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HomeMy WebLinkAbout14994 (30) CITY OF DIAMOND BAR � --��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 2]660 E.Copley Drivc Suitc 190 (909)660-3195Fax(909)861-3117 PRESS SUII,DING PERMTi'APPLICATION FIRMI.Y S+�y JOBSITE � APPLICATION �"'� � PERMIT Q P/C o ADDRESS pA7E NUMBER � IF $ ISSUE TYPE OCC APN LOT TRACT DA7E CONST. GROUP � OWNER p ADDF�SS��_�l� )e��' E� ,qpt"�,_ ZONfNG SETBACKS cirv D.i� ZIP �, 'fEL. �/��,,/�q/�-� FRONT RW ❑ APPLICANT TEL.i�',�-d.a REAR ❑ � SIDFJSIDE STREET�! RW ❑ CONTRAC O SIDE ❑ g ADD S PROPOSE�USE CI ZIP TEL. � ARCH/ENG/ DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. y DESCRIPTION SQ.Ff: FACTOR PSF ADJ.AREANALUATION � ONrtJER-BUILDER OECUiiATION ' SFR/MD/REM 0 I NEREBY�FFIRM UNDER VENAL7Y OF►EIWRY THAT 1 AM E%EMiT FROM iHE C�MMCTORS lf� Ganpa/Csrpon � CEN6EtAWWHTMEFOLLOW�NOREASOH(SEC.7037.6&151NESSANOPROFESSIONSCOOE:MIYCRYOR (n WIMIP/MM1YL1iREOlARES1IPERMRTO00N37RUCT.ALTER�PROYE.GEM0U5H2ORREPAIRANYSTiIUC- �AJ Pelip/DBCk IURE,PRqR 10IT8 ISSUANCE,MFA RKXIIRES 7HE APPLICAHT FOR SUCH PERMrt 70 Fl�E A SIONFD W - BTATEIAEIR 75Ui ME OR 8HE 49 UCENSED PURfil1+1N7 10 7NE PROVi51ONS OF THE CONTWICTORS LL . CENSE LAW(WA77Efi f(COMMENC4JO WIiH SECTWN 70DD)OF DMSION 9OF TNE BUSNIESS M1D PR0- � POOU$p9 FESSqN6 CODEi Oq TW�T HE OH Sl1F IB E%EMV7 TMEREFROM 1WD THE&1SI8 FOp iHE ALL60E0 E%ENP• 710N.ANYYqLATIONOF8ECT10NTOJ1.6BYMIYAPPLIGM'ffF'GHAVEPMIT6UBJECTSiHEMPLICNJiTO � z Re-Root � ACIV0..iENALiY OF NOT MOfiE 7HAN FIVE MINDFED DOLURS(t6o�.1: ' � O4ASONMEqOFTNEPPOPERTV,ORWEYPLOVEESNATHWAOESl15THEIRSOLECONPEK4A710N, L� Commerclal - lY1LL pp T1E MIORK,M10 TNE STRUCTUqE IS NOT IARENDED OR OFFEREO PDN 9ALE(SEC,70�1.BUSI- J NESS ANG PqOFE8810N6 CODE:TiE COMIiAC7Qfl.4 LICWSE lAW pDES NOT AOVLV TOµOWNER OF ? � PROPEHf'(MIlIDBU4DSONYPRWESTIEpEON,A1mN+IqO0E38UCM'NORKHINSELFORMER6ELFtlR CC TfIROUGHiiSOftHEROWHEMPLOVEES,FNOVI�ED1HA78UGilA1PROVEMENfSMENOT111fENDE�OR m pOFFEREDFOAEALEF,HOWEVEA7ME9lALDINGORWPROVEYEM1690LOWRMNJUNEIEAHUfCpARE- � �710M,TIE ON7YER�UItDEii 1MILL MAVE 7ME lUR�EN OF�F10NN0 YHAT F1E OR BNE qD NOT BULLD OR MPRDVE iOR THE PURP06E OF lFLE1. .. � ❑I,ASOMMENOFiHEPHOPEHT`/.AMEXCLUSIVELrCONTMCTMdOWITMIICENSEDCONfFUCTORS TO CON,rTflUCT THE OH6IECT(8EQ 7oN,BUSME6S/WD PROFE661dJS OOOE:TME OON7RACTORS LI- V811181IIX1 ADJ.AREA CENSE UW OOES NDTAVPLY TO AN OYlNER OF A PFOPERTY WXOlUILOB OX NIVROVES TNEREON.AND WFpCq(TRACf6WR8UC11►RO.IECT9WRF7ACOH�MCTOR(s)LICENSEDWRSUAMTMTHECONTMG QUANTITY OESCRIPTION FEE � TOIIS LICENBE LAW.). a O IAM IXEAPTUNDEF 8EC. B.i P.C.FOR THIS FEASAJ q U � � DATE OYITIER U � LICEN3ED CONTRACTORS DECLARATION W � INEPEBYAGFiWUPDERPENALTYOFPERR1FfVTNATIAMUCENSEOl1NDFHPROVI310NSOFCHAPTER � � •(COMNENCtq Wliq SECTIDN 7000)�OM9qN�OF 7ME BUSINESS AND PROFESSIONS CODE,AND z �� MY UCFN6E 16 N Fl1LL FORCE AND E'ECT. ����� (J � QFF�� UCENSE C IIC.N0. �7 � OATE � CONTPACTOR '�"� OJ. WORKERS'COMPENSA710N pECLARATION Q � I MEPEBYAFFlNIA UNDEH PENAl7V OF VE0.AIFY ONE OFTFIE FOLLOWINO0EC1AMT10N5: U � Q � �_IMAVEANOYVILLM��NTAINACERTFICATEOFOONSENTT08ELF-INSl1REFORV✓ORNERS' _ CqNPEN5AT10N,ASPpONDECBYBECTIONa7000fTHEUBORCODE,FORTNEPERPDRMANCE � OF T11E WOFlK FOR WN1CM TMS PENAIIT IS ISSVED. � 0 �I HAVEAt�4VILL MAINfAPI Y/OAKEIIS'COL�PEN6ATION INSURANCE,1�5 REWIRED BV SECTqN 4 9700 OF TiE LA60R OO�E,FOR iNE PERFORMANCE OF THE MIORN FOR MMiCH 71u5 vENMI71s � ISSIIEO.MY"�KERS'CUMPEN611TION INSURlWCE CARRIER AND POLICY NUMBERAHE: CONSTRUCTION � CMRIER I'i r,�,� PLAN REVIEw . � ►a.arruMaen �A�G! � �LECTRIC p (IFi58ECI�oMAE�HOTBE00ARE1EDOFT1EPEiMfKPoRONEVi►l]FEDD�LiMSR��%�LE551 PLUMBING � ICEPTIFY TNAT N7HE PERFORMANCE OFiF1E WORK FOR WNICF17HI5 PEHMR IS ISSUED,1 MECHANICAL (� SHALL1pT EMPLOY ANY PERSON IN IWY MMlNER SO A4 T0 OECOME SU&IECT 70 THE (q WORKERS'COMPENSATIONUNISOFGLIFORNIA,NJ�AC3REETHATIFIS/IOl1L�BECONE INSPECTIONFEE S BIIBJECTTOTHEWOHKER50DMPENSA710NPqOVISiON50F8ECT10N�7auOFTHELABOR � D.I SFMLL ni ca.�a�r wini 7}�QSE PqOVISIONS. ISSUANCE OQ DA7E. APPLICANT: _{•r� _ - . SMIP � nn�I� '��` �— ENERfiV P/C _� J 4�,+ - y `� WARNI :FAILU T06EWREWORKERS'COId�ENSATONODVERAOEISUNLAWFU�ANDSH.LLLBE (((��� �-�-�j7�[�► � Sl1BlECf AN EAIPLOYERIO CRIMINAL PENALTESAND CML FINES UP TO ONE MUNOREO iNOUSAN� ENERGY PERMIT �i�Y � OOLLM9�i1D0,000),WAGOITipNTOTHECOSiOFCOMPEN5AT10N,DAlAA0E+A8PRWIDEDWFlM C t S J SECTION 9]0!OF 1HE IABOR O�DE.NTEREST,ANO ATTORNEYB FEES. RETENTION FEE: (�. a CANS7RUCTION LENDINO AGENCY PFiE-ALT FEE: �i�I O f� I HERE9YAFFlRW UNOER VENKTY DF PERNNM THAT THERE IS A CONSTRUGTION LENDINO AOENCY uz• FOH THE PERFORMANCE OF THE WORK PoR WMICH THIS PEqMIT 1615SUED(SEC.70Y7.GV.C.� W � LENDER'S NAME � LENDERSMCFESS y � � ICEpTIFYTIATIWq/EFEAO7HISIWPLIGTIWANOBTATEThU1iTNE/IBOVEWFORAIATqNIS�RRECT. TOTAL FEES � IAOREETOCOMPLYYYITFIALLCRYANDCqUNIYOIiDINANCE5AND5TATEl1�NBREIATNCiTO8UL01NG ODNSTRlKT10N,MIOMEREBVIAITMWiREAEPRESEMATIV SOFTMISCOUN7YTOIXfERUPON7HE ' S� /80VE•MENTIONED PRDGERIY FOfl IN9PECT10N VUNP05 . COMMENTS 9 QRIAIT7EEN�WEIPWNTj � � y BqlU OFPEfU11TTEE 7E , � RECP7:NO. P/UD BY VALIDATION WHITE—Departrnent Copy,YELL —Flnence Copy,PINK—Assesaa Copy,OOIAENROD—File Copy,aR EN—Applicanfs Copy �