HomeMy WebLinkAbout15249 (19) . j f �,
- - - --- — - -- - --. .. �
_J� CITY OF DIAMOND BAR �
.. DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES
21660 8.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
�'�^'� BUII.DING PERMTI'APPLICATION FIRMLY
o'� JOBSITE �/ APPUCATION (��(J PERMIT P/C
ADDHESS�35 �A� f} T�.= !/T-s DR� DATE � -�+ NUMBER_��X
$ ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
g OWNER -��—
"' ADDRESS ZONING SEZHACKS
� CITY 8<�- ZIP TEL !v �.-3 _ FRONT RW ❑
APPLICANT /TEL p�R �
� SIDElSIDESTREEf RW ❑
CONTRACTOR �I , SIDE p
� ADDF ST�S ` � J P OSED USE J _•
C� f.T�.,�..po ZIP TEL �7? �94. • . �
� ARCWENG/ � G.3-�Ia IN�����—f �r -����S' o v_.M•`�
DESIGNER {ryEL �NO. NO.
ADDRESS UNITS � - STORIES ' ' BEDROOMS
� CITY ZIP TEL
�
v� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR7ADD/HEM
O
p 1 HEHEBY AFFYtli UNDER VENALiY OF GE1ilURY THAT 1 AFI EXEYVT FROM iME CONTRACTO(LS LL GarogelCarport
W CEMSEUWFORiMEFOILOWwOREAaON(SEC.7W1.68USWFSSINOPiqFESSqNSCOOE:ANYqiYOp (n
y OOUNfY11R-0CFIREWIFESA7ERlAfit00]NSiiWCi,KTERW7flOVE.DEMOlISFLORREVAIRMIYSTRUG 11J
u� lURE,VRIOq TO Ii5 RSUANGE ALSO REOUWES iHE MPLIGNT FOR SUCH VERMIT TD FRE A SIGNED W PB�IdUeGk
STATEMEHi TVIAT HE Oq SME LS UCFNSED iU0.SUANT TO iHE GROVISWNS OF 1NE CONTRACTORS U-
� CEN7E UW(OIAP7FR�(COMMENCYIO YATH SECTqN 7000)OF DIVISqN i OF TME BU51NE55 AND iRO � POOUS�
FESSqNS WDEI OR MA1 ME OR SHE IS EXEYPTiHEREiROM MW THE 8ASI5 FOR iHE ALLFGED EXEMP-
TION.ANYVOLATIONOGSECT10N7W1.6BYFHVADOLICM/TGOiIADERNIT5UBIECTSTNEAVVLICAN7T0 Z Rg-(app�
� A qY¢7EtLLLiY OF NOT uOAE T11AN FIVE HIF+DFEO Oal1AR5(i5oo)):
� OL�trNNEROFiNEVROPEH7�;ORMYEY�L01EE5WIiHWAGESASTNEIR50lECOMPEN5AT10N, � �me�C13I �
YM100 iHE WORIC AND THf STRULTURE IS HOT WTENOED OR OFFERED FOR SILE(SEG)oa1,&15b J
N NE55 N/O FROFESSIONS CDDE TIIE OONTMLTORS LICENSE UW DOES NOT AVPLY TO AN OWNER OF ?
ViqVEHiY MR10 BuIDS Oft MPRDVESiMEREOK AND WNO DOES SUGf wORK YUMSELF OR MERSELF OR �
-� - � � iHf10U011w50AMEAOMMEYGIOYEES.OROW]EDTUTSUU1WDp�vEUENTSANEN0T1NiCN0E�OR. . Lfl . .. . ._. .- _. _ ._ ... .. _ .
Lj1 ,OFFEf1EDiORSKEF,IqVlEYERTHEBLLDYWOAYPROVEGBfTISSIXDM7TlaMONEYEAHOFCOMPLE- � . . .� . . . � _ �
Z �TIOrI.TME OYINER-BU4DER M7LL INVE TME BURDEN OF PROVYq TMAT ME Oq SME DID!qT BU4D OH
� �ADAOVEFOR7/1EWRPOSEOFSALE) - - -
W Ol�4GN�MERCFiHEPROPEHf7,M1IXCUTSNELYCONiRACiwOWfT11LICENSFACONiMCTOR4
� TO CONSTRUCT iME YNW EGT(SEG 7ow,BUS+NESS M1D iR0iE5910N4 WOE:TiE COt/TRACTOpS LL Valuation AQI.AREA
CFl/5E UW OOES NOTAiRY TOAN OWNER OFA PROPERTY WHO BULDS OR W PROVES TNEREON./WD
IMq001(iRACTiFOqSUCJIPRplECTSWItHACONiMCTOR(S)UCENSEDVURSUANTTOiNECONiRAG QUANTITY OESCRiPTION FEE
� Tqi4 UCfriSE UW.}
O 1 M1 E%EYGi UNDER SEG B.1�.G FOR TMIS REIi50N Q
U
W �
DATE oWNEA U
J
� LICENSED CONTRACTORS OECLARATION W
� IMEREBYAFFIRAIUNDERPENAl7YOFPENURYTHATIAMUCENSEDW+IDERiROY1510N50FG1APTFA Ur
� ���DMAIFNUNO WRN SECTqN 700010F OMS�ON]OF THE BUSMESS MID PROFESSqNS COGE M!D Z
`L W UCEH&E IS N FUIL FOHCE AND EFFECT. m
� uc�wss L°3 y uc.r+o.�L3 6�.�.�o �
�
v w� 7,�-�/�c«�rrw�cTo�
W
a� WORKERS'COMPENSATION DECLARATION /'
�
N IHEJiFBYPfFWMt�ERGENALiYOFPERlUMONEOfTHEFOIIOWWGD U
l� Q
� �INAVEANDYnLLMNN7AP7ACERTi�G7EOFCONSENiTObELi NSUREFOR S' S
� CONPENSATION,ASiROVIDE0BY5ECT1OND7000FTMELABOR E,FOHTHEPEflFO
OF T11E WpFiK FOq NM1YCH TMIS FERlIIT IS�SSUEG
G
� _�,IHAVEAtOVALLMAWUWWORKERS'OOMVENSATIDNINSUiLWCE,ASREWWFAHYSECTION �^ �
Q9700 OF iME IABON COOE.FOfl THE PEHFOWAANCE OF THE WORK FOF WHICH TNIS D 5 �/
� 155UEp.lAYWORKERS'WMPENSATIONWSUHMICECAR ERANDPOIIC NUM6 TION
� �y�q � R��
� ca�cYriumeen 7-� , � CTRIC
o (n�ssccna+�IDrrneeoaar�rman�r�.+nawnor� oaUrsB+ao� LUMBiN
w
Z ICERi1FYTM1NiMEPERFORMN�CEOF(MEM�ORKFORWH1qt 'SDERAIITISISSUED,1 � HANICAL
(.�} SNALL N0T EMROY MIV YERSON W ANY Mu1NER SOAS TO BECOME
y WORKERS'CdADfNSA7GNUw50FCLLiFORN�A/wOAGHEETN�i1FISHOIIL�BEC0IAE INSPECTIONFEE
S SUB.7ECTTOTMEIMDRKEiIs'COMPENSA7qNPROV�S�ONSOFSEGT10N�7o00FTMElABOR �
000�,isrwiFoan+wm�w�+Rrvnn+rrasevaa�s s. ,� ISSUANCE
� Q �� v SMIP �
p pATE: APPLICANT. _� .
WARruH6: AILU TOSEWREWOfYtEliS'COMCENSATialfAVEMGEISUWAwFUI,AND6wLLl8E ENERGYP/C
LL SlR1ECTANEMPLOYERTOCRWWALPENKTIESANUCMlFP1E5UVTOONE1Nx1DREDTMWSIWD �fERGYPERMIT O
DOl1AFi5(1100,000).W ADOITqN TOTHE COST OG C04oEN5AT10N,DAYAGES K GRONmE�FOH W (��
J SEGTqNi70eOFiHELABOHCODE.MrTEREST,/�NDAiiOfWEY'SFEES RE7ENi�QNFEE: `r �t�
aW., CANSTRUCTIONLENDINGAGENCY PRE•ALTFEE ���
� IHEREBVAFFlNIAUNDERPENKTYOF�E0.A1HYtHATTNEREISACONSTHUCT10NlENDwOAGENCY
aZ- fORT1EPEifFORMMICE�FTHEWOW(FORWHN'MTM�SPERAUTISISSUEO(SEG7oGl.GV.G). .
W
� IEN�ER51u1AE
�W IENOER'SADDRE55 // ,
ICERT6YTHA7INAVERE/�MISADPl1GT10NAND5TATfTMATTHE�80YENfORAAAT10NI5WRHECT. TOTAL FEES
� IA6REE7000MttYWITHAILCT'ANOCOUNTYORDINANCESANDSTATFIAwSREIATWGTOBUlDINO .
CONSTWICTION,ANDNEREB�AUTMOFYZEREGRESENTATIVESOfTH15COUNTYTOENTERUPONTHE - �
� IBOV61AEN7qNED DRODERTY FOR WSPEGTqN PURPOSES. COMMENTS
C y� ^ A �
� 1� /T l�W N��'��
m PERMI7T E(OR�lin �
� ��-. /° CdL __7l y/:.-��
� S�Ch�UkE6FPERMIT7EE DATE
� RECP7 N0. PAIDBY VALIDATION
WMITE-Depanment Copy.YELLOW-fnance Copy.PINK-Asaessor Copy.G LDENROD--File Copy.GREEN-ApplicanYs Copy
I � � , I j � I.�._�-- I �
_ _ _ _ ► f ;- �
. : �� � - � � ' � ' ' �
� ' ���' - i -� � � ' i � �
i` ;��! i � I I � � . �
� ',• � f .
;- I �
� - _ , -- - -
,��� - �
� �, f ,
� � _ � �
�' ._ � ; - -
� � � �
� o � .
i : �_
OC 1' ' � z am � '. .- J ;''
Q � �'- � � � � o ¢ ' � c� � � ?
m CL F�, o c� 7zmaw z � c� ¢ aLL o c:: '
� �h�= u� oo � m ❑ wmc� oo � z d �n ¢ vi � z � z �
❑ U �tf�i�n � o o wwzn o ? � a � � � gz � a ? � d u. z,k -
. � � i�'i O � J J V V O � Z ❑ C7 ¢ W Z a O C7 d � Z H W �n ��.''� �
� O � i� Q LL LL "Q �d m p m Q z �. C.7 J W z W F- Z U ul p w � W �' n C ' .
�:�, W J J 2 W LL LL F" Q W N � �
� '� � CL W W d a = m J C.7 V C7 = _1 J J CA C� � � F- .� � � :�' ' . _ _ .
Q z ��0 C O O w W � �' LLJ Z � � O O O lL O Q � � 4 W q > W °T - . � . _
O !J Z Z Z � ¢ � Z Q W O Z O O U LL W Z Z Z CL W W Z ��
Q LL LL � � LL. LL TC [0 !L d CO Q LL 6. Q. n. O ❑ lL � O LL LL 2 � W - .
LL V _ --
_ O W
>- a' �' ' -
~ � ` , _
U — - -
� _ -
�
- '� � � -� :, .;.
_ � ' � (
�. , � r t
{, . - 'o � . .,��.���r.
J � z ' "� � F O W �� �
. .. �.�tl W 2 (7 J U f/l Z U' N� -" _ �' ' - �
H � m . W Z (7 Z Itl �' F- f
_'�''! c�l O • • U F- Z � m t- Z � 'Q J �� C7 V � � �N '} �. !��� �;
- - '�I � Q � W ¢ j F Z CL F- U � d � q � T Y ~ F= Z q m F- Y N �
� C7 -� p � CL Q W L! Q LLI � � (n J � � 2 J � � F- U � ' z `� �' ► r.� : +.� ,.i,�,:
i�Y � U a ¢ ?r w w Z.> w J J C � ¢ � w Z ¢
p ¢ O (n 2 C'3 O S W CL CC F � - J I- 1-� ~ p L]J J J W I'-F_ f
� Q � CC Z � n, � f l! Z U S 2 2 � Q ? Z 4 ¢ U o. � U 2 t t l G � U d -y y'.. �
� � m � p„ W LL LL U` (.7 C7 -+ W � a Q J J J J � -
_ ' ''� -
- z
C�ia � J ¢ J 1L ¢ O � O O O O O -+ "a S-' 3 a W v� C Q <C < ' '- W W ,
� Q W Q W liJ W Q�2 L Z O ,
':. U1 � W C7 (!� F- �i K LL CC CL CC CL (1� W ? U O !n cn U) C7 lL LL tL�1`I U . . VJ(n �f ,^ "
`._ _. _ _. .. . _ . . ___. _ _'_ _. . _ _. _. _ _ . . _ .. . �._. - '_"'._.. _ . . .�_. -'- _ _ _.