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HomeMy WebLinkAbout13-430 ����.� ,` _,��� _ CITY OF DIAMOND BAR � - � DEPARTMENT OF CO1VIlI�IUNITY &DEVELOPMENT SERVICES 21810 Copley Drive,Diamoud Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS ������^� BUILDING PERMIT APPLICATION FIRMLY � J08SITE b � ��, �L APPLICAT ON PERMIT' jf�, P/C � o ADDFIESS�(�So� �lA„" n�. �r� "�fLwd� 1,lN^ DATE �11 S �13 NUMBEF`-��_�# l3—`�'�d o� ISSUE IYPE OCC APN LOT TRACT DATE � CONST.�Z�ROUP p OWNER X LI/ANGT' �HB'I.I � ADDRESS ZONING SEfBACKS Z ��7Y � ZIP TEL. � �7�T�3�1'flS� FRONT RW ❑ � � APPLICANT TEL. REAR ❑ o SIDE/SIDE STREET RW ❑ 4 CONTRACTOR SIDE ❑ I ¢ ADDRESS � � CITY ZIP TEL PROPOSED USE aARCWENG/ � • �i a ADDR SS NO.DWEL. NO. NO. I UNITS STORIES BEDROOMS � CITY ZIP TEL. � �, � DESCAIPTION Sa.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUIIDER DECLARATION SFRlAD O 0 I HEHE9V AFFlAM UNDEA PENILTV OF PE0.IURV 7/1AT 1/JI E1(EMPT FR061 THE CON�MCTORS Ll- Gafa98/Caf�Ort W CENSEUWFOHhIEFOLLOWWGREA50N(SEC.7m1.SBU5WE55ANDPRoiE5510N5CO0EANYG7YOR (n , U CIX1NfYWNICHRE0U1RE5APERM1T7000NSTAUCi,ALTERIMPROVE0ElA0U5H2OHREPNHANYSTiiUG W patidDeck Z NRE.PPIOR TO RS LSSUANCE.1�150 REOUIRES THE APPUCANT FOR SUGi PERAIIT TO FIIE A SIGNEO W w STATEh1EHT THAT HE Ofl SHE l5 110EN5ED PURSUANT TO THE PqoVISIONS OF h1E CONTMCTORS U• � CENSE UW(C11AP7ER o�COMNENCVlG WlTli SECT70N 7Caa1 oF OIVISION]OF T7E BUSINE55 ANO PR6 � PooUSpa � FESSIONS COOE)OR THAT HE�R SHE IS IXQAPTTHEREFROM M!O iHE BA515 FOH 7HE ALLEGED E%EMP• � � 710N,INY VKKATION OF SECfION 7o]1.S BY ANY MPIIGNT FORA PEANIT 5U8JECT5 THE I➢VIJCMR T0 Z qaRool � A CIViL VEIULTY OF NOT MORE TH�N FIVE HUNOHED OOLURS�SSao).�: Q ❑I.ASOYMEROfTHEPROPERTY.ORMYEMPIOYEESWfTH1NAGE5A5iHE1fl50LECONPEN5AT10N, � COlfIfilBfClal Z YALL W THE WORI(ANO THE STRUCTURE LS NOT IMFNDED OR OFFERED FOH SALE(SEG 7oM,8U51- J . NE55/�NO Pf70FE5510N5 COOE�THE CDNfMCTORS UCENSE UW OOES NOT APPIY TO AN OWNER OF � VROPEHIYWY109UIlOSORIMPROVESTHEAEON,/J1�WHOOOESSUQIWOFlKHIMSELFORFIERSEIFOR � [[ THROl1GHHI50HHEROWNEMPLOYEES,PROVIOEDTHAT5UQ11MVpOVEMENTSMENOTOITENOEOOR m W pF}�pmFaqSKEIF,HOWEVERTME9URDINGOR1A17pOVEMEHTL5501DWffHINONEYEAAOFCOMPIE � T10N,7HE OWNER�BUItDER N1LL HAVE TNE BUfiOEN OF PROVWG lHAT HE aR SHE DIO NOT BUILD OR ' Z WPROVEFOHiHEPUPPO5EOF5/�LE} _ ❑I.ASOWNEROiT11EPPOPEATY,AAIIXCLUSNELYCOMMCTWGWfTHUCENSEDCOMRACfOfLS � W [[ 70 CANSTRUCT THE PROJECT(SEC.7aN,BUSINESS INO PROFESSIONS COOE hIE COMAAGTORS LI- V31Udtlon � \��� -�� ADJ.AREA W CENSE UW DOES NOTMPLY TO/N OWNER OFA PROPEATY WHO 8UdD5 OR UIPROVES THEREOt�M1D � WHOCANfAACT5FOF5UCHPR0.1ECf5YffTHACONTMCTOH(5)LICEHSEDWqSUANfTOTHECOMAAG QUANTf7Y DESCRIPTION FEE Y TORs CENSEUw.). � J � �AN IXEM�T UNOEA SEG 8.17.C.FOH 1HIS REASON � �i ¢ � OA7E � � OwNER U � Z W � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFlHM UN�EN PEILLTY OF PERJURY THAT I M1 LILENSFD UNDEA VROVISIONS Of CHAPTER d, 9�COMMENCWq VATI SECTION 7000)OF OMSIIXJ]OF THE BUSINE55 ANO PPOFESSIONS COO�AND Z 'O� X I./Y LICENSE 45 W FUIl FORCE AND EFFEGT. LLI m Q UCENSE CUSS IIC.NO. � J V �ATE COMAACTOR a W � WOFKEAS'COMPENSATION DECLARATION � � � � a � U � I HEREBV AFFIRM UNOER PENALTY Of PEAIURY ONE OF THE FOLLOWING OECUAATIONS: Z a 0 I HAVE AND WILL AWNTAW A CERTIFlCATE OF CANSENT TO SELFINSURE FOR WOfiKEAS' _ � COMVENSAT7[NJ,il57ROV1�EDBYSECTON]7000FTNEUBORLOO�FORTHEPERWHMANCE U ¢ OF THE WOR7C FOfl VhIICH TIIS PEiiMIT IS ISSUED. ' � � w _I NAVE AND WILL MAIMAW WON(EAS'COMPENSATION INSURANCE,/5 RE�UIRED BY SECiION Q ]70o OF THE UBOfi COOE.FOq THE PEAFOfiMMlCE Of THE WORK FOR WHIGi THIS PEAMIT IS � � ap� �a � LSSUED.AIY WORKEAS COMPE?15ATION INSUHANGE GAAIEN AND POUCY NUMBER ME CONSTRUCTION . j c�aaiea PLAN REVIEW O� �'� � POLICY NUMBER ELECTRIC � Q � (IHBSEGfIONN�NOfBEOCMfLETEDOFThE7FA�f�6FOfiCNEHUMRm00.LIiLSlilao�ORlE5S1 PLUMBING w MECHANICAL Z I CERTIFY 7HAT IN TY7E VERFOHMANCE OF hIE WORK FOR WMICfi TF1I5 PERM�T IS ISSUEO,I — (J SH/J1 NOT EAIVIOY ANY 7ERSON IN AflY MANNEF SOAS TO BECOME SU&IECf TO THE � � WORKERS'COMPENSATION UWS OF GLIFOiiNIA,AND AGREE 7HAT IF I SHOUlO BECOME INSPECTION FEE � SUBJECTTOTHEWORKE0.5'COMFENSATIONPFiOVI5qN5OFSECTION77a0OFTHEL/i80R •� CA�E,I SNALL FORfHVJITH COMPLY WITH THOSE PHOVI51ON5. �$$U�C� p DATE � APPLICANT: SMIP , � w ENEFGY P/C J WARNING:FNWAE TO SEGVRE WOWCERS COMPENSATION COVERAGE IS UNUWFUL AND SHALL BE � SU&IECf AN EMPIOYER TO CFIMINIL PENPLTIES ANO CJVII FWES UP TOONE HUN�f1E0 T110U5AN0 . �ERGY PERMIT DOLLARS(SIOo,Oaa).IN PDOITION T07HG C0.5T Of COMPENSATION,OANAGE51 S PHOVIOED FDR IN O � ¢ SKTION 770e OF h1E LABOR COOE�NTEREST,ANO ATTORNEYS FEES. flETENTION FEE: pw_, CONSTRUCTION LENDING AGENCY PF}�-ALT FEE — � � d � Q I HEREBY AFFlHM UHDER PENI�LN OF PERNFY THAT 7HERE IS ACAlLSTiiUCfION lENO1NG AGQlCY /����� � a- FOR T}�E PERFOfiMANCE OF THE WOHIC FOi7 YMICH TH15 PEiU1R IS ISSUED(SEG]Cs7,GV.G4 �' . Z W � LENDEitS NMIE � LENOEASAOORE55 � �� � ¢ tCEATIF'/7YIATIHAVEREADTHiSA➢PUCATIONANOSTATETIAT7HEABOVEWFOiU/A710NISCOPAECT. TOTAL FEES �a �3�4�3 w I AGREE TO COMPLY VATH ALL CfTY I�NO COUNTV ORDWANCES ANO SiATE LAWS RFIATWG TO BURDWG " � CONSTRUCf10N,ANDHEflEBY�LLJfHONZEPEPRESENTATIVESOFTHISCOUNT'ITOEMEAUPONTYIE ZABOVE-MEHTIONED PROPERtY FOP WSPECf10N PUqPOSES - COMMENTS � � �N — �-1 o U — m P��R _ � l���l �l� \3Giq� \ \3 a _ � � SICNA7LflE DF PEAMfREE DATE � RECPT,NO. � ' PAID BY� VAL10AT70N � VYHRE—Department Copy.YELLOW—Finance Capy,PINK—Assessor Capy,GOLDENRO�FiIa Copy,GREEN—ApplkanCs Copy q^, ��-�./ ^ g f17 .,^� +12'i +-e .:e .�'� . �-+". A 7 y.,�i' �5�'�:U�S.,rj•,iiJ 1.35�.'S • 9�°...+ §��.'�i ��b`�'• ��:: ,,.ye�i�..F �T i ;�rz ..Y . Y t_ r .; ... . ,� ..�,�: f-�,�c-t T `�',� _ ...�:ti ...� � �: � �'� �-5�•-' � .-'lL�i y"T.�.,:�—�Jy� i �.j 5-� r �J. �i � .� � �: .��� 9 1 ��-i 4 p�i��i 1 .1 [7 i ��'jp 1��+' � "�7 z -. � � ��i '` ���z f��B �o �� �- � ., E�-�� �� � . 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