Loading...
HomeMy WebLinkAbout14069 � CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �,� � 21660 E.Copiey D[ive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS �"�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �/�7 � � APPIICATION PERMIT P/C � ADDRES�„�xQf S ��'��WIC� , DATE ��� NUMBEH # c� ISSUE 7YPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER • � "' ADDRES �?3 S��S �-/71fj•�/�Gv/ ' ZONING SETBACKS �� CITY ZI�Q +� TEL.�%' '�� REART �W ❑ APPLICANT TEL. SIDE/SIDE STREET RW O � CONTRACTOR % J N ' SIQE ❑ � ADDRESS �f PROPOSEDUSE LC/p�� r t�c�� • �i7`� + CITY ZIP� TEL � � o ARCHtENG/ � DESIGNER NO.DWEL. NO. J NO. ADDRESS UNRS � STORIES ` BEDROOMS � CITY ZIP TEL � DESCRIPTION SQ.FT. FACTOR PSF AW.AREANALUATION a OWNER-BUILDER DECLARATlON SFR/ADD/REM p I NEAEBY AFAHM UNDER PENALTV OF PERRIRY TNA7 I AM IXEMM fROM THE CONTMC70fiS LF Garege/CarpoA �� f�A15ELMNFOR7HEfOl10WIN(1Nf.1150H�SEC.7091.58USME55M10PROFE5510NSCOUE:MIYCITYOH. (n O011rtYMMCti11EOlNtESAPEf�TOCOlYSTRUCT.ALTERM7ROYE,09pLISlI.OqREPNRANYSTAUC• W p8tiofDBCk 7UHE,/RqR 70 ffS 158UANCE,/d.40 REW IHES THE MPLICANT PoR SUG91 PERIAIT TO FILE A SIGNED SG7DAENT THAT HE OR SF�19 tJCENSEO PURSUANT TO iF�PROVISIONS OF hIE CONTRAC7OP9 LI� � CENSE UW(GHAVTER Y(4�OMMENCMO MIITH SECTqN 70D0)OF DMBION 3 OF THE BUSINE55 AND PRQ � PooVSPa FESSqN3 OOOE)Oq THAT HE OR SNE IS IXEMPT7HEREiROMANO iHE BA515 GOH7HE ALlE6ED E%EMP• /f� TqN.ANVYK%11TIONOf5ECT10N7D31.66YAMYAPPLIGMFOR�PEFWITSU6iECTS7NE�PPUGMTO Z RB-HOOf S QO�[f � AavILVENlILtloFNoiMonEiNANF1VEMiNroaEDDatARsl7soo).Y. � � OI.ASOWNEROF7HEPR07ERTl:ORMVEMPLOVEESWITHWAGESASTHEiR90LECOMPENSATqN, � CWIIrtIBfClal - YVRL DO TNE WOAK,ANU iHE STHUC711RE IS NOT INTEI�EO 011 OFFEFIEO FOH SALE�SEC.70N,&1S4 J NESS!!A PHOFES&ONS CODE TN£CONfR11CTOH5 LICEN9E LAW DOES NOT APVLY 70 AN OWNER OF � PqOPEHtYMFID&/KDSORYVROVESTHEREOtyAA1DMIF10DOE55UCHWORKHWSELFORHHLSELFOq � (� TMIpU[iNM50RHEROWNEYPI.dPEESVNOVIDE�TiMTSUCFIMIPROVEMEMSMENOTMRENDEDOfl m � OFFEREDFORSALEIF,FIOWEYER.7/1EBUILDINC90flMP110YEMBffIS50lDWRHf10MEYEAROFCOMPIE- � TpN,THE OWNER�IJIIAER WILL NAVE 1}IE BUi�EN OF PqpVINO THAT ME OR SHE DID NOT BUILD OR NAPRDVE PDR TNE PUFP�E OF SALEL � OtASO�INEROFlHEPlqPERT;JJAIXCLUSNELYCQNiRACTWGIMTY7UCENSEDCOHTMC'�OAS i0 CONSTRUG�T1£PHQIECT(SEC,70M,&131NE3511N0 PpDFESSIONS CWE 7FIE CONTRACTDRS LI- V81U860I1 AD�.AREA CBi4E LAW OOE8 NOTAPPLYTO AN dVMEH OF A PHOPERTY Wi10 BU�DSOfl IMPROVE57FIEREON.AND � wrqop�rtw»crsr•oqsua�vpaEcrsmiHAooHrnhcmn(s)L�cENSEDPUnsuw�rtToll�Ecoriiana QUAtJTITY DESCRIP'fION FEE . � 70RS 110EN8E WN.). . . . . 0 ❑I MI E%El/PT UNDER SEC. B.l P.C.FOR THIS PEASON Q 3 � w � d1TE OWNER V j � LICENSED CONTRACTORS DECLARATION J � W I HEREBYAFFIRM IMDEfl PEWLLTY OP PERNH"I TfUT I AM UCEN&ED UNDEfl P(i0Y151�l5 OF CHAPTER � � Y(CO�MENCWWIiHSECT�ON7000)OFDMSION90F7HEBUSINESSANDPpOFESSIONSCODE,ANO Z 4J MY UCENSE IS i!ML FORCE AND EFFECT. �J' /j,aJ m 0 LICENSE�j S LIC.N0. J e.,. 7`� � J � pA'1E ` COFI�fiACTOR OO � WORKEHS'COMPENSATIONDECLARATION "ry�-�. � ✓ ¢ � IHEREBYAFFlPMWAERP@UILTYOFPERNRYONEOFTIIEWUAN�NG�EG1AFi�TIIXJS: U f/� a � �IMVEIV�WfLlM11R1TAfl7110EFTfFlCAiEOFCONSENTTOSELFdNSUHEFONWORKERS = � . � - . COMV@15ATION.AS PROV�OED BY SECTiqi 9�ao Of T1E UBOH�E,FOP T}iE PEflPoRMANCE G.) Q �iHE WORK FRi NMI(717HI5 PERMIT 13 ISSLJEO. � w �i{�yE Ap�p yy��y IMMT/W WOPo(Ep8'COIAPENSATIDN INSUMNCE,AS PEOUIREO 8V SECTION Q 37000F1MELABOXCOO�fOflTHEDERWRMANCEOFTHEWOFiKiOflWHIq1T115PERMfY15 � ISSUED.MYWOPKE 'COWENS�7/10/NINSUMNC`E�CAHPoERANOPOLICYNUMBEflME: CON$TRUCnON ? �rpq�Ep . ,i^G��J' PLAN REVIEW � . � �aicrrx�,+een — � � EIECTRIC o �s�ct�r�rur�aa�ErmoFnfpepurrsa�np�r�nooua�smoo�oA PLUMBING W 1 CEIiTiFY TUT M TiE PERFORMANCE OF THE WORK FOR NMICH TMIS PEFM�T IS ISSU£D,I MECHANICAL Z () SINI,LNOTEMPLOYANYPERSONWANVMPNNEHSOASTOBECOMESU&fECTTOTHE INSPECTIONFEE � M/OPoCERS'COMPENSATION UN5 OF GIJiOHN1A,AND AGREE TFNT If I SHOIAD BECOAIE S 3U61ECTTOTHEVfOFlKERS'COMPENS�TIQNVROVISIONSOFSECTqN37000FTHELd1B0 ISSUANCE caoe,i �rn croMa�v MRIH ,E�Pq'OVI51_0N�5.�� /�^ �p/� /j/ ,/' pDA7E: �_��t���IAPPLICANT.�(�/�/�C4�Fi�1'J_s J� SMIP ��., _. � IA� � ENERGY P/C `�'r' � WIWANO:FM.URE TO SEWRE WDPKERS'COMPENSRT%X!COVERAGE�S uNLAN/FUL.ANO SHALL BE LL Si�,lEC7AMEMPLOYER70CRWVIM.PENALTIESANUCM�fMlESUPTOONEHUNDREDiFiOUSMIb ENERGYPERMIT OOI.LARS(f100.0001 BI MDfiION 70 TME COST Of COMPENSATIIXi.DAMAGES AS PROVIDED FOH IN JSECTpN 770!OF T/E UBOR CODE,NIEREST,ANO ATTOFWEYS FEES. � �'i�I,�� � RETENTION FEE: ���� � � _ d CONSTRUCTION LENOING AGENCY PRE-ALT FEE: �•� Q IHEREBVAFFIFlMUNDERPENAIiYOFPERJURYtHATTiEREISACONSTRUCTIONLENDINGAGENCY CI11 O�Ui:-`1"� , � �-viV�:�fZ s FOR7HEPERFOFWANCEOFTHEWOliKFORWHId71N�SPERMRISISSUED(SEC.3aW,CIV.C.). DTTiY TTT,��• (.}7.,,�t�.n�•-- ;� Z O V!lrEJ11-tiJ J� y r s W � lENOEN'S NAME � lENf1E1M5�DDRESS ¢ ICERTIFYTHATIHAVEREADiHISAPPLICATI0NM7DSTATETMTTiE�BOVEIt�oPMAT10NI5COR(1ECT. TOTAL FEES � I MREE TO COMPLY YVIh1 ALLCT'AND COUNTY OqDMM10E5 N!D S�I1TE LANS RELATMIO TO BU�OING 1 � CONgTpUCTpN,A!W l�REBY AUf/10NIZE HEVRESENTATNES OF THIS COUM�Y TO ENTEH UVON THE -�-.� S� #IENTIOr1ED PROPERTY FOR IN PEC 10N PURPOSES. COMMENTS - .� � �� � f-. ? �f? . m �1 mrnKn �i � Z��^ (.� ;. %`�' / .�/ � 510 R PERMIITEE OATE � RECPT.NO. _PAID BY VALIDATION WHITE—DepaAment Copy,YELLOW--Finance Copy,PINK—Assessor Copy.GOW ENROD—Flle Copy,GREEN—Applirant's Copy ' Cll'l�° t3� I���S� �� � 1N���G�"t�"� �E���C3 ,. ,�_ , ., . ,� �, _ .,. . �: w �s��"F'3"1i�, .� P,�j�3fi� • .. ,::� �. . �.�� . :, � , . � � g aS SET�3ACK ' , �LC7C3R JQ1ST �TGSl�OF3�;��i�TEEL ' � i FHA REQ?ATS _.__.___. . .��.— _ _,__— _ ___ ELECTi�IC GRCIilPJL} j I UNDEFd FLOOR�UCT E __ _ �_._—_—__ _� _.._____ ________.. _ ' --__..._...._..._ GF�OUN�F'LUPv�E�!^�G T--__��� UNDER FLOQR CGa!.�UiT I � �� • _ .� _ �,�.� ____..�.... , TEMP PC3WER ' - j �1REP�ACE FOUa3��,i�7i� ! g S�AB GR,4D� _. FER —. _.�_-- ------- _—-- —- __--9 Ef�LACE 6C3ND BEAM � . . _ 1NF�TER SERV�'fi� {J1ICj F9T. C-3C7(�D B�1"id`a'7 j r �___..______._______.__. �_". _....; F�£}UF SN��`tTHI�vCa _ ' ��3�T.8t)f�D�EANi FR�1NfIh�GtVENTdLIA1"fUN i F=1i�AL 8t3ND BEAN £-_ �c�c��=cav�� ' I � ��E-��€�ai�G � _�___ ___._. �c��r���a�,��;�rt� ; ��r�c�ir�� ; Ro�c��-�����;��ic ; , �oucs���a,r��r�� -----_—__ _��_ �---��� _— - ��:�c�r-i��.urvt�i�t� ; �ir�is�s��A��t�� ! ? ���y�r:��,;�r�a��s� ; C pa�����cT�t�c �� � ����.�L���I-t;S1Dll�G �PfJOL�ENCING ,__._�__..�. .. _ 5 l''Jt�,L!���i}LAiIC1�; �!. ; PC3�[FfNAL i ,�______�____ _ ___ _ _____ , G�3i_i%��i�Ii;�tJ��4T1C?P3 i i C�FF S1TE Ih�1PS, j __. G1r�"'�"u`��.� �aA`Ll�f� � ! � DEDICATIC7NS } .�__.__._..____..,. _ ___.__t__._.__....._.._.__ C� , � ���"r'::�_.____ �---j �._ FI�AL EPdG. j —_� --- _.—. --��- —_-��._____--- ��:s;.�P i I�:it�tvii � j 1„AN9�SC�PE(IRRIG. '; i 's -- — �__....----•- �'� C��i a�....�... , ����t����1r��.�'?. �. � � �. �..,..T __ .__ ___�._._._-'— !---_.- — ` . l r'- � i,'i § -ar'y-f j i F�3�f�i ZC7hllhy{a � � "r �: ���a�3 a`�'. ` r � � i�(�SE i��F"P'. Fi�lt.;� _�---_.�._ .____... ------ �-�� � � f��=a�.:_s-3�.�T3N� __------- -y� j k-���LTt-�DEf'T'. �ItL'AL ��� _________._.____�_.. _. -- ---.._. � ���GTRl�`. ! DEY FEES PAID ; _. ...� ___._ --- ---.__ �___._� -: f'�Ut''tB!#��_--___-�� � . � , ENEFdC`aY ! + � , --�__�_ }.._�.__ _._� _w_____ _,. �----- � I r ---- --- I ;� °��" �, -- ._ _ : __ _ . _—-____ .. __ _-- . _ _ __�_.._— —-_ — —' -- --- __. . _ . sk,, � . � �� ;�,� ,�d��vi�I�T� :� � " �`' ��—a______.__`�-��,-�..���a,�-�.�.� . ` '� . �. � ______. _ _� � f� � s _ _____ ___ __� �...� , ; ______._-� __ _ � ___ __�__ .—___; f _� —._ �____� --–____ _ .� —__- ---___.. ____. --_ ____ ___------___..___---_____. SEP i IC T�411K�d?� _._�. _-- ��EP i'IT1L!SI�� ..��� �" .--.— ----_ __�_ _ __----.___. i , ^ : ,4 _ _.________ ________.__._______._.......��.__.__ Y �_ _...____ __...___....�. �__.. _ __ ---� , " � � ; , , . . _..,._. .__._ ��____.... __ ..—_ ..._._ __ — � � �� __....__ ._______ —_.. _ _-- ___.____� __ �._.._..�_�_.__.._._...---__ _ ______--.---:___....._..____.._____�� � �; �