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HomeMy WebLinkAbout14666 (20) _ ___._�.......�--�' � CITY OF DIAMOND BAR ` � DEPARTMENT OF COMMU1�iITY&DEVELOPMENT SERVICES � � . 21b60 E.Cop2ey Drive Svite 190 (909)860-3195 Fax(909)861-3117 PRE$$ ��^�'�' BUII.DING PERMIT APPLICATION FlRMLY oy JOBSITE t ii,� �P p�r.� �,/t��\�- . DATE CATION�` �UO NUMBER/ !�b �/C ADDRESS �"T � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP � OWNER �����C�7�i4'fL B ADDRESS 1��04� QB vl 7'^I ��` ZONING SETBACKS CITY�li}Ht%� �i..21P TEL. FHONT RW O APPUCANT ��, REAR p SIDFJSIDE STREET RW O CONTRACT ��#' �.`I C� SIDE ❑ � ADDRESS� �� C � PROPOSED USE ��TZ �-� C ZIP �TEL 3 � � ARCWENG! � DESIGNER NO.DWEL NO. PJO. = CIDTMDRES3 Z'P � UNITS � STORIES �' BEDROOMS � � DESCRIPTION SQ.PT. FACTOR PSF ADJ.AREANALUATION Q OWNER•BUILDER DECLARATION gFRlADDAiEM O : 1 i�RE9Y AFRRM Idd�R PENN.TY OF PERRIRY THA7 1 AM EICEMPT FRDM T}IE CONTRACTORS U. - _ - , -�'f�- ._ CENSEUWFOR7VIEPOLLOMANOREASON(BEC.7m7.88U51NESSANDVROFESSIONSCODEMIYqTYOF. N Garage/Caiport -- ���'--, : OOUMYWNIWREOUWEBAPERMIT7DOONSTRUCT,ALTERMPROVE�DEMOUSi.ORREPAIRANY9TNIIG. W PatiolDeck .-. tIIRE,�RpH TC 17S N9UANCE,iLLSO REQUIRES 7HE APPLICANT PoR lUCH-PERMIT TO FRE�810f1ED� W STKfEYENT 7FNT XE OR SHE IS tICENSED PINISUNIT TO TNE PRDVISroNB OF 7HE CUNTMCTORS ll�' CBYSE LAW(C117�PTEA Y�GONMENCIN(i WITN tEC710N 7000)OF�lVISION 9 OF illE BUSINESS AND PRO-. �' ��.P8 FE65pNS OOD�OR TINT HE OR SHE IS IXEIIPf iHEREFNOM AN�7TiE 6�SIS FOR 7HEAlLEOED EXEMP-` TpN.ANYNDlAT10NDF8ECT10N7Wt.6BYANYAPPLICMfTFORAPERF�TiUBJECT37HEMPLMMITiC1- Z �i6-F1Opf � A dv�ve�u_7r oFta7 uoaE 7fiw m�wn�IDNEo oouatt51t5ao1�R . . . . � OI,ASOWNEROF7HEPROPEiiTY,ORMVWPLOYEESNf11HWAGESAS7NE1R9OLE00AtPENSATION.'" �qmmBlClel �. MflLL 00 THE WORK,AMD THE STAt1Cil1RE IS NOT MJfEPOED OR OFFEqEU fOR SALE(8EC 7Cu,BU&-. �J NESS AND PROFESSIONS COO@ iHE COMRAC70R6 LICENSE U1ri�OES NOT APRY TO iW OWNER aF• � PNOPERTYWI108ULDSORIMPROVE8Tf1EREON.ANDNM1IOWESSUpiWORKMIMSELFORHERSELFOR-. _ TNROUOFIMISORFffROWNEMPL0IEES,PNOYIDEDlNA79UCHIMPROVEMENTSAAENOTk�TEN�EOOR � OFFERFD PORSAI.E IF,NONIEVEi�TIff BIMLDIN00R MPNOVEMENf 18 SOID WRHINONE YEAfl OFCOMPIE� TqN.TiiE OWNER�UILDEA WILL HAVE T1E BURDRI OF PqOVING THAT FIE OR&1E DW NOT BUItD ON WVROVEFORTNEPURiOSEOFSAL�. - - ' OlASOV111EROFTHE PV'�PER7Y,AW EXCLUSNELYCONTRACTNO WI7H LICENSEO CONTRAC�OFS-. TOOOdSTRUCTTIE Pf10JECT(eEC.1w1.BUSINESS ANG PHOFESSIONS OO�E:TIE CdWiIiACTORe U-. VelU6tl ADJ.AREA CENSE lAW DDEB NDTAPPLV TO AN OWNER OF A PqOPEflTY WF10 BUlL08 Ofl tlAPipVES 1HEREON,M1D" wFaoorrrw�crsronara�nnarecrswmucorrrrucronfs>��cEnseorvnsua+rmniecattru�o QUANTfTY DESCHIPTION FEE � 7GIi5 LICEI�ISE tAW.} . � . .. . O I AII EXEYPT IAJDER 8E0. 8.i P.C.fOR THIS REASON - U � � �� � = � ' U wRE owNEn U - g G�{'�J � UCENSED CONTRACTORS DECUIH/�TION � � w �,I HEREBY KFitlA UIS7ER PEWKTY OF PERURY 7HAT 1 MI UCENSED UNDEH iFqVISiON3 OF CHAPTER � � �(COMYENCNO YA1H 9ECTION 7ooD)OF OMSIDN 9 0F T}iE BUSINESS ANO PROFE9SIONS CODE,AND z LICENSE IS N1 RLL WRCE MID EFFECT. 0 � 3E CLA35 � �� LIC.ND. � `�CJ���fS j W Z-� �� t - CONTRACTOR �"�1�' TL-• . C�. � � �. <.S� C�.S.�n-� WOiiKERS'COMPENSATION.DECLARATION � - � ' �-sT , d � I HEREBY AFFIRM UNDER PENAL7Y OG PERIU0.Y ONE OF THE FOLIAW WO DECLARATIONS Z ' ' . . . Q _111AVEMI�WILLMAINTAINACERTffICATEOFCONSENTTOSELF•IN5UREFORNfONKERS' _ Z OOMGENSATpN.AS PROVIDW BY SECTION a70o OF T4iE U�BOR CODE.FOR iHE PERFOFMANCE U Q OF hiE MlORK Fd{Wri1Cf1 THIS PEipIR IS i6511ED. W � �I HAVE AND WILL IAAMTAIN WONI�RS'OOMPENSATION INSURANCE,AS REWIRE�8Y SECTION � � Q 9700 71iE LABOR OODE.FON TME GER WHMANCE OF THE WONK FOR MfH1d17NIS iERMRIS K6U NORKERS'COMPENSATqN INSURAWCE CARi11ER AND POLICY MIMBEH ME: CONSTRUCTION j ie Z-Ew►D�+�.1 PUW REVIEW � Ep � � �fZ^ EI.ECTRIC . �o� o eEcror+��areEm.a�oanEvew.�rsFon«+e�a,�namoaLwsmm�«+�a� PLUMBING � � 1 GERTIFYTHAT N 7HE PERFOfMANCE OF TNE WORK FOR WHlpi TMIS PERMIT IS ISSUE�,I MECHAMCAL ,__ � SliFLLNOTEMPLOYMIYPERSONINANYNAKdER50A5T08EC�lESUBJECTFO7HE p� WORKERS'COMPENSATION UWS OF CNAFORNIti Mm AOREE THA7 f I 8F10ULO BECOME INSPECT4ON FEE � S SU6IECT TO 7FE WONKERS'COMPENSA710N PROVISIONS OF SECTIQN 97U0 OF THE UBOH cap�� annnn�couv�rrnnrnasEaaov�snNs. ISSUANCE �� O � DA7E: ��APPLICANT: - ��� SMIP W/JWIHO:fALURETOSEWNEWOFC(ERS'COMPENSATpNCOVEMOEISUM.AWFi1L.R1m5HALLBE ENERGVP/C �y BUBJECTANEMVLOYENTOCRNdINILLPENALT�SAN�CMLFiNESUPTOONEM11ND1iEDT1Kri19AND ENERGYPERMIT r OOLI.ARSIitaO.oao}INADDITIONTO'INECOSTOFCOMPENSATIDN.DAIMGESASPHOVIDE�WH14 � SECTION afoe OFTHE LABOR COOE,MERESL AND ATfORNEYB FEES. . RETENTION FEE: CONSTRUCTIDN LENDING AGENCY PRE-ALT FEE: I IIER�V AFFlq1A UNDER PENAL7Y OF PEKR1(tI THAT iHERE IS A COAISTRUCTION LENDING I�GENCY z FOR 1XE PERFORMANCE OF THE M/ORK fOR NM1iiqi 7HI3 VERMI713155UE�(SEC.]07/,CIV.C.). W � LENDEIYS NAME � � � LENDEIC9ADORE55 � 1 CERTIFY THAT I IIM/E pEAD TNIS MPIJCATION AIJD BT�TE7HAi TIEABOVfi IHFORMATION IS COFIRECT. TOTAL f E ES � IAOREETOCOM7LVNATHALICRYANDCOUNTYWiORJANCESANDBTATEUW5RELITINOTOBUILDINO � OON5T1tUCT10N,lWDlEAEBYMJ71WP12EREPRESEMATNESDiTHISCOUNTYTOFMERUPONTIE - ABOVE-MEMqNEO PROiERTY PoR WSPECTIDN PURPOSES. COMMENTS 9 c�,q.r�L,t� sc�v i 2-- � PERMITTEE E(P � �'��c�— e�� 3��� �L. N YWNASUREOFPERIATIEE DA � . RECPT.NO. PAID BY VALIDATIO WHITE--0epartm�t Copy,YELLOW�hanoe Copy,PINK�1lseesea Copy,GOLDENHOD--File Copy,aRE icanCa Copy CITY £�F D1�f1�AND ��,R � . ` � Il��F��CTi°E4� R1E�C��� , .. _ . �.,, z. _,� � .� �a,.,:� - �.. _ . . n ._ x_ £,, . __. r._ : . ���_ ��� � � �� • � - � � � a � • ��� - �, SET Qt4i�Ft� ' i- " ,. I Y ` f 'FLOOR Jf.,IS%, , ��� ,�__ .'3 r 1 �'N. FTG�I�O�1l1S;STEEG_ —� —�-- _ � FHt�REQi�1TS _ ( � --- __— — ----,----- : , _. Ef�'vTRI�t'a��UND � i UNI�ER FL�OF� DU�T . , t GF?�?!s��� �'LUPv18lNG � � UNDER FLOflF�CUNDJIT ;; : 3�, , -. , ' � . _----- ' — - - S!},u=�'..zF�i�(�c � FIREPLACE FC3UNLlATIOAI + . - _____-�_._� ' • rE�� ��'v'�FE� ; ; I FIRE�LACE BOFdD S�AM . �_ 1��4TE�S�.fiViCE 1_ __ ; ; MiD HT. BON ��ANi , : , . . . , . . ; � _--______---_-� . •_ ' ; . . ... . 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