Loading...
HomeMy WebLinkAbout11188 (5) �\ � CITY OF DiAMOND BAR �� E, COMMUNITY DEVELOPMENT DEPARTMENT � -,. 21660 E.Coplty Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ""' BUiLDING PERMIT APPLICATION FI R M LY o� JOBSITE S 1�l DATE'CATION / � C�� NUMB R///8� nlC ADDRESS ! � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP � OWNER O o ADD $S ZONING SETBACKS z CITY A,.+- l ZI � TEL. � —SD FRONT RW ❑ g APPUCANT ' rs3El. REAR ❑ � SIDFJSIDE STREET RW ❑ � CONTRACTOR 2 SIDE ❑ � ADDRESS � � �Tit� l T G��,� � CIN � Ci ZIP TEL 0o-�,¢sy� PROPOSED USE o ARCH/ENG/ z� DESIGNER NO.DWEL NO. NO. a ADDRESS � CITY ZIP ��„ . UNITS STORIES BEDROOMS � cr� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER�BI;ILpER OECIARATION _ - � $�q�qpDrtiEM O I HEREBY IIFFlRM UNpEfl PENALTY OF PEfWRY THAT I AM EXEMPT FROM THE CONiMCTORS L4 � G4lC�?!C8!COR W CENSELAWFORTHEFOLLOWMIOREASON(SE0.7o7/.5BV5R1E55ANDPROFES510NSO00EM7YGTYON (n � U COUNTYWM(SiREIXJIPESAPERMRTOCONSTRUCT,ALTER�7ROVE.DE�AOLl9(ORqEPIJRANV$TitUO W patiolDeck � NFE,PRIOR TO R�ISSUANCE,AL50 REWIRES TF7E MPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � SlATF1AEM 1H�T HE Oq SME 14 UCENSEO WASUM7T TO THE VRONStONS OF ME CONTMCTOq4 L4 LL LENSE UW(CHIIPTEX 9(GOMMENCMO VATH SECTqN 7000)OF DmSqN]OFME BVSME55 AND iFO� POOVSpa � fE5510NSCODE)ORiHATMEOR5HE15E%EF�PTTHEREFR01dAND7NEBASi3FORTHEAlLE6EDE%EMP- (' .V TpN.ANYVpUTqNOFSECTqN7071.S8YANYAPPLICAMFOq�DERMIT5U3)ECTSTXEAPPLIGINTTO ' Z Re-Roof � A CML PENA�7Y OF NOT I.qRE THAN FNE HUN�RED OOLURS(f50u)h 0 ❑1,11SONMEROFTHEVROPERTY,Of11AYEMPLOYEESYfiTHWI�GE5A5THE1RSOlEC0�7EN5AT10N, Q (�`pmmBfCldl Z WILL DO THE wOAK,AND iHE STRUCIURE IS NOT IMENDEO OR OFFEAED FOR SALE(SEG To��,BU54 J � NESS IN�PROFESS�ONS COOE:T11E Cp�1TR4CTOR5 L�CENSE UW DOES NOT AvvLV TO/ul ONMER OF � PROPERTY NTq BVRDS OR MVROVES TMEREOH,AND YMO DOES SUd1 YIDRK HIMSE�F OA HERSELF Oq � THFlOUGHMSORHEROwNEMPLOYEES,PROV10EDTMATSUCNn.1PROVEMENTSAiiENOTMTEN0E00q m W� OfFEftEDFONShLEIF./lpWEVER7MEBULD�NOORIMPROVEMENTIS" NATMINONEVEAROFCOMPLE 0 TpN,THE OWNEA BUiIDER WILL MAVE THE BURDEN Of PROVINO THAT HE OR SHE DiD NOT BURD Oq Z 0.1VROVE FOF 7HE RIRPOSE OF S/LLE� Q= OI+�OYMEROFTHEGROVERTY,WExCLU51YELYCOMMCTWOYNhiLICENSEDCON7MCTORS TO WNSTRUCT ME VRWECT(SEC.7041,9USiNESS ANO DqOFES510NS COOE TNE COHfMC70R5 LL V81UHtI0R ADJ.AREA W CENSEUWDOESNOTAPPLYTONiO'NNEflOF�PROVEATYY.'MOBUILDSORIMPflOVESTNEflEdi,AND � WNOCONTlUCTSiOR3UCF17RO1ECT5MATHACOMMCTOq(5)LICENSEDPURSUANTTOTHECONTMG pUANTITY DESCR1PT10N � FEE � 70RSL10ENSEUw1. p O I AM El(FA1v7 UNDER SEC. B.t V.G FOR TH�S REASON � � U t� ¢ DA7E OwNER V , O �¢ LICENSED CONTRACTORS DECLARAT�ON W CC IHEREBYAFFIRMUNDEqPENALTYOFPEM1NFYT1uTIAMLICENSEDUNDEHVRW�5lON90FCHAV7Eq p. 9(COAIIAENCRJONATHSECTION7oo0)OFDMSKM1�OFh1EBU5iNESSANOVROFE55qN5CODE.AND Z bi't� Ljr I X MY UCENSE�5 RI FUl FORCE AND EFiECT. m W � o ����5E�,55 �-3� ��.�. (� q 48 � V DATE�carrrv�cron a w � WORKERS'COMPENSATION DECURATION Q � � IHEREBVAFFlRMUNDERPfNALTYOfPEiUU5YONEOFTHEFOLLO'MNODEftMATqNS: Z � _�I/�VE ANO VIIIL MAMTAM A CERi1F�CATE OF CONSENT TO SELFJNSURE FOq WORKERS' T COMPENSATION,AS PROVIDEO BV SEC710N 97ooOF 7HE IABOR COOE,FOR THE VERPoRMANCE W Q `•OF TMIE WORK FOq WHICH iH14 PERu1T IS ISSUED. � /\I HAVE AND W14 MARlTAM WORKER5 COMPENS�TpN INSURANCE,A9 REWIqEG BV SECTqN Q T 3700 OF iHE UBOq COOE,FOq TME PERFORAIANCE OF THE WOFK NR NM1IICN T1i14 PERMR IS ISSUE�.MYWO KERS'COM7ENSATIONINSl/RANCECARRIER ICYNUAi ERARE CONSTRUCT7ON � ��q��, S�a�-�te� Ccwp �-rs ��,o� PLANREVIEVY 0 PoIICYNW4ER �'-t CQ^ _I�IO�7 EI.ECTAIC � � - . � g. � (11dq5EG'11JfINE�PlOTBEW�.PtEtEDOFTEeEi7AT6roHONEFIUL�REDDOLtM3lttOqORLE5.S1 P MBI Z 1 CEpTIiV THAT R11HE 7ERFORMMICE OFTHE WORK FOR WHIU1 THIS PERMIT IS ISSUE�,1 MECHANICAL � WOPo(ERSCOM ENS TK7NU�w40FC�L�FONNiEA�NO�GR ETH�iTE I�SIIO�ADBEC061E INSPECTIONF ��S� - - N � SUBJECTTOTtEWORKER5COAIPENSATqNPROV1510N50F5ECTqNl700pFTHELABOR ,J• � OODE,ISHALLFO�iTNWRMCOMPL�VA111iliO5EPFlON5�ON5. SUAN p OATE: APPLICAHT. SMIP �A�� � j � WAPN�NO:FA0.URETOSECUREWORKEASCOMDENSATqNCOVERAGEISUMAWFUI,ANDSHALLBE �ENERGYP/C �_ �SUBJECTANEMPLOYEfl70CRiMi!lkVENALTIESANOCMIF�NESUVTOONEMUNORED7HW5ANO ENERGYPERMIT DOLURS(Sloo.Dool.N�1 IDOIt10N 70 THE CAST OF CqAPENSATION,O�AGES AS PROVpED FOR IN ¢ SECTqNJ70lOFTHELpBOFCOOE,MTFREST,ANpATTOi7NEY'$FEFS. RETENT�ONFEE: � oCONSTAUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRAIUN�ERGENALTYOFPEfiNRYTHATTHEXEISACONSiRUCTIONLFNOINOAGENCY Z FORTHEPEflFORMANCE OF TNE WORN FOR NTIICHTHiS PERA/iT IS ISSVED(SE0.9Dt7,CIV.C.} , W � LENDER'S NAME � LENOERSADORE55 � W ICERTIFYTHATIHAVEPEADTH�511PPLICATIONANDSTATE7NATTIEABOVEINFORMATN)NISCOqRECT. TOTAL FEES �i ,� d 1 AGREE TO COMPIY N1TH ALL GTY AND COUNry OHOINANCES PND ST�TE U`NS REUTINO TO BURA�NO ✓ �� .� � CONSTRUCTION,hNDHFpEBYAUTHOHIZERE7qE5ENTA71VE50FT1iSCOUNTVTOEMFRUDON7HE Z �BOYE�MEMTqNEO PAOFERTY FOR iNSVECTqN FURPOSES. COMMENTS � ��t G����'e �e.nG�`�f S�h m PERII�TTEE NA/AE(FRt � �c;r,k..�-� 1���.oc�.. [��9,4� � y SIGNANRE OF VERMITTEE DATE �T— pECPT.N0. � PAID BY C�Ki VAUDA710N � WMITE—OeDertment Copy.YELLOW--F�ance Copy,PINK—AssessaCopy,GOLDEtJROD—Fite Copy,GREEN—AppliranYs Copy �� C7� T T T T � � � � o n � m � � � � � � � � � � � m � � ' m m ' z Z z z D m m m � m y x x o O o o � O n m r p r m Rl� ( � �� D D D D � m � `L � r � O C C G O O -{ � D O m L� -i , �_i ' � ���, r r r' r y � _I fn � r G) L� L� -n � T m v W C C� (n � � 'o C� � �I, � � 2 C� �p v c) 7J D � z � m 2 x S (� Z tn � '� � � � O n �/ mo � -i v� vmx0 � = � -1-f ;", fTl; C m D z '� r D � Z C = � r r m < � m m_,� p .o c� 3� T. D , Z. � n =� C/� f m/l i- Z Z � � C C rtl y rr1 D ���rt r G'I � . cz ' .� m 9z -� ...i , �c n � � ow � � � � z � � n m � � �' N f� , . ��� G� n � z � O � m Z 9 � �: r= z m� m �c -1 • . .m N . � � Z '� � � ' -qi � � � � m _ z o i z �i�' � � � t %i ' `4 � - ' I . �� f � � - . Mt '�iY� I . i _ .. F � � _ � � � �� m.o � n � � ;%� -i ° �, ma T -n �npDr -noO � vvT7� mv -nm � TTc c -n -n z m m m � � oozo �n �o z z = � _. _ .. ._ . __ _. .-- -- - -- - �--- � -- � m < D Z o T O O O C Z m Z � � m m � D D 3J Z Z Z ~ .__ _ . _ . — _ _ __ ._ _ .. _ _. _ _ _. . � _ 9 T -r-I O � -i f�i� � (� tn r r r = L� 2 � r W ,-=i � � 77 � m 9 Z � . � 'n rtl T T N rtl C) ff1 D -1 ?7 'rl fil 2 3] W O � D �- � .�• �O i' �' -G m v �° O D z -i m � z m � G� Z r O z m � � �.� p p m ; - v� -� z � vc� o - a � c> ozoo 3 Z � ' � • � 'm0 -n Z � � z � r � -�I p D � 2 � Co z � 'n O O � -,�-I • A � . - � D -i z � � � v� � � p Z o � L� m D m � O 7� � � � . . � D � � n L� � � � � � o Z � • v D . - - - r Ir1 � � .-� � � i� � c Z � - - � � ' - � ., � � . . . i . - _ , _ . 'I' ` . . ''. . - L : � �, � _ ' . � i , � _ - • /"