HomeMy WebLinkAbout14005 (7) I
C1TY OF DIAMOND BAR ����Cd
�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
1
e 21660�Copley Ihive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
'�^'�� BUII.DING PERMIT APPLICATION FIRMLY
� J08SITE 'Q�Q ��'�(T���/' n� APPLICATION ,� PERMR /C
o ADDRESS < <�� ��• r DATE NUMBER �
� ISSUE - TYPE OGC
' APN LOT TRACT DATE CONST. GROUP
p OWNER -
" ADDRESS ZONING SEfBACKS
$ CIN ZIP TEL � REAR RW ❑
g APPUCANT TEL SIDE/SI�E STREET RW O
� CONTRACTO SIDE ❑
---- ADDRESS
- — - --- - -- --
PROPOSED USE — -----� ------- -
O CITY ` � 21P TEL �l. -
� ARCHlENG!
� DESIGNER NO.DWEL NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
N DESCRIPTION SQ.FC FACTOR PSF ADJ.AREANAlUAT10N
p� OWNER-BUIIDER DECLARATION SFR/ADD/REM
O
1 HEREBY AFFWLI IROEA VENK7Y OF iEiLUFV THAT 1 AN FJCENPT FiloM TNf CONTMCTORS LF ��9���h
B CENSEUWfONiNEfOLLOHPqRFASON(SEG70.77.6BUSWESSANDPROfESSqNSCOOEANYGTYOfl (�
ZOWNTYNRYO/REOUIRESAGF3v,4T7000N57RUCT.KTERVPF7DVEDFYOl15M.ORRFVAiNANYSiRUG W PatiaDeck
�L TUfiE,G(ipiY TO R8 ISSUANCE ALSO REW IRES THE MPUCANi FOH SUGi PER�NT TO F0.E A SiCNED W
� ETA7ENENT iYIAT HE qi SME IS UCENSED YU0.5UANT TO 7/1E iROV1510N5 OF TXE COHiRACTORS lF � �
� CE115E UW((SIAMEN�(COuuENCNW YAiH SEC710N)000)OF DIYISION a OF TME BUSW ESS AND DR0. PaoYSpa
FESSqNS COOf)Oii MATHE Op SifE IS EXEA1Pi T/iEREFRdA/ND TME BAStS FOR THEALLEGED EXEMP•
TIOf1.AN'IVqUTqNOFSECT10NTo�/.6BYANYAPPIICJWifOR�PEWMTSUB,IECTSMEAD7liCJN�TO Z Re-Roof
� AtlVILFENKttOFHOT110f1ETHANFNElUNDREDDOLLAHS(fSaO).):
� OlASOwNfROFiHEPi10PfRiY,ORYVEUPIOYEESNATIIWAGESASTHE1p50LECOMPENSATION, � (`,p�nmelCidl . �
WILL DD TNE MroPoC N�D TNE STRUCR1FiE 151qT WTENDED OR OFFERED FOR SKE(SEG 7aa.BU54 J
yEca M/D VROFESSIONS COOE TME CONTRACTORi LILEHSE UW DO'c5 NOT APPLY TO AN OWNeR OF
� PR076i[TYVIIqBURDSORIYVROVE5T11EREON.ANDW110DOES5Utl/WOHKWMSELFORNERSELFOR =
(� TFWOUOMWSORNEROWNEMVLOYEES,VROYDEDTNATSUpiM7ROVEYENTSARENOTMENOEDOFi m
OOiFfREDfORSALEi110WEYERTNEBlAlD4N30RWVPOVENENTISbOlDW1THWOhE1'EAHOFCOYPLE• _
Z �TION.THE OWNERBUYDER wIU.HAVE THE BUHDEN OF PNOYW(i TMAT HE OR SNE DID HOT&IIID OR
= 91PFlOVE FOR THE PURPOSE OF SFLF�
O l��ROF TNE FRD�EKTY.AY EX0.USIVELYGONIRAGT010 WfT/!UCENSED COKfMCTIXiS
� m caar�n+E vWo�ECT Iscc.iau.euswEss um vnocFsswr+s moE:rtiE m�raacroas u. Valuation AQI.AREA
W CFNSEUWDOESNOTAVPIYTONIOKR:EROFAPHOPERTYW1qBUlD50RA1FAOVESiHEflEON.ANO
� wwwrrta�crscoawcacrxi�EcrsNitn�corrtw�ctoWs���r+seownsuwrtromeconrw�c pUANTITY OESCRiPiION FEE
� TORs utENSE uw} _
J
O I NA ExEMPT UNOEA SEF B.t P.G FOH TMtS it�ASON U
3 �
LL" OATE OWNER � . .
Z W
� LICENSED CONTRACTORS DECLARATION �j
� IHEqEBYAFFWYUNOERGENALNOiPE0.AlRYiMATIAYIICENSEDUNDERDROVi510N50FCMAOTER � �. O
(� �fCqAMENCYlO YATH SECTION 7000)OF OMSION 9 OF TME BUSwE55AND PROFESSpkS COOF,y�O Z .
LLJ MY UCENSE IS N FIAl i�RG��FEGL 11C.NO. � / m U
O �� � OZ`�25 �
� UCEruE ct,,ss L�c.J V
� ^ J
DATE_��_�c—T.—COHTMCTofi d
W
� WORKERS'COMPENSATION OECIARATION a .
� IHEREBYAFfPA1WDERDEWLLTYOFpERXJRYONEOFTHEfOLLOWWGOEGIAFUTqNS: U
� Z
� _IHAVE/JAYlILLMNNTAINAGERTIFICATEOFCONSFMTOSELFaNSUNEFORWOqIfEfiS' _ . .
� WYPEHSATqN.ASPROV1Dm8YbECT10Na7ooOFTMEUe0RCo06[O{1TMEPEAiORA1If:GE W
OF i1iE YIDqK Foq WMKyI T}N9 PENM1115155UED. �
� �
✓ IHAyEM�WILLMMliNNWORICERS'COAI°ENSAT10HwSU1W10E.A5RE0U1REDBYSECTq1i
Q 170o OG 75iE IAB�R CODE FOH iME PERFORMANGE OF TME WORK iOR WHICFI TH15 FEHMIT IS
�ssuEp,wYwauc�+.:'canv�r+sATartu+su ua 'ER�uOca�cvHuusERu�: . CONSTRUCTION
� �p;Eq PLAN REVIEW
Z voucv�+uuesa ELECTRIC
d � Q
Q (n+ss[ctin�nEIDwicEoa.a�moFi�v�a�rrsior:a�Mrn�nmu�wsRiWl«+�ssl PLUMBING —
1 �� MECFiANiCAI I
z ICF0.TLLYTNATINTHEDERFOPNANCEOFTHEK�ORKFORWHICHTHISiERMITISISSUEU,I
(f' SMALLNO7EMYLOYNfVPER50NWANYIAANNERSOA5TO8rCOMESUBIECiTOTNE
� WOH1cERSW�.��ENSATqNUW50FCAL1FO�w�A���E7MAiIFIS1qlADBECOME INSPECTIONFEE �
� SU&IECTTOTHEWORKERS'COYPENSATqNPF10VI510N50F5EG7qNi7000GT/iFU�BOR �SSUANCE
rj " E,1 M WGPLY NA�o SE PRDVISqlIS. �
� ����� \/`�� SMIP � „�
ww,e �vP►�Nr: r�
T� ENERGY P/C � `�
WMwNf3:iALUi7E TO SEWRE w0lil(FRS'COMPENSATION COVERAGE IS UNUWFlII,M10 SHALL BE
LL SUBJEGTANWiWYERTOCiLNNALPENALTItSN�DGMLFWESUPTOONEMINOHE�Ti0U5AND ENERGYPEAMIT �i, TOF'/D� A,t �`T
DOl1AR5(5100.00O�NA�Dii10NTOTHECOSTOPC0IAGENSATIDN.DAMAGE9ASPHOYIDEAFORu/ ULL.IJII�Tl_ •
� SECTION 9701 OF iHE IABOR CODE MTEREST,M1D ATTORNEYS fEES. ��nTT�(��Y+r.....t�
RETENTION FEE d,��
d CONSTRUCTION LENDING AGENCY ppE•ALT FEE
O �
CL IMEREBVAFFIqMUNDERVENIIIYOFPFRNRViHATTNEREIS�CONSTRUCTiONLENDW�AGENGY
� FOH iNE FER�ORIAANCE OF TME WORK FOR M'1uCii THLS DERMIT IS ISSUED(SEG 70Y7.GV.G). � ,
W
� LENDEfr5t4WE
. C LENOEH'S/�DDHESS .
I� � ICEHTIF77lVSIMAYEPEADTHtSAGVUCATqNM1DSTATETFiATTHEABOYE�NiORMA7qNISG1�NiEGT. TOTAL FEES t
W IAGREETOWYDLYWITHALLC7iYM1DGOUNTYOFDINANCESM/�STATEUWSREIATPKiTOBUM1DWG _ _
' � CON,.TRUC7IGH,ANDMEFEBYAUT1qWZEpEDFiESEM TNESOFTWSCOIMiYTOENiERUPONTNE �
� �ove+.��r�enrnov¢Anronuu cranwa asEs. DM E TS .
; j��
� [J �_���.-�---rr— ; �
. m PEHMITTEE E Iow�
¢ J - �
�, -- .
� N SIGIUN VE ITfEE ATE �
� RECPT.N0. PAID BY VAUDATION
\ WHITE—Department Copy.YELLOW—Fnatxe Copy,PINK—Assauor Copy.GOLDENROD—File Copy,GREEN—Appirant'a Copy
.. __
Tj"_
, , .
� � � ,, , , - -
� --- � -- - -- - - - - - -
,� ur��. ; _ . . ._ ._ - -- - - -- - -- - -' _- - -- - -- -
__ _
o . ,, . , �. . . .. . i _ _ .
I _ .. _. _. . " .
� i I I
� .
„ ,11r',' �; -' -"'��_
. �1� i_ � �; _� a..
� ' ` �l.r � _ 1 � � _ -
�r� t. , ��
Ity��lr � i._ — � �'
�i - }� _ , � � i
. �� i
� � ' �� o Q � �- �
�. Q , '�I' cF--ioom � , > Q , i i•- i-. ,
'' Q' '� � O 'Z p W ��C �'. � C7 J z t � _ i
m �'.: �� o v � zmaw ' zZc) � ct aLLo Icr
0 (�'. � r cno o � m a ¢
. O 1� � O O ui o z p Z o C3 ¢ ¢ U c� � g z t�Ii a z � W a �- � ; �
� ¢ O o- � Z h cn �.. ;
� ¢� : ,�t O � J J d O o Q � = W z _ C� � � Q � ^ '
� ' J � = 2 - w � u. F- ¢ w �N x w , ,....
� `�
...i 2 Z Z _ C7 Z W Q a p .
- a ¢ w w a a Q o m ¢ - � U w w >- i
LL LL 'Q 07 Z
. �� CC 2'J m .
, . J C7 _ 1- lL Q ._ y�_'.. ._. __' _ _' '
� Z .-',� o O w w < W Z � � O O O �-o Q Z � Q W Q > w � _ _ '
.� � �� ¢ ¢ - ri Z OC w O ? o o O � w ? z z ¢ w w � . il�.� - - -- .. _ . -
�U ` 1� � � � � u. � ro � am ¢ u_ aaao ❑ u. go � LLx ❑ w a!
' �' � - - _ �
fA �o�.,
. �Z ; _ � _
�
�,_ � �� — = ��
:�' `�� - i . %
��� - - ���'' ? r�
�i � � ��
, , �
.�� � � � � �� -
� - I z � f � . -
1 - o i
1 � o cs i=- z w
�I w
�
c� f;;:w Z z ' � � ,- � U � � z D � � �' . . N � , .
� � 0 m ' v z F •. Z ¢ m F Z p ~ z U �. _ . [I�N , I
�� � � � a W Q a W w a � > > � g � d Y � � � Z � m , �, , Y u>
z � � �:
.',�IY ¢ v a a � w w Z > w � .� � _ Z z J w f= U � Z � F¢-I_ �.
c� O o ¢ Ov� = C70xwa � = � � � Hf- F" Ow J J` W `
. `4� � ¢ z � a ¢ snZU = sxwc ? � ¢ [cc� a�� c.� = wa � ��� Un.
' � �y[O � U � m p. W u. � li (7 C7 Ci `�'r -� .J Z W F_ p:I S u I� � '� Q.W'
. . �^. �� � J ¢ J W F- O � O � � � O F_ � _� � >' n. W�rl� `_.�'� . .
: -�+� rii ¢ D [L O O O O = X Q W ¢ ut w w <t • ^-� �O - ' � .
%' �Sm_ ri w c� rn r- � cr u rc ¢ ¢ ¢ cn w 3 c> ❑ u� cn �� cu � �I i ' , U rWn cWi� ��