HomeMy WebLinkAbout15136 - �_.
� �'� �� ` CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
- � 21660 E.Copley Ihive Suite 190
� � (909)860-3195 Fax(909)861-3117 PRESS
� '�'� BI1dDING PERMIT APPLICATION FIRMLY
oN JOBSITE / +1�`� �j/���-lG,,�K Rn�1,� APPLICA110N Q� PERMIT /- p/C
ADDRESS�lX b L DATE O NUMBER ����y Jt
g ISSUE TYPE OCC
APN _LOT TRACT � DATE CONST. GROUP
� OWNER � G � ENL�
o AODRES6 G dN ZONING SETBACKS
� Cf1Y n�O ZIP �7�r TE O S'q'� REAR RW p
APPLICANT �/f TE � SIDEJSIDE STREET RW O
� CONTRACTOR v �' C /EIQ�✓ U /N SIDE p
ADDRESS C � � � �
gC(TY � e 4 ^ZIP 71�{ g PROPOSED USE `• r //�'�
� ARCWENG/ �
.��
DESIGNER N0.DWEL NO. NO.
ADDRESS - UNITS STORIES _�BEDROOMS�_
� CfTY ZIP TEL
�
v� DESCRIPTION Sa.FT. FACTOR PSF ADJ.AREANALUATION
� OVJFlER-BUILDER DECLARATION SFR/ADD/REM
i�f�er uria+u+o�s1 rEn�utr oc vewuar nuT i�w�vT rno�nre carrr.�cmr+s u Garefle/CaToR
W CENSELAWWRTT/EFaLLOWRqHF/I;ON(SEG70]1.6&15PIESSANDVROFESSqNSC90EANYCIfYOR (n
57 CDlMTN1NilO1REIX11NESA0ERMRTOCON57qUC�,/1�TE0.�PROVE�EA�Ot)SVtORREPMiANYSTHUC• W
�Z ttMiE 7Eqq TO R3159UANCE,A150 REOUIRE9 THE APPUCANT FOR 311CH PE7WR TO FlLE 1131GNED W PdTi0JD9Ck
� 9TATfl1ElIf i11AT NE Ofl SNE q LILENSED WHSUANT TO T/IE PfqYI510N$OF THE COMMCTOR4 l4
cEnse uw�auaTsa�foou�+E�win�sEcrqa�000)oc orns��oc n+e euswcss um vAo- � PaoVSpa
fES5qN5 OODE7 OA THATHE WI SHE 19IXEMM 7HEREFROG PND TME BASI!FOR THE ILLIECED EXEMP•
TION.ANYVIULATIONOf5ECT10N7v77.6Br�NYMVLIGNTFORAVEfvA1T5UBJECT57HEAVGLICANTTO Z qtqpo}
� ACMLGENALTNOFNOTIAORETMANFNEIAIHDREDDOLUAS(tSOD).Y
� OL��EROFlHEPROPERTV,ORMYEMROVEE3wITIwACESASiHEIR50LECOMVENSFTqN, 0 �merNal . -
WNL DO 7ME WORK,M!D iHE STf0.1CTURE IS NOT INfENDED OH OFFEREO WH S1LLE(SEG 7oN,BU54 J
� NE53/lD VAOFEASION9 OO�E:7ME COHfNACfOR3 LICENSE UW OOES NOT nORY TO AN OwNER OF ?
PROPEf{TY VYlp BUtDSOR YPifOVES 7HEREON./V1�tN10ODES SUCII YIOHK MMSELF OR MERSEIf Oq
ft TIiR0U011N150HHERONMEMPLOYEE3.PiqVDE071/l1TSUGIMPROVEMEHT4MENOTNTENDmOR m
� ,OFFEAmWRSALE611DWEVEM1iHEBUIDRqORIA17ROVE►1ENTI950LDWITTiINdJEYEAROFCOAIPL6
� TION,Trt ONR7ER-0UfIDER N7LL HAVE TNE BUHDEN OF PqOVM3 iwtT NE OR SME O�D NOT BURD qi
Mi1qJE FOq iHE NRPOSE OF SALE1.
W OlA90WNEAOFTFIEPl10FEtrtY,IWE7(CLVSN0.YCOHTMCiNOWfTlIIICENSE'JtONiRACTORS
� TONNSTRUCT iHE VqO.IECT(SEG 70u,BUSMESS AND GFOiE55qN4 OODE TXE COMMCTORS LL Valuatan ADJ.AREA
� CEHSEUWOOE9NOTMRYTOIV70:`MEROFAPHOpERTYW/qBUIIDSORMPHOVESTiEREON,NID
vnvcartn�crsFonsucrvnauecrsmn��cartrucror�s���NsmruRsuuvrTon+emrrtrua �UANTITY DESCR�PTION fEE
� iOR5l10EN5ELAW). . . ,.
❑I/W QEYPT UNDER SEC B.t G.G FOR TFnS FEASON Q
3 c.> , , ,,
u' D.ITE ONMER U .
� UCENSED CONTRACTORS DECIARATION �
� w
IHEAEBYAFFiNYUNDfROENALTYOFFE0.AIRYTHAT1AlAUCEH5E0tM7EROROVI51DN80CCHA0TfH �
� �(Od.iYENCWOWIMSEC710N7000�OfDM510N]OFTHE&/SiNESSMlDPROfE5510NSCOCE,MlD Z �
W UCENSE�S N NLL FORCE/WD EFFECL ��/ A^ m
1 u ' �
a i.K.Qas�'aa5$ uri.�o. v �
~ DATE � coNtrucron � � � a
w c /
� WORKERS'COMPENSATION DECLARATIGN /�� ./ �
� I HEREBY AFFIRAl1AAEA VEHAl7Y OF VERIURY ONE OF iHE FOLLOWttN7 OECIARAT1C115:��/ Z ., . � _ , r .. .
� _I/UNEFNDWILLIMMTM7ACgHTIFIGITEOF[SX75ENTTOSELFINSUREFDRWOiWCEFS S , � '� - , -
OO�RENEATION,/�t PROVIDE➢BY SECTION]700 OF 1HE UBON COOE FOR TNE iER�0AMM1C U
� �Of iHE WOfU(FOX YMlql TMIS PERMR q ISSUED. �� �' .f W � �
. . . �. : ., .' � . . . 7 . .
� �iHAVEMlDWR1MAM�d1M'Oi110ER9'COMPEHSATpNINSUR�NCE,ASRC-0UIREDBYSECTION � � '. : , ,' A
Q ]7OOOFiHEIABOiiCOOEPoRTNEiERfbRMIINCEOfTHEWORKPoqWHICHTHISGEPMRIS • • � . . , Y -30
aweo,r.n oas�nor� c�nn�en�Ovoucrr+ta+een�: CONSTAUCTION'�
� ciw�uEn �� � _�-N!J PUW REVIEW
Z ���BER � ELECTRIC �
4 � .�1
�sccnaN�wreem.r{�acnfa�aMrahaaar+Eraronma m���tV PLUMBING � � ..�.
Z 1 CERTIFY TUT MTHE VERfORMUJCE Of ME wORK iON WHM)11M4�ENUT asu�.i MECHANICAL u t�li i'�
SNALL NOT EM7'LOYAHV GERSON N M7Y MANNEfl 50 AS TO lECOME SU&IECT TO TME
� YAPo(ERSCOMPENSATIONUYV90FCAUFORN��MIDAOREETIIATIFISFqULDBECOME iNSPECTIONFEE �
SIAJECT TO THE M�OpKERS CdI0EN9ATION P(iON510N5 OF SECTION]700 OF THE U�BOF
S OOOEISHIW.FORIHvnTNCpIP�YwIhi7HO5EPROV1510N4. ISSU�ICE �LT: t� n 7(1f1(1
� c. �.J Z..LTT- �
p DA7E: APPL�CANT. SMIP r /'� A r�l,`
� WAPo�lRR7:FAILURETOSECUREWOHKERYCdAPEN54TI0NCOVEM0E13UNLAWFIA,AlASH,1LLBE ENERGYPlC Cl�11F�,Il1I`�U`V1�T t[��
� SUBJECTMIEMPIOVERTOCft�MPULPENALTIESANOCMlFNESUPTOONE/MAREOiHOUSAN� ENERGYPERMIT ni TI!.I 1�N�t r,`+"�i�l'F'•l Y
O�LLMS(f t00.000).N ADDIi1DN 70 iHE COST Of COMPENSATqN,�M1AGE5 AS PROVIDED FOR M -
� � SECTION77oeOFTHELA80RCO0E,NTENEST,IUJOAT70RNEY'SFEES. RETENTIONFEE: .
nw. CONSTRUCTION LENDWa AGENCY PRE-ALT FEE
O
� I HERfHY AFFIRII LINOER OENALTY OF PE0.NRY TNATTHFRE�5 ACONSTRUCTION IENDBJO AGENCY
Z FOR Trt iEA W�ANCE OF 1NE WOHK FAR N�1t0/T1�5 CERMtT IS ISSUED(SE4��7,CN.C}
W
� LENDER9 N1�E
F" lEN0ER5hDOHE54
� ICERTIFYTHATIIUVEREADTi15MPLIGTIONIWDSTATEiH�TTiEABOVENFORM�TqNIS00RRECT. TOTAL FEES . , 3 �I6
p� IAOREETOCOMPLYWITHALLCT'ANOLIXINTYORDINANCESANOSTATEUWSREUTINOTOBUILDINO
� CONSTiR1CT10N,M7DHERCBYAUf1qRIZEREPFiESEMATNESOFh115COUNTYTOEMERUPONTME
ABOVE.1AENfqNEp PROPEqiY FOR MSPECTION PURPOSES.
9 , r r � �r N� COMMENTS
_
¢ ��E F ��, � v O a
�
y SqNA F P TEE DATE
� RECPT.N0. P/UD BY VALJOATION
WHITE—Oepertment Copy,YELLOW--Fhetxe Copy,PINK—Assessa Copy,GOLDENROD—File Copy,GREEN—Applicanfs Copy
- -- .... _ r
__ .__ �. . I 'T �'TI T `Il S7 (n f/1 V7 C7 C� ...� .. ' '_ " T ..�. .
1mm O � � nya ` s � -r - � � ._ N �.� � �
___ mcn � � � v
- _ - ..:_..._, -- _ n �- ammlm9mnr. xOooO ro � . � pmG� � �{
�„�i �"". N m � � -G r r O C C C C � O m .D �7 C (7 v� W
, , �� fTl'D '� r r r. r D � � � z r' � G� L� G7 y � p o� � O � 7�1"�4'
- � . 'L7-i � �, .Tl f:l 2 C) � 'D (� � D � Rl 2 T = (�,� � -n � .�1' '
� . . ��. "D C) . � �. r r �r7 o�-I �i -1 , rr" � � 2 � vr � m o,� m m � r ��. C� � T. ..�.�
� ' � �fi1 C rn Y L rt1 � Z � 2 (n C (`n � C t'�7 D irt m 2' 27 m Vm r�f+) � ,��
� � �D � � Z �, m "� 2 Vi � r T� � D C � � P � � � A Z� � n � �.� � � k�l � .
!t)''� . � ..�',�i� cn�S. �� � �C!) �'. ' � Cj � ' Z � O Z m Z A GZi ;' � Z m W z m ��,, .
.. .. .: '' m(/� . ' , � � G� O ? � -iG'� n � � ' L�� D �. . �I ,. '
. � � � , . m � � - -- - � �i ' .
Il.I� .._� 1 � �I' f 1� _ �� ��! �.
� ���' ' �, � I� � � I �'!�`
'� . � �� . 0 . � � . . , �.
� I � �� �� '�� i _. .
, � � � �� ��� ' �
� ' ,� � � - �� � .r- ,0 �� � �
� < � � �i � o
T�..,' A ' � � _ ' - j - m
i n �
� ��j � . . � T � O � "0 "9 T �7 W 'D ?1 CO � '1'i T C C TI TI . � v �.-
_. - - . ` ic-/� Ti mC rmr � � = mp � � D � � r �I�I Z D
�� moxTTo -T, 000 omDz z ao
.IC� Z Z � � � O o O ` � n m r D O
_.._
--- -� � -ri -t o -i cn � . .= 2"� �p . r fn ` .l.�l� �
'�
_ _ ... _' _ _ _ . J � mS � � rn Dz � � � mrn � � � ➢ OGmCtnr�'- r � O �.�, _R� Z
- �- - - . ..I,� C i�_Y� D � Z � N 9 � O � r`p_ � � Z o 'n.� m � � O�O � � u�i -N�i Ji,!'� 'O-�
- i � 1(�k � .�W
�i��' o -n a � n � � D s m p z o � ', �'; � D
, z � c� � ;� m � c� �. .d;�73
� m � o �
� � o �
, I � Z � � _.
. � { r
�� , � � ..�� -.
'" - �� i,'
���c � ' � �' �
� � - ='�!'
i, i �,
: � � •��
.. . q � ���� .
� � I �
�
• - '
� �
, . .. ': �.� �� � - :,.. _ '.� :_'. � , ., ...... �. .. .
-_� ... __ , "'__. ' ' :__ _:_ . - . ,; . ,. . ' . . .. '. .:� ..�. .�� . .