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HomeMy WebLinkAbout13171 (17) � _ I CITY OF DIAMOND BAR � � DEPARTMENF OP COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 (909)86Q3193 Fax(909)661-3117 PRESS ''���� Bi)ILDING PERMTT APPLICATIUN FIRMLY o� JOBSITE Q Q � � � APPLICATION PERMIT P/C • ADDRESS a y� y�`✓.J�w+� r DATE NUMHER I �_'�_ 1f ISSUE 2 TYPE OCC � APN LOT TRACT DATE_ J I Z.�I—G.C�, CONST. GROUP � OWNER � ADDRESS � �� ZONING SETBACKS CITY rS�_ _ ZIP TEL..��jL-� FRONT RW ❑ APPLICANT _ TEL. REAR ❑ SIDE/SIDE STREET RW ❑ CONTRACTOFi SIDE ❑ ,ADDRESS � CITY ZIP TEL. PROPOSED USE . P++ AACH/EN DESIGNER NO.DWEL. .. .. NO. . NO. � CD��DflESS ZIP TEL. UNITS STORIES BEDRODMS u3 DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADWREM O p 1 MEREBY AFFlqfA UNOER PENI�LTY OF PE0.RIRY THA7 I AM EKEMPT FROM TNE CONTRACTORS ll- (38�8gBlC81p017 Cxl COiSE1AWFOR7}IFiOLIOWWONEtiSON(SEC7081.69USWESSANDPROFE6&IONSCOOE:ANYCRVOR (� S� OOUMVMMK�IREOUIRESAOEiWRTO00N3TRUCT,KTER,MOROVE.DEMOUSH,ORREPNRANYS7RUC• u� TURE,VRIOR TO RS IBSUANCE,KSO REWIRES T1E MPLICANT FOR SUCM PERMIT TO PILE A 91GNED W Petio/Deck � OTATEMENT TXAT ME OH&fE IS UCENSED PURSUANT TO TXE PROYISIONS OF TNE CONTMCTORS�I- CENSE UW(CHMTEN Y(COMMENCINCi WfTM SECTION 7Wu)OF DIVISqN 7 OF iNE 6U51NE55 MID PRO- � PoOVSpP FESSqNSOODE)OIItMATNEOR8HE18E%E6IPTTHEREFqOMAN�THEBASISFORTHEALlE0E0E%EMP- (� TION.ANYVqLAipNOF8ECf10N70.11.6BYANYAPPLICANTFOpAiERMITBUBJECTSTMEAPPIICAN7T0 Z Re-Roo1 � A qVIL VENALTY OF NDT MORE THAN FNE XLNDRED DOLURS(i6ao).): � O4��NEROFTMEPNOPERTY,DIIMYEMP�OV6ESIMTHWAGESASiHEIHSOLECOMPENSATqH, 0 COff1111BfC181 - WILL DO hIE MIORK AND THE STRUCiURE IS NOT IMENOED OR QFFERED FOR S�LE(BEG fDaa,BU51- J NE65 AHD PROF'ESSIONS COOE:THE CONTRACTORS UCRlSE 4AW�OES NOT AVP�Y 70 AN OWNEP OF � PROVER7YMIFiOBUN.DSORMIPR01lESTiIEREON,AND1M1000E5$VCHWqiKWMSELFORHEP9ELFOR � � 71Yi0U0H/NSOR NER OYYN EYPLDVEES.PHOVIDED TW�T 8UC11 MAPqOVEMENT511RE NOT NTENOEDOH m OFFERED WHBALE IF,MOWEVERTIIE 6UlDMVQ OR IMPROVEMINf IS SOLp WITHIN ONE YEAR Of COIAPLE- �TION.TME ONMEF-0UILDER WILL IWVE THE BURDEN OF PROVINO THAT HE OH iHE 010 NOT BUIID OR MPROVE fOR THE PURPOSE OF SALEI. ❑I,AS DNMEAOF THE PROPER7Y,AY EXCLIIENELYCONiRACTNO WRN LICENSEV COMpACiORB TO COHSTiM1CT TME PROJECT(SEC.7041,BUSINESS ANO PROFESSIONS CODE:THE CONTPACTQRS LI- VgIUBtVOf1 ADJ.AREA CFlL.E LAW DOES NOTAPPLV TQ AN ONTIER OF A PROPEATY YN10 BUILDS OA IMPiqVE3 TMEREON,ANO WFqOOHfMCTSFORSUpiPRO,IECTBWITHA00NTRACTOR($)LICENSEDPURSUMITTpiHECONTMG QUANTITY DESCRIPTION ta�s ucase uw.�. �E � 0 IAN EXEMPT lk1DER BEC. B.�P.G FOq iH15 REASON q U ZDATE OWNER U � � LICENSED CONTFACTORS DECLARATION W � If1EqEBYAFFIRMUNDEflPEWLLTYOFPERIURY�MATIANLICENSEDUNDERPflOVI510N50FCHAPiER � f�WMMENCMlOWITMSECTqN70o0)OFUM510N30F7ME6USINESSANDPROFESSIONSCOOE,ANU Z X MY LICENSE IS W FULL FORCE MID EFFECT. m `� ���E��s ���.�. 33 6..�"3 � _ � � o�h - .- CONTRACfOR � a WORKERS'COMPENSATION DECLAHATION � � I MEREBY AFFIRM UNOER VENAITY OF PERA/RV ONE OFTHE FOLLOWING OECLARATIONS: Z � �IHAVEANDWILLIMINTAINACERTIFICATEOFCDNSENTTOSELF-INSUREFORWOIiKERS' a OOMPENSA7ION,lS ViqVI�ED 9Y5ECT10N 37000F THE LA60N COOE.FOH THE PERFORMMICE W a �E MlORN FOR NMId17H15 PEHMIT IS ISSUED. � I HAYE AND WILL MNMAR!WOPICEHS'COMPEHSATION INSUMNCE,AS REOUIRED BY EECTION O s�oo OFTME IABOR OOOE,FORTNE PERFORMANCE OF TF7E WORN W R WMICMTHIS PERMR IS ^� �� � ISSUED.MY VYORKER' PENShTpN INSURMICE CARRIE D POLICY NUMBERARE: CONSTqUCTION ��. C_.LJ � c�+�n PLAN REVIEW �"a� � ��y�Ep--�� -� ELECTRIC � (M59EORY�NE�NOTBE�Mfl.EfmOFTHEPEAAif16FORqVEM1t�O1tED00l,LARS(Stao�ORlE55) PLUMBING (� Z I CERTIFY hUT N THE PERFORMANCE OF iHE WOfiN FOR WHICH Ti15 PEFMIT IS ISSUE�.1 MECNANICAL "1. � �(`�� SHALL NOT EMPLOY ANY PERSON IN ANY YANNER 50 AS TO BECAME SU&IECT TO TNE * --�`� !�� (�J� NM11iiNE11S'COMPEN9A710NUWSOFCALIFOHNIA,WDAQREEh1ATIFISHOlADBECOME INSPECTIONFEE �S� ay4�":_y'C" � SUBJECT TO TNE WORKERS'CCYAPENSATION PROVI510NS OF SECTqN 970a OF T1E 1A60P �t ��. cao�.i sH�u wan�witr�caMr�r xnni rrros nowsioris. tSSUANCE � v �`1� � '� ~ — 1�_�'', p a��: APPlic�rri: SMIP .0 ��C� . �1 � ENERGY P/C�1� t�r WARNINO:FAILURE TO SECURE WORKERS'COAIPENSATION COVEM/i 5 UNIAWFUL,AND SWLLI BE ^{��_� � SUBJECT AN EMPLOYER TO CRIM WAL PENALTES NJD CIY�L FINES UP TO ONE HUNDRED THOUSAND ��� DOLLAii6(f10D.000�,M ADDITON TO THE COST OF CdAPENSATION,DAMAGES AS PROVIOEU FOR IN ENERGY PERMFr � SECTION 37oeOFi11E LABOR CODE,NITEREST,ANO ATTORNE`f3 F�ES. RETENTYON FEE: 4 CONSTRUCTION LENDING AGENCY 0 PRE•ALT FEE: � IHEREBYAFFPMUNOERPENKTYOFPERJUFVTHAT7HEREISACONSTRUCTIONIENDIN(iAGENCY FOR THE PERPORAIANCE OFTHE WORK WP WHICiI THIS VERMITI9133UE�(SEG JOs7,CIY.C.). � � IENDEW3NNAE C LENDER'SADDRE55 � ICERTIFYTHAiIWNEREAD7HISAPPLICATIONAN�BTATETUTTNE�BOVEWFORM�TIONISCORREGi TOTAL FEES Q I AOHEETO COMPLY VATH ALL CITY ANO COUNTY ONDINANCES N!O 6TATE UWS REUTING TO BUILD WO � CONSTRUCTqN,A!W HEREBV AUTIpRIZE REPflESENTA71VE5 OF THIS COVMY TO ENTEH UPON TXE �BOVE-MEMIONED PROPEHTY FOF INSPECTqN PUNPOSES. COMMENTS 9 0�fr _� 4-�S T�� � PERMITTEE NAME(P � y BqNATUREOF EE DATE � RECPT.NO. PAID 8Y VALIDATION � WHIT —0epartrnant Copy.YELLON/�inance Copy,PINK—Asspssor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy .. . ,1. - � .. � . - .. . � . .. � i . . . . � , . CITY OF DIfi�Fi�QhlD E3AR , . . Itr[SPECTIQ�! i�ECAF3� ..g._,., ..,,;�- .�;�W�- ..�,q..>_�,..�,,,..�.�..�, .�, �,�� •;.�:��-�-;�.-�x�- `.��`.�.�.P� �� � ' � �;' �. ��' �^. ,. . il.�'•�,.��p m�.��.���,!�a;����.... . � _ �.��_-�.�.-� ,, -----�--j-- ' -'-t�--�'---�.'=-- . . .., 5ET BRCK ! 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