Loading...
HomeMy WebLinkAbout16011 _ �,� CITY OF DTAMOND BAR DEPARTMENT OF COMMUIVITY&c DBVELOPMENT SBRVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fa�c(909}861-3117 PRESS �"""` BUILDING PERMIT APPLICATION F1RMI.Y o� JOBSI7E APPtiCATiON PERMtT ., ' P!G - ADDRESS_ I f C7 p`�i i t�.l U E i.'t" r� dATE °f- 2 f•- 2G c,0 NUMBER ���-�' � APN LOT it;3 TRACT__��<.r3'j A EE � NPE OCC ct CONST. GROUP p OWNER �a��a r.� t3.�__'�'.t��:,�ssa h+ o ADDRESS_i13t70 !-`.ntc, r,�v�vv i7i2, ZONING 3ETBACKS � CITY �y�r�owa'�'�,�s�R ZIP �t76;� TEL�aor'r IFiF[-�`�tr FRONT �yy � APPLIGANT c�wr.rr:-;z 7EL. � �� ��AR t� � SIOFJSIQE S7REET RW ❑ CONTRACTOA SIDE � ADDRESS � CITY ZIP TEL. PROPO5ED USE��?N �fvnri — �;FA��rN� �) K�r���,,q;-r��r-� � ARCH/ENG! F�rt,LY Rc.c�rt r-'x-r-�t,i�i c-,n1 Ntn�'r � ,i� � � DESIGNER Nd.DWEL. Np. � RDDFiESS UNITS� S70RIES B dROOMS � CtTY ZIP TEL. � DESCRIPTION St�.Fl FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLAAATION O SFRfAOD1REM Q I HfREBY AFFIRM UNpER PENALTV OF PE{LIURy THAT I AM EXEMPT FROM TNE CONTRpCTORS LI- GBffl�B/CflfPOfl � LJ CENSELIWWRi}iEFOLLOWINGREASCNiSEC.iasi.seUS�NfSSANDPFOCESSi6N5CdDE:ANYCiTYOR (n � CfJl1M'�41111CNflE�IiiRESAPERMtT7000tiS7RUCT,ALTER.IMPROVE,DEMOlISF1,apREPA1ftANYSTRUC- �jf PBtio/DBCk � TLIRE.Pqpq'(p ITS IS$UANCE,ALSD REOUIRES iHE APPLIGANT FOR SUCN PERMIT TO FII,E A SI�aNED W STATEMENT THAT HE OR SHE IS I.ICENSEU PUp5UANT TO TiE PROVISIONS OF THE COFITMCTORS U- CENSE tAW(CNApTER G{COAil1{ENGM16 Y1�TF}$EG710N�000}OF OIYISIDN 1 OF THE OUSINESS AND PAp- � PaoVSpa FESSIWY6CODE}ORTHATHEORSHEISEXEMPT7NEREFR(MAqN07HE6A515FORTHEAt,LEGEDE%EMp- (7 TpN.MryVpI,ATIONOFSECTIqN7o315BVANV�pPUCANTFORAPERM175U&lEGT5TH6APPLICANT70 Z Re-Rooi � A CIVIL PENALTY pF Np7 Mf7RE hiqN FfVE HUN�RED Oq,URS(5560).)', Q ❑�,ASOWNEflQFTHEPAOPERTY,4RMYEMPtOYEESWiTtfWAGESASTHEiRSOLECAMpEN5A710N, COR'iiTiBtCial Z MALL DD TME MYORK,M!D THE 3TRUCTURE IS NOT INTENDED pR pFFERED FOR SALE{SEC.7D41,BUSI- � � NESS AND PRpF65SpN$(„ppE'.TNE CANTRACTORS LICENSE LAW DOE5 NOT APPLV TO AN OWNER OF j FflOPERTY WFiO BUIIOS OR IMpROVE57HEREON,AND W1��0 DOES SUCFi NropK NUASEtF OR NERSEIF OA w TNFbi?OM NIS IXi HEi3 OWN EMPLOYEES,PROYI�EQ 7NAT 9UCH ItdPRQYEAI6MS ARE NOT WTENOED QR m Q OFF6NEDR7RSN.EIF.HQWEYER,TNEBUILQINGOflN1PflOVEMENTISuOLpWffHINbN6VEAROFCAMPIE- Z TqN,THE 1?WNER-BUILGER WILL HAVE THE BURDEN OF�qOVINa TMAT HE OR SNE OID NpT 8U�10 pR � iMPROVE FOR THB F(lRPOSE OL SALE). .�' (y,� ❑�,AS�WN£R6FTliEPR07Efi7Y,AMEXCLUSIYELYCONTMCTINGW77lfLIGENSEDCONTRACTOflS d TO CONSTRUCT THE PRQIECT(SEC.704�,OUSINESS ANO PRDFESSIONS CODE:TME CONTRAG70R5 LI� VOIUeti0rl (C?4�C�{�'/\DJ.AREA W CENSE LAW DOE9 NOT APPLY TO AN OWNER OF A PROPFRN WHO BUILDS OR IMPROYES THEREON,AN6 �: W}iOCONTPACTSFOHSUGiPPOJEOTSWiiFtACptiTRACTORi5iLtGENSEDPi1qSUNtTTOTHEGONTRAG OUANTiTY DESCRIPTI4N FEE � TPRSUCENSELAW.}. ❑I AM EXEMPT UNDER S�C,_ e,a P.C.FOR THIS R"cASON Q � U � DATE OWNER �— ¢ � W F UCENSED CONTRACTORS DECLARATION W � � IHERE9YAFFlRMUNOERPENAITYOFPfFiJUkYTHATIAMIiCEN5E6UNDfRPAt7ViSi0NSOFCt4APTER � � Y(CQMA�NGNd(iWtTh+SECfpk7tlop)4�41YISION30FTHEBUSINESSANDPROFESSiQNSCADE,AND z ��� MY UCENSE IS IN FULl FORCE MID EFFEGT. m � LIGENSE CUSS � I.IC.NO_ � � V 4ATE CONTR4C70R ,_ a Li.l � WORKERS'COMPENSATION DECLARATION a � I NEREBV AfFIRM UN�EN PENALTV OF PE0.IURV pNE OFTHE FOLIOWING DECLARATIONS: U fJ7 Z � .,��HMYEAND'MIIAUiNTAMiACERSiFlCATE�C(NI$ENTTOSEIF�INSUfiEFOftWGRKERS' i GOMPENSATION,AS PROVIDED @Y SECTION 3�n90F THE IABOR CppE,Fbq THE PERFORMANCE U Of THE VYORK FOH WNICM THIS PEflM1T 18 ISSUEO. W ' � � F.�,. ��tHAVEANDWILLMAIN7AiNYyt7pKER5'COAiP�T75ATiONiNSVRANCE,A5REtWiREDBYSECTqh " �,�, 3"!tl0 t�TiiE tA80R CODE.FOR THE PERGOfiMAFtCE OF THE WOft+(f0!?WHlCM 7HIS P�RMIT 15 /�/'"�{'� i� ISSUER MY Wf?RKERS'COMPENSATlON 1NSUpANCE CARpIERpND POt,iCY NUMBERARE: CONSTRUCTION �:t t''f � � j CARPoER �' �---��••_—� PLAN REVIEW �^^�� `�I 1 .�_ Zcaucr nuMeeR �_ ELECTqIC �-'����- Q _ � .�`�.r � � i�s[CrtiauNEHINJ7eEIXY.#'lEtE6cf'MEPEw.(r�rortauErit�REopJlA,nas{s+coyoatFss7. PtUMBiNG ��7p .SyGS,� � 1 CEf271fY THAT IN THE PEHF4RMANCE OR THE WORK FOR WHICH THIS PE WAIT IS ISSUE�,I MECHANICAL __ � ' ` '�ry SHpL.LNOT EMPLOY ANV PEflSpN IN ANY MANNER SO AS TO BECAME$U9JECT TO THE (,/) WORKERS'COMPENSIITION tRWS OF CAI.iFpRNiA,AN[SAGREE iHAT iF i SH6Ul0 BECOME IMSPECTI4N FEE r r•,. � SUBJECT TO THE VtC}RKERS'COMPEPlSAT#NV PROL4S10NS Of SEC710N 3foo pf THE tABOR z "'^'�,� � C{mE.ISNAIiFORTNWITHCAMP4YWIiHTNOSEPRpVIS10N5. ISSUANCE _�1� - �w. �--�i��� p DATE:_ APPLICANT. �,. SMIP � N��T,'�y����'`" � WARNitiO:FAIWRE Ta SECURE WORKERs'cAMPEN&ATION COVEHAGE IS UNL4WFUl,AND SHALL BE ENERGY P/C �. � �- h ' . k.ti1'(j�j��' .• LL SUO,lECT AN EMPIOYERTO GRIMINAL PENALTIES ANO CIVIL FINES UP TO dJE NIJNDRED THqUSAND � �_-��( �_�� ._ OOI.I.ARS(f100.C100),IN ADOITION Tp THE COST OFCAMPENSATN7N,pAMAGES AS PROVi0E0 FOR IN E.NERGY PERMIT 1.� �� � SEGTiDN 37oeOF THE U84R CQOE,iNTERESi,MXJaTfOflNEY'S F£E5. {�ETENTION FEE; � � W tl CONSTRUCI7QN IENDING AGENCY PRE-AlT FEE: � I NEREBV 0.FFIRM UN�EP PENALTY OF PERJURV THATTHERE VS A CONSiRUCT�ON�ENDING AGENCY FOR Th'E PERFORMANCE OF LFlE woRK FOa wHfCH T»IS PERMITlS ISSUED{SEC.3447,CIY.G.). � � � � _ __._ LENDER'$NAME F- LEND6R'9APDRE53 � � i CERTIF!TNAT i HAVE READ THIS APY{,ICA7IONAND STaTE THAT THE A80VE MFpRAiATpN 15 CAqRECT. TOTAL FEES Q i AGftEE i0 Ct}MPLY WITN At,.L CtTY RAI�COUNTY Ofl6WANCES ANO STATE lAWS RKATUiG T4 6U0.DINa � � i � CONSTAUCTION,ANDHERE@YAUTh10RIZEREPqESENTATI4E5OFTNISCOUNIYTOF.NTERUPQN7HE ppp�����,\ A80VE-MENTIONE41 PROPER7Y FOR MSPEGTION PURPOSES. � ��� L(y }f 1' ,� p COMMENTS �.i ��l.�ll � � t//-�-5 A ni R. �R t ti!►v"�}S sl�✓ � ITT6E N,tME(PAIkT) d Q� . / �? GLI.G:w/L�v�r„*.r-.G.vf..-�--� �• /7 '�! �. t (� � —. � SiGNATUqE OF PERMITTEE �ATE � � i7ECPT.N4. PAID BY VALIDATION WH{7E-6epaAment Copy.YELLt?YV-finsnce Copy,PfNK-Assessor Capy,GCSLDENR4[?--File Copy,{�FiEEN-Applicant's Copy ���� � ������� ��� ����������� ������ • ,� � b r � ae � � � � � �4 � { '�"��`� �t�°^ -� C-� � ... . _ �,... ._ ._ _._...._S _ _ _ __ .�',�—_�_. _..._ _ .... �...._ _". .. .__. .,.. � �1 C� ��'r�" � '� E�� ���r•-a!���'''�,�!i�-�/� F 1 � �,"' _ _. _ _ _ � , _ _ , -__, .. .�__ _ _ _ _ i r=1 �C.�i-�€� t�FiC��t�ti'a t �..__..�_ ._ ' E�itstil �' "�'+-`-�,�t^ r � __ . _ _ _. _ � � __._ _ _ __ _ - . _ C='�{� �r4�? � �ia,=�, � F {��E;� ti f "`��.� :l? � � , . � r_�a n ? ., •'> f �.�......�. _, . ._.... ...,_,. _...n ..LL ......_.. ._ u... _ ,� ..... � ".._ � _._ ...... . ....... . .... . . . t �y�1`'s�` �.,�,� +�. ` : �' ... � .?i". �. � _:��" �'•-hx �,✓� - - - �_,_ . :_ . .__ ..__ _.._ .._. _ �_....._. .....�...._.._..._._._,.. ,. ' i : . _. r� ... ,�.q �_ _... �_..._... .. ...._. _.. - 3'L Y4} 'l t�J f�'.,_.;."} : . . � �-. ^A�3 i.��i.. t �"��..�,.'! � � r •..A......-... .. _.... . ._...,..._._. <.__....{ _ . .. . p �J ..— . ...___ ..�.._m�..._...,_. . »_.. 5� .,....__ .__. .�...._ _ .�_ . ..._.�_.._......�...._. , .._.. € V�S{'Lt'��-2 �;..E`{J ��i..: ,. t: t . 4'��C�r'�lfr . � ._ . . _ _..._,_,._� ._.__ ._-- - -_._._.,. ___ _ ._ .....__... �_--.. .� . ._. .__ ..�_ _.. . ..... �. �^'�f r �'-� �':�R tes'S9 , Z .-sry� _.. . ; r '-. + §�?�{r`',l+ e. _ �__ �� ..._? .�_ "`�^�.,,�. , . _ ... . ._ ..___�._ , _ _ �_ _. ,.£'1/���7�°��t4f�' �'v;�.i � �°'-a�+� ,. '� .. _.... �. �, �-25t-4"-(�����""-..— ., r -; ���€-�-� 3, _ _ _ . ____ ._ . . __ _ . _._ , - __. . � . _ . r �:���C,7= < :. �� �� � a-i r,�� ���.� - ^ _.. �.,_ _._J.._W.. ,._...,.._._ _. -<....__.._'"--i--._ _.,..___ ._.... ...._... ... ........_ ........ ...._._.._ .._...._. ��.... ...._ ...f ..,_. .. . i ?-`��=`_.st.,�.¢ ;._r �t`��i��; !;. ! E:`_ :e�;,-F��� _ _. __ , , � �� : � __ � _ _ _ _ _ � �C��`al� �� � �-4t" 32�jv l s,,,,, "� x ^A `t� € _ � _ _ _�,,., _ __ . ,it � �t .� v t�,�`°.a t,l �_ ; ��, � ����. _ �2�� .._ . __ . �.__..._._. _ --- """��., __ _ _.__ __ �� .__ . _ _ . ; _ __� _ i ;;ms t .... y--��..y..,,- i ; ` .µ.at �y :'� --j'��"%�{�, i �', ��� ._._. _ __ _.._.._. . . _...... �-.,._....... _ .._._ _._.,.�.._ . __ ._... ..._...�._._._-.-;._. __._�. . ___ _.._ _.. ... . .. — ��}a '.^;"s�#- !��i�,�.c- � �Fva�P�SE� i � _. _, _ ,..._._I,�� � ._. � _.�. �_ _ __ _._ _._. _ _ �,;.o t x ?� ; 4 {.0 d � i�.r T v r� �"� jwht . �. .,. . . ._ . .�, ._. . ..,.. � „,_... . ...,_ _ ._.._ _ ... ___ _ _. ...___... . _.._ ..... ___ .._. ... ....,.���,,,�1 t fi , r . . , ��. , - � -y^� ,_.. � �, w., s , � .+t'� �". ��Gf�t �� � ...,'' . :i_ ;.'`. . . . ._ _ _..._ _. e .._._.._ ., ..._ _.._..__ ., ._ _.._. _. . � , , �r r . ..._. _ _. _ .... . .,,. r .��I � ir - . :, ,�,. . . � �� >: �-�^'��-�'l -�"`'� �` >i , . , ._.. z , _ . . .. .,, _ ._. .,.__._..._._ . _._ . .. .._ _.. . v, .,. � - , S ... .W. . " _ . r ._ . . , . ._._. _ __. . ..__`_.__. � ..__. _.,�._.._ ... __ _ _ _.._..._ ._� .._. _.____ ... ..._ __.. .. � � .� ,°-i�'.°�. ... _a . _� _ .'�� ,.t �. . ._ _ _�._.._.. ,..., __.._, _ ....�. _..--.._ .........._�.. ..__..,,.._.._._.._.._ t . .. . ,.__.. ..._ . _._..__.....� ..._... .._, , _.M.,..._ .._.>,.. ... ��.. . � _ . ..-,-..._..._...__ _....... ..... ._. . .. . � .�. . ��� ,. � L: , . . . .W. . _......_._ _._. .._� _�.._._.._ ., _ _.w__. . �,�- . ....� _.-.-._ _ _r_� _. _v.._. _ ._....._ _, _.. ._ _ . .. .... ...._ _ . ��4 . - .,e„� � , .- ti .., . . .... %� . .. �, .. _ �...- i . . ____ . __ . ...... _ ._ _ ,. '. R � � �. ' '_ m_ _. __ ... _. _.. . . . _.. . . )�� . � �/�'� : r; . .. . ._d . ...._. ....,..,.I w,.�...,_... - .. . . .. ,..._ . _. . .__._ _.. .. _.,.._.. ... � '_ _'__.. . , .._. __„ ,.�.. '"_ _'._ .._ . .._ .. �'� ; �^ r .� .. .. .. ... . _.. _ d.� ... ,. ._ . _ ,. _ ._ ._ .,w__ . _, . ._ �,�,. an ;�m.:�1�� � a ,� _ _._ .... . ..... .. _. . . .. . . p � 1 ��:er,2�:.(�,wA;�91.:d, �r�. ,..�,. . �� 3 �.� t � €_.._...-.. ____ _........._...._ .__.....__.._.._.,.,.,,_ ...,..__.._.._ . . . Y""_._.__ ........ _ ... ..... ....... . _..__.. _. ... .. .. .. .... ... .._. ... .. . .. . � Y ! M��¢.,�r�t . ..-�. .. . .... . .... .. _ ...... . ... �. -.,� � . __ ..._. � � 'kY W k���t �t�� 1�1��4`��$'.�, , ..... ...... .. .... . . . ,p � 6�a ` ",a,7 4 � , _,_ . . . _. ... ........_.� ,� .__ .__. .____ _... . ... .. a I � -�� _ _ _.... ,. _ _ _ __ # _ __ i i jl . ., i _._ _. .�.- .___.__.. — _ _. __� ._�___ .. . _ .__. . .__. ._. ..... .__ _... _ � r .. .. _ .. �. � � ,.., � . .___ ._,..�__ � __. _..._�. w.___ ._ ._.. -- -..�.._....._ ___ ...__ ._ . . . . t �a ° : , ._._._ . . __�., . ....__ ...... ....� __.. _._ . _._ _ . . . ... i b . _ .._.. _..... ... ._... _._. _... . __.._ _ ....... _ . ._...._ . . ._.... . . ..... _.. ... ... ... ... . . : : . _ _� ...�...... � , � __,..._ _�..,_..._ _.... .._..__. .... „ ._... .... . .. . ..._ . ....... . . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMTT APPLICATION PRESS FIRMLY APPLICATION PERMIT„ P/C', DATE FI-=�-f•-2oc;0 NUMBER � #J i ISSUE TYPE OCC DATE� CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDEISIDE STREET RW ^ SIDE ^ PROPOSED USE ::�V N POn I'i-R FAZ rN c� P1 K EI�� i-[c� � FANI Ly IZO I;f7 Fx7-F 7.�•'i� IJ - 11 c�/'I-= -�'/a<��r— N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM � Garage/Carport W Patio/Deck LL PooVSpa Z Re-Root � Commercial m s' Valuation f��'�� '��ADJ.AREA QUANTITY DESCRIPTION FEE Q U w w C7 z m ) a ) Q u z Q w r� CONSTRUCTION I� PLAN REVIEW ELECTRIC PLUMBING' MECHANICAL -''^ INSPECTION FEE x?'�' ISSUANCE"' i�� k�� SMIP . T r',h,tj�}S r� � „ ENERGY P/C�„�,,�, 2� as �7�T�.�3.. ENERGY PERMIT 'r IJI' RETENTION FEE: PRE-ALT FEE: 0 TOTAL FEES � ����+� COMMENTS U I ��� I i-t �\ / RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy