HomeMy WebLinkAbout13908 (17) CITY OF DIAMOND BAR �
-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
_ 21660 L�.Copley Drive Suite 190
(909)860-3I95 Faz(909)861-3117 . PRE$S
� ����� BUQ,DING PERMIT APPLICATION FIRMLY ;
o ADDRESS J l-/,(. �Y• DATECATION 7(��`.. � � NUMB R 1� /� O �/C
V
$ ISSUE TYPE OCC
p OWNER �i�I� T�,�T DATE CONST. GROUP
i n� �Vc1
"" ADDRESS ZONING SETHACKS
$ CITY 1 IP TEL. d tS/ �.z` FRONT RW ❑
g APPLICANT '�' J �e TEL. Q REAR ❑
� SIDFJSIDE STREET RW ❑
CONTRACTOR SIDE '�- ❑
g ADDRESS � . R� �-"
CITY ZIP�� TEL z PROPOSED USE'- 1—
� ARC NG/ _ `
DESIGNER NO.DWEL / NO.
ADDRESS UNITS / STORIES � BEDROOMS
� CITY ZIP TEL
N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
0 1 HEREBY I,FF111d INDEq PEN/LTY OF PEIWRV 7HAT 1 AA1 E%EAIDT F�THE COMiMGTORS t4 Garaqa�CarPort
��yy CENSEUWFORTHEFOLLOWNOiYEA50N(SEG9aI1.68U5PlESSANDPROFESSIONSCODEMIYCRYOfi (n
U COUNTYN?IItl1RCGUViESAPERMRTOCON5TFRICT.�ITERMPFIOVF.DfM�USKORREPAtRNJYSTRUC• W patfolDeck
Z IUHE,R1OR 7D RS 139U�NCE.ALSD REOI/IRES 1TIE hPVLKAIfT idi SVQ7 VERMIT TO FflE A SN3NED
�1� ST�TEMINT 1HAT HE OR SHE IS LICENSED iURSUANT 70 ME FMNSiONS OF iHE COHTMCTORS l} W
� CFNSE UW(CMAPTER O(CdAMENCINO N'ITI SECTION 7000)OF DMSION�OF iHE BUSiNESS ANO PqO. � PO�VSDB
iE55qN5CO0E�ORMATHEOR5HEI3DCEAtPTTMEAEFRDIAINDiHEB�3iSidiTHEA1EOE0E%EMP• (�
iION.AHYVIOL�TpNOFSECT10N7w1.68vANYAPPLICAMFpqlIPEiWtTSUBlECTSiHEAPPLICANTiO Z Ro-Roo(
� A�IVM1 VENl1LT/OF NOT MORE TMAN iNE/1UNDRED�OLL/IAS fI5001-}.
� O�ASGMNEROFTMEPM7ERiY,ORMYEMPLOYEESwITHw�CESASTHEIH50LECOMPENSATpN, � CpmmatC191 '
WR!DO TIE WOiU(ItATHE STirtJCTURE IS NOT�HTENDEO OR OFFERED FOR S.LLE(SfC 7 W 4,BU54 J
/E54/tHD PiqFE5510N4 COOE THE CDNiMCTORS LICENSE lAW DOES N�T MPL1 TO i1N OWNER OF
� PROPEifTYN5i0BUlMORYVROVES7NER[ON.ANDN?7000ESSUp1VAf1KH!MSELFOqMERSEIFOR �
� THRGIllOHM50RHEROYMEMROYEES,DFDVmmTHAT5UC71MPROVEME!lTSARENOTMENDEOOR m
OFFEAm FOR SILE IF,/IGV+tYEK TNE BIAD�NO OR 1MPROVEIAE V T IS uOID YAhi1N ONE YEAR OFCOMPLE•
� TION,TME OM/NER�URDER VnLL HnVE 7HE BUADEN OF vqpVwO TIUT HE OR SME O�D NOT BUfID 09
MPRWE fOq THE PVRPOSE OF SAlE4
O l��EROF TME PROPEHTY,M/E%0.VSNElY COMMCTNO YNTV+l10EN5ED COMiMCfO�i!
iD[ONSTpUCf 71/E iRLECi(SEC 70U,BUSME5411tA YROFESSpNS W�E:il7E COHTRACTOHS L4 VaWafwn_ D
W CENSEUWDOESNOTMPLYTOANOW�IEflOFAPROPEfltYM4qBVRD50fl7APilpVEgTHEP.EON,M1�
� WIqCpRRACT4F0.iSyJCHCFOlEM4VATH�CONTN�CTOA(4)lK'fNSEDPURSUANTTOTHEWMTRAG OUANTITY DESCRtPT10N FEE
� TORSLICENSEUW�. . . . . .
OI/JIEXFYVTIRDEflSFG B.�V.C.FOR7MSRrJ50N Q
U
�
V" DATE OWtnR V
� �
LICENSED CONTRACTORS DECLARATI04 W -"y
� �HEREBYAFFlR4lM0ERPEN�iT'OfPEFWRY7741tIAMLICENSEDtJPA:RiROVi910NgpFCHAPTER �
p� ��C01AAtENCINOWIT115ECTIONfanO�OFDM510N]OFTMEBVSMESSIN�OR6Ff5510N5LOCE,AND Z
W LICE�NSE IS N FUl FORCE IiNO EFFECT. m
o ��E�,Ss C-19 ��.No. L1z�7 ;�-s = Y p -
� DATE � C�C�[� corrr�ucTOA � -E' � G a D • ,
IN � r .
WORKERS'COMPENSATION DECUIRATION -i
= U
� I HF� Y�FFIRM UAER iEN�LTY OF iEMJ4Y ONE OF TNE iplLOWiNO DECURAT10N5:
CfJ Z
G �_IHAVEfNDWN1/A�IMTAMACERi�FlCATEOC[YINSENTTOSEL�-MSUPEFORNORKER5 2
� COIICENSATION,ti5 PNOV�DEU 9Y EECTION 37000F THE UBOR COOE.FORTHE PERFORMANCE W
Of iHE N9RIC FOR WNId17H15 iEPMiT R ISSVED. �
� _IIUVEfNON�M1I.�1MUNW�RKERSCd��EYSATIONINSVHIIVCE.A5REq11RED8VSEC'f10N { � J• / ./1
�7COOFT1ElABORCOOEFOH7HEPERPoP.M�NC£OFTHEwO�CFOHNMILNTHiSPERMRI ! / I�V 1 _
t55VED,AryW,K1KER5 COMPEN�TqN INSU CARR'EA M'D Pal Y EP RE CONSTRUCTION < <LJ`�
l f. (T�t PLAN REVIEW
� �PoEw�-�h fY2� ��, S��
� ICYM1Al9ER 1. I� /�.,a/ //� i �I /j q •
K t t —� ELECTRiC
� (MS;,[CII[N1.IfIDrq7gECp,RFlEDOLTfCdA1t6P�0.d,ElarLri�00UM9(S�oo70f71E5S� PWMBING
Z ICERTIFYTUTWTHEVEFIFORMANCEOFh1EWOHKFORYMdITP.SFEFWRI5155VE0,1 MECHANICAL
(,�j � 51UlLNOT E7A7lOY�NV PERSON W AN'!4MMEA SOAS TO BEOOfdE SUfl1EC7lO TNE � � '
N NOPoCERYWMVENSATIfX1UV/SOFCJIL�FORNiti11ND/IGREETNATIF15110UlDBECOME
SUBJECTTOTMEWOl1KFR9COMPEN4ATIONPROVISqNSOFSECTION]7 THEU�BOR
OcovE.i s+ui Fonn�wn�couc�v vnr�rr nasEJfro��N s. ISSUANCE = - - -
p DATE: APPLICAIQT:�n�Cr-/1/�/ � ��✓'"�
� P� � .
WARN�N4 F/uLURE TO SECURE VJORKERS COMPENSATqN COVERAOE IS UNUwF1R,AN�SMALL BE
�y 5791ECTANEMPLOYERTOCRIMMAI.PENALTIE4ANDCMLitNESUPTOONEMN�DREDiFi0U4IND ENERGVPERMIT
O0.URg(f too,000�,tl ADD�TION TO THE COST OF CaM0EN5AT10N,D�MAGES AS OROVIDEO FOR IN
� sEeiqw�io�ocn+EUeon000e.MreaeSLum�TrowaErscEEs. RETENTIONFEE•
oCONSTRUCTION LENDIN6 AGENCY PRE•AlT FEE:
� INEREBVAiFIRAIUNDEADENALTYOFFE1WaVTNA7TMERE15ACON5TRUCTIONLEN01N0AGENCY
FOR TME PER�ORMAVCE OF TME WORK fOR WNICM TMS PERMIT IS ISSUED(SEC.�oG1,CV.C).
�
� IENDER'4NwE
� tENOER'3ADORE55
� ICERTIFVTUTIHAVEPEMTIISMPLIGAT�ONANDSTATETlUTh1EABOVEMiOR1AATqNISGDRRECT. TOTAL FEES I ��• 5
W I�GREETOCOMPLYWI'fMN.LCfTYANDCOl1NTYORDINNiCESANDSTATEUNSRELATINOTOBV0.D�N0
� CONSTRUGTION.IJNHEREBYAUTF1pPIZEREPFlESENTATNESOF7NiSCaVNTVTOENTERUPOHTNE
Z /,gpy[-1AEMqNEp GHOOERT/FOR INSOECTIDN 7URP04 . COMMENTS
� �� v
� P�fiTEEN 1� :, `` t .`, `� _ _„
t VJ rA�' _ . �/'�� 1,1
•y 5 tU. O PERMI EE OATE ;
� RECPT.NO. PAID BY VALIDATION
WHI7E-OePertment Copy,YELLOW-Flnanca Copy,PINK-Assessa Copy.GOIDENROD--File Copy.GREEN-Applicant's Copy
___�_..
- --•�----_ �� �� � '��,.I� � rn cn cn o n s m cn � � z� � -n a g-i tii G�'m =n m
� mm � �•: ` ��m � � � mD �r.� s0000Doamy � mG7 � -;i
�-� S .,I�:�` r�-� -� n � � � O c c c o o -+ S W O n � .
. . � ro rn 2 c) � c) G� c� -n � -n m v C ,� v� �T,'I
� � �, -vc� a `n � n = xx � zm �' � � z �, -*, a
, �� m ' c rn � � -i I� r �r`J- � c ? � � � m � � m m � r � C� � � '�"�' i
. �D z . � n `I [n (t'rin r Z Z ln (n C C 1�7 y i n � D 31 R; D r L� ` .
:1��} ''f, z � 'm_ � z � �l. :, ac � oms. c� � vZ � < � m � � v',
� ��. N U) ; ..'V) . G� n�� Z � O z m Z � � � z m m �C -�i �.
- m m _ � L� Q z � -mi � o � � � y� o � '"d''
� �� � `
'Rtt � Z
�_ __________----. , � `. �;
� -_ _ -- � �;
_- � �
,
�
� _ � ; �� .
. I ',e z �
: � �
I — — ' I n O
I � .ii ' 0 S TI 'n O �TI p O � "D � 'n 3J W 'D T W � T �t C C T � i -{ � �
� ��� mmyzz zm � o0ozom � z � o � � o oy o I O D
`m ;� amy �, Zyo '� 000 c �na mm
'tt �7 .T � � i- � O r- n Cn r r r = � C� � r m = 'o v m m � O _" z �
f� ;.. ��rtl 2 fr1 N m n fn D -i T �t fn 2 2 � � p � r r 37 31 m 7"`I � Q
r � �'�b { � p � O y z =� m z z m � � � D O z m n n rT- � Q O
� •_ -iz � c� � ozeo � :'�i m z
� m m
i � i- ��I D -mo �, z U� � � � � � Z -ni 0 > z � m Z m � o o m -�'i ' n 0
� _ • 'r, � Z L7 . � � � 77 z � � m m � O O 7J 77 �F .Q
\ .� O � � � n � Z fTl D m Z �'I �
` � ; �� D r � � � ' � p D.p � ��'i O�D
�i �
. I I r D � O � - �, �
I � O � I
i
� . I . . .
�) �fl
V �1 '
�; .��
.`� � � —— �' -
1 _ ''
1
• �I
� �{�
� ; �
I''- i o ,
' _ ; - - ' _ . ,.
: � � -' w��l
� _ I � I ._.a