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HomeMy WebLinkAbout11039 7 ! J } :� ----�'`�-- CiTY OF DiAMOND BAR ��^' � COMMCJNITY DGVELOPM�NT DEPARTMENT Ip ;w:;;' 21660 L.Copley Drive Suite 19U v� PRESS (909)860-31951�ax(909)Rfil-3117 \�"'""'� ]3UILDING P1;RMiT APPLiCATto� F'IRMLY � JOBSITE .�r-� APPLICATION . � C PERMIT P/C � o ADDRESS_,��-�_ ��Z ���'' DATE � �_� NUMBER � �� . #____.______._ o ISSUE TYPE � OCC � °T APN___ LOT TRACT DATE _.._.___..,..___CONSL _ GROUP .__._.__ p OWNER ....._ Y�L <S jU�-J�� _ � `L � U ZONING SETBACKS � p ADDRESS--I�=a--�l.y�-� -- ---- i i . ,.. — �•--- FRONT RW C � Z CITY /`�7 v' ZIP�� TE c� �y�.� .------- � APPLICANT ' s• �` , . ' �— REAR ,_ ___.._. ❑. _-____ f� o �pK� TEL ' ..;��_�f�:� SIDE/SIDE STREET RW :_; � ¢ CONTRACTO 4J�J• '`. � L.G� .._. �. _. �� -- SIDE —___ _ .----- _-----..._ ; :..-----......___ y�:..r� - r ,F� � �/ � CTY ESS � ���,�L�_ ZIP_� �_�} TE .`7 _ � ��,% PHOPOSEDUSE___ ��_/T�L /c-�f��.J�:��J/���f�G'_�1If� K. o — -- �3 �c�� � i,. . L4 t5 . . z- : w ARCHlENG/ � � �L �3 �-G' '�� o .�y LL _ � w DESIGNER NO.DWEL. NO_ NO. � ADDRESS----.----.----_----..---.-.-.._,--._-- UNITS-- STORIES -----._.._..------- --------BEDROOMS � CITY ----------- ZIP----- TEL..--------�------ � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BI;ILDER DtCLARATION SFR/ADD/REM O p I HeRE6Y AFFIRM 11NDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI� Ger�9E/CefpOR W CENS�I.AV�F(1FlTHf�OI.LOWINGREASON�SC:C.'/a31.59USINfSSAN[1PRO�FSSIONSCODE,ANVCITY0I7 (n ____ G� CDl1NTyWHICHREQUIFESAVEHMII'TOCONSTRUCT,ALT'cR,IMPROVF,DEMOI.ISH,ORREPAIRANYSTFUC� W Palio/Deck w TU�iE,PRIOP TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH I'EPMIT TO fILE A SIGNFD W STA7fMf:NT THAY HE OR SHC IS LICCNSf�PURSUANT TO THf Pf70V{SION;O�1'HE(�NTRACTOP.S il� � CF.NSE LAW�CHAPTEH9(GOMMENCING WITH SECTION 700a)OF UIVISION30F THE BUSINESS AND PRO� U' POOUSPB fEE5:ON5 CO�F)Ofl THAT Hf OR SHF.IS FX[MPT TH�liCFilOM AN�TH[(1ASIS�OR TNE PLLLGED f-XF.:MP- � TICN.ANVVIOIATIONOf-Sf_CTiON703f.5flYANVAaPL.iCANT1"Cf1APFRMIT5U6JFCT5THEAPPLICANTTO z �@-RUo( � � ACIViL PENALTY OF�OTMORE THAN FNE HUhORED DOLLARS($Soa).): � I 11,AS OWNEH O�THI:PIIOPFR7 Y,OR t.�Y EM1I7LOYF.F.S WITI I WAC'c5 A5 Tl{F.!FI iOLE GOMVcNSATiON, Q 0 �.ORIfiIBfCl:3� Z WILL DO THE WORK,AN�7HE u^TNl1CTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.7J6a,BUSI- J __— � NFSSAND Pq01'FSSIONS CUUF:THF CON�HACIOFtS LICENSE LAW U()CG NOI'AF'PLY TO AN OWNER OF � PIiOPEHI'Y Y/l'10 f3UILU5 OR IMP(lOV[5 THEHtON,�ND Wi 10 f)OI:S SUGH W(JRK IIIMSELF OH IIEHSELFOR CC THROl1GHHISORHEfiOWNENPLOYEES,PROVIDEDTHATSL'CHIMPROVEMENTSARENOTINTENDfD(h'i m W (KlEHEUFOiiSALE.If=,HOWF.VfR,TH[AU:IUINf:ORLUP�InVfMfNTItiSOL[1NlITHM(]YEYcAROF'COMPLf:- � TIO�,THE OWNcR-BUILDER WILL IIAVF TIiE BUNOEN OF PqOVING TIIAi IIE OR SHE DID NO7 BUILD OR — Z IMPROVE FOR THE PURPOSE UF SALE). �_ ❑I,A5f1WNEqOfTV{[p{�UVEPTV,AM1:%CI.UUIV!:LVCONiRACIINGWI1fiLICLNSF�CONTRACTOHS TO CONSTRUCT THE PROJECT(SEC.7044,BUSINE55 AND PFOFE3SIONS CODE:THE CONTRACTORS LI- ValU2ilOf1 � :�fi \� ADJ.AREA W Cf:NSLLAW�OESNOTAPf'LYTOANOWNFROFRf'ROf'EflTYWHOBUILDSORI.UPROV[STHLflFON,AND -- — -- '-- ...... � WHDCONTRACTSfOHSUCfIVHOJECTSWI�IIACONTFACTOFt(SJLICENSEDPURSUANTTOTI{ECONTqAC� QUANTITY DESCRIPTION FEE Y TOflS LICEN3E LAW.). _ � i.;I AM EXEMPT UNDEa SEC. B.&P.C.FOR THIS REASON Q O �� 7a .------...................------------__..__..__..._........---._... ...............-----.........-- �C � � unre-----.......- ----...._....._...__..._owN�n .. . _ _...... ..... _......_.— U� z O J _' F I..ICE.NSFD CONTRACTORS DECLARATION W ¢ -- � CC I HEREBYAFFIqM UNDEfi PENALTY OF PERJURY THAT I AM LICENSED UfvDEH PFOVISIONS OF CHAPiER � � 9�COM.McNCINGWi111SEC1'IOh7000)OF[71VISiON30fTHC8USINCSSANDPROfCSSIONS(:ODL,/eW Z X MYLICENSEIS!NFUiLFOHCEA4DEFFECT. m LJJ (� .;1� O .�"� � _ � LICENSE Clq SS '" , LIC.NO. � F— J J U DATE �` �� � � CONTHACTOR 4. W ��^^77 � ORKF..qS'COMPENSATION D CLARATION V� 7 [,� Q � IHEREBYAFFIf1Ml1ND[RPENALiYOfPERJUflYONEOFTHEFOLLOWIYODECUfi'ATIO�'�/ �. � Z f� _IFIAVf.AN�WII.LMAIUiAINACCIlTIFICATEOFCON5E4TTOSELF�INSUREFORWORK[RS' � 2 QCOMV�YSAfiON,ASPHOVi[JLOf3Y5F.GIlONJ]COOF7HF;lAHORCOOF..FORTi1F.PEHFORMANGC U Of-THE WOHK fOR WHICFI'fHIS Pf.fiMlT IS ISSUED. W � � w ......_.���hVE�NUWILLMAINlAINWOfiNEHS'COMPENSAI'IOYINSl1RANCF,A$NE(]UIHE�IiYSECTAN �q � Q37000FTHEU180RCODE,FOH1lIEPERFONMANCEOFI'HCWORKFORWHICIiTHISYEHMITIS � /7 � )r�7� :� _ ISSUE�.MY WORKE�COMPENSATI(Zh'INSURANC[�fl H AND POLICY NUMf3f:RMC- CONSTRUCTION _„_._..__ �`/�i ✓ , j� �. �/ _, i_�. PLANRFVIEW —..-- -�_r�_ �- --�— cnnnntR------=� � ( � ' �-� �-----....._......---- -.......---- -- - �. z POLICYNUMBER--,�J�J��-Lf�.....---............--------......... _ .. ELECTRIC . .... ..------- --...._ .._..._.._— ; _._...--�----��- � (IH65'eC7KKJNEEDNDTEI[�APLEIEDOFiII[PCRMfTISfURON[HUNDFiEDOC7LIARS�5�0�) �aiEss�.s� PLUMf31NG � � ---------'--. ......---.....---------- s w ' Z I CERTIFY THAT IN THE PERFOHMAYC[OF TIIF WORK fON YlI1iCH THIS PEI7MII'IS IS:iUF:D,I MECHANICAL � '__—........__'—'"_ ' � SNALLNOTEMPLOYA4VPEfl50NIN�NYMANN4HSUA57'UDECOMESUBJEC'I'I'OIf1E % '� (J� WORKEflS'(:OMPENtiATIONI.AWSnFCALlfO(iNIA,ANDACfteETHAT sHou�c>arr,oMt: INSPF.CTIONFEE � -- � % r� SUBJECTTOTHEWORKERS'COMPENSATIONPROVI5loN5oF5Ec N33ooOPTMFLnROR � CODE,ISHA FO HWITHCOMPIVW' THOSCyROVI5IUNS. ISSUANCE � ___.__ ... ��.� � � ' � ' yp /� � . . - ': p DATE:�� ....f_� _. APPLICANT: �{t5' _ :�L/I L"� SMIP "-'-_-_—_— F ._� �; � WARNINGFAIW [TOSECUflEWORKEflS'COMPENSATIO OV hGE15UNLAWFUL.ANDShNLLOE ENERGYP/C . . __.._ . py __,..___.._ _ ,' � SUBJECTANF.MPI.OYFRTOCHIMINALPI'NALiIFSMUCN fIN� UPTOONEHUNDfi[DTHOUSANO ENERGYPERM�T � 4'^ �OLLARS(f1W,oW),INADOITIONTOTh1EGU5TOFCOMP NS ON,DAMAGISASf'IiOVIU�IIFORIN ---- �fw �' � w --.. i J SFCTION37oeOFTHELABORCODE.INTEHES'f,ANDATTO r�sr�Es. RETENTIONFEE: ___ 3 Q ! --....._---- d CONSTFUCTION LENOING AGENCY PRE-ALT FEF: p --- ---�---'.. � I HERE6YAFFIfiM UNUEN Pf:NAL7V OF P�R1l1RV THAT THeflE IS ACOYSTflUCTON LENDING AGENCY , ' FOR T11E P�41fORMANC[OF iliL WORK FOFl WHICH THIS PERMIT IS ISSUED(SEC.3oJ7,CIV.C.). --"""""—'-""' ' Z w _.. .. .._____—______._ ' � LEN�[fi'S NFMF. _ � �� LENDER'SADDRE55 '-- — "-- � — '--. .. ....................."....._...._....__--_ '_ ;. � TOTAL FEES � � ICERTIFYTt1AfIh1AVEREAUT1115APPLIGATIONANUSTA7F:TIlATT11EA[iOV[INfOR11ATIONItiGORHk:G� � I AGR[[TO COlAPI_Y WITrl A1 L CITY AND COUNTV ORDI�VANCES AN�STATE LAWS RELM1TING TO BUiLDING P � CONSTFlUCTION,ANUIIFRI:UVAUTHORI7[f7f..f'RESfNTAT!4[SOFTHISCOUNTVTOENTff7UPU'JTHf Z A130VE�MFNT;ONE�PROPERTV FOR INSPECTION PURPOSES. Q • COMMENTS _.__-------_.___ : J �! � �� t `�r�G _._ -------.. - ------- _ - -- - ------ - ----.. m Efl TTEENAM[(PRIN)' ___ Q .� "__......... ."—_...__' � � ���' --�� �� � . _ __:__.. _ _ __ - --- � 5 E PF.FMI�i' ' DAT �� , � ' _ � RCCPT.NO.---.,-.—.-----.._._.. PAID(3Y .. ALIDATI --I -.------- ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Flle Copy,GREEN—ApplicanPs Copy , _ _ __. ..� _. � . , , � � �e���� ��� ,�� i � i , � ! � i� � � � � - � � , ' 1 �`� �' �, ���,. �k.� � � � ' ' ° � � � � �� ,�� � �� � � 4 , ��� "�� ; _ , , � ? �I � M r' i. - �_ � i � � '.x � ��.� ����.� �s� � f i f i 3 �` � 1 `� a 4 � � � � � � � ��� � i 7 r � � � r � � � � �����������i� �� � � � � i � � � i •��� r � r � � �� �:3�� '�r �'�3�� , d � ( ' C.s i� i_� i '`s �,{ � ?� j r, ,,, i #�'��J ! fi� 1" ✓ - �' I ' :I a _ T ,, '� �� - � ��_ �" � �7 f � � t � i � :j ��t �� �� _ � �,"+-�/°�, i � � ,. 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