HomeMy WebLinkAbout15767 (20) � � �� CITY OF DIAMQND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ,
�,� 21660 E.Copley Drive Suite 190
', (909)860.3195 Fex(909)861-3117 PRESS
���=^'�� BUILDIIVG PERIVIIT APPLICATION FIRMLY
'� JOBSITE �� '� /e APPUCATION � {L PERMR f ��r1 I �P/C
Q ADDRESS DATE � � NUMBER l 1 �li �►
� APN LOT TRACT �SSUE TYPE OCC
¢ DATE CONST. GROUP
p OWNEH �Q�tsf>\1
ADORESS ZONING SETBACKS
� CITY TIP TEL FFiONT RW ❑
APPLICANT TEL REAR O
� SIDE/SIDE STREEf RW ❑
CONTRACTOR ✓1 SIDE ❑
� ADDRESS � '�'-'
CfTYCnV vlfi 21P I�7J� TEL/�L 33�f-2� � P�OPOSEDUSE� .-�� S � ��� �O�b
� ARCWENG/� . '� �c r� I ` '[ �� �1(.b0
DESIGNER NO.DWEL NO. NO.
ADDRESS UNlTS � STORIES Z BEDROOMS
� CITY ZIP TEL
y DESCRIPTION Sa.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFRlAD4�REM
O
(] I MEREBY AFFIRY UIDER iENK7Y OF YERAIRY TNAT 1 AM E%EMPT FHOA1 TME GONTRACTORS L4 Garage/Carport
� CFNSEUWiORTHEFOILOWW6RFASON(SEC70.31.6BVSWESSANOVNOfESSqNSCOOEANVGTVOR (J�
GOUN7YNNKNREOUYiESAVEWIRTOGONSTRUGT.KTE0.�PROVEDEMOU9tOHREPAtRANYSTFiUG W P8110/D6CK
iUNE,PRqR TO R4153UANCE,AL50 FFW WES TME M7LICA�YT FOR SUCH PERAUT TO FllE A SIGNED W
STAiEMENT T/1AT ME Oq SNE IS UCENSED PUFSUANT TO iME iRDY1510N5 OG TME CONTFiAG'f Wi5 LL
� CFN9E lAW(CliAPTER 0(COAIAIEHCAiO WITN SECTION)000)�DMSIOH a OF THE BUSINESS M&1 PPO- u' POOUSp2
GESSONS CaDE)ORTMAi ME Ofi SME IS E%FMPT TMEREFfiOM Iv�ID TME BASiS FOq TME AIIEGED E]cEM7-
iqN.AHYVqLATqNOFSECTqN7a71.68YAHYI➢PUCAHTFOqAPERMIiSUBJFCTSTHEMPLICANTTO Z Re-Roof
� AGYILGENALTlOFNOTAIORETMANFIVEMUNDFEDDOUARSli50o).0
� 04�SOw1+EROFTMEPqOPERiV,ORMYEAtPIOYEE5w1iHWACES/5MEW50lECOUPENSATqN. O CpmmBlGidl '
W111 DO TFIE WOfif(MD iHE STRUCNiiE lS Ii�T URFIOED Ofi OFiERFO fOR SALE(SEG 7W.BU54 J
HE551WD iROFE5510NS OODE iHE OONTMCTORS UCENaE LAW DOES NOT/u'+PLV TO fN OK?.tR pF
� PHODEFfYMhtl&1tD50qY0ROVESTIIFREON,MY1VAqDDE55UOlYK%L(M145ElFORMERSElFOq m
. - -(= i1W0UaiWSORHEROYMEMPLOYEES.PRDVDEDT11Ai6UGiN1VROYEMEMSMENOTNiENDFAOti
l�1 OFGFRmFORSALEGHON'EVFRTHE6UldNODRMI7ROVEYENf650lDVATMWONEYEAROFCO4VlE. .- __ . � _. ._. ._
..U� �TIDN,iF1E OYINER-BUtIDEH YML F1AYE iNE&lRDEN OF PROVwO iF1AT HE OH SNE D1D NOT BUIID OR � �. . . . �� _ � . �� � '
� YPND'✓EFOR7T1EVl1RPO5EOFSALEI
u' �1A50wHEROFiHEiROYERIY,MADt0.U51VELYCONTMCTpWW1THlICENSEDCONTMCiOHS
(� i0 CONSTqUCT TNE iRQ1ECT(SEG)Ou,BUSU1E55 ANO DROiES510t15 CODE:THE COHiiUCTOqS tL V�u2I10f1 ADJ.AREA
Lll LENSEUw00ESNOTAPPIYTOMIOMMEROiAVROiERTYYAiOBULLD50HMPpOYE5TI�EREON,AND
� wHocartw�crswasuaivaa�crsmn+�oorrrw�cravs���scovuaw,wrron+Ecartw�u pUANTIN �ESCRiPTIOt� FEE
� TORS 11GET,SE IAW.I .
O IAY E%E11PT I.TDEq SEG &i P.0 FOfi TM15 RFASON �
U
� �
oue ormFa V
� J
UCENSED CONTRACTORS DECLAFiATiON W
� INERFBYAFFWNUI�EHPEwLTYOFPERA1FVTYuiIAAALIGEN5E0UN0EHPfi0VI5qN50FGMAPTER V.
� �fCOYwEHCINOW11H5ECTqN7oao)OFDNISqN�OF1NEBUSWESSN+DPFIOFE55iOi5GODE,AND Z
W UCENSE tS M FULL FOHCE AND EFFECT.
� ��«„��.'z� �.►�.-�24 2 ' �
�
wwte /o^31—2C0'L cartw�croa - C in� a
� J
- � WORKERS'COMPENSATION DECL.AFiAT10N �
N IHEREBYAFFtlWU1DERPENALTYOfiE0.1URYONEOFTHEFOl1DWWGDEGl�fi4TpN5: U
� Z
0 �1 lNVE MID W�LL W+/TAW A GER7IFICATE OF CONSENi TO SEL.iJNSURE fOR VJOfiKERS' �
� OOYVENSATqN./3 iP01f1OFD BY SECTION]700 OF iHE U180Fi CODE FORTME PERFOflMANCE W
OF TME WOFiI(FOR Y(YUGI TMIS iEPW i 14153UED. �
0
�I NAyEµp WILL LLUHTAW WOHKERS'COMPENSATqN INSURANCE,AS REOUwED BY SEGTION
QS7o0 OF TNE IABON GODF.FON THE iERfOR►UNCE OF TIiE WOWC fOR Yrt4CH TMIS PEqM1715
� lSSUEp,L1yVAfycF,pS'0011PENSATqNWSUPANCECARWFAM�D70UCYNUMeERARE CONSiRUCTION �1��
Cuuu[n PLAN REVIEW � 4;:
0 vd.icr K+ueEa ELECTR�C �' �`��
0 (Ri55ECilONr�wtBEmMIEfIDOFi1fPE11MT6FOFttt+EFLWfiED00LLA'7s�t+a01�NLESS} PLUMBING
W
Z 1 CERTIFY THAT N T}1E PERFOFYAANCE OF THE WOFiK FOR YM1CM TMIS CERMR R ISSUED,1 MECHNNICAL Y Q� � � n n n�
� n�owcE�TCEo�r�vENsµi,rriorrEUwa IFORNIAANOAGREET�MATIFI�SHOUIDBECOME INSPECTIONFEE —��
N SUBJECTTOTliEWOiiKE0.S'WA�PEHSATIONPqOVi5�ON50FSECilON�70oOF7 . Oq
rj coo�.isr+�ticoan,wirNcon�a�rvnrnrr dEv ohsa s. ISSUANCE ri�,,. rlliA�.101in h -:�� V
r �'�C— �
0 0��: _ -po ��;� sM�P G A�?�5;;��. .5�
� WAANUIGFAILURE705EWNENOFI(E1i5' ENSATION VEMGE45UNU UL,ANDSMALIBE EIJERGYPlC
SUBJECT/WEMPLOYERTODUTAINAIDENALTI SMIDCMIF ESUPTOONEKRmREDTIK%AAND �ERGYPERMIT
DOLUftS(ifao.oao).1V ADOITION TO THE COST OF COMPENSATION.DNAAGESAS PHOVIDED FOR W
� SECTqN9tolOFiHEV�BORCaDE.NTENEST,ANDATTOHNEYSFEES RETENTIONFEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE
Q IHEREBYAFFIRYUNDERPFNALiYOFFERAIRYTHATTMEREISACONSTRUCT10NlFNDWOAfiENGY
Z�- FOR THE PER�O��NCE OF iHE N'O�iK F�p MM�CH THIS GERMIT IS ISSUFA(SEG�oY7.GV.G).
W
� LENDEHS N�E �
�S IENDERSADDPE55
W ICERTIFYTMAiIHAVEREAp7T115APPLICAiIONMiDSTATETNATTIIEFBOVE1NFOw,ATpNISCORRECT. 70TAL FEES I �� � 0
� IAGi3EETOCOAICL�N7THALLC7PIANDGOUN1YOi7OWlWGESANDSTATEUwSNEUTwOTOBU4DwG �E'
CONSTRUCTqK AND HEREBY AU7MOaIZE HEPRESEMA7NES OF TlNS CWNiY TO ENIERUPON TNE
� ABOVE�ENTiONfDPROPEHT/FORW5PEC71ONPURPOSES. COMMEMS
� ���� �� ��\d- ���V'
m Ew�i E(v
� / `/ �
� S NA REOFPEfYMTT E DATE ,
� RECPT.NO. PAID BY VALIOATION
WHITE--0epaRment Copy,YELLOW--Finence Copy.PINK—Assessor Copy,GOLDENflOD—file Copy,GREEN—ApqraN's Copy
� �.: � _ _ _ i � � i
� �I;a�.': f '
• �" _ _
�'! ' '
r �'1, - ��
' I
(+ �',g^�I� _ .
f : ' I�',.�I ' '
�
i � _ '
t 4� j O Q '' _ .
,1 ¢ �
i� Q � .�' � � � � C � U' C7 J Z '
m CL ,;a.l, o t> > Z W � ¢ zc� c� ¢ ¢ u� .)- :
�. p '�? t� t� ooawmc� o � � z � cn � uiC� z � � 4,,^'.
f � U T"`'�~i, r`�- o o �. m Z m � z a Q � � � g z u'7 a z u- � n �,r::
I Z W �,:T�'�p 5 O� O--' U � o ��z � c7 � � w z a o C�3 d � z r= � cn �:'.�. r
'. O OC , ,� a � �- ¢ amom � z � � � wzu, � za — oaoui } s:.
c �'�.Q � � CL -1 J � = S W Lt LL � Q W CJ W N lil F � �,� �".�
G � ��.0 W W d � _ � J CJ U C.7 � J J J (n U J Q ~ � � J . � ''�7
�.� ¢ � O w W � Q W Z � O O O u. O Q z � ¢ 4V q � w
a Q � ,� = Z Z [C ¢ � Z ¢ W O Z O O O u- W Z Z Z c[ w jL 'Sel�
�a u. LL > > � � � co � a m tL u_ d a a O ❑ � � O � � x � u`.i `,j,
o w �1
H � .�' ,
U �"�I
�'I �I- �
V.� i
;;f,�:' ��_ � I
��; . �� -. � _
I I .�«:
c p �
�
". 7 Q Z _ � ' � � ,, :. Z N �'
� 4�-� F- � m W Z '� C7 ¢ Z W Z � O Z . CJ (7 C!I 1V . . . !
�,; � o S � � z � m �- � � � � z cr� s
� cn ¢ � wQ � � wQt= c� � � o � ¢ Y � � r �- � m , � z� �J
�i z � -' ow ¢ a W a w � � c n � � z z � � c> : Z _ � ., �r
� `Y Q U a Q �i W W � > W J J C � � Q J � 7 ¢ W � W -' F-1_ .
i�s c� o o rt o cn s t7 o x w a ¢ � � — � r F- �' o w � � r � i
. i ¢ � � z �ry a a[ cn z c> x = = w ¢ z c.,�7 ¢ ¢ c) a. � v z u a � . V n- . .. ' . �.
�� F'-' J ? W � J J J _ i' '�
—r1mv� � � mawLL � � c� c� c� � � � n, � F—a
J�W � J � J W 'Q O � O O O O � � ¢ W � W W W C Z z � � � W W �
�#�:,� r� +L;
� v� fi w c� v� r- � a u.. [r cr ¢ cc u� w � c� ❑ m cn m cn � u. u. c::I U - - cn cn .,,.�_.�_ .�_.,_..._