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HomeMy WebLinkAbout15179 (20) I ����� �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES 21660 E.Copley Drivc Suiu 190 (909)860-3195 Fax(909)861-3117 PRESS �TM�� BUII.DING PERMIT APPLICATION FIRMLY ��„�, JOBSITE 1� S �J, f L • APPLICATION �, a� PERMR ' P/C o ADDRESS � �L DATE � NUMBER �� � JI � ISSUE TYPE OCC APN LOT T CT DATE CONST. GROUP p OWNER "" ADDfiESS � ZONING SEBACKS � CITY � IP �"7EL ' FRONT RW ❑ APPLI T TEL. REAR ❑ � ' SIDElSIDE STREEf RW O CONTRACTOR�� '-- SIDE O � ADDRESS_ � CfTY ZIP - �TEL PROPOSED USE �v d � ARCWE G/ DESIGNER N0.DWEL. NO. NO. ADDRESS UNfTS STORIES BEDROOMS � CITY ZIP TEL. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAIUATION � OWNER-BUILDER DECLARATION SFR/ADDlREM O � 1 NEREBV AFFIR►1 UNDER CEN�LTY OF PERAIRV TNAT 1 IJA E7QMPT FH011 TNE CONTMCtt1R5 L4 GarapdCaryort W CENSEUM�FORTMEFOLLqMH�REASON(SEC.70.71.lBUSINESSAIOPROfESS10N5CODE.AM'CRYON (n �.7 COUIlT`f1N11Q1REOlM1E5APEiWRTOCONSTRUCT,KTERMaROVE.DEMOLISH.ORREPNRANYSTHUC W�pa!i � NRE.PfUOR TO RS t56UANCE.A150 REOUIRES TME MFLICAIdT FOR SUCH PERMIT TO FIIE A SIGNEO ETATEMENT iHAT NE OR SHE IS UCENSED PV0.5UtHT TO TME VROVISIONS OF iHE COHTMLTORS LI� CENSE UW(CHAPTER�(COMMEHCAHi YrtTH SECTION T000)OF DMSION 70F iME BV9NE55 AND PRP u' POOVSp3 iES510NS COOF�ORTHAT HE OR SHE 6 E%EMPT iHEREFROM ANO THE BASIS FORTHE�LLEGED EXEMP• T10N.ANYVtlLAT1ONOF6ECTION70]1.6BYANYAVOLN'.ANTFOHAPERMITSU&IECTSTMEIIPPLILANiTO z Re-Roo1 F A CMLPENALTI OF NOT►10i7E h1AN FIVE MINONED DOLUNS(ts00)-): � OL�WMENOFTHEPROPERTY,01IYVEMPLOYEESWIMwAC[SASTHE�RSOIECOtAOENSATqN, � COmmBfClal . - IM�LL DO iHC WORI(ANO THE S7N1C1URE IS NOT IMENOED OR OFFERED FOR SALE(5EG 7oN,BU51� J ,� HESS M!D iROFE5510NS COOE.7NE CDNTMCTORS LIGEHS[UW COES NOT AFPLY TCI/iN OwNER OF ? iROVEHT7YAq BV RDS OR MPROVES MEREON.AND WHO DOES SVp1 riOfiN MIYSEIFOR YIERSELF OR Q iHROIXiHHI$OflNERO'MIEWPLOYEES,VROYIDEOTIiATSVCMMvppyEMEMSARENOTMENDE00R m � OFFEREDFORS�LE6.HOM�EVERT1EBUlDIN00HWVf10VENEMI550lDWTTNNON[YEAROFCOM7lE� � �•710M,7H[OWNEH-BUILDER M'ILL NAVE T/1E BUROEN OF GqOVINO THAT NE OA SHE DID NOT BURD OR �IviqVE FOq if1E OURPoSE OF SALE} W 04ti.^aMNERDFiMEPROPEHTY.AMf%QUSMLYCONTRACT:NdMTTILICENSEDCONTRACTOR4 � TO WNSTRUGT iNE Pi10JECT(SEC.10/a,B VSMESS IWD PROFESSIONS CODE.1ME CONTMCTORS LI� V8�U0Ii0n ' ADJ. EA CEHSE lAW DOES MOTA7iLY TO AN OVRiER OF A PROPERTY Y.Tq BUILDS OR 0.1Pi10YE5 T1IERCON,AND � NTqCOHTRACTSfOiiSUCMDROJECTS'MTNACONiMCTOR(5)LILENSEDPI'RSUNITNTIIECONTMG pUANTiTY DESCRIPTION FEE � TOR4 UCENSE Uw�. � ❑IMIE7IEY�TUNDERSEG B.iPC.iOR7H15REASON 4 3 � � � DATE OWNER V � LICENSED CONTRACTORS DECLARATION -� � w INEREBYAFFlIWIRDERFENALTYOFVE0.NRYTMATIAMLICENSEDUNDEAPRONSqNSOFC1iAPTEH Vr s f(W14�ENCWON7T15ECT�dJ7ooa)OiDM510N�OFTHEBUSINE55M�DiHOFC5510NSO00E.N1D Z ��L W�ICENSE IS W fU1 FOHC£AND EFFECT. /�/" � � � LICENSE CLASS L-`� UC.N0. �� J V DATE � CONTRACTOR � a W � - ERS OMPEN ATION D�CLARATIO a � , U EREBYAFFIRAIUNDEN►ENAIiYOF E EOFTHEFOLWN�NGDECLAM710N5: Z Q IHAYEANOWILLtW CE IFI ATEOFCONSENTTOSELiaNSUfiEFORYK�RKERS' 2 , S CROVIpED B [ TION 5700 OF THE LABOH CODE.FOR THE FER�ORMANCE U OFMEWORKFORWHip/T113OE aIT15155UCD. � O \\A � 4 �7�•.FIHAVEANDWILL►WMAW W<KiKERS'CA�IVENSATION WSUqANCE,IISREWIRE��'lSECTION G �� "V�7DaOFTNEIADORO00E,fOR7MEGER�ORAIMICEOFTMEWORKFORWMI NISPEFMI ,. 0 ISSUED.W V.OM(ERS' ENS T INS:��M1Cf CARR:qAND POIICY MOERAAE: CO�STRUCTION � � unaEa _ -� {'\ P AN REVIEW � �� z ��'�eER ^ LECTRIC d � �s[cnor�ra�nrareEme.nFiEnaFn�P[n.�rsrona+E �s t� 1 PLUMBING W MECHANICAL � I CERTIFY THAT IN TNE VERFONAINCE OF T1E WORK FOR WH H TF115 PE W T IS ISSUCO,1 SNALL NOi EMVLOYAHY►ERSON N ANY MANNCR SOAS TO 8 COME SVBJE T TO THE N WORKERS'COI.1vEN5�T�ONUW50iLALIFOfWItiAND�GREETMAT615 UBE INSPECTIONFEE �� S SUBJECTTOTHEYID�iKCiLS'COM7ENSATqNGNOY1510N50F cran»000Frn� o ISSUANCE �� � v� E.1 SH�ll FORT/NnM CpAPLY WITM�Si0N5. � pDATE:.�,� AVPUGulr. � SMIP ��Mn .� � ENERGY PIC vU _ WMNIHC:FMURE TO SEWRE WOF'J(EAS'CONPEx5A710N COYEMGE IS UNUMlNL M!D SMALL BE A� � SUBJECTANEMPLOYERTOCRIMWALPENAl71E5ANOCNILFINESUPTOONENUNDRED71qU5AND EN[RGYPERMIT �i1T1�RliI� pOILAFI.(f tm.oaol,W�DITKKJ TO 711E COST OF COMPENSATION,O�MAGES AS PROVIDED FOR IN ^ ¢ SECTION7�OeOFTHEUlBOi1CO0E.WTEREST,ANDITTOANEY5iEE5. RETENTIONFEE��p��jr+Ch�� l� VD a CONSTRUCTIONLENDINGAGENCY V�����"�� PRE•ALT FEE: � IHEREBVA�FIRUUNDERCENALTYOFGERNRYTHATTHEREISACONSTRUCTIONIEND�NGAGENCY ' n- FORIHEPERFORAIANCEDF7HEWORKWRWHICJIT/157ERMITISISSUED(SEG�097,CIV.G). � � LENDER'S NAUE � IENUER'SADOF[55 ' � `� WICERTiFYiHATIMAVEPEADiH�SAPPLICATIONIWDSTATETNATiMEABOVEINFORIJAT10NI5CORHECL TOTAL FEES � IA4REETOCp.�PlYW1THN.LCINANOCIXMTVORDIIUNCE5ANO5TATEUw^+REU7WCTOBULDIN� CONSTRUCTiON. MEREBYAUTlqRREREPRCSEMATIVESOF7HI5COVNTY70ENTERUPONiME Z �ABOVE�ME UnE •RovER7YFORINSaERqNPUpPOSES. COMMEMS � � t m CENIAITTEE (Pf11M� ^ 4 �.��5� ���-�-� � � vj SM.N1UURtiOFPERMITTEE �A7E � RECPT.N . _PAID BY VALI�ATION WHITE-0o0artment Copy.YELLOW—Finence Copy,PINK—Asses�a Ca ,GOLDENROD—File Copy.GREEN—Applicant's Copy .... . ..,, .. . . _. " . „r, e.. _ .�.,,r•� . . _. - - ��' . . .�' , ..•�� . , � . . s'.�i , .. . .. -.�G' , ' . . . ,.. . . . 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