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HomeMy WebLinkAbout15763 CITY OF DIAMOND BAR � ? -- ' DEPARTMENT OF COMMUNITY 8�DEVELOPMENT SERVICES � . � . 21660 E.Copley Drive Suite 190 (909)86a319S Fax(909)861-3117 PRE$$ � ����� BUILDING PERMTT APPLICATION FlRMLY o D R1ESS � o-r� �l S�0. ��. DATECATION �� � � y NUMB R���N� � ISSUE TYPE OCC APN lOT � TRACT 7�Sd DATE CONST. C3ROUP S OWNER �-L-�- ADDRESS �Tb��AN ' L.J6' • ZONING SETBACKS e CITY O� 'C ZIP9���TEL.�lD StLU3�{f� FRONT RW ❑ APPUCANT TEL. REAR ❑ SIDE/51QE STREET RW ❑ CONTRACTOR �--� G C- r'L- SIDE ❑ g ADDRESS /A?_ CITY ZIP 9171�TEL. Z PROPOSED USE � ARCHlENG/ � DESIGNER SS� � NO.DWEL. NO. NO. ADDRESS UNITS STOHIES BEDROOMS y CITY ZIP��TEL. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OVYNER-BUItDER DECLARATION SFFVADD�FiEM y O eI NEREBY AFFlRM UNDER PENALTY OF PERAIRY h1A7 1 MI E%EMVT FROM TFIE CONTMCTORS ll- GgfBgBJCi190R � GENSELAYYfORh1EFOLLOWWGREASON(SEC.7WI.EBUSINESSANDVROFESSION9CODE:ANYdTYOR (n WWITPYMIi01REW61E311�[flMRTDO0IVSTRUCT.ALTERIYPflOYE.OEMOUBH,ONREMIRANV9TFSUG W patlolDeck lUilE PRIOR 7D fT8 ISSUANCE,AL30 REOIJIRES 7HE MPUCMIT FOR SURI PERMIT TO FlLE A SIONED � lTATEYENf TiAT HE OR 5HE IS LICENSED PUitSUANT TO THE PROVISIONS OF THE CONTMCTORS U• CENSE LAW(CWPTEii Y(COMIIENCINO NATN 6ECT10N 7000)OF�IYI910N 90F THE BUSINESS IJiD PR0- LL PoOUSp& FESSqNS COOE)ORIHAT NE OR SHE IS O(EMPT TNEREFqOAdAND 7HE BASIS FOR 7HE ALLE4ED EXEMP- TION.ANYVIOLATqNOFiECTION7W7.6BYANVMVLICANTFORADERMIT6UGECTS7NF�PPLICANTTO � pe_qp� � A CIVIL�ENAL7Y OF NOT A1ORE THAN FNE HUN�RED DOLURS({6001.k . 0�1130WNENOFTHEPROPERTY,ORMVEMPLOYEESMATHWAOESASTHEIRSOIECOMPEN5AT10N, � CORIRIB1CIfiI WILL DO i11E MIOFIN,AND THE 9TRUG7URE IS NOT IN7ENOE�OR OFFERED W H&{LE(9EC.70H,BUSI• J NE55 MID PFlOFESSIONS COOE:TME Cpf�li�CTORS LICEN6E LAW OOES NOT APPLY TO AN OWNEh OF ? � PHOPERfYYVFqBUILDSORMPROVES7NERE0N.ANDYVFi000ESSUCHWORKHIMSELFORHERSEIFOR STM110UOM HIS DH HER OWN ENPLOYEES.PipNDEO THAT 9UCH MPROVBulENTB ARE NOT MITENDED OI4 m � ,OFFERmWRBALEIF.110N�EVERTMEBl1N�IN�OpMAPROYFMFNTI360LDW17NINONEVEAROFC04PLE- TION.INE OWNERBUttDEH NALL W.VE TNE BUNDEN OG PPOVINfi THAT FiE OH 8NE DID NO7 BURD DN LIPpDVE FOq iHE PUPPOSE OF&LLE� �y,� O I.ILS OYMER OF THE PROPEHTY.MI EXCLU3NELY OOMMCiINO Mffili LICENSED CONTMCTORS � MCONSTRUCT THE RiOJECT(SEC.7041,BU91NE89 AN�PRDFE99qN9 ODDE:IHE CON7RAC70R911• VIIU![{011 ADJ.AREA � CENSELAWOOEBNOTMPLYIOANOWNEROFAPHOPEN7YWFqBUILDBORIMPf10VE9TNEREON,NVD M'FAOONfRAC15FOli8UCNPROJECTSW17XAOON�RACTOR�S)LICENSmPURSUANTTOTMECONTM6 Q�ANTITY DESCRIPTION FEE � lOiiSl10ENSELAW.�. ❑1 MI EXEMPf 11NOER SEG B.i P.C.FON TNIS REASON � DD �+'��G�L� � � c5 �� � ¢ °"� °"""ER � Z G .n r � LICENSED CONTRACTORS DECURATION -� C'._� � W _ 1 HEREBY AFFIfW tR�DER PENALTV OF PERIURV THAT I AM UCENSEO UNDER VfpVIS10NS OF CHAPTER � � �(OOUYENCINO WI7H 9ECTION 7000)OF DIVISpN 90F THE BUSINESS AND GfiOFESSIONS CODE.AND Z W LICENSE IB MJ FULL FORCEANO EFFECL � �! , � LN;ENSE CU1S5 G��v LIC.NO. • / `� � J � S � oarE / �D cornAacTOA ��-F . iL. n. Z �+ � WORKERS'COMPENSATION DECLARATION Q � IHEREBYAFFlRMUNDERVENALTYOFPE0.JUpYONEOFh1EFOLlAWINODECIARAiqNS: Z � _IiMVEANDIVILLMAINTAINACERTIFICATEOFCONSENTTO6ELf•IN6UREFORYNORI(ERS' � OOI/PENSATION,A4 PRUV�ED BY SECTION 9100 OF THE LABOR COOE.FOFl THE PERFORMANCE 'U /OF 1HE WORIf FOR MM1IICH MIS VERMIT 18 ISSUEO. � � V I MIWEAND WILL AWMAIN WORKERS'CONPENSATION INSUMNCE,AS REOUIRED BY BECTION 0 J700OFTiELABORCOUE.FORh1EPERFORMMICEOFTHEWORKPoRWHICHTHISPERMITI3 � I63UED.W WOHKERS'�SATIOyJN�CE,C11RqIER AND POLICV NU4BERARE� CONSTRUCTION � CARRIER �•l•Ki IG V VV� PLAN REVIEW .r � POLICYM1MBEp � �O��d �i�' ��� ELECTRIC � (Tf6sECt�NPE�no78Ea01�LEfEOOFn£a6Nt�IBwRoIEMJf�DilEoOa�ARSp�oo�onLE55� PLUMBING ►IAIf 1 Q `�11� Z 1 CERTIFYTIAT N TFIE PEHfORNANCE OF THE WORK FOR WHICH T11S PER41T IS ISSUED,1 MECHANICAL (� SNAL1./qT ERIPLOV ANV PERSON NI ANV M/JJNER 90AS 70 BECONE SUBJECTTO THE • 1' 1\; � WORKERS'OOMPENSATqNUW50FCALIFO1WIl�MI�MiREETUTIFIBFiOUIDBECOME INSPECTIONFEE FL1Al+I � SUBJECTTOTHEWORKERS'CpAPEN9ATIONPROVISION50FSECilON97000FTHElABOR 6 COOE.ISNAI.LFDRTNWITHCOMPLYMA7HTNOSEPROVISIONS. ISSUANCE Bljti.nlN(; ATM1I3 Sr.F � • p DATE: APPLICANT. SMIP � WARN7N0:FMLURE TO SEGURE Wl�IiKER9'COMPEN9ATpN OOVEflAOE 18 UNAWFUL,AND BNALL DE ENERGY P/C LL Sl1BJECT AN EMPLOYERTO CRIMINAL PENALTIES/JVO CIVIL FINES UP TO qVE NUNORED TFIOU9AND ENERGV PERMIT OOLLARS(i70o,000),Y1 ADDRION TO 7HE COST OF WMGENSATION,OAM�GES AS PRONOEO FOR IN � SECTION J70sOF hiE LA60R COOE,INTERE3T,ANDATTUHNEV'B FEES. qETENTON FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEflEBYAFFIqM UNOEfl PENILLTV OF PERIURY THATTNERE IS ACONSTAIICTION LENDINO AOENGY Z FOR 7XE PERWRNANCE OF TFIE WORK POR WHIC/I THIS PERMIT IS ISSUEO�SEC.7W1,CIV.G), W � LENOER'SNAME � LENOER'SAODHE55 /�� � ICEHTIFYTNJITIIMVEqFJ1Dh115APPLICA'fqNAN�9T�TETMIIiTME�BOVENiFORM�TqNISCORFECT. 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