Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
12878 (11)
_1� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � , 21660 E.Copley Drive Suite 190 . (909)860-3195 Fax(909)861-3117 PRESS ��-���'��� BUILDING PERMIT APPLICATION FIRML,Y � JOBSITE APPUCATION/_y.�-Q 1Q� PERMIT ����y.�jQ� P/C � ADDRESS � OATE ! � � NUMBER.��O �i c� ISSUE L ` TYPE OCC APN LOT TRACT DATE �~ � ..9� CONST. GROUP °C OWNER �,��l� �s�svsv�.✓ OO. p ADDRESS �^rr ZONING SETBACKS gCITY ZI l7 „��L, � FRONT RW ❑ APPLICANT �3' TEL. REAR ❑ � _ SIDE/SIDE STREET RW ❑ _ CONTRACTOR �f..�� S ,.a/ SIDE ❑ o ADDRESS_-��7`-_L`__= ��'`` PRC?POSED USE ��) �.3�r('� .�Sf.t9CC 3� i o CITY �?/�-. ZIP ,�TEL. , Z"'a ' ��_C'Crp`� ' � ry'�,� ��i '�- �u ARCH/ENG/ _ � DESIGNER NO.DWEL. NO. NO. a ADDRESS UMTS- STORIES BEDROOMS � CITY ZIP TEL. � N DESCRIPTtON SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECLARATION SFR/ADD/REM O . p i HEPEBY AFFIRM tRdDER PENALTV OF PERJURV THAT i AM EXEMPT FROM THE CONTRACTO0.5 LI- G8fdg0/COtpOfl. W CENSELAWFOHTHEFOLLOWINGREASON(SEC.�031.56USINESSANDPROFESSIONSCOdE:ANYCITVOH (n � COUNTYWHICHRECtHRESAPEpMiTTOCONSiRUCT.ALTEfi,IIAPROVE,DEMOLiSH,OPREPAIRANYSTpUC- W Pat101DfiCk T1RE.PRIOR TO ITS ISSUANCE,AL50 REWIIRES THE APPLICANT FOFi SUCH PERMIT TO PILE A SiGNED w STATEMENT iHAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROV1510NS OF THE CONTR4CiORS LI- � CENSE LAW(CNAPTEfl B(COMMENCINO WITH SECTION 7000)OF DIVISbN 3 OF THE BUSINESS AND PRO- V" PooVSpa � FESSIONS�E�OHTHAT HE OR 6HE IS EXEMPT7HEflEFROM AND THE BA515 FOH THE ALLERED EXEMP• � TIOPI.ANYVIOLATIOPIOFSECTIIXV7091.68VANYAPPUCANTFORAPERMITSU&IECTSTHEAPPLICANTTO . Z R8-RDOf - - - - � - �. AdVRPENA1.iYOFNOTMORE7HANFIVEHUNDREDqOLIAHS(SSoo).): - �� ❑I,ASOWNEROF7HEPHOPERTV,OFMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, ❑ COfilrtlBfClBi - WI(.1p0 THE WORK�D THE STRUCTURE IS NO7IYTENDE�OR OFFERED FOR SALE(SEC.7o4a,BU51� _1 NESS AND Pp�FE3StON3 ODDE:THE GOMRACTOAS LICENSE IAW�OES NDT APPLY f0 AN OWNER OF � - � Pf�PERT'WFWBUIIASOflIMPROYESTHEfiEON.ANDWHODOE55UCHWORKHIMSELFORHERSELFOR � � hlqOUpHHISORHERONMEMPLOYEES,PfiOVIDEDTHATSUCHIMPAOVEMENTSARENOTINTENDE�OR m - Q� .OfFERIDFOASALEiF,HOWEVER,THEBUILDMGORiMPROVEMENTI550LDW1THINONEYEAROFCAMPLE- - Z TION,'fHE OWNER-BUILOER WILL HAVE THE BUROEN OF PROUIN6 7HAT HE OP SHE 010 NOT BUILO OR. � IMPROYE FOR THE PURPOSE OF SAL�. O I,AS ONMER OF 7NE PROPERTY.A61 EXCIUSIVEIV CONTHACTING WITH LICENSED CONTRAC70R5 �h Q TD CONSTRUGTTHE PROJEGT(SEC.70t4,BUSINE55 AND PROPESSIONSCODE:THE CONTRACTOR8IJ- VeIUetIDO �4° � ADJ.AREA W CENSEVWDOESNOTAPPLYTOMIOWNEROFAPHOPERTVWHOBUILOSORIMPROVFSTHEPEON,AND � � WFIOCONTRACTSFOflSU[xiPRQ1EC75WIT!!ACONTflACTOfl(S�UCENSEDPURSUANTTOTHEGONTRAG QUANTITY DESCRIP710N FEE � TORSIJCENSEUWJ. - � O�NA ExEMPT UNDER SEC.- 6.&P.C.FOR THIS REASON Q � — V � � DA7E OWNER . V . . W o LICEN5ED CONTRACTORS DECLARATION W - �- IHEREBYAFfIRMUNOERPENAI.NOFPERIURYTHATIAMLICENSEDUN�EflP{tOVI510NSOFCHAPTER .� ' , d �B{COMMENdN(i W1TH SECTION 7000)OF DIVISION 30F THE 6USINESSAND PRaFES510N5 CO�E,AND z X ;MY LICENSE IS IN FULI.FOftCE AND EFFECT. m 6sJ �ry �. �,..� Q 'IiCENSE CLASS��? IIC.NQ. .:. 7 ��_� - . � .: . � U -�ATE�"_.[���COMRACTOR � ,�.2 � ' .��Lr �a W � � WORKERS'COMPENSATION DECLARATION Q � . IHEREBYAFFlRMUNDERPENALNOFPERIURYONEOFTMEFOLLOWMGDECLAFtAT10NS: U C!� Q O _IHAVEANDWILLAIAINTAINACERTIFICATEOFCANSENTTOSELF-INSUHEFORWORKERS' 2 � ' CAMPENSA710N,ASPROVIDEOBYSECilONa70uOFTHELABORCODE.FORTHEPERFORMANCE �U OFTHE WORK FOR WHICH7HIS PERMRIS I6SUED. � O � W _IHAYEANOWILLMAINTAINWORKERS'COMPENSATIONINSUfiANCE,A3RE�UIRED8Y3ECTION - - ,,,+++ p Q 37o00FTHELA80RCODE,FOR7HEPERFORMANCEOfTHEWORKFORYJHICHTHISPERMITIS � ��r /� ISSUED.MYWORKER/S'�COMPENSATIONINSl1RANCECARRIEFIWDPOLICYNUMBERARE: CONSTRUCTION � t > CARRIER ! P � - -. �W �� � POLICY NUMBER�� �y��r ELECTRIC Z Q � jIHIS8ECTpNNE�N�TBEO�EfmOFTHEPERMIT�SFORCNEHINJDFm00LlA�(57oo)ORLESS) PLUMBING —____..__._._— - w MECHANICAL � Z ICERTIFYTHATINTHEPERFORMANCEOFTHEWORKFORWNICHTMISPERMITISISSUE�,I -�-�--�--�-- � SHALLNOTEMPLOVANYPERSONINANVMANNERSOpSTOBECAMESUBIEC�TOTHE IN FEE y WOflNEFS"CObiPEN5AT10NLAW50FCALIFOPNIA,ANDA6REETHATIFISHOULDBECOME - SUBJECTTOTHEWORKERS'COMPENSATIONGROVISIONSOFSEC710N37DOOFTMELABOR - a� � CADE,I SHALL FOFiTHWITN COMPLY WITH iHO3E PROYISIONS. 1S CE o �,r �- ' ' ��-�. M �� p: DATE:��� APPLICANT - .. � . w ENERGY PIC J WARNMGFAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE - � SUBJECTMIEMPLOYEA70CRIMINAIPENALTIESANDCIVILFlNESUPTOONEHUNDREOTNOl15AND ENERGVPERMI7 DOLLARS(51 aO,OW),IN AD��TION TO THE COST OF COMPENSATION,DAMAGES AS PROVIOED FOR IN � ¢ SECT�ON37080FTHEL480RCOOE.INTEREST,RN�ATTORNEV'SFEES. RETENTIONFEE: — �� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I NEREBY AFFIPM UN�ER PENALN OF PERJUHY THAT 7HERE IS A CONSTFUCTION LEN�INO ROENCY FOR THE PERFOPMAN�OFTHE WORK FOR WHICN THIS PEfiAflT IS ISSUED(SEC.30B7,CIV.C.). , Z W �� LENDER'SNAME ' t- LEN�ER'SADDf1E55 WICERTIFYTHATIHAVEREADh115APPUCATIONANDSTATETHA7h1EP80VE1NFOAMA1bNISCORRECT. TOTAL FEES � t� j� � {y � IAGREETOIXkAPLVWITHALLCITYANDCDUNTYORDINANCE5AND5TATElAWSREUTINGTOBUILOMG J �t �� . CONSTRUCTION,ANDHEREBYAUTHOflIZEREPRESEMATIVESOFTHISCWNTVTOEN7ERUPONTHE i L `y ZABOVE•FIENTIONFA PPOPERTV PoR INSPECTION PURPOSES. COMMENTS � _ /t ��J�j'L/ C� Aa7� � . . . apERMITTEENAME PHI(_Nn �� L_�� .. ::_ ., . � `�01� .'l_� �_ � SIGNATUfiEOFPEH611TTEE ATE �� = RECPT.NO. PAID BY � � VALIDATION_ l i ~ � WHITE—Depadmant Copy.YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—Ffle Capy,4REEN—ApplicanYs Copy � � � >��� ����i ��Po! w; I � i � I � 3 (. "� '+9,..,_�.._..,._.._.i_�,.�._.m, �.. ; �.__..�..„..._� 4 .� I „._..._.._.._. o i '���I"'' � I � � �. :.� � i. ( , i J � (� I a (� � � (.. .(._ �.� I � � ; � € �. � � I , ( E i �_� � ; ' i i , � " f � �i� j i i I € � � 1 7 � i � �. E I I i � � i � � � - .� �� -� i � � � I � � � � , � � � � � � � � � �� � ( . � 1 � � � � i i � i � � i i y i � .i � i � � � � i � f � � ' � I. I i � ; �' ���� i I � I � �. � ; ( j .+ i � � i � . - i � � � [ � � � � . � � � �� ( � � � � � fi I � � i I � � ; , I ; I f � �-;--I-�--�--;:��_ __;__�_�__i-__--_� ; � � � . I r i I: ; ; � � �_ � _� � � ; ; ; � � , - �� ( i � � � ; � ' � , � � ! � ; i �� � � � i ; 4 � ' i � � �� t � � j � � � ,� � � t � , ; ( r � � . . �_ � E � i� 3 � � i i I . � I �- 4 7 � � � � ? i fI � ( � ' � .- . I—t� � _-I� � { � � i � i �_ _i � � i �., i � k � ..I . � � � � } € ! ' � � 1 € i � ' � ' � � � 1 i i � � I I i + € . ��- ?��i� I I i ' � € { ( � t � i i i j ( - i i � � ` �� °��i � � ; � � j_ � 1 ( [ � I ' I � � ' � 1 a a I � �� r v E�.`x I!L��, Y� � � � � F � ( �J� ' �. { � - � { �� k � . J . k"� � �lc,�,i� ��eC�- i'"-+; � �I I i �C`S € .i� ��t j € � � � � I ] � ' L"Et.:j� � ''L3�."�CI ��„'l� ;� I- 1 � ( `- -i ! �. � ; 7 # �1 � � � ��f�"F���i�' d`�i m c�s� r� . �, ��� ��l � ���.' r: � � , � s � i� �'-� u3 G°[�i..c� cst � i � � - �i �.,i �7- �tts G'�� -��a �_ i 1 _3 � � m rr , r � ��c) � �[€'�i'' ,i �z t�t �. �' �- °z � � � I � � - (C7 C9��,u ,u( p i (r�+� c3 KS i � � � - � ` � � .�9 p 1� J C?' � � t:3 i KL I T` ( �.,��:` � I u= � � ; ' ' ` � Ci����k� � �-��C;i��� i=�Eu:�� IC>�C^„s�� � � �ary��� � � i • ( � f E � � t i RS.. dr 31-�7�) �"iJ M-{�t i. �}� 2 �� f j i ' � � � � � �;� cv rc( i���y�;C3 �- u. � � w � .a_ i- Q +�a �7�� „� u€ ��G���� �� � 1 � i � ��:,cL ,y����C�- 1. �tc��.J CS �; '�, � os�:fl G.`- ..� t��� ���;E�..��i;� ` � � � j i � °� ,; ¢1��o�u, saC�,1 � w � � `�'` �}< �o � --� � `�i� ��u� r� � =� � t' ' � E � � �,� .a'1� w�.E_. �..��; r^ 3.�i r Z � a �" � "�' .��Lt' � ��'� 1 - . � � . � I � € � , � � � � � � G� ���t �iu��� �c�� � �t�! � � , ; �� � ue��.rl� �s.�(��c:?��. , � rs u,.�r cx�ca. Q�� � � � _ u.is_ Cs�t..tl � � F � , ' i � � �. C�.� ��-��- __�—; ' _�—� '— -!--- �� �� ` i. � j � ( [ ` j —�- T— � � � E 3 i } ' � � � R i E � i__� ' j i � � 8 � , � � f I { i � � � �� I S ' � j �( � � � i � ( �, i f � i ji : E � i i � � � � '� � � � ( � I i �-.� { � � � i i � "� ' 3 i � � �� � I s � � �. ` ' � i �' ' � � ; � � � ; IG i � ! G � ; f � � ' I ( i �� , ( � E , � E 3 � ; : ; ! j � � € � � I ' � � � ' ; , I � I ; ' � , ; I� ,— --r---;—�-- {—�— , s ��_j_� � i � � � I � � I , � f� -_-� 4 � �q' ,q� �_ i I o1 -r__�� � ` i [ � :� � � i � � � o��E � I � � i � i � �� 3 I ! � I�� i � � ( + � � � � i ! k i�l �°p� � l ' � � lao� ' � � � k � E a , i ; ; �___�_�-' � C , � ; i ��`� ; � i � � � � � � � __�— �_- _— . � � �� � ;�--�--t —�----�---F-�-- � � � � � � ` ' � � '-' ° � � i E � ; w 3 , � � ' � � � � + 3( � t � � � 3 �. � ' � . :.i� �t �,� i '�4� j ��` t �C���3 ��-� �?'..�` � { � F l 1 � ; ' j . � � � � � � , .I,�ir �.; l��.�' �-� ,� �I�ir; c'� ����I � ' j ! {� +,�� � �,..v?� i � � 1 � I CF' �:.: . 'c� ���`�� ��� � � �,��i+-��"��i,�tr-i.� .�a � � � i `=�=1�-��� ' E � � i� ct �; �� � '�,u'`!!�� � `� � E �. �I�I ���{�iEs- � � ��" � � �` '"�CL„J�`�'i ��a�Ed3�.l,`'�i,( f:��t'E3""�..�.d��-� �� ��_'�" i tr�".,y� "" L.�.� � � � � �., .�� � � (": a���„ � �� �; ,,, �:(�,.��,,�a?�I.� Ca z � I�.�, j t � � � � � S � s s� 1 � :, '� crl;+��,� ���� ���i�' '}���I��t��� -� � �, ��:� � � .�. � i _� I { � � Ir�� �� j.7 �"��C`i� I��Q:7 '��J.{�-���C� �`"�I""'�I.a ��"� 4 n.� i i���P�3 � 3 ;� , � y 7 { (k.,�,. . - .� u:;�l"��� �`1� ���I��C> '���s�c�:������"'tu:����� �'�j���`'�i�';;�( � j � ��� � � i � � ��a;ii - cr;�r� ±a�t:� ir , � t�, a�I�. r c� u- ..a � ��c,( � c1 �a.��" �.�. I �.� �� t E � ..L..n����....�.._.��.� `.`�..�.�,,.�_..�..�.I_.1a ����.�.� � � ._...,�`` �` �. .�_ a,.»�_m._s ._._.3