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HomeMy WebLinkAbout16864 (30) . � �CITY OF DIAMOND BAR j --J� -- DEPARTMENT OF.COMMUNITY&DEVELOPMENT SERVICES ;� � ' zi�o E.c�i�Y na�o's�c�i90 �G �43S I C.� �: I� C �\ PRESS '� � (909)860-3195 Fax(909)861-3117 � � ��� BUILDING PERMIT:APPLICATION ,�, ,:: : FIRMLY �. JOBSITE APPUCATION �� O PERMR P/Q'� S� � � o ADDRESS DATE NUMBER A �i' $ ISSUE ,NPE OCC APN LOT TRACT DATE CONST. GROUP °� OWNER . . ....._ -. �_ p ADDRESS • • ZONING SETBACKS';"'�ir-`:I�i.� 1� '. r�a � CIN � ZIP. TEL �FROPlT..--_._-._, _ _ .. _ RW ❑ APPLICANT _ � TEL � REAR ❑ � SIDE/SIDE STREET RW ❑ CONTAACTOR SIDE ❑ � ADDRESS PROPOSED USE" " ' ' - �`'•�'''+ ' ' �� � CfTY P TEL ARCFi/ENG/ /t� � DESIGNER �1 NO.DWEL NO. ; �.p N0. ADD UNITS" �� STORIES,�- •;BEDROOMS � CfTY ZIP TE - Z ' N DESCRIPTION SQ.FT. ' � 'FACTOR PSF ADJ.AREANALUATION Q ONRJER-BUILDER DECLARATION � SFq1ADDlREM a7r I � O i 1 HEREBV AFFlRM UNDER OENALTY OF PERJUPV TMAT I/W EXEMPT FR04 THE CONTRACTORS lb G8�0�e�rt �� G� 8 CENSEUriFORTHEFOLLOWNOR[�150N(SEC.7a77.68U5WE35N10VROFES510N500�EANYCITYOH (n C� COIMTYNROCNREOUIRESAVERMRTOCONSTRUCLALTEftIMPROVE,DEMOLISM.ORREOAIAANY57AVC- W PA[IOIDOCk LL� 7URE,VRqFi 70 R9155UANCE ALSO PEW MES 7NE MGULMIT FOR SUpI YERMiT TO F0.E A 61GNED .� lTATEMENT iNAT HE OR SME IS UCENSED PUHSUANT 70 iME VROV6ION3 OF TME CONTMCTORS U• . � C£NSE UW(dUPTEN 0(CdAMENCMAIMTH SECTION)OOO)OF DMS�ON�OF TNE BUSINESS ANO PR0. V" POOVSPB fE39qN4 COOEI OR iHA7 ME di 5ME IS EXEIAPT TNENEFNOM AND 1HE BASIS FOR 1HE ALLEOED E%EMP• TION.ANYV�OLATIONOFSECTION70.17.6BVAHYAPVLICIWTFOqADEMUTBUBJECTSTHEAPPLM�RTO Z qe-qoof �� A CryIL pENA�7�/OF NpT A1OfiE THM�FNE HUNDRED DOIUIRS(is00).1: ~QQ OLti40WNEROFiHEPf10PERTY,ORMYEMPLOYEESVATHWAGESAST1Etq30LECOMPEN5AT10N, 0 (`,q�m0fCi21 � � WILL pD TNE WOPoC,AND 7NE STRUCfURE IS HOT IMENDEO OR OFFERED FOR SALE(SE0.7a�,BU54 J NE3SANDGROFESSIONSCOOE:TMECONTMCiORSIICENSEUWDOE5N0Tl�VVLVTOANOWNEROF = I,�j ��,-�� �� � � iROVEHiYWIqBU1LDSORIGPROVE9THEREON.ANDVIHODOES5UC1/NVFKWMSELGOFiMER3ELFOq m � iMROUGHHI40i1HERONT1ElA➢LOYEES.VHOVIOEDIHATSUCHMVROVEMEMSMENOTNTENDEOOR � OFFERED FDR SALE 6 HOWEVE0.�BUtdN�OR IMPfCNEYEHT L4 SIXD MATMM ONEYEAR OFCdA%.E TqN,T/1E OWNER�BUILDER WILL NAVE TME BURDEN OF VROV WO THAT NE Oit SNE D�D NOT BUtID OR � MPiqVE FORTNE PURPOSE OF BALEy. ' i I . W OI.ASOMMEROF7HEPHOPERiY,AMIXQUSNE�YCONTMCTNOW1RtUCEN3EDCONTMCTORC (� 10 CONSTRUC'f THE PR0.tECT�SEC.7ou,BUSiNE53AND PROFESSION9 CODE TNE WNTMCTOfiS LI- V01UeSlOf1 ADJ.AREA lll CENSEUWDOESNOTIPPL�TOANONHEROFAPROPERTYM?fOBUIDSORIMPtqYESTHEPEON,MlD � v�n�ocanrucrsr�suaivr�o,�ersvnnuco�+rwicro�cs��rc�l+seovuRsu�wrTornEcartru�c pUMfTITY DESCRIPTION FEE TORS UCENSE UW.}. � D IAM EXE�.�PT LNDEF SEC. � B.t V.0 FOR T/115 REASON 4 - � • � � � � � LL' DATE ONMER � � � �" •"' � � - G ra 6 LICENSED CONTRACTORS OECLARATION W � ��.� CL INEREBVAFFIiLIUNOERPENALTYOF0E0.1URYT�UTIIUAIICENSEOUNDERPROVISIONSOFCHAPTER � V. , � .� .. . . . p., �(CdAY[NCtMWITHSECTqN70oo)OFDMSION]OFNEBUSiNE3SANDOPOFESSIONSCOOE,AND Z ��� �� W LICENSE IS N FUIL FONCE IWD E�fECT. � � �I � 0 UCENSE CIASS LIC.NO. ..�.� - � l .� .CI� � , - � DATE � ,__ CONTMCTOR a V C G–�ERS'COMPENSATION DECLARATION � � I IV � IHERE IIFFIRA{UNDERVENALTYOFVERR1qYONEOFTHEFOLLOYJiNGOELlAM7iON5: y a ' � C �HAVEANpMALL1.WNTARIACERiIFICATEOFCONSENTTOSELFJNSUREFORWOHKEHS' S � � � COMPEN4ATION,ASVROVIDmBYSECilON�7o00FTNELABORW�E,FOA7HEPERFORIAANCE W CA pF TME WOqK FOq W11K71 THIS PERMIT IS ISSUED. � . � O �I NAVE AND 1MLl MAM/JN WORKER5 COMDENSATION INSURANCE,!S REOUIRED BV SECTION Q OTOOOFMELABORCOOE,FORTHEPEA�OPMNICEOFTHEWOf77(FORNM1/Ip1THISVERMRIS � ISSUEO.MY ERS PENSATqNINSURIW GWHIERANDFOLICYNUMBERAR� . CONSTRUCTION CMH:ER PLAN REVIEW C �rrti�o \/�f � l l. . . ELECTRIC Q �����g�pp,S�EIFppFi}EpEq,t{gppqp�EH,�DiiE.ppOIURSR:oc7oqlE55� PLUMBING L� O. � 'S ICERTIFYTNATINTHEPERFORMIWGEOFTHEWORKiORMnnCHTNISPEIWiT1565UE0,1 MECHANICAL _ �] WOPo(EHSCOMPEN5ATI0NEUWSOFCAUFORNNEA.ANDAGREETNATIF1�S�qULD ECOME INSPECTIONFEE `��(\ N SUBJfCTTOTHEWORKERS'COMPENSATIONDROVISIONSOFSECTION77000FTHElABOR \J � s ¢,�sww.ia+nrvnn+coMr�v wi se aowsar+s. ISSUANCE O ,�.,p �/�.�p � p OA7E:«�29�1 APPLICANT: 11 i �� r {1.,��1— SMIP � �w WARNINO:iALUHETOSECUREM/Of7KER3'LOYPENSATIONG�VEMGEISUNUWFUI.ANDS/UILBE ENERGYP/C 1 � SIRJECIANEMPLOVERiOCfUGWALPENALTFSANDpVILFINESUPTOONEMUNDREDiMOU4AND ENERGYPERMIT OOLLMtS(f 7o0.0D0).N ADOITION TO TNE COST OF CdAPEN5ATI0N,DAMA6E3 AS PROVIDED FOR IN 'y` � SECiqN770lOFTMELABORCODE,INTERES�ANDATTOflt1EYSfEE9. RETENTIONFEE: ` W a CONSTRUCTION LENDING AC,ENCY pRE•ALT FEE: � INEREBVAFfIRMUNDERPENALTYOFVEM1RIRYTHATTHEREISACONSTRUCT10NLENDINOAllENCV fOR iME GERFORMANCE`O/Fy�T/1��E WpOHK VyM''I�CMTN�S PERMIT IyS,,I/$�S,U�ED�(SEC.9o9�,dY.G1. , � LENDERS NAA1E^ -V' ' �/ � ` �'\��L1�,1LL..� r�- � � . � . � LEHOERSAODRE55 ' . . ^l �"� � IGERTIFYTMATIYWVERFAOh115APP4CATIONANDSTATETHATTIEABOVEINiORMATqN14CORRECT. TOTALFEES ,', .' �J�al �`J . p_ IAUREETOCOMR1WR1111lLCIT'ANOCOUN7YOROWN/CESANOSTATEUwSNElATH6TOBULDIHO . ' CONSTRUCTION.M10 NEREBYAUi1iORRE REPRESENTATNES OF TMIS GIXIHTY TO ENTER UPoN T1E S� ABWE-MENTIONFACHOCENTYFORWSPECTIDNVUR706E5. 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