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HomeMy WebLinkAbout10084 (5) - CITY OF DIAMOND BAR /� COMh7UNITY DEVELOPMENT DEPARTMENT "� 21660 E.Copley Drive Sui�e 190 PRESS Y (909)8643195 Fax(909)861•3117 ^'�^', BUILDING PERMII'APPLICATION FIRMLY o qppR�g O7O J T���L��Cr�4�E t,A�,(E APPLICATIO�/' Ip+} PERMtT ,/y�ij�P/C Z DATE Y CJ/ -I / NUMBEH—,�[!��L A � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GFiOUP . � OWNER A p ADD SS O O E ' E ZONING SETBACISS "' CITY � ZIP TEL — � FRONT RW O _ � � APPLICANT TEL. FiEAR ❑ SIDElSIDE STREET RW ❑ � CONTRACTO ESTE �- SIOE ' O � ADDRESS ` � '� CIN ZIP � TE . _ � PHOPOSED USE w ARCWENG! W DESIGNER NO.DWEL • NO. • NO. iy ADORESS UNITS ' STORIES BEDROOMS � CI7Y ZIP TEL N DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BL:ILDER DECUIRATION SFFUA�D/REM O p 1 MEREBY AFFIRM LAIGER DFWLLTV OF PEiUJRY THAT I I/A E%E►IPT FPdA TIE COHTRACTORS l4 Garopa�Cerport � W CENSEUwFOiiTHEFOLIOW�NORE/50N(SEC.7att.6BU5�NfSSIVDiiiOFE5SqN5CO0E:FNYCRVOH (n � COVNTYYM1q1RE0UIRE5APERIA�TTOCONSiRUCT,KiEqM,17ROVE.DEMOlISH,ORREPAIRANYSTI7UC- w patidDedc W iURE.iHiDR TO RS ISSUANCE.AL50 PEWIRES iME APGLILMR fOR SUp7 iERANT 70 FRE�SiGNED � $TATEMENT iHAT ME Ofi SME IS UCENSED WRSUN7T TO TNE VROYi510NS OF TNE COHiRAGfORS LF CENSE UW(CHAVTER i fCGYMENCNO N7TH SECTION 7000)�DIVISqN]OF THE BUSINE55 NJO FRO- � P��Pa FESSIDNS ODDE)di IMAT NE OR SME IS E%E4PT THEREFHp.I AN�THE B�15i5 FOiI iNE AILEGED E%EIAP• "���— -T�ON.AwYVqtITDNpiSEL7lpHia'ft.6BYANVA7PLIGNiFORAiERM1TSUB1ECT9TMCMPL'.fJ�N7T0 Z Re�Raol ' ' '- � • � � A CML OENALTY O�MOTVOf1E TNW iNE HUNDRED DOLU�RS({5a0))' p�/�¢OMIqEFOFTHEPROVERiY,ORYYEMP�OVFE61MiHNMOE5A51NEMSOLECdNENBA�bN, ❑ (�`pmmBfGb� n�is Dp THE WOIiK AND THE STRUC7URE IS NOT INTENDED Oit OFFERED FOQ 6�LE(SEC.7ou.BU51- J NE53 ANO YiqfE5510N5 O]OE:THE CONTMCTOi19 LICENSE lAW DOES HOT AOPLY 70 AN UM�ER OF � VR07EHiY1NiOBUM1D50R11.1VROVESTMEREON.ANDWNODOE55Up1WOFNHIMSELFOqHERSELFOH � ' Q T/1i101X',MHISORHEROWHEMVLOYEES,VRDVIDEO7NATSUCMMPROVEYCNTS�REMOTMENDEDOR m � OiTEREDFORSAIEF.IqWEVE0.TMEBULpN00R11lPROVEMENT1550lDWITHMONEYFAROFCOMPLE• Z TION.iH[CMMER-BUIDER WILL H1WE 7NE&1RDEN OF PROVINO THAT ME ON SHE Oro NOT BURD OR � YPROVEFORTNEVUPPOSEOiEALEI / W O�ASONMEROFiNEPAOPERTY.A4EXCW5NElYCOHiMCTRMWITNLICCNSFDCONTRACTORS � TO CONSTRUC'T iHE PRQ7[CT(SEC.70��.BUSiNE55IN0 VROFESSION^+CODE:TNE COHTRAL70R5 L4 VeIUlti0fl ADJ.AREA W CENSEUWDOESNOTAFPIYTOANO'M�EROFAPROVERiYWT100U1LD90RMPfiOVESTIEREON.AND � W11000NfMCTSFOflSUCMiRO.ICGT5WITIACONTMCTOR(5)LICENSEDPUHSUAMiOhIEtONTMG QUANTI DESCRIPTION FEE � TORSLICENSEUW). 0 O I AY EYEIAPT U1aER SfG B.i P.G fON i1N5 REhSON U ?� � — , • DATE OWNER V __. . � . � ' ` - Z w � UCENSED CONTRACTORS DECIARATION w � IHEREBYAFFWAIUNOERPENALTYOFVEFWRYTIUTIAYIICENSEDUNDERVROViSqNSOFCHAGTER V. p. �(COM4ENCWO VATH SECTqN f000l�DMSqN�OF 7N[BUSINE45 AND PROFESSIONS LOOE.MA Z X MY t�CENSE IS N FUIL iORCE AND EiFECL m lll R j � LICENSE CUSS •✓ LIC.N0. � J - . F— ' V DATE �_CONTRIICTOR � a . . , . W ' � WORKERS'COMPENSATION DECUIRATION Q � IMEREBYAFFIiWUN�ERVEWLLTYOFCEiUURYONEOFTHEWILOYANCOECUMT70N3. � N Q � �IHAYE/�lqWILLMAMTAINACERTIFICATEOFCONSENTTOSELFiNSUREFORMR7qKER5' S � � ('q1APEN5ATION,AS Pi1DNDED BY SECTqJ Yla00F TME 1AB011 COOE,FOR THE DERFOPl1.WCE W OF TME WORK FOf1 Yrt11CH THIS PERMIT IS ISSUED. O � �� _I NAYE M1D IMLLMANTAIN WORKE0.5'COMPENSATION INSURIWCE,AS REOUIRED BY SECTqN ///1�� Q �10o OF TME IABOR CODE.FOq TME VERFORMANCE OF 7HE WORK iOR WMCM iHU^FEMUT IS �T—�'� ISSUEO.MYYIDRKERS'COM7ENSATqNIHSURANCECARWERANDPOUCYNUI.BERME: CONSTRUCTION ����I 4 ` ] X �WRWER PLANREVIEW I7 � � POLIGYNUMBER ELECTRIC � �(i1KSECTIOrIKmNOTBE�ETIDOFiIEiEFXIf6fi7RONEHUs%iEDDC/1�iLSRtOo�ORL6S� PLUMBING Z ICERTIiYTMnTNTHEiERFORM�WCEOF7HEY�ORKFORWNIp1TM5iERYR151 .I MECHANICAL (,�} SHALLNOTE4VLOYM7YPEHSONNAN`/MIWNERSOASTOBEWMESUBJEGTi ME y WOWfERS'COMPENSATqNUN50FGLIFORNI�AN REETMATIFI ECOY INSPECTIONFEE SUfl1ECTT0T11EriORNE0.5'COMPEHS�TIONVitO i0 OfSECT� 0�0 E � COOE' SWLL FORTIANTHCp.�PLYWIT11h105E 510N5- .�.I ` �SSUANCE /�/L 'p OATE: APPLIG1Nf. �/r ' � SMIP � � ENERGY P/C WAANING fA0.URE TO SEd1N[M�ORKE0.5'[LXIOENSA710N COVERAGE IS IINLAWFUL AND SNALL BE � "U6IECTANEGPLOYERTOCR9JWALPENKTIESANDCMLFNESUPTODNEMUNDREDTKM15M1D ENERGYPERMIT DOlURS(ft00,000),W A�DITION TO THE COST OF Cq/PENSATION,D�ACES A9 PROVIDED FOR W J SECT10N170sOFTMEU1BOitCOOE.WTEREST,AHOATTWWEY'SFEE9. RETENTIONFEE: � a CONSTRUCTION LENDING AGENCY pRE-ALT FEE: � I NERCBY hfiVLA UNOER FENKTY OF PERIURY TUT THERE 6 A CONSTRUCTqN IENDiNO ACCNCY Z FON ME PENFOf W M/GE OF 1HE WONK/OR WMICN iN�S PERMIT IS ISSVED(SEC.io97,pV.4). W � IENDER5NN.1E � LENDER'SA�DRESS W ICERTIFYTWITIMAYEREFDTMSAiR�UT10NW�O5TATETNATTMEABOVENFOR1AA7qNI5WMECL TOTAL FEES ! � I ACREE TO COMPLY VlITH ALL CIT'/ANO COUNTY ORDPIANCES ANO STATE Uw5 REUTIN�TO BU0.�INO • CONSTRUCTION.AND HEHEBY Alll}IORIZE REPHESENTATIVES OF TMIS C9UNTY i0 ENTER UPON THE � ABOVELEMqNED7NOOERNFORwSOECi10NVURFa6E5. COMMENT$ r• . � �/1,VL--STb - -�r � �° o¢a.mee ruw��rw�+r� �! ^ � y - � S�GNANREOF RMITTE O�TE . � HECPT.NO. AtD BY VALIDATION WHiTE—Department Copy,YELLOW—Finance Copy.PINK—Ase�sea Copy.G N Copy,GREEN—Applic�nt'a Capy n, � , . �.. . . . � . ., � ..;�:� �.. .�... .. ,.r. . .a--. . ..,.,..,,:. .... _ . .•,.. .... s . .....�_....._ , . ...s••-. . . ... .. . . . � ... , . . CIT1'.QF Qlf�f��ON[3 C�'�l4 ; •..-. 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