HomeMy WebLinkAbout15197 (19) � �
"('�� CITY OF DIAMOND BAR � �
`"` ' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
. � 21660 B.Copley Drive Suite 190
(909)860-3195Fax(909)861-311? •- PRE$$
'�^�'�� BUILDING PERMTT APPLICATION � FIRMLY
� JOBSITE �� 6Q ���G�� F (U�`P/ — ,�—U c� NUMBER✓ �� 7t
� APPLICATI � PERMR P/C
o ADDRESS, DATE
g . ISSUE TYPE OCC
APN LOT 'TRACT DATE �� CONST. GROUP
p OWNER
�` ADDRESS ZONING SETBACKS
�W CITY ZIP TEL'] � � REAR RW O
APP CANT �� SIDFJSIDE STREET RW O
� CONTRACTOR (: , SIDE ❑
� ADDRESS O USE � �
^ CITY ZIP TEL . .
d ARCHlEN ' 0 .Q.t
� DESIGNER NO. NO. �
� ADORESS NITS � STORIES�BE�ROOMS
yCITY ZIP TEL
DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q " OWNER-BUIIDERDECLARATION ' , SFWADDlREM
0
� 1 HERE81 AFFYW lROER PENALTY OF CER1UflY TW1T 1 IVA EXEMPi fROM THE CON�RACTOqS�F GaragdCarpon '
CEHS£UWWI1TNEfOLLOWp10iiEA50N(SEG7611.SBUSP1fS5ANDFFiOFE5510N5CO0EAN1'GTYOfl (n
(bIYQfYWN10fREW�7E5ACEAWTTOWKSTAIKT.KTERWPROVF.0E610115KONREiMRANTSTiil1G W patiorDeGc
IURE.►R1011 TO Ii8 158UANGE K50 qE0U1qES TNE APPLICAr7f FOR SucF1 PERW T TO fllE A SiGNED W
STATEMEHT THAT HE Ofi SHE�5 UCENSED R10.SU�M TO iHE ViqV1510NS OF TME CONTRACTORS U.
� G�E lAri(�TEp P fCaMMENCIN(l WI7H SECt�ON)0001���+`�7 Of THE bU51NES5 AND FRO� � u' PooYSpa �
FESSqNS COOE)OR TW1T ME ON SHE IS EXEMPT7NEfiEFRdA AND TME BA515 FOH THE ALLEGFD E%FYP-
TION.�MlYIOLATIONOFSECTqN�671.6BYANYAVRICJINIFOH�PEWA1T5UalECTSTMEMPLIGWTTO Z R�ROOf
� ACfY1L PEHAIiY OF HOi MOHE T1W1 iNE/WNOHED DOLLMiS�t5oo).4 .
, � 06udM�EROFiHEOfqDER7Y,ORWEMVLOYEE5IMTHWAGE5A5TMEu150tF001JPEh5ATi0N, Q �m���jy -
WY100 TME YARK ANO 7NE STRULNRE i5 NOT WTENOED OR OFfERED FOR SALE(SEG�Oa1.BUSF J
hE55 AND PHO�FE5510NS COOE TME CONiRALTORS LICENSE UW DOFS NOT MPI.Y TO AN OWNEA OF
N HOF ?
PROVEATY MRp BULA4IXi YPROVFS TMfAEql AND 1Np DOES SUG1 YARK W45ELF Oq IiERSELF Oq
� Tui0UfU11c50fiHERONMEMPLOYEES.VRDYIDFDTHATSUCHYPROYEMENTSAHENOTINTfNDE00i1 m - . '
OFFFflED fOR SILE IF,HdWEVER 7ME BIRDIN�OR WVROVEYIXf L4 SOlON77laN ONF YFAROFCl]IIR6
� �TqN.IHE Ow11ER�BU0.DER W411uvE i}�E BUFiDEN OF if10VW0 TWV HE OX 6NE Dm tqT BUIID OR
I�IPIIDVE FO�R THE DUHPOSE OF 6ALE}
OLiISOW!(EROFTNEPROPERfY.NA E%CLUSNELYCONTRACTWG WRNUCENSFD WHTFALTORS
� TOCONSTW.JCTTNEOpWEGT(SEG7W.8USiNESSINOPROFE55WN5CODETHECONfMGTOftSU- Valuation �1DJ.ARE/1
W CEN3ElAWOOESNOTAPRYTOANONNENOFAVkOPEHiYWFIDB�ILD50HYPfiOVESiHERE01LAN0
T�- ri/qCONTAACTSFOH6UUIFNOJECT5WITFlACOft�RACTOR(5)IICENSWPIXtSUM7TTOTlffCONiRAG pUANTITY DESGRIPT�ON FEE
� TOR4UCFJ/SELAWJ� . _ . . .
OIAYEXEAVTUNDfFIbFC. &1P.C.FOqTWSPEASON U
3 ¢ � , .
u' DATE� OwNER F' . . . .-
, ZQ V
F W
LICENSED GONTRACTORS OECLARATION �
� w
IHEREBVAfFIftlIUNDERVENK7YOFiE0.0./RlT11ATIIWUCENSEDUNDEFYfiOVI5qH50FC11AP7ER �. .
p_ ff�MENCYqW17/15ECTqN70001��5qN70FTHE&151NESSANDGROfES510N5C00E,Ifm Z .
u� Wl10EN5E15NNLLFORCE FFECT.
m
, � ��«� �.No. o � g2 �
� wt� '��, "'rZ coHTrucroa -d a
� � �.� _. WOFiKERS'GOMPENSAT.IONPEC Tl �� y _ , . . - , -- - - .
� IMEfiEBYAFFYWUlIDERVENKTTOFPEfWHYONEOFiHEFO WW(ie/ TqN� •• � U . -
(n � .. ,.. .,.. "�� Z .,ti __ ' _
� _I/IAVEANOWILLIAAINTAWALERTIiIUTEOFCONSENT SF1FaN FOHWOWCERS' . � •� . . .. • , ,
� COMV[NSAiION,/3 YROVIDED BY SEGTION 57oa OF TME
OF TNE riOFiK Fqi WM�GI TH�S PEM4T IS ISSUFD.•. a. . W , . . . . . . _ ,
G . . . � . . . . .
�INAYEANDM7lL4AY(iAWYNDRKERSCOIAVENSATqNINSURANCE.ASPEOUI � BYSEC7qN t � �.�� '� I .�.
� ]70o DF THE 1A807i CaDE FaN TME PERFOf WANCE OF THE WOWC FOR WM� THIS PERMIT S ' - ' . . �_ r i
� ISSUEA MY WORKERS COMPENSATI(��j}ySURMK/E�CARF�IERAND POI�C ►�sEau�� N RUCTION .
� �Ep N / � P RENIEW� ... . � .
o2 vaucr rnp+ecx � . ` ELECTR�C •` ' ; .� - " � •.
4 . �H'� . ; _ �-. �: -' " ` .� .
y r.
Q (i}#S6CCfI0NhEID1pT8EQp.q,Ei�OF1fEPEHARSFi7ROr,filllL�FnOai�AsR�m1��1� � , PLUMBING �
Z � �CEqi1FY7HA7 N T/E iERFORMMKE Of iME WON(FOR WHlpl THIS PEfY4715 LSSUED,1 MECHANICAL � ' � ~
C7 51/ALLNOTEYPlOYM7YVEA50NNANYUMYiERSOASTOBECOYESUHJEC770THE -; ' . , � - ;t' � '1 �• t �
� wowecarcoravEnsaionwvsoccuiwrwi�uo�ar�enwrm�w+an�seca.� ' ,WSPECT�ONFEE � ;
�� S�7ECTiOTHEM/ORKERS'WUPENSATIONPROV1510N50FSECTqN17o00FTHEtABOR ��jUANCE
S CO06.IblWLFOFiIA'ATHC04PLVWITHTHDSEPROYISIONS. �� \ t�
pDATE�� ~���APPLIW�L '� SMIP �" ` � �
� WARNIN(3:FA0.URETOSECl1REWORKEfi5GD1AV -A �GOYEMGEISUMAWFULMIDSNALLBE �'1ERGYP/C r�i• �.Tt,�r�unS!'
�y SI�JEGiANEMPIOYERTOCRWWALPENKTIESANDCN�LFWESUPTO�NEHUNDHEDTHWSAND ENERGYPERMIT
DOUAFiS(tlm,oaoti IN ADDITION TO iHE COST OF GO�PENSATION,DAYAGES AS PROY�EO iOR W
� sEcmr+araeoFn+eu�eoacao�.Wr�esiM+o�rroAn�-sFr�a RETENTIONFEE: _
¢
� . CONSTRUCTION LENDING AGENCY PRE-ALT FEE
CL INERE0YKi1RMUNDERPENKTYOFPE�IRY7MATiHERE15�CON5TilUCT10NlENON10AGfNGY '
�Z- FOpTHEPERfOfLAANGEOFTHEWORKFORWNICMiWSGFAM�iISISSUED(SEGw]7,aV.G} .
W
� LFriDER'S NAME .
� LENDERSADORESS ���
� �CEp7iFy7HAT�XAyEpFj�pTM1$/yp�IGATqNM1D5TATE�TTMEABOVEM�FORA/�iqNISWNiECL TOTAL FEES �
� I AGREE TO COA1Pl�N7TN ALL CfT�'�'N�CWMY OHDWANCES�ND STAiE UwS RELAtWO TO BUIIDiNO � � -
LONSTRUCiiON,M�DHEREBYAUi1qRIZEREVRESENTAT1VE50FiW5G0UNTYTOENTEHUPONTHE . � ,
Z ABOVE-MEryTqNEDiHOPERTYFORWSPECTqNWRi'O..ES. COMMENTS �
� �� �( lJ�► � ��� . �
� ��VEaWR wE v ��ri�,�_
.�I� s u�
� SJO OFP EE OAiE
� RECPT.NO. � PAID BY VALJDAT70N
WH�TE—DeparlmeM Copy,YELLOW—Finente Copy,PINK—Assessor Copy.GOIAENROD—File Capy,GREEN—Applicant's Copy
' __
� • .
1 I �
..�I � I I . -
j ; - - =- - -- -- - - - - -- _ �=� - � - - -- -
� � � < <. �� , , �
, , �, �. �� -��
�iL, i• � .ty �' � I
i � �'� ' _ i � I�
, {, i � ��
i
.M
�
, i
4 9���q� �: �,..� � --
: � ; ; � �� �
:k _ _ �� �� ,
_ �-
,�
�
; -
- z
;
, , _ � o � : _ ; o �
� - � _ � 4 , �;:�`n -�s �
.� ���t � ¢ �
f� ` O W � � � � J � i ,'�� �
f � Q .�-'P - �� � �.� m Q .�'g '. � � . �� C7 J 2 .' � I '��y� I�I `� '., .
a-a�^ - o � � Zm � W ' zZ � � � ¢ �- o ��-x ; a��I' �
I [�. ., cc � oo wmc� , o � � "� cn ¢ ciic� � � c < � �{ I
I ���-� '�,�:I•F- cn O O u. m � m Z ¢ 0 I- � °_' z t�i d� Z �'- n. a �� '�I V+�_���� �� `� . I �
� n-V ��r�u� 5 O D w W O o 'Z O c� Q w Z - ` a s a. p c7 �l-'.. S ��� .. :
Z W , '�;O uJ. ii U V m 2 p ¢ _ c7 z w W --- �., .'--�� �
O � , 1� CW1 �� Q z � w LL tL t- a wQ [� w Q W J W � _ ,:i `C � _�1:� __
.. .�/( � _ ¢ Q � ' F_ m m_� 2 = U U �2 'fn F- Q � LL .• _lS ' . _'.'_""_" _._. .__ ._._ . ._ __ ._..
� Q O C7 Z I-- cn
r�, J W r- O } aniY
i � � ..�?�Q � W W a a = J () � � J J J � �7 J � � J � `"" (�' , __ _ '" _ ' ' _. ' ' "'_ "
Q 0 ,o = � zcc ¢ � � z�wozo °oou � zzzzr� W w `,' �T� T' ,cl I
. 0 ,u. u. > > u. � z m u� P- m [c � a a n. O ❑ u. � O � � x � `w l
� � . _� ��
oW _ -- ; � � � ��I _
� ~ � ��II L �.�� '� ? al� � _
. � t,. _ � �� -
� i
,�
U -
� -
�
�
I - � d � ,
� �u ; - , _ �) � � , �
: f�i � � _ I '� � j � I .'
� ''� � i I I I ' ' 4OI .�''�i' �� ��� ,
- n� - i ; � i 'I � j �`�+� I ,--���� : _
v� _ - � ' � � � �� 1� I �I w,�,�Cl�I' t �
' ��- j � ; I •�� � � � � � � � �� � �' �� '�` i�� �----j.
''. j' Z � ' ; � I � !`
. ;
� � � r�
�
Q - - - .
- i
� \ '
- X
-' 1I C7 � F- �.': � j. Z , ', G - W .+Y, � . . _ � t
� �r�w Q z ` ¢ , U C7 cn � Z O Cry 'i 'I j ' .'V � ; J � � . � '� �, N W ; .
. .. �•_ w z - � � - - z w � H z , C9 - � ' 'v :� �N . � i
� � ��y _. f- 7 m ��. , w.` � =' Z Q m r Z O � . .-.� � U z i- � -�U3: -j. .- � � , Y<n
i, ��`� ' � ¢ � ¢ � = Z � F U i m o ~ � Q ' �c ' f-'t_ Z � m , � F- �I �I' �� �: #', �}I,
�, g C7 � p w ¢ 4 w w ¢ ul � � tn S L Z z � w � H U � 1 � ' Z 'Fy !�{,� I Q�, E
�yWWZ � WJJC � f. Z W � LLI y= i � ;1 r�
_ - ^' � o " o � o �n = c� oxwc. � � �n - � � r �-'.o `� � � i � �..� c�a �
- C LL ¢ z � a Q rn � U Z 'r y W z t7 a ¢ U d.�,Ic.� z u a ��� � . : , .
� f- — g z � � a � � � i '�' �3 f=a
. � 3.� � w � m � � � �� °� � ° u�, w.r �_o � � � �{�I� � � ��f � :(�j �_�"`\'_v�� _ l- - m� _.....:s�.� �
. '�-4 � F- � � � � � ¢ J E G' 4 �I -7
. : � - . 1"_�""'��"' ._ -"'__.�..._ .�