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HomeMy WebLinkAbout16502 (34) �� , � �.�, ...... �. _ . J� CITY OF DIAMOND BAR;, .. ` ` . DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES � . y 21660 E.Copley Dnve Suiu 190 '` � (909)860-3195 Fax(909)861-3117 �a ••� p PRE$S �����ry BUILDING PERMIT APPLICATION. �� ' : �.�,7� FIRMLY o DDR'ESS ��� l �� C�� C DATE CAT10N �,�� $!�� NUMB R���A� � �� � APN LQT � TRACT S-ZZ CO^] �SSUE '' �-•TYPE! - . OCC . V c ' ,,,,��,,,�' DATE CONST. GROUP LL OWNER _ ADDRESS Y O I ZONING SETHACKS '�;� -:;;, Z CITY U ZIPgZ(yLZ� TELC��L)� 7�J'�Sf - ._FRONT . - 4 RW ❑ g APPLICANT ��, REAR O � SIDEJSIDE STREET RW ❑ CDNTRACTOR � SIDE ❑ ADDRESS � PROPOSED USE � CITY ZIP_T_ TEL ` ug AACWENG/ � . � DES�GNER �' L" S ��� NO.DWEL. NO. NO. ADDflESS `'- NITS STORIES BEDROOMS � CITY ZI TEL � N DESCRIPTION SO.FT. ACTOR P F ADJ.AREANALUATION ti � OVYNEH-BUILDER DECV+RATION SFR/ADDlREM �i O 1 HEREBV/�FFIPoA UNDER iENALTY Of VEiWRY THAT 1 AM E%EYVi FS10M TIE CONTRACTORS U� G8�8QB/C81pOR 8 C615EUWPDRTNEFOLLON7NONEASONISEG)071.68USWESS�IJDFROFESSIONSCODE:ANYGTYOR (n � � WUNryWHIpIREOUIRE3AGERA1R7000N5TAUCT.ALTE0.�7F10VEDEM0U5FlOHREVAIRMlYSTAUG W PaUo/Deck Q iURE,PiWR TO RS 159UANCE,ALSO REOUIRES iHE ACPLICANT FOR SUCH PERMR TO FILE A SIGNEO w STATEMENT T/AT HE OR SNE IS UCENSED PUKSUANT TO TNE PiqVI510N5 OF THE CONiMCTOH9 LL LENSE UW(CHA➢TER�(CpAMENCINO VATI 5ECT10N 70a0�OFDIVI5IOH 7 0F THE BUSINESSAND PRO� � POOVSPd / "' ' FESSDNS OODE)ORTIAT HE O(i SHE iS FXEMITTNEREFROM M!D THE 6ASIS FORTHE ALLEOED E%EM0. � TpN.AN11V10LATIONOFSEGT10M70.7/.68YANYAGPUUNiFq1APEHMRSV&IECTSTHEMPUGANiTO Z Re-Rool � -.. _-� ' �,. . � AGVILPEN+LLTYOFNOTA10HE7Fw�FIVEIUNDnmDOLIARS(isool.k - -. � OIASOWNEROFiNEVFq7ER?Y,Oi1NVElA%AYEESWI7HWA(iE51l4THEIR50lfCOMPENSATqN, � Commercial � . r � WII.L p0 THE 140RK,ANO THE STRUCTUNE IS NOT IHTEHOFA OR OFFERED FOR SALE(SEG 70N,BU54 J NESS AND PROFESSION9 CODE TNE OONTMCTORS LICENSE UW DOES NOT APPLY TO AN OWNEp OF . � � pqppEl�ryyNpBULDgOqpADROVESTHEREON.ANDNMO00ES5UCHMR]NI(HI1ASElFOfiHE0.SFLFOfi � . � i � T/i1IX/OHHISORHERONMEMPIAYEE3,PROVIDEDTHAT51KHW7ROVEIAFMSARENOTINTENOEDOR m OFFQ3ED PoR S�LE IF,F10WEYER7NE BUILDINOOii MIPROVEMEMi4 SOID WRYCN ONEVEMOf COMPLE Z TION,TME OWNER-01111DEN Wll HAVE iNE BURDEN OF PROVYIO h1Ai ME OR SHE DID NOt BUILD OH W PFlOVYE F011 TME PURPOSE OF SALE1 � , � ❑4ti70N7�EROFTHEVROPERh:AME%CWSNELYGOMRACTNOM7iHLICENSEDCONiMCTOR3 � TO CONSTiIUGf 7NE PRQIECT(SEG 70N.BUSINE53 ANO PROFESSIONS CODE:7ME COrlTMCTORS U• VBWBlI0f1 ADJ.AREA CENSE UW DOES NOTMPLY TOAN OWHER OF A PROVERTY N'Ii0 BUlD30R IMPROVES TNEHEON.AND r�ocorrr�uciSwAsua�PnaECTSNnMAoortiru�cioA(51UCEN5EowASUu+iron+Ecorrrw�c OUANTITY.. DESCRIPTION FEE � TOR4 LICENSE UW.} ' . (� O 1 AM�CEMPT UNDFA SE4 B.l P.G FOR iNIS REASON ' v 3 � Z .S,v _s, �=" WiE OWNER V Z �. UCENSED CONTRACTORS DECLAHATION W . �y� � � INEREBYPFFIfWUNDERPENKT/OFFERPIMTNATIAAALICENSEDUNDEHPROv�SiONSOFCw1ViER Z _ G/j/ft J .. ' l' •(CdJYENClW W(TTI SECTqN T000)Oi DMSION]OF THE BUSINESS AND PFIOFESSIDN9 CWE,J1M) W UCENSE IS IN R1LL�ONCE AND EFFECL m '�'�, � UCENSE CIASS LIC.NO. � � � � � DATE � �CONTMCTOR_ � d � � � WOFKEflS'COMPENSATION DECLARATION U S ' „ � IHEREB AFNWUNDfRFENALTYOFPfR1URYONEOFTHEFOLLAMANO0ECIARATI0N5: 1 ,� y � a IHIWEANDW�LLAWMNNACEHTIFIU7EOFCONSEtfTTOSELF-INSUREFORYIDRKERS' / � ��' � Q � OOIAPQI5AT10N,AS PHOVIDED BY SECTION 770D OF TNE IPBOR CODE FOR iNE iERFORMM�GE U OF 7HE WORK Fdi WNlpl MIS VEHMIT I915SUED. � � AF �W W6 ANp WILL 1IAMAIN WORI(ER5 COAIOENSATIDN W SUiUNCE.AS REIXIIRFD BY SECTIDN Qi7o00FTNEl/�BORODOEFORTMEVERiORM/NCEOFTHEWONCiORVMiO1THISPERMRI3 = 155UE0.11'(Y�/��7.f��(�FR3'lGMF�N5AT10N INSUR/N�F IEP ANO POUC�Y N;UM�BER ARL/� CONSTRUCTION, j cuwtER J"i°'i��� ���L�1'���--�J� C�U_ PLANREVIEW o �cr nurnaEn ELECTRIC Q �S���� gE��p��ppqor+EFarnr�ooalN�slstoo�a��ssy PLUMBING � Z ICERTIF`lTNATIN7HEPERFORMANCEOF7HEWOf1KFORWH�CHTWSVEiwIT�545SUE0,1 MECHANICAL ��� (� S/ULLNOiENR.0YAN7PER50NINANYNANNER50ASTOBEW�.�ESU&IECTTOTHE y WOPo(ERSOOMPENSATIONUWSOFGUFORNIAANDAGREETMTIFISHOULOBEWME INSPECTIONFEE � S SUBIEGTTOTHEMpHKERSQOMFENSATqNPROVISIONSOFSECiqN37000F7MElABOR ISSUANCE �U, � � CODE 1 SNALL iORTM'AM CdAPLY WITH SE PHOVIS�ONS. p DATE:�O.C�APPLICANT. ' //���C� �SMIP � �i�C.1 � � r —� '/ WAiWi �FA4.URE TO SECUitE WORKERS'ODIAPENSATION COVEfiAGE IS UNUriFUL.M1D SHN.L BE ENERGY P/C 1 � 7T �7. r-'y SUBJECTINEL�PLOYEH70CRIMWKPEN/LTIESANOCMLFWESUPTDONEHUNDRWTHOUSMIO �ERGYPEFMIT 1 `I� V r OOLURS(llao.oaoG IN ADDiT10N 70 THE COSTOF COMiEN5AT10N,DAMAGES J�3 PilOV10ED FOH IN . - - � SECTION87oeOFTHEUBOHC00E.INTEREST,ANOATTDRNEY5FEE3. RETENTIONFEE: � CONSTRUCTION LENDIN6 AGENCY PRE•ALT FEE �� � INEREBYAFFlHIIUNUERPENAL7YOFPEtiJURYTWU7NEREISACANSTRUCTIONLENOWOAGENGY � FOH 7HE CERFORYANCE OF THE WORK FOR NMICH TM�9 Pf RM1T 15155 D(SEG OOi7,C1V.C.} � ,��,�"� '.'•' � ��E�,�E ,�/r�F �f�v/r��_ , � IFNDEii'S�DDRE53 - - � � , 1 CERTIFY h1AT I HAVE RfAD TH�3 AVPl1CAT10N AND SiA7E TNAT THE ABOVE NFORMAiqN IS CORREGT. TOTAL FE ES �,�, ' � � 1 MREE TO[01AVLV MATH/�11 GTY/�NO COUNTY ORDINANCES AND STA7E Uw5 iiEIATINO 70 BULO WO ,. . � CpNSTRUCTqN,ANOHEREBVAUT110Ri REPRESENTATIVESOFIHISCOVNTYTOEMERUPONTH@ . . . �, PBOYE-MEHT10HE0 DiqvERiY FOR�N. 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