HomeMy WebLinkAbout18-1239 C1TY OF D1A 1ND BAR
DEPART ENT OF COMMUNITY&U V LOPMENT SE[tVICES
�" 21810 Copley Dr�ve,Diamond Bar,C,4 917b5 PRESS
,,,� (909)839-7020 Fax:(909)861-3U7 Bu�ldmg lnspect�on Rotline(909)839-7027 FIRMLY
''�� BUILDING PERM�T APPLICATION www.c�tyo[d�amondbar com b ilding@d�amondbarca.gov
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� � APPLICATIpN DATE P/CIF
a JOB 5!"fE ADDRE55
2 155UE DATE PERMITIt
� APN LOT TRACT �i�- Z
� OWNER TYPE CONST OCC GROUP
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� ADDRESS '-
CiN Ip. Af�TEL � � O
Q APPLICANT W�'�✓ ��''-Y•a TEL s�o or wo�
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o CONTRACTOR
ADD 5 G-�V - �— -- •- • •
li DWEL UNffS A STpRIES A BEDROOMS
� CIN TIP TEL
ARCNIENG/
DE5IGNER aESCRIPT10N SQ Ff FACTOR PSF A�J AREANALl1ATION
ADDRESS SFwnbn�Renn
CITY ZIP TEL GaregelCarport
� ownei-e�mnei oEcuxnnaH W Patia�Dack
� I herehy aflirm under penelly of pehury thal I em eMempl Irom the Conliaclnr's 5ta�LJcense Eew lor Ihe reasan(e) � P�VSpa
oYdWdtatl below hy Cie d�eckmark{s) 1 hara pdsced�d m 0�e applNrhle I�m(s)�Sec11m TRi1S,6imi�miE Z Re-Roof
2 Profassio�re Ooer AMr ury m mum�r that requ�s a pemut m mnsW�i,slmr�unPmra.den�al��or repah�eo!'
a amc4�re,pnor m[ta Isauanee,e�o�equlrea the epplfeant farlhe permft m flle e s�ed efuYmmrt thet he or ehe 9 Commerelal
'r' b f�e P�m the Qraralans a1lhe fantraeEo�s Smm Liamna tew{CheP�r 91 f�m�u�q r�h S�an m
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� 7ppp af OM�pi 3 af tlm 9uehv9us�C Prafaae3m�e fada�ar thal he or she Lv eMempt from 14censu�e and the basls Ipr
y 1he alleped er.empdOn My vlolaUon a1 SecHpn 7p31 5 br anY aPP���B permN 9ub(eth Ure eppllrartt to a ciril peneNy
p of�ot mo�e tt�n dve Inob�gQ d0�a�s(S.�QO}
e {_J I,Ss ownBr p�thg prupBrtr,w my BmployB98 witll wrBges e9 the[r salB eompOnpafion wlll da�)911 al or(S parUaae
ar nm wo�k a�m me swcdue w�iose�wea or oeared ta sa�e�Secnm�oaa &�resa ana arat�Code rne Velerattorr Ad� Area
Lbntiactore S1aSa Lken.se Law doas fiot apDtY 16 9n owrier o!DmP�iP wlq tluoup�CmQforee3 or perBpW effnl,bulid4
or Improves me properly,provitled that the Improvements are nol Intendetl or atfered for sale If however me bullding or QUANTiIY DESCRIPTIQN FEE
Imprareme�R is eold wlRiln me yaar a!comP�etlon,me o+�e�ide��n�are me o�d�or u��a n�n+�s�n��n
� a hnpovetl rm tlre pmpase or�yle y �
_ {�i,es owner nf tha properiy,em erelisively rnMrenlnp with IdrPnaeA Contreetore ro canstruct the pro�ect(Sei,ifon �
�aa Bw�a ana Proirssbns Code nre Contra�ore S�ate lkeree�aw aoas mt appy a an aMner W oraoah who
bu�ldspf Imp�v+e4thBrEon 8ntl wlq Wfih8tlH fOr MB prO�eGl9+vltl�fl IIOBrt99d COMrBCturpufBug�M rotl�B CenVaClnre�StatB �
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� {�i em manpt han ficensisa unne�the(aontractore 5tam ueenve iew lar ma Idlo�rinp reaaan{af m
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� BY mY s�nahne below I�JcnowleOpe mae,mrceDl fm mr verspial r�dence in whltA I must lave resfdetl la at leavt ane a
year pr�or ta complellon ol the Improvemen�coreretl by th�s permll I caniql lec�ally eell e ahucture Thal�have bull!a5 an �
a mrflBr bulidPl il 11 has 110t Oe811 Cq�NIL19d In IL9 Cf11IfBry hy Ik'CIL490 Cdltr�r8 I Wlder6t�l0 thal fl DOpr al the
� epph�ble lew�Se�.iion 7044 a!tlie Bimne�BnG PMPS91a�8 Coda w availade upan rEquB8t when thl8 eppll�tlon Is �
� suhmltted ar at the}aflowing Web slfe M�lwww Iegl�Ao ra povlcalaw hlml �
�j LICENS�I;ONfRACNR'S�ECLARARON
� I hereby affirm uMar penalry of per�ury Ihat I am Ilcensed under pravlslo�v a!Chap[er 9 Scammencing wllh Sectlan 7000► W
� rd�fnvon 3 rd the ,ng9g�ntl Profe�w�6 Catle my I�e L5 u�I efled �
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� u � f` UC No � CpNSTRUCTIpN i z-
�hhTE CON�RhCTOR
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1YpR1(EA'S CO�RPENSATION�ECLpRAT10N Q�`1 REVIEW
� I HFAE9Y AFFwM UN�FA PEw1tTY OF PEEtRp1Y Ot�OF T1fr FOLLO'WWG OEQAFIATIONS ELECTRIC
o I nare end win ma�npin e Cemrirate W Can9ent ro Sen-insure�or wort�ers Camper,setwn es orwieea er PLUMBING
� �3�no al me�e6or Code ror u�e pertm�wice ar me r�ak for wnlr�m�permh�s� MECNANICAL.
� I liawe antl wfll melntaln Workers Campensatlon I�urercs,as reqwretl by Secllan 3700 al the Labor Caae fm
� mepertamancem worklarwhlch Issued MyWaker's nireurerceCerrleram 1N5PECTION FEE
��N (��� C�' � 155UAP10E o
G4iiRIER
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(11�SECTprINffoHOT6EODMPLEIFDFTHE (S1oQ� LE5� ENERGYP/C . �
o ��h'�1�mePer[�ceatlhewakFor thlsve��� ��I�e�+v�1'�Yw�Ne�Y����� ENERGYPERMIT
o lu the worMers d CaUfmda I aqad m the 4Yakere
of5ec11on3700o1 a I forth �orre RETENT1pN FEE _ lJl�
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� � ��T PRE-ALT FEE
� WARNrNG F�1uiB f0 Seare Wdke�a COm er�SBtdOn tV+BrBgB+8 unl9wful antl Sndll Sub�ECt an emplpygr lo tAminal gpSF /• 0 J
w paildlll98 and cirll 4nea up 16 one huntlred Ihauvantl tlollere�1000ppj In eatlitlon tn f�e Caql 01 tl�6 mmpansatlan
o d�mages es prpvltletl la In sectlm 37Q8 W the hehortotle interest,ar�a�fume�s lee5 PLOT PIAN
� CONSiHIICTION LENDING AGENCY ZONING CLFARANCE
2 I Irerabr afl8rm�penariy af pe�wy tfffi G�ere Is a�truellon l��p A9pscl for Ihe DeAormance al 0�e+ro�lc for
which tlds permlt Lv L4s��ed I5ec 3087,Chr C J
� �o�s na�n�.
� LENOER S A�OHESS T0T,4L FEES � � I ,
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� I cerLly thal I have rasd�his appliwtlan end state that Ihe abmie Inlametbn Is oortecl I aq�ta comply wlth ell rJty and �MMEiV'T5
w�Mr ada�es ena sram raws reraw,�m wi���e�n�euy a�m�+za rewese��aures a m�s coumr m
emer upan a6ove men0lonad pra far s ectlon purpoaea�
a PERhSI f (PRI P/C PAIO BY VqUpATION
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y FiECEIPT� �/ PAIp BY VAIJDATI�
� SGNhilR1E OF PER dATE
WHITE—DepartmentCopy YELLOW—FlnanceC4py —PssersorC�opy
CITY OF DIAMOND BAR
INSPECTi�N REG�RD
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S�'B1�CK1'E.EtTER '�,TRACT AND L�l7GER
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N�hi Y�AT�i L�I�� 'HERS REPORT RECEIVED
S�R�FJ�,IQUT ' ',�EM4LITIOPJ
RO(}F"�HEATHIN� ' 'ROCIF DRA(NS
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SHEi�fl 41tALL5 iNi�E�{tdR FIi3UGH FUIMgING
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',II�SUL�TION WALL i PQ��P�E�ECK B�ND#NG
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SCFIATCH COAT �tAE.�.SQN���A i
EI�CTRIC METER RELFJI5E WALi.d�ll�dt�EAI. '
CAS M�TER RELEASE �iAt.l..�(�1�3.. ''
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�taMMENTS
