HomeMy WebLinkAbout15137 (1092) �'� J,� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� � . 21660 E.Copley Drive Saim 190 �/� (909)860-3193 Fax(909)861-3117 ';l PRE$$ ''"" BUII.DING PERMIT APPLICATION FIRMLY � ODRIESS ` J1������ �����'! APPLICATION� � � PERMIT �X�/3� p ,�Q�q G DATE NUMBER' � It �'�p` � $ ISSUE 7yPE pCC APN LOT TRACT DATE CONST. GROUP p OWNER �� "' p ADDRESS �S� � � LLC i''� ZONING SETBACKS � CITY ZIP TEL. �OM RW ❑ APPLICANT TEL. REAR p � � SIDE/51UE STREET RW ❑ CON7RACT0 --LL' SIDE p ADDRES �a � ` � �.� g CITY G✓L-. ZIP TE��v��� PROPOS�D�E � ARCHJENC�/ � DESIGNER � `� ADDRESS NO.DWEL NO. � NO. � CITY ZIP TEL. UNITS STORIES BEDRO�MS � DESCRIPTION SQ.Fr FACTdR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFRlADD/FIEM O I NEREBY AFFlRM INJDER PENALTY OF PERJURV 7HAT 1 AM E%EMPT FROM THE CONTMC70RS ll- GHfeyB/CAIpDR C@15EUWFORT}IEFOLL0IMNOREA60N(SEC.7ua1.6BU5INESSANOPROFE55KKV5CODE:ANYCITVOR (n OOUNiYY11FYCHAEC�JWE3APERMIT7000N5TpUGT,ALTER,IMPROVE,OEYlO1J5H2ORREPAIRANYSTRUC- W P8110/DBCIC IURE.►RIOR T01T5 159UM10E.pL30 REW IRES iNE MPUCANT FOR SUqi PERMIT TO FILE A SIONm W BTA7E4EN7 TXIIT HE OR&1E IS t10EN5ED PURSUAHT TO 7HE VROVISIpJ3 OF 7FIE CONTFUCTORS U• C�JSE UW(Qf0.PTER 0(COMMENCq1O YfIiH SECTION 7000)OF DINSION 9 OF THE BlI3INES5 ANO PRO- �'i' PDOI/Spe FESSIONSCODqOR7XATHEORSHEISE%EMP7TIEREFROMANDIMEBASISFORTHEILLLEGE�6xEMP- � TION.MIY VIOLA710N Of SECTION 7031.6 BV ANYAPPIICANT FOR A OERMIT SUBJECTB TNE MPLICANT TD Z Re-Rooi � AqVIL VEN/LTV OF NO7 AAORE TU1N FNE NUNDRED DOLLARB(=500�.): D4A.^OWt1EROFTHEPROPEHTY,ORMVQ.IOLOYEESWITHWAOESA5T/EIR80LECOMPEN5AT10N, (,`pmmBICiOI WILL DO THE MfOH1C,ANO iHE BiRUCTVRE IS NOT IMENDED OR OFFERED FOR SALE(9EC.7w6,Bu51- � y NESSAND iilOFE5510Nb OODE:7NE CONiMC70R5 LICENSE LAW OOES NOT�PP�'!TO AN OWNER OF � PRDPER7Y Wl10 BUILOS OR IMPROVES 7NEREON,ANO MM110 DOES SUCH WOpK HIMSfLF Oq HEHSEIFOR � TMf10UfiMNI50RNERONM�APLOYEES,PROVIDEU7WITSUCMWPROYEMENT3ARENOiINTENDE00p IL� OFFERED POit S1VLE tFliOWFVER11�E8UIl.01N00R IMPHOVEMINT IS SOLDV/11HIN ONE YEAqOFCOMPLE- TION.T1E OWNER�BURDER N1LL HAVE TXE&1RDEN OF PRONNO iHAT ME OR SHE DIDlpT BUItD OR W PROVE FOR THE PURPQSE OF 9ALE�. W OI.AlOWNEROFTFIEPROPERiY,AME%CLUSNEIYCONTMCTINOWRFiUCENSEDCONTMCTOR$ ' (� 1000NSTRUCTT1ff VRQIECT(BEC.70M,BUSINESSAND VFIOFESSIONS CODE:7HE LONTRAC70h5 LL 9Wi[I011 ADJ.AREA �i� CENSEUWDOE8NOTAPPLYTOANOWNEROFAPROPERTYWFIDBUILDSORIMPRDVESTHEflEON,AND Z WFIOCONfMGT6FORSUCHPROJECT3WIT1111fqNfRACTOR(S�LICENSED%1qSUANTTOTME00NTRAG OUANTITV DESCAIPTION \ FEE � TORSl10EN5EUW.�. • J /' ❑I AM EXEMPT UNDER BEC. B.i V.C.fOR THiS REASON U � �= DAiE OriNER F� � U q LICENSED CONTRACTORS DECLARATION W 2 IHEREBYAFFIMIUNDEflPEN.LLTYOFPE0.IURYTHATIAMLICENSEDUN�ERPROVISIONSOFCNAV7ER � S ��COMMENCWON7THSECTION7000)OF�NISION�OFTHEBUSINESSANDPNOFESSIONSCODE,AND Z 7[ W LICENSE IS rl FULL FORCE AND EFFECT. /'] � LICENSE/Cj'A 55 C��! LIC.N0. �a� ` .�,��,r-� � DATE r'/ � C �'d� CONTRACTOR G ti � a WORKERS'COMPENSATION DECLARATION ,� � IHEREBYAFFIRMUNDERPENALTYOFPERAIRYONEOFTHEPoLIOWINODECLMAi 5. ��r z � __IWWEANDWILLMAINTAINACEIffIFlCATE�CONSENTTOSEIF-M1511REFORWORKERS' _ OOIAPENSATIDN,A9 PNOHbED 8Y 6ECTION 3700 OF TFIE LABOp'(.O�E.FOq THE PERFqRMAN W Q OFTHEWORKFORWHICHTHISPERMIT1915SUE0. � � �IFUVEANOWILLMAIIirA1NWORKERS'COMPENSATI�NINSUfUNGE,A5REQ11RE�8V5ECTION Q 37000FiNElABORO00E,FOR7HEGEH�ORMANCEOFTHEWORKFORWHICHTHISPERMRIS � ISSUED.NY WOq'K`r�B7�yCO NSAT�INS j�PNCE CARRI ANO POLiCY NUMBER ARE: CONSTRUCTION / -� �j GRAIER "/ ' � PLAN qEVIEW .. . � vaLCYNuueER '�' ECECTRIC � (MssECIpNNE�NOTBEC�LE�oF7HEPEwAiBWRa�EM1WREODcuNL9(f� on PLUMBING � IC6RTFV 1}IAT NJ TME PERFORM/NCE OFTHE WORK FOR WHICM THiS PERMIT IS ISSUEO,I MECHANICAL SIiALL NOT EMPIAV ANV OERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO TNE � WORKER9'COMPENSATIONUWSOFCALIFOi1NIA,ANDA EET IFIS BECOME INSPECTIONFEE SSUBJE p70 EIMORKERS'COMPENSA OF OOFTNELA90R - -�L J�i�rnca.+a�r ISSUANCE � � l Q� ��✓^ .�r.�.��,..:i.�� p DATE: APPL�CAN7: SMIP � ENERGY P/C WARNING:FNLURE TO SECURE WOflKER5 COMPEN511TION COVEFAGE IS UNUMIFUL,AND SHALL BE �y, SUBJEGTNJEMPLOYER70CRiAiNNLVENALTIESNVOCNI�FMIESUPTOONEMUNDREDTFiOV$ANO ENERGYPERMIT ( �� ¢ OOLURS(i700,000),IN PDDI710N 70 TXE C0.ST OF COMPENSATqN,DW AC,ES AS VHOVIDEO FOR IN SECTqN 7iW OF THE LABOH OODE.IN7EREST.ANDATOHNEV'S FEES. F7ETENTION fFEE: J �'' nW. CONSTRUCTIONIENDINOAOENCY PRE-ALTFEE:����'�Jl' �jl�•x`:r�'�i� �:.�Z� � IHERE9YAFFIRMUNDERPENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLENDINGAUENCY l"�'�} AT'��� G'1;;;:'" Z FOR 7NE PERFORMANCE OFTHE WORK FOR WHICH 7HIb PERMR IS ISSUED(SEC.70o7,CN.C.�. !'-71����E��`3 � "�`� 1� W ��,n� � LENDERS NAME � IENDER'SADDRESS � ICERTIFY7HA71HAVEfiEADTHISMVLIG.TqNANDSTA7EhIATTHEA60VEINFORMATI0NI5CORPECT, TOTAL FEES /' '� d 1 AOREE TO CddPLY WITH ALL CRY AND COUNTY OROINANCES AND STATE lAWS NELA7N6 TO BU0.DING 4 (.7 � CONSTHUCTION,ANOHEAEBVAUhIORIZEREPRESEMATNE50FTHI5Cd1NTVTOENTERUPONTHE r � / � ABOVE.MEMIDNED iROOERTY FOR INSPECTIDN VURG06E3. v a ���� �^���, �� co MENTS 4 P EE E I �! �+ � r J � I� E 1 E DA � RECPT.NO. 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