HomeMy WebLinkAbout12223 (13) �
1� CITY OF DIAMOND BAR ` �
DEPARTMENT OF COMMUNITY&DEV E E
� 21660 E.Copley Drive Suite 190 ' • . , . .
(909)8GU-3195 Fau(909)861-3117 PRESS
�`�'� BUILDIIVGPERMITAPPLICATION FIRMLY
� JOBSITE / - . .` � � . APPLICATION' PERMIT � P/C
o ADDR�SS�/���_, �A6L� �'icN OATE NUMeEy� 3x
� issue TYPE OCC
� APN LOT TRACT DATE CONST. GROUP
p OWNER �� �
p ADDRESS ZONING SEfBACKS
�"' CITY� ZIP ' TEL. � ` L R�R _ RW ��
APPU - TEL. SIDE/SIDESTREET �� ^^
� _ �
CON7AACTOR � � I o G SIDE- O
� � ADDRESS � PROPOSED USE Q��l�1I�E� C�D � �L��-- —�--
0 CITY � ZIP�TEL 3 .
� ARCFUENG/ [r- T J,(�j
� DESIGNER NO.DWEL NO. ' O..
ADDRESS � UNITS STORIES -�-- BEDflOOMS
1.` � CfTY ZIP TEL
. N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� Q OYVNER•BWLDER�ECLAHATION ` SFRlADWHEM
_ O .
p 1 NEREBY AFFlRN UNDER iENKTY OF PEf WRY THAT 1 AM EXEMCT FROM THE CONTMCTORS LF GatapB/Cd(pOR . .
O CENSEUMiWNTMEiCILON'W(1fiEISON(SEG)atf.6BU5wE55ANDVHOFE5S10N5CODEANYtl7YOq (n
C� GOIMTTY1tYCMREWWESAPuiMfTMWNSTW�JCT.KTEf�MWf10VE.0EMOUSh7,OHNEPAIHANYbTFd1G W PatiaDeck
Z TUPE,PItqN TO R9 59UANCE AL50 FEOUIFIES iHE AGPLICNli fOR SUCH YEW.uT TO FLLE A SiGNFA
� SiATFMENT iWU HE OR SHE IS UCENSED DU0.5UANT TO THE PROVIS�ONS OF TME CONTRACTORS tY � . .
� CENSE UW(C/WTEN 0(COAIUEHCWO VAiH SECi10N 7oDq OF OIVISb.`1 i OF TME BUSwE55/�ND PR0. V" POOUSpa
fE5510NS CdOEI OR 711AT ME OFiSNE L4 EXELPT THEREif10Y AND TNE BA515 FOR iME ALLE6ED EXE/IV.
TpN.AHYV10.AitONOFSECTION)W1.68YANYAPVL1CANiiORAGEpAUTSUB,lEGTSTMEMMICANTTO � Z Re-Roof
� AC7VILVFHKT/OFNOtA1ORETHANFNE1M10Rm00LIMSif50o).r
. � OLA+�NEROFiMEPfqPFATY,ORYYEwPLOYEESWITFIWAGESh4TXEM50tECOMPErW7qN. O Cpnr�6lCldl . .
NRL DO THE WOiY(AN�THE SiRUCTUFE IS M�T WTENDED OR OFfERFD FOq SALE(SEG 7u1.BU54 J
11ESS MO YROFESSIONS GUDE TNE COHTFALTOHS IICENSE UW DOES NOT MPLY TO AN OVlNEfl OF
N YNOGEitTYYMWBUlA401iM1VRDVEbiMEREQN.AHOYAWDOES5Up1wORKWMSEIFORMERSFLFOq �
' � 1)NOUGH WS OR HER ON�N EYPLOYEES.PRDYIOEO i11AT SLCH N/PROVEMENTS ARE NOT MENDED Oq m . . . . . . .. .
O .OGFFAEDfOR8�LEIFHDL�VFRT1E8tADUM30RMDR0YEYENTBSAtDVATMINONEYF.WOfCQLPLE- . _ . .. .� . ... . . . .
__ '. " ._ ._..
_ .. .. Z .TqM.THE OWMEPrBU4DER MALL HAYE i11E BUROEN Of GHOV WO iHAT ME OR SHE DO NOT BULLD Oil
� MPHDVEfOHiMEPUfiPO5EOF5/�lF�. �
� OL�OWMENOFTHEPROPEHi1;M/E%0.USNFLYCONTRACTNOYIRHLICENSmCONTRACTORS �v�
i0 CONSTWJCT iHE VHO.IECT(SEG 7oN.BUSWE55 AND PiqFE5510N5 GODE THE CONTHACTORS LL Valuatiofl (7`� AQI.AHEA
CFN9E UW DOES NOTMPLY TOAN ONNER OFA PROPERiY Wlq BUILD9 OR M�PROVFS 711EREON.MA
t� wwmirtw�crswasuo�vao.�Ecrsrnrn�cornw�crows)ucEnsEowrr.wurtmTNecorrtw�a pUANTITY OESCRIPTION . . . FEE
� 70KSUCF+SEIAW.�. .
J
p IAM F.XEIIPT UNOEN SEG &i P.C.(-0R TH15 REASON U
Q
, u' OATE OWNER �
J
� UCENSED CONTRACTORS DECLAFiAT10N W
� INEREBYAFiWYUNDERiEHALiVOFVER1UtiY711AT1/JIIILENSE�IFJDENDHOVIS10N50FCHAPTER �
•IG01�a.ffNGNOYrtTHSEGTqNluo�)OFDM510N70FT11EBUSWESSANDPROFESSIONSCOOF.AND Z
W LICENSE IS N FULL FGiGE ANO EFFECi m
o ���«� L—��.�..�,�pv �
� a�ts� c«lrrucroa a
� WO 'CAMPENSATION OECLARATION �
� 1 MEiiEBY AFFYW IB�IUER PENALTY OF PERRIRY ONE Oi iNE FOLLOW WO DECUMTqHS -.. U ._ .
N Z
� �µ�VEµpWILLMAW7Ap1ACERfIFlCA7EOFO0N5FMTO5ELF�INSUREFORM/ORKERS' 2
� �COMPENSAi1DN.l�S PROVIDED BV SEGiION 370D OF TFtE IABOfl WOE.FON TME PERFORMANGE w
OF iT1E WOfiK FOH Y/M1C/f 7VNS PENAIT W ISSUED. �
W
�IHAVEAtmWLL1►UPliAPIMrOW(ERSCOMPENSATIDNWSUHhNCEASiIEOIMEDBTSEC7pN I'� �1
Q ]7aoOF7ifElAeOfiWOEFOfiTMEPERFOIWANC',EOFiHEWOPKWRWFUG1TwSVERM1T15 �T.i�
155UE0.MYYNFYCEascauvFN5A7aNwsuwwcEUAtiFRH�DP.�LICYHUM6ER�wE: CANSTRUCTION
� wawEn �k7� �,�/�n .. .-- - ... .PLANHEVIEW .- _-. . . -
� ra�cr'uueEa ELECTRIC
p �s�cmr�e�ra�e�mi,a�rmoF ro�rsrrAor�Er�rnr�npaw�R�ao�ea�ss} PLUM&NG
- � �CEqTIFyiHATNTHEPFNFOAMMICEOFTNEMO�KFORWNICNiWSDERAUTlSLSSIJED,1 MECWWICAL
(� S/WLIq7EMVLOYANY�ERSON�NANYMFNNERSOA5706ECOME5U8JECTTOTME
� WOPoCERS'COMPENSAtqNIAwSOFC�LiFORNIAµDAf'.RFETMAtIF151qUlDBECW.�E INSPECTIONFEE
- . � &/BJECTTOTMEWOiiKERSCOMPEN5AT10NPROViSIDNSOF5EGT10ND7ooOfTMEUBOR ISSUANCE. � . . . 1
CODEISh1ALLfOfiTifWITHWMPIYWIiHTMOSEPROV1510N5. `
� SMIP.
� � O1lTE ' AVRIGANT: - .
WAfWIN�: AILUiiETOSEWREWORKERS'COrA0EN5ATqN YEWlGE�SUNUWFU�AND5FIALLBE
ENERGY P/C �
� bl%IECTANEA1PlOYEATOCRWWALVENALTIESANDGViLFWE5UPi00NE1YN�DREDTnDUSNyD �ERGYPEAMIT
OOLLAfiS(i Ioo,000�,W ADOITION TO THE COST OF COMPENSATqN,DMNCESAS PROYDED FOR W �
� SEGTIDN7)WOFiHELABORCO�E.NiEREST.MIDATTOPNEYSFEEi qETENTIONFEE. �
� GONSTRUCTION LENDiNG AGENCY PRE•ALT FEE
� IHEIiEBVKFIfWIA�ERPENALTYOFFE0.AIF'�THATii�HEISACONSTRUGT10NlENOw(lAGENGY r �
FOH iME PERfOPMANCE OF THE WORI(FOR NM111CF1 iMIS CERANT 1S ISSUED(SFG�Oi7.GV.CJ.
�
� � IENDERSNAME . .
� LENDER'SADDRE55 -
� ICfR11FYTHATIMAYEaEADTM�BIPPLICATIONANOSTATE�TTMEAbOVEWfORMATqNISCOHHEGT. TOTAL FEES � �
� 1 AOREE TO W'/PlY H7TN ML CRY N�COUNTV a7D�N�NCES ANO STATE Uw5 REUTPJ(i TO BUM1DINO y� � ,
CONg7p�CTq1{/WD HEREHYAUT110fUZE RE7FESEN7AiIVES OF THIS GOUNiY TO FNTEfl UPON iME �- 'l .- !\ � � ` ,
� ABOYE�MFMqNEAVf10VERTYfONuiSPECTIONPUFiPOSES. COMMENTS � � �) U U
� ��� �
m v�au {v rrq
� �. � � /i � i n , �/' —
� &6NA OF E � DA _ J
� � RECPT.NO. PAID BY� VALIDATION
WHITE-0epartment Copy.YELLOW—Fnance Copy,PINK—Assessor Copyr.GOLDENiiOD—File Copy,GREEN-1WqicanCs Copy
—r �
n
� _ _ _ ..:. . . .,.. �•.. .' . �.� ;.. -- �.
... � ,�� _ --- '-
. . ; . . . ._ ._ - .. � .
- -. �
. _ _ - - - � .� f
1_, �..
_ , y
: -
- �
��=
, ; � -
- ; �; _
� - � `,. _
, : - ' � - �
' . . . '.. , 1 � 1
. r �-. ,
Q � ' Q
: UOQma' . � , , � � zLLa ��.:.
�
���Q�� , e . .. O O z Z �4 W �. z z Q Z .. 0. � � � Z. u. 6~. 6a. : S . .
� - l�l 4. -. �if i .
m 'O. r cnoo ° m �moz � ¢ � � ¢ � ot7 ¢ � oao � y �, . _ -- -
� (� : cn F- o ou+ wpozQz � � � wz � ¢ w V W n� wx � � - - -
Z .w `L J J U U m Z O W LL- �' ❑ tf) Q 1]J � � �cy _ -_
. O Q u_ �+- J 1- O m � = 2 � � � � U ¢ ¢ � � �i
� Q ' � u� cr ccga. = m � � v � `� poou. ozzZz2ww z ., -
� a O o z � z � ¢ Q � � � m ¢ uZ—. aaaoou. go � u`. xaw ,..
.. 1�3.. W � � LL' LL. � p , _
_ 0 :LjJ ! I t�,�
. �
- � � �I � :.:'�.. "
� tu�
' ��I�', , I 4. � . . -•
��. � '. . �., ��
. ' �/ ; �I . � i
a I :� 1 �� - Z Y� ��I
1 '� r f .I_ � �r� ^ O � ' ' ', U � � ', z� .�
- . ,"'„ ' Z �? , c� a o � � cry � z 'i �� � � z r YF :
° ._, . c7 z "' z ° � � f.. z m
� , ,� F j m '. � �U"Z F--.:�,. 2 ¢ tn m � � � ¢ . Y _i c/� u~i �-- U � l�j,J , U O. .
cno � ` xzcr � oL � yg �nz z �; wzaw �
� ¢ � wW� rQu+ waw � � z � ' f¢„ t:- rowJ -� g a,,w
- �1 c� -' ❑ � w � > W ..� -' � i cn — � cc c.) x W a �'� , � __-_._-- ,
- �� � V 0. 4 Q � 2 �yr O Z w Q' � F^ Z U` 6 [t U a Q .J :J :J J .� . `J ��, .
A ¢ u� zc� six g z � w �. a ¢ ¢ < a O �
:.r < O � Otn � W O ¢ OO � � � � 4 U � cnv� v� c� u. u- u' u' V
` ¢ u., Q tL rL [G Ul
', f�� �y w C7 t�J) F �i O ¢ W 'yi