Loading...
HomeMy WebLinkAbout12493 ti M_� CITY OF DIAMOND BAR � ---��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRE$S � � ��ro��V BUII.,DINGPERMITAPPLICATION FIRMLY � DDRESS ��G�o �DG�C_Fbq'f ' DATE'CATION �D�I 6�-�� NUMBER L ` #!C � c� ISSUE TYPE OCC = APN LOT TRACT DATE l� � ���'�� CONST. GROUP p OWNER 5'�,t,ry�_I9'1[+ �/�}Y LE?� � a ADDRESS t�},(�L '�7E�"1L Fob� q(�i ZONING SEfBACKS z CITY Ds.A�ns7.J� (�� Z(P 1'71C TEL. � �t-'7T8$ FRONT RW ❑ _ g APPLICANT � C�7+�1 REAR ❑ � SIDE/SIQE STREET RW ❑ � CONTRACTOR +Mti�cE C��ri SIDE ❑ a ADDRESS..�b�i E. A3�.+�rm A-t1E � � CITY S�A-nI O�n�nc ZIP iZ73 TEL�`;�'� PROPOSED USE n ARCHlENG/ � DESIGNER T�'�o N't)�6 ksfl�i NO.DWEL. NO. NO. a, ADDRESS $$�io L�kw.DC : UNITS STORtES BEDROOMS � ci7v Rt�.aara ��r.+.�c ziP f`x}1 TEL:g�S��ti � DESCRIPTION SQ.Fl: FAGTOR PSF ADJ.AREANALUATION � - _Q -OWNER-BUILDERDECLARATION SFWADDIREM ' - - - - O 0� i HEREBY�FFIpM UNDER PENALTY OF PERJURV THAT 1 MI EXEMPT FROM THE CONTRACTOpS LI� �- Gdf2 8/C R - W CENSEIAWFORTHEFOLIOWINGREA50N(SEC.7037.SBUSMESSAN�PROFESSIONSCODE:l�NYCITYOR (n .. U COUNfVNAiICHREIXliRESAPERMITTOCONSTFIUCT,ALTER,IMPROY[,DEMOUSH,OftREPAIRANVSTiR1C - W PdIiO/DBCk � -�: TUpE,Pqpq TO ITS ISSUANCE,ALSO RE�UIqES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNED - w - STATEMENf THAT HE OR SME IS LICENSED WRSUANT TO THE PROVISIONS OF THE CONTRACTOHS LI� �� CENSEUW(CHAPTERB(COMMENCING WITHSECTION�oDO)OFOIVISION90FTHEBUSINESSANDPRO- -�'- POOVSp2 FESSIONS CWE)Ofl 7HAT ME OR SHE IS EXEMPTTHEftEFROM AND TME BlSIS FOA T17EALlEGED EXEMP- V TION.ANYVIOIaT10NOFSECTION7031.58YANYAPPL�CANTFORAPEMIITSU&IECTSTHEAPPLICANTTO Z� Re-Root _ � AqV�LPENAt7VOFNOTMORE7HANFNEHl1NDREDDOLLARS(f500).): - � ❑I.ASOWNEROFTNEPROPERTY,ORMYEMPLOYEESWI7HINAGESASTHEIRSOLECOMPENSATION, O COmnlBfCiei - _ WILL DO THE WORK.�NO THE STPUCTl1RE IS NOT IMENDED OR OFfERED FOR SALE(SEC.1w4,BUSI� J NE541�N�AROFESSIONS fbD'e:i1iE GONTMCTORS LiCENSE LAW�OES NOT APPLY TO AN OWNER OF. _ - - �� PFiOPERTYVh10BU9.O50RIMPROVESTHEREON,ANDWH000ESSUCHWORKHIMSELFORHER6ELFOq - . a- TMpOUGHHi50RHEHOWNEMPLOVEES,PHOVIUEDTHATSUCHIMPROVEMENT5ARENOTINTEN�E00R � � = �_ .OFFERmFORSALE�F110WEVERTMEBUIIDMGOR�MPROVEMINTi3SOtDW1THINONEYEAROFCOMPLE � -TION,THE OWNEfl-BUItDER WILL HAVE THE 6URDEN OF PROVING THAT NE Oq SHE DID NOT BUILD OH IMPIKIVE f-0R TME PUPP�SE OF SALE). - ❑I,AS OWNEROF iHE PROPEflTY,AM EXCLUSIVELY COMMCTING WRH LICENSED CONTRACTOHS � - -d�. TOCONSTRUCTTHEPqOJECT(SEC.70�4,BUSWESSMIDPROFESSIONSCAOETNECOMRACTOflSLI- VelllAflO� � ACIJ.AREA � W GENSEUWDOE5hGTAPPLYTOPNOWNEHOFAPROPERTYWHO8UILDSOflIMPROVES7HEPEON,AND � -y/HpCONTRACTSFORSUqiPHOJECiSWITFfACOMRACTOR(S)LICENSEDPURS�ANTTOTHEWMRAG- QUANTITY DESCRIPTION- FEE - �roqs ucENss uw.�. �_ �AM EXEMPT UNDER S�C. B.8 P.G FOR THIS FEASON Q ' _C � � �' � f� V � : � � � u' OA7E , � ONTlER - Z �VyJ � � LICENSED CONTRACTORS DECLAHATION iy � .IHEREBYAFFIRMUNOEHPENALTYOFPERIURYTHATIAMLICENSEDUNDERPROVIS!ONSOFGNAPTEH --� . - � - p„- --e(COMMENCIN(iWITHSECTION70W)OFDIVISION30FTHEBUSMESSANOPROFESS�ONSCOOE,AND : Z - 3G MYLICENSEISINFULLFORCEANDEFFECT. - m L1! - o LICENSECLASS � LIC.NO. ��,�3 � r ( -- � � DATE ii7�lGi�i� - CONTRACTOFl YhIKt P���'T�.. � a iu_ ;� ,� � � �- � WORKERS'COINPENSATIONDECLARATION �c� � IHEAEBVAFFIflMIJNDENPENILLTYOFPENURYDNEOFTHEKOLIOWINGOECLARATlO - C!J Q G _IHAVEANDWILLMAINTAINACERi1FICATEOFCONSENTTOSELF-INSUREFOftWOPKERS' _ Z COMPENSATION,ASORON�EOBYSEC710N3'IODOFTHELA80PGD0E.FORTNEPEflFORMANCE U Q OFTHEWORKFORWHICHTHISPEflM�TI5155VED. � O - - W 1HAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE.ASiiE�U1RE06V&ECTIOY � O �370o OF THE LABOR COUE.FOR THE PEHFORMANGE OF THE WORK FOF WHICHTHIS PERMIT IS ��I�� ISSUE�.MYWOflKEAS'COMPENSATIONINSURANCECARRIEflAN�POL�CYNUMBERAflE CONSTRUCTION < J }- cARqiER - PLAN REVIEW Z POLICY NUMBER � ELECTRIC. —/� ¢ 0 (TFAgSCCiqNNEpNDTBE�EIEDOFTF�PERM`TISfOR�NEHINURED00LLARS157oo)tl7LFSS). PIUMBING . ____ Z I CERTIFYTHAT IN THE PERFORMANGE OF THE WORK FOR WHICH THIS PERMI7IS ISSUED,I MECHANICAI ('f SHALLNOTEMPLOYANYPEflSONINPNYMANNERSOASTOBECOMESUeJECTTOTHE N WORKERS'COMPENSATIONIAWSOFCALIFORYIA.qN�AGREETMATIFISHOULDBECOM.E INSPECTIONFEE �j r- SU&JECTTOTHEWOFKERS'COMPENSATIONPflOVI510NSOFSECTIDN37000FTHELABOFi ISSUANCE �_{�`�" � CODE,ISNAILFORTNWITFICOMPLVWITHTHOSEPqOV1510N5. � SMIP — p �ATE: APPLICAM. . ___ __—_.___ __- . � ENERGY P/C WARNING FAILURE TO SECURE WOFKERS'COMPENSATION COVERAGE IS 11NlAWFUL.AND SHALL BE �y�- SU&IECTANEMP�OYERTOCHIMINAIPENALTIESANOCIVILPINESUPTOONEMUNDFEDTHOUSAIJD ENERGYPERMIT DOLIARS(S1oo,o00),IN pDDITION TOTHE CAST OF COhiPENSATION,DAMAGES AS PROVIOED FOR IN � SECTbN37080FTNELABORCODE.INTEFESLANDATTORNEY'SFEES. RETENTIONFEE:�v�r�� pW„ CONSTRUCTION LENDING AGENCY PRE-ALT FEE: 1.+A�7J.�j+ QF D � IHEflEBVAFFIRMUN�ERPENALTVOGPERJURVTHAT HEREISACANSTRIICTIDNLENDINGAGENCY BLij+� -______ FORTHEPERWRMANCEoF7HEWORKFORW`HIC�H ISPERMITISISSUED(SEC.a097,CN.C.). � w I�i �'S � LENDER'S NAME ___ f F- LENDER'SADDRE55 iy_ wICERTiFYTHATIHFVEREADTHISAPFUCATIONANDSTATETHATTHEABOVEMFORMATtONISCORRECT. TOTA�FEES � �( � �. 1 AGPF.'-TO C061PLV Wf�M ALL CIN AND COUN7Y OROINANCESAND STATE IAWS RELATING TO BUILDINO � � CUJSTFlIICTION.ANDHEREBVAUTNORIZEREPFESEN7ATNESOFTHISCOUNTYTOEMERUPONTHE - . - Z ABOVE-MENTIDNEDPROPEATVFORMSPECTIONPURPOSES. COMMENTS __ k = C ��� m pERMITTEE N (PRIt7f) � � r�.`16..�'� - � � sicna D-�,.TE RECPT.NO. PAID BY VALI�ATION � WHITE—Department Copy,YELLOW—Pinance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicaM's Copy � - _ � ___ ---�- -� �-__ - _ _ .�.i __ a..� - , � - --� � � i � , _ � � E : � ^ ' � . � ; I : ' ' '� � � ; � � , ��� i ( i � ' ( � � 4 � � � � I k ' i I � i , i � i � �� � I � I I �( i I ( �` `- i � , ' I � � i � � � f I � k � E .- � ;. � z I_ - � 1 � ( ; , � r � , � , ` � I i i , ! i � � � ' ' ' I j , � l � � ! � E � � � � � � ' ' ' � �� � � i � ' , � ; ! � � � , � � I � � � , , , �� � ' j i ` i , ; � ' i � � ! I i I � i 4 : i �. � ; ( � �� , , , , , � , � . - � - ' ` -- � ; � .:� , � �� � i ; � , � � , � ; �-� ( � I ( �_ , , � � i ; i ' `I , � I � E , , i I t I , ', ' 3 1 � q � � ( ' I ; � i t i ' , 4 '� ` � E - � I i ` � � , I � j � � f > i 1 � � �i 1 :, � x i � �._l ---.' y ;- � � ! ; I ,� _ ,— ; : � � � I i i i , � ._� � I� ; , i , � �I i E � ! � ! � I , { i . � : i ; � ,� { �� i , I (...��_k �_._ � j ( i f ; ` . � € ...}(=' � � ��� i i � ��I i - � i 9 j ` � � � `� � � � �j .I'�._' � � � � ` t � (^ � I �''� � I � I., � i � .� i � � i �i � I"'z � -. I .I � � z: 1 �� � � ! ; i 1 � i , ` �.. � ; I I � �� � �G -.�7 s I .il �C, �a;I c� � 'j� � .,. I ` � �i � +,, � � , � ( � � � s � �,� n' ,�.� rt :i �� �_,, r- � - � i.s� n i y :; fia� : I I { ' i � ', � E# �. V :L 3 r -`3 �i� `` �C� �d 1. " "� . � . ( i ' i � ! 8�` '� � � � �s ,i ''�''1� r �`"` `� � rl �'�`j{ � ` IF �`t I.`';i C �,� � ; ; . � I � � I I � ; � i � , � � � � � : , �� (� � I ; � ; � ; ; ! , , , , i � � �` � �i i �''" �� � �'` ;�� 1') ` r- ���. . ..> �, � y, ,N�� E i � � � 1 i I � i i � �; �� _€.� :3 �s t_ �s u_ ^ 'E r 'r' ;,�i_ �. C',1. �`^ i � �� � 't � q � �?� ��•-_i�_�.r i� } J�'� ��� -''- -�--�_-� � .._.�� ; � ( j � I � '� � }� � � ' ', i 1 r� � _..� .� i ; . , � !i G I i 1 � �°' � �.�-y i �� i 3 ' �r i :; ''- � _ � � i ! � . � � i � I � � �i �, �"� �� � j E j � j � � ( I R . � l 4 ; 1 : ` � � 1 �5.: '�„�E 4 � � i ; 3 � .� � j � � � � � i ( 7 i � �tL k � ' E � . �5�� � � ' !� � � I �, �' i•�' � I , � ' • � r�IDr ' � � I � €'`i I ' ! � ' � ' , i � I � � { i' I � a . �� 3�' � � i �, I € I i � 3 � i S _.�^+� f � � 3 � i i � I Fi � I �. ._ E � 3 ;> € re� r.;'.�'� j { 3 ; ., �. � J,=_L _-I i � ' F j �. E � „ � �� ;��1 I �— '�� �, , � � , � � S l _� � � � �� � .,,_ . 1 ( '� � � i � � � i i ( ' ' j. i 7 ( ; �'. ,. � ��`'�' � i ` i ; �� ' � i � �; � � ' j , . � i x` � s E ,�` �. E <_ �--�--� i`—a � i � � r- } -1"`'J i t � j i � •`r �g��. �.���'� � , }� '� � � i, �+` I ' � �j � ' , � i � , ny�� a � °��� �� �s � i� � i � i i { � � ' ' � , ��� :����Y.� ¢ `�, I � i t`" f � i � a° � � � : l s � � � �'"��� ; .�c„..a .�. ':� �-�' � �`� : . I � � �� - � �„ � ��� r� ,r - � i - o' � i , � - �..�.. ��'�e� � i � t f�- �" � - . �� t a � . � �€�5����'� S �a � j �,I c , � � j �� �i �� ., �. E���i € i ( _ 1'. 1 (: � � �� ������� t ��-n � � . i ws k� , �� c t j _ 3 �r�i � I � � � .:j � � � �����'� ��'������`�� � �� ,� ` i ( � E�E� � � ( s �� 3� �,� �`��.�� � �.�-������ � i � r p , ; I i �_ .,- ; �I ;-�1 � � ' ��� �� �=� -�. . - m , c . . � , [ i . + _ ` . � a , i ( 4' _ � , .� �'_�_a.,._..__..._._...._-_Q.1,.,,_i..._,,.., ..�..�i_......Y...�.�._.W.____.r._._..�,_,.1.,.�..f..�.._�.� � _�_�,.,.�_..�_..�_,��,e....=_. ...�..___L.F.�s,.�._�_s.x._.n:,.:�>_��.._�.�.._,.��...�