HomeMy WebLinkAbout10952 �
�
4
� CITY OF DIAMOND BAR �J��i��„,�.�
COMMUNITY DEVFLOPMENT DEPARTMIiNT
� 2166O E.Coplcy Drivc Suite l90 f'
,,,y�,,:.., (909)R60-3195['ux(90I)861-3I17 ��� � �_ ��u� PRESS �
_ BU1LDlNG ' MiTAAPI,ICATTON FIRMLY �
o��r JOBSITE �^� �� �_ ��r�a APPLtCATION NUMB R � ��PlC �
ADDRESS I DATE �
o�o ISSUE�� TYPE � # OCC------ ' �
APN______, L T TRA T_ � DATE �'
pOWNER w < �___..,---___.--- ..----------- __ CONST._ GROUP �
� /r� � .c �. --- ,
ADDRESS 71 L y r7` ,- , ZONlNG SETSACKS �
o -' _. F_i . . .
z CITY� ��L __^ ZIP TEL.,__ FRONT RW -� !
o` APPLI NT --- 7E1.�---L REAR __ ---...---- 's
-- ------._...._---�--- J -.. .. .---
----- !
Z - ` SIDE/SIDE STREET RW ; I_____.___ �
� CONTRACTOR � -- — SIDE -__--,------------,.
� ADDRESS ���L— �� ~ . — - �- � :� �
-�-�'- re�i".�_y � ,
� CITY w. �cy �ZIP.� L TEL.�IO Z�;7 PROPOSED USE o�._�k�;�%•• C o r� f ,J j„i�r.../.� °
w ARCH/ENG/ � � L � - ___�.___� k
0
z DESIGNER ��--.--- q��`-`�f��' �
NO.DWEL. NO.
ua�. ADDRESS_.__._.._ ----- --------- N0. ,
��. ��-" ---'--'-' UNITS STORIES __ BEDROOMS p
� CITY.__ ZIP ------ TEL. ---- --- _..-----_._
� ---- -
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATlON �
� OWNER-BI;ILDER DECLARAI"ION
O SFR/ADD/REM �
p I HEREHY AFFIHM UNJEFi VF:NALIV OF PEIiJURY THAT I AM F%kMVi FRO!A TI{L CONTfiACTUfiS 11- GafdJB/CBfPOR
W CF.NS[tAWFOflTHEFCLLOWINGqEA50N�5[C.1o31.tiBl1SIYESSANDPROFE55:ON5CUDE.A�Y(:ITYON (� �
C-� COUN�YW!!IC!lRCQIIIACSAPCA.N77TCCO4STRL'CT.ALTER.1`.fP1?nVC,I)FM1;OLrSM,t).RRFPAL4ANYSTR'JC� (ll R
W TURE,f'flIOR TO ITF ISSUANCE,AI SO fif(]UIRf_S TH[A�PLICANT FOR SUq{yf:fIM1T TO FILE A SICN[p �ai10/�@Ck
' STATEMFNT THA7 H[Oq SHE IS LICENSED PUHSUANI"TO 11!E PftOVISIONS OF THE CONTRACTOHS LI- W--- �
� CENSE LAW(CHAP fF:fi 9((:OMMFNCING WRH ScCTION 7000)OF DiV15�(]N 30F fil[yU51NC55 ANU PflO� u' PooVSpa �
"�' �F:;SIUNSCODE)OFTHATHEORSFIEISEXEMPiIfiERCfqOMANDTHEBAS15FORTHeALLEGEUEXEh1P- (� y
� TION.A4vV1(iLATIUi�UI�SECIlON7C:11.59Y�1YAP?I!CANTFOHAPENMITSUfiJ�CTETHEA�PLICAVT'O €
V A CIVIL PENALN OF NO7 MOHF 1I IAN fIVL f IUNun[o�oLLARS(55ai).): Z F1e-R001 �y 4Y' �p'� 4
F- P
� ❑I,ASOWNEROtTH[PROPERN,ORMYEMPLOYEESVJII'HVdA�ESASTHFIRSOLECOMPEN5ATl0�. O COffIR10fC18I �
Z WlLL DO THE WGNX,ANU 7Hf.S'IRiJCiilfiF!.S NO'IVTENDED OR OFFEREU r OR;ALE(SE(:.�n44,(3USI- J
� Nk:SSANONFlbfCSSiONSCODE.THECO�THMGIn�i511GLN5ELAWDOcSNOTAPPLYTOANOWNEHOF = '-�-
PFOPER fV WI IO BUILUS OR IMPi70VES TNEREON,AN�WI10 L)Of�S Sllf.li WORK HIMS[LF Ofl HERSELF Oq .'
p_,' iHRqUGHHISOflHEftOWNEMPLOVEES,PIiDVf�EDiHATEUCHIMPROVEMENTSAHENOfMTCNUEUGH L� �
�L CfFfRE:�FORSAIC.IF,HOWEVERTHEBUILDINGORIMPfiOVtMfNiISSOLUWITMINONEYEAROFCOMPLF.-
j0 TIOY,THE WdNER-OUILUER WILI fIAVF TH[611F�EN OF PROVI�G illA�HI�OR SHC:f11D NOT BtJILD OR �,
IMPfioVt FOFl THE PURI'OSE OF SALF),
uJ p1.A$OWN[flOFTHC�PROPER7Y,AMEXG!USIVELYf,ONIfiAGTINGWITHLICENSEDCOMRACTOF75 - �y� i
(S iCi CON57pUCT THE PROJECT(SEC.7041.[SUSINf.SS AND PROFE5510N5 CDUI'THF GDNThiAGTOtiSll- � VOIIIafI0f1 _/ `�� ADJ.AREA
L1.1 CFNSELAWDOF.SNOTAPPLYTOANOWNE4i01=AI�ROP[iTTYWH06UILDSORIMPROVESTHE(7f.ON,AN� ---------.__._____..._..___,_,_,
� WHOCOtiTR�GTSFOR5UG41P1iOJ[CTSWITHACONTRACTOFi(u)IiCFNSLDPURSIIANTTOTHECO4TqAP OUANTITY DESCRIPTION �I FEE
Y 7oliStICENSELAW.). �
� :-,I AM EXEMPT UNOER SEG __.__. __. _ti.&P.0 FOfl THIS REASON q °
_. U y
� — -- ----------..._ ---- I OC
�
OA7e _OWhER___.___- ` }- `�
�
� LICENSED CUN7HACTORS DECLAAATION � t
Q W
� IIIEFlE9YAFFIRMUNDERPENALTVOFPEN.IIIRYTHATIAMLICEY5�0UkDCqPROVISIONSOFCHAPTER � �
� J�COMMF:NCINCWITI75ECTION70W�OF7IVISIONiOF111EUUSINESSANDPROFES510N5CODE.AND Z __,_ �
�X MY LICENSE IS IN FULL FORCf:AND[�F[CT. .m
� LICENSE CLASS_ [. " ,_�j . .._ LIC.NO. � �
- _ _ '.._-__ . . �
U DATF ..��{/'- 5�..__ GCNTRAC70R _._ ___`_ '�i�C,.,�+- d E
W �
� WORKEftS'COMP[NSATtON DECLARATION J - --- G
a A
� 1 HEHEUYn��IIiM UNIIFR PENAL7Y O"r PF"liJUHY ONE OFTNE FOLLOLYI,tiG DFGLA71A1'IONS: U �
� z
Z ____, II{�y[ANUWIII.MAINT/11NACtRlIFIGA�FOFCONSENTTOSELF�INSURF.FORWOHKEfiS' a 'r
4 COMPENSATION,AS PROVIDED BV SFCTION 3/aoOf THE LABOR COD'c,FOH 7HE Pf�fi�ORMq16CE (� y
OF 711`t WOf7K FOR WHiCH THIS YF(iMl f IS ISSUEO. W R
� � A
QW _IHAVeANDWILLM0.I.YTA',NWORKEHS'C(:M.VF�\SATIOYINSUAANCE,ASREQUIRFDlV5fC710N
s�ouOFTHELA80RCU[)C,fOHTHEPEHFOIUdANC[OfTHfWOPKFOHWHICHTHISVEHM�TIS i ��
ISSt1ED.lAYWORKf:RtiCOMPE4SATIONINSURANCECARRIERANUPULICVNUMOERARF.: CONSTRUCT�ON 7� �� �
J
� _._.
� CARR)ER_'_'' '
-� ...__._._ PLANREVIEW :�
--- ---- - -- ....----. ,
� POIICVNUlABEH____ _ .__._ .- -._.. I ELECTRIC �
4 -- .-------- u�
0 (fHSSECIh�NNF.CDNOT6ECON�F'LETEDO'rTViCPFItAUTISFOppVEHUWHEUDOLU�RS(St00�ORlESSj PLUMBING ___ . _
L27 -
_ �;
Z I CERTIFY7HAT IN fHC PERFOftMANCE O�II IE Wp17K fOR V.'HICH THIS P'eHMIT IS ISSUf.II,I MLCHANICAL . 4�
C� SHA��.NOT EAIPLOY HNY PCRSOti INANY MANNCt�SOAS TO P[CO CTTOTI{E �� ���-'���-' '"-- ,
�/J WORKEHS'C.O�UPENSATfO.M L�N'S Of CAl7tOFlNlA,A!J'D GAEE� 1 IF I tilV l/ iL(;OMF INSPECTION FFE ��
= SUBJECTTOTI{FWOFtKI'HS'CO.UPENSATN��P OV• .�VSOk CTION 0 HEIA[lOH � � / �--- ;
CO/pE ISHAIIfO/HTHWITHCOMPLYWI(HTII ' ROVISIO , I ISSUANCE fS ��
O •%/�(�•./ _ _ � $M�� '_"""'_'_"_ -- _ __ �
p f1ATE:.___ APPLICANT. p
W ' ' ___' '__ '_"' "
ENEHGY P/C �
J WAFlNIN(3:fAILURETOSECUREWORKEHS'Cq EN ATIONCAVf.f1AG SUNLAWFULAN�SIIhLLAF � �
_J _
� SUBJECTANEMVIOYI=RTOCRIMINALPENALIIESAYDCIVILFINESU�OONF,HUNUHEDTHOUSAND ENERGYPERMIT
DOLI,ARS(E1o0,00a),IN AUOITION TOTHE COSf OF CONPENSATION,OAMAGES AS VNOVI�k D FOH IN .--
J SECTION 3lo6OF 11IE I ACiOft CODE,INTEHEST,ANU A1 fORNEY'S FEES. ------- --'"
� ,_ RET[NTION FEE: _ _.________________� ,I. �_
i
OCONS7RUCTION LENDiNG AGENCY PRE-ALT FEE: ._. .. __ �
� IHEH613YAFfIRMUNDEqPFNnITYOt PCRJURVTHATTH6R61SnCON51f�UCTIONLEND:NGAGENCY �
�OR THC P[F7FORMANCE Of I HF.WONK fOfl WHICH THIS PERNII 15 IS5l1C:)(SLC.3097,CIV.C). - -� -- - -� �
Z -_
W
_._. �- '--' - '
� lCNOEH'SNAME__
"'_'
H LENOERSAODRESS - "'_ _ _ "_ __'__ -'__ '_-__. _.""____.". . ._ ' -- � � _...._.. �
W 1 CEii(IFV�IIqT I HAVE REAU lfi;y9CPPl.I(:ATI NANO STATETHAT flll-AiiOVC,\F()GIMATION IS CORFECT, TOTA� �EES ^ ��C!- �y
� IAGREETOCOMViY ITNAIIC�YANDCO IYORpI:JAN(:ESAN�STATELAWSRELATING'f08111IflING N
CONSTAl7C.TION,l1 11F.RCl3yfqt17HORllk: P NTAT!VE^un�IHI:;C(N1NlYlUElrTERUPO.VTHE �
� ABOVE�ME i0�'. PROf+E �Y FOR IN (:7'I urarosrs. „
- . : COMMENTS �
- - '--
� / -----.'.--- i
m ' -' - /- - �--... ._ �%
- -- � -- .. .,__... _
� AE ENnMf q. ' (°
� " /� �q - . ._. _ _' —___ ___ '
__ _. �.G�C�✓S'�s� /�—���[ . - -
Uj SIGNA UF F MITT[E � DATE � ' ^ ------- - --- �
� R[CPT.NO. .�__ pqiD BY VALIDATION_._ .._ ,_ �
WHITE—Depadment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplicanPs Copy �
e _. __.�_.� _ _,_ _.... ___.._ _.,.._ ._ _ __ _. ---- _._ . , -- - - .- -
�-_ � _ � � _.; �-_-- _.� (
,. � i I , I ; I � ' I { ���.e
� i �� � . f j I � i - � . '; i �, '
'.� i i i I i � i I . � ( , � i I I . �� . � I � �
� � � ' � ( � ( ' � ' � � � ' I '� � ' , ij
= i � � � � I � l i l I I ; � ! , I � � � � , �
; i � i ; � I � i � ' ' ' � � � �
��� i � � i ' I � ' � j � � � � f I � ; i �
' ; �
I I � ' I i ' : ( ' ' I i � ' i i
� I � I �
_ �_� ! ,_ ' { I i � � _ �_..!. I �- _ � � _ � , � � i � � � � j � � i
. i � i i � I �� i k ! a ; I � � � ; '
� I ' � i ; ' � '
� �� � ' 1 , k I ' ` - , '
�'�t' I � : ' � � i , � i ' � �i I I ' I � -
�4�.. I i ; i 1 I ; I � � � ' j � � � i i i ? :
�.
, i i . j � ,
�,� � I � � i i � � �
� i
i �
. , ; i ( ' ; ?
�t������,-_t -- t. � � I f--�.- � � i � } � ' � ' I I ! I ! �
��� � '-- � ! � i � � ( i ! I � i I ' �� ' ; I �
� w ' � � ' . � ' � i � �! ' i � ' i
.� �� �1' : ; , � ; i � � � � � i i � � ; � � �' �
1 #r'�� I '�-.;�n r�-.ai`�� I. .� � I . ; � i �.�;I I � ' ; ! , i � � ' I ' '� i �
. � �rs� ( ��;,� � � r._�i �`�' i IC `� - �'�I "r: r ' � � � , � . � I
� `-`' `�j n� � �i i "� - � � rr `t' u {I r i i i , ' � � r
�- � rti��i:' ( :- .S' t�7 'r' I�' �(k��C]1 i� (�u Gt 1.� �ti :� i`.. N-�`r - � : . ; � - j _ i '
� `I . �� { (�, � � �� � : � � . I i ' : I � �.
, � �� t,�I '"1 ( t c^ .. � i
t � . i_ � ?�—a u,� > , � �z 1 �� � I
C3<1� .� , �p- �F i��r `�. `_ � a� �. � !_ ,�� r�t i i �� �� i � 1 I � i
*^�' € �. �f� �i r1 ,_1 � J � � s � � ' �� I i � . I I � �� � f
1� �� P � �f i � �- � c � � �. � � � �?� I � i � r
- y,. ���. ; ') i�� II k� i�' C7 v l. Li �L r . :
� ,,, �iI 'i ra r �. � � � � i,r s'� .
a�9 ' ��� � '' ' -.�1 ' - —,. � ��� i � i � � � : ; � �
� �� ���� I '....� ' _ � i- _ -� -�_ { i � f i � 4
�• Er� ��' ' , I � i � i i ' ' � ! ; I ' �
' ��" # }�t .�' � , i /j I � � � . , I . i . � 3 i . ' i �i � 'i ��; � ;
r � °f i ' !, I I i � f . � � I � � ' , , I � ' I ` ' l , .
� �.�� '� � ' I � ' � ! ' � i . '. i �" � �: � i � ! , � �) i
r���� , 1 ; � � , , , _
� � _ -� i—; � - ._ � I ° f '-_ _} _i : I i I f ' �, �
� I_ � �- [ I i ' I
��� j j �,,��4 i � � ! � i I � '
i ;\ I
— ( -- '� ---- -..... � l__� , _.
. . ,
I ,
_ � � , , � ' _. ,
; ' , i �. �,_ I i j i t E I � i � i ` �- ' ? �
�� �� :i � ��ri� � '� � I I
+ ; � � ' ��a' E
�� n' u� �i I� i � , � ( '' ,i � i i " � 5� � I (rr E ; � i (�:, �
� .� �, ci` � �� � ,) ( I,�,� r ���� � � � � � ! i 1 � �-j �
d a�. � J j tq 111 � � �
�y.'$ .� i. i . ',uz � � i �_ �-�� i� � j .� � � i ���.W
� �" �. � i ''� I t �� (.5 r ; I E ^ 1
� � ��.�_� j` .% ri .�;I,�I ' ii�4� ` � �,� � ..i �� �' {,' } �,,� I ( �i � ��` .� i L�i � _ I
��,, L � � ' ( , iI , �I- 4, , � � [ � � u. ��1 ' 1
�t���n L ( i._C.+ � �., 'C.�� ' t<.�.� I� - ��t . -,� „ - - � � _..,.g __....._� _......._.._.. .. __ 1__..-._�a�._._._.__...._.__......_.._,._,____�__`
I
, , '
.�._.i.... .... . _ __.._. . __ i ._.a__, .t.. (m�_ � � ___ ...: .._a:.�_ ,_:. , ___1_.