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HomeMy WebLinkAbout13466 (24) J� CITY OF DIAMOND BAR ' �' DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)8b1-3117 PRESS �'�^. BUILDING PERMTi'APPLICATION FIRMLY } JOBSI� � �t� DATECATION �Z �� NUMB R � P'C o ADDRESS ��3 / S•I(��r �-CL � c� ISSUE �1 TYPE OCC APN LOT TRACT L O DATE �� ���`7 CONST. GROUP p OWNER � LLL �- "" ADDRESS - { " � ZONING SETBACKS � CfTY ZIP�L�L{�+ TEL. � � n0 FROh7T RW ❑ APPUCANT TEL. REAR ❑ � SIDE/SIDE STREET FiW ❑ CONTAACTO , / t G SIDE O o CfTY E S ZIP� TEL�' s( ' PROPOSED USE '� � I�L�L i a�i ARCHlENG/ � � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. N �ESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION y � DWNER-BUILDER DECLAFUTION . SFR/ADD/REM p I XEREBYAFFlRM UNDER YEN�LTY OF PEKAIRY TMAT 1 M/ExEMP7 FROA1 TME CONTMCTORS LL Garage/Carport � W CENSEUwFORiNEfOILONnNaRfASON(SfC.7o71.SeV5iNE55ANDVROFESSIONSCOOE:�M'CI7YOR (n � COUHTYYN10iRE0URE5APERMRTO00N5iRUCT,ALTEfiW�FiOVE,DEMOUSM,Oi1flEPA1RANYbTAUG W PatioJpeck 7URE,PiWR TO RS ISSVANCE,11L50 REGUIR[S TNE ADPLIGNT FOR SUCN CERAIIT TO FILE A SiGNED � � STATEMEM TMI1T ME OR SH[IS t10EN5ED PUHSUNI7 TO iME PROVISiONS OF ME OONiMCTORS L4 -� CENSE UW(QUPTER 0(CdAMFNqNd WIiH SERION 70D0)OFD�NSION]OF THE BUS:NE55 AND PRO- � PooVSpa iES510N5 WDE)OR THAT NE OR SHE�5 E%EM�T iMEREiFqA1 ANO iNE 6ASIS FOR 7HE ALlE0E0 E%EMP• TION.ANVVICl�T10NOFSERqN707�.68V/WVAPVLIGNTFORAPERMITSUBJFCTSTNEACDLICA4TT0 z RtrR00i � AC7VILFENMTYOFNOT►10REi/wJFNENUNOHED�0.LAiL5(tso01�1: � 04�OWNEROFTHEPROPEqT'/,ORMVEMPLOYEESMATHW.ICESASTHEIIi50lECOMGENSFTqN, O CORIrt1BfC471 ' MALL DO THE WOill(MID THE STRUCTURL IS NOT NTENCEO OR OFFERED FOP SALE�SEG 704,BUSI• J NESS AND VfiOFE5510NS COOE:7HE CONiRACtORS IICENSL UW O0E5 NOT AGPLV T0 AN O'NNCR OF � /MPEiRYW1/08U1D50RIMVROVE57HEREON.IWDYAfOWE55UCNYIDRKHIMSCLFORMERSEIFOR � � TiY1GX)HHI9qiHERONMELIPIOYEES.PROVIDEUTNATSUCHIYPROVEIAEMSMENOTNTEHDEDOR m OFFEfiE0iOH5ALE1F,110WEVERiMEBUIDWOIXiMPRJVE4CM15` 1WITM!NpNETF/WOFCOMPIE• Z 'iION,7HE OWHERbV4DER YALL IMVE TNE BUfL^.EN OF PROVINQ THAT ME OR SME DiD NOT BUttD DR = MVROVE FOH THE MIRPOSE OF SLL�. w OL�ONR(EHOFTMEFROPERTY.MIE%CiUSNELYCWlTMCT�NOW.THLrE45EDCONiMGTORS � TO[DNSTRUCTTNE Vid�IECT(SEC_7oN.B1151NE45 AN�PROFESSIONS COCE:THE CWTMCTORS LI� V31t1Blipll ADJ.ARCA CENSE U'N OOE3 NOTAGPLY i0 AN OIYNER OF A PROVERTY W1i0 BURDS OA 0.1P{1pV[S TNEREON.AND S yqpppl�TpAC75FORSUCNGP61ECT5WITIAWNTRACTOR(i)LICENSEDPUPSUA4TTOTMECONTMG QUANTITY DESCIZIPTION FEE F� TOilSIICEN:E UW). � ❑IAM E%EMPT UNDCR SEC. B.\P.C,fOR 1Ni5 RE/SON Q � U LL' OATE OwNER ''" � U LICENSED CONTRACTORS D[CLARATION W � IMEPEBY�F'iIRNUNDEfliENA�TYOFPE0.NMTMATIAML�C[NSEDUNDERPROVISION'+OFCHA7TEA � ` ' � � � O � �(COAMICNCWO WITH SECTION 7000�d'ONISqN 7 0F T11E B1151NE55AND CROFE5510N5 COO[.AYD Z X MYLICENSEISNFULLFOFGEANDEFiECL m l O ' O 11J 1 O J 2 UCENSE q115S��LIC.NO. 6 `J 1-- � Dl `E-�5 a �'j D�rF��/ 1 y-2_corrrnacTea � LU l Il l�l � • u, �/ r' [� . 4 � WORKLRS'COMPENSATION DECLARATIOV � � d � IMEREBYI1fFIRYUNJEHiENALTYOFVERRJRYONEOFIH[FOLLCYnNCDECIAMTqKS: � N Q 0 _INAYEAlDYlILLMAINTAR7110ERTIFIGTEOFCONSENTTOSELF�WSUREfOfiMORKCR;' _ � � COAIPEN3ATION,AS PROVIDED BY S[CT10N fMn OF THE UCOH CODE FOR TNE�EHFONAANCE `U OFTHE WONK LOR WN�CN THiS VERIIIT IS ISSUCD. � 0 _I HAVE/hU 1N�LL LWNIAW MNNCERS'COY7ENSA'fION MSUiIANCE.AS NEOUIRCO BY SECTION 4O �7000FTHELABORCaCf,FORTHEDE��OH1AAhGEOFTMEWCRY.FONWMiGIITMISPEflMfT15 RSUED.MYYYOR!( 5' YPE�+S(�TpNINSURANCECARR:EAMIDPOL�YNUMBCFME: CONSTRUCTION � qpyEq � �i� PLAN REVIEW � pauerriuraoea � � �� ELECTRIC '"` i � �nss[ctayn[mrroie[m.s�rmoFn[venRt�srona+Ewar�[�Oat.�cs+¢�on�ss, PLUMBING Z �"'.r� •. - Z ICERTIFYTIATNTHEPERFO(iMA.YCEOFTNEWORKFON1Mnp7iH15VERM�T1.`rI55UED.l MECHANICAL G�n (•} SWLLLIqiCMP�OYANYFERS�N�NANYMANYERSOASTOBECpA[SU&JECTTOTME T1J�" , � � WOHI(ER5CW7ENS�TIONLAWSOFCALIFOiWItiM1D�GREF7HATIFISrOULDBECOM[ INSPECTIONFEE • � S SU6IECTTOiHEWORKERS'LOMPENSATqHGiqV1510NSOFSECTION]7ooOFTHELABOR \� , � *` CdOE.ISHAILFORTNWI7MCM�PLVWITNTNOSEPROVIS�ONS. �SSUANCE � � �v {���,� .:•a,) �"`� � SMIP ��� vey i`�'�`� .�.���Y p DATE: APPLICANT; . � ENERGYP/C .•�! C)�� _ ;•.1"` WARNIIM:FALURE 70 SECURE M91iKER5'CW PF.NSATpN CAYERAOE IS UNUWFUL IWD SMAl1 B E � SWJECTANEMP�OVERTOCRI4W�LVEWLLTIESMIDCMLFNESUPTOONEMINDREDiMOU5M10 ENERGYPERMIT � �'�t��ti,` pqUf{5(1700,000),N►DOITION T07T�E COST OF CqAPENSATION,D�CCS AS FROVIDED FOFi IN �t�. ¢ SECTpNl7oeOFT1ELABORCODE,N7FHEST,ANOl1TTOiWEY'SFEES. RETENT�ONFEE: a CONSTRUCTION LENDING AGENCY FR[•ALT FEE: O CL INEREB�AFFI(WUNOERiENALTYOFPEfWflYTNATTME�EIS�CONSTRUCTIONLENOWO�GENCY n- FOR iHE PERFOMIANCE OF iME WORN iOR WHiCM TMIS OEWAii IS ISSUEU�SEC.]oa�,CIV.C.�. � ZL LENDEflSNAME S C LENDEf�SADORE55 wICERTIFV iHAT I NAVE REAO TN�S APVLICATION/NO STATE TMAT T1E ABOYE INFORIAATION IS CORRCCL TOTAL FEES � Z�� � � IAGR[ETOCi7MPLYWITMALIGTYMIDCWNTYOR�INANCCSANOSTATEUWSREUTlqTOBUlC�N6 �� CONSTRUC'f10N,AND MEREBY AUT1qPtZE RE�RESENTATIVES OF TNIS COUNTY TO EMER UPON 7HE . . Z ABOVE�MEMKINEDPROPERTYi0AIN5PECTqNiVRPO5E5. COM�v1EFITS � � E���� _ ��� o�a1,�r�, m PERYITi N�wE(P � ¢ ;/r2� � � SIGNATUR[OF DFAM: D�TE � flCCF'T.N0. PA1D 6Y VALDATION WHITE-0o0artment Copy,YELLOW�inance Copy,PIN1(—Assessa Copy.GOLDENROD—Fla Copy,GREEN—Applicent's Copy . . . . � . � .. .. . . .. . .. .. . . ' . , ' . . � . ' .. . . 1 r. . . . , .. , CITY �F DIAh��f�D E3AR � .. � ltdSPECTIO�J RECORD . _...,�...�___.___ _.._. . .__ ,._..... _ .� ._ . .. . _ --� ' 1►'!-'1:��.1�'I�l��i ��_'�_1�= !.1►��-��=c`'I��;,j� +� �►E���=�,��;..�il^l►�I +� 'd�':'�i'= fi`E�`�-�=��::�¢��� . .. .�._.._.._.. __..__.._.,..._....r_...._.._._..___.._....J. _...r___ .��..._.�.�.___----._4.,�y..........___._:.._�.__.....__.._,. _ ......_._.,. .. .. .. .. ...,- -- -- SET BACY . . ��•'�- ' ,, � . FLOOR J015T � � � _.,� . ., . 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