HomeMy WebLinkAbout10211 (5) ���' ��� ,!
CffY OF DIAMOND BAR %
COMMUN[TY DEVELOPMENT DEPARTMENT
2166oE.Copiey Drive Suite 190 �'' PRESS
(909)8643195 Fax(909)861-3117
�""'� BUILDINGPERMITAPPLICATION FIRMLY
� ��� /� APPUCATION '�I PERMIT //�1 P/C
o ADDRESS � / ° ' � ��' DATE / NUMBER v it
g ISSUE TYPE OCC
� APN LOT TRACT DATE CONST. GROUP
p OWNER � �'
u' ADDRESS ZONING SETBACKS
� CIN p 'E�, FRONT RW O
APPLICANT �, REAR ❑
� SIOE/SIDE STREET RW ❑
CONTRACTOR f ,�, SIOE p
� ADDRESS
CITY ZIP TEL
PROPOSED USE � ��' -
o ARCH/ENG/
� DESIGNER NO.DWEL NO. NO. �
d ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
�
�n DESCRIPTION SQ.Fi. FACTOR PSF ADJ.AREANALUATION
� OWNER•BCILDER DECLARATION SFR/ADDiREM
O
p I HEREBY AGFlR►1 UJDEF VENKTY OF VEiUJRY THAT 1 A11 EXEIJPT FFqAI iHE CONTMC1diS L4 GarapelCarport ' .
W GENSEUwFORTHEFOLLOWMOREASp/(SEG7o71.68U5M.�ESSANOFHOFESSqNSCOOE:ANNCT'OR (n
OJIMTYWH1diREaUIRE3�PENYITTOCONSTRUGT,ALTER�PNOVE.DEMOl1M�NEPA1NNiY3TRUG W PetSOJDOCIf
� NRE iRpR TO RS ISSUANCE�L50 REdU1RE5 TNE AFRICANT FOfi SUGI GERMNT TO FllE A SIGNEO
� STATEMENT 1HAT HE OR 5/1E IS LICENSED PUFSUANT TO THE VROVI51ON5 OF T11E COMRAGTOpS LL LL
� CEN9E UW(QWTER f(CdAMENGW WI7H SECTIDN 7000)Of DMSIDN�OF TNE BUSINESS N10 PM P���
FESSqNS OOOF)Oq TMAT/1E OR SME IS EXENPT 1HEREFHOM AND T1iE BA5�5 FOR TME ILLLEOm EJIE►w•
T10N.ANYVqLAT10NOFSECT10Nto]t.6BYANVACOLICANTFORADER41rtSUBlECtSiHEAPPLIGAMTO Z ae-R00}
F ACML FENAITY OF NOT A10qE THAN i1VE MMOREO DOUARS�1500)Y
O ❑1�30MMEROFTMEPROVERTV,ONMYEMVIOYEESWITNWnGESASTNE1q50lECO11PENSATqN, 0 (`,pmmOfd2�
Z WRL 00 7NE WORK,AAD 7NE S7RUCTURE�3 NOT INTENDFD di OFFERED FOR SALE(SEG 7aa,BU54 J
� NE55 AND PPOFESSIONS COOE THE CONTMCTORS UCENSE UW DOES NOT MPLY 70 NI ONMER OF ?
FROYERTY N710 BUIDS OH MPipVE9 TMEFEOq,NN W1q DOES SUC11 MORK MIMSELF Oil MERSELf Oq
� TXROUGNIUSOAHEROINJEYVLOYEES,GROVIDEOTNATSUf}10.1PROVEMEMSMENOTMENDEOOR m
� �1 OFFEAEDFORSALE6/10MiEVERTHEBUIDM�ORuapOVE1JENT�S!q.OMnTNMONEYFANOFtOMPLE-
Z TtON,TME O�MHEREUM1DER 1NLL IIAVE TI�E BUHOEN OF PROVRp TNAT ME OR SME D�D NOT BURD OR
= MVROVEFORTHEPUNPDSEOFSALE� .
w OI��MT�EROFTHEPROPERfY.lJAIXCLUSNEIYCONTRAGTR7aW1T11lICENSEDCONTMCTOR3
� TO OONSTHUCi THE PROJECT(SEG 7a1,BUSINE43�NO PROFESSIONS CODE TFfE CONTMLTORS U• VBIV9h0l1 ADJ.AREA
W CENSEUWDOESNOTMiLITOANOMMEROFAPROPERTYNTqBULDSORYPROVES7HEREON.M9
� wNooartiucrsconsuwonaEcrswm��oartructorys�i�c�sEownsu�wrrornecarrruo QUANIITY DESCRIPTION FEE
� T00.S 110ENSE Uw} .
0 O I IA1 EXEtAOT UNOER SEG B.i P.G WR TNIS REASON
�
� � OATE OYMER
Z
� LICENSED CONTflACTORS DECLARATION � � n
�
1NEREBYAFFYOAUNDERPENKTYOF7ERIUR'/T11ATIlWLICENSEDUNDER►HOYISION9OFCMAPfER � '"�
d •�GOYYENCNO WI7N SECTION 7om)OF�MSIDN]OF THE BU51NE55 AHD VROFESSIONS OOOE,AND z �/� �
� W IILENSE IS N FULL FORCE MA EFFECT. ^� (� Q
UCE�SECU55 ' �.— �IC.NO. V��S, 9 ( � ;J �� � -� .
V OATE COiJTAACTOR '�` a / -
c� WORKERSCOMPENSATIONOECLAF1NT10N �/`IC-•
�
� INEREBYPFFIPo.IUNDERPENKTYOFVEiWMONEOFiNEFOLLOWNO6ECUMT70NR
�
� _I HAVE ANO N9L1 MAMTAN A CfiRIFlCATE OF CONSEM TO SELF�RISURE FOR VARKERS'
OW PENSATIDH,AS PROVIDED BY SECTpN 770o OF T11E IABOiI CODE,FOR iMf VEHFOFMIINCE
OF THEHCRK FORNM17ICH TH15 PEH�Ati IS ISSUED. �
0
� �INAVEANDWII.l1�MlTAMWORNERSOOV7ENSATION�NSURANCE.ASREOUIREDBYSECTION
Q ]70o OF THE L/iBOR COOE.FOq 1HE PERFORMANCE OF THE WORK PoH YAi�G1 Ti114 PEfWR IS
� ISSUEp.W �3'�CENSATIDNytCYWUJCEC IERAN�POl1C/M1A�ERME CONSTAUCTION
� ua�En_^��•L'7�� PUNREVIEW
� POLICYM1u8ER E�E
0 m+55Ecroi�tmeemm�noFnfvv�iswaor� oai�{nao�aatas► UMBIN
Z ICERTIiYTNATNiHEYEFiFORMµCEOFTNEWORKFORWIIN]ITMSPERMITISISSUE0,1 HANICAL
(} SH/!�NOT EGOLOY AN'/VERSON N�M/fAM1NER 501.5�O BECOME SUBJECT TO TNE
� M'ORKER5LWVENSAiqNUw30FCM�FORm^MtDMHEETUTIFISHOIIDBEC04E INSPECTIONFEE - �
SUBJECT TO THE WORKERS COMPENSA710N PRJYISpN50F SECTIDN]700 OF TNE IABOR
rj cooE�sHUL Foatr+vnni ca.�v�r v�n�nase vaovisaNs. ISSUANCE �l���1. �,��ri� i
� SMIP j�—�. ��b h� �'
0 o�re: �vA.�c,um
� WIIItl�ANO�F�IURETOSEQJaEWOfU(ERSCdAPEN5ATI0NCOVERAOEISUNLAWFIIl.MA5HI11BE ENERGYP/C
�—y SUBJECTANEIAPLOYERTOCRAJWJLLPENALTIESNJDCMLiNE3UOTOONE/NNDRED1110USAND ENERGYPERMIT �`fy�� f1 �I�Q7
OOIlAf15[i100,DW�,N ItD01710N TO TT1E COST OF CpAPEN5AT10N,DAWGES AS PROVIOED FOR IN
Jp� SECTION))WOFTNEU�BORCODE.NTEREST.ANDATTOPNEY'SiEEi RETENTIONFEE: � ,� lj •
4 CONSTRUCTION LENOING AGENCY PRE-ALT FEE -
O
� IHEREBYAfFlRAiU10ERPEN�LTYOFPERR/NYTHATTNEREISACONSTflUCT10NlENOP1�AGENCY
FOR THE GER�OW.IANCE OF hIE WORK iON MMK7/TM�S VERAIIT IS ISSUEO(SEG�097,CN.C�.
�
� IENDER9N�E
� LE7DEH'SADORESS
� ICfRTIFYTNhT11UVEREMTHISAVPLIGTIONANDSUTETUTTF/EABOVEINFORMATI0NI5C011HECL TOTAL FEES � ES
� 1 AOFEE TO COMPL�M1rtM AL.L CRY ANO COIMT�ONDa1Al10E3 MA STATE UW4 RELATNO TO BUILDINO
� CONSTitt1CT10N,ANDHEREBYAVf}fDRRERE0RE5EMATNESOFTH14COUNTYTOENTEHUPONTHE
MqNm PROVER 40R SPECTqN PURPO5E5.
9 COMMENTS
� � �
°D v[ ca
a �/,a
u� w/
� 3�6NA HEOFGE� . TE �
� RECPi.N . PAIDBY VAUDA
NMI7E—Dapartrnent Copy,YELLOW�nance Capy,PINK—Asaeasa Copy,GOLDENROD—Fik Copy,GREEN—AppllanCa Copy
� �(n Cn � I C��. ��T T Ti T � V) l/7 lA O (� � fn 37 31 27 � T 37 t =1 C/7 L� R1 � (n �
-� �! mm Zz z � Dmmm � my � 20000A0 `D mr 7� � �i7
f � '�tn'D � � I 0 I D D D D � m � � �.r O C C C O D p ^I 's �^ p m G7 -i � :. ,
v_f i � r: rrr 'o � r,
D m � Z � c) c� G� -n � �n m v W c ..n.� � m '7�� '
� 1 . �. 'D C7 - . ��. �. v m S Cl � b t� 31 D � Z � m S 2 2 p Z fn � 'v L� 2 � T D 1 -
� � r r m p � -1 � m � � In 2 O G) 2 Cn O � O O n I... ..
` �i �_ '�D . _ � z' � � cmi � � m !-' z zm � cn � cmn' � � mm � o � � � � ,��.�
�I7 1 r 1 �� - � -I l w � z -t -�i !- � nc � Ow � � � � z = <_ 9mc � �' �i _
` � Z fi� r" OJ �
� 'N Cn ; ;--Cn . ��.� C7 . . z � O � m Z � GZj . :r�-- z m �i �m �c -�i o 1
i � ' � mm � i � ; ,I i G� pz ; � G� � ;! � � ' � o � ��
� ' �� � ��, . ip
�'; � Ji i I� i � I Z -
;, ' - �-;- I _
� ..�II �
1
�
M
�l
_ ' , .. - . ��%�, _
� ' . . I�I �' .
��� . � i I I L � i.) � II I ',I � , .
., : i ��% ` ' . � �I � - i i
.. i 1�.� I :� -
I � /~
- 1
' :�
�
1,`
�
� i
, ,
�/ - -L�
i '�' a��_� ' i j � � r C)
� - � � � ! '-`�'J 'D;�
i` i _ i � I ' m'_O .
' ' ' � n.
_ _'_._ I '' -Rl O S T T � �f��l O O � � � 'Tl 21 m "0 T m 7 T 'ft C C T T �� � .
I___- _ -_ ___ .__. _____ ______ - __ __' �'- T < D � � Z z z O ,�.� D OA z O m 7� o a 7� Z Z = � _,
_ _ y • fn D � D � O O O - C Z fr1 D m m � O D O -- �i.�
- - - - --- � -- -.. __ . ._.._._ _- ..r-_.� 'n � p � �.� r n [n r r r = Ll (7 L� � m�� 'v v m m �7 � .� �. G"-� .
. . . m 2 m N m f� m D -{ -n �t�m 2 2 �j Cp � . r 37 � m �
; � . � � �y� j m p �p p - y Z � m Z m r G) � Z.y O Z W D � 4� �- .l" _� ��.-:�
!� (n -1 Z 2 m 7^3 n"n r O , m�,^ .
� � - ' m y v � O � D C7 O � G).� Z O O m m. O O � tn i i I . � �
� � I - . � a. y � T � � � � � � L � O � ;Z � m � oi�i O O a� -i �, '_ 17'�
� - � m m
o -nn � v' � � � z Damoo � o, - ,j ' 0..�.i
: � � :� � ma � � � � � ��
.i � - . D -� O:."'� +.' I _
i � � =i - _
I _ � s
L __:.,I '� I
' t� � ' � v ._ . _
I I - �� � � ,
; '
� � . i � � � �� �
i � � _ � • �. �
! i'
� 1 �' �
- � I � I _ ! `.p - .
�� . �� ' il!' .
� � � . I fr
j i �
� _ _ . _ � u I ��''
---- - -- -- -- ._ _ _ _ _ ._. _- - -- - - - -- - - - - ---
i� - -.r,: . ..., � .,, - - -- - .
... ,� .- - �� �-� � - -
.. .. . , �. � , - �. .
.�� � �� �::� _ � . . .. ''. - ..�_. .,. � -., . .�. ._. � :. . .. !�� ... -_ .,. �, .' c. �_ �:_ .�. '���.,; .,. . i �
-�