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HomeMy WebLinkAbout14272 CITY OF DIAMOND BAR EX PI R ED �-�— DEFARTMENTOFCOMMUNITY&DEVELOPMENTSERVICES � . 21660 E.Copley Ihive Suibe 190 D E C 01 2000 pRESS (909)860-3195 Fax(909)861-3111 '��°�^� BUII.DING PERMTT APPLICATiON FIRMLY o DORESS��7R �'�' I L�� �,�1(J�' pA�CATION-I ' �/ NUMBER /�X`C � ISSUE TYPE OCC APN LOT TFACT DATE CONST. GROUP �j OWNER /4iE'.'T�f/� /�� LL ADDRESS /LV ZONING SETBACKS � CITY O//I"MC�� ZIP E REAR pW ❑ APPiICANT TEL. SIDE/SIDE STREET RW ❑ CONTRACTOR�..� ' N SIDE ❑ � ADDRESS n f�n��4'-�1�f1 PROPOSED USE �DL�TI(��,',�(� C�'ry � �'�//�!f� ZIP ��(F✓TEL I=/l I/�� T � ARCHIENGJ DESIGNER NO.pWEL. NO. NO. ADDRESS UNITS STORIES BEDRO�MS � CITY ZIP TEL. y DESCRIPTION S�.FT. FACT�R PSF ADJ.AREANALUATION � ¢ OWNER•BUILDER DECLARATION SFRIADD/REM O 1 NEREBY AFFlFM UN�R PENILLTY OF PERRINt TIU17 1 AM E7cEMPT FROA1 THE CONTPACTORS LI• QB�A9q(��K CENSELIIWFORTNEFOLIOWINGHEA£ON(SEC.7011.68USINESSANDPi�FESSIONSCODE:MIYCITYON (n COUHttWHK]iREQMESAiERMR7000WSTRUCT.ALTER�PROVE,DEMOLISN.ORREP44RANYSTRUC- W PB��O/D9Ck S7� TURE,VRqR TO RS 169UMJCE,AL.SO REOI11RE8 THE APPLICANT P�H SUCH VERMIT TO FILE A SIQNED W iTATEYENT tHAT HE OR SHE IS LICENSED PURSUIINT TO TIE 7imNSIONS OF iHE OONTMCTOFIS ll- CENSE LAW(CFUPTER a(COASMENGNG WI7H SECTION 7000)OF OIYWION a OF TME BUS�NESS AND PRO- � �OVSpB FE93fONSCODE)ORTHhTHEOR9HE15E%EMPTTNEREFRpAANDMEBASISFOHTHEALLEOEDE%EMP- (� TION.ANY VpLATpN OF SECTION 7031.6 BYANY MPLILANT FOR A PEFiM17 9U&IECTS iNE APPLICANT TO Z Re•Rooi � A CML VENALTY OF NO7 MORE TW W FlYE XUN�RED DOLURS(iGao).): o OI,ASOYVqEROFTHEPfiOPERTY.OHMYEMPLOVEESWITHWAOESASTHEIR90LECOMPENSA710N, 0 COTT91CI81 � Z MRl DO 7NE WOi1K,AND THE STRUCTURE IS NOT INTENOED OR OFFERED GOR SAIE ISEC.MN,BU51- J � ME95 MJD MiOFES510N3 OODE THE OONTMCTWlS UCENSE LAW OOES NOT APPLV TO/N OWNER OF = PROP6ATV MM1IO BUN.OS OR MPIWVES THEREON,ANO W11000ES 9UCN MARKXIMSELF OR HER6ELF OR � THROUGHHSORHEROYJNEAAPLOYEEB.PROVIDEChIATBUCfIMPpOVEYENTSMENOTWTENDFAOR m OFFERED PDR9ALE i,FqWEVEi�iHE BUILDIN(i ORIMPROVEMENT�SOID M/1TMIH ONE VEAROF COMPIE TqN,i11E OWNER3UILDER YALL MAYE 7'ME BUROEN OF YROVINO RMT HE OR 9HE OIO NOT BUItD OR 1AVfiDVE FOR7NE PURPOSE OF SALE} W 04ASU1NNEROFTIEPROPERIY,AYEXCIUSNEIYCON7NACfWOWITHIIC�VSEDCONTMCTOfi3 � TO CONSTAUCT TME PROJECT ISEC.7d4,BUSINESS AND PIIOFESSKKi3 CODE THE CANTIUCTORS LI� VeIIINIWI ADJ.AHEA C@/SE UW�OESlqi MPLY TO AN OWNEN OF A VROPERTYMh/0 9UIlD5 OII MPROVE9 TNEREON,AND WHOOqJTpACTSFORSUdIPROJECTBWITHACONTiiACTOR�S�LICENSEDPUA9UANfTOTHECOIJTMG pUANTITY DESCRIPT'ION FEE � TORS LICEN6E IAW.). ❑1 AM E](EMCT UHDEfl SEC. B.i C.C.FOR TFIIS REASON U LL F DATE OWNER V ��[ UCENSED CONTRACTORS DECLARATION w ¢ INEREBY�FFIRA/IpiDERiENALTYOiPER1URVIHATIAMIICENSEDUNDEfIPflOV1910N50FG1MTER � � /(COYMENCNKi YYfIM SEGTqN 7000)OF DMSiON]OF TNE BUSINE9S AND PROFE99qNS WOE,AND Z W LICENSE 6 N FLLL FORCE AND EFFECT. m � LICENSE CUS9�Z 7-r�3 IIC.NO. .,����� � F.. � � DATE_,� CONTMCTOR ' WORKERS'CaMPENSATIOND LARATION y I MERE2YAFFlRM UNDEA PENALTY OF PERJURY ONE OFTFIE FOLLAWINO DECLAfUT10NS: U � Z Q G _IFMVEANDWILLMAINTMNACERTIFlCATEOFCONSEMTOSELF-INSLIREFOAWORKERS' _ 001IPENSATqN,ASVROVIDED9Y8ECT10N97000FTNEl.�BORCOOE,FORTHEPERFOflNANCE U � OFTiE WOFIC FORMMIpI THIS PERMIT 191SbUE�. � _I IUVE AND NALL MAIMAPJ WORKERS'COMPENSATION INSUiIANCE,AS qEWIFlED BY BECTION /� � 9)0o OF 1NE LABOR COOE,FOR TNE GERFORM�NGE OF THE WORN fOR WM1CH THIS PERMR 19 () ISSUED.MY WORKERS'ODIAPENSATION INSUMNCE CARRIER MID POLICY NUMBER 11RE: CONSTRUCTION ��p � !� '! \I� � CMRIER ��{��.Ts.j/CI A PIAW REVIEW � (]� � / � POLICVIUMBER���(� ELECTRIC 0 �n�ceEcrpdr��wrBEaar.�.ei�aFir�aEr�irsFloaor+Ehur��oou.vtsR+mlaq�Ess! PWMBING T � 1 CERTIFY TlMT IN iHE PERFORMANCE OF iHE N'ORK FOR WHICH TMS PERF�I715ISSUED,1 MECHANICAL ��T■ ■ � SHALL NOT EMPLOY ANY PERSON W ANY MANNER SO AS TO BECOME SUBJECT TO THE y WORKERS'COMPENSAT10NlAW50FCALIFORNIA,AN�AGREETHATIFIBNOUL�BECOME INSPECTIONFEE SUBJECTTOTFIEVNORKERS'COMPENSATqNOROVI510N50FSECT10N37000FhIElhBOFi _ � S CO�E,1 LLFONTMHITNCOrAPLMWITHT106EPRONBIONB. ISSUANCE p OATE:� APPL�cnrdr: LC/ y�(�L/j.'j ��i�/ SMIP ,� �^� � WARNINf3:FNLURETOBECUREWORKERS'COMPENSATIONCAVERAOEISUNU'NFUL,ANDSFUILBE ENERdYP/C � SUBJECTAN EMPWYER TO CRIMINAL VENALTIES Ml�CNIL FINES UP TO ONE NUrDPEDTiKK15AND ENERGY PERMIT r y, OO�Wi9(i100,0u01,��DI710N70THECOSTOFCOMPEN5A710N,DAMA0E5ASPROVIDEDFORN J SECTION 9708 OF THE UBOR CODE.MEREST,ANDl1TiORNEY'S FEES. RETENTION FEE: QLu c� CONSTRUCTION LENDING A6ENCY PRE-ALT FEE: O � 1 HEREBYAFFlHM UNDER PENAL7Y OF PERIUM THAT THERE W ACONSTRUCTION LEN�WO ACENCY FOR 7HE PERFORMANCE OF TIIE WORK FOR WHICM TXIS PERMIT IS 183VED(SEC.]OY7,CIV.C.). 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