HomeMy WebLinkAbout15367 � � : �
�� CITY OF bIAMOND BAR �
• � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Coplcy Drive Suiu 190
(909)860-3195 Fax(909)861-3117 PRESS
�'^°� BUILDIIYG PERMIT APPLICATION FIRMLY
o� JOBSITE a�O3 //2 D i/������ APPUCATION PERMR �� /C
ADDRESS �� DATE NUMBER �F
g ISSUE TYPE OCC
APN LOT TF�ACT DATE CONST. GROUP
� OWNER
o ADDRESS ! � ZONING SETBACKS
� CI1Y ��V ZIP TEL. REAR RW ❑
APPUCANT TEL SIDFJSIDE S7FEET RW ❑
� CONTRACTO � SIDE p
ADDRES �
� CITY Zi TEL � PROPOSED USE � • �.
Pii ARCFUENG/ � 7�L�J-'L+I�v
���,, DESIGNER
N ADDHESS UNRS EL NO. NO.
2- STORIES BEDROOMS
N CtTY ZIP TEL
cn OESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
O OWNER-BUILDER DECLARATION SFRIADD�AEM
Q I NEREBV AG�IRN UNDER VEIUITY pF DERIURY TNAT 1 MA EXEAIGT iRpJ TNE CONTRACTOFiS LL ��9���n .
lL CEhSEUWfORTHEFOLLOYlW(iREASONISEG70.t1.6BU5WE55ANOPfiOGE55q1:SCO0EAN'fqiYOR (/)
Ca OOIk(IYMMICHpE0U1RESAPEpA1RTOCONSTRUCT,/LTER�P��DEYOUSH.ORHEPNRAHYSTNUG W
Z TURE PWOH TO R9155UANCE,AL50 REW IqES TME AiPIIGWT FOq SUp1 VERMIi TO FLLE A SIGNED W Patio/Deck
� STATEMENT i11AT HE OR 511E�3 LICENSED GUfLSUANT TO TME PROVISiONS OF TME COHTRACTORS LL � , .
� CENSE Ltri(GW iER Y(COM4ENGWfi WI7M SEGT70N 7000)OF 01vI5iON i OF THE WSINE55 ANO DRO POOYSpa �
FESSqNS COOf)Oil THAT HE OR SHE IS E%EUPT iMEAEifiO4 ANO THE BASiS FOH TMF ALLEGEO E%EUP-
TION.ANVYiOlAT10NOF5EGTqN7Wt.68YM1YMYlICVJTFORAYEWAiTbU61EGi5TNEAPPIIGNTTO Z qe-qpp�
�„� A CNiL GENALtY Of N07 NORE T11AN FNE MINDRED DOUAFiS(S5o01.�:
O ❑4ASOYAVEROfiMEGPOPERTY.ORIA`(E4PLOrEESMA7/1WAGESASTHEIR501E�04PEN5AT10q. 0 Cp�7m0fCi81 -
Z W�LL DO i1�E WOFK AND THE ETFWCTUfiF LS NOT WTRiDED OR OFFERED FOH 6ALF(SEG 7aa.BUSI- J
� NESS AND iROFE5SqN5 CODE 711E GONTMCTORS 11GEN5E Uw�OES NO7 AVvlr TO Iol OWNEN OG ? .
VfiODEATY MAq BULpS Oq 4DqOVFS Tl1EFE0r1 ANO Mhq DOES SUCH WOqN WAISEIF pq MEFSfLF OR
- � TMqOUOMwSORMEROYmEYVIOTEES.PROV1DE�i11A7SUCHWPpOVEYENTSAHEHOTNTENDE00R � .
OiFEAm iOR SALE�F.NOwEVEiL iHFBU0.Dwc70H MPHOVEUFM�3 SOID VATIwONEVFM OFCOYRE-
z TqN.TNE OWNERdU0.DEA W41 NAYE 7ME BURpEN OF PpOVWO i1NT ME OR SME GD NOT BUIID qi
= MPpOVE fOp TNE PUMOSE OF SALE}
w OI�OWNEROfTMEiiqPERi`I,AME%GLUSiVELYCOHTpACiNOYrtTNLIGENSEDC.oNTflACTOR3
' � TO CONSTRUCT THE GqD1ECT�SEG 70N,BUSINESS/�f1D OROFESS10N4 WOE iXE CONTRACTORS LL VaIUdGOf1 /�J./��
CENSE Uri DOES fqT MPLY TO/J/ONNER OF A PPOVERTT MNO BUIlDS ON MPROVEB iHEREON,MU
� wwcartqacrscoAsucHoaaEclsvnn��cana�cToa�s���,usEowruuN+rron+EconTw�c pUAN DESCRIPTION FEE
� toru ucErrse uw.�. .
O 1 MI FXEYPT UNDEN SEG &�G.G FOH iniS RFASON U
3 � ,
LL' DA7E OWHEN U
J
� LICENSED CONTRACTOfiS DECLAFiAT10N �
OC IMEREBYAFFWNlMOERPENAIiYOFPEii1uFYTWlTI1JAlICFHSEDUNDEHFROV�5qN50FGMM7EH V,
(_ �(COAINENCWOWITHSECT1DN7oaa)OFDm51GN70FTMEBUSWESSANDPpOFES5iON5CO0E.MID 7
X 1AY UGENSE 6 N FULL FORGEArO EFFEGL m
� UCEHSE CLAS LIC.NO. �
� CI��
� wh corrrr�cr a BUILD
� WORKERS'COMP�NSATION LARATION �
� IMEfiEeYAFNWIRAENPFNN.TYCFPERIURYC+JEOFMEfOLLAWINGDECW1ATqNS Z
� _IIIAVEAIDVALLMAMTAWACEqTIFIUTEOF�tiS'cMTOSEIFINSUREFORWOFiKEflS' _
GONPEHSATqN,ASGpOY1DEDBYSECT10ND7000FiHELABORCGOE,fORTHEPERFORMANCE W
OF T1fE WORK FORVAUCN TWS PER14T 15155UE0. �
�
_I NAYEAND Vnl1 MAu(!NN wORKERS'COMCENSAiqN WSUFANCE,AS pEWIHEO 8Y SECiqN �,
Q a7oo OF THE LAd00.CODE.FOR 7NE�fRFOF4ANCE Oi TNE wORK FOq YMIp1 THIS DEf W li IS '�- `
� 65UE0.MYNOFKERS'GOAIPENSATpNWS�RANGECAMIERMWPOLIGYNUMBEq E NSTRUCTIO - J'�J
j GYiNEfl� � C_ �� �-2�'��� ��+� PLANREVIEW
� POUCYMJMeER �C,7��j��I D.� ELECTFIC
� f�ssccior+r�noreEoont�rmeFnee�aMrswRa��ar�moauraSRiao�oa�ssl PLUMBING
Z ICERi1FY7HATNiHEVEiiFORu/NCEDFMEwORKfOqWwCJ17w5VEW.IITLSISSL'FD.I MECH/wICAL
(7 SMALLNOiEMPIOYANYYER50NNANYMANNER50AST08ECOMESVBJECTTOTHE
� WOfiKE0.S'C9MVENSAIIONUW50cGLtFORNyANOAGHEETMATIFISHOIhDBELWdE INSPECTIONFEE
S SUOJEGTTO7MENOfii(ERS'COUPENSATqHPROV1510N50F5ECiqN77ooOFh1ELABOR
caoE.�5lutLfo�inrMnlcoMvtrvnn+rNosEVNov�s�DvS. �5 � (
O
p MTE: MFiICANi: . .
� WAwi1NO:iAIURETOSEWfiEWOF4(ERS'COIivENSATqNCOYEMGEISUMAwFIA.MASM�LLBE ENERGYP/C
LL SV&IECTAHEMPLOYERiOCA1MWAL.FElY171E5ANOGVILFwESUPi00NEHUN�REDTNWSAND �EFiGYPERMIT
OOlLM31f Ioo.oWl.�N ADD�110N TO iME LOSTOF COAIGENSA71oN,DAMAGESAS PROVIDED FOR W
� SEGTqNiJolOF711ELAB�RCOOE.�NTEREST,N�WATfOaNEYSFEES qE7ENTI0NFEE:
a CONSTRUCTION LE�DING AGENCY ppE•pLT FEE
� IHEREBV1Fi1RYlA8ERVENALiYOFYERJUfiYTXAiT11EREti5ACON5TRIKTIONLENOWGAGENGY � ��
�- fORTHEPEHFORIAANGEOF1///E(w�OHKFORNMiCH7HISpEAwTI5155UFA�5EC.7oi7,qV.G}
� lENOER'S WwE " ' �C . .
C IENDER'SAODfiE55
� 1 CERTIFYTIUT I NAVE RE1D MIS AVPIICATqN NJO STATE TNATtNEABOVE WFOHI/ATION IS CURqECL TOTAL FEES D - �
w I AGiiEE TO COAIVIT M7TH KL GRY AND GOUNTY ORDWANGES MIO SiATE Uw5 REUTwO TO BURDINff
� CONSiRUCT10N,M1DHERE8YAU11qFlIZERFPRESEMATIVESOFTNLSCOUNTYTOFNiERUPONiHE ' - � -
ZABOYE�EHTqNEDGHO�ERTlFORWSFE PURPOSES - �
9 COMMENTS
� � /`
Qv ITTEE lo ,,,r>��
N G
5 PERiMTTEE OAiE
� RECPT.NO. PAID BY VlWDATION '
WHITE—DeDartment Copy.YELLOW—FYiance Copy,PINK—Assessor CoDy,GOIDENRO �Ie Copy,GREEN—ApqicanYs Copy
' . . 0�.',1 -_�. - _I I I _f; ,I' � i � �
' r�°'-�., . �I � i I I I �
.. �; - � I I i � . I I I � - ,
�. _ � �- � = ' I - I
_ ���; �.� -- : -_.� � � �� - ---�---� � �� �i I �� �:
_, . �� � :: , ; I � �I� �
. ��o r �..
� ,
� � �; � � Qm � . . �
a Q �,. � o � oW ��z �, �; JZ ; ,
m tL" i ! . � � � zco ¢ w zzU � cL < � � ;t�', .
O �; oo wmc7 �i cc z
0 F'- � O O ti m�� pp z � p ¢ z a tn cri � � � < �+ -
V � � �- O O w w z O � Q V V � g z w a � a a a��- -
Z uJ - . ��:Z.I p � � J V U O ❑ 2 ❑ C7 � ¢ W Z a - � C7 � � -� h= W rn ::; •
o � ��.T`{-� O u. � m Z p ¢ Z C7 � W z W ¢ � ❑
'�.¢ W ¢ � � � F o m ¢ = x � w � u. r_ a w � W � w ` w � i-k
� � �n Q CL W W W W 2 m � � U CJ � J J �l Cn U J Q F— J � J � Q �:.I,
� � � � w Q > W ���
Q �,O Q O O tu Z � - O O O � p
� O �J 2 Z Z ¢ � � Z � W O z O O O �- W c{ Z � W W ^ a�S � �
Q h LL. LL � � lL ll.. � [0 Li d (D CL LL n. � d O ❑ LL J O LL lL 2 O W t'�'! .
u. U — --
O �
� � °' ''F'�� ;
v ? �" �
k �� , I I
1` .. .�,,— �
{���::�' - 1 ' ' _ - _ �'
�I i _ �I I I . - '_
`� _ O � _ '� I��, S',
Q ¢ Z
� .' .� Fw- � o w 2 d , C71¢ Z W � p O Z � ,.t: N W ��'�� y ��i
rn p g '� U = t- Z � m F- ? � � � � U Z (n cn N }}
' '.i t�u � � J W � � F- W � H U � m � � C Y J y F= Z � m �. F- Y[/J :.. �T�.�'.
� W Q L!J � � (IJ � (1J Z z (/) �._, Z
Y � U 4 � W W Z > W � J t � Z J W Z 4 U � � `Z . �� �v�, �r},��
� U O o ¢ O tn 2 C7 O 2 W a. ¢ 2 � � � F- ~ � W W � I-F-
¢ u. � z � a � cn = c.� = xx W ~ ? � accUa � c> S w o-'. � Un.
' m Cn U = CO d W lL � LL C� C.7 C7 � � J Z LLJ � p_, G J J J J G F d �I�
� C'3 W � Q z F- O Q O � � � Q J � � � 6_ W [n Q ¢ Q 4 d Lil
.. (J] � LL7 GJ V1 F �j � LL Q � CL CL (!7 � SS U C1 fn fn !p C7 LL lL lL .L OU Cn(q .
. . . . _' _ ' ' (c � _ . . . ._ -- r-
L'