HomeMy WebLinkAbout11491 (5) i
�'``�---- CITY OF DIAMOND BAR
I i� COMMUNITY DEVELOPMLNT DrYAI2TMENT
'�'��( 21660 E.Copley Drive Suite 190 PRES�
h`, (909)R60-31J5 I'nx(909)R61=3117
��'.""' BUILDING PERMIT AI'PLICATION FIRMLY
�: JOBSITE ��s��� �� � APPLICATION J�s/��� PERMIT � P/C ��
'�o' ADDRESS' �������� .���_�(_V� �" pATE__,____'��_� NUMBER� #Y .__ �
�o -- � ISSUE 1 TYPE OCC
APN LOT TRACT__ __.___ DATE CONST. GROUP i
� OWNEH `
'0., ;
v ADDRESS OC� l�'�•�A"'�OP•!� `9,�h'Rr �e V� ZONING SETBACKS �
� - FRON7 RW _ U_.___.
Z CITY���]r�4 I�k'� ZIP TEL. __ -----
�" 11PPLICANT ._ TEL. REAR ___ fl_._ _
� — -- SIDE/SIDE STREET___ RW____.__ i�__._.
m CONTRACTOR��J��F1�'�1�.�1/t. ; ���5� SIDE ______ _. I� j
� � ADDHESS_�¢P�� � . ,.!t,�l�2F` /�t•J e�_ � E
p CITY 9�°Y� �.eaM�^= ZIP"t t'"1 4S! TEL �� ��.'�at°��1 PROPOSED USE��. .��6..�'ij'1��''1�.� bl�1A�G.0 �
- a �-- _ Ti�^ ��ifl1s+7l�-- �
w. ARCHlENG! �
z"' DESIGNER NO.DWEL, NO. NO.
� ADDRESS UNITS_ STORIES BEDROOMS �
, �" CITY ------ ZIP----- TEL.,._._ _ --- -- – I .
cn.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� �. OWNER-Bt;ILDERDECLARATION � SFRIADD/REM �
p, I IIFI{1:6Y AfFINM UIvDER PEN�ITY OF PLpJUFY THpT I AU EXEldPT FROM THF.CONTRhCTOf15 LI-� � �
LL[ GFN::EiAWFORTIIEF'OLLOWINGRF.ASON(SE�:.�o1i5�USINESSAN�P90FESSIONSCODEANYCiTV00. '� Garage/Carport (.
U COIhVTYK'lil[;1lfl[c]UIqESAPENNI1l�CONSTRUCT,ALTER,IM1SPFlOV[,D'cMOLISH,CHREVAIFiANYSTRUC-' �J,J Patio/Deck ��
' �" TUflE,PRIOR TO ITS ISSUANCE,AlSO RE9UIf1F_S THE APPLICANi I'OFl SUCH PERMI7 TO I�ILF A SIGNfD' ' W
u� S1AiEMfNT THAi HE OH SiIE IS Ul:EN5E0 PURSU�Ni IU THE PROVISIONS OF lHE LONTRAGTOH5II-' �
.S•�CENSE LAY1(CHAPTeR 9(COMMENCING WITH SECTION 700a)OF�IVISION 30F THF OUSINESS AYD PR0- S � Pool/Spa F
�. lF9S:ONSCODE)OFiIIIATH£0954EISEXEMPi1'H[fi[FRONANDTlIEftA515�ORTHE�LLEGEDEXEMP-. � (� '—' j
U OV�.FNYV;OI.ATiONOFSEC110N7o315BYANYAPPLICARTI'OHAPERMITSUBJk:CT�111EAPP.ICANTTO � Z qe-Roof �
� A CIVIL PENALI v OF NOT UIORE THAN FNC HUNf1(iED DOLLARS(5500).): i
p "I,ASOWNEFOFTHEPftO!'ENiY,ORMVFMPI.UYFISYiITHWACES�57hFIRiOLf.COMPENSATION,' � Coinmercial ;
7 WILI DO'fHE WORK,AND THE 5(RUC-i UHr IR hOT iNTENUEU Uli OF�[RED FOR S�l[(SEC.1U44,BU51� I J._ �
Nk�S!;AND�fiDFESS:OVS COOF.THE CONTRAC fOfiS tICF.NS�LAY�OOES KOI APPLY TO AN OWNi:R OF � �
�� PROVERIYWHOBUILDSOHIMPf10V[STHEREON.ANUWHOUOFESUCHWOHKHIMSEIfORHERSELFOR m
fY, 111170UCHHISOHNE�f70WNCMPLOVEES,VROVIDEDiHATSUCHIMPROVEMFYTSARENOTINIENDF.I10fl ,
�' Uff'tP.E[1fOR5PLE.IF,fICWf:VCR,THEBUILDWGnFiIM1'f10VEMENTIS50!.DYn1'HINGNEYEAROFCOMPLF.� ' '
C�'�1 T:CN,THE OWNI:I{.[�ILDER WIIL f1hVf:�HC 9URDEN OF pHOVI�C THAT HE OR SHF D!D NOT 9UILD OR � — '
� f I,UVNUVeFOa��IF.PUR�O5EOF5ALE). �
= 1 �I.ASnYIN[ROFTIIEPROPeFlTV,AMEXCLUSNCLYCONTRACTINGWITHLIC[hSEDCONTRACfURS �
(ju ` f0 CONSTP.UC f THC PROJ'eCT(SEC.7CE4.['•USIN[55 A�iD PflD�E551t)NS CODE:7HE CONTRACTORS LI- VflN891C __��CJ C�� __ __ADJ.AREA______.__ _____ �
6S1 �f c;FhSC4AWDOESNOIAP('LYTOANOWNEHGFAPlIOP'eRTYYlHOI3UIIDSOftIMPpOVEGTH[FEON,AND • � � `
��'1 WHOCONfRACiSFORSUCHPRDJECT5WITHACONTR�CTOR(5)LICENSEDPURSIJqN�TOTHECONTFiAG- ' QUANTITY DESCRIPTION FEE E
F r TCNiS LICENSE L�W). '
Y ! J
� i'
� � i�IM".EXEMP1VNi)F.RSEC. _._ _ _ ___' '_B.&P.CFORTIIISREASON U �
� .._.-_. ,-.... ."-__ _"-" -"'__ � h
� DATE_ ,. OWNER_...- ~
� � __' '_ "_-' __'..._ W �
, � LICENSE�CONTRAC7'ORS DECLAHATION W
'x �K' Iff'c.f1CBYAFFIRMUNIIFRPCNALTYOFF£fiJUf7YT'r�AT1AMLICC�NSEDUNDEflPROVISIONSOFCHAPTER �
� 5(CONMFkCNG WIT4 SECTION 70oU)OF DIVISION J OF TH[BUSINESSANU PRO(E55!ONS GOU[.AND z �
X Ml'LCENSE�i I\FUl l fORCc AI�U FFFLCT.
W, ;7 �
U IICENSE CLASS��+(PJV �
� . LIC.NO. `I�ZC�{�� �
C� "_"' J
DATF_,� �(�^(,¢__.. CON i HACTOR�� �
w ead��
e� WORKERS'COMPENSATION DECLAR ��I-�� � �
� �/�4�P �� ? S
� IHER[PVA�fIFl41U�GEHVENAL?VOFPEHJl1qVONEOFTHEFOLIOWINGDECLARAilUKS: J'J� U •,
� z 1
a F
� I __ __I HAVI:AND WILL MNNTAIN ACERTIFICAI E OF CONSENT TO SELF-INSURE FOR WORKEHR' 2
� c:pMPC�SATION,ASPHW1Uf:DBYSECilUN9/ooOFTHElAE7041COD[,FORTHEPENFORMANCE U L
¢, Of il lf VJORK FOR WHICII THIS PEHMIT IS ISSUEO. � '
Q �
� �-1HAV�AhDWiLIMAINTAINWORKERS'COlAVENSATIONINSUknNCE,ASflEOUIFEDBVSCCTION �a �
'G J/COO:IHF.lA60RCODE.FOHTHEPERFORMANCCOFTHEWOHKFOFIWHICHTHI5PEHM1T15 ��U�_
U � i55U�L1.MY WORKEftS'GVMVCNSATION INSUHHNCE CARRIER AND POt ICY NUMBERARF.: CONSTRUCTION __ ___
_ —_.. ..-...-
: G � cnn��irra����--_ ... PLAN REVIEW ..- -`--�- -.'_--' ----
.. —._ —- -------- ---.. .._ ..
� roucrnu�+ar.n�_'�` ELECTRIC �
� j --- - —...- - -- l
—.... - —— �----
CJ
{ QHSSECTYJNNemN�T[3EIXN.!PLE7tDOFT1�CF'f.PMRI'sFORQ:EHU`ARED�OLLMS(5�0.�)OfiLESS). PLUMBING ______ __—__ ___ F
!tl �
Z � I CEHfIFY THAT I�THE PFNFDFiMANCt OF Iltl WOflK FOH WHICIiTHIS PEFMIT IS ISSU�Ci,1 MECHANICAI _ .._—. ._.. _. -__. . .-- �
ff" � SHALLNOfCMPLOYANYPtIiSONINANYMANNI:RSOASTOBECOMF:SURJECTTOTIIF
�/� W(1fiKEf75'COMPENSATIONLAWSOFCALIiORNIA,A�UAGF�= ' L'I�HCCOME INSPECTIONFEF _ ,___..._.._ .____.____ '�, �
� SUBJt.^.TIOTHEWOfiKERS'COMPGNSATI OF FCTIOV3/00 tTHF.I.Af?OR ,�-
cooE,isi���Fga7,Ny,vnHco r+nio r s. ISSUANCE _ _ _--_ �'�
��r G8.St" L.,
� �[T` dU � . SMIP _.� f
uDATE�'_I_—__._— APPLICAN7. -- -._-- '
� -- �- �- --�--'- ENERGY P/C • !
J WAl1NINC:FAILUHE TO SCCUflE WnfiKF.RS'COMPENSAIION CAVERqGE IS IINLA`NFUL,AND 5HPLL eC ---— - - --- - '-- ---"—
J �
LL SU9.IFGIANEMPLOVERTOCHIA9NALPENAITIFSANDCIVILFINfSUPTOONE41UN�f1E.UTHOUSAND ENERGYPERMIT ��/�� ._
DOLLARS(E100.na�).W ADDITION TOTHE COS(Of CO�APENSATION,�AA�AGES AS PHOViDI-0 FOFS IN --(�,�-��}�� ���p(^�Ig3'— -' !
J S`cCT10�37080FTHELA80RGOUC.INTEREuT,PNDA?TORNEY'SFfES. AFTENTIONFEE: �"�� �� �� •�' _
IL —. ' "' "'__-"' ""_— •
i"� CDNSTRUCTION LENDING AGENCY pRE-ALT FEE: _ I
� _..-- --- ----'- --
� IfiEHFRYA�FIRMU\UFfiPFNALTYOFPLRJUflYTHA1T11C:RC.ISACONSTHUCIIONLENDiNGAGENCV �
a- FlNiTfIEP[flFORMh4CEOFTHEWORNFORWHICIIT�i�5PENIAITISISSUF.[)(Sf.G3097,GVC.). � �� � � �� � �� �� ^
Z _ _-' _ _- ____—.__ —__ �.
u� f
-C LF.Nf)�!7'SNANE""'___'_'_ "_ __ '___" '__'""_
s _ _"_"._ . _.. .. .—'_'_.. .....--.'—"
H ( LENDER'SADURf:SS_. .__.--_ _ - ' - - - --- `— F
� ICEiiTIFVTHATIIi�VEN�A�TYIS�PPLICATIONANDSfATt1'HATTX'cADOVI:INfOfiIAATI041SCOfiRF.CI T�TAL FEES � �
.�y_ I AGREE T9 COIdPLY WITrI ALl CITY AND COUN7V ORDINANCES n�ll STATE LAWS RELAfIh(;10 9UILDWG V,
CO�STRUCTION.ANDHEREgyAUIIiORIZEREPRESCN(AI!VESOFTIiISCOUNTVTOENTERI!PONIIIL (p�`1 � 5 ,
� ABOVE�MENTIONEDPHOPC.HTYFOpINSP[C(IONPUflPOSES. �U{v ����� '��1�11�W�,Qr�,i � � ' :
Z � . C M NTS .._...._ ..-- -----�-----' ---'— �
� 1\Q����r� . '�'� -� - -- -- -._-... -------" --- �
�
� - - ��'-. . - ---
m �ERMI7IrF NA! (P 1N � (�'" ___ _'_ _ _ _ '_"' _ " _ . _ _'_ �
/j�� x ri �
� '}��--� �� __ r �t--�."=�'- - - -
SIGNATII i_ ER ITTNE -' ' " "--�-� -~. � L..
�n RECPT.NO.__._�. _PAID 8Y �VALIDATION_
� _ . . - ----- ---- — �
~ WHITE—Department Copy,YELLOW—Finance Copy,VINK—Assessor Copy,GOLDENROD—Flle Copy,GFEEN—ApplicanCs Copy
x
.
.
:
� o �
r- oaw Q
� � • o � z � � � a � � -�
O � z z � o o� a "_ a .
m F � � � o O� mp w m c7 � z � z a rn � vi � � � ¢`
� U m t- p p wts� z � a � ¢ ¢ C~J <� -� � Z u�Iaz �- a a
� tL . p � J J � Uoozocs ¢ wzZ — oc� a � zao v�
-� (j' LL LL Q d IT] Z O ¢ Z �` (� J W W F- '� O W } �
O � Q W � � � J F O Od Q = 2 W Li. LL V_ Q W V W N W 2 W
� �i � CL W W a a = m J L� () C] � J _l J N U J p ~ J � � LL' �
Q � a � � Q � � � Z W Z � Z O O O LL � Q Z N Q W Q � W �
� O [JL L=L � � t1 Ll. 2 4� W d m CL LL d d a p � LL J � LL IL 2 C1 LLt
��♦
LL V
W
� a .
� us .
� z
. ., z..,
:'� ,.
�; ,:
- Z .�'' �- I
0
� � O � U = F- zFmF- z � O � t7 � Z � cnN
tq � � ttl � > F W Q t- U�r2 m 0 c{ � Q Y ,J fq F� Z � 00 f-� Z fA
�2 � J 0 W Q ¢ W ¢ W � � - J
Y � (� O"' Q `�r W LL] Z '� W J J �. � � Z Z d � F 2 Q W � W 1-F-
c� o � o oco �n = c� Oxwa � = cn - rF- Ou, � �
a u. �, z � aQmz � sxsw ~ ? �7a ¢ V a � Us w a � Un.
Cj] � U � m n, W Ll. � LL C� (J C�S 'Zi � J z W F:- q Q J J J J � I'��L
� cnw o � � o ¢ o » > o � � � awv� ¢ aa a aw
W � agwaorc0000 = � ¢ w � � wwaazzz o u�w
cn �i w c7 cn t- $ ¢ u. ¢ ¢ ¢ � cn w � v o cn m cn c7 � u_ � u. U cn tn