HomeMy WebLinkAbout12343 (13) �� CITY OF DIAMOND BAR' - • ' •� ;=i'��
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERYICES ' ;' �'
�, � 21660 E.Copley Drive Suite 190 ' ` � �
(909)860-3195 Fax(909)861-3117 ' PRESS
'^^'� BUII.DING PERMTT APPLICATION FIRMLY
; QJOBSITE �J2�—� ��T Gr7'!I/�/�.�II� pAPECATIONIn�-Z� [U NUMB R_�23�3 �lC �
Q ADDRESSvJ %[� ��
� APN LOT TRACT � ; ISSUE I Q Z,�d} r/fYPE OCC
_ p OWNER G}�CN b �ATE ��� CONST. GROUP
� � ADDRESS S�YYJ!_s " ZONING SETBACKS
CITY ZIP TEL FRONT RW ❑
� APPLICANT�/ZrSSN SH�G[�f TEL ��SXY REAR ❑
; � SIDESIDESTREET RW Op
CONTAACTOR Bl'�f,'7� �T_NC� �
.-
oADDRESS /�! G�-�rr�7�ziL' �- '
CITY ��L'�7�'} ZIF�ZN Z/ TEL�7-r,l/�s"� PROPOSED USE�t S IG �,^ _ �� �7i��GD
. -' : L y
„ .
P aacweNci �
o .. , mrrz.r-r3 v ,�t�a�� a
��'7 DESIGNER - - -
ADDRESS NO.DWEL �•-NO. . NO.
CITY ZIP TEL UNR$ ' STORIES � ' ` BEDROOMS
�
tn OESCRIPTION� SO.Ff. FACTOR PSF ADJ.AFEANALUATION
p� _. _ OWNER-BUILDER DECLARATION ' � �- SFR/AD�lREM � � - - � ��� � - �
O ' . .
8 1 HEREBY AfFWI/UNDER PEwLLT/OF iER1URY TNAT 1 IW EXENPT FHOM TME CONTRACTORS lL " G8f8gB�C8ry0fI. � � '
CENSEUWFORTMEiOLLA�Yw6REASON(SEG1a71.68U5WE5SMIDDROFE55qNSCODEFNYU7YOR (n
. U CO1MiYWHICHqEOUIpESAGERMtTiOCONS7AUCT,KTER7�PROVE,DEY0U5M,ORREPAIRMIYSTHUG W PBtiNDBCk � . . ' . . - . .
� TURE,PiiiOfi 10 IiS ISSUANCE A450 REUUIRES TMF AFPLKNfi FOH SUCH PERANi i0 FILE A SiGNEO W
STATFNENi iIMT NE OH SME IS LILENSFD PU0.SUANT TO 1ME PROVLSIONS OF TME CONTRACTOfLS L}
� CENSEUWfOWTERa(COMUENCINONAT15ECilON)oo010FDM5qN�OFtNEBU5iNE55ANDVRO� u' POOUSP3 -� , ..
FE5510DLS CODE)OR T11AT ME OR SME IS E%FIIPTTNEREFpOMAND Ti�E B�ISIS FOp 711E I11.E0E0 E%fYP.�
TqN.ANYVqIATIDNOF5ECT10NTP7t.68YANYAFiLK,ANTFOpAiEM1115UBJEGTSTMEMPULANiTO Z qB-ppp� Z
� ACIVILiENAL7YOFNOIMORETIANFIVEMMDRED00l1AfLS�fSoo).):-� �- - - -
� �IASOYMEROFiHEDROPERMOflMYEMPLOYEESVnMWAGESISiHEiRSOIECOMPENSAiqN, ❑ +(Am��� . - . . .
W1lL DO i/1E MIOAK.M1D iHE 6ti[1GNiiE 4 NO7 WTFNDm OR OtiERED FOR SALE(SEC)WI.BU54 ...)
� NE55 MG]DHOFESSICX:S WOE T11E CONifUCTDR4 LICENSE UW DOES HOT/�PPLY TD M/OWNER OF � j ' � . .
VPOVEpfY VA1DBUlDS OR MVROYES iHEREON.AN0 W110 DOES SIIG�WOHN W MSEIF ORHERSEItOq- .
Q TWOUGHNISORHEROKNF/JVLOYEES.VfqYiDFDTUTSUCHWPqOVELENTSAqElpTMENOFAOq m . _. -..
. .w OFfERmfOHSMfS,IqWEYE/l7NEBlMIIYVOORMPROVEYINf650lDwITwNONEYEAROF00MPlE -
�P iION�iM6 ONMER-BUIIDEH VALI NAY4 iMfi BUFi�FN OF PROYNIO iHAi HE O!i SMi OW NOT 8U1LD OF . . . . . .
. = YPRDVEFONiNEPUM0.5EOFSALE} -
W ❑4ASOWHEAOFiMEGROVERT`�,NIEXCLUSNELYCONTRACiWOWfiHIICENSmCOHTMCTOR$
[� TO Cd1STRUCT THE DfiNECT(SEG 7ou.BUSINE55 AND VRDFESSIONS LOOE THE Ca1lifUCTOFLS ll• VaIUat10f1 O /��J,/1f��/1
L1� CENSEUWDOESNOTAFPIYTOANOWNEROFAPROFERTVYAID&1lDSORMIPROYESTNEREON,MA
t wr+ocarta�cracoAsua�vaaEcrshnnt�cartw�croWs�uccNsmvuawurtton+Ec«na�c- - pUANT1TY DESCRIPTION FEE
� rof�uccr�sE��vt.� . _ ,� _
� ❑I/W EXEYPT UNDEi15EG' B.1 P.G FOR THIS REASON �
� . . . Q ., . . . � . .. , - - . . . _ ' _
�=' pATE OMMEN � - �
� w .
UCENSED CONTHACTORS DECLAAATION w
� IHEREBYdFfYWUNDEHPENALtYOFPE0.R113YiwlilMll�CENSEDUNOERPROVI5qN50FGUPTER- Ur ��
a �(C041/FNGNf7W1iHSECiION)000�OFOM510N]OFiHE6U5wES5AhnPHDFF5S1oNSCOOEANO . 2 .
� x MY UCENSE�RI FUII FORGE AND EFFECi. � �
� ��«,,� C• 3y �.►�. �/�s/7�3 �
, � ontE /�• 3l-�i cl corrrw�cron � a
� WORICERS'COMPENSATION DECLAFiAT10N Q
� U
� I HEREBV/�FFIRAI UWER PEIULTY OF GERRJRY ONE OF TME FOLLONNIO DECLARATIONS .. Z . . .
� _IINVEAfAVALLAwNiAWACEFiTIFM1TEOFCONSENTTOSEtHNSUREFORY+ORICERS' 2
� COHPEHSATqN,A5FR0+MfDBV8ECT10Na7a00FTNELABORCOOE.FONIHEVERWRMANCE w
_ oF nrE woaic coa wwa�nus vEawT�s�swEo. �
_i waeu+o vnu w�c+uw waacEas couvExutan u+suwwcE�s ncoumco er sEcrar� _. . _ _- --
Q 37000F THE LABON COOE FOA THE iERFOflYANCE OF 1HE WORN FOR WMItl17MLS 7ERlIIT IS
iscuEn.nn EASCOYPENSAiqNWSURANCEUiNR�ERANDPOLiClNJL�BFHAAE: CONSTRUCTION ���2�
j GRIUER ��/Z�I PUW REVIEW. . .-
� Poucv tantsER �D�/Z8�6/ JO� — ELECTRIC. _
� (fFiS5CCi1pNt{�PpTgEQ01,qFiIDOFh£PEpnitsPoHorEtuLPIDDatuisa�m)aitFssy PLUMBING
Z I GERTIF`I7MAT NTME PEAFONAINGE OFTME WON(FOR WI/ICIV THIS PERWT IS ISSUEO,I MECHANICAL
(3 6NALLNOT EMROY ANV PEPSON IN MIY MANNER SOAS TD BECOA/E SUBJECT TO THE
� NORKERS'COM7ENSATIONUw50iCALKOW��I�NDAGREETwITIFISMOULDeECOME INSPECTIONFEE
.. SVBJEGTTOiMEYJORKEf4S'WMPENSATqNPHtlYtSiONSOFSECTqN77000FiHEUBOR /�
OCODE 1 N.L MiMNnMCOAA7LY WITIiFfOSE Pi10V1 IS - . .ISSUANCE . . . . . . �. . . . �v
o a�: v z s ,���:�. ��-�,�'--� SMIP . �o
� ENERGY P/C
W1PNiNa:FAIURE TO SECURE MKIRKERS'COMPENSAiqN COYEMGE IS UNLFWFUL,MW SFULL 6E
� SUBJECTANEMPIOYEHTOCF7�MiNN.PENAl71ESNWGVILFNESUPTOONE/RINDHEDiNOUSAHD '�ERGYPERMIT -"'-"
} OOUARS(Sf00.oa0�,W IDO�TION TO THE LOST OF COMPENSATpN.DNAAGES AS PROVIDEO FOR W
J SEGTqNa7asOFTHELABONCOOENTERESxANDATTWWEY'SFEE& p�7�TI0NFEE: '
Q
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE
O
, � IMEREBYAFFIRAAUNDERPENKTYOFPEMIRYTMATTHEREISACONSTRUCTqNIFNOW(3AGENCY '
FOR 7}tE VERfOiU1MICE OF TF/E M10RK W R N71M11 iNIS PERMiT IS�SSUEO(SEG�vu7.GV.G�.
Z
w
� lElWER'S NM�E � -- - -- -
!� LFN�ERSADDRESS
¢ TOTAL FEES }� I � � (..�'7 L
W 1 CEflTiFY iTNT I HAYE READ THIS MGLMAiqN ANO STATE TMAT THE ABOVE WFORAUTqN IS CORf1EGT. / /-�
� IAGPEETOCpAPLVN7TIALLCT'AN�WIR�NOfiDWANCESANDSTATELAWSREIATWOT06UCDIN(7 / / /
, � WNSTqUCiION,MW MEREBYAUriqMZE RECiiESENiATNES Of iN15 COUHTY i0 ENTEq UPON THE _ _ � 4/ �
z PBOVEJAENTqNED GpOPERTY GOR WSPECTqN PURPOSES. .
COMMENTS �
� �i=7y�- Sft�'.z�� .
m PEiwl NAYE IP �-r��� ���T J 7 /�� ^ . .
� (!1 •S�GJL�i �h'�5[/ �"`T/� /�/G'/% (J
� O�FEHAYTfEE OATE - - '
� . . RECPT.NO. PND BY VALIDATION
.. . . . ....--- " WHITE—Department Copy.YELLOW—Fnane9 Cbpy.PINK—Assessa Copy,GOLDENROD--File Gopy.GREEN—Appiicanl'e Copy .
'� :� �. . �� ..� .", : . ': .�. :; �1; '' ... : . _ - .
_ • . , .. '"_ " "' ' '_ ' __ . '_ _ - .
.. .. _ .... _ . _ _ ' '_ . _ '
O I '
� _ _
'
�
,
I
.- �� �
� ; � p Q W '�, . � J . � . .
Q �� �. • � O z p Q � , Ur ' C7 � z .
` �! � � � � zm ¢ w zzc� � , cc a � o � .
� - .O '- F- v) O O � m � W m C7 p - ¢ Z a f q � (!j CS z F- Q .
� V � � �- o owwzm � Z Qac~ic� � gz � az �- n- a �
Z ►�� - p � J J oozac7 � u� z ¢ — ot7a � zrwv� ic,.
-� G w u. v a °o z O ¢ Z � � � w z w �:- z a O d � w
� O -n' � W CL ¢ � -� F� m m CC = _ = W lL li F- d w � � N Q S W � �� ' i �.
�. � ;Z p fL W W W W S Q � C) U N _I J ..1 VJ U J p y Q lll J � � cf " '_ '_ _ _ ' _ '_ _' _ _
0 Q � ❑ o W Z � O O O k O a Z > W
p Q "O � sz zcc ¢ � z ¢ woZ000u_ wz zzrtu� w z � - -
� � u. � » u. LL � ooLLamczu. aaa0ou. � OLLiix o w � _
u. ;U
� 'n. .
: � '� � - �
:z `
. cj — - v , � i � j � ` �
'�r '',i I ' , � ;Y, �
'' - L � �
1, �.+ ; ` _ ,�' �! -
- o e'J� N I � � �__��6 i { �'1:
` N. (� �I
' � Z i r
� I
� - � �
--� W �� C7 � . F- ; '- :- � , � ' ' LL��
Z � (7
. .o .`J v��i O � � U Z F- � � 2 ¢ m � z � p z � � - �' U �` ' � i t'A N
� (n [L � � = Z [C F= U�� a7 � ~ � J � F' F= Z ¢ m �'� F�- Y.N .
4 � �` -� O w [L Q �� W Q W J � (/J � (n z �Z "'� � � F- U � ,.Z ' Z
! Y ¢ o aa3wwZ. > ui � .., � z z Q� ��
U o � aOm = c70xwa � � cn � � � r' ow J J W F_}-
�� � Z U = _ = W Z (7 [L
¢ �- � z <ya ¢ g Z < ¢ c� a vx w a � ' Ud
- m �n U � m a w u- g �'- C7 C7 C7 � .� w F, a 4 J J :J J ' � � F-d
rii � � ¢ � w a o � o 0 0 0 � � ¢ w � � w w a z z z z O �'� _
�n � w c7 cn t- � ¢ u. ¢ ¢ [[ ¢ cn w � U 0 cn �n rn c7 � � � � . U ' � cn�vl