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HomeMy WebLinkAbout16908 (42) % J� CITY OF DIAMOND BAR i DEPARTMENT OF COMMUTTITY&DEVELOPMENT SERVICES ' ��� 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS • ��%::� BUILDING PERMIT APPLICATION FIRMLY • o ADDRIESS �9�-g .���(��K y�fc�� DATECATIO�N^D� �d I NUMBER� #,C � ISSUE Ei TYPE OCC APN LOT TRACT DATE�� D�� �f CONST. GROUP p OWNER "" ADDRESS �9 Z�I S'1�(L� /J G ZONING SETBACKS z CITY ���,LIZ/S�L ZIP TEL. FRONT RW ❑ g APPLICANT TEL. REAR p SIDE/SIDE STREET RW ❑ � CONTRACTOR � � �n-/ SIDE p oADDRESS ' —r � PpOPOSED USE_�i�%r^ �✓.ic�/1�7� �/F_ o CITY WJ;L�"r ZIP TELy' o ARCH/ENG/ `z DESIGNER NO.DWEL. NO. NO. n. ADDRESS UNITS STORIES BEDROOMS � CIN ZIP TEL. � v� DESCRIPTION Sd.FT. FACTOR PSF ADJ.AREANALUATION p� OWNEFi-BUILDER DECLARATION SFR/ADD/REM O p 1 NEREBY AFFIFM UNDER PENILLTV OF GERIURv THAT I IU.�EXEMPT FROA1 THE CONiMCTORS LI- G2r0gelCdfpOR W CENSEUWFOHTHEFOILOWINGREA50N(SEC.7071.SBUSIN[SSANDVROFESSIONSCODE:MIYCITVOR (n CJ COUNTYN711pIRE0UIRE5APERAIITTOCON57RUCLALTEF.IMVRJYE,DC1A0L15H2ORREPAIRANYSTRUG W pati0/Dbtk TURE,PRIOR TO RS ISSUANCE.ALSO REWIRES iME ACPLIGNT FOA Sl1CH VERIAIT TO FIIE A SICNED W STA7EIAENT 7HAT NE OR SHE IS LICENSEO GURSUAN7 TO TME OROVISIONS OF TNE CONTRACTORS L4 W � CENSE UW(CHM7ER Y(COMMENCIN6 YAiH SECTqN 7000)OF DIV1510N�OF TH[BUSiNE55 MID PRO- � PooVSpa FESSqN50DDE�ORTHATHEORSHEISEXEMPTTHER[FRpAAYOTHEBA515FORTHEALIECEDEXEMP- (� V TqN.NiYYIOLATKKi OF SECTION 7071.5 BY ANYAPPLICANT iON�PERMIT SUBJEGiS THE APPLICANT i0 Z Fjg.Rpp} � A CML VENA�TY OF NOT MOHE THAN FIVE MUNDRED DOLLARS(fSooJ.�: p O�ASOWNEROFTHEPROPENTV,ORIAYE�PLOYEESNnTMWAG[SASTHCIqSOLECOIAPEN5A7lON, O COmmErCi31 Z W:LL DO THE WORK AND THE STRUCTURE IS NOT IMENDED OR OFiEHED FOR SALE(SEC.70a�,B'JSi• J � NC55 ANO PROFESSIONS CODE:ME CONTMCT00.S IICENSE lAW DOES NOTAVPLY TO AN OWNCR OF j V R07ERTV W410 BUrtDS OR MVROVES THEREON.AYD NM1IO DO[5 SUCH WORK HI45fLF OR HCRSELF OR CL THqOUGHHI50RHERONMEMPLOYEES,PROVIDEDTHATSUGIRAvppVEI,lENTSARENOTINTFNDE00R C� QOFFEREDFORSALE.IF,HOWEVEi�T1EBULDIN�ORIMVROVEMCMI550LDWRHI40NEYE�ROFCOMPLE- Z TION,THE OWNER�BUILDER WILL MAVE TNE BURDEN OF PROVING MAT ME OR SHE OID NOT BUIID OR = W PROVE FOR THE PURPOSE OF SALE). w 04ASOWNEROFTMEPROPERTY.MIE%CLUSNELVCONTMCTINGNn7H�ICENSEDCANTRACTORS (L TO CONSTRUCT TH[PR0.IECT(SEC.70t1.BUSIN[SS AN�PROFESSIONS CODE:TME CONTRACTORS U� Valu3liorl G� ADJ.AR[A W CENSEUWDOESNOTAPPLYTDil40VMEROFAPROPERTYMTIOBUILDSOHMPpOVESTNEREON.ANO � N/qCONTMCT5�OR5UCHPROJECT5W1T11AC�OHTRACTOR(5)LiCENSEDPURSWNTTOTMECqJTRAC- QUANTITY DESCRIPTION FEE � TORS lKENSE Uw.). � ❑I AM E%EMPT UND[R SEC. B i V.L.iOR TM:S REASON Q � U � � DATE OWNER V � W � LICENSED CONTRACTORS DECLAFiATION W � INEREBYAFFIPoAUNDERPENALTYOFVE0.NRYT/UTIAIAUCENSEDUNDERVROVi5lON50FCMAGTER � � Y(COMMCNCWOWITMSECTION70W70FDIVISION�OF7MEBUSINESS�NDYROiE55lON5CADC,AND Z ��� MY LICENSE IS IN FULL FORCE AND EFFECi m � LICENSE 55 � IIC.NO.��°��Z j V DATE �� '� Q CONTFL4CTOR���1- �f�(�-T�/ d W � WORKEFIS'COMPENSATION DECLARATION -� a � U � IHEREBVAFFIPYUNDERVENALTVOFVE0.NRYONEOFTMEFOLLOWINCDEd.AMT10N5: Z Q � �I HAVE MlDK9LL MUNTAIN 11 LERTIFICATE OF WNSENf TO SELF•INSUR[FOH WORKEAS' _ CqAPENSATqN,115VROVIDEDBYSECTION71000FTNELA80RCO0E,FOfiTNEPERiORMANCE U � OF iHE WORK FOR WHlpi fHIS VERMIT IS ISSUED. � � �I HAVE AND WILL MAINTAiN M/ORKERS'COMPENS�iION INSURANLE,AS REWIRED BY SECTpN Q J7000i iHE LABOR COOE,fOR iME PEFFORMANCE OF THE WORK FOR WN�CH THIS PERMIT IS �/v � ISSUEO.MYWORNERS'COA/PENSATIO NSURANCE RHIERAN�VOIICYNUM�ENARE: CONSTRUCTION ��9 Q � CARRIER CT � V PLAN REVIEW Z va�cY NUM6ER_ _�, ,�i r O ELECTRIC ¢ 0 (M65ECf10NNEmNOT8GO0M1itFfEDOF7FEPERM76NOFGf2Hft(iC�00IWYSRt001«1LC55} PLUM6ING Z I CERTIFY TUT N THE PERFONIANCE OF TXE WORN FOR WHILH THIS PERMIT IS ISSUED.I MECHANICAL (�} SNALL NOT EA!PLOV ANV OERSON W ANY MANNER SOAS TO BCC/J�E SU�JECT iOTHE � VYORKERS'W�aPENSATqN�AWSOFCALIFORNI0.ANDAGREETHATIFISMOlJLOBECOME INSPECTIONFEE S SUBJECTTOTHEWORKERS'CO��PENSA7qNPROV1510N50FSECTiON]�OOOFTH[LABOR • cao',i sM�{L FORTNw;rn cana�r win�rwse e�ov�rons. ��� ISSUANCE p OATE:(� �)U/ AOPLICANT: j���f��� SMIP _�U J ENERGY P/C J WMNING:FAILM[TOSECUREY+OfUCERS'CAMPENSATqNCOVENACEISUNUwFUL.AN�bW�LLBE �y SV0.IECTANEMPLOYERTOCR:MINALPENALTIESIWDCIVILiINESUPTOONEMUNDREDTHDUSAND ENEAGYPERMIT WlUUiS(f 100.000).N ADDITION TO TME COST OF CqAPENS�TqN,D�MAG"c5 AS PROViDED FOR M � SECTqN]7t!OF iH[LABOR CODE.INTEREST,AND ATTORN[YS FEES. RETENTION FEE: �'' ow.. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � INERCBYALFIRMUNDERPENALTYOFPERNRYTHATTHEREISACANSTRUCTIONIENOiNG�GENGY /� nZZ- FOR THE PERFORMANCE OF THE WORK FOR WMIp/7H15 PERMI715 ISSUEO(SEC.]oa�,QV.C.�. �T y� LENDEf75 NAAIE�(ALy�� � � LENDER'SAODRF55 �� �L � ��� � TOTAL FEES rT�a a ¢ 1 CERTIFY iMAT I HAVE READ THIS APPLICATIDN AND STATE iHAT TME ABOVE INFORAIATION IS CORRECT. W IAGREE TO COMPIY WITH ILLLCITY AND COUNTY OR�INANCES AND STATE UWS PEUT WG TO BUILDING � � CONSTRUCTION..WDMEREBVAUTHOR12ER[PRCSENTATNESOFTHISCOUNTYTOENTERUPONiHE z A80YE-1AENTIONED PROPERTY LOR WSPECTqN VURPOSES. COMMENTS� / O����� o �� a ��L �,� n , � m PERMIT7EENMAE oRi ���r-�r/___11f�-�,Qrj+�Q ,���� � � 1 J7 y SiGNA, � �' IR DATE � � AECPT.NO. . � _PAID BY ' VALIOATION WHITE-0epartment Copy.YELLOW—Finance Copy.PINK—Assessa Copy.GOLDENROD—File Gopy.GREEN—ApDlitanl's Copy . . . . ............ �............_..,.. .,. , ,� • � � , - � r. 7 r . . , . . . .-"--- .. . �I i 1' OF '�i��(��OI�3Q �f-�I� 6tE'Sr-'��C'�lOi� ��:CO;:D I►��-'i��=f:I'I�.I►�� ' �1�G't:��_--��,k�'i::l:;c��rsa;.------I��k=f.l�:c ['l�'1►'! 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