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HomeMy WebLinkAbout16535 - - �- � �,�, �� CITY OF DIAMOND BAR `'6 ,�I DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �\ 21660E.CopleyDriveSuite190 ��` ' � PRESS h����~ BUQ.DINGSPERMIT APPLICATION \ FIRMLY o ADDRESS �t� � N ko ck kl Y�« ��'��. APPLICATION L���,�_�` NUMBER �� o� DATE �J � ISSUE NPE OCC APN LOT TRAC7 DATE CONST. GROUP � OWNER Lf R l�f��F_ G'D L 'S�/� o ADDRESS��,�' I'�I [7CKQlV�2 D/7 . ZONING SETBACKS � cirr.QJ�¢M��ta ,r�A/L ziP�� TELY � REART RW �p � APPLICANT TE�• . SIDE/SIDE STREET RW ❑ CONTRACTO �Rnpi�A�. GOCLIw� NE$:rY(. �-�E' SIDE ❑ � ADDRESS �.D ./3cY' ��? CITY,�JLC�J/..i4N�,_ ZIP��(,TEL�091 �.2/�/ PROPOSED USE � ARCFVENG/ • DESIGNER NO.OWEL NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER•BUILDEF DECLARATION SFR/ADDlREM O p I FIEREBY AFFlRM UNOER PQlALTY OF PEiWRY tHAi 1 AM E%E1AaT iiqM THE CONTAACTORS L4 Garape/Ceryort W CENSEIAWGORiHEFOLLONfNOREA50N(3EG7W1.68U5wE55ANDYPOFE5510NSCODE�NYCITYOR (n � OOUlIttNMIp/REOtMESAPERMRTOCONSiFiUCT,/�1TERp.1PF10VE.DElAOUSH,ORREDAiqANYSTHUG � petldDBCk � iUqE VqqR i0I7S RSUMlCE pL50 REOUIfiES TNE A7GLICANT FOR SUCM PEPMIt TO fILE A SIONEO .� lTAtEMEHT TWIT NE OH SHE�UC£NSEO 7URSUM7 TO 7ME PROVISIONS OF iNE CONTMCTONS L4 � CENSE�AW(GIAVTER f(CpAMENGWO VATH SECTION 7000)OF DMSION�OF TNE BUS WE55 ANO FRO- � PooUSpa FESSIONSCOOE)ORTHATHE�SHEISEXEAIPT7FIEHEFROMMlDTNEBASISFORTHEALLEOEDE7(EMP• C7 TpN.ANYVI0U710NOFSECT10N7W1.68YANYMPLICANTFOFAVENMITSUBJECTSTNE�VGLICAHTiO Z Re-Roo1 � ACIVILiENALT/OFNOTMORETWWFlYEHUNOREDDOLURS�l500j.): ' , � O1.0.SOWNEROF7HEPR07ERTY.ORMVf�DIAVEESWITHWAGESASTNEIRSOLECOUVENSATION, � COmTBftlel YIKL00 TME WOi'<K M1D TT�E STRUCTUPE IS N�T IMENDED OR OFiERED FOR SALE(SEG 70ar.BUSb J NESS AND PROFESSIONS CODE TME CONTMCTORS LICENSE lAW OOES NOT AVPLY TO AN OWNEN OF N VROPERTYMA/OBULD90RMVROVEST1EREd1.NIDWHODOE55UCHWORKHIMSELFORHERSELFOR = (L TFQiOUGHMI50flMEROWNEMPLOYEES,GRONDEDTWUSUCHMPqOVEMENTSMENOTINTENDEDOR m �l� OFFEREDFORSKEIF,FqWEYE0.TMEBUlDINQORMPROVEMFNTi5501.DWR1aNONEYEAROfCOMPLE � TqN,TME CM'��ER�BULDER M'�LL MAVE TNE BURDFN OF PROVWO THAT HE OR SHE OID HOT BUIID Ofi W PRDVE FON iNE PURM}SE OF SLLEL � ❑I,A90WNEROFTIEPROVEiRY,AMEXCLUSNELYCOMMCTNOMRiT1UCEN5EDCONTRACTOR9 , TO�NSTRUCT 7HE iRQ1ECT(SEC.70a1,BUSINC55 ANO PROFESSIONS CODE TME CONTMCTORS l4 V81U8[IOf1 ADJ.AREP, CFN6E UW DOES NOTACPIV TOAN ONNER Of A PROPERN WNO BUILOS OR 1/17ROVE3 TIEREON.AND � M1qWMfMCfSiORSULHVRQIECT9YlIT1ACONTMCTOR(SjLICENSEDPVRSU�MTOTNECONTMG pUAN71TY DESCRIPTION FEE � N0.S UCENSE UW J. ❑I AM IXEMPf LNDLR SEG B.t P.C.FOq TNIS REASON 6 U u" O�TE OWNER � __ .. . . W � UCENSED CONTRACTORS DECLARATION W . �-- � � IHENFBYAFFW.IUNDERPEN�LTYOFOE0.IUMTUTI/WIICENSEDUNOERVROVI510NS�FCHAPTEH � � f(COMNENGPKi W1TM SECTION 7000)Oi DIV1910N J OF THE 8U51NE55AN�PROFE5510NS CODE,AND Z W LICENSE 61N FULL fORCEAND EFFECT. m � ucer,se cuss�'-7n r ff/C- ��c.No.�z�/�a'`� j �--j p,�� e✓t'-�./—O/ _corrtrucroA'T�o/ A�L a ad WORKERS'COMPENSATIONDECLARNTION a � ffL( d � � IHERE9YAFFWMUNDERPENALTYOFVERNR70NEOFTNEFOLLDW�NODECUMTIONS: a D � � � 0 _INAVEANDNALLNANTAINACERTIFICATEOFCaNSENTiOSELF-INSUREFORWOqKERS' S � COIAPENSATqN,ASFROM0ED8Y5ECTON]�OOOFTHEUBORCODE,FORiNEPERFORMANCf W OF iME WORK GOR WHlqi THIS VERMIT IS ISSUED. � C _I HAVE AND NALL YA1MA W WORI(ERS'COI.IPENS�TION INSUMNCE.AS REWIqE�BY SECTION n �looOFTMEIABORCODEFORTHE7ERFORMANCEOFiNEWOHKFORWHICHiH�SPEFWRIS ISSUED.WNORKERS'CDYPENCATIp:�NSURANCECAPRIERANDPOLICYNUAIBERAfiE: CONSTRUCT�ON � c�wwEn � 'T1 G 1�2� U�DEI�-�.t9�/i Cl�� PLAN REVIEW � P0.ICYNUTABER fv(y�C�j..�v�{sZE,= �-=B E�� ELECTRIC � fn�ssccrcNrEmrareeoc�EiEncFn[veroRrsroaa+e�ooawis�S+cmaatEssl PLUMBING Z ICERIIFYTMATMTMEPERFORMANCEOFTNEWOWCFORWHICHTHISPEAMITIS�SSUED,1 MECHANICAI � SHALLNO7EMPLOv�NYPE0.50NWAMlYANNEPSOASTOBECO SUBIECTTOTHE �u'%ti-:- � WORKERS'COMPFNSAT10NlAWSOF RNiAANDAGFEE tIFIS�KK1lDBECOME INSPECTIONFEE a �� SUHJECTTOTHEWORKERS'CpAPE AT VROYISION50 �lOOOFTNEUBOR . , ,�(� S coo[.�swu.�rortnnvm+caaa�r r osevnovis ISSUANCE � s � '_ZI"L� APF'LICAMF, j'Int�_ SMIP p WTE: W ENERGY PIC WMNIN�:FIJLURE TO SECURE YlfMKEqS'COMPENSATION COVERAGE IS UNUWM.MA SNAL�BE ^ � SUBJECTAN EMPIOVER TO CPoMINAL PENALi1E5/ND CNILFINES UP TOONE NUNDRCD T/qUSAND ENERGY PERMIT � , + � DOLIARS(t��.�1.IN ADOI710N TO iHE COS10F COAIPENSATION.DAAIAOES AS PROVIDED FOR B1 �.;-p-� aSECTION]70lOFTMEtABIXiCODE,IHTEftEST,ANDATTORNEYSFEE3. REI'ENTIONFEE: L1� ��"'�"'�' � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � INEitE9YAFF6iAlUNDERVENJILTVOFPEMIRYTHATTNERE�SACON57pUCT10NLENDINCA�ENGY a FORTHE7ERWRMANCEOf1HEWORKFORWNiO1TMISCERYITI5ISSUED(SEC.JOW.CIV.C.). � � IENDER'S NAME � LENDER'S�DDRE55 � ICERTIFYMATIHAVEREIDTMISAPVIICATIONANDSTATETHATTNEABOVEWFOIWAT10NI5COHRECf. TOTAL FEES ����� W IA6REETOCOAIPLYWIiNALLCRYANDCOUNTYOPDINANCESAND$TATEU�NSRElA71NOTOBVILDINO � � CONSTRUM�ON.M10 NEREBV AUTIqRIZE REPRESENTATIYES OF THIS COUNTYTO EMER UPON THE ZABOYE-MENf1O`1EDFROPERn'FORINSPECTIONPVRPOSES. COMMENTS � J � ¢ PER4R7EEN�IdE�PRINT) � N81GNATURE�FPEflMIT7EE OATE � qECPT.NO. PAID 8Y VALIDATION WHITE—Department Copy,YELLOW—Finanoe Copy,PINK—Aseessor Copy,GOLDENROD—File Copy,GREEN—ApplicenYs Copy � CITY OF DIAN90ND BpR ,� , - . � . , . .. _� .:if�'Si�EC7'iOh! RECOR� - . : . 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