HomeMy WebLinkAbout10121 �
- CITY OF DIAMOND BAR �
COMh1UN1TY DEVELOPMENT DEPARTMENT (
;,. ' 21660 E Copley Drive Suite 190 PRESS
(909)860-3195 Fax(909)86l-3117 '
'M" BUILDING PERMIT APPLICATION FIRMLY
o� .10BSITE /` / APPLICATION Z� � PERMR�/''�� �, P!C
ADDRESS ���N D ('� . .. l.,�. -//L. pATE � NUMBER�1 '� A�
� APN LOT TRACT 3'�� ISSUE TYPE �—`-- occ
p OWNER ,2�� DATE CONST. GROUP
ADDRESS ZONING SETBACKS
� CITY ►Aw-.1 RA✓ ZIP ql�)�{C�TEL_ � � REART RW p
APPLICANT TEL�— SIDEJSIpE STREET RW O
� CONTRACTOR � o.- 1.:�-r S10E ❑ �
� AODRESS -. �
p � PROPOSED USE U
CITY W ZIP � TEL �
o ARCH/ENG/ -
� DESIGNER NO.DWEL NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP 7EL
�
u� DESCRIPTION SO.FT. FACTOR PSF AW.AREANALUATION
� ONRJER•BI:ILDER DECLARATION SFHlADD1REM '
O
p 1 HERE9Y AFFlRM UNDER PENALTY OF PERUA`f TW1T 1 AM EXEMM FF10F1 TF�E OOMTMCMAS LL Gsraga'Caryort
W CENSEUwFORTMEid10YlR1f3RFASOH(5£C.7WI.SBUSwE55.�PROFE5510H5CODEANYp7VOR (n
U C0.MYWHICNpEOU�RE9AVER�fiT7000N5TRUCT,11fERMP{q�E0E4CU5H.diREV4(iM1Y5T(7UG �f,� PgfiC�BCI(
� NRE,iA�DA TO RS ISSUANCE�I.50 NEOUIRES iHE AVVI�C�Hf FOq SULII VERMR 70 FlLE A sGNED �
ST�TEYFM TiUi NE OR SME�5 LIGFNSEO PURSUINi TO 7HE PflOV1510N4 OF TME CONiRACTOR3 L4
� CENSE UW(dUVTER f(CpAMENCWO WITH 5EtT10N 700010F DMSiON 7 0F THE eUS�NESS AND GM� � PooVSpa
FESSKKI9 OODE7 d17MATHE OR SHE�9 E%EMFI7HEHEFHOM IND THE BASIS FOq THEALlEOED E%EMP•
VTION./WYVqLATqNOF5Ett10N17l1.SBYANYAPRICAMfOqAPERMR5U8JECTSiNEAFP�K:A1lTTO Z Ro-Roof
� ACN40EN/LTYOFNOiYORETWWFNE�AINOREDpOIURi(lSOolk
� 04��'�M'EROFTNEPR07ER7V,OqMYEMPLOYEESW�THW�CESASTNEIR50lECWdVENS�TDN, Q Cp�mBf�tiy�
WILL DO THE MORK,AND TME SiRVCNRE 13 NOT IMENDED OR OFFEAED FOR SILLE(SEG 70Y,BV54 J
NESS/ND VROFESSIONS COOE TME COMfMCTOR9lICENSE UW DOES NOTAPPLYTO MI OWNER OF
N PROPEHTYYMOBUIlD30RSA7ROVE4INEREON.AND�M1000ESSlKHNCMKHn15E1fOqHERSElfOq �
[L T11qOlXfHMSdiHEROVMEMPLOVEE3,0itONDED71UT5W1WPRpVEUENTS�RENOTMENDE00q m
�p OfFEREDFORSKEtF,NOWEVERTHEBUldN00RMPR�VfuENT1360lDVVRva�ONEYEANOfCOMPIE-
Z TlON,1HE ONTlfR�BUItDER Mm.l HAVE iNE BURDEN OF VROWlO TUT HE OR SNE 01D NOT 9URD dl
_ �1VnDVEPoR7NEPURaOSEOFSitLE1
W ❑�ASOWNEflOFTHEPROPERTY.M/IXd.USNELYCONTFUtCTAJON7TN�ILENSEDCONTMCTOR9
(= TO CONSTRUCT iHE ii1WEtT(SEG 7G�.BUSMESS IND PROFESSqHS CODE THE CONTMCTOR�U- V3h1atl0n A�J.AR�A
W CENSEUWDOESNOTMPLYTOANON'NEROFAPROPERT'W1108VILD40R�/PfiOVE3TI�EREOKµO
�.�C wHomrrrw�cisconsuo�nao.�cTsw�nucowrn.�cron(s)��r+sEoamsuurrTon+ccartruc p(lANTITY DESCRIPTION FEE
� mutKErrSEuw�
� ❑�u�E%ELFTtMDER SEG 8.t i.G fOH TNIS REASON �
� U ,.
� F
DATE OMMEN U .
� UCENSED CONTRACTORS DECLAMTION W
OC IHEREBYAFFIMdUNDEROENAl7YOFOEtWRYTH�TIMILMENSEDUNDERPROVI510NSOFCHA7TER V.
d �(COMMENCHO NttH SECT�ON 7oaol OF DMSqN f OF iHE BU51NE541iN0 VROFE55�ON9 CODE,AND Z
X W tICENSE IS N F1R1 FORCEMID EitEtt. m
LLl
0 LICENSECLA55 LIC.NO. J
V OATE COMRIICTOR a
W
� WORKERS COMPENSATION DECLARATION �
Ni��er�rr�uNocn onautr oc vEaum owE ov n�E rouwro+o ocauuTnus z
� �I HAVE M1D WILL GA�NTAW A CERTILICATE Oi CONSFM 70 SELFMSURE FOR MO(RERS � �
� COAIPENSATqN,ASCMVDE0BY5ECTlON77000iTMEUBONCODE,WNTHECERFOillAANCE 1U
OF TME NqFiK iOR WN�CM�HiS PERIAI7151SSUEO. �
�
�1 H�VE AND WILL IAAMTAM N'ONCEAS'COIAPFNS�TION MSUMt10E.A9 REOVIRED BY SECf10N
RI /LJ�
Q �to00F THE t1�BOR COOE.fdl TNE FERFOM/AHGE OF TNE wOR�(FON YMIC117Vn4 OEP4R IS ��../ •Z
� �suEo.uv vroracEaS eaaP A nasU eu+wEn um ra�er rur.+eER ueE: CONSTRUCTION
CE� n
7 CANPoER 7�1 �1� �N fa��/
Z va.icr ruue� �'�v P�,ft EIECTR�C ��
¢
� (hLSSCCroNNFIDwTBEm.YlFfFDOFnEPFAMtsR)aa+E�u�OolWts(f10010qLF551 PLUMB�NQ
z i ccnTrcr nur e�n+¢ocAFaw�r+ce oF n�e Nroa�roA vnna+nas ve%ar a iswEe,i MECHANICAL
(,7 SHAl1 NOi EMPLOY ANY VERSON MI N7Y MINNER 50�l5 TO BECOME SUBJECf TO TNE � -
� YVOPo(ER4'CdAVENSATqHU�WSOiC�UFORMAAND�GREETMATIFISM]LLOBECOAIE INSPECTIONFEE / 1
' � SUa1ECTTOTHENORICENS'ODMPENSATIOf17R0VI510N50F5EGT10N�7000FTNELMOR - -���
000�,isw�ucarrm�nn+cwetrwm�nas Howsar+s. ISSUANCE
� SM�P
p oxtE: �" _ �va�curr: L
w ENERCaY P/C A DI� � �1 ��0�
� WAqMN@FAILURETOSE0.INEW�DRICERStOMPENSATpNCOVEMOEI -1MNFtA.AND5HNIBE —rZj--RT�—TTS�
� SIRJECTANENPIOYENTOCfl1MMAlPENK7�ESANDCMLFWE3UPTOONEIMANEDTV10U5MfA ENERGYPERMIT
DOLURS(f 100.000�IN 11�d710N TO TNE COST OF COUPEN3ATqN,O�QES AS PRWiDED FOR IN
� SECf�ON77aOFhiELABONCOOE,HTEAESf.AN0A7TORNEV'SFEES. RETENTIONFEE:
a CON5TRUCTION LEND�Na AGENCY PRE-ALT FEE
O
� iHEREBVAFFlFWUNDERiENALTYOFPEfWRYTUTiNERE13ACONSTRUCT10NlFNDM70AGENCY '- ' -
FOq iNE 7ERFOHMMlCE OF THE W�K FCR NM1CM TIIS PERMIT i3155UE0(SEC.f0o1,CN G�.
�
� IETIDER'9 NAA1E
F– lEN0ER3/DDRE53
� i on"Eio�cor.'iv�`�rven+�Di�u�crsn�i o��urrro�TniwcisTr.w�"sr�r�BOEu�"TT1ONworo�Ho TOTAL FEES �� .(�
� CONSTNUCTION,ANDHEREBYAU1Ti0H2EREPf7E5ENT�TNE30FTHi5COUNTYTOENTERUPONTIE
� /80YE-MENiid1FD CHOPERTYFOR INSPEttION PURI'OSEA COMMENTS
� �2�C� Z'r� �'��
_
m PEIWiTTEEN+WE(PFVM�
� • c�-� — x7i r„ —, �3�—r ,
y Sq1UNREOfVERMITTFE DATE —� V
� RECPT.NO. PAIO BY VALt0AT10N
NT11T Rmen COpy,YELLOW--Fhanta Copy,PINK—Asa�ssa Copy,GOLDENRO�Fib Copy,GREEN—AppllanYe Copy
.. ,
-- - - - ___- - --- -- ----- `
—'-'-�-^�-� cn rn n, � ,i �, �n cn cn 'cn o c� g cn � � � i� -n A K -� cn � m � cn �
1. ' ' � m m ' z z z z � m m m � m y � x o 0 0 0 � o y rn f � � �t7 �;
� ��R7 V I i � ��� C� R7 ,� � � r O C C C O D O -i . D 0 fn ,n -i `' ti
� �.,v_i � : i �''� ,�: � � � y �a -� m �' � � G� � T s �t m v � c � v� m 7„I .
' -a C� ; ' i ' �� v m x o � v c� � � � z � m x x x n.z cn a *� G1 z D -n a li .. � i
� � �� r' m O � -{ �cn � v m T O L� S � O � O 0 n -1;i
•' � �'�D � m I � �z n � m !- D r Z c = r r < � m m � D .o C� � X l
ij}, ��'�ZT. -Zi' � � z -�i -�"if' � v � � oaisn � � m = � mm � � cn � �'
r � � Z 37 . I �i
m� i (/) � � � i Z � o � � z � � r� � � jl ' W � m �� a
� m � c� o , � � i -�+ ' i 'czior-m- _:� .
� ��tel � ; , � ��, � - - - � - � _ � k
' , , ��JI� i �� i i � � I. - 1
I i ��1
h
�' i f
� - +�
I
' , . . � I '��i �� �� 'i - = '����� �s
� � V
�
- i:
�
I v � V
4:. I
� � �� ��� I I j I -
� ,�.�, - - . '
� �'�^. ' � t� I _ _' '_- -
, �:� � I I � I _ � � _
� i _ � �
i - - j ' J � ,n-�
� , i •<
�k
� �.
' I -
I
i I - i
I I
- - ; i - I m o -
i' � <'? i7
i .
i,', _
_ - . ' __ - I�� O T 'n p �� �T Q 0�17�'t7 .'D 'rl � G bI"il m T " T C C T .'n . ����
;
— — — r
� —
i I m —
� � , .. I � '. � . _�� m � -� Z Z m T O O O � O., � Z � 0 7��� � Zo D _ Q��,,•,
_.— � �— - --.__ i .n � Z p � O � �
-.._ . _ .. - ---- �-- - ---t-� - -- �,- fTil S � N � � m D,-a�-n T m = S � � � v v-m r 7] � -_ . � '-,
- I . '_ _- �� � . m � cn � O O O C C� D ' S
L� S -i r � 3] D m � �
� .-. � . r,i -< m o p m y Z --� m = m r L� � z D O � m � � -n � O � Tr .- � O
�, . �: � r� �m m :-{ z s �n ti� ol� `n � n y x� G� o z o` o m m � � � � � m'�G :
I r � , r' D .-�i .-" G cvn -L" U'-'c � zs oo 'z � m � m �n o o t�i�, -u'i ^i _.�,C 7
z a Iv; � � m o-o � � � -. 0
� I , � "'� a '��� �' � � �' A � mz � � �o -1 �,:G
' . - ;. � � I � � D p � C � � _ :D-� �.
; ' . � � ., � - - S � O_o � .
`.I - '
. - �
� � �� . ' .I � - � .�� �' , � �� .... .
- i. �
" i i ;�
_ ,. . _ . _ i. "i I,,��
�i', : -� , . /
� I -
. t
i i
I i
I
_ �
� _ �� �
� � . . - - •p .".
i I
-�
� I I ;�i
i � � � - � � - ,es�
,
.
.
� . . . . _ . . ._ .. _ ' _ '
_..' ._" '_ . —_.'_' _ `_' __ _" _" _-_ _" '__ '_._ ._"' _ ' -' _ ._. -_ __ .' . _._ _
i, '• . __ . � .. .. . �... _ _ _ . _ _ _ '_ ' _ _ _ ,
. . . . . . . il _ - -