Loading...
HomeMy WebLinkAbout12975 (13) . CITY OF DIAMOND BAR .�i�I��� ^--- J�' DEP ENT OF COMM NITY&DEVELOPMENT SERVICES ARTM U 21660�.Copley Drive Suite 190 ��w (909)860-3195 Fax(909)861-3117 PRESS � ��'A�' BUILDING PERMIT APPLICATION FIRML.Y I }', JOBSITE �j f.���� �����A � ��' DATEICATIOHI�� 7 � � NUMB R�•- p/C o ADDRESS '�' /\l ISSUE TYPE OCC ' �' APN LOT TRACT DATE CONST. GROUP i p OWNER � C _ "' ADDRESS ��nZf,s d �� ZONING SETBACKS w Z CITY i ' _ ZIP���j TEL. � FRONT RW ❑ g APPLICANT � '���.z TFI � REAR u_ � — SIDElSIDE STfiEET RW fl CONTP,ACTOR -�3�� � �y__ SIDE u___ O- ADDRES ��� CITY � ZIP TEL. L. PROPOSED USE o ARCWENG/ �z �ESIGNER NO.DWEL. NO. NO. iy. ADDRESS UNITS__ STORIES ___ BEDROOMS � CITY LIP TEL. � DESCRIPT�ON SQ.FT. FACTOR PSF ADJ.AREANALUATION O, OWNER-BUILDER DECLARATION SFR/ADDlREM W ', . %�u h`, P.ru • . , .,, , .. c a�u � � Garaga/Carport � `�. '' �.'..i ND R 4 '.TV�O�r"� �. : . •AM PT F „ .4 TO S , � W E OM TH CON ��.::. M1 ,. .. ••��.•• ' . �. , ;lhti.v�":" `: , . `1 • • ', ��' • ,..::. •...r:, ' ;� � W Paho/Deck . ... •}..: . • . �� ' . Mi.\�•� � W �/�ti� �� .� � •��� �� ��. ' •��� �� :� �- PooVBPa �. •.,• , . , �� '� � Re-Roof � , ,. .. . . � 5 �� � � ' y ' J Commarcial - p� � M .�ti��� ' . . „ ' • ' � � m Q . .. , . � - Z . ,.� . .. ..� ^' - �:";' . - , _. + •� 1 w r�P��.�r...E,,,:��- a •..,..•..'•,,���.' . . +-'�� ,,h y.y �• . . . Valuation ADJ.AREA � , .. InH i,. - - .- . --• -.- 7oas � �� .•..� � . ., ., . „ � � . x +r,�� �. .. -._-��. � • .• � � • .. .�, 'cFN��. .,.•.`...;. �h .'..�.,.. . . ' " - �UANTITY DESCRIPTION FEE F- IU S IAW� � . . .�..n .. � ) Q ❑IAMEXFMPTUNDERSEC ,___ _B 8PC FORTHISREASON U I � ,__ _" '-__-'__'_ � j LL' OATE OWNEF � I � ._" _"-__" -" W �¢ LICENSED CON7RACTORS DECLARAl10N W I [[ ...:.�. �i. �y,�; . , ., '• ' .-'AM LICENSEO 11N�ER PROVISIONS OF CHAPTER � & _ �'� � !� (L :+„l',��Y ti ��; •, .' • „ �. � � TNE BUSINE55 AND PROFESSIONS CODE,AND z � „ .,.•. .,..,•.' :•. . . C)t 7�? � m �-'' � r_ � LICENSE CLA55___��_._UG NO � } � �s/ F"' '�2` CONTqACTOR__ � _ .if� a V DATE--�—�..r�_`�—� � W _ a�i WORfCERS'CAMPENSATION DECLARATION � � IHEREBYAFFIqUUN�ERPENALTYOFDER141RYONEOFTHFFOLIOWINGD:CLAFATiONS � i � z d INAVEANDWiLLMAINTAINACEi3TiFICATEOFCANSENTTOSELF�INSUREFORWORKEHS' x � � CAMPENSATION,ASPROVI�ED9Y5ECTIONa700oFTHELABORCODE.FOFYHFPEflFOqMANCE U OF YHF.WORK FORN'MICH THI9 PEFMIT IS ISSUED. W � 11nJ �/ � - ✓'��t HAVEAND WILLMAMTAIN WOflKERS'COMPENSRT�ON INSURANCE,�5 REOUiRE�UY S'cCTIOY � 37000FTHElABORCODE,FqRTHEPERFORMANCEOFilIFWORKFORWHICIITHISPE�MITIS 0 ISSUEU MVWORKERS'COMPENSATIONIN URANCECARRI[HAN�POLICYNUM6ERAHF CONSTRUCTION .__,__ ' " "'-"_' __ y CARRIER_.�Z^�� ��/�,-r-f -- PLAN REVIEW --- ------- ,--- ------ a C7 POLICYNUMBEF___�_~C���[1—V F ELECTRIC ________ _ Q W (IHISSLCfpNNE�NOTOE(%71.5PLEfEDOF7HEPEfiAY�ISFOROD1EhUMFIEDDJl1AR5(51W)OHLCSS) PLUMBING g .��� . „ . A MECHANICAL ���� � :�.:•.. . .. . r••.�� �� --- ---- — � I SHA V •• M1'. . ..... . .. � ' SR icnni ' ' PFl°visw ' � INSPECTIONFEE ___— __---_-- .—- • _ LLfORTH' • •. . , .. � COpE. �W�H�MPLV WITHTF♦4i5F �`..-.� . �� 1 ISSLJANCE ` __ _ _'--_.��_� \/ ��1 .. . _�`�-��'���'�-_' � - � DATE•_ �' __'--". '_.—'_ ._ � _ __._____ --_— �"� � •1Al.l BE ENERGY P/C l�,�°Y I.}�.�a a�,4 w°a v���� J .A., .�.�� .. l. . . �. ' ' T�g-� �T ��p�y ��� �y -__'- — � ' , , :. y , . . "� v.. , . ls�qNN ENERGYPERMIT�k/3.i��ttV�s�z2"(-�'���'#3�# -- ��. � . ' . . .., . . ..�. . � • �� ' .� • . . • . RETENTION FEE: --_----_--- -_.--- pW., CONSTRUCTION LENDING AGENCY PRE•ALT FEE� _______ ,_ ._.___.___ ___ O QIHEREBYAFFIRMUNDEPPENAITYbFPERJURYTHAT7NE17EISACONSTPUCTIONLENDINGAGENCY _ ___, , ____ ,_ _ FOR THE PERFORMANCE OF 7HE WORK FOR WFIICH THIS PEflMiT IS ISSUE�(SEC�09�,CIV C� W _'_ dZ LENDEWSNAME_ __" -"---- "'-"-- j _ _'__ "'--_, _'_"- � LEhDER'SADDRESS______. -. �------- ['� W . . , ---•-- - -- -�- . _..._'.... F �,,..,,,.;,��,.o�,.r TOTAL FEES �`J' 7� � . .. , : Z . V` •;: .. . . , • ' • �� ' � � COMMENTS�a��-�s��l /AJ'\�—�CL�'�� � �T'C�'�(��,�;� - - --- J _ --- Ct] _` _"_-__ ¢ PEflMITTEENNME�PR „ y�n _. -_ --- - � (n � �'�� � �� L / ___ _ -____ � � /' � SIONATUREOFPEFMI E DF� �� � RECPT.�� PAIDBY � VALIDATION V �.�`_ � � WHi7E—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy � i _. ._._�._�____a,.m _�._._.E , i ...�.�. i. w�. _�_...�._._�. i j ' � � I � r �� . ' ; � ': ? ' I � ; � " t . � � z , �, �: � � , � , { ; � j ; � # j � ; ; ' � � � � � i � � ; � ;� � : � 3 ; • ' I ` i � € � ' `i � � � j j j � I �� t 1 ^ � � i � r � � ' � � ; E I � ` � � � ' .. � � � � ; i � r � i �J �� F� � � � � I � ( � j� �; �: � I � i � ; ! ; � � e` - F � a i : � j ' ' � ;� '� � _� #j '. � � � !f � 3� I' � � j � � �`� ; j : ; j ; � ; E t � I � j � j E } j J i i ' � � � ! � '< � 3 � �'�,:� � � � i ; � ' i i; � ;;; ._� � � ; � � � ' � ; , ;I , , ; ,� .,. � � � ! � � � i ! � �' � � ; � � � , t : ; . i ; , f � , Y I + � c i �— ; � . ; � � � �. j ; i � f � 9 � , , y � ; ' i ' , � ' {a � rVa � I � � I � 4 i � Y s I � � -i � � � . � � ' � � i � ; � _ , � g � � r .. :. � � � � t 4 . � i i � .,.w...........:........�.,.__:.�._.�.....,,�...-a-.....,..-�....�.._._.......�.,�.�.......m<m.�......,.-_ ......-.-......,..�..,�;,-'<