Loading...
HomeMy WebLinkAbout11103 (5) � _ C1TY OF DIAMOND BAR I , COMMUNITY DEVELOFMENT DEPARTMENT ' ;, 21660 E.Copley Drive Suite 190 ����� PRESS (909)860-3195 Fax(909)R6t-3117 ""' BUILDING PERMIT APPLICATION FIRMLY y �D��TE .�r,,,� APPLICATION t�G 0 AOORESS �� .7V� �r ��1f2-�S �� ��+ DATE � 1 ` NUMB R `E� #r �Z� � ISSUE TYpE pCC APN LOT TRACT DATE CONST. GROUP � p OWNER-��J M\�LI ��ht a�L7 Q ADORESS rL '3U �� 112 �YE ZONING SETBACKS Z CITY��A hIQSD �� ZIP �1� .�TEL ��3�Z3 REART RW ❑ g APPUCANT Sfl�� TEL SIDFJSIDE STREET RW ❑ � CONTRACTOR SiDE ❑ ADDRESS � � � CITY ZIP TEL. P��POSED USE \ C�b M - C Cb � 0 ARCH/ENG/ Z DESIGNER � AD�RESS NO.DWEL. NO. NO. � CIN ZIP TEL. UNITS STORIES BEDROOMS � rn DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BI:ILDER DECLARATION �q/ApD/REM O 1 HEHEBV AFFIRN UNOER PENALTV DF PEH.Il1HV 7HAi I AIA E7(EIIPT FHOY 7HE CONTMCTORS LI- Gfl�89B/C8fP0lt ! W CFNSEUWFOHTNEFOLIOWMlGREASON(SEC.70.11.68USINESSANDPROFESSqN500DE:ANYq7YOH (n � U COIMiYWMICMREWIRE3AVERMITTOCON57RUC7,ALTER,IMPROVE,OEMOLISM,ORHEPNHANYSTRUG W ���� � TUHE.PRqR TO ITS ISSUA!lCE.ALSO REWIRES TME AVPLtt:AM fOP SUCH PEPMIT TO FlLE A SIONED � 5T�TEMENT THAT HE OR SHE IS UCENSEO PURSUANT TO 7HE PROVISqN9 OF THE CCYITAACTORS LI- � CENBE LAW(CIiAVTEfl B(C0IYIENCNM N7TH 9ECTION 7000)OF DIVISION 9 OF 7HE BU9INESS ANO PRO- � POOUSPB iESSpNS COOE)Ofl T1iAT ME OR SNE IS E%EMPT iHEREFROM ANUTHE 6A515 FOR 7HE ALIEOED EXENP• (� TION.ANVVIOLATqNOFSECTIdJ7D91.58YANVAPPLICANTFORAPERAMTSUBJECTSTHEAPPIICAHTTO Z FlB-Rpp� A CML PENALN OF NOT MORE TIUN FIVE HUNDRED DOLLMS(f6n0�.): 0 ❑I,ASOWNEROFTVIEPROPERTI,ORMYEMPI.OYEESWITHNMGESASTMEIRSOIEWMPEN8117pN, � (,`pTR18fC181 Z WILI DO iNE WORK,MA THE STRUCiURE IS NOT IMENDEO OR OFfERED FOR SRLE(SEC.7a4�,BUSF J NE55 AND PROFESSIONS CW E:THE CONiMCTONS LICENSE lAW DOES NOT APPLY TO FN OWNER OF /�� � PRDPEHfTW1i09UMD50Fi1NPHOYESTifEREqJ,M1UWHODOESSUCMNAflKHWSELFORHEASELFOq = V� �'-1 � (,r THAOl1CJ/F1ISORHEROWNENVLOYEES,PROVIOEDTHATSlKHI1MROVEMEMSAHENOTWTENOEDON m QOFFEREDfORS�LE1F,FqWEVER7HEBUILDINGORM/PROVEMENTI550LDWI7NWONEVEAROFWAI0.E- Z TqN,THE OMMEP-BVIIDEH YALL Ii�VE THE BUHOEN OF PROVINO Ti�T HE OR SHE DID NOT BVtID Oq � WPibVEWRTHEPURPOSEOFSALE). W ❑1,AS ONRIEROF THE PRDPERTY.AN E%ClU51VELY CONTMCTMG N7TN LI[FNSED CON7PAC70R6 [[ TO CONSTHUCT 7HE PROJECT(SEC.7aF1,BUSINE33 AND PROFESSIONS CODE:7HE CONTRAGTOAS LI- VSIWI1011 ADJ.AREA W CENSEUWDOESNDTAPPLVTOANOWNEHOFAPR07ERTVWHOBUILDSORWPROVESTHEREON,ANU � WFqCONfMCTSFORSUCNPqOJECTSWITHA00NTRACTORiS)LICENSEDWHSUAMTOTHECONiMG QUANTIN DESCRIPTION �E � TORS LICHI3E U1W.�. O 1 AU EXEMPT UNDER SEC. B.t P.C.FOR THIS RE/SON � � U LL � OATE � � ONMEF � U � W Q LICENSED CONTRACTORS DECLARATION W . OC I MEREBY IIFFIfOA IXYOEfl PEN�LTY OF PERJURY TMAT 1 AM LICENSED UNDEH PiqVISpNS OF CHAPTER � d 9i��NCMlGN7THSECTION7a0o)OFUIVISION30fTHE8USINES3ANDPf�ESSIDNSCODE,MI� Z X Mv LICENSE IS W FULI FORCE M10 EFFECT. m LLI � UCENSE CU55 LiC.NO. � V DATE CONTfUCTOR d W � WORKERS'COMPENSATION DECLARATIDN 4 I N 1 HEPEBY AFFIRM IRJDEfl PENALTY OF PERIURY ONE OF THE FOUAWINO DECUH�TIONS: Z � � _IH�VEANDNNLLNAIHTAINACERTIFICATEQFCONSENfTOSELF-INSUREFORNORKERS' _ � COMVEN511TION,ASP�VI�EDBV9ECilON97aoOFTHELABOflWDE,PDRTHEPEflFORNMICE W Q OF THE WORK FOP WHICN TMIS PERMIT IS ISSUED. � w _IHAVEANDWILLMAMTAWWOPoCERS'COMPENSATIONINSURANCE,ASREIXIIPED9VSECTION 6 J7000FTNEUBORCODE,FORTHEPERWRMANCEOFTHEWORKFORWHICHiNISPERMRIS i� .�-�-1 ISSUE�.YYN/ORKERS'CdAPENS�TI0NIN5URANCECARRIERANOPOLICYNUMBER�RE: ONSTRUC / �,t 5 v ! j CARPoER PLAN REVIEW � I � pa�cr r�u�.�eEA ELECTRIC Z G � (nassECroNI��NOT8E0DYREiIDOFT1EaEfiRsiORarEHJl�oaiARSRtoolaiLE5s1 PLUMB�NG Z 1 CERTIGY TMA1 N TNE PERFOPMANCE OF 7HE WOflK FOfl WHICH THIS PEflM1T 4S ISSUED,1 MECHANICAL � SHALLNOT EMPLOYANY VERSON W ANY AIANNER SO AS TO PECOIAE SU&IECTTOTHE (n WOFKER5COMPENSATIONLAWSOFCALIFORN�A,ANDAGREETHATtFISMOULDBECOME INS� P�CTIONFEE = SUBJECTTO7HE WOFKEHS'COAAPENSATION PHOVISIONS OF SECTqN 97ao OF THE LABOH cooE.i sNru wAn�vwn�couv�v wm�nase vaowsroNs. sSuAN f.�U O O �f,.� p DATE: APPLICAM: �!'�/ J WARNINO:FALURE TO SEWRE NARKER5 C0IIPENSIITIDN COVEMGE IS UNUWFUL,11M191ALL BE ENERGY P/C �y SU&IECTANEMPLOYERTOCRWINALPENALTIESANDCMLFM/ESUPTOONEHUNDREOTIqUSMID ENERGYPERMIT DOLL�IRS(i100,000),VI ADDITION 70 THE COST OF COYPENSATION,OAMAOES AS PROVIDED f-0fl IN � SECTIDN 370!Of T1E LABOR CODE.INTENEST,AND ATfOHNEV'3 FEES. RETEMION FEE: d CON5TRUCTION LENOING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMImAENPENALTYOFPEfUUNYTMATTHEflE15ACON5TRUCT10NlENOMOAGENCY ���'s FOR TNE PERFORWINCE OF THE WORN WH NRilql TMIS PEiW1T IS ISSUED(SEC.JM7.CIV.C.�. Z � lEtY1ER'S NAME � � h— LENDERSADURESS W ICERT�FY7YUTIHIWEREADT113�PPLICATIONANDST�TETHAtA1EABOVE1NFOiMA�TqNISCORRECT. TOTAL FEES � 1 AGREE TO COYPLY WITH ALL CIT'AND O]UNiY ORDINANCES ANO STATE UV�REI.ATING TO BUILOINO CONSTRUCTION,AND HEFEBYAUhqF12E REPiIESENTATIVES Of T115 COUNTY TO ENTEA UVON TNE �^ S� �BOVE•MENTpNEO PROPERTY FOR INSPECTION PURP03ES. COMMENTS �a V � � 1 � )!Yt c�iY�L V S Pt�'p Y2 V Q -PERMITTS!'N�ME`R1t�� 'V� Q � / [ / �Cl � ( y BItINAIURE OF PEIM DATf � RECPT.NO. P/UO BY� LT�� V � WHITE—Department C�y.YELLOW--Finance Capy.PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applkant's r.�.•E`i � � `�',�•i�3 aMa�.���� �� � � 61'diJ���= . e'....1'i� !��F�ts4��� � 1 _ ,` �� �� :._ _ ...e ..... . .. 5 w�� F � a�iY�',�_'_.—'____._. �T�"s,'.CiC � i �LJC�'R J015T ; -- —-------� ---+— - '-� � ' -----_------ r�i u�rrO:�TFi°�'S'i tcL ; � i FI-iri riEC��ril� j - � _- ---, I� __ _.___ LL�GTit�:,Gi�GU�ai� ; ' I Ui:�,R FLO�N[?l1CT j!� ---- - _ ; - - — --t-- = --__ -- C:i'ri:,Ufi'�`J i LU��ul���: � I � I UI:`�; Fs F['JC7'r9 G(;";�I�'lJ7T i � _ _ ._ _ -- _ --------- __ - -- — ---- -- ----------- � t-- � t � :ii.l't�ir.f:i"��1L � F�t�[-YL.r..('.�F"l�iii:..�it��l.ii � , _i._ . --- -- i__ _._ �..r ____..�__ i i� iS���i'li'r r� � _ ! i i i�iZ��'�_rn�,[ t��i}t'ii)[.� ttiv ' `�_--- __'_'�._._ � I � rL � � -,� — . � '__... ,- — ' : . -T i _____._ _ � � I � � . . - i �Ar�s��vr�e - � �,��n�r ;:� �.�=�; ; � i � — � -----;---- -- � , � ,:;�. �ri�„Tf'1 '�:. �� (� j � �i r f Ei:3�vD B t,.'� j i I . ._ -- _ -------- . ._ _.� _ � � r-�r 'n��_n.°e_i»TI� i:1ii��"f���� � =G -- �_.. i t l;d,.' E�Oi��D Et:��:�.9 __ � � � � ,:n;,-c���r-t; ; -i rj �-�;r c Y, >L;ir��7 ! i � -- __----- , _ , — __ _ --fi--- _ - — ---- --- �c.�r��,��ri�,� i ; I , ��r c�E����� � ----._ ______��--. __._T_ --- --- — �___._.�___ __ , 1 _. , ,� �----.�_� ._ ., i��itita�i C_L..:v i i i€i� I i I ! hivvL ti �t� �tiJ�.; � ...I__._ —._._. — — -._. ,__.-----�- ------ --- _... .------_. . _ . . -;--- -- _ ._. .___.___— _.._._.._ ..� ,. .-. � ' i ��_���1 f�-_� 1�..�U'�1t��J�i"kf".+ , I �iiltJUtl i-�Lif-.,:..ti„�3 � � � . _ . -.�_ � _�_-��'} __"""_-.�,�._w..._.___._ ;; ';� ' R•rfU TLST i I ; ( F CO� E�.E�C I H1�r;v.._._�_�_�i_. _i. -- — � _—__ --------T-� --- ( u.l. �.r��YU:.li�li'ace j j � i i�v�JL� L'i"ii���';� � , �-----'---.._�._. .� _. ....- --�-- __— ._---�...____.__._._�.- � ` ' � -- ._._..—._.__ ._._._._�_..��.,.�. � `.�:�1-.��_�i�.w�,�L.�,�fJ�. -.. , .._. i-- � j � ll�.i�.( il'-.'ri'�_ I i - -- _..._ ..�_-. . . _---�-- _.__..t ..._----- -- - -------- 7- - - - -_._ ..__. + �.�I�li�:�I„ �1L,�IV�a �L 9 f� � rl°rf `�ITc IT�°i .`, , --- i � � � --- - _ _ �J�;r r� L� I� i .� �t.ftr. �� � I � UcCIC`�TPC�',��_.._._._----- ' -.._ - ----- � --— ---- - -�- 1 , __._ —__ ...._e ._f� i _ __ .—_..______— i—I�'�/"1��41\�7�.. �_� f 1 �.- "�" � � � � . } �__—_—.__—_.____. _.__ .__..._. . —!— . ._____—'—' �_.__._._'_.____.._. .,:.:r .?., rn.:�� j ' I �.;yf l�avi�i���!��Z�iiiu. j '. ; , - . . .----- -----!-----'-- -`�---_�_.,.__.._.._._.�e � � -------.__ ..�_.�__.....__---__--__��.�.__. � ., i`i li�.�. � i :....SI��C lir-�:?. ' I .-.._ . i . _ __ ,. ._ __-- �.-____. . ...__'.____'_'-_._ .._.______ . _. __. _ .__-____ .:i'."��.t Ai�i i I i_.�{ i, j i'�^i<,v�,�1�15`�1"i'C' I .. � --�-- .��s.� --- -- - - - - . ;. L t-��: i �,�:�v i. i I;'t D i t ���a.i. ' __ �_�-���-�, - --- -- �_ �-- -- _ - --� -_--- � r�„�,LH._,.ft�;(� , , r.�f.L��i lict'l. rli, ,;_ . - --_.�__._.--�.--- --- __ _____— -- --- __ ----- - --- � r ��i�i�°.����L�Y����`:� ; ' . . t��C4�. � t.�.,� i�;t{iu i j . . _.- ----------------. .._�-- _......... .. ..._--. . . .--`--------'---- ------------- '--____ ..... �=L� _f'LU':.��i;�:�; � 1i:tt,.�'i ----._-------I_ � ,___-----—-- __ _._.__: _ -_ . ___ _ _._-- -_ , ' --------__.___.�._�__ ----------- I _ �__��_._ , . � _ ___..__._ ....__.._._ ; - _ '; _ - _ __----------_-- -- t;.,'a��F�",l=�� i"�: i < - ----------_ --- ---.._ __ �_�___._._._..._��. ` - ---------- -�...__------._.�______ � ; — — — ----- � i -�___ __��.....- ___ _ . --- ---- ---------...._ , _ _ - - __ ____._ _ - -----_-- —.._ _ .. _ ._._—___.._.__ i �.__— _.—.—_—_-__——______ .___. �—_..� � � _.�.______ .__..____.__. _.__.__..'__.__... __.. _ __ .. _._._. ._ _ _____ —__..____ _ - _ ; � . .—. '—_'._—'___��..�...____._�._v. - ', � ��—_�_____________ __._______._—_—_---_____—.____-' ._..— .— _ . . ___._____`_.__._._�'_'.___....."__'____ _�._.�__�-- �_—'._ _._ _.___ � '�.� ,r���� � ` S'�iJTi�T.`,�e�YC 51LL . ; S"��€' i'11-JU �l�;� --— --�__�_.,----_ __ _ _ -- _-- __ ____ _— --- — _ —_--- -- ' : , ___ � � __-- -- ------ _-----__------------— -----". � .r;7; ; : ��;., , . _-- - ; i V . !, _.._... _..___ __`__...�__"�._"'_. -_..—_ r --'__ __..__._ _"_—__ __.--—. ___.a,_.__... _'�__'"_`�� � E ' �� �; � � .1... ._....,_....� _.�._,_..�„-..�._. I�