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HomeMy WebLinkAbout13698 CITY OF DIAMOND BAR ��� ----��-- i.:r� DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 .. ..,� (909)860-3195 Fax(909)861-3117 PRESS ��' BUQ.DING PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION PERMIT ��} P/C ('�"' �' o ADDRESS2�24�- E. Sylvan Glen RC�.. DATE ' '�� NUMBER� -�` �� �# "/ ������ � APN � LOT 7 TRACT 3 5 7 5 4 ISSUE TYPE OCC � DATE CONST. GROUP p OWNER I�iaria N. Pinuelas " ADDRESS_ � �7an en ZONING SETBACKS g �,n Diamon dZ' ZIP TEI. -6 b � FRONT RW LJ APPLICANTiSiaY'13 N. Pinu�a��.g --6 6 REAR I_I � — SIDE/SIDE STREET _ RW Cl CONTRACTOR 1' ^ r� SIDE U_ � ADDRESS PROPOSEDUSE 1Jat1� GOV2Y' � CITY ZIP TEL.__,_ - oARCWENG/ — z DESIGNER — NO.DWEL. NO. NO. � AD�NESS UNITS STORIES BEDROOMS � CITY ZIP 7'EL._ � �ESCRIPTION SQ.FI'. FACTOR PSF ADJ.AREANALUATION N OOWNER•BUILDER�ECLARATION SFR/ADD/REM Q 1 HEF�BY AFFIRM UNDER PENALTY OF PERIURY THAT I AM EXF.MPT FHOM THE CONTRACTORS LI- � Garage/Carport W CENSEUWFOflTHEiOLLOWIN(iREASON�SEC.7037.5BU51NES5ANDPflOFE951ONSCODF::ANVGTVOR U COUNTVWHICHREWIRESAVERMITTOCONSTRUCT,ALiER,lA1PROVE,DEA�OLISH,ORREPAIRANYSTHUP W p81I0/DBCK �(so w TURE.Pfl�OR TO ITS�SSUNVCE,ALSO REWIRES TME APPI ILNNi FOR SUCH PEflM1T TO FILE A SIONED W � STAiEMENT THAT HE OR SHE IS LICENSE�PURSUANT TO THE PROVISIIXJS OF 7HE CONTqAC70FS LI� � CENSE UW(CHAPTEfl 9(COMMENCING WITH S[CTION�WO)OF DIVISION 30F THE BU5INESS AND PR0- u' PODUSp9 FESSIONSCODE)ORTHATHEOFlSHEISE'(EMPTiHEFEFftOMANDTHEBASISFOflTHEALIEGEDEXEMP- � ' V TION.ANVVIOUTIONOFSECTION70.A1.5BYANVAPPUCANTFOHAPERMIiSLIF3JF.CTSTHE�PVLICAMTO Z Re-Roof , _ ACIVIL VENN.TY OF NOT MORE THAN FIVF:HUNORED�OLLARS(5500)): -- S� �I,ASOWNEROfTHEPROPERTY,OR�YEMPLOYEESWITHWAGF.SASTNEIqSOLECOMo[NSA'�ION, A Commerciai 6 YlILL DO iME WORK.ANO iHE STRUCTURE IS!�T INTENDED OR OFFEREO FOR SNLE(SEC.704t,BUSb � NE55 AND PROFESSIONS QDDE:THE CANIPACTOflS LICENSE UW DOES NOT APPLY TO AN OWNER OF N PIiOPEii'fVVh109UIL�SONIMPROVESTHEFiEON,ANDYW.ODOE55UCHWOPKh11M5ELFORMEHSEIFOR m � THROUGHHISORMEflOWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMF.NTSAFENOTINTENOEDUR W OfFEHEDFORSPLEIF,HONhVE0.7MEBUIIDMGORIMVROVEMENT�S50IDWITHINONEVEAROFCOMPLE� TION,TNE OWNER�F1UIlDEfl N1L HAVE THE BURDEN OF PROYINO THpT FIE�1 SHE DID N01 BUILD OR � ya •� � IMPROVEFOPTHEPURPOSEOFSALE). LLy.Z� � � ❑I,ASON7VEROFTHEFROPERTY,AMEX SIYEIYCONiRAC71NGWRHLICEN5E0C0 ACTORS � TO CANSTNUCT THE PROJECT�SEC,70�4 INESS AND PROFESSION' UF:THE CON 70RS LI- VdIUfiI101 ADJ.AREA„_„____„_ W CENSEUWOOESNOTAPPLI'TUAN ROFAPROPEflTYWH00Ul 50 IMPFiOVES IE EON,AND � WliOCONTRAGiSFOflSUCHPfiOJEC WITHACONTRAC'OF(SjL�CE eorunsun�vtt r+ ccwrrac- pUANTITY DESCRIPTION FEE Y 70RS LICENSF UW.). / - � � •--� J � Xll M1 EXEMPT UNDERSEC. .&VC.�OR 7HI5 REA � U LL - �T - `fft--�- =- � � DATaJ E .� V W � LICENSED CONTRACTORS DECV�RATION �yj � IHEREBVAFFIiUJUNDERPENALTYOFFEfUUfIYIHATIAMLICEtiSEDUN�ERPROYISION50FCHqPiER � a i(COMMENCINGWITHSEC710N7000jOF01YI5:ON90FTHEBUSINESSANDPFOfES510N5CODF.,AND z `__V � X MY UCENSE IS IN FULL FORCEMO EFFECf. llJ m � UCENSE CLASS-__"__�"_LIC.NO. � -_ `--� U DATE _ _COAITF0.CTOR_____._._-_--_- a ' ' LL � WQRKERS'COMPENSATICN DECLARATION � — U � IHEREBYAFFIRMUNDEAPENAI.TVOFPERJURYC4EOFTHEFOLLOWINGDECiARRTIONS: � z �z — C> _IHAVEANDWII.LI.UINTPINACERTIFICATEOFCONSENTTOSELF-INSUREFORWURK�,HS' =C � f,OIAPENSATI0N,A5PROVID[DBYSECTIUN37a00F7HELAWRCOU[,�OHTMEVEHFORMANCE w OF TME WORK FOR WHICH THI9 PERMIT I5ISSUED. � O W _,_I HAVEAND W"LL MAIMAIN WORNEHS'COMPENSATION INSURANCF.AS NEUUIRFO 8V SECTIIXV O37000F THE LABORCODE,FOR THE GERFORMANCE OF THE WOflK FOR WHiCN iN15 PERM!T IS �� �%'� _ 139UED.fAYWOqKERS'COMPENSATKKJINSUPMICECARRIERANDVIX_ICYhUMBERAHE' CONSTRUGTION __..� ` ^'/� ..._.._.j��v— �y GAflRIEfl______"_'_—"____..._'_"""-- -.- PIAN REVIEW �..1__6t�__ __—_-__" � POLICY NUMBER_____.. ---� ELF..CTRIC _,___. ______, f � (IN5SFC7qNNCkD�TBER�44'IEfEDOFTHENEW�4TISFO�ONEFlMX)fiEU0.'AiAfu"I5100)OFiLE4SSS). PLUMBING „'___ __"'___"' "'"'_'"'__"_ � O zICERTIFVTHATINiHEYEflFORMANCFOFiHEK4JRKFDRWIUCHTH15PfPlAITISISSUED,I MECHANICAL . ____ _______ ___._____ (,�J SHALLNOTEI•IFLOYANYVEHSONIN�NYMANNERSOA5T06EGOMESUBJECTTOTHE � WORKEflS'COMPENSA710NIAWSOFCNJFOPNIA,ANDAGR[F.THATIFISFIOUL09CCOME ,�F�C7TO EE .__ _ _,_.____. -� __-____ = SU&1[CT TO TNE WOHKEflS'COIAPENSATION VHOVISIONS OF SLCiION 3i00 UF THE LABOF ,� � �c � �f [%JUE,I Sh1ALL FORTMN�TH CQMPLY WITM THOSE PRUVISIONS. � �' " ISSUA ___.._... .._._..._ _ �� _— O ��p� v J l_J p DATE:___.__'_____'_'_ APPLICANT. ____.___.__.,-._.._.._"'_.'.— �_._..":_....____ '_"—_"' — w �_.. J WARNINO:FAILUPL�SECUflEWORKERS'COMPEN9A710N(bVCflA6FISl1NLAWPUI,ANOSHAl.L6E `H'HfE YP/C .__ ________ _._._._.. LL SU0.1EC7ANF.MP�.OYERTOCHIMINAIPEN�LilESANDCIVILFINF5UPTOONEHl1N�REDTMOl15AND ENERGYPERMIT .'� DOLLARS(5700,000�.IN f�01TION TO THE COST OF COMPENSATION,DAMAGES AS PftOV1�ED FOR IN � -'---'�-----�� -'--' "-------"---"-'- � SEGTIDN37080F7HEL4BOFCODE,INTEREST,ANOATTORNEV'SFEES. RETENTIONFEE:;�',�:� ___..___---.__-.- -_-_-- dCON57RUCTION LENDING AGENCY � . � '1 O .:y,^; PRE-ALTFEE: --------._. ..._...-- � �HEREBYAFFIRMUNDERPENALTVOFPERJURVTHATTiiEREISACONSTRUCTIONLEN�INCAGENCY t'��.`�'�`_____,_ __ __.____,._.. - FOR THE PERFORMANCE OF THE WORK FOfi WI iICH THIS PERMIT IS ISSUED(SEC.9097,CIY.C.). Z _'___'- _'__'_ - w _-'_ , ':. .:�':.. � LENDER'S NAME__.-_-__"'-__--_-___-___""_'__' _._'__. .... � • 1- LENDER'SADOflESS -�--- �y wICERTI�Y IHAVEHEMTHISAPPUCA'IIONANUSTA7ETIIAT7FIE OVEINFORMATIONISCORRECT TOTAL FEES C�' d 1 AGRE O CA PLV WITH ALLCITV PND COW N�OROINANCES AND TE LAWS RELATING TO BUIIPING CA RUCTION,ANDHEflEBYAUTHOFIZE PRk VESOFT IS UNTVTO NTfRUPONTHE � 11 ,-� Z A VE�MENTIONF.D PR,�P[RTV fOFl INSP. 10 UR . COMMENTS �._ ._ - -�-__ - � -' - __""_- . � � � J • ' r _"___-"...__.__"_ _" '__ m ER TE" �7 INT�'' ' `../`� ' Q , -__-__"_..."" 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