HomeMy WebLinkAbout11778 CITY OF DIAMOND BAR � ���'��
--�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 1,
. � 21660 E.Copley Ihive Suite 190
� � (909)860-3195 Fax(909)861-31t7 PRESS
����. BW.DING PERMIT APPLICATION FIRMLY
o ADDRESS��3.�e ��cz� _ cY►�? DATE CAT10N/ '_LJ � I � NUMB R �� IF/C
fD �
c� ISSUE �t (j �+ �/ TYPE OCC
APN l0T TRACT DATE a— / � l d CONST. GROUP �
p OWNE��1��(��
�'`" ADDRESS ZONING SETBACKS
Z CfTY ZIP TEL ' REAR RW ❑
g APPLICANT TEL SIDFJSIDE STREET RW O
� CONTRACTOR � SIDE O
� ADDRESS
�m, �t�t�4 GS Z�P R � PROPOSED USE
� ARCH/ENG/
_ �� DESIGNER NO.DWEL NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY• ZIP TEL
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OVYNER-BVILDER DECLARATION � SFR/ADDiREM
O
1 MERE9t AiFiRM UFDER PENKiY OF GEiWR`/TH/R 1 AIA E7�M7T FROM iHE CONTMCTORS L4 GaragelCarpoR '
8 CENSEUW�OqT/EFd10N7i0RFASONISEG)mt.SBUSINE53M1DPHOiESSqNSCADEANYdTYOfl (n -
C� OOIINTYY/111WREOUWESApENAf1000N4T1K1CT,/�LTERMPfpVEDEMOLISH.ORHEP/uRANY5TRt/C• W Pfl1101DBCk '
b 7UaE,PRiOR 70 R9 ISSUANCE,A150 REWIRES iHE MPI�CAM FOR StlGI FERWT TO F0.E A S�GNED
� STAiE11ENi TMAT ME OR SHE IS L10ENSED PURSUANT TO 7HE FROV�SiONS OF iHE COHTMGfORS LL
� cExae uw tw�vTSA��Mewcn+a wm�sEcr��aoo�oF orvisaN a os n�e eusmEss ivro vr�o. � PooVSpa
FESSUNS OOD�OR THAT ME OR SME IS IXEMPTTMEREFROM M�O lNE BASIS FOR THE ALLEGED ExEMP-
TIIXi.MlYVIOLATK7NOFSECTION7071.6BVANVMPLICJJ7TFORAPERMRSIRJECfSTNEMPLIGNTiO Z Pe-Roof
F A CML PENKTI'OF NOT A10HE 15uN FIVE IIUNDRED COLURS(tSoo)}. .
� O1�30WNEROFTHEPROPERTI',diMYEA1PLOYEE9VnTHwAOE5A5THEIR50lECOMPENSATqN, � CWfIR19fCI91
WRL DO 7T�MIOAK 1W�TME STRUCIURE 4S NOT R(TENpEO OR DFFERm FOli SJILE(SEG 7vu.BUSF J
NES!Nq ViqcE4410N9 COOE TME CONTMCTORS IICENSE Uw DOES NOT ACPIY T0 AN OWNER oF �
N ppppEqryylrqpUlD30liMVRO'JESTMEREON,IfON1pDOE95UdINOFlKH11.i5ELFORNEitSFLFOq m
� T}RqUOM MS OR NER OWN EhMLOYEE3,�RO�'iDED i1utT SUCN MPROVEMENf3 ME NOT NfENDm OR
OFFERED WR 9ALE 6,V10VlEVER1HE&11LDIN0 OR YOHOVEUEHTIS SOID WrtMNONE VEAiiOFC0M0.E.
� TpN,THE pW11Eq-0l7�lDER NALL MAVE TNE BURDEN OF PilOVwO THAT XE OR SHE DD NOT BUttD Oq
MPROYE FOH 7/7E PURPOSE OF SALEI
�y ❑1A10MMEROFTIEORDVERfY,AIAD(QUSNELYCOMMCTR70W1THLICENSEDCOHTMCTOR4
� 7p CONSTRUCT THE ONOJEtt(SE0.7o1r,BU4�NE54 AND FROfESSqNS CODE TNE COHTRACTORS Ll- Valuation �ADJ.AAEA
CENSE UW DOEJ NOTAPPLY TOAN ONT/ER OF A PROPER7Y 1Nq BUILD9 OR IMPFpVES iHEREON,/ND
� nwmrrtrucrs�onsut�vno.�crswrtt��oo'trn�cron�s���+seuvunswwrron+ecarrruc pUANTITY DESCRIPTION FEE
� TOA9 UCENSE UW F �J
O I IUA D(EMPT UlDER SEG B.t PC.iDR TN�S REASON a
� � U . . . - -_ . -
�
u' DA7E OWNER U
�< UCENSED COFfTRACTORS�ECLARATION w
K IHERERYARIMIUNDEHPENN.T'OFPERIUR/TUTIJVAIICENSEDUNDERFF10N5qN90fCMAPTER � V. s�WQS �'er G b
� �(GVhMEN(.710VffT115ECT10HTooajOFOM510N]OFTHEBVSINESSFNDPROFESSIONSCOOE,AND Z
oW UCENSE 6 N FU1 FOACE MID EFFECT. m
uc�,sE cuss C3C� uc.No. � 3
V pa� �—'�'�u corm��cron a
w
. � WORKERS'COMPENSATION DECUIRATION � _ __ .
� IHEREBV1�iTWMUNDEROEtULttOFPE0.R7RVONEOFTHEFOLL�WPI4DECLARATKXIS: V
� ZQ
� __IHAVEMAWILLYAMAMACERTFlCATEOFCONSEHT705E1F-MSUREFOAYARKERS 2
� GdAiEN3AT10N,A9GRONiDE9BYSECTqNS7000FTHEUBORCaOEPoRTHEGER�0A1.uN[E W
OF THE WORK FOR YMKal TM9 VElWIT IS ISSUE�. �
�
_�I iUVE/WO W�LLMAMAM Y/OfIXERSO0M7ENSATqN INSURµCE.AS REOUIRED BY SECTION
Q 77000FTiELAeORCOD�PDRTHEFERFDfMNJCEOFTHEWOPJCFOHWHICHIH15PEPA1R15 �
ISSUEp,�/y WpR1(Ep5 Cd�PENSA710N M13UMNCE CARR�ER AND POIICY M11.�BER ME CONSTAUCTION
� c�r+m�w A l� � Czi���I'�J PLAN REVIEW -
Z vaierru�En la� � 1� -. ELECTRIC
<C
� �ne,ysEcrn+r[�rrneem.s�FrIDOFnErtzs.+rsrnna+e�wr�nodlu�5tnar�on�ssl PLUMBING t
Z ICERTIFYTUTNTHEPERfOFWI�AICEOGNEWORKFOAWHid17M4GEPAtrT5155UE0,1 MECHANICAL
(;j AULL1NOtEMPLO�ANYPER50NPlANYMANNERSOASTOBECd.�ESUeJECTTOTHE
N WO�iKERSCOIAVEN5ATI0NUN50FGL�FONJIAµDAGREETHATIF15110U1D8ECOME - 1NSPECTIONFEE - /-.� �-7- -
S £UOJECfTO�HENOFKERSCd.1vENSITqNVROVi5�40FSECTION]7ooOFiHEUBOA ISSUANCE � IV V
000E�sN�u.ioatHvnn+wrer�r sar+s.
� /� �__Q/�, �� _ SMiP
p DATE:�V APPIIGUt* = ��
� ENERGY P/C
wAiMNS FALURE 70 SECURE MKMKER4'CdAFENS�TqN COVERACE IS UNLAWFU.ANO SNLLL BE
. � � �ctu�EMatorERrocannau�veru�nesu+oavair+esuvroone�a[nnausum.- - - -- -ENERGYPERMIT - - - - --------------- ----- ---
--------- - -- �- -�---
r pOLt,PRS�itm.000),M7/�Drt10NTOlHECOSTOFWIAVEN5AT10N,�MU�E5A5PHOVIDEOFORIN
� sEcnor+»oeovmeusoricoo�,►r�nesr,�r+e�rroRu�^scEEs. RETENTIONFEE•
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IHERfHVAFFWAUNOEAVEN.LLTYOF�EM/RYTM1�TiHERE13ACONSTRUCT10NtEND�NOACENCY
Z FOR THE iER WR1A.V:CE OF 1M7E WORN FOR WMICH 1H14�ERIAR IS ISSUEU(SEC.JaY7,CIV.G).
W
� LENDER'S NM�E �
!— LFNDEft4MDRE55
. � ICEiRIFY7MIlT�NAVEf4EADTM5A7PLICATqNNASTATE71UlTTNEABOVEINFOHMATqNISWRRECT. TOTAL FEES • '
p� IA6REETOCOMPLYWITM/LLIC�TY1U1DtOlMrOHDMANCE4ANDSTATEUNSREUTINOTOBULDttIfI
WNSTpUCTpry,µp NEqEgY AUT}IOWZE PEPRESCMATIYES OF iF114 COUNTY TO ENffR VPON THE -
S� ABOVE�4EHf10NEDGROPERTYFONiNSPECTDNPUtiPO5E5. COMMENTS � / ��
9 �A1`[L I�ti'�L�� t I I lf /.�
� fT h� "
m 1 ,^^�_J��! •
� ���'1 ��T - �iL'I- JV
� SIONAIUREOFP OATE
RECPT.NO. PAIO BY VAIJDATtON
� WMIiE--DepartmeM Copy,YELLOW-finenca Copy,PINK-Asaessor Copy.GOLDENROD-File Copy.GREEN-AppfiwnYs Copy
! n : T T � T � � � � o n g m m � � � � � � g a � � m � �
�� z z z z a m m m A m y x o o O'o � o a m y � m � �
mm
�,� .. � D D D D � m v � r r'� O C C C',O D O 1 � � O n �
; �� �r r r r D -o -_I m � Z � � � G� � L� T � -n m v � � m �
; �. � m x c) � �o c7 �] D � Z�� m 2 2 2 n z'tn � -p L� z � -n D
�O r ' r m m O � � -I � r -- v� _ � m 2 O � 2 m O D 0 C) 70.1 �. � i _
fll C D m
�-I D Z C �- r r C �y �
� �D -- z s � � czi� � � z zv> u, � c mnmm � � r" mr G� � e�I
� z —{ � � z -i --i , � Dc � om � c» �az = v c � � r� :
i N c�n f!� � � �? z � z cZi N z � � C � m w � r-ar a '
imm c' Z -{ c� -ri � cZi � � � � ;
��. i ' �. ll � / �
� � � �
".: :,,, , ! � '� ; �
�
� � �
� � � - - � �
. �
- , � CEa
�; �� � - - - - �� �
,�, Z —
- - � v, �
_ � m. o
c� � .
� ' - - r ' Rl O S T T O � T O O � 'D � �l 37 W 'D �i m �y T 'n C C T �1 -' 0
' . _: z m m � z ... n m -n o O O Z �c m � a o p � z z Z
.�. m < �' DN � oT zm .'� voao D
_ . . _ _ .. . -_. . . . __. _ . , . _ If 77 r r- _ O � n y r r r = � C7 � r �p S v � m m 70 � �
T -i D --I ln 2 -1 r 77 D m 7J
� � 'n Rl 2 Rl N (11 n T D -i T 'it rt1 S 71 W O D � � �T O
�' "� m -o O z 1 m m r G) z n O z m -n �n U � -
cn � riz � � G� O � rZ�- nny � c� ozppmm � � � � m Z
� a 'D v -nz � L" � .zv -� oa Z � mZw � o ocn -i • n D
1 ' � � � � � � � � � � � � ' � D ��� oo � � _ � �
a c� ' � _ � � o � c�i � � n
� � � ' „ D -Dj,O 1 . .: �
� � p � .
L , r.l.� � _ .
I � `I.� .. - ,� _
� � -
'
I - -, . . , � - � .
� j � �� - I �� _ .
� s
- --.. . - ..- -- - -__-� -- _ _ _ ._ . . . _ .. . : . ; :. ._� ._ _. . _ ... ' _ _ - -- - - � .
. . - . . - , - - r - -- - --