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HomeMy WebLinkAbout13169 1� CITY OF DIAMOND BAR � �-- DEPARTMENT OF COMMLINITY dc DEVELOPMENT SERVICES �� , 21660 E.Coplcy Drivc S�dte 190 (909)860-3195 Fax(909)861-3117 PR ESS � �^�� BUII.DINGPERMITAPPLICATION FIRMLY o ����TE S',�►�3 T/IL APPLICATION PERMIT P/C ADORESS DATE NUMBER�� x � APN LOT TRACT �SSUE .�J /�}�(�/] TYPE OCC � DATE � v 1 ` �"1 CONST. GROUP OWNER ADDRESS ZONING SETBACKS �� CIT! ZIP��TEL �9�/!/ REART RW ❑ APPLICANT TEL. SIDFJSIDE STREET RW ❑ CONTRACTOR - SIDE ❑ g ,ADDRESS CITY ZIP TEL. PROPOSED USE � ARCWEN DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL y DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � OWNER•BUILDER OECIARATION SFR/ADWHEM O � 1 HEREBY AFFlRM UNDEii VENALTY OF PERRIRY TW�T i AIA EXEMPT FROM TNE CONTRACTORS LI• ��e�8�rt CENSEUWFORTNEfOILOWNGREA90N(SEC.70.t7.6BUSINES3ANDPROFESSIONSCOGE:/lJYC11YOR (f� COUHTYINMICMREOUIRE511PERMRTDOOfiSTRUCT.ALiER,OdPROYE,OEMOySM,ORREPAiRAN1'STRUC- W Patio/Deck 11ME,PRIOR TO R9 IBSUANCE,AL60 ilEdllqES TNE MPLICANT FOR SUCN PERIJIT TO FILE A EIONED W 6TATFYEM TNAT HE Oit 81E IB LICENSEO PURSUIWT TD THE PROyISIONS Of THE CON7RACTOil8l4 � CEqSE LAW(CNAP7EN V(OOMMENCINO WfIH SECTqN 7oDo)OF pYIS10N a OF T11E BUSINESS AND PRO LL' POOVSpe FEffiIONS C�OFJ OR TW�T NE OR SNE IS IXEMP7 T/iEREFROM AN�TNE BASIS FOR TNE Al,LEOED EXEM0. TION.ANYVqlAT10NOF8ECT10N'M�1.6BYANVMPLICANffONAPERMITSVBJECiBTHEAPPLICANTTO z F{g•ROO} � ACML iENALiY OF NOT MORE 1HM!FI4E 1%1NOPE�UOLINiS(i5oa1.): � ❑�ASOWNEROFiNEPqOPERTY,ORMYEMPIOYEESWITHWMESASiMEIR50LECOMPENSATqN, � Cp�7ry�BfClel MIILL 00 THE N�ONC ANO 1NE BTRUC7UqE IS NOT MTENDEO OR OFFERED FOp B�LE(9EC.7o�a,BU51• „J NE85 MID PADFE5910N5 COOE TNE CONTMCTORS t1GEN9E IAW OOES NOT MYLY TD AN OWNER OF � YROPERfYMhiOlUlD50RYPiqVES7HEREON.MIDMh1000ESSUCHWOAKH145ElFORMERSELFpq � � TNROUOIi HIS OR HER ONIH E41PlAYEE3,Pi�VIDED TMAT SUCN MAPROYEMENTS ARE NOT INTENOED OR m OFFERW FDR SNF IF,IqWEVER 7HE BULDM100R NAPROVEM'cNTlB SOID WITNINONEYEMOF COYPLE TWN.IME OWNER�URDER WILL IIAVE TFIE BURDEN OF PROVWO iHAT HE OR YHE D�D NOT BUILO OR MPROVE FOR THE PURPOSE OF SALE1. � OtA60NMEROFTF/EPROPERTY.AMO(lYlI3NELYCOHTqACTIN0YN7MLICENSEDCONTR�CTORS TO CON57RUCT iHF PROJECT(SEC.7ot�.BU81NESs MI�PROFESSIONS OODE:7HE CONTilAC70R6 L4 yelufltfOn ADJ.AREA GENSE lAW DOES NOT MPIY TO MI OWNER OF 11PROPERTY YYFq BVIIAS OR M1pROVES TNEREON.ANU YVFWCONTRACTBFORSUCNPR6IECTSWITiACO1JiMCTOR(S)LICENSm/UFSUANfTOT11EWt1TRl,G QUANTITY DESCRIPTION �E � tOqS UCHJSE UW.). ❑1 AM E%EMPT UNOER BEC. B.�P.C.FOq 7HI5 REA90N Q � U V' DATE OWNER � � � LJCENSED CONTRACTORS DECLARATION W � INEREBYAFFIiUAU1DERPEWLLTVOFPE0.N11WTFIATIMALICENSEDUNUERDROVISIONSOFCFIAPTER � s 0�COAIMENCIH[i YYlhi 8ECTION 7000)OF DMSiON 9 OF THE BUSINESS i41D PROFESSqNS CODE,AND Z '; YY�ICENSE�S W FUl FORGE MN EFFEC7'. m � UCENSE CLASS (--1� LIC.NO. �S ./I j DATE��►--����CONTRACTOFI � d 4VORKERS'COMPENSATION DECLARATION � � IMFqEBYAFFIq1AlpNERPEKLLT'OFPERIVRVONEOFTHEFOLLOWINOOECUIMTIONS: Z � �I/UVEAHDMALLMMJHTANiACEfiT1FIGTEOFCONSENTTOBELF-IN9UREFORNqFiKERS' _ COMPENSAflON,AS PROVIDED BY SEGTON 3NOOi T11E U1BOR GOOE,FOR7}IE VERPoRMANCE `U Q WORK FOR NMIRI TH4S VERI.IR IS I6SUE�. � �F7 1 MAVE AND W�LL IMMTAIN WORKERS COMOEN5AT10N INSURANCE,AS RE�UIREO BV SECTIDN Q ]700 OF THE LABOH CODE,FOR TNE PERFORMMICE OF THE WORI(FOH WHICH THIS PERMI7IS � ISSUED.IAYWOi1KERS'COA/7ENSATIONINSURANCECARRIER �POLICYfJUA1BERAFE: CONSTRUCTION — � .� �• � clwwen �.�_��i�-�� PLANREVIEW —�1�.�. � POLICYNUAIBER ELECT'FlIC � massEc�qN�raoraEoa.ctE�oaF�rE�rs�on�tunOr�000�WLsb��l��ss? PLUMBING _ -^ Z I CERTIFYTHAT INTMF PERFORIdANCE OF 1HE WORK FOR WHlpi iH15 PEAMI715135UED.1 MECHANICAL ������ � (�' &1KL NOT EMPIOY MIY iEflSON W ANY MNINER SO AS TO BECAME SUBJEGT TO THE ��P�ti' p��laz� � „ � NfORKERS'COAIPENSATqNUW50fCALIFORNIAANOA�REETHATIF16HOl1L�BECOME INSPECTIONFEE r'+ 8U&IECTTOTHEWORKER6'COMPENSI1710NOROVISIONSOF6EC SlaDOFTHELA80R ,�,y s cooe,t swui�mirrrmrn coMa�v rnn+T rrrov�sroNs. � ISSUANCE ��s�L O(�� � OA7E:�APPLICANi: �q SMIP ����3 • WMNINO:FAI�URETO6ECUREWOXKERS'COMPENSATIONCOVE GEISUNLAWFUL,ANp&1KLBE ENERGYP/C � BU61ECfANENPLOVERTOCRIMINALPENALilEfiM10CNILFlNE511PTOdJEH11NDRE�TMIXISAN� ENERGYPERMIT DOLI.MS�{t00,00D),IN ADOITION TOTHE COST OF OOMPENS�TqN,Dl1MAGE5 AS PROVpED FOR IN � BECTpN770�OFT1EI,ABORGOOE,INTEREST,ANDARORNEVSFEES. RETENTIONFEE: O CONSTRUCTION LENDING AQENCY PRE-ALT FEE: � � 1 NEREBY�FfIRM UNDER PENALTV OF PERJURYTFI�T THERE 18 ACONSTRUGTION LENDIN4 A(3ENCV Z FOR i11E PERFORMANCE OF7XE WORK fORYA1ICH THIS VERM1715ISSUED(9EG 3oG7.CIY.C.�. W � LFNDER'SNAME �� �S LENDER'SADOHE55 W ICERTIFYTMqTIHIWEREAOTiIS/1PPLIC11TqNNIDSTATETHATME�BOVEINFORMATIONISCORRECT. TOTAL FE�S d 1 J14REE TO CdAPIY WITH ALL CRY ANO COUNTV ORDINANCES M1D STATE U�NS REUTINO TD BUILDINO � CONSTRUCTION,AND MEREBY A47M1IDRYLE REPRESENTATIVES DF THIS COUNTY TO EMER 11PON TiE ABOYE-MEN71qV�PRDVERT'WH INSPECTION PURPO6E5. o /� COMMENTS J 4 C � L 5�/V � QVEqMITTEE1UMEfP 1 � N Vj 816NAiURE OF F DATE � RECPT.N0. PAID BY VALIDATON WHITE--0epartment Copy,VELLOW—Flnance Copy,PINK—Aesesaor Copy, OLDENROp—Fik Copy,GHEEN—Applicant's Copy , CITY OF DiAMO1�D E3�4R IF�SPECTIOt�! RECCJRt� � _ K�;���.� � �� � � �" E �'��'�'��� •w����'�' , - ► SE�BACK • ' � FLOOR JC�1�7 . 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