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HomeMy WebLinkAbout11527 . .,... . __�.T_..._._ .._._._.�_.�_._...,�...�....��--..._.._ -_.. _.._ � _. .. __._ , . �5 �1 ���---�---. CITY OF DIAMOND BAR � ;� �.1 I ! � � � � COMMUNITY DEVELOPMENT DEPARTNIENT �� �; q� qIR :'�:-;;; 21660 E.Copley Drire Suite]90 �'1�7 � ._. (909)A(0-3195 Fax(909)861-3117 � � : PRE`S.S � ���'°"'� BUiLDING PERMIT 1PPLICATION FIRMLY � JO ITE �+ APPLICATION PERMIT P/C o ADD ESS '��'� L'v A'y C9(,� �j�Zj�/N Le'�b' DATE NUMBER Z� # o� ISSUE �,s TYPE OCC APN LOT� TRACT�e Z'� DATE_P y i � CONST. GROUP p OWNER,�����C y/4'K�I' � /�1N� C'�%U y�-i`w7' ADDRESS'Z G�'� � F��OZK�� DIt2/v� ZONING SETBACKS z CITY .1�. ��__ ZIP���j TEL.���C'. �z'�T I FRONT _ RW ❑ � APPLiCANT _. TEL. REAR C � SIDEJSIDE STREET RW C' m CONTRACTOR�"LPt//� St�7�i•/t;�/�idrv j�..�eNP•�eL�,Cr / SIDE C__ oADDRESS/' �-. � �`E ��� C' PROPOSED USE. L�"�� ��'�-G�rL L!o� CITY _ iN7�K 5'Tl2�,� ZIP / TEL.�� f� �w ARCHlENG/� � z DESIGNER��� SL��7l(R-A NO.OWEL. NO. NO. a ADDRESS-S5� d✓ � h�ti T D -�/�I/1Z C� UNITS STORiES BEDROOMS � CITY �C� ZIP��f�'�L/'TEl.�7��2� Z.� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BI:ILDER�ECLARATION SFP/ADD!REM Q G I 4ER=9V AF=1RM UND"cR PcNAL:Y O��ERJURY THAT I AM EXE`AP'�ROM THE(:O�TRACTORS LI- G2ffl9BiCefp011 W CF�'SeLAVJFORTFIEFOL�OY/INGREA50NI�EC7�31.58U5ME5SA`:DPROFc5Sl0\SCOOE.AYYCITV09 (n _ U COJ.�TY�V�ICHRF_CU'RESAPEa611TroCONSTR.I�T,AL'FR,9.IPROVE,DEMCLISF,ORREPAIRANYSTRUC� W Pdtio/DOCk � TU7E,PR'�� 'O I"F ISSUANC[,A_SO REOUIRES Tn'E APPUCAYT FOR SUCH P[RN�T T FILE A SIGNED W � STATEAAENT T HE pq SHE IS_:CEt�'SE�OUaSUAVT TO THE�ROVIS!G1'S Gf T�'E N7aACTORS�J- � CENSE LAW;CHA R 9(CAMMENCING W17H SECT:ON 70001 OFDIVISION 3 OF Th USINESSAND PRO� ��Y����SPB FcSSIO�5C0]E)Oq THEORSHE•SE%EMPTTFEREFROlAA4DTHE�ASIS' -H'cALLEGEDE%EMP- � � T:O^:.Rh'VVIOLATIONOF 'CTION7^.3158YAtiYF�?'..ICAYT^ORAPEqMI? BJEC'STH=APALICANTTO Z Re-Roaf � A GIVIL?=_\'0.LTY OF NOT A1 =TF'AN FIVE riUY��ED'.)CLLARS(55IX"" � GI ASO`NNEqOFTHEPfi RN,OR!AYEA"PLOVEEStNITrI ESAS'HE;RSO_ECCMPEM1SA:iON, � COmmGfCidl z NlILL 70 THE VJORK,A4�TH'e 5T. iUnE IS NOT INTENDE OFFERED FOR SALE(SEC.7044,9USI- J / /f q � �E55 AND PRO=e'SS70A5 COOE TH= 1'TRACTORS LI ..[LAW�O[5�\'O'APPLY TO AN OWNEfl CF � ��ry�`L'`�� ZC1 • ) /s G�C PROPE.i'VVJHCBUIL�5091NPROV'cSTn EONAN HODOESSUCHWORKHIMSFLFOF.:dERSFI.FOR J , C[ 77�Fi0UG�HISORHERO'h'NEM?LOY'cES,PR � THA75U6�IMPROVF_MEN'SA7EN0"�NTENDEDOF m��`�/�� 3�v W OFF'cR_�FOA�A�EI=,HOWF_VEaTHEBUiL�I . �ROVEMENTISSOW^WITHItiCNEYEAROFCOlAPLE � 'IOV,-HE OWtiER-BUILDER WI'�L hIFVE" UPDC-M1 �P.GVING THA?HE OR SHE DID NOT 9UIL�OR � :�'PROVEFOR�HEPUR!'OSEO:SAL'c � L]I,AS OW�'eR OF'H'e PROP= V,AIA J(C_US.VELY COtiT TI4G IYITH L'CENSEO CO+1TflFCTORS � TO CONSTRUCT T4E PROJEC7' C.7C4a.EUSINESS AM1D PPOFESS� ' CO�E:THE COMRACTORS LI- ValuatiGn :"� ADJ.AqEA LL1 CF�SE LASN�70E9 NOT APP OAN OW.�ER OF A PRO�:RTY 4YFI0 BUIL� �MPROVES THEREON.AND � VAiOCONTRAC'SFOR ' HFRQIECTSWI'HACO\TRAC?OR(S)LIC-tiSED�'J �TTOTHECOMRAC- QUANTITY DESCRIPTION FEE 'OPS LICENSE LAYJ. � rIAM� MPTU�'.DEaSEC._ _______._A b?C FORTHISRF.ASON Q �w�I����L- .�'� 7�'r —..."""""""_'__'__"— __'_—_— � �� 4�� J LL' �]AT. OWIiER___"_""_ ~ • � _—_'___"" ... .___ . -- U � LICENSED CONTRACTORS DECLARATION. W ¢ Q IHC!lE3YAFFIR'A'J\OERPENA�YOFPERJ:IRYTHATIA'ALICEtiSEDUNCERPROVISION50FCHAPTEA � a, 9;MN'A[NCINGVYIi71SEGT'ON7�]O�OF:lIViS'OM130=THE3USINESSANDP�70=ESS�ONSCODE,A\D Z X MY L�C-.tiS[IS:M1'Fli�..FOflCC-ANJ EFFECT. �3 — � L�CENSE CL.A55_�___' uC.NO.�..31 C�.(_1...."._..._"__ � � U DAT[_�=���� GONTRACTO �+� a lJJ e� WORKERS'COMPENSATION DECLARATION J � 4 � I N'caE3YAF�IRM U\D'cF PENA"V OF PERJ'JRV ONE O=THE FO�LOWI.UG D'cCLARATIONS U Cl� ¢ � I HAV�AND WI;L MAIVTAiN A CEflTIF'CATE OF COkSEN'TO SELF-:NSURE FOR WORKERS' _ CAMP[NSATION,ASPROVIDEDDVSECTION97000��HELABORCODF.,FORTHEPERFOqMANCE U 4 Or=THE WOR'{cOR W�ICH iH5 PERM:715 ISSUED. � `� _�I HAVE AND WI:L MAINTA�N WORr(E95'GGAIPENSATION 115URFNC'c,AS REQU:RED 9V�ECTION O s'a00FTHEJ160RCOJE.%Cft'HEPEPFOnMANCEOFiHe1YORKFORWHIC�'HiSPERMI?IS j�� �y+- ISS'.iED_A!V WORKERS'COM?ENSA7�10iN 1NSAUR/AN/CE CARR)IE,r7�JAND PO'.ICY YL'MBERARE: C STRUCTION _______ / � j Ch.'.P'EF�_�-!�y�-'S ./''Li7��l1Tl�7��- �f��✓ �/�E�/l� —____---____—_ _ � FOLI'V AUI.A7ER__�G C3""_'1� J� E�E�rC.R _'___ ' "'___ � r �� �--'__'__ Q 0 (�-lSSEC'IONI:ErDM'JT�ECCMi�LEfEDCFTNEPEP.NR:SFORONEHUM1�REClX7lLAAS(Si00�ORLESS!. PLUMBING _ lL Z IC[P.il'-^!T::ArINTHE�EFFOR:APYCEOFTHEWORK=CRV�HI^.HTNISPERMIT1515SU'c�,I MECHANICAL ___,.___ ____ ___._ ('3 SH4LLI.OTEM?�OYAN1'PERSONINAN�MANNERSOAST03ECOMESU9JECTTOTHE �hSP_FC.IfONFEE � 'MORKERS'C01.1�c�'SAiIOM1LAW50FCALIFOFN:A,AN�AGREcTHAT1=15HOULD9'cCOME � _ .._._.— _ _ SU3J'cCT'OiHEWORKERS'CO!dP:N5AT10NPRC`lISIONSOFSECTION3loaCF?HcLA60R � � "` �w'"l �1Q � CODE.ISHALLFORTHWITHCA�dP�V IT4THOSEP VISIONS SUANC __7�-' � � '-- p enre:�- Z�.���.� AP?LICA . ___ _" " ' SM� ______--- �'F�"`� � � ENERGY P/C � WAPN�NGFAILURETOSECUAEWORiC'eR5'� .PENSATIONC 9AGEISUhLAWFVL,AN75NALLBE � ----- � SUB.1cCTANLM.�LOYcR-OCRIM!1ALPENALiIESAKDC'VILF�h'eSUPTOONEHUN�REDTHOUSAND I �=NERGYPERMIT DOLLARS(E'�O.o�o).I\A77ITION TO THE CCST OF COMPcNSATION.DAMAGES AS GROVI�ED FOR IN -- — J SEC-10N 57CB OFTNE LA60R CODE,Ih'iEREST,A�DATTORYEV'S FEES .',+�.,.,� l� � RETENTION FEEi1� � W I � a:���y� � I CONSTRUCTION LENDING AGENCY � PRE-ALT FEE: � _ � I, 'GRG3�'AF=�RlAUNDFa�_VALTVOF�ER.URY'HAiTH�REISACO!�STRUCT'OhL[N�IAGAGE�tiCV � � I I=Cfi"HE"'cRFORMANC[OFTH=WORK FCR WH:CH TH;S PERAAIT IS'.SSUE���SEC_3�D7,CIV C.�. ---�-�����- Z i ' M ., ��.. ,L �/�,�L; _ �,cy,. _ ,. f :: � � LE�DE�S�AME—(�.�.. . . ...w.-�. . � .M1.. 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