOT MDRE TMAN FIVE HUlI�R W DOLLARS(i60DIJ: o OI.ASOWNEROFTNEPROPERMOR4VEMPlOYEE8WITNWACE3A9TNEIRSOLECOMPENSATION, q��ptCl81 � NIILL DO THE WORK./iN0 TME STRUCTIIRE IS NOT INTENOED OR OFFEREO FOR SALE(EEC.70N,BUSI- � N NE38 AND CFWFESSIONS COOE:TME CONiRACTOqS UCENSE LAW DOES NOTMVIY TO JJV OWNER OF j VHOPER7V NM1iO BU WS OR IAIPROVE8INEREON,AND W110 DOEE 8Ud/WORKHIMSELF OR MERSELF OR � THAOUOIiH150RHEHOWNEMPLOYEE9,PqOVIDE0TNA78UCHMPHOVEMENT8MENOTMRENDEOOR m OFFERED PORSALE IF,HOWEYERIME 9UILDINOOq IIAPAOVEMEM IB SOLD WITIUN ONE YEAROf OOM%.E- TqN,iME OWNEfi�UILOER WILL/UVE TME BURDEN OF►ROVINO TNAT NE OR BHE DIO NOT 9UILD Oq = MAVROVE fOR TXE PURPOSE OF&LLE). � ❑I,AS OWNER OF TME PROPEHTV.AM E%CLU8IVELYCONTRACTINQ WITN LICENSED OONTRACTORS TO CONSTRUCT 7HE PRQIECT(SEG 70H,BUSINESS AND PAOFE8310N3 OODE:TNE CONiMCTORS U- V814i11011 /��J,/�� CENSE UW DOES NOTAGPLY M AN OIMJER OF APiiOCER7Y NAiO BUND9 ON IMPROVE9 TMENEON,ANp � WHOCONTMCT9PDRSUCF10qpJEC}gyWTMACONtRACiOR(5)LICENSEDPURSVMIfTOTHECONfMF pUANTIIY DESCRIPT1pN � TORS LICENSE U1W.�. FEE � ❑1 MI EXEAtPi UNDER SEC. B.�P.G FOR TYNB REFSpJ � � � � DATE OWNER U LICENSE�CONTRACTORS DECURATION W � IHEREBYAfFlRMUNDEHPENALTVOFPE0.RIRVTHATIAMIICENSEOUNOERPROVI9qN9OFCHAPTER � � �(COMMENCINGYYITMSECTiON70oD)OFGMSION70FT11EWSINESSANDPROFESSIONSCOOE,/WD Z �� YY LICENSE B W fULL FORCE Af�EFFECT. m � LICENSE CLASS G�� UC.NO. ��43 I� � �j DATE � CONTMGTOR Ll/JIJ ,�^�Fa � W �i.�( • � WORKERS'COMPENSATION DECLARATION � � 1 NEREBV AFFINA11p�DER PENALTI OF GERJURY ONE Of TME POI1aWINO DECLl1RAiqNS: Z � _IHAVEANDWILLAUINTAINACEHTIFICATEOFCONSENTTOSELFINSUREFORMGIV(ERS' � COMpENSATI0N,A9 PROVIDED B`IBEC710N 7IOOOF TME LABOR CODE,FOR iME PERFORMANCE (_J Q OF7HEWOPoCPoRWMICHTWSPERIAITISISSUEO. � Q �1 NAVE AND WILL►WNTAIN WORKEH6'G�DMPENSAiION INSUfLWCE,A6 REOUIREO BY 6ECTION � 87a00F T1E LABDR OO�E,FOR TME iEHPoRMANCE OF THE YiORK RDR WHlpi TNIS PEHIAR IS � .�S � f59UED.61YWOflKERS'COAAPENSA710NIN3URANCECMq1ERANDPOLICYMMIBENME: STRUCTI / � CAHRIER �� P VIEW � va�cr nuMeEA �.d^� �- ��I S � ELECTRIC p (�����BE00ARET�DFhEVEwxi6�LRONE�a.roPmOClWts(�IaojonlESs} PLUMBINO LLJ 1 CENT6Y TH�T Nl THE VERFORMANCE OF THE WORK FOR NRYCFI TNIS PERMIT IB ISSUEO.I MECHANICAL SHALL NOT EMPLOY ANY PERSON W ANY MANHER 90115 TO BEOOI.�IE Bl1B1ECT TO THE (p WORKENS'COLIPENSATqN lAWS Oi CALIFORNIA,AND AOREE THAT IF 1 SMOULD BECOME INSPECTION FEE S SUBJECTTOTiIEWORKERS'COMCENSA7qNVROVI510NSOF5ECT10Nf7000FT1EUBOII , .7 CO�E.1 BWLLL FOR7MNI711 CpAPLY Nnh1 TFqSE►ROV1510NS. O ��/-s y�y�,.r. A� /. '�..� � DATE: �`//1`f � APRICAM: �I��C/�!�/�^"��G /�'� SMIP A WAAIJING:FAILURETOSECUREMpRKERS'COIdPENSATIONCOVERA0E18UNLAWFUL,ANDSI/ALLBE ENERGYPlC lC� / If 7CrtS� � SUBJEC7ANEMPLOVEHTOCRIMWAL►ENKilE3JWDGVIIFlNESUPTOONEHlX1DREDTlqUSAND �T�� � DOLLMS�i100.000).WApDfT10NTOT11ECO8TO�COMPENSAT10N.0AMMiElASPROVqE�FORIN ENERQYPERMIT 6ECTIDN�7a OF TME IABOR OODE,NVTEREST,AND A7TORNEY'8 fEES. RETENTION FEE: c� CANSTRUCTION LENOING AGENCY PRE-ALT FEE: � 1 NEREBY AFFIqM UNDER PENALIY OF PERJURY iNAT THERE IS�CONSTRVGTION IENOtl7a AOENCY PoR T1E PERFORMMIGE OF ME WORK FOH NRilp1 TXIS PERMIT IS ISSUEO�SEC.7aW,qY.FF � � LENDEfiO W1ME � LErUER'9A�DRE83 � � IGERTIFYTIIATIIUVEREAp1H13Mp61CATqNANDBTATETIiAT7MEABOYEWFOHM�7qNISCORRECT. TOTAL FEES /Y � � I MREE TO COMPLY MATN Ml CIiYANO OOIMTY ORDINANCES AND BTATE UWS HELATW�11D BUMDINO / ' r'� � CONSTRUCiqN,ANp HEREBV M/TipRRE REPRESENTATNES OF THIS COUNTY TO EHfER UPON 7NE �BOVE-YENTIDNED�ROGEHiY FOR INSPECTION Pl/RPOSES COMMENTS 9 C ', t � � vew ENlWEryRINn �� p� �jj g y /��/i� / , .� aK1N�7UREOF PERMrtTEE . DATE � " ` RECPT.NO. PAtD BY VALIDA170N WHI7E--0epartmenl Copy,YELLOYV—Fherca Copy,PINK—Jluessor Copy,ROLDENROD--FIIe Copy,GREEN—AppllcanYs Copy � �. . . .. .... ., . , :-. ., �. � . , . . .. • . . . . „ �. , � ' T+ . -" . ' ... ... . . _ ,L'., �. . � ... . � 't.'. . -. . . , ., . CITti' (�F DIl.W'tOf'dE) BAR � It�'S�E�'I"lQ�� �E�GARC� .._. ....... , w �- e � s f � � • � c : � 's���v c,, -l�►f� o � �_ ��.��� - ... , . _ .. . , _ • _ - -- .. ..�._...... ... . . --- -.. .. . �: ... .. . .. . .. .... ... . ... _ _... . _.. 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I ; : ON SITF- IP.AF'S. . � --�--- -. ..------ -- - - ----- --f- - - -- -- -- _...--- -- -- -------- --- GAS AIR TEST i i F1NAL 70NING _ I_ _ i ^ _�- -- -...... ----�- - - ------- ---. _.. .__._..._... .__......_.._.._.. ... 1 FIRF DEFT. FItJA.L , FINAL CONST. �f 97 r - � - ----- - - ------ --� - - --- - ' ----- FINAL HEATING I - - �------ -. _ .._ _... --- - ... .---j�------- -;----� ----------�---------� - - -- � HEALiH [)EP7'. FINAL i ------------------ .. . : _ - --- - - - ---...... .I . .._.. - �----- - . _ . - ---- - ._.. ...--- --+-- - ----�----.._._._.... - - FINAL ELECTRIC T- ; ' C)EV. FEE:S PAIU ' ,. , ------------- -�-- ------------- . .. ._._.. .... _...--�- -------- --------�------._.._..---- ---._._....- ----�-----�-----•-----•---�--...--- FINAL PLUMBING � , . i ENC�:RG`r' . ----1-----------�------- - - - ; -- - - ... . - - -. . . - - - .. _-- ----------------- - — ; ., -� ti� . � � .� , ------- ------...�_--------...-� ------..... - - ----- � - { � -------- , �...,-... � _ � ,�;..., .�`. � - - -1 i ,.. r . ti.. � �k.''.:.,,,:r�►,..��1�� - - ---- ---�-...---------------�-------- — --- - � � COMMENTS -- -------. . ------- ------------- -�---- - - - ----------.. ._. _... ..-- ---------------- ------ ------------- ------�---------------��-------�-- . . �,..,�r- ; -:;.1--. -�----. ._.. ;- - ;- ,-,, ' , --- - - - -- --------�------- -----------�------- - ---._...- -- -- - �_ - -- ---- � ------------- - ; . ,... •.: _. .- -,-- __...-------------------...-------._--- _ .. ......._ .. ..-- -- ---- ,. - , 'i �]S.. .!��....Y:� A . , � I • � . 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