HomeMy WebLinkAbout10621 � j� �kp�
CiTY OF D(AMOND BAR � ��`O
COMMUNITY DEVELOPMBNT DEPARTMENT
21660E.CopleyDriveSuite190 eT o� PREss
(909)86a3195 Fax(909)861-31 l7 �
�''"'� BUILDINGPERMITAPPLICATION ?��� FIRMLI�
Q JOBSITE // ,�J �¢����. � �� APPUCATION �� �� PERMIT P�C
4 ADORESS �15,l,,J �/ DATE NUMBER #
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER � �'.
�'- ! ✓* ZONING SETBACKS
o ADDRESS ,!',�:1/�! i � � J �.�- i r,� 1
� �j�ZIP TEL. �7� FRONT pW ❑
CITY ^�'�Q�/
APPUCANT TEL. R�R � �
� SIDE/SIDE STREET RW ❑
CONTRACTOR -° r�t t SiDE ❑
� ADORESS PROPOSED USE '
CITY,.�G� �9�'1c! ZIP �TE . `/
o ARCH/ENG/
� DESIGNER NO.�WEL NO. NO.
ri ADDRESS UNITS STORIES BEDAOOMS
� CITY ZIP TEI.
�j DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUAT40N
� OWNER•BI:ItDER DECLAHA710N �q/ppp/qEM
O
p 1 HEHEBY AFFlqM UNDER VENKiY Of PEFWqY h1AT 1 AM EXEYM FROM THE CONTMCTORS LF GeIB{�B/C9rpOtt
�y,� LEµqELAWipq711EFd,1.OWINGpE"W(SEC.70.91.58U51NESSANDPROFESSKKJSCODE:ANYCRYOq {n
C� COuxTrwN�}1AEdJ1qE311PERM7T7000NSTRUCLAITERMPROVE.�EMOL13H.OHREWUNANVSTpUC• W �t����
W7UqE.PNON To A5199UANLE.AL50 REWIlIES 7NE MPLICAM FOR SUd/PEWNT TO FllE A&6NED �
g STATEIJEN7 TUY XE di SNE IS LICENSE�PURSUANT TO TFIE PNOV�SIONS OF THE ODNTRACTOMS ll�
� CENSE LAW(tl1APTFR B�COMYENCMIfi WITN SEGTqN 7900)OF 01VtSqN 3 OF TNE BUSWE83 AND PNO� � POOVSpB
FESSIONSOODE�ORTXA7NEORSMEISEKEMVT7HEREFROMAN�iHEBASISF01i7HEAl1EfiEDE%ENP- (�
� TION.ANYVIOUTIDNOFSECTION7a91.59YANY�P%.ICANTFd1APEA41T511B1ECT5iNEMP�IG.WrTO Z AB-Rpp�
� ACML VEW�1SYOi NDT 11bHE TWW fNE HUNDAED DOLLARS 175m1)�
O 04����TMEPR04ERiY.OqMYEE1PLOVEESWITNWA6ESA5THEIRSOIECOYPEALSA710N, Q C�m��C��
Z WIL6 p0 TH6 WOpK,AND TNE STRUCTURE IS NOT IMETDED Oq OFFENED FOR S�LE 45EC.76M,9US4 J
N6S5 AND PAOFES510N3 CODE:TNE C04TRACTORS LICENSE LAW DOES NO7 APPLY TO W OWNER OF
� PROPER'fYN1fOBUq.DSORN/PROVESTNEREOM,INOWHODOESSUCItWONICN415ELFqiHERSELFOq �
� �Wi0l1OHHISpiHEROVMEAIPLOYFES,PROVIDEOTHAT3L1CF11MPNOVENEN75ANENDTMTE�OEDOR m
W pFFEpEpFpq$,y,Eli,l7d�YERTHEBURpWOOHNMi70VEMENi145qDWRNWONEVEAAOFOOYRE-
� Z TION,THE OWNEfl�8U1LDER NpLL H�VE THE WflDEN OF PROVINO THAT NE OR SNE DO NOT BUI(p pq
� WPFqYEFbRTMEPUHP0.REOF5KE1.
_ ❑4��M'NENOfTHEPHOPEHTY,.VNE%CLUSNELVCONTMCTN10WfTHLICENSEDCQNTRACTOHS
� � TO CON&TRUCT THE PRQIECT fSEC.7W1,BUSINESS AND PROFESSIONS COOE:7HE CONfHACTOi15 U- �/91UBfI0f1 AOJ.AREA
� W CEN9EUWWE9110TAPPLVTOANONTIEROF�PROPERTYW�108UI1O80RNIPqOYE6�HEREON,AND
Z WMptOryTp/1Cf5FOq3UCHPqR1ECT5WITHACOHTMCTOf1(SILICENSEDPUFiSUNIfTOTNE00NTM6 QUANTITY DESCRIPTION FEE
F- TORSLICENSEUWJ.
� ❑I W E%EYM UNOER SEG B.8 V.C.FOR THI9 REAAON �
1 �
�
LL DATE W�NER V
� = W
� LICENSED CONTRAC70RS�ECLARATION W
I � IHERFPYAFGIftlAUN�ERiEWLLiYOFVEqA1RYT41T1AML�EMSEUIMIf)ERVRONSIONSOFCMA?TER �
d p(CA►NAENCNIQ WITµ6ECT10N 7000)OF OMSIDN 30F THE BUSINESS MQ VROFF3SIONS CObE,M1D Z
A1Y LICENSE IS W FULL FONCEAND EFFECT. /
0 �'(' uc.No. �7 J �L7 �
� uCEn�sE cuss J � j
� UATE "'I1�' CONTMCTOR��J a
� W /
i � WORKERS'COMPENSATION DECLAHATION t..'3` � L J
U
� � 1 HEREBY AFfIRM IRJDEH PENALN OF 7EiWRY ONE OF THE iOLL�'MNG DEGiAM(qNS: Z L. A.
� C^"
� IHAYENI�MAILMAp7TAtNACERTIfiGTEOFWNSENTTOSELHNSUREFONNbW(ERS 1
C04PENSATION,ASPIIOVIDEOBYSECTION]7000iTHEU180RCODE,PDRTFIEPERPoRYANCE W
OF iHE NbRK FOR NMICVI TMI5 PENAl1T IS ISSUEO. �
O
w _INAVEMAM7LLW�MTAPIWORKENS'COAIP�NSATIONINSUqANCE,A5RE0UiH.ED8Y6ECTION / �
d a�aoOF TiE UPOR CODE,Fdi 7NE PERFORMANCE OF TNE WOFK PoR W/11d1 TWS PERMR IS � �Z� �
3J �SUED.MYN�OHKEAS'COMPEN311TIONINSUF�NCEGIRFIERMlOPOIIGYNUM6EPAAE: C�SjAUCT�ON �✓
j CAHiUER PLAN REVfEW
t � 7�UCV NUMbER ELECTRiC
! � �SSEC�ONryE�Np7gEdpMRFf�Ofn#pEpdfsiOpp�EMll![1ll�pxiMs�yroo�oqlEss�, PLUMBING
,� Z I CEpTIF/THAT N THE VEPFORM�NGE OF TME WORN iOR NMiCF1 THIS PEiUAR 19 459UED.l MECHANICAL l
!' (� SNALI.NO7 EYP�OY ANY VEPSON W ANY IMTYJER 50115 TO BE E SU9JEGf TO THE
WOPo(ENS'COAIPENSATqNUW50FCpLIFORN10.AN011�REE iIFISHOULD ME INSPECTIpVFEE
�'� � 6UB7£CTT0154EWOR�tERS'CO0.I�ENSPTpNPROVI O ECTION]T00 LABOR
� �
cooE,is�uuFor�r�+u�nn�ca�r�rwirn� s. 45SUANCE ,� rnn-,
l � -���� �-� .
QO OATE�J` APPIICANT. .����L./ 9MIP + • e '
� WAPNIHti:FA�WRETOSEWFiENR�RKERS'COYPENSA7X?NCOVEHIU7EISUMAWFUI,MDSH�LLBE ENERGYP/C
�y SUBJECTAyENPLOYERTOCPWMALPEWITIESANOCIVILFMIESUPT�ONEHVNOREDTNIXANlD ENERGYPERMIT
DOtAARS(floo,o00).Ml ADDITION TO hIE fASiOF COMPENS�TqN,UMIAGES AS VROV�DED FOR IN
� SECTION77PoQFiHELA80RC�DE.MITERES7.AND�TfORNEY'SFEES. RETENTIONFEE:
q CONSTRUCTION LENDING AGENCY
o PRE-ALT FEE:
� IilERE6YlIFFli1MlINDEqPENALNOFPEiWRYTHATTHERE1bACONSTRUCTIONLENDINOAGENCY
FOR TME VERFORIIANCEOF TNE NiONK FOR VAi1CFf TNIS PERA/1T IS IS9UED�SEC.�OW,C1V.C.�.
�
� IENDEH'6 NAME
i� IENDERSA0DNE35
� tGEX71FYTHA�tHAVEREMTM�SMRJCMIONN�DSTATETH+1TtHEABOVEINFONMATIONISWHRECT, TOTAL FEES
a 1 A(iNEE N OOAAPLY NnTN ALL CITY Mm COUNT'ORO�NMICES�N�ST�TE LAWS RELATINC TQ BIl�l0�N6
CON&TR1)CTtON,/�ND NEREBY AUT110RI2E REPRE8ENTATIVES OF TNIS COUNTY TO ENTER UPON THE
� ABOVEAdENfIONEDPROOERTYFORINSPECTIONVUHPO$E5. COMMENTS
j G�'<<`_
P �TTF�'�.��gM f(p11INT1 ✓ s �
f/� /"w7 ��/1 ����-I / ''"' I
� 'St�,.RT� VEN��ITEE OA7E S
� RECPT:NO. PAIO BY VALIOATION
WHITE—OepaAment Copy,YELLOW—Finence Copy.PINK—Assessa Copy.GOLDENROO--Fila Copy,GAEEN—App1lc�Ys Copy
�—_--.,._ . __.... _ __. .__, I c_ � � ��< � ��I— `�� c '� � �r;�
r.._ � � r� .
cr; ',� I � , l , i� r � i_ � C � c, t��, f r C� i
e„ r,i� ! I j (a I '..p�, a t �r_'I i i : _ r �ee� {,II��C � I e I� , 4� ca
�� { � ` I �r r- i ��' [` I- � �� r� T .
— I 1: �' � ` ' ��
i I ` ' � � �I r I� C � I � C ,r5
_ �I I � � � � . i „r!��I I �,� i( l:�I� ��.�L � f 1� � �Ji� �� �. f„+
+ � �� � f �I ( I C r-��'`$i g � I `i � �A � . j � , �
� 'I I �� I I i .-� I " I' � f � CJ ��1 E �.�IK� _'I, i J U'I
��f .� - � i. �.' . '# ~�I I � C .7 . � �G4 �� .:)� j C � R .. .
...� VS ' '�, � � .. �,C C% � . i IJ �} ~ ,
(; tJ � - ' � ' � � � I I I I '� �- � i ��' �� r� i�� .
. I - � ' � , i ! . I ..
i,1�� �, I . I � �, , ' ' � � � `� I � I � �.
� ,, � } � , . I`- I .._,.--.. .—. ...
��j .. � I i.. � ;: �, �� -��— _-.__�� � ,-..�� �_.-i-_. —�_ �. �.'....— ..- .._ � .
_�
� � � �
� ' � � ' I � ; � ' , ' I , � �� � ,
I �, � � '
', � , � , � ; - �
' . , '� � � i ' � : '-- � ��- i � --- ' ---
,
� , , i ' � i
� I I ' I ; r I I i � :_ _ I I �' �_ ;I._ _.__ i_ _�__ _ �
� � � � � ( � �'� 1 I � � I � � � � �,�i ;, � I ' ' ��
� � � ! �, ( � I � � � �' ' �' �� ' � � �
1 � � �I � i I � � � � ; i II .I I f I I � II � I
i i � i , ; i
� � I ` I '' � '� � i
� � � � � � � � � � j � � � � � � �" i
I l , . . � � � ; I � '� � i
� i � , i � I I
� � I � � ; �; � � i �i ; � �j �� � I �
�
; � �
I , � , � I �
I ! i � �
, � i ,�, I i
� � � j , � I � I i ' __ ' - —- �- — ' -- � ..
� �
i i �
� � �, � � _. - - i
� ; �
I ' . . -
� � � " � - - �
I • i � ;'� ,t �"^�� C I ,c T; 'i_ � i ' ` I�, a
I � �. �� �' '�s
� . . Ir �.- ,. .. , _ ,
' � � - - i���� I I',i i
�; � '. . , . , — � !- � � � -EI �� I: �. .���, � -��-rl..i -
�� - �r . , _ .. [� �i�
(
_
i I I I 1- r
I P
I � _I.' .�. �+i
i � V ; , ' � �, � �i �� � � �� , � :! ' ,�_ � ;�,, � �,� - � �
j � . , . I .I� �__ � ri �,F 4 I i C �,C',� � .�
a ( i �� . , 'i � � � - C i f,. r � I 1 I r� [ ���I �I V, � � �
' � I j �. , _ , � , �I � " � � I
, �I .� i. � I . I. . . . . , � , -"I C3�C7 ��7'� �
�
�
'�� . � . . . . ' I -
I�I �, . , i �, , . ' ,�.i I'
� I i� ! ' I � �,, � �� . .,r� �' , i � i � f i', �I�. '
� � �'� � � � � '. �i � � �I , I � � ' ! I� I' ;
�
�
� I
I I I
, � I .,. �, ' . �. ' "__._ I . — —— "_ ' ',
I
t
i � i . . . � . � I
� � I �, � � � . , � , ' I . i i '
� I � 'I i , �� I �i i _) ..�_
i I I I I
i
+ i j �. . i . I �' � i � �
�� �i � � ,� I � � � � �' � � i� , � � � � � I I � �_ �
' , �' �
j I I ' I I i I I , � � j I , i ' � I I
I � I � ' � � i l I I, � ' _ � i_ . - � �' � � — - —
�I I I j � � I , �,- � l � 'k� �
� � �i �� ��. � � I �' �: � �� � ��� . � , �. i � � � � � . � I j ' , � ,
�� ' i II ! � �� ' � �� .. i . � , i � ., �I :, i � ( i I � �. i
� I i , � � � � I I I� � � ' I � I I
I �
i � ' � �. � ', . , . I �. .
? i I �. �I � i , I j , . . i I , i � I � i i i
I j ' ! � I i � � � 'i I i
� �
� � ,
. , , � � . .. i �� �I i . I � i
� � i � � I
` I� � � i I i ! � � � � i I �i '� i i i � I' I, � � I � , � � ,. � I� � � . .
I � , , �
, � ; � , . _
; .
� , x , �
� ! � � � '
i __