HomeMy WebLinkAbout15356 CITY OF DIAMOND BAR � `,
" ' �� DEPARTMENT OF COMMUNITY&.DEYELOPMENT SERVICES J
21660 E.Copley Drive Suitc 190
(909)86Q3195 Fax(909)861-3117 PRESS
��^�'�� BUILDING PERMIT APPLICATION FIRMLY
o ADDRESS ��I��� I � �I35� � �UgL�� APPUCATION��(I_/"1�� PERMR I{� P/C
OATE �II (�� NUMBER ✓ " �
� ISSUE ��/1 `� �n I 7YPE OCC
APN LOT TRACT DATE �� V v CONST. GROUP
�j OWNER TR-t.�L-v 6.�OoD I�,D.A ,
ADDRESS ZONING SETBACKS
� CITY ZIP TEL FRONT RW ❑
APPLICANT TEL. REAR ❑
� SIDE/SIDE STREET RW ❑
CONTRACTOfl �J 1J ��F �C�� Tf�L. SIDE O
ADDRESS h - '
� CIIY NiSSion llir:n ZIP TE aN91�IS�'�XI40 PROPOSEDUSE � �;'
� ARCWENG/
DESIGNER N0.DWEL N . NO.
AOORESS UNRS � STORIES BEDROOMS
�N CITY ZIP TEL
DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-6UILDER DECLAFiAT10N SFR/ADDlREM
O
I HEREBY AFFHM 1lmEH VENALTY OF PEiWRY i1uT I lul E%EYP7 fROA1 THE COMiMGiOfiS L4 GaragelCarport
8 CENSEUWFOIilHEWLLOWP�GiiFa50N(SEG7031.6BUSWESSANDPROFESSqNSCODEANVGTVOR (n
� CWNi1tYR4[71PfWIRESAiF.fWITTOCONSTiWGT.KiERY1PRDYE,DEYOUSM,ORREiAIRMTSiAUG W PelidD6Gk
TURE,PRqH TO RS 1S9UANCE.A150 REW IHES THE MPLICN�T FOp SUpI PER1.uT TO fILE A S�CNED W
� E7ATFlAENT T/IAT HE Oti SNE IS LIGENSED FURSUNR TO THE PFIOYISIONS OF T1fE COHiFiAf iOHS LF
� CENSE{AW(R4PiER Y(C9MMENCINf]VlITH bECTqN 7oa0)OF DIVLSqH i OF THE BUSINESS AND PqO u' POOUSp3
FESSIONS CWE)OR TiNi HE ORSHE IS E%EMVTTHEREFH01d ANOTME BASIS FOR TNE ALLEGED EXEMP•
TqN.ANYV10lAilONOi6ECTION7m1.6BYANYMPL1C.4fiiORAPEFAUTSIfeJECiSTHEMPLM,N1iT0 Z RrRoof
� ACIVIL iENALTY OF NO7 MORE THAN i1VE MINORED DOUARS(SSoo)1:
� ❑4��MMEROFiHEFROPERTV,OitMYE11PLOYEESMIITHWAGESASTHE1RSOlECOMDENSATqN, O (`,p��mercidl �
WILL 00 THE MK%YC AND TFfE Si WJCTURE IS NOT W TENDED OR OfFE(iE0 FOR SALE REG 7oat,BU54 J
NE53 AND PROFESSIONS COOE THE CONTR�C70RS UCENSE UW DOES NOT APPLY TO AN OWNER OF
� YROPFATT1MiO8ULDSOqYPROVE5IHEREON.Al�MR10DOES�ICMNORKMiMSEIFORMERSELFOq m
¢ T/u10UCi1WSWIMEROVMEIAPLOVEES,PPOViDEDiNA1bUp/WPpOVEMENTSARENOTMENDEDOR - ��
OOFFFAEDFOASKEIFWWEYERTHEBUlD4WOfIMPROYEAIFMI550lDWIT1W/0NE`lFai10FODAIVLE•
Z TpN,THE OWNER�BUpDER W0.11uVE iME BUROF.N OF PfiOVYKl THAT Nf OR SHE DW N�T BURD OR
= NPROVEFORTHEVURP0.SEOFSALFI
w 04�OYMEROFiIiEPROPEflTY.AMEXQUSMELYWNTRACTNOWfiHUCENSmCONTRACTORS
� iD C0ltSTAUCf iNE PiDJELi(SEG TOM.BUSWESS IWD PHOFESSIOHS OODE 7ifE WNTMCTORS lF V01U8I10f1 AQI.ARFJ\
CENSE UW DOES NOTAPPLY TOAN ONMER OF A PROVENTY NT1D BU�1DS OR MAPiqVES TMEfiEON.M�D
� wHomirw�crsc«�sw�vaaEcrsvnrn�carrrwicroa�s���+smvuawxrrron+¢ca+rw�c p�q� DESCRIPTION FEE
� TOFiSUCENSELAW.J. ,.J
O I MI DIEUPi UrDER SE0. 8.L P.G iOR TWS REASON Q
U
�
LL DATE OwNER �
� J
� LICENSED CONTRACTORS DECLAFiATION W
IHEftEBYAFTYWU�EHPENN.TVOFPENURYTNATIM1lICFN5E0UNOERPRONSIONSOFCHAGiER V.
� /�CqANENCWOWfTM5EC710NIC00)OFDIVISION70FTMEBUSWESSANDPflOFE55qN5GODE,AND Z
X AIY UGENSE IS N F1'LL FOFCE AND EFFECL ' I m
� UCENSE CUlSS (D_�q LIC.NO. - • �
�
� wrE '�-1 q-�� __coHrw�cTOR I F (-�OtJi.� a
w
� WORKERS'CAMPENSATION DECLAFL�TION �
� IHEFiEBYAFFIHMUI�ERPENALTYOFGEiWH`�ONEOFTMEFOUOwiNGOECUMilONS: U
C!) ZQ
' � �INAVEANDWiLLWVNTAWACERTIFIGTEOFQDN+EMTOSFWNSUREFORWDRKERS' S ' � �
COA/DENSATION./tVROV10ED8YSECTION]TOOOFTHEIABOflCOOEFOqTMEPERiOFUAINCE U
� OF AfE WO(iK FOR WMK11 iw5 iERMIT L415SUED. �
� �II/AYEANDVALLYAMTAINWOHI(EflSCAYVEN5ATIONIN5UFWICE,ASREOUtREDBYSECTqN � !`7
Q i7W OF TNE UBOR CODE FOR iHE VEHfORYMICE OF THE WOHK FOFi YAu01 TN�S PERu:T 15 �iSV
155UEp,yyVA�RKERS'COM7ENSATIONINSUNANCEGMiUERM1DDOLICYNUYBERAAE CONSiRUCTION �
� �Ep �ITATE Fl,ll�� PLANREYIEW �'�'
�
� va.icrr+�aca MY71. 7�0� L�X-I_ ELECTRIC ~••
� (RaSSCCfIONtJE�WTBE00r.HE7IDOFT�fPEWdT6faa0r+EHlar�EDOCU1J51L�oolOR�cc� PLUMBING
� IGEHT�FYTW�TN111EVERFOAMM7CEOF7HEKORKFOFwM�CMTFUSPERu1TL5155UED,l MECHANICAL � � —
SH�IL NOT EuvLOY M1V VE0.50N N ANY MANAER 50IS t0 BECOME SUt3JECT TO TME
� MqW(ERSCOMPEHSATiONUM/SOFCNJfORN1AANDACREETMATIFISMOUIDBECOME WSPECT�ONFEE � •
SUBJECTTOTHEVAORf(E0.5'CqAPENSAT10NPfi0Y15qN50F5ECTqN770oOFTMELABOR 'i� ��
Ocoo�,/is�iw�yr/p�jnrontrcouc�rmn�rrascvqov�sar�s. ISSUANCE �ir��II`r�5� - �/�
� p O�tE� �"1'VlJ APRIGANT. SMIP y 6 LL
J ENERGY P!C
WAANW4 FAILURE TO SECURE NOpKE0.S'COMVENSATqN COVEMGE IS UNUWFUL ANO S/WL BE
�J—y SU6IECTM/EMPIOYEHTOCRIMWALGENALTIESANDCM�FwESUPTDONEHUtAi7EDn1IX15AND ENERGYPERMIT
DOiL�RS({f OD,OW�,N ADW i�ON i0 TNE COST OF COMPENSATIDN.OMUGESAS PROVIDED FOfl IN
¢ SEGTION97WOFTMEUBOALOUEMITEREST,lJIDATfORNEYSFEES RETENTIONFEE
W CONSTRUCTION LENDING AGENCY PpE-ALT FEE:
n.
0
� INEREBYAFFIRMUNDfRDENKTVOGVERJUNYTUTTMERELSACONSTRUCTiONIENDW6AGENCY
Z FOfl THE PERFOiiMANGE OF TME WORK FOH YnuCH TH�S PERMIT IS ISSUED(SEC.3097,GV.C.).
W
� LENOEfiS NAME
� LENOERSADORE55 �j7
� ICERTiFVTMATIluvERFJ�DiMiSMPIICATqNANOSTATETFI�TTMEABOVEwFORA1AiqN15CORAECT. TOTALFEES �/ ��
W IAfIiiEETOCdAPIMWITNAl1G1YMWWUNPlOF7DwANCESAIWSTATEUWSREUTWOTOBU0.DW0 '
� CONSTRUCt10N,ANDHEREBYAUT110HiZEREPRESENTATNE50FTWSCOUNTYTOENTERUPONTME
Z �.�,��T�EovtiovEancoAu+sPEcranwavosEs. COMMENTS
� CUFF T�2D1�� I�OOF=��� �'�G.
� PEHM NAME(VWNf) �/ �f M
[A / �� / �"�v _
N SfGNA OFPERM�TIEE DATE
RECPT.NO. PAID 8Y VAUOATION
� WHITE—Depanment Copy.YELLOW—Fiiar�Copy.PINK—Assassor Copy,GOLDENROD—FileCopy,GREEN—Applicant's Copy
I
- �- 1-= - - � ' I
: ; , . - - - -
; �
�,
�;
. �5
�
� r��p
��'
�
A
�`II � o �
+J' � f" ❑ Q W J `" _
� p o l o z m � ^
� O z p G � �r C7 J Z
CLI � �I O U � ZmQ W Z � U Q Cl� o "
p � �1 r- � o o ° m o m m z o o � z � � � � � LL '' 2 `-�J
U �:u� � O o w w Z � ¢ ¢ U U � g u� a. �. a a. n�,
;. Z L1J :S'IoaiJi. � � �' mzpaz � ¢ � wzw � Za � zar_' o W iki
� O CC ��� u� ¢ ¢ � � F: omtc = = � wLLu. i- ¢ wUW � wx � � c"t
� _y�p cL w w a a = m � c7 V C'3 � .� � � v� U � � F= � � � �'- Q .::^. -
¢ ¢ w
p ¢ p o w w ¢ w z � O O O � o y � ¢ j y
a O � = z z � ¢ o � z ¢ woz000u- wZ zzcrww � -
0 �,�u. LL � � � u'. � m �i a m cc u_ a. a a O ❑ � � O u. ti S o `w �=f
; o a �_ — --
� u� o ` . ' -_ ,� ' _ ,�
U � �f f; -
;�� _ � i' � -���
'�j �i
` �.
:" ;�' � .c�o
�: ��_
Nl :,�: .,= , g - �`;_. .
, `i' I ,�,t
z � � �,'�
o I
.� '.. wo � ¢ � F- � W ;
' �� ' F�- � CD� W '�" "'i C7 U Z W C'3 Z F- � � N UJ � . o
(`` '� � U = F- Z � 07 F" Z � g �—` � U` L j � fn I�
�u �n '= � w � > f- Za� t- c� ? m `o_ � � F- t- z � m 1- � Y� . , 4
,zc�1 apu' ¢ ¢ u-' w ¢ w � � cng ,u�� z z _"nrn � U = z �� � '��;
��BY � � Q � wwZ � wJJC � ^ � � _; Fz .� W � W t.c-i
�T�U O � o ¢ O u� 2 c O S W a ¢ F � � t- t_ � W � J - �I
.. "�� a u. �, z � a ¢ cn c.� xxxw z � < ¢ c� a � c� xw n_ z Ua .
��C➢ � U � m p_ W lL. � LL C7 C'} C7 � � J 2 W F— 6. Q J J J �I � {—R ��. J'�.
: � --i� c� wa ¢ � r- o � o » � oF � � � saw �na ¢ <rc 0 cLw
J � J Itl ¢ O � O O O O 2 X a W [C W W W �C � �' � W W � �
.:.:.�..._��..___.....w.,.�:...�
.
� �v� ri w cs u> t- � � u. ct ¢ ct ¢ u� w ? c� o m �n cn c9 �� u'. u`. ii_ � !. U � cn cn .�''� . .,