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HomeMy WebLinkAbout16325 ' CITY OF DIAMOND BAR 9 �� -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 � (909)860-3195 Fax(909)861-3117 PRESS ' ��?Y�°� BUQ.DING PERMIT APPLICATION FIRMI.Y � JOBSITE „,� tl� � y� APPLICATION PERMIT P/C Q ADDRESS_`�"� `�� '-)�����/"' ��' _ pATE 3�2$��� NUMBER 16325 p � APN LOT 7RACT �SSUE TYPE �CC �— DATE CONST. GROUP p OWNER _. I1''Z.i'�LG�C _._ !_ "' ADDRESS N'O�' ZONING SETBACKS � — FRONT RW L]____ CITY ZIP TEL._ REAR ❑ APPLICANT 7EL._ SIDE/SI�E STREET_,_ RW iJ � CONTRACTO � � ., S, �1'��:�5 � �. ._ sioe _� n__ Q ADDRESS ��� �ts Dishwasher Chan e out � CITY LI�U L� ZIP �y TEL• �'.�, - J� PROPOSED USE g tp0u ARCFVENGI --" �z DESIGNER -- NO.DWEL. ` NO. N0. � ADDRESS_ --� UNITS STORIES __ BEDROOMS � CITY ZIP TEL._ y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OINNER-BUILDEF�ECLARATION SFRIADD/REM Q I HEHEBV AFFIRM UNDER PENALTV OF PEPJURY 7HAT I AM E%EAIPT FFOM THE CONTRACTOAS LI� Gdld9e/C3fpOR W CENSELAWi-0RTHEFOLLOWINGREASON(SEC.7031.56USINESSANDPROFESSIONS�AUE:ANYCITYOR (n U �INiYWHICHflEQUIPESAPEFMITTOCON5TftUCT,AITER,lA1PROVE,DEMOLISH,ORREPAIFANVSTRUC- W pgli0/�6Ck w T1RE.PPIDR TO ITS IS5UANCE,AL50 RE�UIRES THE APPIICANT FOR SUCH PEflMIT TO FRE A SIGNED W � STATEMENT 1HAT HE OR SHE IS LICF.NSEO PUFiSUANT TO THE PROVISIONS OF THE GbNTRACiORS LI� � CENSEUW(CHAPTERB�COMMENCINOWITHSECTION7mo)qFDIVI510N30FTHEBU5INESSANDPNO� LL' POOVSVB FESSpN5CO0E�OflT}lATHEORSHEISE%EMPTTHF.PF.FROMqNDTHEBASISFORTHEALLEGEUEXEMP- (� TION.ANYVIOIATIONOF6ECTION�031.SBVANYAPPLICANTFORAPEFMITSU0.ILCTSIHEAPPLICANTTO Z pe-Root r ACMLPENALTVOFNOTMORETHANFIVFNUN�RED�OLIAflS(5500).): � 111.A50WNEflOPTHEPROPERTM,OflMVEMPLOYEESWITHWAOESASTHEIq50LEWMPENSATION, G COf11111BfCi.�l ' WILL D07FiE WORK,pND THE STRUC7UR'c IS NOi INTENDED OR OFfEREO L'OR SALE(SEC.70ad,BIJSb _J .� NESS ANO PROFESSIONS CODE:THE CONTRACTOFlS L�CENSE lAW UOES NO7 APPLY TO AN OWNEF OF � PflOPER7YNM110BURDSOPIIAPROV[STHEREON,ANDWHODOESSUCHWORKNIMSEIFORHEPSELFOR � � � 7FiROUGHHI50RHEROWNEtdPLOYEES,PROVI0E0THAT5UCHIMPqOYEMEN75AFENOTINTENUE00q � � OifEREDFORSKEIF,HOYYEVERT�'�EBIJILOINOORIMNPOVEMENTISSOLDWITH!NONEYEAROFCOMPLE I � TpN,THE OWtJER$I1ILOER WILL HAVE 7 HE 6URDEN OF PROVING THA7 HE OR SHE�IU NOT BUILD OR J�- � IMPflOYEFOATMEPURMI5EUF5ALE1. �y ❑I,ASOWNEROFTHEPROPERTV,M!E%C�USIVELYCONTRACTIN6Y/ITHLICE�SFOCANiRACTORS A�J.AREA [= TO CONSTflUCTTHE PROJECT(SEC.704<.9USINE55 AND PRO�SSIONS CODE:iNE CONTflA�.TORS LI� Valf18[IOII__.,,.__,__ __ _____ ___ __ LlJ CEN9ELAWDOESNOTAPPIYTOANOWNEROFlPf10PENTVWHOAUILD50flIMPROVE6YHEREON,AND - h WIiOCOMRACTSFOR3UCNPpNECTSWITNACANTRACTOH(SJLICENSEDPUaSUPNT:DTHECANTFlAC- QUANTI7V DESCRIPTION FEE � Tbp5l10EN5EtAW.). —_--- Q J O ❑IAM EXEASPTIJNDER SEC.____._..__ B.8 f.G FOR THI$HEASON U 3 --�.. -...._'__"'_ � LL DATE___ OWNER. ._ _ ~ _"_'_"_— -' W dd LICENSEU CONTRACTORS DECLARATION �j —��— f.L 1 HEflEBYAFFIR.M UNDER PENIIN OF PF.RIURY 7HA�I A!A LICF.NS[0 UNDEft PROVI510�5 UF CHAu�f:ft � � Y�COAIMENCING Wlhi SECiq4]000)OF DIViSION 3 OF TNE OUSINESS ANO PflO�•'_SS�OIvS CODF.A!JU L _ �� MYLICENSEIS:NFULLWRCEAN�EFFECT. m � L�GENSECLASS �� ��� _,_LIC.NO._�+� �?�^� ___'___ � --^— � DATE____ ,. CONTRACTOR.._.....__.._-_"'.'__�— d . .. W ___ � WORKERS'COMPENSATION DFCLARA710N Q� � U �n IHENCBVAFFIRMUNDERCENALTYOFPERIURVONEOFTH[fOLLDWINGDECLA�.4TI�N5: Z Gl _I HAYE ANO WILL MAINTAiN ACERiIFICPiE OF dJNSFNT70 SF.L�-INSUNF FOH WORKEFS' S� � COMPENSATION,R5PROVIDEDBYSECTIIXJ37WJFTHF.LABORCGDE,!-OHTHEPERFpqMANC� U_ � OF THF.WOqK FOP.WHICH THIS PERM!T IS ISSUE�. � C� - � _,_iNAVEdNDWILLMAINTAINWORKERS'COMPENSATIOYINSl1RRNCL,FSHE�LINEUBY3ECTiON Q 37WOFiHELAtsORCJ:..FORTMEP'cRFOHMAKCC-OF1fIEWOfiKFUFlYJH;CHTHISP'cFUA1T15 - - ISSUED.MYWOFlKERS'COMPENSATIONINSUMNCFCARqIERCNL)P[7liCVNUMOERARE: CONSTRUCTION � . PLAN NEV�EW ---...__ ..__ ..---....---. . .. ---'---� ; L'ARRIEH'"_"'-' —_'_'_'__-__ _"' '—"'-- 'p�--s—T' � ao��crNurneFa.wc_f_I�� -���-- — [LFCTRIC ,----_.- ------ a 41.50 p (MlSSECf10NNe37N:7THE(S71N'L�TEOOFThEPEMAT.51"O(i0NFM/AOFU.D�OL1f�R51E10D:ORL'cS5} PLUMDING — -----._,-- -.—.-- .--- y I CER7iFY THAT IN THE FEFlFORMANCE DF THF.WONK ftiR WHICN T411S VERMIT I5 ISSUED,l MECHANICAL -"'_-____— - .____ _"'__ � (j SHALINOTFMaIOYANYVERSOYINANYMANNEHSOA5TO8EWME5UBJECTT07Hf: � WOHKERS'COMPE.NSATIONLAWSOFCALIFORNIA.AN�ACPEFTHAI'IFISHOULDBECOME INSPECTIONFEE . __ _,_.__...__ _ _. SUBJECT TO TFIE WORKFRS'COA1P[kSATION VROVISIONSOI�SF:CTION 3700 0F THE L480R -�C.o o � � CODE,ISHALLFOR7HWITHCOMFLVWITHTMOSFPFlOVIS�ONS ISSUANCE � ..� , __ _, J � � . DATE:__._'_"' .. AFPLICANT: SMIP . ..'_ ."__—.... �'; . ...._'___._'_-_'...'_'_.._— -_ __......_._ _ � ENERGY P1C .__ .. Cif���� P SZ �n O� J WMNINO:FARURE TO SECURE WOflY.ERS'COMPENSATION(bVGRACE I5 UNLAWFUI.AND S11ALL BE -'-'rv�' ' --" ""' "-'----"-- LL SU&IECiANEMPLOYFRTOCRIMINALPENALTIESANDCIVIIFW.':SUPTOONEIIUN�FEDTVi0U5AND ENERGYPERMIT OOLL4FS�SIOO.OoO),INAD�ITIONTOTHECOSTOFCOMPENSATION.DAMAGESASPROVIDLDFOftIN ---- -- '--- -"" ' � SEGTION 37080F THE lPOOR GODE,INTFFlEST,ANDAiiONNEY'S FEES. RETENTION FEE: ,�(��F�-�T ___ d CONSTRUCTION LENDING AGENCV PpE-ALT FEE: I'-'Y•__.�— _.___—__ — O � � I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTI�N IF.NDINC AGENCV � FOR THE PERf-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3U97,CIV.C.j. � ����� �� � W ___�______—_._..___ _'._— �_"'— � I ENDPR'S NAME__"'__"""'"-__""_'_"''_........__.- ' F- LENDER'SADDRESS ---.--._..__-_____. � ICFRTIFY7MATIHAVEREADTHISAPPIICATIONANUSTAIETNATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES 66�JO � IAGREETOCOMPLYWITHALLCINANDCOUNNORDINANCESANDSTATf.LAWSRELATINGTOBUILDING CqNSTRLICTION,ANO HGR[BV AUTHOflIZE REPRLSF.NTATIVES OF THIS COUNi Y TO ENT[R UPON THE � 1100VE�MENTIONEOPqOPEHtYFOHIN5PEC710NPURPO5E5. COMMENTS _...._-.-___ — � --� '____'__'_ _"'_' '_'_ ' — _____"_—_._— m PEHMIiTEE NaME(VRINi) __'-_-____- ---_' ----_ Q dJ '"" —'-_"._ Vj SIGNATURE OF PEPIAITfEE DATE �� C�� � RECPT.NO.�;�+" PAID 6Y ��_.,_VALIDATION ,�__.___ � ~ WHITE—Depariment Copy,YELLOW—Finance Coyy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applican['s Copy _ .. _��: : _:__. _. .. � �:� i � � � � � � _ � � � �'� � � � � � i - � , � , _ , � . ' f � .. � I� , ' I' ' i � I � � � i . Y� .. . i ' " � . '. .i . _. .. ..._ .. � I .. . , . . ... ., . .�I � I �... . . �, i '�i � . ' .,�.. � ' ' _ �, , . � * �[ , ! I � � i = j ' �I� I , i � , . i .. .) � ; ' i i,. � . . � ' : : ' . . . . ; . .._�...!'. j�! ' , . ' ' , 4 , , . ' � � � . ( � � .., . � � . ` a. I , ' j - , ! . ' ', . 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