HomeMy WebLinkAbout15482 G� 1�
�Ji �� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
�; 21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS_
��^^ BUII.DING PERMTT APPLICATION FIRMLY
� JOBSITE G�! ,/� C�D(�'/, ^J..�L APPUCA170 2'] PERMR 15(�i�P/C
o ADDRESS 4�(O�!' /�/� C��`�1L DATE �/ �- NUMBER /U #
$ ISSUE � TYPE OCC
APN LOT TRACT DATE CONST. GROUP
°C OWNER � C�'�
S ADDRESS Q ZONING SETBACKS
� CI7Y ZIP ' TEL ( REAR RW ❑
APPLICANT TEL SIDFJSIDE STREET RW ❑
� CONTRACTOR � JV V �/V SIDE ❑
� CD�D�+RESS Z'P �' �L � K' � PROPOSED USE T (7 � �- �
� ARCFVENG/ � ♦ t
� DESIGNER NO.DWEL NO. NO.
CtDrDrRESS ZIP �L UNRS ST IES � BEDROOMS
�
� DESCRIPTiON SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFH/ADD/REM
O
Q 1 NEREBY RFF1W lMOER OENALTY OF OE0.URV TUT 1/Ud fxEMii i170i1 TNE CONfRICTOR9 L4 G8f8g&�.8�p0�
W CEHSEUM�FORRIEFOLLdA1NaRFA50N�5EG70]1.SBUSWE59ANOFROFESSIONSCODEANYdNDR (f)
C 7 �p(J1(}yy�11p�RE0UIRESAGERMRTOCONSTRUCT.ALTER�PHOVE,pEMO(ISH,OqqEVAIRIINYSTAUG W patia/Deck
Z TUR�PRqR TO R9 ISSUNICE,�150 REOUIRES THE MPLICNIT FOR SUCN PEFIAR TO iRE A SIQNED
��� STA7EMENf TN�T NE OR SME IS UCENSED pJRSU!M TO 7HE GROYISIONS OF 7HE CONTiiACTORS LL W
� CENSE U1N(CHADTER f(CWMENCPq YAT}�SECTIDN T000)OF DM510N 7 OF TFIE BlJ5ME55 tND GRP � P��Pa
iESS10N5 COOE)OHiHAT HEdi Sf1E IS E%fMCi iHEHEfROM�NO THE BASK FOF TNE ALlEQEO E7CEMV•
TION.ANYVIOlA710NOF5EC'f10N)0.71.6EYI1M'APPLIGNfTFORAPERMITSUBJECTSTMEMPLILANTTO Z RaRoof
�„� AGVIFENALTYOFNOiMORET111WF1VEMJNDREODOLLIJiSlS50o).r
� ❑4��EROF7MEPFOPERTY,OilYYE1APLOVEESN'iTMWA6ESA5THE�R50lECOMVENS�TqN, ❑ COrt11fIBfCFdI '
WILL DO TIE WOFiK,MID TVIE STRUCIURE IS NO7 IHTENDED OH OF[ERFO fON SALE(SEC 7aI,BUSL J
N HE55 MW VRDFESSIONS CODE 7HE LONTMCTORS LICENSE UW DOES NOT AVPIY TO Ali OYMER OF �
iR07ENiY Mh1O BULD90i11MOROVE57HEREON,IUJO VMO OOE9 SUCH NORK HIMSEtF OR MERSELF Oq
� TNiqUGH MS OH HER ON'N EMPLOYEES.iROViDE91NAT SUCH aAPROVEAIENTS AIiE NOT AVTENDED OR m
�-�1 OFFERm�OR SILE K,{IOMEYEt�THE&14Du1�Ofi IA1vIqVE7AQfT15 SOID N�TMNONE VEAROG C040.6
Z TqN,TME UNNEABUtlDER WILL H�VE 7ME BVPDEN OF iROW�O TNAT ME OR SME Di0 NOT BlnlD OR
� MP{qVEFOR711EPURPO5EOF91LLE4
O t ti70wMER OF tHE PRDPErtTY.MI OCCLUSNELYGUNTMCTMO wrtflliCENSED CONTMCTORS `
TOGONSTpUCT Tf1E iF10JECT(SEG 7ot�.BUS�uE44 hN0 PROFE5510N5 COOE 7NE CONTMCTOA5l4 VelU0t�0r1_ 0 V ADJ.AREA
� CENSEUWDOESNOTA➢VIYTOlV10KNEROFAPHOPEftTI'WNOBVILD30R'MPROVESTiEREON,AND
wwcartiucnrcnwd�vra�crswitN�cartwcror�s���cEuseoamwiwrron�Eoarra►o pUANTITY DESCRtPTION FEE
� TORS UCENSE UW} -
OIII�IXEMVTLNDEHSEG B.�PGF09TN!SAEASON ¢
U
� �
OATE ONNER V
� UCENSEO CONTFU+CTORS DECLARATION -�
� w
I MENEBY IIFF�M1 INAER PEN+LT'OF VER0.IRV TNAT I u.1 LKENSED UrAER iROV15qN4 0f CHAPTER �
�(COu1AENCNO N'IiH SECTqN 7000)OF OMSidJ]OF THE FUSINESS AN0 7HOFFSSpNS ODDE..wD Z
Rry LICENSE IS!1 ilAi FORCE M�D EFFEGT.
o ��c��y� �e�C 3 g ��.�.� a v =
� pATE��O GONTRI1CTOq ' � ¢J.
= WORKERS'COMPENSATION DECLAHATION Q
� 1 HEREHYAfFlR4 UNDEA PENALTV Of PEiWRY DNE OF THE fOLLOv'INO DECLAMTqNS: - U • , .
� Z '
" Q
� _IHAVE►lAWRiWRlTAIN1ICENT�FICATEOFCONSFNfTOSELNNSUREFORriVRKERS' _ . ' ,
CdIPENSAlqN,ASPNOV�DEDBYSECT10NI1o00FTNElADORCO0EFO4TNEPFqFOF71AANCE U
� OFit1EWOR1(FOi1NMIClITMi9pEWMISi55UED. �
�
_IIUVEMAMALLMAttR1�NWOiB(EASWUPENS�TpNIN4VRANCE.ASREWiREDBVSFCTION /�,/`�/�
4 77000FTNEUBOiIOODE.iOHTNE7EAFORMANCF�FIMEWORKFORWF11q1TM5PEHMRIS �.% �
� ISSVED.M'I WORKERS'OD��FENSATpN INSURMICE GRRtER AtA POLICY NUMBER ME CONSTRUCTION �
� uwmEn ���(L� G� PIAN REVIEW
� POIICYlMABEH.I.(� }'�`�� �� • ELECTRIC ,
py�s�crurr�NpreEm�.aetppFnep[sa.rtswqa+�Hrar�oalnasR+ov�ont�s� PLUMBtNG
8 ICfqTIFVTUTR7IHEPEAFORAIMICEOFiMEWORRFORWHICNlH�SPERMITI5155UED.l MECHANICAL
- - (7 - � tqT EUPLOY ANY PERSON M N!Y��fR 50�5 TO BECOME Sl1BJECT TO THE
� VN]Po(ER5COMPENSATI0NUW40fCALIFORMAMIDACREET/U71i15110ULDBECOME 1NSPECTIONFEE - - - - - - -- -
S SIAJECTTOTHEWORKERSCd.�PEN5AT10NVMYi5�ON4OFSECTION�7000FTHEUBOR
; � �oanhnn�coua�vvmm��osevro�nsnrrs. ISSUANCE
� n �(, �� r � SMIP ♦
� DATE:�L� v- APPIIC/tNT.� h+� l
WAM11N4 FALUR TO SECURE YARKFM14'COMPENSA710N COVERAGE 14 UNUwR1l,AND SHALLBE ENERGY P� �,7�n
� yVBJECfANEMPLOVERTOCAIMWALPENALitESANOCML�NESUPTOOr�EM1NDREDTHOU3M10 ENERGYPEFMIT /'�TTl7!1�!� /� /�(�iVL D
DOU,ARS R100,Oro�,N�DOITION TOlHE COST OF COMPENSATION,pAMAOES AS GROVIDEO FOR IN —�I-Z-TpQ-t��!1�+`+ TT
J SECTIONi7olOFTHEU90itCODE�AEST,ANOATfORNEY'SFEES. RETENTIONFEE: �H��nTI"` AA���Af'['��
� CONSTRUCTION LEN��NG AGENCY ,v�
PRE•ALT FEE
� IHEREBY/FFIRMUAOERFENAI7YOFPfRIUAYlMA77MERE13ACON5TRUCTIONLENDINOAGENCY
FOR TME PERfORNANCE OF T11E WORK W F WHICi/1Mi3 DEiWIT IS ISSUED(SEC.Mo1,dV.G�.
�
� LENDER'S NNAE �
� LENOEft4ADORE53 /'
� ICERTIFYTNATIHMEREAOiH�5A7PlICAT10NAND5tATEiMATTHE�BOVERIFORY1.t%klISCORNECT. TOTAL FEES /y�/��I
p� I AGREE TO WMPLY WITH ILLL CITY ANO WIRrTY ORDINMJCES ANO STATE U�VS NFU1M0 TO&1M1D�N0 / y
IXINSTRUCiION.MA H[REBY AUfi/ORIZE REPqESENTATtJES OF 7HIS COIMTY TO EMER UPDN TNE `
ZAAOVE�MEIf�lONEO PR07ER7Y FOR MSPECTION PURPOSES. COMMENTS
� �
m PEiWITTEENAA�IP A
� « Z2 va
(n SKlNl1NREOFYE I� EE DATE
� RECPT.NO. PAID BY_ VIWDATION
WHITE—Oepartment Copy,YELLOW—Fnenca Copy,PINK—Assessa Copy,GDLDENROD--Fite Copy,GREEN—ApplicanYs Copy
- - �
- , lntn : n = -n =ri -n Ga cn v> v� o n g m vi � � �o � �ri � g -� rn � m � v�
m m � z z z A m m m A m n x x o 0 0 0 � o a m 9 r
mv .-�,� . Srnncnm � � � rr -+ occcoDo -� � � om � � ,
�-1 . I S �; r r r r y '9 -1 m r ,n Ll ,f� T1 �:�1 m '� � C n � �7 .
� -D(7 . I� �' ' �� ri 2 C� �7 'D n 77 D � Z � ITt 2 2 2 n Z.U7 � 'D L� Z � T D T�{ .
i �,I -i-I�•� t T 1 c m D � -I � y r Z � 2 � r r m � � m m � D � C� J��.7 7�C r
�,' Cz -�Z . � ..n.� 'icn u m ii- Z Zcn U' ccmym D7o o r L� " �J'g
/. m z -� � a � � m -� < mm �i
� �•� O' -I Z � � . --i r � oo W � -i � y = � c � �
� N� (/� � n Z � � Z m p Z �i C� 's O (n ��
��. �, ,� m N � � z � �n � [� � r-y G) m Z z m . ��i
� - , � rr� z � -i G� � r- "-i
O , �
_�4�.1,l��� � _,_„ � — � Z ��� .
s
J i�1 .
4 � .�� �! -
_ 8 -
��
, ,;�;
- _ .�� � �
� `�� N �
� m o
� _ - � -�� �
� 'i;a rn O 2 T � O � � � O � v � T ]7 m -9 -n m g T T C C T -n . �
,,1 z m m � z -- y m T O O O z o m � Z T � � Z Z = � *' O
- t,7 m < Y m y � Z y, p -r� O O O C Z m y -1 � m�m O O D O t D
e:j D � -ri o � --� � r n (n r r r = L� n � r m 2 � v m m 7� O��, z �
c ,t..,;�, � m o -mo O m y z -ni m z m � � � z D O Z m D � T � p � '?1S; � �
�-'��6 (n m ;-� Z � v G7 O D -' m � z7 L7 Q Z p D m m � � � � :"',..��'( R1 Z
4�`�� � 't7 D Z � � N Cn r 'n � O A � O D ¢7 W O 17 77 � 'i ..LL' (� IA
� L� . � Zo � mm � p F
�;
_ - _ i Z r 37 C] � � D z m � z.C) O 'i° �
i D c� � �,S W o o � ;�-; p D
. � r m D� � _..{ �
I T � 1
� _ I
i•. '�` ��+F�
- =`i
�
Ij��
- i,— — _
- ' -
- _ - � � - _ ��'.
�
� ; � �;� :
I ' , �� ..
.
i ._�' �
r