Loading...
HomeMy WebLinkAbout17023 �-��-\�� � �� �.���� ���. CITX OF DIAMOND BAR —�' � DEPARTMENT OF COMM(JNiTY&DEVELOPMENT SERVICES �"� 21825 E.Copley Ihive (409)86d-3195 Fax(909)8bi-3117 PRESS ��g�.. BUILDING PERMIT APPLICATIOi�T �) Y � JOBSlTE j,��,{ f� � ADDRESS� � /J✓�t�G�- G'►�'� J� L APPL�CATION �, � "" PERMIT l--7 • '� "- P1C � L.J DATE ' �_'- � �J NUMBER i � � y� # � -- ISSUE TYPE OCC APN_ LOT__ TRAC7 DATE CONST. GROUP d OWNER � AdDRESS ZONING SETBACKS � z GITY ZIP TEL. FRON7 RW d � APPLICANT TEL. REAR �� � SlQE1SlGE STREET RW^ � z . ,`�m� CONTRACTO N i'��✓'vi7 [. r-✓ SIDE � � ADDRE S CITY /'� ZIP�� T 2- V -(; �, pROPC1SED USE � ARCH/ENG/ W DESIGNEfi NO.DWEL. NfJ. NO. a ADDRE5S UNITS STORI6S BE6ROOMS = CITY_ ZIP TEL. cn rn dEBCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATIdN � OWNER-BUILDER DECLARATIQN SFR/ADD/REM O i HEREBY AFFIRM LINDEN PENAL7Y OF P€RJURV THAT I AM EXEMP7 FpfJM THE CONTRACTORS LI� GefBJe/GBfPOf1 W CENSEUWFORTNEFOLLOWMGREASON(SEG7C31.SBUSINESSAN'JPROFESSIONSCADE:ANYCITVOp (f� C.� COUNTYWNICHREQt1iftESAPEi#.iiTTOWNSTAUCT,AlTER,iMYRQVE.DEtXJ1.i3H.ORREPAiftANYSTRVC- (jj py[IO/DeCk W TURE.PflIOH TO ITS ISSUANCE,ALSO REOUIRES TNE APPLICANT FOfl SUCH pERMIT TO FILE A SIGN[p W .g STATEMENT THAT HE OR SHE t9 LICENSED PURSUANT TfJ THE PROYISIONS OF THE CONTflACTt?RS lh .�,'- GENSE lAW{CHAPTER 9(CAMMEhCiNG wtTN SECTIQN 76q6j OF DIVISiDN 3 pF THE BUSiNESS AND PRP � POOUSpB FESSIqNS CbDE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE 9A515 FOR THE ALLEGED E%EMP� � TION.ANYVIQLATIQMOFSECTION?03t.58YANYAPPL�CAMfCR0.PEflMITSU&1EGTSiHEAPPIICAPlTTQ Z R0-RWf � ACIVIL PENALTY OF NOT MORE THAN('NE HUNDRED DOLLAAS(;500j.): � GI,ASOWNEqOFTNEPROPEFTV,OqMVEMPLOVEESWITHWAGESASTHEIR50�ECOMPEN5ATION. � C0t71m8(Cidi � Witl DQ TNE W4RK,l40 THE 5?flUCTURE IS NOT INTENpEQ OR 6FFERED FOR SAtE{SEC.�oda,eUSi� J , NESS AND PROFESSIONS CODE:THE CONTRACTOflS LICENSE LAW DOES N07 AVPLY TO AN OWNER OF � PROPERTVWMOBUIl�50RIMPROVE5THEftEON,ANDWH0�0ESSUCHWORKHIMSEIFOpHERS6LFQR � � THROUGHNtSORHEROWNEMP.4YEES.PFOVIDEDTHATSt7CHiMPRLiVEF.iENT9ARENflTINTENbED6R m � OFFEflEDFbRSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- � TION.TNE OWNER�6U1l�ER WILL HA4E THE&UROEN oF PROVING T-1AT HE OR SHE�ID NOT BUIID Oft � lMPf�VEFORTHEPUPPO5EOFSALE). W ❑I,ASOWNEROFTHE7FOPERTV,AMEXC�USNELYCONTRACTINGWITHLICEN5EDCqNTFACTOq$ - [[ TO CANSTRUCT TNE PrlQJcGT(5EC.70da,8U51NE3S AND PROFESSIONS fADE 7HE�N7RACTORS li� VBIUHFtO(i ADJ.AREA � W CEN56 UW bOES NOTAPPLY TOAN OWNEit OF A PROPEfliY wH0 BUILDS OR IMPROVES THEREON,AND - � � WFIOCpNTFACTSFORSUCHPROJEGTSWITHACONTRACTOR�S)UCEN9EDPURSUANTTOTNECDNTRAG OUANTITY DESCRIATIQN FEE Y TOR51.icENSE IAW.}. � ❑I AM E%EMpT UNOER SEC._.., ...—...... B.8 PC.FOR THIS REASON J {'� Q `. -,�> _ U LL _ ¢ �ATE_.._ ONMEP, .__ U W � �ICENSED COMTRAGT4Ru 6ECLAFiATl4N � � I HEREBV AfFIHM UNDER PENAI.7Y OF PERJU%Y THAT I AM lICENSED UNQER PROVISI�NS(}F CFAPTER � ,., /,,.'��y�� / d e(COMMENCW6 WITH SECT�N 7�)OF OIVISION�OF THE BUSINESS AN6 PRQFESSK]N_<.CADE,AN6 Z •Z����C...+til ! "� � �. � MY IIGENSE IS IN FULL FORCE AND EFFECT. 1y m )� •,/� a.1J s ' `''^) C7 f j� / ."! , �.a / � UCENSE CLAiS C. �'�� ,_LIG,NO. � / �L�' _ _ j �- -� ,_ %,(�tt!�-"�GT'1. �/''�'�'�-s �;,�.��-7 F . !, .�7 , _ J � DATE 7S �� f^{i,�, ..._ CQNTftACT4R � �.V �`�J't!� ... `✓f O.. W � WORKERS'GQMPENSATION DEGiARATiON � ¢ � IHEFEBYAFFIPMUNDERPENA4TYOFPERJURVONEOFiHEfOLL�WINGDECLARnTIONS: Z � _IHAVEANDWILLIAAINTAINACERTIFICATEpiCON^uENTTOSELF�INSUREFORWOqKERS' _ CQttPENSATiON,AS PROVIOE6 @Y SECTION 3JDo OF THE 1A60ft CAOE.F4RTHE PEflF6RMAWGE C} q OFTHE WOflK FOR WHIGH THIS PERMIT IS I55UEn. � ^l !:a W �I HAVE AN6 WILI MAtNTA1N WORKERS'C6MRENSATION iN$URANCE,A£REOU�RED I]1'SECTION Q 3]00 Qf THE LA84R CObE.FOR THE PERFORMANCE OF THE WORK FOR WHICM THIy PERMIT IS ISSUED.MY WORKERS'COMPENSATI4t31NSUFiANGE Gftf11ER ANO POUCY NU ER ARE: GONSTRUCTION y CARIiIER '���.�� t�NS'�.� " �''�: �� PLAN REVIEW ..� .....— � coucvNUMeEa N��-�J ��� ELECTRIC _.., . _ ¢ -7 0 tM�ssE��NEmnnraFccwn�.�oocn��m.ur�swaa�Fnn�oa[co�uaas�sim}aaGEss�. PLUMBCNG _`^ _ : I • 1 t% W t GERTIFY TNAL�!THE PERFOftMANCE�F THE i'tGRK FOft WHICH THIS PEflMFT IS ISSUcC,i MECHANIGAI. � (MS SHALLNOT FMPI,OV ANY PENSON INANY MANNER SOAS TO BECOME SUBJECT TOTHE uj WO%KEFS'COMPENSA7iUNLAW50FGALIFORNIA,ANDAGREE7HATIFISH4ULDBECOME INSPECTIONFEE , SUBJECT it7 THE NtORKEftS'COtiPENSATKNJ PR6Vi5iONS OF 9ECTIQN a74a OG iN'. . ' `""' �- � CO�E,I SHAI.L FORTHWiTH COMPLV WIT HOSE PROVISi(�5. ISSUANCE _„ , �,`'���� F � :,_„ � ` �� DATE:�..,,!����,_ APPLICANT: �,d-�1' SMIP _ . . W ENERGY PiC � WAflNitiG:FAKVRE TO SECURE Wt�RKERS'C PENSATION COVERAGE 3S t1NtAWFUt.AND SHA�8E —���-- W SUBJEGTAN EMPLOYER TU CqIMINAL PENAI 5 ANb CIVIL FINES UP TpONE HUNDRED THC7USANCI ENERGY PERMIT OOLLAFS(y1(p,cx10}.IN PDDITION TO THE COST OF COMPENSATION,DAMAGES AS PR4vIDED FOR IN — � J SECTION37680FiHEl.ABQRCt}DE.INTERESi,'ANDATT6RNEY'SFEES. RETENTIGIN FEE: - 4/ ��} � � GONSTRUGTION�ENDiNG AGENGY PRE-A�T FEE: „_„_,,,_ � INERE@�AFFIRMUNDERPENAL7YOFPERJURYTHATTHEREISACONSTNUCTIONIENDINGAGENCY d- FOR THE PEftFORRiANCE OF iNE W�RtC F6R WHICH iHiS PEARiiT IS tSSUED(Sf.C.3037.CN.G}. ' �' .—'� W . ...�.... � IENDEftS NAME_,. . _.... ...._ ... 1— I.ENDER'SAOOftLSS . ._.^_..... ._... /J � ICER?IFYTNATINAVEFEADTNISAPPUI:A�IONANDSTATETHATTHEABQVEINFORMATION15CORRECT TOTALFEES � { 'i`� j �yJ � IAfifiEETOCOMPIYW{TNAllCi7YANUCOVY7YORDINANCE5ANO5TATEtAWSRE�ATINC�TD8UCl0ib1G � � � � CONSTflUCTION,AND HEREBV AUTHORI$E REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE Z ABOvE�MENTIONEb pROPER7Y FClfi MSPECTK?N PUflPO5E5 �QMMENTS �`, " ..�1/i'"� ,�v�%� � _ �._. � PERMIfT NAMF�(PRINT� _ _„ (,()� ;% . 'r � . ..-.--,. � �. _. —.. . �- ' , � � 51GN EOFPEpMITTE��� �ATE RECPT.NO. PAIDBY ? L--� VALIDATION�.,..,_ ~ WHITE-6e artment Co YELLOW—Fnance Go PINK—Assessar Co GOLDEh1ROb—File Co GREEN—A IicanYs Co P PX PY, PY, PY. PP pY *�r a c '�' �`-� �' r��a� � .�� - . .. , ��.a . , ,,.�"��,�n�� �:a W � . . � „ , , �, . .'. , .:3 : ,. : ,'•' , ,�ro � . . .. ._ . . ,. i.. . . _. . . . � .. . '�, . . � .. , ... .. � , . , . . . ����� , _ . .. .. . . �.:. . ... . . .. . .... . ...... . ...... ._._.. . � r—� .... ,... � . i•'-�3-G�=-.:..�_�.��-.- � , ... � , �..���;,.. �� �. '�},�j,g-',,^' `6��.� _ �-- ; � � z. ` � ; re�`� � ��� ~m!�` � ._ _ . . �07�D..� t��� ��69'`�� JJ L�'���(�l�/ — /Y� � � � �� _ _ � _ _ _ _ _ �_'!�� � �..�e���' ��� s� `� . ._. .. . .. . . . .. _. ... .. ... .. . . . ... . .. . ...... ...... - - . s � a���t�°�:i�,N��' ' a �� h :� M � ��4� � � a'�,re��-x.;_ '� _ _ � �� ��hk'�� �5�� '� !� � .:. ._. .. . . _ . . . . . . .. . .... . . .. ... �_, � - � w� u �: . . � T � c . .. ... .._. ...... � ,� t 1' S+4 � . - . . . . .. ... . . .. .. . . ._.. 3� . ., � . . . .. k '� {a'�'" '$ S ���39[4fi C ...< . ..... . . _ . — i ' y o� .. .. .. .. . .. . .. . . �F ��' ��� i� � {�,ID. . ... . . . . . . +i < < . �� a: ' " :� � ¢n,l �➢ _''� � .. .. .. . .. . .. . _.. _.. . . .. _ . _. .. . .. . .. a , y £ . e � •, ° � I r' ..�« ..� p ... . . . .. . '�� _� � _ . , . , �_ 'i �tI �i..�� 'h��a�� t � ', ... ... ..._ __ ...._ _.. .... _,.. - �. ,r��1 l�, �, \ - � � � -- CITY OF DIAMOND BAR��� ' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Far(909)861-3117 BUILDING PERMIT APPLICATION �����1 � PRESS FIRMLY 0 0 W 0 W Z 0 m 0 0 w v Z W 0 U I--- 0 Z Z Q x w 0 U w Z w 0 J Z Q 0 w Z C7 0 D w J Q W d 0 2 a Z W cs z D J\ ��. F- APPLICATION �,I PERMIT'+"-P/C 1 ( DATE• � NUMBER� � �# ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM � Garage/Carport W Patio/Deck � PooVSpa C7 Re-Roof Z � Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U F- U W J W m f� � �,,� -� �Is J Q u z Q z u w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING� ��j I--�i M ECHANICAL INSPECTION FEE ISSUANCE�- '�-�'�-� �, .Y SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: -� ,�� PRE-ALT FEE: TOTAL FEES�(4�'1 � �� COMMENTS RECPT N0. PAID BY t L--VALIDATION�-�'", WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROb---File Copy,GREEN-Applicant's Copy . �r �1 � 1