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HomeMy WebLinkAbout15781 (23) CITY OF DIAMOND BAR � � • --� DEPARTMENT OF COMMUNITY dc DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)8G0-3195 Fa�c(909)861-3117 PRESS � �'� BIJdDING PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION PERMIT n�/ PIC � ADDRESS 22'�g L, ���s�`� DATE NUMBER �iD/ � e� ISSUE TYPE OCC � APN LOT TRACT DATE CONST. GROUP p OWNEH �/UK�KC� �'� LL" ADD ESS ZONING SEfBACKS � CITY�*•� ZIP� TEL. REART RW p APPLiCANT TEL. SI�E/SIDE STREEf RW ❑ � CONTRACTOR �-L' �3 SIDE ❑ ¢ ADDRESS � � � CRY ��D ZIP � TELv+��''YS�a' PROPOSED USE � ARCHIENG/ DESIGNER NO.DWEL NO. NO. ADORESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION N � OWNER-BUILDER DECLARATION �q/qpD/REM O p 1 HER�Y AfFliW WDER PENALTY OF PE0.AIRY 7HAT 1 AY EXEA�PT FHaI THE COMRACTORS LL G8f8QB/CafpOR � 1,1! C915ELAWioRTIEFdlOWINQHFh40N(SE4�0.71.58USiNE55ANOPpOFE53iON300DE:AMYCITYOR (n � (� COIMYMM1qdI{IEOVIFiESAVEq1ARTOCOl6S7TR/Cf,ALTER,IMApOV6DE40LISH,OAPEVAIRMJVSTqUC W Patio/Deck � IUHE,PfllOil Th IiS ISSUANCE.A150 REW IRE5 iHE APPLICANT FOR SUCH PE WIIT TO FILE A SIGNED STATBAENT THAT HE�R SHE IS LICENSEO M1ILSUM7T TO THE PROVIS�dJS OF THE CONiRACTORS LI- � CPiSE UW(CHAPfEEi i(Cd�A�ENQNO WfTl1 SEGTION 7000)OF�IVISION 3 OF TNE 9USINE55 ANO PPO- V' PooVSpa F64310NS CODE)Ofl 71NT ME Op 9HE 19IXEYPT THEREFiWM AND THE BA919 FOR iHEALLEOED EXEAtP- TIOry,N/yypl/�TIpNOFSECTIQN7al1.5BYMIYMVLICANTFORAPER1A1T3U8JECTSTHEAVVIICANT70 Z qe-p�f r A G1�0.PENKT'OF NOT NOFE 7 WW FNE MUNOFEo DOLURS 4S6o�).): � ❑I,ASOMINEROFTHEPPOPEHTY.OfiMYEMPLOYEFSWITHWAGESASTHEIR50LECOAIPENSATION, Cpmf118tCi81 ' Y/0.L OD THE WOfp(,MID TME STRUCNRE IS NOT INTENDfiD OR OFFEREO FOR 511LE(SEC.70M,BU51- O NE89 A!n PROFESSIONS CODE�C07TMCTOi1S LICEPL4E L+V1/DOES NOT APPLY TO/,N OWNER oF ? � 01qPEqiYMIN09U1D.90HYPR�YE.47XEREON.AAC1VJ/1000E55UCHNORI(HWSELFOiiMERSELFOFi (t 7lN10UOM hN30i1 MEH OMR!EMPLOVEES,PRONDED iHAT SUCH WPROVEMENTS ARE NOT N�TFNDED OR � 4.1 OFFENEO F�iSKE If.HOWEVER 7HEBUA.DING DR MIPROVEYENT IS SOLO WITMNONE YEAPOFCq/PLE- ziqN.TME OMINER�BtAIDEH WILL f1AVE 7ME BURDEN Oi PPOVMrc3 THA7 HE OR SME DID NOT BUItD pq � MPROVEFOR7HEPUiMOSEOFSALEG W ❑4u�AOFTMEPXDPERf1;ANE%0.11SIVELYCONLRIICTINOWITHUCENSEDCdMTRACTOP3 � TO CWISTRUCT THE PROJECT(9EC.7ou,B1151NE55 ANO PpOFE5510N5 CODE:7HE COHiRACTORS LI- VdIU8t10(1 A�J.AREA CFNSE LAW DOES N(7T APPLY TO AN OMMER�APROPEXTY WHO BUtlDS ON YPROVES TNEPEON,AND MRKJWMRACTSFOflSUpiPR61ECfSWITHACOHTWIGTOR(S)LICENSEDWR3U�NTTOTHECONTRAF QUANTITY DESCRIPTION FEE � iOFSIJCENSE LAW.). ❑I MIIXENPT 1R10ER 6EC. 6.8 P.0 FOR THIS RFASON U Q LL DATE OWfiER F' � W 1 LICENSED CONTRACTORS DECUIRATION W � IHEREBYAFfIPMWi�ERPEILLLTYOFPERJURY7H�TIAMIICENSEDUNDERPROV151DN50FCHAPTER � �lA�♦ ♦/tL/�y�" ��CdM1ENCMqWITNSECT10N7000)OFDMSIONJOFTHEBUSINESSMlDPFOFESSIONSCO�E,AND Z ���MV.O�r��`/� W LICENSE�S M FULL FpRCE ANO EFFECL m 0 uc�sE cuss C�� uc.No. S�'4-�'-� j v nnh l��' corrcancron a � WORKERS'COMPENSATION DECU�RATION ¢ � U � 1 HEREBY AFFlRM UNDER PENAITY OF PERtt1F�1'ONE OF THE FOLLOVlINO DECLAMTIONS: Cq Z Q � _IHAIEMIO1MLlMAINT�MiACEIifIFlGTEOFC0�15ENTTOSELF-IN5UREFORWORKERS' _ COMPEN511TlON.�15 PR�VIDFD BY SECTION 7/00 DF THE UBOR CODE,FOR THE PERFORMANCE �U Oi THE WORI(FOR WHICH 7Hi5 FERMIT IS ISSUED. � � I MAVE MID WILLMNN�/�Pl WOR1(ENS'COMPENSATION INSUflANCE,AS flEQUIflEO BY SECTION Q J7ooOFTNEt/BORCODE.FOR7HEPERWRMMlCEOFhIEWORKFORWHICHTHISPERMtTIS I$SUEp.MY WORKEqi��OOMPE,N�S�ATITON INSURMICEC��R�ER�ND PO?L.ICV NUMBER APE: CONSTRUCTION � cAnfuEH ' _}�"�G%'� �" -- -" J�L-� PLANREVIEW � � POLCVMM6EP �'� �-T�_� .. }. """'�. ELECTRIC � f�accrqtit�No7eEoo�a�cF7r�aEPo�isfnr�avErax�Doat.v�s�iao�ot�tFss� PLUMBING ' tj � I CERTIFVTUT WTHE PERFORAdANCE OF THE YJORK FOR WHIqi lHiS�EPMIT I5155UED.l MECHANICAL SFf+1LL NDT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SU&IECT TO THE YVDFKERS'COMPENSATIONU�WSOFp1LIFOHNIA.ANDI.fiREETHATIFISHOlKDBECOAIE INSP�CTIONFEE � �'_I�a�n � SI�IECTTOTHENIfMKEH3'COMPE f�R6VIS1aft5'OF-GE�qN9�o00FTMEUBOR �j pppe,isrutLsopnivnTf�coMr�v�sEraowsaN& \� ISSUANCE ���_ O ` -t. - `�r.' ..._. i . ee a;. i pAT6: �4 APPLICAM: 6� SMIP y w WARMINO:FA0.URETOSEWREWORKER5COMPENSATIONCOVERAGEISUNLAWFUL,ANDSNALLBE ENERGYP/C ����' �"���+i�J'L�1�i�J.}d-�.a'ie,.�Yr � SUBJECTANEMPLOYERTOCNNIMAIPENALTIESANOCiVILFMESUPTOONEHUNOREDTHWSAND ENERGYPERMIT DOLURS(i100.000).W PDOITON TO THE COST OF C0IAPENSATION,OAMAOES AS PRWIDED WH IN ¢ SECTIDN910eOF7}1ELABORCOOE,MTEREST,PNDATTOPNEY'SFEES. RETENTIONFEE: � CONSTRUCTION IEND�NG AGENCY PRE-ALT FEE: � 1 HEFEBV AFFlRM UNOER PENALT'OF PE0.IURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FORTME PEHfORMPNCE OF THE N'ORK FOfl WHICH TitlS PEPo.11T IS�SSUED�SEC.30W,CIV.C.�. Z W � LENDER'3 NAYE � �� F- IENDEWSMDRESS � � ICERTIFY7HATIHAVEREIDTHISA7VlICATIONAN�ST�TETHATTHEA80YEMFORA1ATpNISCOHRECT. 70TAL FEES ' d I I1pREE TD COMPLY ri7TN NLL CfTV AND COUNTY ORDINANCES ANO STA7E UN5 REUITINO TO BUILDINQ COHSTf1UCT10N,M1D HEREBYAUT}N)RIZE REPRESENTATIVES OF THIS CIX1NT'TO ENlEN UPON THE � A90VE#1ENTIONED P PEHTY WN MSPECT�ON PURVOSES. COMMENYS O ���L�' �VC�� � m PEltlAfTTEE N NT) � � � SIONANi7EOFPERMITTEE OATE � HECPT.NO. PAI�BY VALIDATION WHITE—Depenment Copy.YELLOW�inance Copy,PINK—Asseasa Copy.GOIDENROD—File Co(ry,GREEN—Applica�Ps Copy �1�"lt' t)� �t�i�°�C��� ��� � 3t�:��������� �������� � _ . :,� ...„ ,� . �$ �.k�,� _ �� µ ��..",i• � " ��,;� � : . ��.� S�T BAG�`; I ! i � �L�J�Fi J:?!ST i ' ___ _----- --- ----____ _ __ � __. _�__________.��__.__.' F7GS�FCJFaf47 !�TEEL I --��_ � i F!-i/°i F`icc�1T�S � � .,__ _,_.___. ____��_______.._..____;,_ - --- ___. _� �LECTRiC G��E�Iv� i � U�dDER FLt3CR C3UCT ! '. --_ -.__ _ ; _...� --- --__-- -- -_.__._._. � ------ _._ GROUNC7 F'LUi{'�biYC-�� i I UN��E�9=LOOR CGP��Ji�IT ; ; -- �— .______ .__. - ; SL.AE3 G�F�y)� � ± � FiRE�'L�eE�C��"�L�AT3C"3 � --. __.__..��____ � ___ ,_. T�P��P P�t�iE�t i i � ( Fi���r��C�B(3iv��ER��1 ; � --_ VdAT�R SER'J1C:� _�Y.���_._ � , y�li�NT. 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I s I � _.�.............�..._.,_... �_'�"_'._.'._'_"�__'....."..._ .._.___._._...�__..._.. .._......._._...__,...._ �..____._.�._..'� 1 3 � __,____v._ ___.--.--� _____�.._ ____......___ __.__.- .." ,' � ', _____._.�., v._��._._.__..____.__.._________.__.__�__._.._,__.. _ __.________ ______ ___. ._.....__.____�.._� i - _,__ .�.____ _ .____.__�__...._.. _�—__...._-- _. _.......__� ; �° ..�_.....�.._.«.�.._.m._...�.�..r._..�.�._ ....._..........._...._._��_. �� ..........____.. _.-_-"__'—s�� ..,_..__.._._.__._......_.._....'. . ..a..,.we.uw ...._.��....._�rv...�.-._.,�.. ..._......._....._........._._._...__._,.. ._._.......a.-_ _ __._.._. ___._. ......._.._......�`."_"'� . v ......._..: ..�e... .�...........n.�s..�..s». ..�.m..«W.�..e.«,.e......:..... .....,..�......._....a ' WALNUT VALLEY UNIFIED SCNOOL DISTRICT 880 SOUTH LEMON AVENUE WALNUT, CALIFORNIA 91789 CER7IFICATE OF COMP�IANCE With Fee Provisions of Government Code Section 65996 � � wt � DEVELOPER �-K� �,��T'eo-?nIt?-Ci onI W� l�. e5. l�.e.t. C�r�, �' Signatu.�e of Applicant ADORESS ��3 G �, Kdt-Te.�t������ The person si gn i ng represents that he/ she is authorized to sign on behalf of CITY/ZIP a,ac�Ne�w� K ��a � the owner/developer and that the TELEPHONE �7�'i� information provided is true and _____________+^__�__?S�o ___����________________________accurate_to the best vf his/her knowledye FEE SCHEDULE: THE OEVELOPMENT FEES LEVIED BY THE WALNUT VALLEY UNIFIED SCHOOI DISTRICT UNDER PROVISION OF SECTION 65995 OF THE GOVERNMENT CODE ARE: Residential Development $1.53/sq. ft. � •-----------------------------Ca_�erciallIr�ust__al_Development---Q_25!sq:-ft_----------------------. � TRACT/PROJECT ADDRESS WALNUT �] DIAMOND 8AR � 91789 91765 NUMBER OF BUILDING(S) IN PROJECT BUILDING PERMIT APPLICATION NO(S) IF APPLICABLE � NE4f LOT ADDRESS USE OF BUII.DING AREA SQ. FT. FEE � 1. Iz i Check here if home improvement/remodeling project: � � �J 9.'��`�`t i^, 13;r�s�Y� �R, i�. '��a�.tp 1�arZ GIi� L-;� ' 13 rn 11S�6 y K.+� . Lot Address City/Zip escrip ion of Proj. Sq. Feet of Addition Signature Superintendent of Buildings Date ----------------------------------------------------------------------------------------------------- TO SE COMPLETED SY SCHOOL DISTRICT St18TOTAL (ATTACH SHEETS) � TOTAL FEES DUE , ��� RECEIPT NUMBER � This is to certify that all fees due to the Walnut Valley Unified School Oistrict A under provision of Government Code Section 65995 as prerequisite to the issuance ! of a Building Permit by the Department of Public Works have been received. Based � I� upon the information presented, this Certification of Compliance is hereby executed. This is to certify that the above described development has been determined Lo be EXEMPT from the development fees of Government Code Section 65995 and Building ('� Permits may be issued therefore. �_) Exemption justification � � :. . Harvey rimshaw, Ed.D., Assistant Superintendent 1/87 Fiscal and Facilities Management Rev. Z/88 Rev. 6/88