HomeMy WebLinkAbout10137 (5) v �
- CTfY OF DIAMOND BAR 5 J��/'
COMMUNITY DEVELOPMENT DEPARTMENT /
�„� 21660 E.Copley Drive Suite 190 C PRESS
(909)86Q3195 Fax(909)961-3117
.' '~'~ BUILDINGPERMITAPPLICATION FIRMLY
•' Y JOBSITE .- APPLICATION PEflM1T / P/C
� ADDRESS • � DATE �/�� NUMBER F �/�� �t
$ APN LOT TRACT D TEE 7/�� �� CONST. GROUP
�j OWNER _ .
a AODRESS ZONING SETHACKS
W �� Z�P �� FRONT RW O
� APPLICANT TEL ��R �
� SIDEJSIDE STREET RW ❑
CONTRACTOR !fJ SIDE ❑
ADDpESS
� C Z1tYl�,»�� �L9 PROPOSED USE
p '/-s���-
w ARCHlE G/
Z DESIGNER
NO.DWEL NO. NO.
�,". ADDqESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
� OWNER-BL'ILDER pECtARAT10N SFR/ADDIREM
O
� 1 NEP.EEY hFF�MA WOER PEN1�lTV OF PFH.IUR'/TNAt 1 AIA EXEY7T FRd1 TME CONTNhCTOR3 U. Garope/Carport -
W CENSELAWFORTXEFOLLWIRARFJ�SON15EG70]t.SBUSME55AND7ROFE5510NSCODEANYGTIOR (n
U COUNTYMAApIREOUIRESAPFANRTO00N5TRUCLI�LTER�PROVE.DE4qU5H2ORREPAWANY57AUG W Pi1fOJDeC�C
�ZNqE,ppqq 7p RS ISSUMICE�13U NE011lRE91ME MPL1CNff FOR SUGII PEFU.aT 70 F1lE�51GNE0
� STATEMENT iHAT HE Oq SHE 14 UCE1lEE9 PURSUNfT TO TF1E PRON510N5 OF TIE COHTMCTOAS L� _
� CENSE UW(6iA0fER Y(C01/YENCINO�NTN SELTqN 70D01�DMSpN 7 OG TME BUSINE39 AND PRO� � P��Oa
� FESSqNSCOD�ORTNA�HEOR3NEISE%EUPTTHEREFROMANDTMEBAS�SFORiHEM1EafDE%EIAP•
V TK7N.INVVqlAT10NOiSECTiON709f.6BYANYA7PLICMTF'OFi11GEfvAi75U&IECTSiNEAVPLICMliTO z RaRoof
� F 11 CfV4 VENALiY OF NOT A10RE TIAN iNE IMIDRED Dd.lARSlisoal.):
^ O�ASOMMERO[TNEVROPEAMORI.IYEAIPLOYEESWITHWIIDESA5T11E6i50LECOAiPEN5A71ON, 0 (`,pnm8rCi01 _ .
?G WILL 00 THE WORK,M1D THE STHl1CNHE IS NOt INTENOEO OR OFFERED Fd1511E(SEQ 70t1,BUSF J
NESS AND PRDFESSIONS CODE:THE OJNTRACT0114 LICENSE Uw DOES NOT AVPLY TO AN ONMER OF
� PROPERTYNRqBVIIDSOR9A7ROVE5TMEREON,ANOMRiODOE45Ud1KORNHIMSQFOqHERSElFOq � �
� THROUCJ/H190RHEROWNfMPLOYEE3,CROVIDEDT11AT5UCNWPROVEUIXTSARENOTMEtAE�Oq m
W pFFEAEpFDRSALE6,l1OWEVERII�EBULDMKlORMPRpVEMEM1350lDWRMMONEYfMOFCdIPLE. .
0 TIOH,IME ON7aER BURDEH VJiLL IUVE TNE BUROEN Of PROVINO THAT HE OR SME Oq!pT BUKD Oq
Z YPRDVE FOq iHE PURPOSE OF SILLE7.
W . OlASOMMEROFTNEPROPEHTY,AMEkClUSN4YCWRRACTN�MRTNLIGENSEDCONftUCTdl4
� TO QDNSTRUCf T11E FRO.IECT fSEG I01�.BUSINE53 M10 PROiE55qN5 COOE THE COMRACTOR3 U• VaIUBt�011 ���� AQI.AREA
CENSE UW DOES NOTAPPLY TO M1 OVMER OFA PROPERTY NM1q BUILD9 OA MVRDVE!7MEREON,MID
� wrawara�crscoasua�vno.�crsvnnr�cavrucroncst��EnsE�rvasu,wrrornem�rrn�c. QUANTITY DESCRIPTION. FEE
� TORS UCENSE UW} -7
� OI/WIXEMPTUAERSEQ B.►P.GFORTHISREASdJ � I�OG � /
3 � /
LL DATE OYMEq V
z W
�Q UCENSED COM'RAC70RS DECUlRAT10N W �I �
tL IHEREBYAFFIHMUNDERGEWL7YOFPEM/Fi'1TMATIIUdUCENSEDUNDERPR0V1410N30FCHA7TER Vr �/
p� �(CqWENCW�WrtHSECT�ON7oao10FOM5�ONfOFT1iEeV5iNE5lANOiROFE55i0N400DE.�ND Z '
X W IICENSE 6 N RAL FOPCE MA EfFECT. m . •. '. . - •
. W - .... - � ,..., .
� u�SE Q�tE�r��'r_ __���►�. - G �1 v j
V DATE + cONTMCTOR�� � �fi"•r���� �-
W
� WOAKEAS'COMPENSATION DECLARATION �
� i�aEeru�AuutioEaoENwrrovvEaumoneosnvewuowwaoEauuraNx v
� Z
0 ��I HAVE AND MNLL MARRAN A CERTIF�C�TE OF CONSEM TO SELF-INSURE FON YAHKERS �
� COu0EN5A1qN,AS OiIOVDEO BY SECTION]70o Oi 1F1E 1A80N OOOE Fdl iHE PERPoP,IMNCE W
OF THE WORK FOR vM�G17MS PFRMIT R ISSVED. �
0
��I MAVE AN�Wtl.L MAMTAIN WOPo(ERSCOMCEN4ATqN RlSURANCE A7 MEOUiFED BY SECTION
O ]7000FTNELABORCOOE.FORIHEPERFOPAIANCEOFTMEWOWfiORVMNXii1a9PEfV�tlT15
...� ISSUE�.Id'/N�ORKERSCOMPENSATIONINSUR1wCECARPoERAlqPOIICYMI4BERARE CONSTRUC7ION
j CARPoER PLAN REVIEW
Z aaicrruueER ELECTRIC : �� '
Q
� (n65EG(IONNEIDNOTBEU7.1RFf�OFnEPE(MiBFt�HU+ElutiiEDOOU/VL9fN0710R1FSS1 PL {NG- �7-•
Z I CFRTIFY TMAT�N 1NE OERfOi81�NCE OF TTIE WORK FOR YMK]i TMS PEHMIT IS ISSVEO.I MECHANICAI. �
. __..(7 ___.. 511/I.LNOTEMPLOYANYiER40NWFNYMANNER50Jl3MBECOMESUBJECTTO7HE .-. p .
y WORKFRSCOYVENSATIONUNSOFGLffOfM�IM'DI1aRFETNATIFI5H0ULD8EODME - - -IN CTIONFEE ■ ' � � _ _
� SU8JEC7TOTHE�KERS�pEN5ATI0NPROVIS10N90F5ECT�ONf7000fTHEU180R O `'
� coo�,i srwl ropnrvnn�cour�r wm�nasE vrowsae�s. ISSUMIC � I/ �
0 SMIP '
p o�re: �oaku�rt:
W ENERGY P/C
� WARMN6:FAIUNE TO SEd1RE NORItEHS'COMPENSATION W VENAaE�5 VNUwFUI.NA SM►LL BE
£UBJECTANEMPIOYER70LRudWALPENAITIESANDCMLFNESUPTOONEIMIDREDTM0U5IwD ENERGYFEAMIT • �
ppllARS({top,OooJ,Rl�DDITION TO THE COST OF COAIPEN511TION.�M1AOE3 J1S PROYpEO FOR tt/
� secr�or�»movinev�eoncooe.ertenEsr,�rm�rrofw¢rs�es. FETENTIONFEE: .-
� CONSTRUCTIONLENDINGAGENCY pRE-ALTFEE: r'{1 Y n�- J'f�'��„U��''� �J� i,-"
� 1 NEREDV AFF1N�UNDER PENALTY OF PEiUURV THAT THFRE t4 A CONSTRULTION LENONCl�CENCY _ P lI�I n�I�v G t�.IV u "!���"�� �
N
FOH TNE FERFO�NCE�FTME Y/diK FOR WM�GI iM5 PEFWiT IS ISSUED(SEC.I�,G`/.G.).
� lE�1DER'9N1J.1E _
- � IEN�ER'SPDDRE9S �
ICEqTIFYiNATIIUVEREIDTMSMPlIUT10NNJD5TATETiUTTHE�BOVENFORM�TI(YlISCORRFCT. TOTAL FEES 87. �S
� IAOREETOOOMVLYWRNALLCT'ANDWUNNOADrtdN10E5M1D5UTEUH'3REUTWOTOBURDINO
�qJSTiWGT�ON.�'1A NEREBYAUTNDRRE PE7RESENTA71VE4 OF TN14 COlX7TY TO ENfER UPON THE ,
S� ABDVE�MEMIONEDPROVERTY FOR WSF ran vunroses. COMMENTS
�
�
m PEAMITTE6 NMIE MT) . .
�
� �' � p /
y TURE O vEwu �� FlECPT.NO. �3�OD U PAID 8Y����Iv� VALJDATION � !
~ . WHITE—OepeRmentCopy,YELLOW--Finenoe Copy,PIhK—AssassorCopy�GOLDENROD—FileCopy.GREEN—ApplkanYs Copy
— --- -- .._
�v�<n i ' ; n' �-ri �n -h ?i � m 'cnv� vc� gm�C <n �i � � � -n � g -itn G� m mfi�
.'�. � �,tmr7 b � . � � p I i a b a i c�i� m v � �s � rD-,-1 p o 0 o OO D OO � � 5 O m L�') -i ",�� .
�. + � � ��-,_,I �, � � ' ,�� r r- r f� b =i Rl 2 Z r c � � � 'il � T rti '0 �,C � V7 W
,�C) i �; 't7 m S C� 37 'D n �D D � Z�� m 2 2 2 (� Z C/7 � � +!� Z D T D �''.
# . . � ��'��•-I '� , ITl , C m m O ,,..� �I -i r (J� _ 'D rtl 2 O L7 2 N O D O � 31 � �I, ..:
T` z r y Z G � r' �" m < fn m � �p ��i�
��Y ' ' � L'��C 2 I�, ,,,�,�' i� -i Z -�.i � S- T. D C'� � W � n '� 3] m -1 < fil � C � C�17 �_ Cf,�
1 �7 Z .'� .
�.� �� ! �il�N(�!1 � - ��,. ..Z � ,.� . r � -�.Z .� q ,2 Z 'i _4 Z m i: I � O � ^rj�
�
1
b � ��mN ; � �, , � � � ozatmn � O � ,�yG� � I�, z zm ,'�',
n' ' �,/: � �. I'• Z -' - - -' c� � r —'.
� ! � ' ; �: o � d :
� r�i ���, !. ��,� '� �' ' � z �
- ; � � � . i�.� � i '
�-. � i .�1'
, �
, � _,
,I � . �
I ��� � � � � �. I 'A (•��I I '�I
1�r I�. , ��'�' '+ � �
i • ' i ' ;i,l � ` 4. ' ,'= i _ -� /';i'
� ,rr � ,c, ��� , � /'.
I - � � _ I� •�,�' - � - �`:i ���� .
� � t i. �� m O
i _ i '{ �
�, - _' _ __ _'_'I ' �___' _ __ �'.'"'_ ••• �-� O 2 T 'i1 T � O � 'C Z` �7 � LD � T � 'r,i'fl C ' T "il �.
' -- - - � _ _ ._ -. � m m � -� � � Z m -n O O O z O m � ; S �I� Z � 2 r" _ Q
- _ . �_ .I. . ._ .. .��, r. C S m ➢�U� ` D 0 T O O O C Z Rl D � � m m O O D O � ..I'-' �
- --- - - - - -- - - .e-- � �^�[t O r � O� r n cn r r r = {,� c� G7 r m S_'O 'II m fn �7 O �� � .,�-, .
I /+ � . . �^t � m = � O _ a�z -D_-t m z m � L7 � z y p � � D � � � � �.1 � ���
r < mc� na' o •, � �
� � - , cna �,zS �ic� o � a � � D � c� ozoommo o � � i��` Ri Z
j ' �i i ' ",' a � �' z �° C'' z -'c � z -� oD z � wom -no ov, -� � z � �
i ' ,_.I "c+ � � D � � � � v� � � Z � ,� W D ,� Z O 37 7� �J �O p
� / �� r -r��., � r. � � � L� � � n�p,D C � ';y _ � � .
- , i . �I � . � /, �?�� � � -� � .
- I {
� J` r :. _
_ I � —j,i. _.
� ,� , � � � �� �
� � ,�^ - i i ;, j�_`l
/ I
j i, �'.:� _ � �. � � I _ �.
� � :.i � � �r .
i - �/ '�,!' . �
- � ��
_ �
� !r I ,�t�F
i �•_ v � , _ . - i _ - . .
- . - i , ., , . ,.1
� ,
� I