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HomeMy WebLinkAbout15708 (23) * 1� C1TY OF DIAMOND BAR DEPARTMENT OF COMMUNTTY&DEVBLOPMENT SERVICBS � zi�o�.c�ioynri�e s,�c�i90 PRESS (909)86a3193 Fax(909)861-311? '�M�� BiJQ.DING PERMIT APPLICATION FlRMLY � JOBSITE I� / S�C'/�R �n� APPLICATION t D D � PERMff � ! P/C o ADDRESS � w «��' DATE �� NUMBER � i $ ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP � OWNER p ADDRESS L ZONING SEfBACKS CITY ZIP TEL. O (� FRONT RW p APPi.ICANT TE REAR ❑ SIDEISIQE STREET RW O ADDRESS O/ ( � , SIDE O � CITY ZIP TEL. PROPOSED USE � L i ARCWENGf f_ �'. !3 Tr� ! /_ a � ADDR SS NO.DWEL. NO. �� ����NO. UNITS STORIES BEDROOMS CITY ZIP TEL. N DESCRIPTION S�.FT. FACTOR PSF AOJ.AREANAIUATiON Q ONMER-BUILDER DECLARATION 5FFVADDfREM O I MEREBV AFFlfiI INDER YENALTY OF PERIURY TMAT 1 MI EXEMP'f FROM T11E CONTMCTORS LI• ('j818901C81pOR CENSEIAWFORTHEFOl4�1MINOqEAuONI5EC.70s1.5BU81NE5SIWDOHOFESSqNSCODE:ANYG7YOR (n OOUHiYMM1i1CM11EOl1WESAPEAIAITTO00N8TFUCi,ALTEfiMPROVE.DEMOLISX.OHREPAIflANYSiAUC- W patioNeCk NRE.M�OH TO R8 133W WCE.KSO REOU�REB 7HE APPLICiWT f011 BUpI PERMIT TO FILi A SIONEO W STATEYENT TNAT ME OR BME IS 110ENSEO PURSIIANf TO iHE PROVISIONS OF 7HE CONTRACTORS ll• CENSE LAW(CHMiER 0(COMMENCMIO VATH BECTpN 7a00)OF DMSION!OF THE BUSINE89 AND PRO- LL POOVSPB FESSqNSCODEJORiHATNEOR9HEISFXEMPTiHEREFROMAN�ilIEBA518FORT1IEALLEOEDE%EMP- ('J TqN,AN1'VIOIATqNOF6ECTM1ON7Wt.6BYANVAPPLICM1TFOilAVEHM1iSUBJEGiBTHEAPPLIGWi70 Z Re-Roof Z � ACMLGEWLTYOF NOT MONE TMAN FIVE HUNDXE�DOLLAR9(Sc00).): O6R9GMMEROFTHEPAOPEN7Y.ORMYEMCLOYEESWITHWMiESABTNEIR60lECOMPEHbA710N, C� COmr1lBfCiBI MLL 00 7Mff MIONK.M10 TME STRUCTURE IS HO7 IN7ENOED OR OFFERED FOR 611LE(SEG 7oN,BU81- J NESS AND VMFE89PON3 OODE:THE CONTPACTOR9 L�CENSE LAW DOES NOT APPLY TO AN OWNER OF ? � PiqPE�1TYMkqBl11LO5d11YPROVE3711EqEON,ANOWHODOESSUCNIYOHKMPASELFOqHEHSELfOIi � iNfqUGHN190RHEHON'NEMPLO`/EES,Pp01MDEVhU1T8UCHMPROVEMENTSARENOTWIENDEDOR m OFFEqm PDR SALE IF,IqWEVER7iEBUldN00R W PIIOYEWBJ718 SOL�WITHIN ONEYEAROFOOMPLE- �TION,iHE pYNER�BUIIDEN WILL FIAVE THE BURDEN OF PROVINo THA7 NE Oq SHE WC NOT BUIID OR MVROVE FOft THE OURPOSE OF SALE�. �4�ONMER OF iNE PROPEIRY,AM EXq.USM0.Y OONTMCTINO NAIH LICENSED CONTRACTORS TO OONSTRUCT 1ME PRQIECT(SEG 70N,B1181NE3S MA OpOFES810N5 COUE:7FIE CIXJTHAC�OPS LI• V81U811011 �O ADJ.AREA GENSE LMY DOEE NO7APPLY TO AN OWNER OF A PPOPERTY WFIO BUIL�S OR N1Pf1DYE9 hIEREON,AN� WIIppDNTqACI8WR9UOlOqO,IECfSWIhIACONiAACTON�S)LICENSEDPUFI9UNlfTOiHECONfMG OUANTITY DESCRIPTION FEE � TORSUCENSEUYY.). ❑IMI EXEMPT UNDER SEC. B.i P.C.FOR iHIS REASON � U �= pA?E OWNER � �d � UCENSED CONTFlACTORS DECLARATION W ¢ �HEREBYAGFYWUNDERPENALTYOFPERIUHY7WRIAMLICENSEDUNOERPROYISIONSOFCHAPTEP � s •(COAI►IENCYN3WRNSECT�ON7000IOFOIYISION90FTFIEBU5INESSANDPROFESS�ONSCOOE,AND Z !G W LICENSE IB MI FIKl WNCE IND EFFECT. m 0 LICENSECL�yS�S LIC.NO._J ,�� J � pATE V � CIXJTRIICTOR � a WORKERS'COMPENSATION DECLARATION a y IMEHEBYAFFlRMUNOERPEN�LTYOFPE0.IV�'ONEOFTNEFOLLOWINGDECLAi1AT10N5: U � Z a Q �1lMYEANOWILLLIAINTANACEFIIFICATEDFCONSENTTOSE�FiNSUREFOIiW'ORKER9' 2 < OOYPENSATION,119PROVIDEDBYBECTION97000FTHEIABOiiCODE,fOATMEPERFORMANCE U � Oi TIIE WOqK FpR WHICFI THI9 PERMIT B 165UED. � � �I HAVE AND WILL AwMAN WORKERS'WMPENSRTION INgUMNCE,AS REWiRED BV SECTION � f7000FTMELABdiCOOE.WR7NEPERfOqMMlCEOFTIIEWORKFOflMMICN7HI5PERM1T15 � � = ISSUED.MY WORK 9'COMPENSATION INSURANCE RIER AN^O PO^LICv�NUMBERA��RrE� CONSTRUCTION j c.�qNEp � � �� �'�-~` PLAN REVIEW � POLICVMlA9ER � ��1��'� ELECTRIC 4 � (n�ss[cnor+r�IDwreeoor.aErmar�aEnart�swna+eMranmoaursR+�)oAt.�ss1 PLUMBING Z ICEFiTIFYTW�TINiHEPERPoflMNJCEOPTNE�M�DRKFORYMICHTF115PERMITISISSUED,I MECHANICAL , � SFNLL NOT EMPLOY ANY PERSON IN ANY MANNER b0 A5 TO BECOLIE SUBJECT TO THE (/� MKIRKEHS'COAIPE�TqNLAW50FG/LLIFORN�A,ANDA(IflEETM�ITIFIBHWlOBECOME INSPECTIONFEE SUBIECT TO TFiE WORKERS'COM7ENSATION PROVISIONS OF SECTION]700 OF THE UBOH � p cwe�Iis�uu nicouP�rNnn+nasevrahsior+s. ISSUANCE � p �ATE:�j��;�mmAaPLICAN7: .�_�__ SMIP � � WARNINO: AILUNE TO SECUHE WORNERS'COMPENSAipN RAOE 18 UNUWFUL,ANU SHALL BE ENERGY P/C ODY— S1161E4TINEYVLOYERTOCRIMINALVEWLLTIESANOGMLFINESl1PTOONENUNOREDi/10U5AN0 ENERGYPERMIT �I��'' � DOLLAAS(ti00,000),W A[1DRION TO THE COST OF COMPtT18ATION.DAMA�ES 113 PROVIOEO FOR IN � SECTqN�10lOiTHELABDRLOOE.p1TERE5T.ANOATTOIiNEY'SFEES. (j�'ENTIONFEE: a CONSTRUCTION LENDING AGENCY pRE-ALT FEE: O � IHEREDYAFFlRMU�ER►EHALTYOFPEqJURVTNAT7HEREISACONSTPUCTIONLENDINOAOENCY FOR TIE PERWRMNICE OF Tl1E WORK FOfl WMIq1 THIS PERMIT 19 ISSUED(6EC.]097,CIV.C.�. � �Z LEN�EH'8 W1ME r � LENDEP'311DDHfigg /''� � I CEqTIFY TW1T 1 XAYE READ THIS MPLICATION ANO STATE TIAT TIE ABOYE�NFORMATION 19 CORRECT. TOTAL FE ES l 1 I `� � 1 MqEE TO COMPLY WIiH ALL CRY M/D ODUNTY ORDINANCES ANO ST�7E UWS pElA71N0 TO WLLDINO ///��� /� OONSTqULT10N,ANDMEREBY�UTHORIZEREPflESEN7ATIVESOFTiISCOVNTYTOENTEqUPONTNE !�O `j.,/_�O � ABOVEJAENfIONE�VROPERTV FOR INSPEC7�ON PURPOSES. COMMENT$ � �i� 9 � � � PERMfiTEEN �� /a_�6 � V �V � SIONAT OF IiTEE �TE � RECPL NO_,_ PAI�BY VALIDA170N_ _ WHITE--Departmant Copy,VELLOW—Finance Copy,PINK—Aasessor Capy.GOLDENROD--File Copy.GREEN—Applicant's Copy ...�,� ..,,...�..,,.."'e''...� ,:.»��-...,.:•:c::�.•....-Y;^.:•_....��.., . • .r .. .. , , ..r. . .- � .. , . ,, , .. . ..'. , �c:,;;,• e�,.� � - � . e.... ... . .�.�..,., .__ .. ,, r. � � , ..._ � . . 'P.'� .i `�►' •�'� 'p' ,, _ .,. . . .�':i��:�.. . . .�. �.. . 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