Loading...
HomeMy WebLinkAbout11340.pdf ��_�__... ��-_.�__„t___,�_,._.__.�.._-�._:.��,�,.. _��.�, ,�- - - CITY OF DiAMOND BAR ` : " � COMMUNITY DEVEL�PMENT DEPARTMENT ` ._�.._._�_..__.�'_..___-... . � � �.jy ..._._.._'__'__ZL�lO.E..S:O.QICj�DilYQS111RC L�'.-.._._�___ __.._;_ -- .. � _�_ _______ �--------____ __ ..____�_------PRESS___- (909)860-3195 Faz(909)861�31IT ' - ' - �""' BUILDING PERMIT APPLICATION FIRML.Y „ ' _ k.� a.�iEss .3�$! ��4Ny°N✓!�W,17�." �n���a -�/� PERMIT � ic = . rxtr�a� r_. � issuE _ rrPe occ , � ARN LOT TRACT II DATE CdNST. GROUP � O{NNER ', _ _. ' ADDRESS 0 & ZONING SETBACKS ua CITY l✓,�� Z!P TEi,. � I . REAR ' . <'RW_ ..�O �- -- / � APPLICANT TEL. �''/ SIDFJSIDE STREET RW O � .CONTRACT�R I� L4 /I� - ._ SIDE _ O � ADDRESS !3 � PROP�ISED USE �L/�/�I�S�it��1 ��� . _ _ ._ .. C1TY Z1P- ! . Z ° _ _.._ _ __ _ ; w AR NCa! , �- , , . r. " z DESIGNER _ . . NO.DWEL. NO. NO , nW, ADdRESS . UNITS STORIES BEDADOMS'� ' � CITY ZIP TEI.. � _ bESCRiPT10N Sa.FT. FACTOR PSF ADJ.AREANALUATION � , ,` _ � , _._. _ _. �WNER-BL'LLDEROECLARkT10N •SFWADD/REM _ .. _ . ; p ��v�cwu uanEa aaw.rr oF r�uuar nur:i ua o�Pr�n+e cornw�ciau� �a�r�rt W CENSEUWPoRTiEiOLIOWNKifiEPBON(6EG7IXit.68U5R7E55ANDVFpFESSIOMSCOOEANYCRYOR- (n . ... . ZcouHrrwrncaiaEauir+ESAP6wrrTocor�srnucr.wrole�rr�.�ousH.oat��enramuc' • W PatidDeck _. . tvas,vpan m Rs�co�..ex�so nEauiaes 7t��rv��ut+r wrt s�v�To��s�o W - ---. _ _ __.---- : . � sr�TaiQ+r rw�7�on��s ucEr+sEo ruasuurr�ro n+e cAowsions oc me coenn�crons u- d3 O � c�asEt,a+rlcwwcs+rt�wm+s�eraa:000)�wwss�a�n�eusir�ssu�oweow. . � P,00llSpa _ � F6SSlONSCODE)OR7NATl�di�iSEXQiPTiNEREff�1AAHDTHEBASISFORTHEIW.EC�DE7�MP• �•. T�IX'1.AN'/YIIXATIONOFSECTIONT03f.68YANYhPP4�CN4fFORAPERMITSUBJECTSTHEMW.K:ANTfO' .�, Z RB-R00� ." .. . - F, ACMLPENALTYOFNOTNORESFiN1RVEFM1INOREDCOl1AflS{i500}•k .. _. . . � . . . . , _.. _� OktiSowNEFi�IlffVAOPERTY.WiYY61PLOYEE5w7TNwM3E5�tSTt1E�iSIXECOI�WEM&HqN., ."�. Q .C,pmmptCldl . . .. .. . � • . WLLlOO 7HE M�qiK MO TiIE 9TFNICTURE 15 NOT WTEtY1ED OR OFFEF�#Y WN SKE(SEG 7aa.BIISF J NESS MA PFqFES510N5 CODE:Tt�CONTRACTON9 LICEHSE LAW OOES N�7'MPLY N MI OY�!!EH� .- . .. . - - - t .. N PFI�FATYYI4ID&JLQSORpAPF�YESTHEHEON.ANPWH�DOE55l1QiWORKMIMSELFaiHERSELPOR = � . - 2 TMHOUC�1WSOflFiERONMEMPLAYEE&PROVIDE�THATW1tlIWVRQVE11INiSlJiElpTMEI�DEUOR- . m . . � W OFF�REDFORSALE�HDWEYERTHEBULDUKIORMPRDVEMENTISSOIDYNTFWONEYEAROFCOi1P[F- .,. . . -- . . ` . . . ' � Z TION.7F�ONflHIi&RDER WU.Hl1VETME BUfOEN-�PROYtl1U 7ritF lff'OR St1E DID iqT EUND OR - . �. _ -_.. . . ._.. .-,. . . . ..�... � . . . . . _ �_. . _ ._. _ _,. - Y.IPROVEF00.TFIFPUAPOSEOFSALE� . .-. � --- -�6ASOWNER�StiEVROPEHllAMEXCIUGIYaYCON7f'iACINGWITHLICENSEDCONfRAC7GL4. � . .� � ..� . .� Q ro ca+sraucr n�rAaEcr�sEc.�ou.eus�r�ss un a�ssaNs�:n�cartn�craas u- ye�ua�fon _ AW_ApEA _ . w �sEuwooesNor�rrou�axw�noF�aaonemwHoeutosonwa�ou���ro . ` . �� WtwODxiR�iCTSFUqSt�HPnP�EC'tSWlrtiACONiHAC[�(s)CICENs�PtFiSilhNrtatNECONTMiG.. ..- � WpryT(7y -- -.�pEgCRIpj1�NQ. _ .. - ....-. . .. -. -.... ..F�E . .-. �.- .. . :.. TORSt10EN5ELAW} ' -: - ' ' ,. _O. .. ._ . . .__. ....:. .. ......_., .. .._.. .__. _. . . . ..... . .....-. � _- .,,.._,- , ____...___ '...._.___._ _ .. - . diAYE7fENPftIH�RSEC. ` -&1P.GFORtFMSFbt50N � _ � � _ _ _ ._ _ _ _. __ - _ . a _ u.. � — OATE OWNEH .._ _ . . � . . . _ � , . _ . . . .. . . . ._._ ' . ... _ W � LiCENSEU CQNTRACTOfiS OECl�►TIQN . � ; � . � • W : ____. _ _. a`� _ tHEREBYAFFWYUNDFAPHJN.TYOFVERJURVhNTtAYLtCBISmUNDERPROVISqN60RGNAPTER - � - !/Ij,4Y S. - " ' ' : :. .. � •(COAWB7W10N7THSECTION7o00IOFDM51dt70F7t1E8U81NESSIWDPHOFESSIONSC00E.AND.. ..:., .- . . � . �„��N��,� 35 29 ; . , � _ _ _ _ _ _ _ " '_ . � 2 3/N��_. t , . . o �3�`_ _ � �c�� �.�. 3 R,A � � . �—' w� J`� _ coerrancToa �/ � n , - ,� 1•t/.4'XG�J�' e�i�4 ,_" �i : ;. ._ .. ,_. ,,. - � WORKERS'COMPENSAT�N DECIARAiION t' U ��� � 1�� �(� � 1 HEREBY AFFIRM UHOER PElMLTY Oi PERKIR'/OHEOFTI�WUAWNO DEC1MIlTqN� Z '� /'3L C] _�HAVENowuMlwTAwl10ERTIFlCA7EOFCONSENTTo6EtFuaStIREwRNORKERs' .- . ._ T .._.. ...._.. ..._ .. . . . ....__. .... �- . �-�'' . . .�� OOi1PFll6ATION./SPFDVID�BYSEGTqN970UOFTHEUBOHCOUE.FORMEPEFiFOFiMANCE U ��' f � ,. , . ��: , _ OF TiE WON(fOR NM1iN�I TlYS PEHMIT�ISSUm. . . _ .. � . _ . ..S\J �C ..S' � . -� ' . . . „ . . ...__.._ . - . W �I F4lVE/1ND YMILL tl/IHdfAQ1 YVOflI�RS'COMPENS�TION INSURAMCE.113 NEflLARED BY SECTION - - � � d 970aOFTNELA6QHCODE.FORTHEPERfORMMICEOFTHEWOPoCiOHYVFMRITFpSPEW.NT15 � . . . . . _ � �suEo.tnwowceris•cauaE�inNwsunu�ciww�u�oraucvtxlMeEa�: ' _ CONSTRUC710N _ .._ _ _- - - _ _ .- > �� PLAN REYIE4V . ' ¢ ��rar�oowwiErmoFnfe�rreioRp��ur+IDaaw�� _ EIECT _ . , . 0 (Me �+I�sl. . P 81 _.__,. , � . Z ICER7IFYTHATNTHEPERFOHMIINGEUFi11ENORKFORYYfNQ7THISPER6NTISI55UE0,1 MECHANICAL � ...�j' .... SHALLNOTEMPL.CVANYPEHSONWANYl1ANNEHSOASTOBECOME51�lECTTOTHE ..._ ._ .. .. _ . . . r.+oru�ns coMrEns�noH uws oF cwu�rwu�u�w raaeE nur��sr�ann aE _ INSPECTiON FEE . / R _ SUBJECTTO THE NN)HI(ERS'COMPENSATION PROVI&IONS�SECTpN 37000F - �% ..t"j caoE.�sw�i tHc:or�v�vwmi s�s. ISSUANCE uai\ n n 1ARtL • O ; . � .. ...... . . . .... . . _.�h' _. . .. . - _ p DATE y�APPLICANf: _ - �P � � : . . W - .. ENERGY R/C.-. WApNINCi:FAILURE TO SECUHE VAHKERS'O�APENSATION COVERMME IS UNUYYFU4 N7�SN�ILL 8E - R � ��—y BUBJECfAN EMPIOYER TO CRI1A9iRl PENALTIES AND GV�I FMIES UP TO ONE HUNDRED Tt10USAND �ERGY PERMIT . - - - OOUM8l37uo,0oDl�WAODfT10NTOTHECOSTOFOOMPENeATqN.DA4A0E5ASPflOY1DEDFaiW . . � �J SECT�DN3t0lOF7FIEth80RCODE.WTEflEST.M�AT7iHVE1"i FEES . . ,�:' . ' ..... ..... . ;.... ..� . . . , ..-• . . . . � RETENTION FEE: Wq� CONSTRUGTION LENDING AGENCY pRE•ALT FEE: � '� . _ _...._.._. _ .__ .__ ._ ,. �. . .__._._. _. _ . _ .. ... ___.__ , O __ , _ ,. �. 1 HEREBY AfFIRM UNDER PENALT!DF PERRIHY TINT 1T1ERE IS A CONSTRUC710N LENDINO AGEN4Y .. . ' n- POHTHEDERfOQMANCEOFiHEWOtiKPORVYHICHTNISPEfWRISISSUm(SEC.90Y7.CIV.C.). . . . . - _. .� . _..._ ._ __._. _. . . . . __ ..__. _ _.._. . . ' . � IENDEH'SNNAE � � � .. . , H � LHDEH'SAOURESS. .. _ . . .. .. .. .._. ._ . _ _... - ` �- ICERTIFYTHATIHNYEPFJ�DIMISMPLICATbN!J7DSTATETM�TIHEABOYEWFdWAT10NISCORHECT. TOTAL FEES - - � ,., _ . . ::, a. -.,IAGREETOWAIPLYK7IHYLLLGTYMl�WIIITYORDWANCESAFASTATEUWSHELA7IN(370BU0.DIIKi �... ... .... . . _ _ . . _ . - -. ' � OQNSTW1Cli0H.AFmHEHE6YAUT}10RIZEHEPRESENTATNES�T4CSCOlMITYTOEMER1J70NTHE .�. � ��:.��� .. � z IIBOVE•MENTpNEDPPOPER'h'FOHWSPECfIONWRP0.4E3. . . .._ . . �MMENTS� : . � � - -, ..... . .� _. _. .....,... ...._ ... • ' �� - i:/�1.:: '1.'(. _ . . ,-. ,, � .. � �._.a -VERW E(PHItII� .. '�r� . . N . . . . ..... DATE . .. ____. ... _ . _ .. ,. , . _ .... , ,,`� .sroruniaE o�rpanEE.,_,,, . RECPT.NO. '• PPJQrBY :� � VALIDATIO � ; � � _ _ 4 Y1fHITE--DePartment Copy�YELLOYJ—F7nenoa Copy,VINK-dlsseesa Copy.GOLAENROD—File Copy.GREEN—Appliswnt's Copy'. .: =, . ._ _ _ _ __ _ _ ___ � Y � _ - ,, . -�-� - _ ,. .:: � . :, _ � - � _ _ :. ,, , r c; r i - - - , . _ _. . _ _ - - - -- - - - - � .. , r .. - _._ . _. , _ �_ _ _ . . ;: � � .. _ c ,- � .� � , ; . - I: _ � ; .. , �. . F _, � ` 4 <: e _, ;. ; a � , � � ' 64^ �.�� •� . �_ � � I �� � ' i � - +� f , � ; I � ; �> 'l � - i, 3 � I . �� l � j ��� �' _ � �I I � �`> � , ��� . i i � I ''�. ' - I - � i i _ -;I ,� 1. s �I, i� � R t � ' 1 �r ' '� f-.. I � i '� 'I �I y ,f1 _ � i . � i, �� � � � � � � �=, � I � � ��'� � 1 � � ( , ` ¢ , i � �, �. 1, • (.�� .� � � r� �� t , , i i �i �� L 4: Q � o" i," p A � Z '� Q 2 U'� � � � '` ' ' � # g 'F� ¢ W �;, �u (!j � � a FS . 1 r m. V � � va O�O ti m �Q m °o z. ¢¢ U U -' � z t`li,a z ��� a i i r, ,�' � � �= � OCJww �Zp � p � � ¢ O o- I � w-' Z'LLI :- o -� -� r� U p � w z tn � z �; '�' vi _ i, • , _ k. C?-OC c� � w "ct'¢ � g m o m ¢,�_ _ � w � u��. � a w N � n�i a r � � ° � l. �-:Z ' O c[ liiwa'� C° QC7V C7 � � _t " V Qp � =r � � � � ? ___ __ __- -- -_ _ t, <,(` O < �a.¢� ri.z � w p'2 p,0 0,�� Z Z z z ¢ a.� w _ 1___ _ . __ _ _ 0 , i 0.— iJa. 0 � za. u.� mu.. aao-o[ u: a. aa0 � u. � Oiiu_ = O w � �_-I h ; i � } I � , : �. � a . � _ i ' � i I � i. � , �I i `- , , �, �� � Z • `; i � I I � j `, � _ � ir V c � � i� � ' � � � �' � i . i �t' � �rl � � ' t � � � 1 � � '� i I ' � _ I � I � � ' i,� � � � I � '' ' I ! l i � � '. � � a I : �� G:� � i - � - ��i � � � � � j ' � � , � i i h i � � { � l� � , ' ` � � � � '� ' � ' ' � � � 4 • � i � � �� � i � � � ` � �`I ' �� � � t �i � F � _� � '� I i I �� f ; ; � ; !, i � �; �:: _ i �� � p { � -- - � � I; j ' I � i i � � , j i WI p U' �i Q i I � F�n Z p�� ! i I ' ,j ;� � � I I � hj` I � ' � �! � � w� z � ` i��. ; � � µi L7 F- z �� � ��` �N � o � � F' cwa Z Y= ', a � � , ,z � g � ��� � � �i � �z ���� �' ��n. � �� � � = ���-w � � m;� � = a � � � w � m�� � ��� � I � �� � t� -+ oW ¢¢ �udw � � � mz a '' Wm � � � Z i I i : � . �`� a ,W >_w � � Z u z q , � ��.. Y ¢;c,� $ w x i i - rn -� I ¢ i.,. w ;�. ;LLI � F-_ p � pu� 2 �' O p �� J F�- � O J I I t,. a O.¢ � � aQu> zCP = sw ~ ? � ¢ a� U4 � U � Cu a � � : �� m ~ � �0. U1 t+- ��LL'C7 � C7 �'S�� J z }y W f;,, p�.,,-'Q J .L J �.-�� � �. � '- ,�i � � � gwa °o ¢ $ o � o �'� aw � ,t�'iww `<"` zZ � iz' - �� j � ' � • ; ��� �.: . :' �n � w c� <n r, � oc u. ¢ ¢ � arn w � ca o v� m v� c� � � �- .� . �Ci � -