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HomeMy WebLinkAbout11495 —r ----�='-"'�----, CITY OF DIAMOND BAR � COMMlJN1TY DGVELOPMENT DEPARTMENT �II�Y -:.W '' 21660E,CoplcyDrivcSuite190 PRESS (909)86D-3195 I�ax(909)861-3117 BUILDING P�RMiT APPI.iCA'fION FIRMLY �' DDR�ES��-1.3��_.•�' '� � DATEICATION L� "� 1f'� NU BER . '' �/C � ISSUE TYPE OCC - APN_.___ LOT TRAC DATE CONST. GROUP __ p OWNER ,• �_ -- ---- --- ADDRES����'_[,',���, IAICi�S. � ZONING SETBACKS � d' z CITY �`, �r��var_�i �L��i X4p�IP�C��.-�,,��G��_ FRONT -------- RW �� - -- o APPLICANT _----- '-------- EL.' ��;Z�� REAR -- ----- - �----- �f�—� SIDE/SIDE STREET_____._ RW ❑ ¢ CON7RACTOR ,�✓'� SIDE r___________ � ADDRESS °� .��._':�' `' r' ; o CIT� ���j�,q Z� '�•� T ,J. .' � "` PROPOSED USE _________ �, o ARCH/E -- -- ; z DESIGN '—'-- w ""--" -'�--'-'--"-'— — NO.DWEL. N0. NO. � ADDRESS � --- UNITS STORIES BEDROOMS__ , � CI7Y --.-.-,-.-- ZIP TEL. _ -- v� — cn ------ — DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ' � OWNER-BI;ILDER DECLARATION SFR/ADD/FiEM C � I H[�l[:BY Af(�IHM UNDt:fl PCNNLIY 01 P[fIJUHY 1MPI l AM L%L-M!'(Ff10M 111[GON7(IACTORS Ll- G8f8g8/C8(POfI W CFNSFLAWF04TIIEFOLLOWMGfiEASON�SEC_70315i11151VE55AN�VHOFE551CN5COUE�ANYCITVOR (n U COUNTYWHICHl7fOl11PESAPERMi1'TOCONSTRUCT,AITf.R,!MPF�OVC,DF.N,O:.ISH,OliliFPAIRANYSTNUC� W Patio/Deck � � Tl1RE,PRIOR TO ITS ISSUANGL,A!SO qE(]UIFlF.S TH[APPI ICANT�Ofl SJCH PCfiM1T TO FILL A SIGNED �L SIATEMENT THAY HE OF^uHE IS LICENSEO PURSUANT TO THE pppVI510NS OF THE CONTRACTORS LI. W � C[YGELAW(Ck1ATER9�CAMMENCINGWI711SFC(ION'l000�OFUIVISION3OFftIEIiU51NE55ANDPRO- LL POOU.�i�Ja O 1"FSulONSGOUE)OIITHATH[pli51:E15"tXEMPTT1iEHEFHOM�NU711E11hSI5FORT11EALlEGEDE%EMP- � �� TION.A4VVIOI.ATIONOFSECTION%031.53YANYA{'f'L�CANTFORAPffiMITSUBJ[CTSTH�APPLICAN7T0 Z He-Roo1 � A CIVIL PfNAL7V OF PbT MORE f11AN FIVE I:UVf)f7FU DOl LAHS(EG00)): — � �iI,A50YlNEROFTHEPFOPERTY,ORMYEMPLOVEESYlITHWAGESASiHEIR50LECOMPEN5AT10N, � Commercial Wi!l,�O TH�WOFK,ANO?NE STRIICTIIRf.IS NnT INTfN�Cf)OR OFFFRF:�f0ii$AI E!SEf,'IOaa,E3USI- _._I_ . � NESSANDPROFESSIONSCOUETiiECO.VTRACTORSLICEASFUWDOESAOTAPPLYTOA40WVEROF � 1 • °?,OPE.9TY NlHO BUILDS Ofl IMPRUVES TMEHEON,AND NlHO DOES SUCH VJOFN HIA!SELF OR HEflSELI'OA � CL 171ROL'GHHISOI7HEflOWYLMPI.OVF.F:S,VFiOVIDE:fITHqTSIICHIMPl70VCMFNTSAfifN()TINIENUEDOH m w OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIM�ROVE.4IENTISSOIDWIiHMONEVEAROFCOMPL[- � G TION,THF.OYJNER-AUII DER WII.L HAVC:THC.PUf1U(N OF Pf10VING THAT HF OR SHF.DID NOT RUII.D bH Z I"A!'ROVE FOHTIIe PURVOSE OF SALE). ' � 71,ASOWNEROFTH'ePROPERT',AMEXCLUSiVELVCONTRACTINGWITHLICE45EDCONTRACTORS � � (O CONSIHUCI It1E PHOJF.CT(SC:C.]044,[',USINCSS ANU PllOFES510N5 COUE'fHE CONTRACTORS 1.1- V8I1J3(I�(1 /a�J,{1RE/�_ �-1-� CFNiELAWDOESNOTAPPLYTOANOWNEROFAPROPERiYWiIOHUIL�50RIMPROVEuT11EREON,AND ---- � LVHOCONTRACTSFORSUCHPR(11[CTSWITHACONTRACTOR(S)LICENSED�UPSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE` F-' '.OHS I.ICFNSF ll�Yf.). �; y� — Jy � ^� � ���AM E%EMPI UN�ER SEC Q r R' /��" �^`� i ^+ , �,J t ,✓ � U ` _""'_""___'..... ...... .... 8.R P C_FOR TFIIS REA501: � U . LL — CC `�,. 'f. M�. ��vt.d' k C)ATC .. .._.__...""____ OWNCFl_ ____' � � z W " F LICENSED CONTRACTORS DECLARATION W . � . LL IHCI\l:AYA(TIfiMUN�C:(iPCYALTYOFf'EfiJtlliVll�AIIAMLICEYSEDUNDERPROVISIONSOFCHpI'TL'H � d V(COAlMENCINGWITHSECTi0N7UCU)OFDIVISION30F?HEBUSINESSANDPROFESSIO4SCODE.AhD Z __ �C MY i:C[NSc IS IN 4 L'I L fOFtf:F aNf]F��CCT tJJ m �.J � .['S �' �j�` �,�� � }._ LICENSE CLA55 d 'S LIC.NO .Q._ , '_. � F-� DATE�a- -S S CONTRACTOR �� '-- --�9W d � __..._...._ . . c�= WORKERS'COMPENSATION 0 CLAHATION f�,��,�.. ¢ ' �� i H'cREBY AFFIRM UN�ER PEN�LTY OF PEHJUqV qNf OF TI IF FC�LI.c)W:NC DFCl.ARATI6NS: Z Q � � IHAVEANDWILLMAINTAINACERTIFICAT[OFCONSFNTIOSELF'�INSUREFOFWOHKEHS' _ � WMPCNSAT:ON.AS PROVI�ED BY SECTION 37000F 111E L11HOH CODE,�OR THF PEAFOHMANGE W � � CF THE WORK FOR WHICH THIS PERMIT IS 4,SUED. c� 4+ � � �IHAVEANDWiIIMAIN!AWWOHKEFS'COMPENSATIONINSURANCE.ASRE�UIREDBYSECTION � t :tm.aOF'fIIELAROf1CUf)F,�OIITHEPERFORMMCEOFTHEYlOftKFORWHICHTHISPEflId1T15 � J 3 ISSUF�.M WOHI�ERS�CAMP,YENSATIONINSURANCECAqRIERANOF'OL�CYNUNBEFARE: CONSTRUCTION ____ S� .. .._..__-.._.. _ . f SJ s ----- �ELAN�RE�EW '-"�� cannirn I c � yj_.�/+J y 'J p ' , --- -._ :- df POLICYNUVUEH V�-- y/o]� 6il� '•• a`l� ' � ELECTRIC�.� _-_--_ .... ._.. 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( � --" _ ..""....._ uUL3JFC�fO Tt:F WOFlN�HS'(:OMPf.N5ATl0\PROVISIONSOF SECTION 37aoOF THE LA60R � �-• ~ COUL,I SIIALL FUFli11WITHCOM�LV ITH TIiOSE WHUV151 S. � IS$UANCt � ���� � :.� .1...�1 __.. ` . �{ � ,, _—___ ' ""_'_"' p j DATG�� �' •-.�-1� APPLICANT. �� .' : �..'�'s�',: , � �Lv'e SMIP .....-____ ____..._-__......-_ w ! �-- 4 . y� J � Y/MNING FAILUfiE 10 Sf:CUIlE WOfiKE:RS� OMPENSATION COVERAGE ISUNLAWFUL,AND 511l�1L0E FNERGY P/C ��� �__.� ____ _ jy SUBJECTANFMPI.OVFRTOCRIMINALVENALiIGSANDCIVILFINESIIPTO04fHl1N�R[nTH011SAND ENERGYPERMIT L`OLLAHS(S��.000),I.V AU[11TIGN TO THE COSTOF COM°ENSATION.UAMAGCS AS PNOVI{)Efl FOR 1Y _ . _- _-__-_ '-" . . �1 .`,l:C:l ION 370A OF TI IE I.ABOii CODE.INTERES7,ANJ�i70HN[.Y'S�F.[5 RETENTION FEE: [[ _'__""' '" '_"'___"'__""_ a CONSTFUCTION L[N�ING AGENCY PRE-ALT FEF: p --� ------------`---- � I HEREBY AFFIRM1I UNDER PENALiY OI"P�fiJUflY THAT THcRE IS A LONSTFUCT;04 LENDMG AGENCY d FUR TFi[P[RfOFMANCE OF iHE VJUf{K FOfi Wl IICI I THIS PERMIT IS ISSUED�SEC.309/.CIV.C.). -'---'--'-'--"- � W _"'_'__ = LENDEF'SNAME � -_._. . .__'-_ ... 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