HomeMy WebLinkAbout15347 (8) �� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
„� 21660 E.Coploy Drive Suite 190
� (909)860-3195 Fau(909)861-3117 PRE$$
'�'°�'� BUILDIIVG PERMTl'APPLICATION FIRMLY
a ADD ESS_ZIOS'I r Z IOS'Z .D�.L(3(,I tiI APPUCATIO _ PERMIT � P!C
p DATE NUMBER �1
� APN LOT TRACT ISSUE � /n� TYPE OCC
DATE� "v CONST. GROUP
� OWNER ?A��eyWrnD F{.0.�.
ADDRESS ZONING SEfBACKS
� CITY 21P TEL R�R RW o
APPUCANT TEL. SIDE/SIDESTflEET RW D
� CONTRACTOR F� .1:� ���G T SIDE O
g AODRESS �Il A1�20 F_" � .
• .� PROPOSED USE " �
o CtTY�1SSi0n l�i ZIP (o / TEL y4y �/��/O
w pRCWENG/
� DESIGNER N0.DWEL NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY 21P TEL
�
�n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER OECLARATION SFWADD/REM
O
I HEREBY 11FLIPY Uf�DER PDl.LLN OF CERIURY TwU 1 AY ExE4DT Fp01J THE CONTR.1CT00.5 l4 Garape/CamoR
� CENSEUriFORTNEFOLLOWMI6REA50N(SEG7P]t.58U5WE55ANDPROFE55qNSODDEANYGiYOR (/j
COUHiYNRYfMRE0UWE5AVFAMRTOCONSTpUCf,,LLTE0.a��YF.�EMOLISN.OHFcPAIRM1Y5TiiUG W patiolDeck
1URE,iNqli TO R9 t55UNICE,I.L50 REW IRES iHE AFPIICAt(T FOR SUGf VERMIi i0 iILE A 51GNED W
STATENENT TNAT HE Oq SME IS UCENSED GU0.SUANT TO 1NE VROVISIONS OG THE CONTILICTORS ll
c CENSE MW(GiAPTER�(COMMENGNO N77H SECTION 70oa)OF DIVISqN i Of THE BUS{NESS AND iR� � POOVSp3
.��.' iE5510NSCD0E)ORIHATHEORSMEISf%iYPTTNEREfRO4INDTXEBAS15FOHTMEALLEGEDExE1dV•
V Tqf1AMYV10UT1oNOfbECt10N7o7�.OBYANYAGYIICANTFOiiAGEfiM175UBJEGTSTMEAPPUGWTTO Z R6-ROD�
� ACML VENALT'O�N�T 1.10RE iNAN FNE MINDREO WUARS(twU11:
� 04A40NMEROFiHEPfiOVERTY,ORYYEMPLOYEESWIiHWAGE5A3iHEiH50LECOA1vEN5A7qN, Q �,pmmefCl2l •
WILL 00 TNE WORK.AND THE STiA1CTURE IS NOT INTENDED OR O�iERED fOR SAIE(SEG 7aa.BU54 J
� NE55/J.D iROFFS51LNS CODE:THE CONTFiACTOf•S 11GEN5E UW DOES NOi I1CPlY TO AN OvrvEH OF ? `'
VqOiERTY MMO BUlA50q 4CROVES TIEREON,M1D N1q DOES SIKYI N�OqK MIMSELf OR MERSELc Oq
(t TTAIOUOIiwSORHEROMMEYPLOYEES.iFqVIDEDT1uTSUfJ/WvqpYEYFj(TSApEHOTNIENDEDOq �
� ocsr�ocaasuF.�c.�avvEVEqnweuinu+coar+vaovEuerr�ssanwir�a.,er�ocmuv�.
TION,THE OYMERSULLDER MALL HAYE iHE BURDEN Of PiiOYMq ilNT ME Ofl bNE D1D NOT 6UIlD OR
MFROVE fORiHE WIHPOSE OF SAIE>
� Ot�50wNENOfTMEiqpVEiRV.AME%CLUSrvELYCONTMCTNOWrtHUCENSEDCON7RACTOR3 Valuation_ •�ti/ AD.I.AREA
TO CONSTRUCT 7HE Pqp,)ECT(SEG.7oar.BUSl/:ESS AND YROFESSiCNS CODE TME CONTRACiOR:t�
� CENSEUWDOESNO7AGPLYTOANdNNEHOFAiROGEflTYYmDBU�DSORYPA0YE41HEREON,M10
wHocarrw�cisconsua�raaEaswin+�oartr�cToa�s�i�scoauawurrron+¢cartw�c qUANTI DESCRIPTION FEE
� TO(i51JCENSE LAYL}
O IAM IXEMiT UNDER SEG B.i P.G FOH h115 pEA50N Q
U
� H�.,
� DATE OWNEA V . - .
F�[ UCENSED COMTRACTOFS DECIARATION W
� INEREBYAFFWMUOERPENAlttOFOEFWRYllUTIMILICENSEDUNDEHVROVIS�oNSOFG�AP7EH Vr
�(CO►M�ENCwO Ma7M SECi10N 7000)Oi DMSqN.f OF THE BUSWESSAND PROFESSIONS CO�E,AND Z
W ULENSE IS N FULL AND EFFECT. m
0 �
� ��� -3 �.No. �_ J
� o�rE ' ' coHrw.croa a
� WORKERS'COMPENSATION DECLARATION �
N IMEHEBYAFfIRMIMDEqPENALiYOFPEfWqYONEOfTHEiOUAWWGDECIAFATfONS; U
� Z
� _INAYEANDW�LLMAWTAWAGERiIFIC/IiEOFCONSEMiOSEIf-INSUREfORWOflKERS' S
COMPENSATION,AS OROViDED BY SECTION 370o OF TME LABOA CODE,FOR THE PFAFORNANCE W
OF i11E WORK FOR WHIGf TMIS PEflAIIT IS ISSUED. �
0
W �IMAYEANDWILLYNNTAPIMPDRNER5COAIFENSATIONINx1HANCE,ASFEOUiREOBY5ECT10N n /� �\
Q 37000FT1/ElA80HCOOE.FORTIIEPERFORMANGEOFTMEWCRICFORYMIG1Tt115PERAU715 � 1 1 L••
isweo.WwowcEascanPEr+s�TqnwsuwwcEuaaERuaoaoucYraruBERu�: CONSTRUCTION V �� U
� �yEq 1� PLAN REVIEW
Z �kY�+�p ��I � �— � ELECTRIC
6
p ��n�r�oteEoor.s�r[DeFi�r�+rs�or+a��noownsR�o�)ca�ssi PLUMBING
Z I CER7IFY 7HAT N iHE VERFORMANCE OF THE H^DWf FOR VAUG1 TFUS DERAIR IS ISSUED,1 MECFiM1�CAL - -
(,7 $F7ALL IqT fMPLOY ANV PERSON PI�NY HINNER SO AS TO BEC011E SUBlECT TO TNE '�-�
� YAfiKERSGOYPENSATUNUw50FCALIFOPfA1M�AGREEinAiIF15`qULDOEWME INSPECTIONFEE
S SUB,IEGTiOMEWORKERS'001AOEN5ATqNPROV1510N50FSECTqN�70oOFTHEU60q
COOEISMALIFOHTNw�TMGOMPLYWITHTIg$E�ROVIS_ �ONS. ISSUANCE �
� ��, �..�d1 SMIP � t
p DATE:1-14-oD AVVLICArti: .
� WARNINO:FAIIURETOSECUREW��ER4'G�MPENSATqNCOYENAGEISUNLAWGl1L.AND5FUILBE ENERGVPlC A
Sl1B1ECiANEMPLOTERTOGRIMWII�ENALilESM:OCN�LfWESUPTOONEMN�DF7FDiFqUSAND �EAGYPERMIT r' • rJO�
DOLW7S(i1oo,000�IN I�DDIiION TO THE CQS7 OF COAAPENSATqN.DAMAGES AS Pf10Y�0E0 FOH W ,
JSECTION87oeDFTHEIABORCWEWTEREST.ANDATTORNEYSFEES r T � L
Q RETENTIONFE6: ��T�����fLT,DSrLT'
d CONSTRUCTION LENDING AGENCY pHE•ALT FEE
� INEREBVAFFIflMUH0ER0ENKNOFPER0./RYTMATTMEREISACONSTRUCTIONLENOINGAGENCV
iOR iME VEHfORMN�CE OF iNE WOw(FON W WCM TMIS PERMIT IS ISSUED(SEG�OYI.GV.Gj.
�
� LEN�ER'S NMIE '
� IENDEfPSA0DRE55
� �CERTIFY,NAT�MAYEHEADTf15MP�lU.qN,,ND51�TE.HATTHE,�BOYEWFORM/,TqNIS�RRE�L TOTAL FEES
� IAGREET00061PLYN7iNALLCITY/�N(1COUNTYORO�NANLESMl�STA7EUN5REUTWGTOBUILDW6
GONSiRUCTICN.AND HERE81'AllTIIONZE REPiiE5EN7AilYESOF TNIS COUNiY TO ENiER UPON iHE
�, ABOVE#1EHi10NEDPpODERTYFORINSDECTqNPURP0.5ES COMMENTS
� �:l l Ff= d3�o�vtiJ I2C�F��vC, , Ti�.
� PEA E NM1E(PWNn
¢ 7'/ ��"O
�
y SIGNATUREOFFERWTiEE WTE �
� RECPT.NO. PAID BY VALIOATION
WMITE—DapartmentCopy,YELLOW—Finence Copy.PINK—Assessor Copy.GOLnENHOD—File Copy,GREEN—Applicants Copy
i��'I I - I � - - .
o! j -
., I�'�'' - .
i' fi�l
' �'I
�!
i
' . I����il�� � .
ol'
Z
i � o c
�, .. F � � W 'c ' i
fj U � � m � c ��
Z � <} ,,� Z
a °a �;� o ° W � Q �
m � zm � w zz � �, � ¢ � o =�
� o 0 oomowmc� o rrZ a � ¢ �; c� z �: � �`i,
(�� i��v�i H p p w w Z m 0 z Q Q V v � g z � a � u. a a .,ji
� LS1 '�"y Q � J J U v O 0 Z O U ¢ Q W Z a O C:7 �' � Z I- � (n f.' .
� d L� tL Q Q Cl Z p < Z � � � W Z W H Z C O � D W �
O � "�'I�. w CL CL J J H O 67 CC 2 S W L� LL F_ �' W U W N w S LiJ } -t��.
� � �.�� CL W W d 2 = mI- J C7 U C:S = J J J (n V _l � F- J � I-� Is- C7 `y:". .
a z .�Q Q O � � � � li Z lil Z � Z O O O tt O a Z � 4 W 4 > W �� .
O I J S Z Z ¢ tu O O O O LL w Z Z Z � W W Z :�',
• � � �nu. u. > > u. � � m ti a m ¢ u. a a n. o ❑ u_ `, o ii u = ❑ w
� a �
U � �{ P '.�, -"
;��.I -> ' -
��i �� -
, , . ��
'�{� — �
, , .
�
� �
�;
�z;
a _
��� � � � �� ���� ��� � � � � � � _:�.
L , ,
� �, I O � . . ' , �, ' . � . ,:
:.%CI ~ a m ' W z '��'' . � � z W Z O � Z � U � �N �
i= z 1- r-
� �i in ¢ � w W j F W ¢ F- U � m 0 ¢ j Q y � �' � Z.(L m , . � -- Y� � .. � �'��I
� c� a p ¢ ¢ � dw � � m -� cn2 z r= ' � � z� h', , r�7.'
� ,rt� Y ¢ c� c � wwZ > w � � r � z -tw �F �
. `'T°�U O � Q O t� 2 C7 O 2 W a c[ � cn � � I-a- F= ~ O w � �,� w . � . .
�'�Q t^. � Z � n. ¢ (n Z U �r- S 2 W Z (7 d Q U a CC �7 T (1. � - U d . � � , �
�'m � w omQ � � o ¢ o » � og � � � � duim ¢ � L �, S dW ,-.. �
i J Q J W `Y O Q O O O O S X a W CL W W tL Q� 7' Z I1 O ,.. _...._.,y �...
��� � W CJ V1 I- � Q LL Q 2 CL CL (!J LU � U O fA Cl) Cfl U L tL L L ..� U . ' [/](n . �f' . . . .
� I