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HomeMy WebLinkAbout13958 • CITY OF DIAMOND BAR ��� �` � ��' �- DEPARTMENT OF COMMUI3ITY&DEVELOPMENT RVICES " j `�b a �w . 21660 B.Copley Drive Suite 190 (909)860-3195 Faz(909)861-3117 PRESS �'Y�' SUQ.DING PERMIT , PLICATdON FIRMLY T J08SITE ,-�,�7� -� "�� �1,,��� �p� �" , APPLICATIONQ �f C�� PERMIT ��'� p/C o ADDRESS �� D,4TE ✓a ' .J NUMBER f�J # � APN_ LOT T�iAC7 ISSUE TYPE O� p OWNER ;� :.�tLYfir:�C/( e = DATE= CONST. GROUP o ADDR S ���Z-I3_�y;�t�s J-QG,-����� - ZONING SETBACKS w CITY �. � ZIP��TEL. '����'7��� FRONT _. RW r- � APPLICANT TEL. REAR ❑ _ — —� SIDE/SICE STFIEET_ RW C gCONTRRCI'OR -Y�' �-' �.3_ � �__ SIDE L ADDRE$ �� � ��t"�� CITY F'�✓�G% ;^- ZIP TEL. ,-1`f� - �'� PROPOSED USE o ARCWENG/ ^ a DESIGNER �° ADQRESS --- NO.DWEL. NO. NO. � CIIY ZIP TEL. UNITS STORfES SEDROOMS tr, -- - — u� '—'-- DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION � OWNER-BUILDEfl UECLANATION SFR/ADD!REM O i HEREtlV AFFIRM UNDEH P'cNALT'OF PEP.JURY TNA:t AM E%ENPT FROM 7HE CONTRACTORS LI� G2f8Q@ICelKlOft � N LL CENSELAWFORTHEFCLLOWINGRFASON(SEC.7031.581JS6YESSANOFriOFESSDNSLODE:ANYdTYOR WCOUNTI:YHICNflEOtiIRESAPERMITTOCONSTqUCT,ALTER,IMPRbVE.OEMOLISH,ORAEPAIRAh�STP.I.'C� � patiolDeck NRE,PRIOR TO 7TS ISSUANCE,flLSO REOL'IRES THF APPUCANT FOR SUCN PF.FM�T TO F!�E A SIGNED � STATEAIENT hi�7 HE OR SHE IS LICENS'eD PUP.SUM17 TG?HE PROV'SIONS OF 7HE CONTRACTORS LI� � CENSE LAW(CHAPTES 9(COMMENCINO WITH SECTION 700G)OF DIVISION 3 O�THE BUSINESS AU�DRO� POOI/Sp8 � FESSIONSCOOE)ORTNATFEGP.SHE!SE%EMPTTNFREFqOMANOTF1E6A515FORTN.EPLLEG'cDE%EAIP� � -- V TION.ANVVIOLA710NOFSECTION7031.5DYANVP.PPLICANTFORAPERMiTSU&IECTSTHEAFPUf:ANTTO n Re-Roof_ � ACML PENALTV OF h'OT MORE TaAN FNE HUNDP.EC1 OOliAFS(4500;.): - � ❑I,ASOWNF.ROfTNEPROPERTY,ORMYEMPLOYEESWI7HWAGESASTHEIR50LECFIMPFN5AT10N, J Commercial _ W!LL DO THF_WORK,AND THE STRUL?URE IS NOT INTENDED OR OFFERE�FOR SALE;S`cC.'od4,BU51� � NE55 AND PHO'ESSIONS CODE:THE f,ONTRACTORS LICENSE LAW DOES NOT F�PLV TO AN OWNER OF � PROPERTY 1YH0 BUIL0.;OR IA:PROVESTHEREON,ANO sMF;C[K1E5 SUCH WOAX}iIMEELF OR HERSEIF Op � THFiOUGHH:�ORHEROWNEMPLOYF.ES,PFOVIOED?HATSUCHIMP90VE41F�iigpqENGTIMEN�EDOR � QOFFEqEOFORSALEIF,HOWEVERI}IE9UILDNGORIMPROVEMEtiTISSOIDN^THINONEYEARQFCOMPLE- Z TION,THE OWNER�BUILDER W1LL HAVE^rIF BURDEN O�PROY!NG THAT NE OR£Hf:DI�NOT BUILD OR - = IMPiIOVEFOR?FiEPURPOSEO�SALE}. d,q� GI,ASOWIJEqOFTFiFPFiOPEATY,AMEXC!USNELY�OMiRACTINGN'li!?LIC�Y�'EOCONTRACTOFlS - � TO GONS'RUCT T4E PROJECT(SEC.7w6,3USV1E55 hlvD PROFESSIO"riS COL'�:?HE GOti?RAGTpkS Lb �•/�IUBIiO�I __,_________ ADJ.AP,EA____,__ Lil CENSEUWDOESVOTAPvl7TOANOriTlEROFRPP.CPF.RTY'NM�BUILDSORIMP?OV'_�TNCREOh,FWO -- _ -- f � 1NFIOCOWTRACTSFfaRSU.^.HPHtlJECTSWI?HACOtd1RAC'fOR�SfLICENSFD'URSUANTTp7VIrCONTRAG � QUANfIIY DESCAIPTION I FEE Y TORSIICENSELAWJ. � _� � J _'_�_`_ � C I FA7 EXEMPT UNDF.A S�C.,__'__'__'_'____B 3�L.'ORTH:S REA£ON ` �� � '__- ( V------- � - ___-'_'_-_-__._ ___'_"._"_'."__-_-' � "_.__ '_ DATE .�__-_ OWNER__-.._'._._..__'_"__ � -- � LICENSED CONTRAC-i ORS DECLAHA7�pk � � —� — � IHEREBVAFFI�bI�NDEpACNPLTYOF?tR1U9VT}1.4TIAA!LICENS'cDI:VDF.RPRCN:510NSOFCI-:AFTcR �, � ��, �� / _�y� d CICOMAiENCWOW17H5cCTiO�J�01+9)O'rD'V!51(Ni8Jfili'eBUS�4Fc'$A�.LPF?<:f-'ESS'CNSCO^F.AND L _ nCG�a.,T'C X MY LICENSE S IN FIiL6�OHCE AND EFFEC7. � " LLI t'� (,� [O I � LICENSE yCU1SS �`q� _ '.IC M1O 6��"`-; ���y��f—�,�,� �f----�-- I _.— ~ DATE_�'L—.1--"-. CONTPACTOR_,�g¢_ �-`.''""� J I.--.—__ _'._ W' y��. �;t':,•��' • ' � � �VORKcR�COMPCySATiON pECIARAT�GN ,�'��f �� -� u� �� ------' -- � I HERE6VhFFIFlM7 uNOF.F FEF.'.Lh'JF PERJ:�RY ON;OF lHc FOLI.CS'J:NC)ECLARATIONS� "� L I ' � I NAVE AhO WILL{hA1NThINqC<RTI�fCl.TE DF�.:^NSFNTTQ S'eLF-INSURF,�C��'+R'WOi1KcRS' �1 S rI � � LOi.1PEik5nTION,hSPROViDF�CVSi-CilON3�GeOFTMELA�}.^,RCO�F.FY')RTHEPER�OfjJAR U` __ __ o OF7NE'NORKFOR1Y7�iCHTHISPEqb!IT;�ISSUF.O ���' W � I � .1 � � ____I HAVF ANO W'LLMAINTAIU WORRE4S'CCWFF.4:.JlTIGN INSJ WVJCE,�A��9ED FV g^,^IO�Ny. n � 3lW OF THE L::fiOR f.bCE,F7P,THE o�qF '7MANCF_CF 7r'E WOFtN FOR Y�F:ICFI i HIS PE!tMIT)s I55'JEO.M'YN'Ofl7/(��yy5'.^.OR{P�NSATYJN VR�NCECpRRIEft�,kD?G:1^YyHFiBERF.RE�, CONSTRUCTIUV �`L CAaRIER /"�1__C.G`�'� � .�------///-- ^��l � ?LANREVIEW -------- ---- _ --- -------- -- - d POIiCYNUMBF.R____ �� �� ELECTRIC ��� L'`.�i'i_�" .-�----- `a ��1 ;n-�s�crex•:r��riorAEoaaa�r.r�es-r�Fra.eru:oF;a�rM:��encxx...ui:ia�m;�oa� ,, PLUM6!N� _��_� � � ICF.RTIFYTiipl'InTFiE?EFFORAIAM1C'cCFT},cytpq;��,�,qyyHiC4iT%il5 SL�FD,I Y1F_CFIANICAL ___'L��'.��:�.��_ C�7 SHA1 MUI'CM�:_OY fiN`/FERS�N IPd ANY MANNEP,SO AS 70 BECOME SU6;;Ci?O'HE "' ''"' � WORKERS'�Si1PFRSATIO4L1W50FGLLIiCRAIA,ANDAG4`F.FTHATIFi51�0U�[]9EiAM[ �NSPECTIONFE[ ____.__ _ _ � S�2JECTTO?4EV/OFKFNS'C.O!RPENS�TiGNPAOV15�Cf:5oFSECTICfJ3�Co0:'�iSLAe H GC%DL,I SHALL FOR�HWITH CCMP�Y W77j;�1i�'E PROVI510.Y5. � /�' j ISSUANCE ��'1 _��' O i "a ,� ,f�" -�r� pDR7E:4<'��_P��9.P?�_ICANT. �'y_�v��i�'''+_.�_�."�' � _ I SMIP - �;.�-'-: ` - _ � � �_NERGY P/C � � ' � J WARNINCFA:LURETOS[CUI:EWORKERS'COMf'EN5ATIONC^VERAGEISUN,nWF:1L,AhDSHALLBE ----- --- SUBJECTAN EMPLOVER TO CRIM:NAL Pc'NALT!ES A�D C'YP_FINES L'P TO ONE HUIJDRED'HUUSAN� ` % �.%3� "' ' � DOLLARS(t1aC,qoC�,IkADDITIONTOTHECOSTOFCOMP'cNSATION,�AMA6E,nsvr�owoenFOR!N c:N�RGY3'ERMIT+;;. ��� ' _ - - J SECTION 9708 OF 7HE L100fl(�77E,IN'.ER'c5L AND AT fORNCY'S FEFS. 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