HomeMy WebLinkAbout15371 V
�� CITY OF DIAMOND BAR
�.. � DEPARTMENT OF COMMUN[TY&DEVELOPMENT SERVICES
21660 E.Copley Ihive 3uite 190 PRESS
'r (909)86Q3195 Faa(909)861-3117
�''�'� BUQ.DING PERMIT APPLICATION � FIRMLY
� JOBSITE ��2 APPLICATION � PERMR I � P/C
o ADDRESS�/0� Dva�ti�n«�F DATE NUMBER� Y
$ issue /A] TYPE occ
APN LOT RACT DATE / V " CONST. GROUP
p OWNER � -
� ADDRES � L- ZONING SEfBACKS
Z CITY �DV.i�✓!1� ZIP TEL R�RT RW O❑
I g APPUCANT TEL SIDE/SIDE STREET RW ❑
� CON7RACT0 SIDE ❑
� ADDRESS - PROPOSED USE ^ � D '
o CffY�G'��Ol/�G� ZIP TEL��j
ARCFUENGI • 7�/�GI
DESIGNER NO.DWEL NO. NO.
ADDRESS UNRS Z STORIES BEDROOMS
� CITY ZIP TEL
I �
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER•6UIlDER DECLAFiATION SFR/AOD�REM
O
� 1 HEiiEBY AFFYW LNDER PElYLLTY OF iEfiIURY THAT I MI EXEMPT if10M TME CONTMCTORS LF Garape/Carpon
W L£NSEIAWFORiMEfO11.OwwOREASON(SEC.7at1.6BU5WES5ANDVHOFE55qN5CODEINVGTYOH (n
� COUHTYNRYCIIREOUWESA7EMIITTOCANSTAUGT,ALTEFiMPROYEDEli0U5HORREPNRANYSTPUG W patiolDedc
IURE.PRIDR TO RS ISSUANCE AGSO REW IRES THE AVVII('.MIT FOR SUG71 PERNIT TO FILE A SIGNED
STA7EYFHT T1A1 HE OR SNE IS UCFNSED PU0.SUANT TO TNE OROVlS10N5 OF TMF COHTRACTOR4 LL
� t@13F lAW I�tEp�(��MENCIIW VATH SEC1qN 7oo0)OF DIVISION i OF ME BUSINESSANO VR6 � POOUSQd
fE5SqN5 OODEIOR iHAi HE OR SHE IS El(FIAPT TMEREFiiOM ANO TNE&WS FORi11E AILEGEO E%EYP•
7qN.ANYVqLAiIOHOFSECi10N7oJ1.6BYANYAP7lKJJlTFORAGERWTSUBlECTSTHEAVVUGIl/TTO Z Re-Rool
� AGYiIPENALTYOFHOTAIORETLWGtVE/Mx�DaFADOtIARS(SSaolk
� OIIlSO1M1EROFTIEVNOPEHT/.ORM1lEMPlOYEESYnMwAGE5n5TNE1fi501EC01dFEN5ATqN, � r,pmmBtCial
WYl p0 T1E WOi1K UO TNE STRUCTURE 15 NOT INTENOED OR OiFER�FOR SALE(SEG 70N.BUSF J
NE55 NO iROFE5310NS COOE:TIE COHTRACTO0.i LICEtiSE L1W DOES NOT APPLY TO AN OWNER OF
N i(iOVEq{Tr/1q9UlD$OqYPROYESiMERECN./J�IDMI0D�E55UGMNUR�fMIMSEIFOHHERSELfOq m
� - � TW10Ucv1W80RHEROWNEIIPLOYFES,VROV1040THAi5UCi/MWROVEl1ENTSAAENOTNTEtiOEDOq -. _ ...
OFFEAED fORSALE�F.IqWEVERTHE&ADwOORUPROVEUFM�SSOlDN9TMN p+EYFMOFCOMPIE•
� TqN.TT1E ONMER�BUftDEH Mnl1lNYE iME BURDEN Of PflOWW iHAi ME OR SHE D�NOT&14D OH
YDPOYE fORTNE fURP0.5E OG SKEI
� 04�SOWHEROFTHEPROPERIY.IWIXCLUSrvELYCdfTRACiNOM97NUCEMSEDCOHiRACTOR4 ,
TO CONSiWJCT THE PHD.IECT ISEG 7oN.BUSINESS IND PROFESSK7H5 COOE 7ME CONTMCiOAS LL Valudiidl AWAREA
� f�ItSEUWDOESNOTMPIYTOANOVlNEIiOFAPROPERTYYMDeULGSORMAVROYESTNEREON,ANO
Mnq00NTRACTSFORbUCHPHO.7ECT5VATHACONTRAC70H(5)LICENSEOVL11iSUAHTTOTHECOHTR�G p� � DESCRIPTION FEE
� TOfiSLIGENSEIAw.} 1 . . . __
^ O I AA1 OCEMPT UNDER SEC. B.t i.G FOR THIS REAS0.N �
�C U
S ¢
u-- w�� om+En V
� J
y[ UCENSED CANTRACTORS DECLAAATION W
2 1 NEREBY i1iFIRM UNDER VENAIi�'OF PERKJRY TMAT IAM LILENSED UNDEH PROYIS�ONS OF CHA?iER V.
� �(OpuuENGNU WIiH SECTION 70001�OMSION 70F 7HE BUSWESS�NO PROFESSIONS CODE.IWO Z
`u ItY UGEttSE 45 IN FLLL FORCE AND EFFEM. m
O /ry A1' � 1
r UGENSE CAA55 �� IIC.NO.� J
V �� coHrrucroA a
w
- � WORKERS'COMPENSATIONO TION Q
N U
� �NEqEByAFFYWUNDERPENALTYOFPENURYO�+EOFTNEFOLiDY✓�t70DECLAfL�T10niS Z
� �I ILtVE At�wlll�TNN A CEtiT�FlCAiE OF CONSENT TO SElFdNSURE i0ii VARKERS' S
COMFENSATqN.ASPROYiDEDBYSECTION]TOOOFTHEUBORCOOE,FORTHEPERFOWAANGE �U
pF}pE�ypq�(FOp W Wp1 TNIS YEiW�T 6155UE0.
0
Q �I HAyEµp ynlL yAWUW WOp1(Ep$'OOMPENSATKR7 INSUfLwCE AS PEIX1iRED BY SEGTqN
i7a0 OF iNE LIB07t COOE iOH hiE PfNFORNINCE OF THE WOAK FOF WHICH TH1S OERMIT IS � �,CJ G.+
� LSSUE0.Yy ypW(Ei�S'COM7ENSA710N W uqANGE CA@NEH AND POLiCY NUMBER ARE
� �,�, r �Q. � PuwREviEw
� po�wrnweEA � , ELECTR�C
� �nssEc�nrdrfIDnorr�ou.s�rIDOFn£e�rsroRor�ru�s�oau�sR+�1��1 PLUMBING
Z ICEpTIF7THATNTMEPERFORMANCEOFTNE�WPXFOl1wH1tl/THISPERAIITISI55UF0.1 MECHANICAL
(,�} SMAt1NO1EUPlOY►NYVERSONWANYA/ANNEHSOASTOBECOMESUaIECTTOTHE
� WOfL(ERS'COiAPENS�TDNUwSOFUIIiOi1wA�DAGfiEETMATIGI5H0UL�BEWME INSP NFE�
S SUBJECtTOTME1Wfi1(EFS'LOAA7ENSATqNPNON5qN50F5ECT10N37000FTNEUBOR - / �
CO�E,I SNAIL FOiihfWlM COMPLY WIil1 iTfOSE PROVISIONS. � `
Q /J
� OATE: APPLICAtiT: �
� WAqNM10:FAlUIRETOSECUREYIOFiKER3'COMPENSATqNCOVENACEISUNUWFU41hD5NALLBE ENERGYP/C
� SUBJECTMIEMVLOVER70LWMWALPENALTIE51WOCrv4iNESUVTOONEMN�DREDT10t15AND ENERGYPEFMIT
pp�J,/�$({�pp,ppp),W/�DD�i�ON TO THE COST OF COu7EN5ATCN,OAYAGES AS PROYIDED FOR IN
_}.1 SEGi10N 77a Of iME LJ�BON COOE.WiEREST,ANOATfORNE�'S iEES. pE7ENT�ON FEE
¢
w CONSTRUCTION LENDING AGENCY PRE-ALT FEE
a
� IHEREBYAFFlRAIIR�DERPENALTVOFPEQJURYTMATTHEREIS�CONSTHUCTIONLENOWOAGENCY
FOR TME PEHfORAVJ�CE OF n1E WON(��5 PEwd�T IS ISSUED(SEC�007,GV.C.}
W l��� IEt+DF.R'S NNAE �
� LENDER'SADORE55 � , �� .
� ��qTIFVTNA1111AVEPFIDTHISADDLIGTfOP1ANDSTAiETHATi11EABOVEWFOPAIATqNISWfWECT. TOTAL FEES . �
� �Af3REETOCOMGLYYATHAI-LGmµOCOUNTYORDINNICESMIUSTATEUWSREU7WCT0&JLLLIN6
CONSTRUC7qK M:D HEREBY AUTMOfU2E REGRESEtrtATIVES OF iFUS LOUNTY(O CNTFR UPON THE
S� ABOVE�A/EMIONE0��7ERTYFOHINSPECfqNP avo s. COMMENTS
OO
i
j
m PE FL
d
� -�.c
� oF E ��TE RECPT.N0. PAID BY VAlJ0ATi0N
� WHITE—Department Copy.YELLOW--Finarrs CopY.PINK—Assessa CcpY.GOLDENROD—File Copy,GREEN—Applicar+Ys Copy
� ' I ' � � " I ' ' ' . �
�� . - ;- i � � ; _ � !_ � _ _ , � � _ C
. � � i � � 1 ! ! � ' _ � �. i �
� �' ' � i � I � , I � � � � � �� �
�: ,� i � i j � I ; i � .
�- �: _ ; : _
; �,, _ i ��--
-� � ; � -
;..
� _J_ � -
; - - - �
� �,��Ei �
;�;r; � �
� �rr
��.��
., �o�;i - - � - ' •.� -'
�• I
f�% � '
F z I ,
� � a
F
- a - � � om � J •
Q
❑ .
o� Q .
� � �
0
Q �:I zo c� � z � . .
� ,.; � �
� ' � ¢ � � m a w ? Z v � � � � o a.��'.
6�1�
❑ O �'� � o oowzm � z � � � cZ`� -' � z u7 � � " °~' a¢. "!,�� _
� z W� ��;O � J J V V O � Z O (7 � CL w 2 'Q � C7 d .� 7 � � tn �+.�
. �{ � p LL.� �. Q m z p ¢ z � C7 � w Z w F- z Q — p a w >- •�•k
O � �:ll,�¢ W � � � J � m m CL = 2 = l[1 LL lL F- Q tL � � N � r LL C7 •_ .
� `�� Q W W d `[� = J U` V CJ � J J J (n U J � J J Q K�"
Q 0 � = Z � [c ¢ � �i Z � W O z O O O � w� Z Z Z Z ¢ W u z !s
0 � � � > > � � � w � a m ¢ LL n. a a O o u. � O u. � x o w ��
u. U
O w %
a
� N ;Q ''
� z i��_ - - �
,
'.�� I
' ', �",I .- � .�' —— _
. IrM�: �. � , ._tif
�� '"' ��� �-,p. `T.ry -
t . � J �
♦ •' '-� � Z ' 1 � �r .a.. tf ..
. i -� / p 4 ` _ � -..��� �i '
`� -� (J . I- ' Z - L1J . �"f
Z a (:3 � � •_ .. N W l
t '���'V � O m � U Z F- Z � pp FW- � � J J � U Z • ' (n cn N � ; • � ,
" cn ¢ � W ¢ j F Z � F- U � m p ~ � Q y F" F_ Z Q m �.- � Y(n .�. r���
���y ¢ U a � 3wwZ > w JJCu' = zz E -� W z ¢ w � W !�-1� '^-' ,,s��
Q � � 0 � O cn 2 C7 0 = w a CC � �n � H H �-,p W � J �
� z �ry a � cn z c� S x x w � ? z ¢ cc U a � c� x w a � U a
� 'm � U � m d W � '� lL C:S CJ C�J � _J - � S F'_ p: C,J J J J i � F'�4.
e _
.
M ' �i � � ¢ J W a O ¢ O O O O �2 X a W C r W W W Q'� Z Z <. O W(W i J -
� �
; , � v� r i w c� �n f- � rc LL o� cc tr rc cn w 's U � r� cn u� c7 � LL ii I� ' U u�cn � ' '