HomeMy WebLinkAbout12793 (13) 1� CITY OF DIAMOND BAR �,
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES -�
T� 21660 E.Copley Drive Suite 190
(909)860-3195 Faz(909)861-3117 PRESS
'�'_ BUII.DIl�1G PERMIT APPLICATION � FIRMLY
JOBSITE � /� 1 . t APPLICATION PERMfT)77 P/C �
o A�DRESS �-dS�� E (_�Y\�u VCf'• � �'`�AI^�� DATE NUMBE��"�� N � �
� � APN ,( �'}Z OT • ISSUE TYPE OCC
� TRACT DATE CONST. GROUP
g OWNER
�` AOD S r- ZONING SEfBACKS
"' CI ZIP a TEL , � FRONT RW ❑
� AP ICANT f i rb��'T1.en.w t TEL���� REAR ❑
� SIDE/SIDE STREET RW O
CONTAACTO�i �+~ ti SIDE ,p
o ADDRESS • 4 I E�QO N _ .
cmr LA,�ccti�6 µ Z�p /4 1��TELGZC-9Ll-8 PROPOSEDUSE '
� nRcwEac� /�
� DESIGNER._�/`I/�'►E �3 713or,G�"/ NO.DWEL ' NO. NO.
ADDRESS UNITS STORIES BEDflOOMS
�v' CITY ZIP TEL
DESC TION SQ FL FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDERDECLAfiATION SF AD M
O
p I NERFBY AFGWM LNDER GENALTY OF�ERAJRY TNAT 1 MI EXEYPT GiYJY TNE CONTRACTORS L4 Garapa�Carport � � � �
LLl CEN9EUWFONT1�EfOl1dNWORFA50H(SEG7W1.6BUSWESSANDFRDFESSION9CODEANYdTYOR (n
COUNTYNI/K?IREOWiEBAVEAMRTOLON57RUCT,/�L7ERAiPROYEDEAl0U5M.ORREPNRAHYSTRUG W Pata/Dedc
TUxE VRqfi i0Ii4 IS9UANCE ALSO REOUWES TME A07LIGNi FOR SUC11 PER4IT TO FllE A 51GNE0 W
6iATEMENT T/4AT HE Ofl&1E IS LICENSm WiWANi TO iNE PROYISIONS OF iME CONTiiACTORS LL
S CENSE UW(�hR�(COMMF�M10 WIM SECiION 7000)D�OIVl510N 7 OF iHE BUSINEu M7O PRD- ' � POO�$�d ' ' - ' .
}; FES9qNSOCOE10qi1/ATNEOi1N1E15E%EUPTiMFREFHOMANDiMEBASISFORTHEKLfGFDEXEMP•
L T10N.ANVV10lAT10NOiSECT10NIo71.6BYMIYAPPIMJ�NTiORAVERANT5UBIEGTSTHEAPPIICM(TTO Z �.Rpp(
� AGVILiENALi110FNOTMOiiE1MM/flVE/UNDREDDOLUR5�i5ao�.X
� �I��EROFiHEPROGEHTY.OR11YEUPlDYFESNnTHWAGE5/STHEiRSOLECOUPENSATtlN. ❑ �mefGal ' '
�wt Do rr�waK�r+o n+E siauctu��s raot wr�oco oa oc�cAcn�oa suE(scc�oa�,sus�- J
N NESS/Y�VROFESSIOHSCOOETNEGON�RAC�ORSLICENSEUWDOESNOiMVIYTOINOWNEROF � .
VHOPEATf WNO BUlA40R Y7f10VE57HEREON.Atm YINODOES SUC/i Y.GW(HIGSELf OH HE0.5ELF Ofi
[L TWIOUGHWSOItNERONMEYALOYEES,PROYDEOTiNTSUCHWPROVEMENTSARENOTNTEN�FDOR m
� OFFSimFDRBMLEFMDYIEYERTHEBtRDIN60RYPfqVEYBfiI55ClDWrt19NONEYEMOFCOYPLE- __ . _ _ . '. _'. _ ..
TION.THE OWNERBUIIDER YALL HAVE 7}IE BURDFN OF PROVWO T1iAT ME Ql SHE DID NOi BWID OFi
MP(qVE FOR TM�PUi1Po5F OF SAtFI
� O1A401NtEHOfT11EGROPEATY,MIEXCLUSNELYCOt(iRACiWOVrtiHUCENSEDCOtlTRACTOFS� � � .
TO COHSTRUCT THE ifp1ECT(SEG 70N.BUSWESSFND PRDFESSi0N5 CODE:THE CONTRACTORS lF V]IW(i0f1 ADJ.AREA
CFJISE Uw DOES NOTMPIY TOIN ONMER OF APNOPERTY NMO BULDS OR wVROVES THfREd{ANO
YlF1000HTMCTBFOHSUGIPAQIECiSW1iHA00HTMCTOH(S�LIGFNSmWRSUANtTOiHECONTiiAG pUANTITY DESGRIPTION, FEE
� TOR9l1CQISE IAW.}
OIAYE%EWTIlOEHSEQ &iP.C.FIXiTFY5HEA50N a �
� V
LL. ¢
wrE own� V
� UCENSED CONTRACTORS DECLARATION w
� IHEREBYAFFIRYUNOERPENALTYOFiENAlHY7NATIAMLILENSEDUNOERPROVI5qN50FCHAViER Z N S �
(= O(COAM�FNCYVOM7T115ECTfON700olOFDMSqN]OFTME&15�NESSANDFROFESSqNSCOOE,ANO
x MY UGENSE IS N Ml FORCEAt�U EFFECL OG✓•L�
ua m
� �«� f3 �.No.�— 53Yol� �
�
�'j wtE /Z-!!- 4 8 corrra�cToa R�wA2v itt�r i LCl//� a / �
� Gv�� G v
WORKERS'COMPENSATION OECLARATION �'- 4
= U
� ��wr�cuwuoEnrEn,�npvveaumroneovmerouowwaoea�w�raa z
cn Q
� Y�5 IHAVEANDWILLIAMiTAWACER7IFIGTEOFCONSEMTO6ELF�NSUREFOHYAN(ERS' _
COMVENSATqN.AS iROVIDED BY SEC710N 7700 OF TME LABOf1 GODE FOH TME PERFORMI�NCE W
OF TME WORK FOR NRUpI iHl.S PERWT IS ISSUED. �
G
7c� i waeu+o wui►wNr�w w�oaucas muvEµsnrnr+wsu�w+ce.tis nEauweo er seaaN b.
Q �7000FTMEL�BORGOOEFORiHEGERFONAANCEGF7MEWOfu(FOflNMICHiHLSPERMITIS �
�55UEp.1,lyy�qHKEqS'CriVEN5AT10NW5lJRANGEU�FiFiIEHMIDPIXILYNUMBFRARE CONSTRUCT�ON
jclw�uEfl $r � �N.n.O PlA
� POLIGY!lwaEN I36 Il C�/ "�H n �� ELECT
d (fliSSECf1oNrFIDt�qieEaf�41ETEDCfitEPEAArswRaNE�uLT��aRLF55) PLUMB�N
� � �
Z 1 CERTIFYTHAT NTME PERFORNANGE OF iNE riOiiK FOR WruCFI TMIS DEiWR IS ISSUED,I NIC �
(� SNKL NOT EYDLOY ANV VE0.50N N ANY YAMIER 50 AS TO BECAAIE SU61ECi TO TME
� 1MORKERS'COMPENSAiqNUw50FCAUFORn�I���ETHATIF151qUlDBECOME INSPECTIONFEE C�'�`��B
SUBJEGT TO THE WOMERS C01.IPENSATqN PROV15qN5 OF SECTqN 7700 OF THE LABOR O
s WOE.I6MALLFOHiMMAMCOAIPLYWITHTMOSEDROVI510NS. S ANCE BTTT7 Te �� .a .
IIZL� .u
p. �� /t`I!-Q8 ��T:/Z,CNA�'L� G- M?L2C///f MIP
W ENEFGY P/C �
WAANIN2 FAILURE TO SEWRE YARKERS COAIVEN5AT10N COYERAGE IS UNUwFUI.AN�SMKL BE �7
� SUBIECTANEUPLOYENTOCR1A1wALGENKTIESANOCNILFWESU�TOOHEHIN�DREDTHWSANO NER6YPERMR � /.Q �
DOLLMS(i100.000).W A�DITION TO iHE COS70F COMPEllSATqN.ONAAGFS AS PHOVIOED FON W
� SECTION370lOFiHELABORGODE,MTEREST,ANOATfORNETSFEES E NFEE: �I � � .
nw. CONSTRUCTION LENDING AGENCY PHE-ALT FEE
� 1 NEflEBYAFfliiM UNOER PENAITY OF iERIURY T1NT iHERE IS A CONSTRUGTiON IFNDwC AGENCY
FOFi iHE PERFORNANGE OF IYfE WORK FOR,pWMiGN TMIS FERWT IS ISSUED(SEG.i0i7,pY.G�.
W N I/9 N i' UwNG�
� LFNDEiYSNAME
� LENDER'SPDDFESS
� ICERitFYTHATIMAVEREADTYSMPLICA1qNANDSTATETUTTHEIBOYEWFOFIAAT10N4500RRECt TOTAL FEES I/ ,
� IAOREETOCOMRYM7TMALLUiYANDCOIMTYORDUU110E5ANDST�TEUWSRFUTIN0T0&1tlDIN0 />O
� CoftSTRUCTION.MIDHEREBYAUY/10iUZEREVRESENTATfYESOFTWSCOUN7YTOFN7EflUPON7NE 7 0
Z ABOVE#1£Mq1/EDVROPERiVFORwS�ECTIONDUR�OSES. CqMMENTS
9 /Z�cy�2� G-A7�1L2Gi��
� m P-E�RW�iT�EE1NA�N�E(P�WIln �,��J�
Cn /w/wl�.S r'�� /YY1'Lvit/1�.UC� l Z'���'qs
� � SqfNiUNEOFPERMITTE -'' , WTF
� RECPT.N0. _PAID BY VAUDATION
WFUTE—Depertment Copy.YELLOW—Finance Copy.PINK—Assessa Copy.GOIDENROD—File Gopy,GREEN—Appiican['s Copy �
,
... `l� _ ... . ....._._._V_..____-- -
� r,
. — — — _ _ . - . .._ _ . _ _ _. — - --�-
� - - �:: '
�- � - _ t,
� �
� � `� , 7
t,� ��<� 11 � - _ v =� �
,.. ti � 1 7 i�� �"�� ' /
n;-
� �
� �l _ �' S^ •�� i �
� ' r ' :, � s ' `= � � �
, ` 1 `_ i 3 �
,
. � '� zo � i � �, „f
� � ; � �.�,+�. ' ,., � � � � � i ;
4 ❑ • `,� � oznw � � � � .� z i ;
m 'p � �'�`�amutmc� ozQz vi � z " � � r�,: `
� f- cn O ` z m � Z a o � � a �^ u7 a Z u- a na. . 1�; i'. � -
� �V tb F- - ¢ UU � � � w
o �'lu oozoc� � ¢ — oc� �- � z � v, ��1: -
Z .w '_: . a � .� � � Qwzz W — ¢ — ao w -. _
-, � p � u. Q m O ¢ 2 � � w _ t- z U w � w
. Q .� '- LLl •- � CA Q — 2 W ti LL F- Q W N T W � �^ �. , �
. CL � W W� d = C� J CS U CJ y J J J UJ U ¢ 0 F— -1 � J � [[ ' ' __ ' " ' '_ _ '
� ,Z � Qp pwwo awZ � � 000u. a Z � a W ¢ > w '�
4 ,p � = z z ¢ ccT �iz ¢ wozooaLLwZQ zZ � w wz , _ -- - -
Q , LL'- LL � � LL LL C W LL 0. CO CL lL 2 � 0.. O O lL _! O LL lL 2 � W — i..;'` - _ -
}�' ^
� V (� /I i
• O W j / . {
��\ `� � I ` ' '�,t �.
. V � I� � _� ' ,l ' � 1 � _
- � � �' '' � / . rr i 1.: .
V''. � � - - . .
.. . � � "�� `n �.� ,1 •1�. O� (' , �,
, ' t. �
�J
- [i -
� , ' j '� I �
� - �� . Z � ` . -
. ; ' O � Z �, _ . _ W
� � '! r ~ O ' ' � N'W
. � w z Z '� � _ U Z w C7 Z F- Z � ' C7 � rA�N
� � O � ; ' U Z � ' z ¢ m ~ z � � J � � � Q 2 � � ' Y'�
. � � [L � W ¢ > 1-=- Z � h U � m � � Q. .Y J � F= Z � [fl f"' Z= '.-
� � a o w.� Q w w ¢ w > > cn � � z ,z J w � i=- v � ' Z � ; Q.�
Y..cr � a3wu.�Z > wJJt � z � ¢ rzqw � - w , �t—H
o ¢ o �nxC7oxwa � scn � r- � owJ J �,. � '� '.., U'n.
cr � aQcnzc� 2 � xW ~ ? Z ¢ wc� °' ¢ � � � � � � f-a
�� � W pmg ~ p ¢ p > jaOgJJ F"' °- aa ¢ a � � " c �'W �
,� ¢ � w '� O [LOOOOS �t � � n: wcn _
a w ¢ w w w a z � � z ,= O w w
u� � w c� �nH � ¢ u. rc ¢ ¢ ¢ cnw � c� ov� v� wc� LLu. � u. U cncn