HomeMy WebLinkAbout13115 CITY OF DIAMOND BAR ��
" DEPARTMENT OF COMMUNITY dt DEVELOPMENT SERVICES
� 21660 E.Coplcy Drive Suite 190
(909)86(�3195 Fax(909)861-3117 PRESS
�'�"� BUII.DING PERMIT APPLICA�'IUN FIRMLY
� JOBSITE APPLICATION PERMIT �P/C
< ADDRESS ��� 8�t�Ry �R, �DIPMcw'� ;�r.
p DATE NUMBER #
� APN LOT TRACT �SSUE TYPE OCC
DATE CONST. GROUP
p OWNER C7c►.r��! �EAE'�a� X3A�K
" ADDRESS Ih�S PAW 'ScN dAK�S $��D -�'Sp ZONfNG SETBACKS
� CITY Pp4N �N ZIP��OITEL R�RT RW o
APPLICANT __Rds N�ut2 TEL. SIDE/SIQE STREET FiW ❑
� CONTflACTOR KARCNE� �NVi¢ONMEN'I�,aL iNC. StDE ❑
� ADDRESS 2 �� a "'� w E ' pROPOSED USE b�'hoL��a,.i ��illE �InCE� R1 S/7jf�!c!'
arv A�pNa,M Zlp C�_ TEL. 'e-8
o aRcwer�c,�
,.z, OESIGNER NO.DWEL. NO. NO.
y ADDRESS UNITS STORIES BEDROOMS
� ClTY ZIP 7EL.
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
Q �HEREBY AfRhd UNDEq VENATY OF VERA1flV TMAT I/�.1 EXEMPT FROM TME CON7RACTORS L�� GIIreQ&/CBF�OR
W CENSEUWFORT/IEFOLLOWMNiREASON(SEC.70.11.SBU9iNE5bANOPROFE55KKJ5CODE:ANYC�NOR (n
� COUHTYMIMOI�ESAPEfUARTOCANS7RUCT,ALTERIMPROVE.UEMOtJSH.ORRERVRANYSTF4IG W Patio/Daac
V� NFlE,PRIOR TO RS ISSUANCE.A150 REW IFiES iHE AiPLICMIT FOR SUCVI PEqMIi TO FILE A Sf(iNED w
� $T11iENENf TMAT ME OR SNE IS LICENSEO iUqSUMtT TO TNE PROVISIONS OL THE CONTRACTORS L4 LL
� (�'NSE UW(CWiPiEN Y(COhtMENCAN(7 N7TH 5ECTIOH�u00)OF DMSpN 3 Of TrfE BUSINE55 MIO GflP PoO�$Pe
fES310NS CODE)ORT}N7 HE Oq SNE IS EXEk1PT THEREFqOM AND TNE BASIS FOR THE I�LLEl7E0 E%EMP-
TION.MIYVIOlAT10NOF5EGTION7091.6BYANYMPLK',ANTFOFAPEflMITSUBJEGTSTHEMPLICANTTO Z R@-ROOf
F A CML PENAL7Y OF NOT MOHf TFI/W i1VE HUN�RED DOILMS(fSrol.):
� ❑4��ER�7NEPqOVERTV.ORRIVEMPIOVEESN7TNWAGESASTNEIRSOIECOMPfNSAtION, � CORlmeftial -
WILL 00 TWE 1WRK,AI'R 7HE SiRUCTUPE IS NOT INTEH�EO OR OFFEflED f-0H SALE(SEC.7041.BUSL J i
� NEs4 uO VNOFESSRFB CODE:THE CONTMCTOHS UCfTRE Uw WFS NO7 AGPLv TO AN Owla6q OF � i
pRDPERfY YR70 WItD50R MPROVES TMEREON.IND YRiO DOES SUCF7 YPDRK NIMSELFOR HERSELf OR
� TWROUNIHISORHEROY!lIEMPLOYEES,PROVDEDTFMTSUUiWPROVEMENTSAftENOTMTEIJ�EOOR C� ,
� OFFEI�D�iSALEIF,WWEVER7NE�ll�WCiORWVi1DVEYBJTLS50L�WITMNONEYEAROFCOMPLE �
Z �ifON,TME OYYHER-01111DEfl VYILL WNE h7E BURDEN OF PROVWc3 7W1T ME Ofl SHE UID NOT BUILD Of1
� WPRDVEFOH7HEVUHiO5E6F¢��n
O 4 A3 UMNEM OF TIIE iROGERTY./1M D(LLUSIVELT CONTMCTMKi WITM IICENSED CON7RACiOfl9 '�
TO CONSTRUCi lf�PiqJECT(SEC.70u.BUSINESS AND PROfESSiONS CODE THE CONTRACTORS U- V01u0ti0n ADJ.AREA I
LL CENSElAW00ESNOTAYPLYTOANOWNEROFAPROPfRiYMIFIOBU1LD50RIMPRDVE3T11EREON.AND �
z NMDCONTiUCTSFORSUCHPRp1ECTSWITHACONTMCTOR(S)L10EN9WPUHSUANTTOTHECONTMG pUANTITY DESCRfPT10N FEE
� Tq6UCENSEUW.).
O I Mi E%EMPT UNDEH SEC. B.8 P.C.FOQ THIS RFASON J
U
� �
DATE ONMER f"
� W
LICENSED CANTRACTOflS DECLARATION �
� W
INEHEBYAFFIFtlAU1VDEflPEN�LTYOFPEpJUFi1'T/U7IAMUCENSEDUNDERPROYISiON50FCHAPTER �
Y(COWEIiCNO WITH SECT�ON 7000)OF DmSpN 7 OF TNE BUSINE55 AND PROFESSIONS CODE,AND Z
X W LICENSE IS P!FULL FORGEAN�EFFECT.
� LICEI�ISE CLASS LIC.NO. `T•I�/G �
� a� 3• I�'4 coNrAncroa a
� WORKERS'COMPENSATION DECIARATION a
N IHEREBYAFFIRMUNDERPENALTYOFPENURYONEOFTHEPoLLOWPJGDECLAMTKKJS: U
� Z
a
� _INAVEMI�WLLIIMNJTNNIICER�IFICATEOFWNSENTTOSELNNSUHEKOflYVORKERS' _
COAApEM$RTpN,�SPfWVIDEDBYSECT10NT7000FTHEUBORCODE,FORTHEPERWRMANCE W
Q pF TNE WOPoC FOiI WHICH THIS PERMIT I$ISSUEO. g
w ✓ 1 HIWEAND WILL M11Nfl1W WORI(EflS'COMPENSATKKi INSUMNC�AS REQUIRED BY SECTqN
� 37oaOFTrrtLA80H�00E.FORhiEPERFOHMANCEOF'�-�EWOFiKFOFWHICH7HI5PEFMITIS I�� �/r�
� GSgU�,►ryNpRKER3'COMPENSATIONINSUMNCECARRIERANDVOLICVNUM6ERARE: CONSTRUCTION ,����_
� �yEp � ZJ.�KfCN AMf�tICA hl PLAN REVIEW
� POLICYlMW�EH W C 2�2.'L��3 O 7 ELEC7RIC
Q (I1iS5ECfpNHE�NDT6EWMPLEf�OF7}fPEiMTI5FL7RCNEM1t�DF'IDOOLLARS(StOD)ORLESS} PWMBING
W
Z 1 CENTIFY THIR W 7NE PERfORA/M10E OF THE WORK FOR WHICH 7NI5 PERMIT IS ISSUED,1 MECHANICAL '�. —
CJ SMAL�NOT EMPLOY AM(PEpSON W INY MMNER 50 AS TO BECOME SU&IECT TO THE �,
(n WUHNE(i5'COMPENSATION UWS OF GLLIFORNIA,ANO�GREE TNAT IF I SMOULU BECOAIE IN ECTION FEE
S SUBJECTTO7HEWORKERS'COIAPEN9ATpNPROYISqNSOFSECTION37000FTNELABOR ISSUAN P:i� S`
COOE,I SF7ML FOfTiNWITi COMPLY WITH TFIOSE PROVISIONS. y�—��y�—
� 3•r�•9q SMIP
Wpp7E; APRIG.4NT. y � L — .
� WARNING:FA0.URE TO 5ECURE WOPKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C .�\-}�\�'�ti l,°:. �~ —
� SUBJECT M1 EMPLOVER TO CRW WAL PENALTIES ANO CIV�L FP/ES UP TO ONE HUNDRED THOUSANO ENERGY PERMIT `�--� �( a —
� pp��{$({1Co,0oo�,WADDITIONTOIHECOSTOFCOMPENSATION,DAMAGESASPROVIDmF�i1N ����p �b�
J� SECTION970EOFTHElA90RO�DE,iNTEREST,ANDATfOPNEY'SFEES. RETENTIONFEE: - � 1p"�
OCONSTRUCTIONLENDINGAGENCY PpE-ALTFEE: �^i� �/t11�
� 1 FIEFEBV AFFINM UNDEH PENA�TY OF GERIURV THAT TNEAE IS A CONSTRUCTION IENOINf3�6ENCY 51�1�
FOR TNE PERPDflMANCE OF'fHE WORK FOfl WHip1 THI9 VERMIT IS ISSUED(SEC.9097,CIV.CJ.
Z
W
� LENDER'S WWE
F– IENDEH'SADORESS
� ICERTIFYTHATIHAVEREAUTHISRPPLICATIONANDST�TETHATTMEABOVEINFORMATIONISCORRECT. TOTAL FEES
� IAGPEETOCOMPLYWITH11LLqTYANOGWNIVORDINANCESANDSTATEUWSREUTNK3TO0UqA�NO
� CONSTRUCT�ON.ANDHEREB�AUTHORIZEREPRESENTATIVESOFTHISCIXINTYTOENTERUPDNiHE
Z ABOVE�MENTIONFD 7HOVEN7V FOR INSPEC7qN PUflPOSES. COMMENTS
� GA�PB�cC �T'
aPERMRTEE NAA1E(PRINTj
�, 3•�5•q9
y 'S16NA7UREOFPERMITTEE DA7E
� RECPT.NO. PAID BY /WDATION
WHI?E-0epnAmont Copy,YELLOW�inanos Copy,PINK—Asaessa Copy.GOLDEI�tOD—file Copy.GREEf�ApplicaM's Cqry
..._.....,.....� _ i -- -- w,.. . _. . _ ..r -- . .
-... � � � � ..._.. ..
, � �� ' � I i I � f T ' � I�
�
I � ; j � ` i � ; ' i � � i � � � � � I j !
- a I � � i i , i I ,. � � ( i ;
r I `
� ` i ' i � i ( � � = ( � � ,;
� � ,� � ! !f � �� � � ( I � i €
i � i I � ' � � � � � i � i � I .. i II � :, 3 (
I � I . � � � ' i , � � ' � , �i � � ,,i If � (
I ' � � I . � � � I I .! � i i ' 3 � {
� ' i
' � %
� � i ' � I ' � i � � 1
;-- . - _ � f � � �__ ! � ' r � ; �
I �
i _ _� ' ' _ _ � E � , � .
, , - I , , � t � :
,
� = , �-
, �_ i �
;
' ' � �� � � i � ��� � � � i i I ` i � '� ! � i ,
� � I � . � , � , ,
;
; , ,
, ,
,
, � � � � ' � ; � i ! i � ` i I ! � '
,
> '
, , �
� I , � , � a � I � � � � i ; � � � �
.._ ._� _s— —1 , r _ � i ;_ " i [ i �� I i
� i i 3 � ( � � ; i ' E
�r;�j LL; I � � � i '�,. � � � � � . ' � � I �
. � �� � )C .I x ' � I � ,.:' ti �� ; . �. ,. � � � .� E
� �'� M i �, L a - .i I { � � , 3 . � . ( I I �
� �; I C� C.�J�r �;� "' � �4 � " t�I � , � � .3.-. F � � { i � i �
�A "L`� CS t I R i �-' tf1 n� L � � _ �e' � � ����
1.s 1 4 � ` I (
Pa � �-I Cfl C7 Q L��`- fY. G �c C �" �C..I'��� C (' _ I�1 � � � I � � i � (
�._: („t en +- O O r. i... � . i i� a.. a. i ; ( - i
� � c`s r .c"i � ��� (� tf i .=1 I 3 I f � I . � i
c
� � � � i,� �,. �i� �.�, � <���'� ��� ''�� u i+:_ ` r I r � � i � � � ; ' ( `
'�^ LL:'�C i W I Lf� CE. r � �(� (S� � �' `� [ �i + � _ �� ; ` � � i i �. � i i � 1 .
�,' � Cj � � t �Y 7 C� � -� ' � .
� �r ��..��u i I..;��'itt�� '..�i C' 'C'�i� l � � � ��I r���i � � � � � � I � � !-
; �^� �`} �i�' ��.-.-���� ��==�1 ��t G �c G�U _u3 .� ,-� ���I �a � : � � ( , '.
� � .�.��� _...._._J`—r i.__.., �....�.�. �._'.... � ��._ I._I "7 �.._.� ._.; ,� i , i � � j i � - ( � � .
�- � �I a .� t� ca � r c �. e a a� x a �,- � z[ .� � �
L4� �.� � � i ( ; , � � � i i
� � � � � � i � � 1 � ! � i i � � � I ` � (
_ �,. �. . % , l � � � � � � ' j ! � ' M � ; 3
t._ � �' ; � � ; ; ' � ; � i -- I � i � ; ! � j � ; � � � i � � ; � �
� , � I , � � � 1 �— ; i i ; I � � , I (( I �
� � i � � � � � �, i 1 � ' i I � � � � 7 i _.�.
. ��� � � I �', � �� j..�� � � � � � i � � ; � � I ��; 1
� � �_� � .o� . �i I � �
�_ I I � , t � i � E � i
� � , ' �
� — .� � �._.�—t—n � �—� ';i �'�����—� � i�� � ��� � ; � 1 � � . � � i � i ?��_
„. ' � 4 }� [ ' ' � ( �
� �� I�y � I�? t`) 3 ?�,lJ I rJ N� i i R '�J; � -�; � k � ( � ,.
� �..� ,.yl i_\�. i ,i�' '� ' �, ���'�} l\��� I i I��___' .(_\,. f . � � � � � � ..��
� \ �- — �. . ...__ � I __.._... , . 3
, �
�_ I �� � ( � ' ���. , � ' ' �
i
r� � � � � � ( ( ; ' .
� I � ��)
� , I
'�'" �C�7'��( �i � � ' ' - � � ,i t I i �°- � ' �
:
' , i
;
G i -,. ` � ' � ., �� ° I � � .. i I I
�
i CI - i � . � � �
. :�) �._ � �.
I � � �—'� � '' E , '� �
. { C I f� � ' C` �! i' ` �, i ( J I � . ; f [
� � � ;l._ 4 �' ! ( I� i�)�' - I.._ t [ � r - i � i - _
t. � � �
�' C I i� J J'. ( �� 4 (-�t E ��.� i � � i' 4 - -_ _ ;
� h�, I �,� I� t: i '� i-_ i���� . � ' � , � #
� ( �� ; �� �v i ' - �` � � s
� !
_a � z ` � i � �a i
� . ( � ' . _ . �
� �= i
T , v� ' � �
. G _ i .. � � , � ��� � � +�.
}