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HomeMy WebLinkAbout15770 �_ CITY OF DIAMOND BAR �� DEPARTMENT OF COMMUNTfY dc DEVELOPMENT SERVICES � 21660 E.Copley Drive Saite 190 , (909)860-3195 Fax(909)861-3117 PRESS ��^�^�.� BUII.DIATG PERMIT APPLICATION FIRMLY o DDRIESS �'� O� � V=EW a,(7 APPUCATIO AERMR n P/C � DATE �NUMBER �� /�� i � ISSUE�� TYPE OCC APN LOT TRA T pATE CONST. GROUP S OWNER � � ADDRESS�-1r � ZONING SETBACKS CITY A�,�.. ZIP TEL�� � REART RW ❑❑ APPUCANT T -��- SIDE/SIDE STREET FW ❑ � CONTRACTOR C7�+✓►.�0.lgU?i.t7S1C_ SIDE ❑ � ADDRESS PROPOSED USE e ' CITY ZIP TEL. Pu ARCWENGI � DESIGNER �OGG- FJ�G'2K�6C'�y."�j�C� NO.DWEL NO. NO. ADDRESS �T c� 1 l�. T�TS[QJ f4�.(7 UNITS STORIES BEDROOMS CIT��iV�Zl4�i. 21Pq TEL.7lSl- 3U'�i►�LO y DESCRIPTION SQ.Ff. FACTOR PSF AW.AREANALUATION Q OWNEH-BUILDER DECLARATION SFR/ADD/HEM O p 1 MEREBY AFFliqI UNDER PENALTY OF iERA1RY TMAT�M1 fi%EMPi F710M THE CONfAACTOR3 LI� GareQO/Ce1pOR lL CENSEI,AYYFd17NEfOLLOW9JOPEASdJ�SEC.7R97.6B118N1ESSANOVROFES510N500DE:ANYCITYOR (n � COUMYWHIGFiRECWiESAPEANR7000NSTRUCT,ALTERINPROVE�DELqUSH�ORREPAIFlMIVB'IRUC• LU PBHO/DBCk u� IURE,►RpR TO ITS IBgUM10E,i1L301iEW IqES 7ME 11PPLMdM FOR SUCH PERMIT TO FILE A SIONED W � tTA7O.�N�RIAT NE OR SHE 19 UCEN3ED►U0.4UM1T TO THE GqOVISION3 OF THE COMMCTORS lF CENSE L�W(CHAPTEq i(COMMENCMO WIiH BECTKKJ TooO)OFdVISION 3 OF THE BUSINE3SAND PHO- � POOUSp9 FES4I�NS OODq ORhUT YIE OR 9NE 16OfEMPTTMEREFROM M1D 7NE BA915 FOR TIiE ALLEOED QEMP• 1pN.M1YVpLA7qNOF8ECTON7087.6BVM7VMPLICANTFORAPEAMI75UBJECiBTNEAPPLIGHTTO Z Re-Roof � A CMl VEN�L7Y OF Ndf MIORE 7HAN flVE MUNDRE�DqJ11R3(t600).1: � 04���EROFTHEPqOPEHIY.ORYYFNPLOYEESWI7HWAOESA5TTIEIHSOLECOMPENSATIOH. Q COrt11Y1BfCi81 - YYILL DO TIE WORK MD TFIE BTRUCTUFIE 16 NGT IN7ENDED ON OFFERED FOH SALE�SEC.Mu,BUS4 J NEbS M1D PNOFESSIONS 000@ TIE COHfRACfOR3 LICENSE UW DDES NOT�PPIY TO AN OWNEN OF � � PfqVFRTYMI1qWIL.DSORNAPROVE8TIEREON.ANDYNi000E55UCHWORKNIMSELFOpNERSELFOi1 � THNOUOIINISORXEROMRIEMYLOYEE9,VAOVIDmTFM7tUG/WPROVEMENTSARENO7INTENOEDOH m OFFERm FONSALE IF,IIOWEYERTNEBUILDINOORIMPROVENINTR SOLDN7TNIN OHE YEAR�FCOMPLE TqN,iHE OMVNER�BUItDEP W1LL WNF iNE WRDEN OF PpOVINO TIAT HE Of1 6HE DID NOT BUtID Op YAPROYEiOR 7NE PURPOSE OF 6ALE� y,� bTASONMEROFTHEPROPERII'.NIIXCLLI9NELYCONfRACTWOWITHLICENSEDCON7RACTORS � TO COliSTRUCT?HE PqQIECT(SEC.7w�,BU8iNE88 ANO►f1OFEBSIONS CODE:7ME CON7NACTORB LI- V91118[IIX1 ADJ.AREA CBlSE LAW OOEb NOTAPPLY TO AN OWNER OF APROPERTY WhlO BUttD50R MPROVES 1YtEREOlL Mlp NrypCONiqACTSFOqSUWCqOJECT8WITNACOMRACTONIsILICENSEDPUR4llANT70TF1ECON7qAG qUAN7tlY DESCRIPTION� FEE � 1OI13 LICENSE L/dl.). O IMI E%EYPT UNDER 6EC. 8.i V.C.FOR THIS REASON U T I t�O � � Tc 30 pA7E OMMER V �4 LICENSED CONTRACTORS DECLARATION � CL IHEREBYAFFIF4IUN�ERPENALTYOFPERIURVIFUTIAMLICENSEDLINOERPROVISIONSOFCHAFiER Vr � �(004GAENCINO N7TT1 SECTION 7oW)OF DIVISION J OF THE BU91NE39 AHD PROFESSIONS COOE,AND Z W UCENSE t8 W FULL FORCE IN�EFFECT. � IICENSE CIASS LIC.NO. � �j DATE CONTMCTRI � a6 WORKERS'COMPENSATION DECLARATION � � A rt '�' � V y1 HEREBv AFFIRM UNDEfi iEN1LLN OF iER1UHY ONE OF THE FOIIOYANG DECUM71ON5: Q �' � T 2 . C �114WEM1DWILLIM�MNNAGERfIFICATEOFO0N9ENi708ElFINSUREFORWDRKERS' �� �� � OOIAPENSA710N,/S PROVIDEO BY BECTION]70o OF 7HE IABOR CODE.iOH TME PEPFORMANCE W OF iHE WOR1(FOR WNIG1 TFIIS YEFiM1T IS 183UED. .� 0 _�1 MAVE MI�WILL�MMi WORKERS'COL�PENSATION INSUR/WCE.AS REOUIRED BY 9ECTKKJ 4� J7oo OF iME IABOF COOE,FOR 1NE PERFORMANCE OF 11i�E WORK FOR WHICH 7HI5 PERMIT IS � ISSUEO.W NOPoCEFiS'COMPENSATION INSURANGE CANRIER AI1D POLICY NUMBERARE: CONSTRUCTION � c�pwEn PLAN REVIEW � POLICY NUNBER ELECTRIC I 3�O8 _ p�y7 �n+ssEcnor��rargemr,r�fnpFifEpgwoiewpor��xr�n�pOaWa�oo�oqLEss� PLUMBING Z I CERTIFY7HAT IN TFiE VERFOfiMANCE OF TF1E WORK FOR WHICHTMIS PERMITIS ISSUED,l MECHANICAL (�' BHKLNOTEMPI.OYANYPERSONMANVMMINERSOIIS7OBECdAESUBJECTTOTHE y WORNERS'COMVEN5�T10N LAWS OF CALIiOANIA,N10 AOREE 7lUT IF I5HOULOBECUME INSPECTION FEE BUB.IECT TO THE WONKERS'CONPENSATION PRONSIONS OF BECTION 9700 OF THE U1BOR O 000e. sH�t1 rn caMv�r vnn� se Wro���n .96 _ � �L ISSUANCE Z i O� rl. rf/,�. 'IT p pATE: � � APPLICANT. � X��S/ al�l'�"`� SMIP � WARNINO:FMLURE TO SECURE MlURKEHS'COMPENSATpN COVERAOE IS UNUWFUL,M1D SHALL BE ENERGY P/C �y SUBJECTµENPLOYERTOCRIMPIKPENILLTIESANDCNILFINESUPTOONEMUNDRED?HOUSMlD ENERGVPERMIT DOlLARS(37oo.oml.W AOOITION TO 7HE C0.S70F GOAIPENSATION,OAMAOES AS PROYI�ED FOR IN � BECTION 770!OFTHE 1A90R CODE,NTERE9i.ANO�TTOH'lEY'S F�ES. pE7ENTION FEE: � CONSTRUCTION LENDINQ AGENCY PRE-ALT FEE: � IHEREBYAFFl�UIUNDEHPENALTYOFPE0.IURYTHA7TIEREI6AWNSTAUCTIONI.EHDINOAfiENCY z FOR 7HE PERP�RMMICE OFiHE WORK FOR NTiK.Y1TM15 DERMI713ISSUED�SEG iD71,CIY.G.). W � LENUERS NAME � �S IENDER'SAODRE99 `� 1GERTIFITHATIMMEREAD7111SMOL�CA7%1NAN�S'TATEiW�TTHEA6WEWFORMATIONISCORRECT. TOTAL FEES � ��� �a � I AaHEE TO COMPLY WI7N ALL CrtY ANO COUNTY OR�INANCES M!D STAiE UYlS RELA7N0 TO BUILDINO � � Cd18TRUCTIOµAND MEREBV MJT110RIZE REPRESEMTATNFS OF 7H15 COUNTY TO ENTER UPON TIE /180VE�1AENTIONEO PROPERTY FOR INSPEGf10N PVRPOSES. 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