HomeMy WebLinkAbout13146 (16) CITY OF DIAMOND BAR �\
" DEPARTMENT OF COMMLJNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
' (909)660-3195 Fax(909)861-3117 PRES$
'�'� BUQ.DING PERMIT APPLICATION FIRMLY
QJOBSITE DA�CAn�Z?j—�9 NUAAB R��A 9Q 077
< ADDRESS � �
� ISSUE { NPE OCC
APN LOT TRACT OATE CONST. GROUP
p OWNER
"" ADDRESS ZONING SETBACKS
0
z CITIf��}�iyvD P�st ZIP TEL — 3 REAR RW ❑
� APPLICANT TEL SIDFJSIDE STREET RW ❑
� CONTAACTOR SIDE ❑
ADDRESS�� �� �
� CfTY�j��rihN�f3iAl�. ZIP'�077 TEL 9.�- �- p PROPOSED USE
� ARCFUENG/ •
� DESIGNER NO.DWEL , NO. • NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEI..
tn DESCRiPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OYVFIER-BUIIDER DECLARATiON SFR/AOD�REM
O
p 1 HEPEBY/tFFtRM UNDER PENiLLTI'OF VERIURt 7w1T 1 M7 QEMPT FRCM T�E CDNTMCiOR4 LL Garage/CarpoA
� CfHSEUWFORTNEfOl10WNOREASON(SECIWI.SBUSNESSMIDVPOFESSIONSCO�EANYCITYON (f�
COURYNHIWREOURESA��qiARTO00N5TT7UCT,KTERUDi1DVE,p(upUyl,pqqEFAIRMIYSTAUG W patio/Deck
1URE,PRqR TO(TS 55UMILE/150 NEOUIRES iHE APR.IG�N!FON SUpI PERMR TO FllE A StONED W
ETATEYENT THAT HE OR SHE IS LICENSED PUR3UAHT TO iNE VHOYISIONS OF THE COHfMCTORS LL
� CENSE UW(O/APTER�(COMMENC010 WITH SECTION 7000)OF DMSqN 7 OF THE BUSINE53 MA PR6 � POOVSP2
fE55qN�OOD�Ofi 7/UT ME OR SME 19IXEMPT THEREFROAI AND THE BASIS FOR TME ALLEOED E%EMP•
TqN.ANYVIOLATqNOFBECTION7071.68YMIVAOPIILAHTFOR�FERAIITSUBIECTSiHEAVPLIGNTTO Z R9-R00�
� A dNL PENALTY OF NOT MORE THAN FfVE 1RIHDRED D0UAR4(f5o0�.}.
� �4��EROFtHEPf10PEHTY,Ol1MYE�APLOYEESYnTHWAGESAS7HEtq50LEO0MPEN5ATpN. CpmmerC�el . . -
RILL 00 THE WOfYC MA TNE STRUCTURE IS NOT IMENDED OR OiFERED FOR SALE(SEC 70tt.BU54 OJ
NE59 MO PROFE65qN9 COOE TNE CONTiUCTOR4 LICENSE lAW DOE9!pT ACPLY TO AN OWNER OF
� PIqiERTYNTqBUIDlORYPFqYESTNEREON,ANDN'110DOES5UG7WORKfttMSELFORHERSELFOq �
� ,OFF6IEDFORS.uE�c.�awEVE0.7NEE�&RDwaoaMvsiOVEA1aR65d.DMrtiHIN^d�Ev�E�w�at6 m
Z 'TION.T1E OYYNEA-0IMDER YALL H�VE TME BVi1DEN OF Pf10VYMi TUT ME OR SHE Oq NOT BUttD OR ,
= MVRWE PoR THE RIRPOSE OF 3+LLE3
(y� ❑lASO'M/EROFTHEPRO7EHfY,AYE7(CLUSNELY�NTR►L'TMOWfifillCENSEDGJIlTiUCTORS
(t TO CONSTRUCT THE PiqJECT(SEQ)Oa/.BU31NE3!IND PIqFFFSIONS OOOE TME CONTMC70R5 LF V81�etKK1 ADJ.AREA
�ll CENSEUWDOESNOTAPPLYTOANOMNEflOFA7ROPE!tT`fWNDBURD50RI/APRpVE5T1EREON.MA
'L wHocdrtw�crswnsun�caaEcrswinucarrw��cmn�s�t�cv+smauasuu�rtmn�Ecawrruc pUANTITY DESCRIPTION FEE
� 7dL4UCEN5EUW.�. .. . .
O IAA1 EXEYCf IRAER SEG B.t P.G FORTMIS REASON �
U
W ¢
,�D sy �, �
� UCENSED CANTRACTOfiS DECLAFiATION �
� w
� IFIEFiEBYARFIINVIAERPENALTYOfPER.A/RYTHATIMIUCENSEDUNDERPROV1510N90FCiV1PTER �
��CWMENCNOWffH5ECT10N70a0)OFDMSpN10FME8U5P1E53ANDFROFES5lON4COOF,AND Z
W 11CFNSE IS H FU1 iOACE/fA EFFECL m
o ���s 3 �.�.�zsr�s6 J
� o�tE corrrrucroa SLlw/4 a
� WOFKER5 COMPENSATION DECLARATION'O��'� Q .
� i uEnEer�mroa uNOEn v�n oc rEaum or+E oF n+e�ouowwc ocaarura�s Z _
O _IiUVEIWDWILL►UIJTAINACERTIFlGTEOFCONSEHTTOSELFaNSVREf-0RWOHKERS 2 . � ... . ..� . � � ..
� OOYPENSAT70N.A9PROVDE90YSECT10N77000FTMEUBORCODE,FOqTHEPERFOHMMlCE' U
� OF 7HE YYO�IX FDR N'HR]I TXR VER/I1T O ISSUm. .:.. ' � .
�I HAYE MA WRl MAINTAR/N�ONKERS CdAOEN3�TION INSURANCE AS PEOUINED BV SECTqN
� ]70U OF THE Ll�BOfI LOOE FOR iHE VERFORMANCE DF TNE YVORK PoR WHICH TAS PEiM1R IS � ' ' � , � . /�
ISSUm,W NORICERSCdAPEN4ATpN INSURANCE CARR�ER�ND POIICYNUMBER ME CONSTRUCTION r� I��V.��
� C�aaiER '� PUW HEVIEW �iC_� -
Z ��'��+ ' ELECTRIC , , .
Q
�sEenn+r�troreEm�oFnf�rswawE�uorID �s+aq PLUM9�NG � _-s1
� I CERTrtYTlUT IN iHE PERfORMANCE OF TNE WORK FOq WHICN TM5 VERurt I515 ,I MECHANICAL �^�.�l
_ .. (� _ . SM�l!NOT EMPLOY I1M'VERSON N�MI A1AMIER 30 A9 TO BECOME SUBJECT i0 THE �. . . _ _ _ _. . _ _
� WDPo(ER7COMPENSlT10NUN50FGLL�FORNU.�NOACREE7HATIF15110ULOBECOME INSPECTIONFEE
SUBJECT TO THE NV(iKERS W�APENSATqN FRON510N5 OF SECTION 770o OF 7ME 1A80R
s 000�,i ro�mnvm�eorev�rwirnnasevnov'is�s/ • ISSUANCE _ �� � �.S.O
O DATE:���%APPIICMlT.�(�� SMIP ��� ��� �R1�
� wuwn+aru�ur�erosEw EWORUERSCdaCENS�TpNCOVEMGEtSUMAWFi1LANOSNALLBE ENEFiGYP/C ��� ��r�
� SV&IECfANEMPLOYEHIOCRMRULPENIITIE3ANDCMIFINESVV700NE1MiDREDiN0U5�ND ENERGYPERMIT ���v
DOUMS(f100.000�N IDDIiION TO THE COSTOF COMPENSATION,DMU�ES AS PflOVIDEO Pofl P7 `, G f�
� SECTIONf7DeOFTHEIABORC00E.NTFREST,ANDATTOFiNEY'9FEE4. � RETENTION �_t�I�v�i��•� r,,V
ow., CONSTRUCTION LENDING AGENCY P -ALT I] �'
� IHERE6VFiFR11tM0ERVENALTYOFPERIIJRYTHAT7NEREtSACONSTHUCTIONLFNDNOACENCY d
FOR iHE PERPDHMNlCE OF 7HE wOAK iOR MMIC11 TMiS PERy[T 14 I5�EC.wv7.CI'/.C.�.
� [ �
� I/l
LENDER'S1UMF �LO /✓
� �
C LEIWER9ADORESS
�� TOTAL FEES
1 CERTIFY THAT I HAVE RFJ�D TH�3 APPLKJlTION AND STATE THATTXE ABOVE NFOiWAT10N IS CORRECT.
d IAGREETOCOUVLYWITNALLCRYANDCOUNT'OtIDINMICE4ANO4TATEUW4RELATNIOTOBUlDINO
� �NSTIiVCT10N,/Jm HEHEBY AUTf10RRE RCORESCNTATNES OF 7ln4 COUNTV TO FNfER UPON 7FIE -
Z ABOVE�MENTIONED iROVENTY FOR ttiSPECTION PURPOSES. COMMENTS �
� � ��
m OERAIfTTEEtUME(PNHT) � .
N �n D3 I�-�-/�
y SiG1uNREOF E DATE � �
� RECPT.N0. PAID BY VALIDATION
WHITE—Depertment Copy.YELLOW—Fnnnce Copy,PINK—Asseesa Copy,GOLDENROD—Flle Copy,GREEN—ApplicanYs Copy
._ _ _ !,
'T %� _.. � cn Cn -. . . .. - -�-- .._ �... . . r i `n =n G? m n tn o c) � ? cn � Z ��S T '1� ,s, � Vi G) m -n cn ."''�
� �� rt7�fil . �" Z Z�D m 77 rn y Y O O O O � J y` r � r -� m I
. �� m �� t11"D '� U� �> T a D V: m v � � r= r -1 O C C C O p `U -� � q O m G� -i �,�1:
_ _ , -p-i � ' �1 - �.� S. r r r r r v =1 m z r t- � G� L� L� -n _�c� m � W C � � tn I
. � .. . � .fl-n , tj �. .'r-o �n'- 2 p x � � 7J r � � � � S S 2 (� ZIt�-' Cf; p �7 O � O C) ;t I
f� �om = O �?1
�� D z -+ r y r � c S � r r m < 'r'n m � T� � (� 7.7 T. �I
�£' ;`i cz �' _ :t) �' Im -n-i z � � � � ' y c rn o a�, r n � � ^�I'�� < 9 � c � � � �
cn T „� , �: z n L� C � � Z m cc � z �:� m �' o � tl , .
�... R_Nl N ' ' j � - � � O Z 4� � � C7 � _. �G� . . Z�, q m > � � '
� . i ' m ' � � � Z � y L�. r ...
_�_.__.._.JJ E �..._ � �h ;��l � �� V�
I � �' �fr.,�.� - i,�p l
'� ` �, '� �I; " 'e��
' , � \ '1� � � I .�a�.`•'"� ��i �
V
. ' � � g S� �I � ���;�,I' �ie �
• � � 4i �\ . �.�� 1 �. I� ? �.
� � _ �`. � ��' '� t L � .
� � �� ::al m o
� . � � n �
� �, m o x T � O � -n � O � � v ,i 7� m v � m � ,i � c c -n -n _ � � �
� �- . - � ���� _ ;?;� m C Y m q � Z D o T D O o Z �c Z m D � � m m 0 � A � � � �
� _:i � -n � p r- � � i- n V 7 r r t- _ � C 7 � r a7 2 -p �,m m � � ': z �
i_ - � � e:" < nj z v O rri Cl m � m �' m � G> z � � O � D � a 7 7 M � T.;
�♦ p D Z � D O �m T -n O �- 1� � O
" - �..,�� � u� m -� Z z -� G> O � D z m �7 � G� � Z. O n 'C'� r' r � O �Tl .z
�:a .a .o n Z v - r c� n D O Z m �rt O O c�i� -v�i I�
; i. ..; � ' � -� p a z ab' ,� � C) �
i ^ �' -+ G' •`n v' z � zc� , c' m "T � �i O
i � ,. : �.e o -nn � a' � c� � z � m m � � � � ^�, -00
r m n o 77: D
�,- - J��:I a � � � � �.r � c+ c � �"
`��, � , s �! .- � D � o � r �� C7.:�
�' �� " ,� „; `. � O,rs Y
�; z�?� � i
. i%. - � �t -�i � L �. � `
; . - � � ��� . I . .
i:� � � — — �: ;�
� r ' ��' � �, ...
` :1- � ; r; i
�� '�. ' •;.� ` i_ ����
�� _ ���, �� � r--�` �
`- �� �
� . � =�,'
;- �v . � i
" _ -- ' ! � ?i?!
'; �� : � r ,�i
,
i;- i� � ,�� I � ;�' :
i ,�
;, i
_
. __ _ -- - _ __ ._' _. - - - -- _ ,
- - _ .. . .. - - - - _ `-_ "'
: . -. „ : ,i_. . •, .