HomeMy WebLinkAbout15374 (13) f� CITY OF DIAMOND BAR �
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
.., �c zi�o�.c�i�ynri��s��i4o PRESS
(90'9)860-3195 Faz(909)861-3117 ,
'^^'�� BUILDING PERMIT APPLICATION FIRMLY
y JOBSITE �//�. ��,3�U$Uit/L�1�VE �PUCATIO � PERMIT I �n P!C
o ADORESS DATE NUMBER � 11
� ISSUE TYPE OCC
APN_� LOT TRACT DATE CONST. GROUP
p OWNER
ADDRE���7�C�A/Ti��C' �U�/�L�l//� 7D ZONING SEfBACKS
� CITY L�0 V/�/A ZIP '���TEL fl�RT RW OO
APPLICANT TEL S�DE/SIOE STREET RW O
� CONTAACTO � egU� SIDE ❑
¢ ADDRESS PROPOSED USE l �
I � CITY��G�A/�717!) ZIP 7E " G�
� ARCWENG/
� DESIGNER NO.DWEL NO. NO.
ADDRESS UNITS � STORIES BEDROOMS
� CITY ZIP TEL
� DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
�
Q OWNER-BUILDER OECLARATION SFR/ADD/NEM
O
� 1 MEREBV AFFIliM UNDER VENALTY OF PERRIRY TNAT 1 AM EXfGOT i11CA1 iHf CONiIiACT00.4 LL Garapa/Carport
W CENSEUWFOR7}1EiOLLOWPxiREA50N(SEG7a71.66U5wE55M1D7HOFE5510N5CODEANYGTYOR (Jj
� CtAMiYMM111CNRE0UNE5ADERA1rtTODONSTRUCT.ALTE0.�DpOVE,DEUOL�51{ORiiEPURANYSTiti1G �jf Pa���
TUii�PRqi1 TO RS SSUANCE ALSO REOUY7E5 TME AVPIM.Ji11f FOR SUCM PE W.�IT TO FLLE A SiCNFD W
. � SiATEl1ENi iNAT ME qi SnE IS UCENSEO PU�iSUANi TO TME Pi10YI510N5 OF TME COfliilAGiORSIF
cF�uw(csunha o lmuuEr�cwa wrtH sEcra+�000�oc av�sion a oF n�eusu�ss uao aaa � PooVSPa
fES5qN5 COOE�OR il1AT NE OR SME IS EXEAIPT iNEREFROM AND iME BASIS FORTHE ALIEGE�E%ENC-
TpfLANTVqlAT10NOFSEGTqN)a'n.6B1lAM/ADPIiCJiNTfOR11iERMITSU&JEGTSTMEAPPIICANTTO Z Re-Roof
� A UVIL VENALTV�F N�T MOfiE TlIFN iNE MINDRED DOL1Aii5(t5oo11:
� O�IISOwt1EROFTNEPROPFRTY,ORYVEI�PLOYEESWITNWACEShSTHEiR50LECOAI�ENSAiqN, O C�mOf�
Nfgl p0 TME YYON(AND iNE STRULNRE IS NOT M(TENOED OR OFiERED iOR S�LE(SEG Toaa,BUS� J
NESS AND VNOFFS510H3 CODE:TME CCx1TMCTOfiS UCENSe LAW DOES NOT A7PlV 70 AN OVlhER Oi
� PROPERTYWNOBULDSORMPROVESTHEREON.M+DW51000ESSUGIN�DNNHIMSEIGORHERSEIFOq m
(= iYYiq10NW50fi1fEflOWNEMVIOYEE3,GROYI�EDTNAt5UC1/MvfiOVEMEHTSAiiENOTNTENOFDWI
� OFF6iEDfORSAIEIF.IqWEVEiLiHE&ADWGORINPROVEMEHTISSOlDN7iwHONEYEAROFCOMRE•
TqN.iHE GWNEq-BUILDEA VALL/NVE TMf BVRDEN OF PROV WO i1u.i NE OR SHE D1D HOT BWID OFI
= YP(i�YE FOF TME PURPOSE OF YLE} �
W O11�40WNEPOFiHEYROVFRTY.IwE1c0.U5�YELYCONTRACTN10Wf1)1UGENSEDCON7fiACTORS
� TO CONSTiWCT THE iNOJECT(SEC.)a4 BUS�NE55 AND DROFESSIONS CDOE THE CONTRACTORS LL VelUati0fl AD.I.AREA
LFN9E UW DOE9 WTAPPLY TOAN OVlM1ER OF A iflOPER1Y Mrt10 BUlD50H MPHOVES THEREON.AND
� YAqCOH�HACTSFORSIXIIPROJEGiSW1THAWflIW�GTON{5)LILFt�SmPURSUN(TTOTMEGOfITRAG pUANTI DESCRIPTION FEE �
� TMS UCE�tSE WY} .. . .
J
O I AM E%FLWT UAER bEG 8.l P.G FOR iMiS R"eA50N �
�
� pAiE ONNER F
� U
J
4 UCENSED CANTRHCTORS DECLMATION W
¢ IHEREBYAfFWYWDERPENN.TYOfVE0.lURYTNATIAYIICENSEDIR�DEPPROVI510N50FCHAPTER Vr
� •(OO�MrENCwO YIRN SEGTION 7000)OF OM510N 1 OF THE BUSWESS AND PROFESSi0N5 CODE N10 Z
oW IICEKSE IS H Fl1LL fORCE AND EFFEGi. m
�/ �.►,o. (v9�5o � _
� ���
�, o,,� % - �v� /llll✓I a
� ORKERS'COMPENSATION DECLARATIO a
N U
� IHE�FBVAFFIRIIUNDERGENKiYOFVERRIRYONEOFTHEFOLLOWiNOOEGUPATqNS: Z
� �IHAVEANDWILLMA4fTNNACERTIfIGTEDFWNSEMTOSElidNSUREFORWOfiKERS' S
COAIVEHSATION.ASPROV�DFDBYSECilON�70oUFiHEIABOIiCODE.fOHTMEPERFOWAINCE W
OF ii1E WpqK FOR WM1U1 TMIS PERMIT IS ISSUEQ �
�
��W�yQµp WI�►HWT/W�yfppKEp$•COMVEN5AT10N INSUfLWCE.AS REOUIRFA BY SECTION i �)
QQ 37ooOFiNEU80RWOE.FOIiTMEPEfiFORMANLEOFTHEWOWCFORWMICl1TMISPERAUTIS G,,,�.!'V
� CAAWERY C�ENSATIONWSttHANCECMNEAANDPOLICYMIMBEFAHE TRUCTION
� ti�� ��11 �O�L
� aoucr raunesA�.1r.,. ELECTRIC
� (1}{�SECfqNNE�IqiBEop�.qEiEDafTECEf�.Il6waa+EHlO�7ED�(111u�R�d7��1 PLUMBING
z ICERTIFNT1uTNTHE�ERFORWwCEOFTHEWORKfOqWHIGITH15iERMITI5155UE0.1 MECFIAN�CAL
(,'} SHALL NOT EAIPLOY IiNY PEFt50N W ANY IAMlNER SO AS TO BECOME SUBJECT 70 THE
� VlORI(ERS'COYPENSATiONUw50FULiFOFWiA�NDnGREE7I+ATIFISHOUIDBECOAIE INS ONFEE
S SUBJiCT iO THE MlOi�KE0.S'OD1dvENSATION PpOV15iONS OF SEGT�ON 770o OF TME U130R C y.�'�(J
CO�E,1 S�NLL iOHTFMATN CO�PIY N7M THOSE PROVISIONS.
O P / � Js� —
� pq7E; APPIICAtlL �
� WAR1/1NU:FALURETOSECUREVIJiY�ERS'COIAPENSAiIONWYERAGEISUNUWFIA.AND5MN16E
� SU&IECTANEUPLDYERTOCRIMWALGENALTIESANOCNLLFM1ESUiTOONEHUNDqEDTHW5AN0 E.ryERGYPERMI7
DOLLAFLS(t1ao.00oG W IDD�i1oN TO THE C0.5T OF GO4�ENSAiiON,OAMAOES AS PROVWED FOR w
� SEGT1ONi7wOF1NEUBORCOOE�TEREST.ANOATTORNEY5fEE5. RETENTIONFEE:
W CANSTRUCTION LENOING AGENCY PRE-ALT FEE:
d
O
� 1 HEREBY AFFUiM UNDER PENIITY OF PERNRY THAT TMERE IS A CONSTRUCTION LENO WG AGENGY
fOR iME PERfORAWiCE OF iME WORI(F R NMMlI 7HIS PERW T IS ISSUEA(SEG 70W,GY.G� .
� ��S�,E N
c �E��u �i �f
� ICENTIFYTHATIMAYEREADT45MGUCATqHMIDSTATETHATTNEABOVEII�ORAlAT10NI5COMEGT. TOTALFEES �O� �/�/ '
� IAGREET0001I7L�MATHALLUiYANOCOU�TYOaDiNN1Cf5AND5TAtEUNSREUTWG706UlD�NG �
CONStRUCiION,AND HEREBY AUTF10iLZE REiRESENTA7NE5 OF iHLS COI/NTY TO FIffER UPON THE
� ABOYE�MENTIONEDPROPEflTYfOf11NSPECiIONPUFiPWES. COMMENTS
� � - � !/��
� :
¢ PERNiTT
tn -_"�
� ��
N NA F F P EE DATF
REGPT.NO. P/UD BY VALIDATION
WHITE—DepeRment Copy.YELLOW—Fharwe Copy,PINK--Assessor Copy.GOLDENROD—Fde Copy,GflEEN—ApplicanCs Copy
� . I ! I � � ► � � i ; � � � i �.
;
� r i i , � � , � � _I 1 _ � � i
� �: � � � I i ; ' � '
�� , � � � � � ;
�"o ! i i � I
' ' � �
�� �,: I � � i
_ - - � �
. �� � i
- -i - _
'�I . ;
, !r-i`
� � ar''� _ � � __
? �� , . �
= z
o � :. i �
F- ❑ ¢ J �
a a �[, � o � pW � ¢ � C7 JZ .
m � o c.� � zm w zzc> � rc ¢ �Lo e�yi-
` � � �'F- cno o � m � uam1mZ ❑ oQZ a�". cn ¢ ui � � F .� :� :
V � �"' O O w w Z � a ¢ U U .� g z u7 a = n. a ,r;��'
z W . ����,p L J .�,U (� D o �z o C7 � Q w z a O L7 n- � z H w cn .:' ,
O � ' i7�i� O � LL m z p ¢ z t9 z w d a � .
�i, W ¢ ¢ � � O m cc x � w LL � H C w V W � w = w >- c't!
.. � ��p � w w a a. = m -� C7 U c7 = � � .� ui U � N �_ .� � � u- � `_�
aZ ���,�� Q Q O W w � a lil Z � � O O O LL � Q Z � 4 W 'S j ltJ r�••
Q �� = Z Z ¢ � - �i Z ¢ W O z O O O �- W Z Z Z a� W w z �k
0 �;iu. u. � � LL u. � c, u. a m tc LL a d n. o o u. g o � LL x o w ��
. O W �
� 0. �,..;i .
H � ;�
U — ''I _
�.
'.;a - �
�'��' ` � " �- '
t '� ;- '�: i::L -
k �
i �' I 'a _ �` I ;�r +L�.
_ . - o , r_ - � � �
; �, wo z ' - ¢ , , � � , o ' � - w "� �.� � � :
; " w z � c� - �� U cn Z c7 . . nt �
z �:I � p g UZt= 2 � z � Z � ~ Z v � ' � y �N �� �
x m r- S =� � �' - �
.. ���, � � � w W > F- W � !- � � m � � ¢ Y ,_j (~Af F= Z � m ;.-J f- Y ln �,.
� c7 Q- p ¢ ¢ �'-' w J J t � � z `'- z � w � F- U � z Z� '�`� t.7��
- I�U O � o ¢ O cWrJ 2 L��7 O S w a ¢ 2 � J � I¢- !_- 1-, �Q W � J � - W I-�-F i
� �CD � V � m a � I.L LL C7 C7 C7 S � J z a W F- Q, Q �.1 J J J � � F-a '-
n. W �
C7 W � � F 0 � � � � � Q F- J J � 2i d SL fb Q G ' C ' n.W
� �iF .� ccg � ao ¢ 0000 = xaw � wwwazzt - o ww -�
:. ;. ��U l L L W �C 7 l n F- �i Q l L Q � � C L C!] W S U � cfI cn U! C 7.11.. lL Lt�lL U _... (/J(n _
. . _ .. . _. . . _ _ . .. _ . ._ ._ _ ._.._ _ . _ �. ...�. . . ._ _._ . . : ._� �