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HomeMy WebLinkAbout14245 (860) �" CITY OF DIAMOND BAR ' - — DEPARTMENT OF COMMUNITY d�DEVELOPMENT SERVICES 2i�o s.c���y nri��s�c�i90 pRESS (909)660-3195 Fax(909)861-3117 ���*^�� UILDING PERMIT APPLICATION ,` FIRMLY N JOBSITE APPLICATION _ _ ERMIT "2 P � o ADDRESS � � � DATE UMBE if � 5 OG ISSUE - _ . . . . � TYPE v ��! � C � L T TRACT DATE CONST. GROUP � OWNER ' " ADDRESS LV ZONING -SETBACKS : Z CITY ZIP / TEL REAR RW p g APPUCANT TEL. SIDFJSIDESTREET RW ❑ � CONTRACT R � ^ • SIDE O � ADDRESS ' � ' PROPOSED USE C(TY ZIP4l� TEL � ' � ARCFYENG/ ' . DESIGNER _ NO.DWEL NO. NO. ADDR SS UNITS STORIES BEDROOMS � CI7Y ZIP�f. TEL(1 N DESCRIPTION �SQ.Fi. FACTOF PSF ADJ.AREANALUATION p� ' OVYNER-BUILDER DECLARATION � •' �' SFR/ADD/REM p - - -- - p I NEi�9Y 11fFIR11 U1DER PENALTY OF PERAIHY TMAT 1 MI E%EMPT FROM THE CONTMCTORB LL� GeteQ9/C8fp01S liJ CENSEUWf-0R7HEiOLLON'NK7REA90N�SEC.7077.6BUSINESSIWDVPAFESSIONSCOOE:ANYdTYOH ,• (f� ZOOIMTYWFNCIIREOURESAGE�WRTOCONSTRUCi,1LLTER�PROYE.0EL10LI5H.ORflEPNRANYSTRUG W PatiolDeck 7URE.PRqfi TO R9 SSUANCE.ALSO REOUIRES 71/E APFLICAHf FOR SUCH PERMIIT TO fILE A SIGHEO +�� 6TA7EMENT 7W�T HE OR SME IS UCENSED PU0.SUNJi TO THE PROVISIONS OF THE CONTMC70RS U� W _ CENSEUW(tlUPTERY(LYYAMENCWOWIiHSECT10NT000)OFDIYISION]OFTHEBl15MESS1W0VR0• u' PooVSpa FE4S10N8 CODE)OR THAT NE OR SNE IS E%EA1PT T1IEREFPAM ANO T1E BASIS FOq TME ALLEIiED EXEMP. TqN.ANVV10lAT10HOFbECT10HM�f.6BYAHYAPPLM.�INTFORAPEH1AiT5VBJECTSiHEAPPLICANTTO Z Rg-R001 � ACML iENKTY OF NOT MORE T!W!iIVE NUNDRED DOLUIRS(i5oo).} �' � O 04�3CYMEROFiHEFROPERTY,ORMVEMPLOYEESWITHWAGE5�4hIEIRSOLECOIAPENSATION, D �mmercial - Z MA100 TME WORK ANO iHE STRUCTURE 45 NOT INTEtAW OR OFFERED FOR SALE(SEG 7ou.BU51• J NE53 MO PROFE561JN4 COOE:TME COMiMCTDRS UCENSE L1w DDES NOTAVVLY TO AN OWNER OF �. PNOPEHTYIMIOBURDSOR6/PROYESTHEREdLANDMhfODOE55UC11WORKHIMSELFORNERSELFOR ' _ - �TIMOUGHNISORHERONMfMVLOVEES.VHDVIDEDTHATSUpiWP1i0VEMEMSARENOTMENDEDOR m �OFFEpED FOR SALE IF,ItlWEYE0.7ME BUlDiNO OH MPROVEMEM LS SOID WITHW ONE YEAR OF[DYPLE• � , ��TIOH,THE OWHER�BU4DER WILL HAVE 7NE BURDEN OF PNOVPt(7 1MAT HE OR SME�W NOT BUILD ON MIPAOVE FOft iME PUAPOSE OF 8KE). � � \.� �_. \ �.�--. f�O�MONNEHOFTHEPHOPERh;AMIXCLU6NElYCAHTMCTNOWITHLICEfiSEDCOfRMCTOR3 � - , TO CDNST(1UCT TME YHOJECT(SEC.70N,BUSINE55 M1D PROFESSIONS CODE TME COMMCTORS L4 �IDIUYI� ADJ.AREA � GENSELAWDOEStqTIWPLYTOAN0IYNEROFAiHOPEHTYYMOBU0.DSORWPFqVESTMERE0N,M1D� NF17CpfTNAGfSFOFSUCMPROJECTSY/ITNACOHTRJ1CTOfl(5)L�LENSE�PURSUANTTO7HECONTMG' � 'QUANTITY'� �DESCRIPTION FEE - � TORS UCENSE IAW.). �.. �.. � � OIMIIXEYPTUNDERSEG, B.IV.GFORTHISRFASON Q 3 � . �_ ,,. ., .,__ _ c� �=' DA7E� OYmER � � . . . � .._ . . . .. ��_� , �� `, LLJ LIC£NSED COMRACTORS DECUIMTION ' W � IHEREBYAFiGU.IVNDERPEW�LTYOFCERNRVTHATIAA�ULENSEDUNDERPROVI510NSOFCHAVTER � � �� , � •(�ENCNO WITH SECTION)000)OF DMSION]OF iHE BU5INE�AND DROFE55iON5 C00E,AND Z - W LICENSE LS IN Fl1LL PoFC �ND EFtECT. -- ' " . .. m � LICENSE S� •� "' '�� LIC.N0.���� � . V DATE ' �� ����_CONTRACTOH , . � •_-__ W . .__— • _ _. _ . - . . _ . ` . . _ .1 � .i ✓ �WORKERS'COMPENSATION DECLAAATION, �`J� U i � • 1� � � I HEHEBYAFRNAI UNDER VEN.LL1YOf CEiiNRY ONE OFT11E FOLLDWWC OECLARATCY3: . �* ._._ Z '.) Q O _I HAVE MID WILL W1MTAINACERTIFIUTE OF GONSENT TO SElFdNSURE FOH WORKERS'� 2 � � �Td- ' COM7ENSATION,ASVROVIDEOBYSECTIONI7WOFTNELAeOfiODDE,fOitTMEGEFFORAIANCE W , OFTHEMfORKFORMRi1CHTM14PERA1ITI5i55UE0.� , � . . � . � ' , .� , -; . , . . . . �:r.. �: , Q �I HAVE IWO Wtt11MM/uN K'OFlXERS'CdAPEN5AT10N INSURANCE.AS REGVIRE�BV SEGT70N 77000FTMElA80RCO0E,FORTMEiERFORMANCEOFTNEWqiKFORWMIq1THI5PEflMITiS - -, _ �� � ESVFD.AIYN'OiiKERSCOMPENSATIONWSUMNCECARRIERMlOPOLICYhVMBERARE: CONSTRUCTION A PLAN REVIEW O � • . � . �'CAFiR1ER • �� `.'`' , � va�cY NwaER ELECTRIC • , \ t . � (tNSS[CiqNNEIDN7IB[OOAREiIDOFhEFEfydt6F0aa+E1l1�D�E1D0aiAa5R�ao�oalEu} PLUMBING � �On•!�C/ W . J� � ICERTIFYTHATNTHEPEi1FORMMICEOFTHEWORKFORWMIp1iH15PERMiTISI55UE0,1 MECHANICAL+ �rf—� �Q�-�L�" .SFIMLNOTEMPLOVANVPERSONINANYMMlNERSOASTOBECOMESUBIECTTOTHE � • ( � -y � '�WOfUCERS COMPEHSATIDN UWS OF CIIIFORNIA AND AGREE TNAT W I SIqULD BECOME t �. INSPECTION FEE. ,� S SUBJECTTOTHEWORKERS'C01A7ENSATIONVROVISIOHSOFSECTION77000FTHEUBOH,'. � ,. _.. . . . ' , ' ' 2 UD cooe.i s�wi.coan�wm+ca.�v�r wm�nasE vWovisroNs. ISSUANCE � . , . .. , ., . .. '�"-•_ �SMIP p DATE: � APPLIGANT.��, � W4RNINfi�FA1lURETO5Ed1REWOfiKEHS'COMFENSATIONCOVEMGE�SUNUWFULANDSHALLBE ENERGYP/C � (�y SUBJECTANEMPLOYERTOCAIA1i1UL0ENALTtESAN�CNILFWESUPS00NENUNORFDiHOIJSANO ��`3'+ � � - DOLLARS p10o,o00),W ADD�TION TOT71E COST OF COMDENSATIDN,DAIIAGES AS VROVIDE�FOR IN- • ,ENERGY PEflMIT. . � �;� •SECT10Ni7oeOF1HELABORCODE.W7EN[ST,ANDATfOiWEY'SFEES. � � " RETENTIONFEE: � � � � - ' a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBVAFFI0.AIUNOERVENALTYOiGE0.NRYTHATTMERELS�CONSTAUCTIONLENO1N4AfiENCV 1 " ' ' � fORTMEFERFORMANCfOFT1EWORKFORNMIpITHISGER4RISI55UED�5EG�0Y7,CIV.4). s F . 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