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HomeMy WebLinkAbout16228 (29) , __ . ... ---� ---_ . __ -- - . _ ._ _._ ...._ .- — _ - ; .- - � , • CITY OF DIAMOND BAR � J`� - DEPARTMENT OF COMMUNITY dt DEVELOPMENT SERVICES 21660 E.Copley Drivc Suite 190 (909)860.3195 Fax(909)861-3117 PRESS ������ BUQ.DING PERMIT APPLICATION C.� ' FIRMLY � JOBSITE �7 �1 I�n, APPLICATION �l PERMIT P/C Q o ADDRESS �7 /�,l _�N`f[JI U VI��,�T DATE ( �� v � NUMBER ��� X O_I�O U� � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP � OWNER �- . "' ADD S 20NING"SEfHACKS-. �� . ' ' � CITY IP TEL. FRONT . RW ❑ APPLICANT TEL REAR ❑ � SIDE/SIDE STFiEET RW O CONTRACT SIDE ❑ � CrOTMDRESS ZIP TEL PROPOSED USE"--' `.• �i i. :...��.� -- � ARCFUENG/ _ _ OESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDHOOMS � CITY ZIP TEL � DESCRIPTION SO.FT. F CTOR SF ADJ.AREANALUATION � Q OWNEF-BUILDER DECLARATION SFR/ADD/HEM ,� O I HEREBV AiFIRM UNDER PEWILTY Of PERIURY TNA71 AM E%fMPT FROM THE CONTMC70R5 L4 GaragefCarport _ � r �� 8 CENSEUWiORiHEFOl10WFM�REA.+ON(SEC.7o71.5BU51HE55MNPROFE5510N5C00[:ANYpTYOii (n � WUHT�MR6(]1REOUWESAVERMRTOCONSTRUCT.KTEiLWPROYE,DEA10U5H2ORHEDNRMlYSTRUG W paq 6Ck � � 7URE,CRIOR Tq RS ISSUMME,K50 REWIRES TME�PGLICANT fOR SUCH PERMIT TO fILE A SIGNED � ETATEMENT 7H�T HC OR SNE IS LICENSED PURSUANT TO THE FROVISIONS OF 7ME CONTfiACTORS U• � CENSE UW(CHAVTER i�COMMENqNO WITN SECiION 7000J OFDIVISION 1 OF THE BUSME55 AND PRO• � P�USpO _ iESS10NS000�ORiHATHEORSHEISEXEIAOTTHEREiRdAANOTHE8ASI5FORTNEILLLEGEDE%E4P• . (�J TqN.ANVNOLAT10HOfSFCT10N1W1.68VAHVAPGIM.�NTFORAVERUITSU&1ECTSTHEAPPLIClU1T70 Z Re-Rool � ACIV�VENKTY OF NOT MORE TV�N F'NE HUNDRED DOLLAi1S(l5001.)' . .. . . ' . � O►ASGYMEROFTHEiRO�ERTV,ORMYEYPLOYEESVAiHWAGESASTHEIRSOLECOMFENSATION, � (`,pmmBfCl81 - WBL p0 THE WOflK,MA THE SiRULTURE IS NOT INTENOED ON OFiERED FOF SALE(5EG 7oN,BU51• . J NES4 AlA PROFESSIONS CODE iHE CONTiUCTORS LICEHSE UW�OES NOT AF7LY TO AN OV/llEfl OF y iROPEFfiYMAIOBUlD50RMPROVESTHENEON,ANDMM1fODOE55Up1YqRKHIMSELFORHERSELFOq m �� � THROUGHHISORHEROwNEYPLOYEES,VROVIDEDTHATSUCHMPROVEIAENTSMENOTINTENDE00R /�� OFFEqmFORSALEIF.HOWEVE0.7F1EBUlDiNCiORIMPROVEUENTL450lDWRMNONEYEMOFCOMPLE- ��G' �' I O � TION,THE ONlNER�BUttDER WILL NAVE 7NE BUFOEN OF VROVIN�1MAT HE OR SME��NOT BUILD OR MPi10VE F011 TNE PURPOSE OF SALE} O 4 A3 OWNEH OF iME PFiOPERTv,AM EXCIUSNELY CONTMCTNO MrtRI LN:ENSED CONTMCTORS � TO CONSTAl1GT TME FRO.lEGT(SEG 7DM,BUSMESS ANO PROFESSIONS COOE:THE CONfMCTOi75 LF V8IU81IOfl ADJ.AREA CENSE Uw DOES NOTAPPLT TO�N OY.MER OF A PROPERTY Vrt1O BUILDS OR MPPOVES iMEREON.AND � NRqCOMMCTSfOfl5U01VHO.lECTSWIiHACONTFUCTOR(S�LICcNSEDiURSUANTTOME00f/TRAG pUANTITY DESCRIPTION � FEE . � TOq9 UCENSE UW.). , _ O IAM EXEII�TUtOER SEG B.t P.C.FORTHIS REASON � � � 1 {� `� � u" DATE OWNER ~ � U � . UCENSED CONTRACTORS DECIAAATION W .–` � IHEREBYAFFIHNUNDERPENALTVOfVERIURYTNATIAA1l�CENSEDUNDERPROVISI0N50iCHMTER Vi . � . S ��COUYENCtx31M7/15ECTIOM7ooa)OFOIVISION]OfTHEBU51NE5SAN�PFOfES510NSCODE,AND Z X ►/YLICENSE IS R1 fULL FORCEANO EFiEGi. m I 11J � � LICENSE CLAS LIC.N0. J � �.+� �'j DATE CONTRACTOR r I� a W � ' WORKERS'COMPENSATION DECLAFlATION U S� � � 1 HERE AFFlRM UNDER iENALTY OF VER7URY ONE OFTME fOLlOWR76 DECLAMTqNS: � Z Q �N4VEANDWILLWPITN"IACERTIFICATEOFCONSEMTOSELF•INSUREFORWORNERS' S � Z CdIPEN9xT1ON,A5pROVIDE08Y5ECT10N77000FTMEUDORCODE.FOR7HEPERFORMMICE U � Q OFiHfM�ORKFORN111CFITFIISPERMITI4155UE�. � �I 0 �I NAYE AND MY�LL MNNTAIN WORKERS'LO�APENSATqN�NSUiIANCE,AS flEOU�REO BY SECTION 4 7)OOOFTMELABOFi000EFORTNEPERWFAUNCEOFTHEWORKFOHN+IICNTNISPEHMITIS �� O��• I � ���_�O � ISSUE�.Wy� ERS' PE i SUR CARRIENA Ol 8[ :E:/�� CONSTRUCTION � � �� �.i/ PLAN REVIEYV CFAPoER,_� � ���f ELECTRIC }/ � 0 BE ocn�vEwRrs�ur+a+e�a�.noa�asa��ta+�ssi PLUMBING Z ICERT7FYTHATMTNEPERFOP4ANCEOFTNEWORKFORWHid1THISPERA71TI5155UED,1 MECHANICAL (,�' SHALLNOTFMPLOYANYVERSONN/NYMANNERSOA5T08ECOMESUBIECTTOTHE - � MqRKERS'COAIPENSATIONUN'SOF�IFORNIqAND110HEETH�TIF15NWLDBECOME INSPECTIONFEE: . S SUB.IECTTOTHEY�IO�iKERS'COMPENSATqNPROV�SiONSOFSECTION]�ooOFTNEIABOR ISSUANCE �O�O � COOE,1 SMALL FOqTHVATN CONPLY SE PROVISioNS. � -22� .P��:''�'°�L-_r� Nom� SM�P � p DA7E � WMNIN�:fA1LURETOSECUREWORKERSCOMPENSATqNCOVERAGE�SUNUWFUI.ANOSHALLBE ENERGYP/C � SUBJECTANEMPLOYERTOCRIMWALPENALTIESM/OCMLFNESUPTOONEMUNOH[DiNOUSANO ENERGYPERMIT pOl1AR5(itao,000�,INADDITIONTOTHECOSTOFLOAIPENSATION,0AAu0E5/.;PROVIDEOFORW . � ¢ SECTIDN]70lOFMELABOHCOOE.N7EREST,NIOAT70RNE�fSFEES. RETENTIONFEE: d CONSTRUCTION LENDING AGENCY pRE•ALT FEE: � O � � INEREBYI1iFIRMUNDERVENAINOFPERIUflYTNATTHEREISACONSTRUCTIOHLENDWOAGENCY FORTMEPERGORM IGEO//F��TM^EyWO�RKFORW11tp17M15VERMITI5,155VED�SEC.3oY�.CIV.C.j. � � ����L! �i— � 1 � IEND[R'SN/wE � � IENDER'SIIDOR[SS . /' � w ICERTIFYTHATIHAVEREADT/1SMFLICA7IONANOSTATETUTTMEABOVENFO{LAATIONISCORRECL TOTAL FEES � S�� � IAOREETOGOIACLVYRTHN.LCfTY/WOCOVHTVORDWANCESANDSTATEUWSREUT�N6TO0URDINC 1 COHSTRUCTION,N1D MENEBY AUi1101V2E REPRESENTA7IYE5 OF TWS CWNTY 70 ENiER UPON iHE � ABOVEJAEnTIDNEOVROFERTYFORMSPEGiqNPURPO5E5. COMMENTS 0 � m PERMRTEE NNAE(PPINT) v�i c.�.R� Z?-2-0 y SIG NE OF DERI�ITi OATE � RECPT.NO. PAIO BY VALIOATION WHITE—Uepartment Copy,YELLOW--Finenee Copy.PINK—Assessor Copy.GOLDENRO�FIte Copy,GREEN—AppliCani'b Copy � . . , .y. .....�.. . , . � . .. .. , . �- � -� ,. -�. . , . . .. . . . � - CITY OF DIAM�f�D BAR ., - . _-� � ..._. . s .-1tvSPEC i ION RECORD , _ . � - - � � �:� . � �- � � . � : ; _.. , . ._ .r . . _. , _ _ . _ � . . .� -.� � o� ,jg � � '' � s 1� " �a _ e , ���E- .����^��,�'f..�_:. __ _. .., �_ . . _ . _ ,�.��.. L..��, ;sEr.aacK�, : ., ; , _ ;� , � ;, ; , , FLOORJOI�T;-;�,,, �.�,�'��� �� � , ;�� ,: ; � :. i FTGS/FORM5/STEEL - � � _ '', -' � ' ---'-` - FHA REbM S •• . ,. � •_. ... .. _ _ __:_ ; : �ELECTRIC'GROUND _..._ '� -�'� _-__ _ _ UNDER FLOOR.D�i�rr '�,� _ , `��� ��,�. - � _ �GROUND PLUMBING Z7�al UNDER FLOOR Cf� tD 17�'s`��'.;�;� ��� " '- - - .'i�t � SLAB GRADE- � � ` _ � _. �.. I ,. 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