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HomeMy WebLinkAbout17859 (19) ---. -- _-__-- .--_ _ _ _ _ _ _ �sr�r� ) CITY OF DIAMOND BAR '3-� '�� ---J� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Coplcy Drive Suiu 190 � (909)864-3195Fax(909)861-3117 `�� ��-J. _�`�1 PRESS n`'^�'�� BUII.DING PERMIT APPLICATION ...� 1 �� FIRMLY N JOBSITE ��� �� � ' t APPUC ON � ` � PERMIT P/C� o ADDRESS �I� �h ot GA.' DATE NUMBER N ��I � APN OT � TRACT_��a6 ISSUE - 7� TYPE ` , OCC 7 OATE " �V� CONST. GROUP � OWNER LL ADDRESS D 20NING SETHACKS - w FRONT -..- �- , '�. RW ❑ � CITY�jQljf�lQ ZIP TELyj�_�J"�('YQ"") REAR . ❑ APPUCANT S� TEL SIDFJSIDE STREET RW D a� CONTRACTOR S�M� SIDE p g C�ESS ZIP TEL PROPOSED USE �NS>�IZ ,, � ARCFVENG/ . �. . _ , , DESIGNER NO.DWE4. '"� NO. '�.',`� NO. ADDRESS UNITS STORIES BEDROOMS � CI7Y ZIP EL. — 7 N rn DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION OOWNER-BUILDERDECLAHATION SFR/ADD/REM 3t{ 139.Z0 W CENSEUWFOH�FTHE�FOLLOW�NOREASONfSEC.70.1 68lYIHE5SN1�vROFE�lONSCOD:E A�M'dTYSOP � Garage/Carport �9 OJ��.L� � COUNf'fNRfCHRE0URE3APEH4RTOCDNSTRUCi.ALTERIMPROVE.DEAlOUSM.OfiREPAIRANYSTAUC• W Pet(O/D9Gk IURE,VRqR TO R4154U�A10E,ALSO REWIRE9 iHf AVPIICAN7 fOR SUCH PERA/lT TO FlLE A SIGNEO W 6TAtFA1ENT THAT HE OR Sr1E IS LIGENSED PUR4U�Ni TO iF1E iROM310N3 OF THE CONTMCTORS LF � CENSEUW(QiAPTFRYICOMA1ENqHUN77HSECTI0N700010FDIVIS�ON�06THEBUSINE55ANDiRO� V" POOVSpa _ � iES510N6CO0E)ORT/NTHfOR5HE15E1(EMPTiNENEFROAI/.NDTME8A515FORiHEALLEOEDEXEMP- C7 iqN.ANYVqUiIONOFSEGTION1N1.6BYANVAVPUGNiFORAGERMITSU&IEC15i11EMPUGNtfTO Z Re•Root �„_, A qVLL 7E1a/LTV OF NOT YORE TUN FM1rE Hl1NDRE0 DOLUAS(f5ool.k � . . � 04�SOWNEROFTHEFiiOPER7V,ORMVEMPLO�EESWITHWAGESASTHEIRSOIECW.iPENSATION, � COf11rtIBfCl21 � ' . � Y/ILL 00 TME WORK.AN�iHE STRUCTUfiE IS NOT INtENOED Ofi OFFERF�FOR SALE(SEG 70a1,BU51• J � NE59/WD DqOFESSION4 CODE:iHE�RACTORS LICENSE UW DOES NOTAPPLY TO/JI OWNEN OF L VROPEHTYWHOBULDSORMPROVESTNEFEON,ANOWNODOESSUCNWORKHIMSEIFORHERSE�FOR � ` v � � �O HO (� 7}WOIJOfIMISORHEROYMEMiLD1'EES.V1qVIDE➢iHAT5UQIMPROVEMENT511RENOTINTENDE00R m 0 OFFERmPORSALE�F,MOWEVE0.7MEBUldN00RIMPROVEA1BfTIS50lDNrtfMNONEYEMOF�MPLE- Z 710N.TNE OMT�ER�BUIIDER WILL FMVE THE BVf�EN OF pROVWO THAT HE OR 6HE DW NOT BUtID OFt _ PAPROVEiORT1�EPUHPOSEOFSALE). � N, aol 19 356.30 W D�ASOVMEROFTHEVi10PEKfY,M�EXCLUSNEIYCOMMCTIN6WRHUCENSmGONTRACT0R5 Q TOCONSTRUGTTFIEiROJECT(SEG7DMBUSINESSANDYROFESSiON500DE:TMEtONTRACTOR3lF V81U8Ii0f1 • AQI.AREA lil CHJSELAWDOESNOTMPLYTOANOWNEROFAPNOPERTYWh10BUlDSOHIMPRDYE87MEREON.AND • � WIqCONTMCf3FOHSUpIPROJECTSWITIACONTMCTOR�S�LICENSEDPURSUMfTTOTHECONTMC` OUAKTITY DESCR�PTION FEE � TO/iSUCEHSEUw.j. O I AM EJ(EIAPT UNDER SER B.6 P.Q iOR TMIS REASON ¢ U � LL" DATE OWNER � � . . � U IICENSED CONTRACTORS OECLARATION w � � IHEREBYAFFUIYUNDERPENALTVOFOERJUNYTHATIAMLICENSEDUNDERDROVISIONSOFCHAPTER V. , „ S �(COMYEHCRIOMATMSECTIDN)oao)OiDM510NJOFTHEBUSME55�NDPROFE55iON5COD[,AND Z �� �y W UCENSE IS W FULL FORCEANO EFiECL � � LICENSE CUSS_� LIC.NO. � �. � � , �' V w�� 9�LQ1 corrtancroR a w WORKERS'COMPENSATION DECL0.FiATION Q � 1/HEq�EB AFFlRAI UNOER FENALTY OF PERn1a�ONE OF iHE FOLIOWINO OECU�UTqNS: Z ` � � G ��MA✓EANDNnLLAUIMNN�CEiRffIGTEOFCONSENTTOSEIF-INSURfFORWORNERS' _ ODMPENSATIDN,115PROViDfDBY5ECT10NI7o00FTMEUDORC00E,FORTHEFERFORA7ANCE U �� 7HE WORK FOH VAllpl TH�S PERMIT 141SSVED. � f ` � 1 1 HAVE ANO NnLL�IAMTNN WORKERS CpAOENSATqN INSUFANCE,AS REOUIRED BY SECTIDN Q J7o00fTNEUeORCOOE,FOitTMEFEFFORMANCEOFiHEWORKFOHWHIqiTNISPERM171S p � � ISSUED.MY ERSCOMVENSATqNWSURANCECARRIERANDGOLICYNUAIBER/WE: CONSTflUCT1ON 1859 46 � 2�07 6� �. CARNEH��'J� f� - PLAN REVIEW Q POLICY NUTABER w� �t 7� :{=n� ELECTRIC Z��•3 8 3 5 3•40 . :4 � fMssEcnor+u�raoreeca�FrmoanEcsro.rraa�a,E�r�noaursR�oo)a��ss� PLUMBING 9�.56 Z28.90 � � IGERTIiYT1UTIN7MEVERFORMANCEOFTHEYlOCVCFORKM1IidITHISPERIAITISI55UEO,1 MECHANICAL �S�OO �Z't�7O � ^MJINOT EMPLOYMfY CEHSON P!NM MANNER$OAS TO BECOME SUBJECT TO TH[ � WOPoCEPSCOMPENSA7qNUWSOFG1iFORNI�.ANDAGREET11ATIFI5no1A08ECOME INSPECTIONFEE SU&lEM TO THE VIONKERS'COMPENSATION VRONSIONS OF SECTqN 1700 OF TNE IABOR � COOE,ISHALLFORMWIiMCOMPLYWiTH SEiilOVI510N5. ISSUANCE �OO.OU � pDATE:��- APPIICANT:���j?�I� r SMIP p 42.64 �. � WARNiNa:FAlLUHE TO SECUPE WORKERS COMPENSATqN COVEf1AGE 15 UhUwFUL,AND SHALL BE ENERGY P/C �o�'� p c � � $U&IECfINEMPLOYERTOCRIMPIALPEWLLTiEStNDCMLFINESUPTOONEHUNORCDTMOl15AND ENERGYPERMIT ��O•7V � DOLLARS�5100.Ooo).N hDDIT10N TO THE CQST OF COM7ENSATqN,DAMAGES AS DROVIDE'J FOR IN � 8ECTION 770C Of TIE tABOfl COOE,NTENEST,AND AITORNEY'S FEES. RETENTION FEE' , a CONSTRUCTION LEND�NG AGENCY PRE-ALT FEE: O � IHEREBVAFFIRMUNDERiENAl7YOFPEIUURYTHATTHEfiLISACONSTRl1CTIONLENDWCAGENCY n- iOR iNE PERfORMANCE OF 7T1E WOP1C iOR WMIGI TIt15 YERM1 IS ISSUED(SEG.]oY7,C .G). ��" NoNF�i(�Q, �ho ../��ir-/.I� 2 469.34 IENDER'SNNAE � LENDER'SADORE55 � ICERTIFYTIUTIMAVEREADTHISAPPLICATIONANOSTA7ETNTTHEABOVERlFOiUA�T10N15CORRECT. TOTALFEES 3�256�00 � IAOREETOLqAPLYYATHALLCT'ANDGOUNTYORDINANCESANDSTATElAWSREUTWOTOBNLDiNO CONSTRUCTION,ANONERE9YAUT1qRIZEREP ESENTATIVESOFTM�SCOUMVTOENTERUPON7HE � ABOVE-IAENTqNEDPROPERT'FOHINSPEC7 warosEs. COMMEN7S � � m GERMRTEENAIAE(PRIt(T r � � �� 4 (A SiONATUa F YEfwITTEE O�TE � RECPT.NO. PAID BY VALIDATION �, WHITE—Department Copy,YELLOW—Finanee Copy,PINK—Assessar Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy . .r,:ina. ._. . . � .. . ,, . . „ . . , , - . , , .. . . . . � .. . . , . . � , _. CITY OF DIAMOND BAR , . il ' .. . . . ♦. ' . �� . . � _ , _ , ; . , 1tv",SP�C3'IOi� RECOPD � = � . - � '� . . 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ROOF C�VER � .__ _ _ BENCH��dG: . . _ -;, 'ROUGH E�ECTRIC _ 2;�- ' . - • _ 'ROUGH GRADING ^- _ ---- fROUGH PLUP�IBING :---� �Z '--• - •� - FiNISH GRADING ' - jSHOWER.,TUBTEST ' -- - - POQL�ELECTRIC i�XT.-!�',TH/51DING -- �� , , .,,�-- - POOL FENCING . - !WAtt INSUtATION ' �'� � ; �, POOL;FINAL ; ; ;CEILiNG ifdSULATiON j �? � �� � OFF SITE IMPS. . ',�7AYI�NALLNItILIi�G" __ , DEDICAThJNS 1�_ _d_Z_ . �SEV�ER _ • _ � FINAL'ErJG. I,SEPT�C TANK',- � � . ,�.ANDSCAPE/IARIG. � 'S�EP_PiTILL. . . . dN SiZE Il�1PS. ( ;Gk:�:'�IR TEST ! FINAL•ZONI"JG =---i - � - FIRE DEPT. FlNAL �FIiJAL�ONST._ _ _ U . . .. /�.. ,, F':^1F,L:-IEF,TI:�G _ _ -� .�_ .. �� - � �-IEALTH t�EPL FlNAL _ , --, . � ;:;;,'�.'L-L•ECTR{i.- � . _. D�V. FEES PAI�J - '."" PLUFffl�^!G .. . � _ ENERGY ` en _ �-�, . - 1 � � _ � _ ��—,-- _ ,�.�.,�...�t �„�....,�•j.�.---.-----� � � " ' __ ��_ �� _ ( ,/. � ���- � .,-1= 7s.; _;__ _. ., , . _ � v�'�t•.�-���1 i S • . 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