HomeMy WebLinkAbout13957 (17) : ,,_: � CITY OF DIAMOND BAR ���•��
�--�� DEPARTMENT OF COMMUNITY 8�DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRE$S
� �'TM'. BUQ,DING PERMTf APPLICATION FIRMLY
o� JOEiSITE /�� � � APPLICATION �/�j PERMIT ,�---,'�I 1C
ADDRESS_ ���' `"/�iSbl� ��1� � DATE / NUMBER � �
$ ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
� OWNER V n a
ADDRE S �� C ��J..� .�s�; ZONING SETBACKS
� CITY � .�t ��TI'�G.�TEL` ° REAR Rw ❑
APPLICANT TEL SIDFJSIDE STREET RW ❑
� CONTRACTOR 1. C�- i� SIDE ❑
ADORESS 2 Ne�e /�f
� Cm, r� ,ti Z�P 7�, yN� �u) PROPOSED USE
o ARCWENG/
� DESIGNER NO.DWEL NO. NO.
ADDRESS UNRS STORIES BEDROOMS
� CITY ZIP TEL
�n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER•BUILDER DECLARATION SFRIADD/REM
O
p 1 NEREBY AFFlIW U10ER PENALTY OF PERIVRY THAT 1 MI EXEMPT FR04 THE CON�RACTOR7 L4 Ger39e/CBrpOR - - . .
W CENSEUWfORTHEFaLLON'NOREtiSpi(SEC7o�1.S8USPlESSMNF0.0FESSIONSCODEANYd7YOR (n
CAIA�/TYMIl11LTIREOURE54PEWARTOC�ONSTFRIGLILLTEAIMPROVE,DEMOLISIIORREPtiRPNYSTRUC• �jJ P82�0/�BCI!
TURE,iRqit TO IT!ISSUMICE,ALSO REd1iAE9 THE APVIIC�NT FOR SUCH PERM�T TO FILE A SIGNED w
STATEIAEM TUT NE OR SHE 13 tKENSED PURSU�Nf TO TNE DRO�n5lON5 OF THE CONiMCTORS LL
� CENSE Uw(p1APTER�(ODIdMENCRq WfT}I�ECTqN 70D0)OF DM510N�OF THE BUSME39 M7D PAO � P��CB -
KESSIONS 000�OR THAT HE OH SHE t3 f%EMF�7HEREfROM M7DTNE BASIS FOR THE ALLEOED F%E1Av-
TION.4M'VIOlATI0NOF5ECf10N7071.68�ANYAGRILANTiOR11GERMiTSVBJECTSTHENRICAHTTO Z R9-R001 �
F �CML VENKTY OF NOi MORE 71UN F1VE 1NIYJRED Ddil/�A5(f500�.g . ..
� O�ASOMfiEROFTHEPW7DERT;ORAlYE4vLOVEE4YATHWA(iESASTN£tiiSOl.EtO'.1PEN5ATC7N, 0 COrtlfliBftldl
YML DO TME YIORK AND TME STFUCRIRE IS NOT ttlTENDEO dl OFFERED FOR SAIE fSEC.loN.BU54 J
y NES$ANp PIqFESS10N4 CODE T1E COHTMCTOR4 UCENSE UW DOES NOT APp�Y TO AN O`MiER Oi j
OiIOPERi1'N7q BUlDSOq IIAViIOVES 7MEREON,AFA VYMOOOES Sl1CH NORK XIMEELF OFi NERSELF OR
K i1fR0UGH HtS OR NEF W'M EIAPLOYEE9,PRCVi�fDTFUT Sllf71 MPROVEA!ENTSARE NOTMENDEDOR m
� ,OCFERmPo�ISALEK.HOWEVERTMEBUID�NQOFMFPOVEUENTRSOIDV�TMNONEYEI�ROFCDM0.E
Z �TION,iNE OMMER-0URDER Wrtl WtvE iHE BURDEN OF GROVWa huT ME Oq SHE D�D NOT BU4D OH
� 1MPAOVEFORiMEPURPoSEOFSALE�.
W O11�40N?lEROF7HEifUPERT�;AMEXQUSNELYCDHTN.CTRKiYrt'HtICENSEOCONTMCTORS
� f0 CONSTPl1CTTHE Pi1WECT(SEQ 7W.EUS�NESS MA PROFESSION9 OODE THE CONTMCTORS LI- V81UB1kX1 ADJ.AREA
CENSE LAW DOES tAT ADP�Y iOAY OiM�EH OFA FROOERTY MAq&11LD9 OR NOFiOVE3 TNEREON,AND
� vnaeonrFucrsrrn+sua�Paaecrsv+in��cartrucrontsl�Ke��Puawu+rmn+ecarrrv�o avaranrr DESCRIPTION FEE �
� TOitSUCENtiEUw�.
0 OI/J.IOcEMPTUAEHSEG 8.{P.C.FORTHISRJSON U
3 � -
"-- o�tE om+En �—
� U
J
UCENSED COIJTRACTORS DECLARATION W
� IHEP.fBYAFFIM.lUNOERPFN�LTYOFPE0.UA'/?HATIMILICENSEDIRIDERDq0VI5iONSO�C1iAPTER � / �� {� C�- �
(� �(CDYMENCmOYfITN5ECT10N7006�OFDM5ION]OFTHEBUSINE59MiDGROFE551ON5COCE./wD ` "� �
X W(J�[N5E 61N FUl FOpCE M!D EFFECT.
h7 m
`� IICENSEClA55�� LIC.NO. v��" j
v wte ��S"��1 eorarruc��_oa f a
� �O V
WORKERS'COMPENSATION DECLARAT�ON � { Q
� 1
� I HEREBY 11FFIR/A UHDEA PENALTV OF PE0.AIRY ONE OF THE FOI�OWMC DEtUMTION.
�
Q
� _IH4vEM�DW4LMAMTAINACERTtFIGTEOFCpi5ENT705ElF��NSUqEFOR .ERS S
CdAo�5�T10N.A3PilOV�ED0Y5ECT10N77000FT}IEUBCRCOC�,FWITHE.- W
OF THE WJRK FOq VhnCH iM9 CERMR IS ISSVED. S
0
w _INAyEFNpyflly�Irlilp�WplKERg'COMP[NSATqNMSURANCE.�4REW�REDBYSE
Q ]7o00F7N[IABOq COOE,FdiTHE PERFORtrM10E OF THEwOHK FOA WHiC!1'Hi5 PERMRIS
ISSUED.Wv�oa/��45C7�APE�SA' INSUiWdCECAARiCR.tV�POIICYMJ48£RARE CONSTRUCTION
� GA'fER �TC W PLAN FEVIEW
?
� POLICYMAABER a sz �-� ELECTRIC
o mss�cm��roraEm.st�ovne�srrnor+eF.,*�moaw�rnom«at,cs y� / LUMBING —
m�
Z IC[RTiYTlUTR1THEPERFO�dnNCEOFTHEWOFKF00.WHICNiHiSOEMAtTI51S D,I � CHANICAL � Y
- (J - SNALL NOT EE�oLOV I�M/CFRSON M FNY MMMER 50 AS TO BECOME SUBJECi TO T E . .. . _ .
N YqPo(ERSCOMFENSATIONUWSOFCALIFOR.M,tANUMiREE7M�TFIS1i0ULD8 COME�•/ NSPECTONFEE - -
SUNECTTOTNEVIORRERSCOM�ENSATqNDFOVIS1Q440F5ECT10N�7000F UBq�/ �.
~ COOE.151U11FORT4WITNCOMPLY'MTNTIK)SEPRONSIONS. "t� ISSUANCE �nn._.
� ;,;..
o �
� o o�re:„�-ZS'�� APPLlCANT: � �sL S411P �.
w ENERGYP/C �I.A,RO��L�� ��
� W1idlIIRi�F1ULURETOSEGUREY/ORKERSCdAPENSI,TIONCOVERAGEI3UNUWRh,ANDSHN.IB �-�jx�• ; ' '
� SU&IECTANEMPLOYERTOCRRAPUIPENALT1ESAkOCMLFMIESUPTOONEIRJNDREDT/10U9�ND �(' � T.�� ;�1;=+�- �
DOLUA4�f1a0.0o0�NADDITIONTOiHECOSTOFCAMVENSATION.DAMAGE3A4Pf10V1DEDFORIN ENEPGYPERMIT v'Q
J SECTK1N770eOFT11ElABONCOOE.MEREST,INDAT70R.vEYSFEES. RETENTIONFEE: " '
L�
�� CONSTRUCTION LENDINO AGENCY PRE-ALT FEE:
CC IMEREBY/�fFIRMUNDERVENI�TYOfPERlUFiYTHATTNEREISACONSTPUCTIONLENDING�GENCY -
aZ- FOR TNE PERFORAIANCE OF THE WO�iK iOR WHidi Ta5 OERUIT IS ISSUED�SEG 900T,CN.C.).
W
� LENDER'SNAME
� LENDER'SADORESS
� ICERTFVTUTIHAVEREIDiHISAFPLICATqNANO5TA7ETFUTTMEABOVEMFONAAT10N14CORRECT. TOTAL FEES ' l�
p� 111GflEETOCOMVL�W�iHALLGTYANDCOUNfVOR01NIWCFSIfASTATEUNSREUTIN�TOBVILDiNO
CONSTMICTION.1�l1D MEREBV AUf1qRRE REVRESENT�TIVES OF TMIS COVNTY TO ENTER UVON TME
ZABOVE�MEMIONED YROCERTY FOfl INS/PE-C�TION 7URPO5EA COMMENTS
� N S �.. I /�7�'�// .
4 PERAIRTEE IUA1E(P � , .
�
y S�ONAfUREOFPEFJA1ITEE DAT
� RECPT.N0. PAtD BY VALIDATION
WHITE—Depertment Copy,YELLOW--Finance Copy.PINK—AesessorCopy,GOIDENROD—File Copy,GREEN—ApplicenYs Copy
-- --- -
_- - -- ---�-
_.
1--�--.---1 - r� �� ..t � ..�I�n u� cn c7 C) � m ��� O 77 � �n 37 � �cn Gl m � [n °'-j.
Cn(n 7
, �. , m� - � � � � r:�`.I � ���j,lni � s � � rn- 'iO �CC �CODO -Di � DQ� m � -m1 �1- .
, � ; �I '9_i � • S � �- �r :-��,..�.° --i m > r r � G> G� � -n � .n m v W C n (n m '"�
, � , , 'D(7 '� ��� rT''= C:I�j! c C) S7 `D � z tn S S 2 n�Z v� � � � z. � �`n D T .
� •-�` r jrn C i� --i � r- _ [n � � � m 2 p�G7 cn O � � O C)
I7'1 'C frl Z�-i�.r y �. f' -, C = a r m fil D n 37 S.
� �� '� � ���� {C/�Z � -Z-� 'm � 7 ,-�i � r � � ➢ C � p � y Cm] -D-I � Z -D-i < A � � � � .
rn m � .
-+ x
m cn � � c�:c' , z � o � m z D � � � m m �c -�'i ,�'
_ . . m � L) O Z � G1 n y � � p m �
z -� � r .
� ° �; :
nM z
--------_..._. _ , _. — �
��'
_ I�(
i
� -
��
� :` �I
- �. ��
,� C� �
� : _ — ' � � ._
- � �ffl O S 'rl 'fl O � T � O 'D '0 'Tl '�"I �7 W � TI P S T T C C T T ��� "'I
- _ _ / .. _ _— -_. ''..` m < D � z c Z Z m � O O O z O m 2� z � p 7� 17 0 0 � p i Q ,,•
, . r-�� � 171 D U7 D � T� O O O C z f?1 D m m
- - - �'r � -n � � r � � r n tn r r r = � n � r W 2 v � m m � 0 `�� ��.
� y� � m = mNmnmr =� -n -nm x = � m -ir � � rn �
m v O Z -_i m m r � z � D � � ',T'� 7) �
.��� v, � -a z D z m � � a o z m n n�� � ° 0 1"I .
' m � -oc� o a � � ozoomm i m��
'0 � �n Z � Z � r C) (� D
l a � z � a' � r» c�n z � � o cZiWmom � o ov-{i � ��1 t�.p
o � — z m a w o 0 � aa �: . O
� � � � � � � Spoz �, o - o� Xt D
- r � � � � � � � �I . � �
_ - i � o � i
,. � i � ;
. -- — � . �
,��I ,
t�r�
—-- -- — i
� I �i
�
�� :
- -. . . ,- --- _ - - - _ i I �-f
( � '_ _ �, - .