HomeMy WebLinkAbout11410 (5) /
!F�--1 CITY OF DIAMOND BAR /
COMMUNITY DEVELOPMENT DEPARTMENT
� ,� 21660 E Copley Drive Suite 190 PRESS
(909)860-3195 Fax(909)861-31I7
''"' � BUILDINGPERMITAPPLICATION FIRMLY
o DDRESS�3 3�%� ��'�I�CI�'7V YU� IJf � � pAPE�CATION� 2� ��NUMB R � l 0 �f C
o� ISSUE TYPE OCC
.- APN LOT TRACT DATE CONST. GROUP
p OWNE�AN h���J
" ADDR�SS �E* �S� L Il1YU:�+ ��- ZONING SETEiACKS
z CITY�� ZIP� I TEL � �o PRONT RW ❑
� APPUCANT iJ i'fZt�J�'n TEL. '� R� �
� SIDFJSIDE STREET RW ❑
r� CONTRAC �R ��h� �F�NG SIDE ❑
_
ADDR S � "� i��"'� PROP ED USE�At��L d FF S�A1r1i N.STA k 4�-
- -
_ � CIN -F — -ZIP (1`E TEL 'lYI - ����� _ � D h�x � US��l�
oARCWENG/ �•+� � ' " .��< /
z DESIGNER NO.DWEL " NO. � N0. '
a ADDRESS UNITS STORIES � BEDROOMS�__
� CITY ZIP TEL
� DESCRIPTION SQ.FT: ' FACTOR PSF ADJ.AREANALUATION
� OWNER-BCILDER DECLARATION SFR/ADD/REM — - - -
O
p 1 XEREBY AFFIFiM UNDER PENALN OF PERIURY THAT I AM EXEMPT FFiOM iHE CONTMCiOiiS L4 Garape/Carport - '
i W CENSEIAWFORTHEFOLLOWwGRE/SON(SEC.7o31.6BU5iNE55ANDDROFESSIONSCODEMIVGTYOR (n
U GOUNTYWMK.NREWIRESAPEANITTOGONSTRUCT,ALTERIMPROVE.OEMOLISM.ORREP/uRANYSTRUG W patiorDeck
w TURE,PfilOii TO ITS ISSUMICE,AL50 REW WES THE ADPUCANT FOR SUCH VEfUAIT TO FILE A SIGNEU W
� SIATEMENT TIMT ME OR SME�5 LICENSED PURSUANT TO TME 7ROY�SIONS OF iME LONTfiAGTORS U
, � GEhSE UW(CMAPTER Y{COMMENCwO N1TM SECTiON 7000)OF D1V1510N 30F iME&15M�ESS AND DiiD. LL Pool/Spa
FESSIONS CADE)OR iFU�NE OR SHE IS E%EMV7 iHEREFHOMMID TME BASIS PoF iME ALLEGED EZEMR.
' V T10N.ANYViOIATqNOFSECT10N703f.5BYANVA0Pl1GWTFOHAPERMIiSU&7ECTSTMEMPL�CANTTO Z Re-Roof
A GVIL�ENAITY OF NOT 1AORE TMAN FIVE HUNDRE�DOLURS(SSOG)k
� ❑4�OWNEROFTHEPROVERTY.ORMYEMGLOYEESWIiHWAGESASTHEIR:ALFCOMVENSATION, � CpmmBICi21 �
� •- Z NnLL DO iME WORK ANO iME STRUC7URE t5 NOi IN7 ENDED OF OFFERFD fOR SALE 1SEG 7ou.&154 J
NESS ANO PROFESSIONS CA�E THE CONiRACTOR$UCENSE Uw DOES NOT APPLY i0 AN OWNEH Of
� VHOPERiYNM1�q&10.D500.YAPROVES7MEREON.ANONM1IODOESSVCHWORKHIA/SELFORHERSELFOq m
CL THPpU('aHN150RMEHOWNEMVIOYEES,DHOVIDEDTMATSUCHW7ROVEMENTSARENOTWTENDEDOR
W OFFEREOFORS�LEIF,110WENER71/EBULLDWCORN/PROVEMENTISSdDw1TMWONEVEAROFW1APlE-
� � TION,TNE OWNEW�IAIDEfl NlILL HAVE TNE BUROEN OF PROV W13 THAT ME OR SME DW N0T BURD OR -
Z WPROYEFOf1iHEWRPOSEOF5/1E1
_ ❑�ASOWNEROFT1iEPiiODEHiY.AA1EXC1I15NELYCONTMCTWGWITHLICENSEDCONTMCTOfLS
W TO CONSTRUCT TNE PRO.IECT SEG 7oN,BUSiNE55IWD>ROFESSIONS CODE n+E CONTiiACiORS LF
cr 1 Valuation GL3�. ApJ.AREp
W CENSEUWDOESNOTA7PLYTOANOWNEROFAPfiOGERNWFiOBURDSOHwPROVESTHEREON.AND
� NM1qWNTMGiSFOHSUCN7fiWECT5W7iHACONiMCTOR(S�LICENiEDPUHSUANTTOTHECONiRAG pUANTITY�- DESCwPT70N FEE
Y TORSUCENSEUW.� '
� L7 IAM EXEMPT UNOER SEG B.L P.C.FOR THIS REASON v
� ¢ . ''. .' . _ ' . , _ . .
LL DATE OwNER F" • � �
- Z - W . .. _ .,. -
�Q UCENSEDCONTRACTORSDECLARATION _ . ' ' W _
CL IMfREBYAFFIRMUNOERPENALTYOFGEFUUqYTMATIAM�ILENSEDUNDENiROY�510N50GCMAYTEq�� � ,
� O�ODAOAENCWGN7THSECTI0N7o00�OFDMS10N70FiMEBU51NE55MIDVRDFE5S10NSCODE.ANO Z
X 4Y LICENSE IS Pl fULL FOHCEM/D EFFECT. . ,
� UCENSE CLASS �� ` LIG NO.��`�t� � '
3 f�c.� J
V DATE CONTRACTOR � �-
W ,
� WORKERS'COMPENSATION DECWIATION t-���JD'� J
N IHEREBYAFFIRAIUNOERPENAITYOFVERAlRYONEOFTHEFOLLOWWGDECUR�TqNS: �� v .
t/) ,'. Z
� _INAYEM701NiLLAUWTAINACERTIFICATEOFCONSENTTOSELF-INSUflEFONM�DfY(ERS' 2 � � � �
¢ itOMPENSATqN,ASPROVIDEOBYSECTqN37000FTMElABOfiC00F.FORiHEPERiORMANCE w
OF THE WORI(FOR NMICH TH45 7EfUAlT IS ISSUED. _. _ _ _ �
0 _ -
w _�iHAyENiDWulMAwTAWWOFLCERS'CW�PENSATqNWSURINCE,/SREWIPEDBYSECTWN
4 ]70o OF THE UBON CODE,FOR TNE VERFOWI.wCE OF iME WOP1C iOR W WCH 7HLS PERM1715 �
� lSSUFD.NYWOFKERS'COAIPENSAT�FWlLECARNERANDPOIIGYNUMBERIWE CONSTFlUCTION �� �
j Wqq�Eq S'��}-i fL }�+�D PLAN REVIEW
o ra�crNaaaeA l���l� � � ELECTRIC
- -0 - (M55ECIqHr�NotsEaa.ptfi[DOFnEaEadfswnwEHl,aim0alARSp�ro)Oa PLUMBING -
Z ICERTIFYTNATWTHEPERFOHM�NCEOFTHEWORKFORWH�CHTHISPERIARISISSUED.1 MECHANICAL
LJ SXALLNOTEMVLOYMIYDEASONWANYYANNEFiSOASTOBELOAIESUBIECTTO7HE _ .
N WORKERS'fAMPENSATIONU�N50F�/1�IFORNItiAND�GREETMATIFISMWIDBECOME INSPECTIONFEE
SU&IECT 10 THE WOW(ERS'COM�ENSAT�ON VROVi510N5 OF SECTION 370o OF THE UBOH
S coo� E,I�FORTMWIrncorav�rwirys+�os�on� . _ . . _ ISSUMlCE �
� � SMIP
p DATE AP���T�
� ENERGY P/C
J WIIRNING:FNLURETOSECUREV10fiKERS'COIAPENSATIOFICOVERAGEISUNUWFUL.IN�SIiALLBE
LL SU&IECTANEMPLDYENTOCRIMWALOENAITIESANDCN4FWE5UDTOONENUNORE�T110U5AN0 ENERGYPERMIT
OOLLAfLS�5100.OW�.W�DDITION TO TME GOST OF GOrAPEN5AT10N.DAWGES AS PHOViDEO FOfi W
� SECTpN77D00FTHEtABOliC00E.�N7EAE5T,MIDATTOPNEY'SFEE& RETENTIONFEE: �
a CONSTRUCTION LENOING AGENCY pRE-ALT FEE:
p .. . . - - � - - - � � . _ .
� INEREBVAfFIRMWlOERPENAl7VOFPERIURYTHATTMEREISACONSTRUCTIONI.EHDWGAGENCY
�- FOaiMEPERFORMMICEOFTMEWORICFOflWMiG17MiSPEFiM�T�5155UE0(SEG�o97,GY.C.). ,
Z
W
� IENDER'SNAA/E
F— LENDER'SADDRESS .
w IGERTIFYTHAT�HAVEREMTNISAPPL�CATIONAN05T1TFTIiATT11EA60VEWFORA1AT10NISCORRECT. TOTAL FEES '
� IAGREETOCOM7L�WITNALLGTYMIDCOUNiYOflDWANGES/J�OSiATEU�MSREIATW�TOBU�IDIN� �^� ����
CONSTRUCtION,M1D HEREBY/WT/IO{UZE REDRESENTATNE$OF THIS COUNTY TO ENTER UPON TXE ��
ZABOYE#1ENTIONEDPROPEHttFORMSPEGTpNPURPO5E5. . COMMENTS 4��
�� ��(�.7 \ •y✓� . .� _
m PERMI WWE(vqlNn ` - . . .
:.a , � P�� ���14�
� `,_
s5�('atU1UREOFPE�ITTEE� - � ♦ - '„DATE y�
. . • RECPT� ` PAIO BY VALIDATION �
~ WHITE—Departmenl Copy,YELLOW—Finance Copy�PINK—Assassor Copy,GOLDENRO�--Fiie Copy,GREEN—Applicanfs Copy
�- . �
- , ' - - -'- ' _
. . _ _" _'__. ,N V1
• __
, _ . /',� , .., �'~ "�.
I • � `` I / _ _ � - r 1 `
� . _ �
� _ . ' , 1���,
t
l �
.. � _ , ' ��� �
' ' _
� �. , _ _ � . { . � �l
� '" � O � " ,
_ F � Q W ', J _ �
ad o � o Z o '¢ � � � c� Z . ,
m Q I� ' � � oo `° wmc� Z ? Q � � � z " � � '
_, � f- �n O O LL m � � Z a m vi � r- Q -
U ' cn F- o OwwZa' � Z ¢ ¢ Uo -� � z u1az �+- n. a ,' • ,
Z. W ' O � J J OOZ � C7 ¢ ¢ wZ ¢ OC7 �- � ZF= W tn c ""
� � -� O u. � U V 'm z p a z (� �ry � W z w F z a p a � w �, �
�. .
�-
¢ w ¢ ¢ � 5 � om ¢ = x wu. LLHawvWn� W = w �
. � z. p ¢ w w a a = m � C7 U c7 y J J � [n U � � � � � � �- ¢ . ..-_�.: _ � '�c - - - . .
�- � Q o o W � p ' a w Z � — O O O u. O � ¢ Z Z ¢ W w Z � ... '.
_ 000 u- w Z - -
a � � � > j � � � eou am ¢ u. aa. a0o �s � O � LL2 ❑ w '
❑ � - -
lL U
. � � e - ^ :
Z
�� (� — - - -
I - ' �
� --� -
i.. . _ o� �
i. � �� r
�L � � � � �; i , .
- w � - � �� � �--r � ' _ ,
� � ��
J ur ' - � ' � __ z __
�I woZ d � F- o w
� w 2 — .: C7 � , V Z w <7 Z F- � N W:
C7
�� F- � ID , lL z - O Z C7
¢ - U (A N
� o � v = r- z � t- ? � g =, ' c� z tn
i � � u) ¢ � W � �'� Z Q F= U � m � � ¢ Y � F'" H Z � m F- . Y ln�:
� C7 -� p W 2 Q W W Q W � � (1 � fA .J CA vj F- Z
�' Y ¢ U n' Q � W�2 � O 2 W a � 2 f� Z � C cj F Z Q W � W , � F¢-F-
• U O O ¢ O J F- H O w � J
� .. Q LL. � Z (� d�¢ lA Z U 2 T T W ~ Z C7 ¢ � U d � U 2 W a � � _ _ � F=a.
m � U � m d W LL �'U.. CS LS C7 � � J Z LLl F a Q J J J J
� W � � �- � Q � � > > � -� J � a W CA Q Q Q Q Q.ll�
. � � W � g � � � ¢ ° � & � � � � � o � � � � � � � � � � n�