Loading...
HomeMy WebLinkAbout11166 � �i ' —f�``�---� CII'Y OF DIAMOND BAR ! � r� I � � ' COMMUNITY DEVELOPMENP DEPAKI'MEN'T � � .��-:.-t: 2I660 E.Copley llrive Saite 190 ! � .,. ,. (909)860-3195 Fax(909)861-3117 �. PRE�J� � `�'""%�' BUILDING FERMITAPPLICATION C�.%'F FlRMLY I I � JOBSITE �Z� '3��yp�(�4L /�O� APPLICATION t�(� PERMIT � p/� j o AD�RESS � "( _-____--___--_ DATE �I��`�� /J NUMBER ( q m ISSUE IYPE OCC APN LOT TRACT DAIE a[ CONST. GROUP p OWNER �'1{�(�Y � j�s�AHr� �H)qN <• o ADDRESS '�� H/ {b� ZONING SETBACKS oCI7Y �D«f'I�N� I��' ZIP�"�/7��'TEL. Fa '�✓ ,a2� FRONT RW C APPLICANT '�DSC���f,�flt9J TEL. f/ REAR C Z SIDE/SIDE STREET RW u m CONTRACTOR 81�RlJJ � �LL(J�t,Q�N� SfDE ¢ C ADDRESS o ��T�' ZIP _ TEL._�__"�� PROPOSED USE Q�LRL;E W/}'f'�Q N�}� �w ARCH/ENG/ z DESIGNER a ADDRESS NO.DiMEL. i NQ. NO. � C�n, Z�P TE� UNITS__,__ STORIES t BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREEUVqLUATION �� OWNEF-BCILDER DECLARATION t-n Q SFR/ADD;REM � �" �� 1 HEREBY AFRPM UNDER PEN�TY OF PERJURY THAT I AM'eXEMPT FHOU THE GOV7HF(;lUHS Lb GBfe JB/CBfPOf[ W�- CENSELA�YfORTHEFOLI.OWINGflEASOM;5EC.7�U^t.58U5MESSAN�PROFESS1045CGDE:ANyCIT�OR (n U� CCUNTYWHICHPEOUIReSAPERbtI770GON5T?�UCT,ALTER,iS,PP,OVE,DEN.OL�SY,ORRE?AIAANYSTRUC- � -t W Tl1RF,PAIOR TO ITA ISSUANCE.ALSO RECUIRES THE APPLICANT FOA SUCH PEFMIT TO FlLE A SIGNtu :W Patio/Deck � � STArEMEN7 THAT HE OR SHE IS LICFNSED PURSVANT t�0 THc PAOV;SION.i OF THF CONTRAC70RS!!- � ' — ------ � �-�� CE�'SE LAW(CNAA7ER 9 jGOMMENGNG 4YITH SECTAY>000)OF O:VlSICN30�'TI�IC BUSINCSS AN�!'RO- � � PooL'Spa - O. FESSiONSCODE)ORTHqTHEORSHEISEXEMPTTH`cREfRO1.tANUIMt9A515FOr�7HEALLEGEDEXEMP- (� — U TION.ANYVIOLATIONOf S'eCT10\]o3t.52VANVAPpUCANTFORFPERl.71TSU83EC7STHfA�P1_ICAtiTTJ z Re-Rocf Ady�L PENALTY OF NOi MORF THAN FIVE fiVNDRE�OO�LARS(550o).i: ' I - ��: GI,ASOWIvEROF7HEPNOPERfY,03f�1YEMPLOYEf-SWITHYlAGESASiHEIR50LECJMPeNSAT;CN, .�I COmtTIOfCiei 1 �Z.. WILI.p0 THE WORK,AND THE STRUC7UFE IS NOT INTENDED OR O'rFERED FDR SALE!SFC.70M14;9USI- � J� � �_ NE55 AM1O PROFf5510NS C�E:THE CANTRAC iOP,S LICENS[l AW OOES tiOT APPiY TO AN OV/NER OF . ?I PROPEHTY WHO 6UIlA5 OR IMPflOVk.S THENEON,AYD WHO DOES SUCH WOflK HIIASEL�OR HERSE:F OR .� CL-. THFOUGHHISORNER�i4'NENP'_OY�ES,PHOJt�F�THATSL'CMIMPAOVEI!c'4TSAREf:D'LVTE4�JEDOa � m �W- OFF�pEDFORSAIE.IFNOWEV[R,iHEBU!IDINGOqIMPRWEMENTISSOL➢WITHINONEYEAROFCOMPLE-- -0' TION,THE OWNEq-BUILUEH WRL HAYE THE BUftDEN OF PROVING TFipT HE oR SME DID NOT BUtLD OR I �" iIUPROVE4'ORTHEPURPOSEOFSALE). � I C I,A3 OWNER OF TI IE PROP[liTV,AM CXCLUSIVEIV COM RACTWG WITH UCENSED CONTRqCTORS ���'. TO c;ON57HUC7 TME PflOJECT(SEG.7Caa,BUSINESS AND PROFES310N5 CODE:THE WNTRACTOHS Lb VelUdfiO� ADJ.AREA �W� CENSElAW00ES�OTAPPlYTOANOVlNEROFAPROP[FiTI'YlNOBULDSORIMPHOY'cSTHEFECN,ANJ --_--- WHOCONTRACTSFORSUCHPROJECTSWIiHACONTRACTOR(5)LICENSEDPURSUANT?OTilECC.VTRAC-. QUANTITY DESCRIP710N '~ �10NSL10ENSELAYl.j. FEE Y �-�_ ��AMEXEMPTUNDERSEG B.&PC_FqRTHiSPEASON :. Q U �� DATE � �2 Z' ..� . OY��ER �. �- ��.�- UCENSFDCONTFA DRS ECLARATION ` W 3 Q �—__ CC- IHEREBYAFFIRMUNDERPEhALTVOFPtHJURYTnATIAMLICENSEDL'�DERPqOV1510Y50FCHAPrEft -'� --'--� ' _� �.d� 8(COMMENCIMG Vl1TH SECiIOfJ'/60oj OF OIVISION 30F THE BUSIMESS AND PROFESS'ONS CODE ANO ; z , _ .`X_- MYLICENSEISIN.'JLIFOFiCEP.\OEf�CCT _ � � ;.�_ LICENSE CLASS �IC.NO. , �� � U�� DAiE CONTRAC70R '- a � W- ���- WORKERS'COMPENSATlON DECLAFATION '- Q � � _� �- IHENEBYAFFl9MUNDEflPENALTYOFPERJ:IRYONEOFTHEFOLLOWI�qDECLARATIOVS U � � � z I i �D3� 1HqVEqNp1/!I�MA!NTAINACERTIFICATC.OfCONS'eNTT0SE4'-IhSUREFORWOqKERS � - - - � .Q�:_ COMPENSA7iON,AS?ROVIOCOBYSECTiIXJ37000FIH�I,ABOR(X%IE,FOkTfiEPERFORMANGE I .��. UI I � � _ OFTHEWORKFOfiWHICHTHISPERMITIS155UED. - � W� W � - _IHAVEAY�WILLMAINTAINWORKERS'COMPENSATiOYWSUPANCF,ASFEQL'IpEDBVSECTiON � � 'O-- 37000FTHELAF30RGO�E,fOqTHEPEflFOHMANCEOFTHEWORKFORWHICHTHISPERM1715 � ISSUED.MY WOFKERS'CANPENSATION INSl1RANCE CAqRIeR A�\�PO:JCV NUMBER ARE: CONSTHUCTION j; caawEa PLAN REWEW - , ` ���- POLICY NUMBER ELECTRIC � ���� Z d �.�:� (�WSSECI'1(XJNEmNOTBENMrLEfEDOFTNt'PERA9TISFpRONEHUt�DR�DOLLMS(51001,ORLESSA MBI W i {5y�p �Z. �CERTIFYTHATMTHEPEFFORMANCEOFTH[W'OHKFURWHICHTHIJ'PERMITISISSUE0,1 MECHANICAL � 'j� r� �� `� ^kT�C.j�"' � -;�C��- SHAILNOTENPLOYANYPEA50NINANYMAN\ERSOASToBECO.V.ESl1RJfCTTOTHE I —'-'����T�� ��JJ�: WQW(EPJ'COMPENSATIONLAWSOFCALIi�ORNIA,AND�IGF ETNATIFiSHOUiD6EGCb1� - � INSPECTIONFEE _ � �= Su&IECTTOTHEWOFi(ERS'COAIPENSA710NPROVISIONSCFStCIICiN3luoOF7F1ELABOR � CADE,I SHALLFORTHWITH COMPLY WITHTHOSE PpOVI510NS. I ISSUANCE i 0: �-`p. DATE: APPLICAN7; ���' I SMIP '��,J: WARNING:FAIW RF TO SEWRF,WORKF.flS'COMPENSATION COVERAGE IS UNLAWFUL,ANO SHALL BE ' ENERGY P/C -�; SUBJECTANEMPLOYERTOCf11MINALPENALTIESAN�CiVILFiNESUPTOONEHUNDRCDTNOUSAN� ENERGYPERMIT �OLIARS(S70G.000�,f�A�UI710N TO TNE CG570P GO,NPENSA7�ON,�AMAGES AS PROVIOEO FOR IN �.'-J--- SECTION37080FTHELnBOFCO�E,INTEflEST.ANDATTOpNE1"SFEES, — �- RETENTION FEE: �aw..� CONSTRUCTIONLENDWGAGENCY pRE-ALTFEE: . O: '�_: 1 HEREdY AFFtRM I INOFR PENALTY OF PERJVflY THAT THERE IS ACO45TRUC�ION LEN�ING AGENGY "Z- FOR THE PERWRMANC�OFTHE WORK FOR WHICFI THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). —-- ---- W- -��' LENDER'S NAME �:. �"-- LEN�ER'S AD�RESS � �: - T :W�-; ICFqrIFYTHATIhIAVEREADTHISAPPUCATIONAN115TATETMATTNEABGVEINFORMA710NI5GOtiRECi �' TO IAL FEES � • � IAGHEE TO COMPLY WITH ALLCITY AND COu4TV OP.�INANCES AND S7ATE iAWS REL4TING TO BUILDIN3 �_ CONSTqUCTIQN,ANDHFREBYAUTHOFRERCPRCSENTAT!VESCFTHISCOUNTYTOtn'TERVPONTHE ,z._ A90VE-MENTIONED PROPERTV FOH INSPECTION PURPOSES. �Q :- COMMENTS_ . � � m� PE EENAM MTj, �` .-. . d �(n_ A�UR FPERMIITEE-... OATE � ..... , �� RECPT.NO. PAiD 8Y VALIDATION � ' - WNITE—�epartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy ���r n�.. ..�e i. ,,:.�_ i _ _-�.._._ ...� t � t fi,_ . ( t ' v ��°_ �a ,�.�, � = s� � � 7 5 c I � �i �; �� � � � �' I � [ ' I � € � � �— E��z � ��� � , e � � � , ,, ` ,�� , �� � -��.. a � i ! � ; c� � � � .�I �i i r �� -r I -�� .�:. � ( i I � �� 5 �� � � �.a ��- � � ( ; � • � , � -� � � i� i � (�— .�.�. ��� �=� �� � ! ( ' ( � �, E I � � , �—s ' � � �� � ��� .� � ; i I , � � ` �.� i �z � � �,�� � "�'� � � �rx� r � � i I ( ; i � i i I ' � E f,� � l I'Y� ��.._ , . � i � � ' F E � # � +� : ( � � . .. � t_- — E —� '� —� -- -- — ��� � ... �r_, .._,. .�. � , , ,; i . ' � � � � � . ' ( 4 f � . .� _i ( i i � �.. > � � � i � ; ( �' � � � I � € �.. i , i � ! � � ! , . �_ , • i � � ; I E � , , ; f ; i , �� �� , � � � , � i 4 � ' ' ; ' � �,. I i j—� — ' — r ��—;— i I�—E i �i �_i—�—;—_; � ' i I ` � � i ( I � � ; , � i - �� i = � � I i '+� I � � I ' i � � i I I i � �: � � ( i , f ( ( . i � I i 3 I� � � � i � � � i � � I f i ,���'. � ��',. � � ! ( : � ' � � ! � , ` I ( ; i I i � � ; � j i ; i I � � j �� � � �� � 3 , ; � F I � � , , i � ,� . � � = a � � ' � � � ,� E , � � --_ — — — � � , �� , � ,� _ ' ' , ' ' � ' j � ' , ' _ -- t � i ' ' � ,� ,� � - � tj ; i I ' , € � 4i ^ ,� , ry i �, � `� � � � i E I i € t : � � I I �"' E �J �'� , �€�� q � � `�;i i �j'�jn'� �! �I .. 4 ,�,�':� ' ��c' o� - � � 1 � , � .�� � � , r' w (I— P �T , I � . �°, �' �. i � f I ; j j ; � I � � r � r r� i ' � I � y' e �' ; s; a� -� t� i 3 � i j E ` i.. � i ' . �.' � ..-yi �s° � ���� r'�'I 'L ���j��� -`I�) ,�' "31t �i �' r. � � 3I ( � � � sP ,.,^ _ -��.,,I i.t]I ' �I� �� �`��I� } �x� t'i�a�"`� �. `3°�''" . �� � i � I i I ' � � ( � i I �� � � _ r`.I 1 � � � i; � ("j�' i �I���s..� C� } �ffi � � f{ ( ( f t � I � , �- I 1 - � ! ( ( � � i � �I� ("' '� . 1 j '. 4 , � i � i j ��, �, � : ( € � I � i � i I f ( � ' I i r I � . ( � � �i � 3 ��I ' ' ' i � a I - - � ' � E � ( � � ��'� _� __� � �- � E � �. � � - �i Gf _ _f � � i . � � -�._ { ] ^`� �.� ! ' I ( f �� _�� �� � � 4 � ' � � I I . � : ( I i ' ��..,, f "{. :,� � : �. . I i � € � I � I ' I f ' ' -� I F t ( � f �� 4 ( � j 3 i i I ;;, ; ! �I__�I_I—I � ) - � I � -� I� �; ; ' � : ,��,__ � +v I ( ' ; I I ' � � i I ° , ; � I �7 �- r• � � � i�,.,> � ( � f j � ;� I i € ( i ' � � I � � � i '� �� � �`: ` � i ' ( � � i i � i � E ( � ( > 1 � � i � I � i 1'" �` . 1 : I � � �Q� ` � ��� . . � � € I � �� i ' ' . � € I ' � � � I �� ! ' �� . j . � I -� ( � � � � - ' � � ' � I !� � , . �. . . � i � : � ��. : i , ' � � - I 1 � '' ] ( : ' � � . i � � .; �. i i ,: i , � � , , �...� � l._.....,.__.�_._.____.._..4._' -_...__._.,_..._ �._________..._.___�.s.._...�_ . � ..-,�._,,..> _�_�.__l._�..._��._ '� -'-_�__'- ' • � .��.�..,�. __ .._ _.._ _._�.._...___...___.___,_...1.__..... �.:__,1.._� __ - .