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HomeMy WebLinkAbout16493 i -----._.�.,.--- - - • -- -- - - _ : Y, f -:. � , .. ..,� CITY OF DIAMOND BAR �''. . � � �--� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Arive Suiu 190 ..`: " BUQ.DINGPERMITAPPLICATION ` � .' ' / � PRESS ,,,. ��' '; !/4✓�.�',!� FIRMLY o ADD ESS� Z 3��� ' � ���� DATE CATION .+��-,� NUMBER ' IPf�, -5 I I�y�3 c�_�S � APN LOT � TRACT `S ZZ�o��. �i; ISSUE . .-'`TYPE' ' '.. OCC i DATE CONST. GROUP ' p OWNER . �, _ u. , � ---- , o ADDRESS �' l ZONING SETBACKS �'`�� •' . Z CITY T�1'J1�! ZIP TEL -REAR _..__.._.:_�.,, . ` RW - ❑❑ g APPUCANT e TE�• '; t SIDEJSIOE STREET ,Rw � ❑ � CONTRACTOR ' - ;; ' � SIDE O � A�DRESS -� ' . ,.1__" . . • . CI7Y ZIP TEL ; ;PROPOSED USE - � ARCFVENG! � I I,,' �. �- � _�..,_ :� �.� � DESIGNER L v'""'-r � � d ' 'I NO.DWEL Y ,NO. NO. ADDFiESS f � '" NITS STORIES BEDROOMS � CITY ZI TEL7' � DESCRIPTION SQ.Fi. FACTOR PSF AQI.AAEAN UATION N OWNEH-BUIIDER DECLARATION . �I i,I 0 � �' SFRlADD/REM_�_ • ,�� e1 MEREBY AiFPW UNDER 7ENN.TY OF PERNHY THAT 1 AA1 EXEMPT FROM THE CONiMCTOR3lF I .''' .- •'�" . . CENSEUWFOHiMEFOLLO�MNONfMON(SEG70J7.6BVSINESSANDPROFESSqNSCODE:ANYpTYOF GBfAge/CelpOR � tOUHTYYMICHREOURESADE�7MRR7CDNSTRUCLAITERMPRONE,DEMOLISH,ORREPAIRANYSTRUG i W Pe110/�BCIC - �_'�,"- �` TUHE PRqR TO ITS S9UANCE.lLLSO REODUiE3 TME A7PLICANT FOR SUpI GERAIIT TO RLE A BIONEO i .� STA7ENENT TIUT NE 0f7 SF1E IS LICENSEO PURSUANT TO THE PROVISIONS OF TME CONiMCTOR.4 LI-� ,. „ _, . � � CFN4E UW(CMADTER Y(QOMIIENCWU WITM SECTiON 7(b0)OF OMSIaN]OF T11E BUSINE53 AND PRO. 'I u' PooVSpa _ FESSqN500DE�OFiTW�1HEOR5MEISEXEMPT7HEREFfi�MANDT/1E81�SI5FORiMEALLEGEDEXEMP• �� (' TIDN.IViVNOLATI0NOF6ECTION7W1.68Yl1NYMPlICAlffFORAPERMRSU&IECTSiHEAPPLIGNiTO � Z Re-Root � � ACMLVEW�LiYfJFNOT►IORE7/UNFIVEHUNDREDOOUAAS(lSoo4)' '1 O ❑1�.40M�NEROFiHEPNOPERT'.OfiMYEMPIOYEESWITHWAGE5A5iNEIR50lECOMPENSATpN, '� 0 COmm0fCf01 ~ .. �� }�� yJ - � YALL DO THE WORK MID TME STNUC7URE IS NOT IMENDED OR OFFERED FOfI SALE(SEG 7ou,BUSI- ', J � NESS AND VROFESSION9 COOE THE CONTMCTOti3 UCENSE UW DOES IqT A7DLY TO AN OWNER OF � � MO N � r�+ O � iRDCER7Y Vno BU0.➢90R MAVROVE9IHERECN.AND Yn10 DOES SUChI WORK HIM50.FOR MERSELFOR [[ 7HROUGHNISOqMEROMt1EMPLOYEES,VRON0E0TIMT6UGIMPROVEUEMSMENOTNTEHDE�Oq �m , � p ,OfFEREDFOR9ALE1F,110YVEVEiLiHEBUIDINdOR�7DpOVEMQfTISSOIDNTTHINWEYEMOFCOYRE. �. l Z iloN,THE ONTIEwBUILDEA WILL HAVE 711E BUi1DEN OF FROVINO T11AT XE OR BME DID NQ7 BUILD OR = W PROVE FOR iH[PUpPOSE OF��LE1 � � ��.� � � OI�SON�7EROFTHEPROPEirtY,AMp(d.USNELYCOHTMCfP1�NrtTNIICENSEDCONTRACfOR3 70 CONSTWI(.T TME FROUECT(SEG 7w1.8U91NE55 AND iROFE5510N5 COOE 7TIE CONTMC70RS U• � I�I Veluetbn AD.I.AREA CENSE UW DOE9 NOTMPLY TO AN ON'NER OF A PfiOPEATY WNO BUMAS OR MPRDYES THEREON.IWD � vnqca�nucrscor�wa�naaEcrsvnnixoorrtw��croa�s���co+seovurtsuurrron�Emrrrw�c �� pUANTiTY 'UESCRIP710N.� K�•-`•�t,- FEE � TORS LICENSE LAW} � � Q OIAAIE%EMPTUNDERSEC. B.LP.GFORTMISREASON . � � Yr 3 . . � �, � � �� u' DATE OWNER � �' � W �� LICENSED CONTAACTORS DECLARATION -r � ' W 1 HEREBY IIfFIfW UNDER PEHALTY OF PERAIRY THAT 1 AA/LICENSED UNOER PHONSION9 OF CHAPTEP S •(COr.IMFNCMOWITHSECTION7000�OfDM5lON70�THEBUSINE55ANDPPOFESSpNSCAOE,ANU Z v�n~ X MY LICENSE IS N NLL fORC EFGECT. m J] � V � UCENSE CIASS � UC.NO. .�' � � J /./' � (/ai ` o+trE corrrrucroa ���_ a � WORKEH�COMPENSATION OECLARATION U � y • N IHENEBYAFFIRMUNDERPENALTYOFPEiWRYONEOiTNEFOILOWINGDfCUMTIONS: y 2 �Q , � �1uvE AND WiLL AUM7TAN A CEHfIFIGTE OF CONgENT TO SELFiNSUNE FOR MGFNERS 2 .-- ��� �� - � - - � � - � �i �/� CpIFEN5AT10N,AS/ROVIOED BV�EC7�ON�70oOF TIE LABOR CODE,FOR fNE OERFORMANCE U � Q THE MNi1K GOR WHICN THIS GENAIi IS I55UED. � �'�� � �WIVEANp WI��MAIMAIN WORNEP9'COIA7ENSATION WSURANCE,AS REWIREO BTSECTION d ]7MOFTNEI/�BORCOOE.FONTHEVEHFORMANLf FTMEWUHKGORWMIGITMISPERMRIS Q LSSUED.IAY "E 1COYPEN�A710N1 UMNC RIERANOVOLIC`YN�UMBERA . . CONSTRUCTION � pJ � �qq�Eq C � O ��iV� PLAN REVIEW 'h� � vaicrnu�a�� - � ELECTRIC �--- J � �secrnr+r�owreeoawc�euoFneeep.rrs�ar�MraaEnoou�rsK,�tontEss� PLUMBING �� � � � � �CEFTFYTUTINTHEFEfIFORMANCEOFiMEWORKFOf1WMdITHI5PER1AR6S5VED,1 �ECHANICA� � SNALL NOT EMROY ANV VERSON N ANY MANNER 50 AS TO6ECOME SUBJELi TO 7ME � �N - WORKERSCOMVEN5A71DNUW50FGLL�FONNIAMUA6REETHATIFI5FI0lADBEGOME - .INSPECTIONFEE S SUBIECTTOTHEWORKERS'COMPENSATIONPROVISqNSOFSECT10N 7000FiHEUBOR . , coo�,i sw�u.coarNwin�ca.�av N��e naovisaas. ISSUANCE � �/,�fT.-Oj . �C �SMIP . � .. . . _ � 0 OATE: (APPLICANT: W ENERGY P!C � WMNINQ:FA�LURET06ECVREVIOW(ER5COMPENSATIONCOVERACEISUNUwFUL,ANOSHALLBE - .1 SUBIECTANEMPLOVERTOCRtMWAIiENALTIE3ANOCMLfHESUPTOqJEM1NDREDTH0U5AN0 ENERGYPERMI7 � �� WLLAHS p Ioo.D0a1.�N AODrt10N TD THE COST OF COMCENSATqN,DNMOES AS PNOWDED FOR W � SECTqNf7oeOFT1ELABOHO00E,MERE51M1DATf01iNEY'SFFE3. RETENTIONFEE: ��-�� d CONSTFUCTION LENDING AGENCY PRE•ALT FEE: � � � INEREBYAFflRMUNDERPENALiYOFFE1tM11fiYTHATTHEREISACONSTHUCTIONtFNOWOAGENCY �, ' ' LOR TIIf VER�ORMN7CE OFTHE�MORK FOR VAI/ICy�1N IS CENu1I LS ISSUE[�i(SEC.]007,qV.C.J. j � LENDER'SNM1E 1 PK /�G+/ _ . . _ � . . .. � � LENDERS/DORE55 i „ � ICERTIFYTUTIIUVEREAD7WSAP%ICATIONMIDSTAiETNATTHEABOVEMiOR)1ATqN45WRRECT. TOTALF4ES �, ��..•31y3�'g�.�, �y IAOqEETOCOIAPLYWI7HALLCffYM1tlCOUNTTOf101NANGESANDSTATEUWSREUTWOiOlURDINO � CpN57RUCTqN,ANONEHEBYAUTHOWZEHEVRESENTATNE50FTH15COUNTVTOEMEqUPONTHE � . 'i : . S� ABOVE�MEHTIONEDCROPfRTVFORINS CTIONVURPOSES. '�COMMEKTS �� I.. � ,✓,r , , .__ m PERMITTEE WWE�VI4 . � ���� '� �� !n ��/�� _�� � � '.�.�I li� . .I �. N SIO REOFPEWA OATE ';1 I' � I I ��' � � ;RECPT.N0. 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