HomeMy WebLinkAbout12892 �.� CITY OF DIAMOND BAR - � -� �` ~~
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES /
21660 E.Copley Drive Suitc 190 . . . ,
(909)860-3195 Fax(909)861-3117 PRESS
• '�"�. . BUII.DING PERMIT APPLICATION • FIRMLY
y�, JOBSRE �! (� �� G� ��' DATEICATIOt�I -(� NU BER""' i �/�!C �
o ADDRESS r�
$ ISSUE TYPE OCC
APN LOT TRACT DATE � CONST. GROUP
o OWNER ' ` �
LL ADDHESS • ZONING SEfBACKS -
� CfTY ' •Sf U� ` ZI O L TEL ' 1' S REAR RW p
APPUCANT TEL
� SIDE/SIOESTREET RW O
CONTAACTOR / SIDE ❑
o ADDR S � - -
PROPOSED USE- �•�
CITY ZIP TEL I w, . ._, • _ . ,
o ARCHlENG/ • '
� DESIGNER NO.DWEL NO. - NO.
ADDRESS UNITS - ' "` STORIES ' BEDROOMS
� � CIN ZIP TEL
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� _ OWNER-BUILDER OECLARATION � SFR/ADDlFEAA - �
O
� I NENE6Y/�FFWM�yqER DENALTY Oi VERAIRY T/Ui 1 IJA E%EYPT FROA1 i11E CONTfULT00.S LL V•ar8pBI•G2IpOR
CEIdEIAWfONiNEfOL1OWWGRE/ISON�5EG7N1A8U5wESSumDROFESSIONSCODEMIYGTYOR (n
LnIMYWNIGMilEOUIRE511PFAAAITTOCONSiFUCT.KTEqWPROYE.DEMOlJSH,ORREFNflAN'lSTAUG W FdliOIDBCII
NqE,VHIOH TO R9155UANCE,AL50 REW WES T1E APDLICANT FOR 6UGf iEMNT TO FILE A 51GHFD w
STATEMENT iHAt ME Oq SME i5 LICENSED PUEWIN�T 70THE PROYWONS OF T11E CDNTRAGTOR+IF
� CENSEUW(GW7ER0(C0IAMENCW(71MTMSECTIC+17oa01�DIVISiONfOCiMEBUSINESSANOCRO- u' PooVS a - .
FESSIONS CODE�ON iNAT ME Oti SME IS E%EuvT TNEREGROAI I7:01NE 8JSI5 FO(i TME ALIEGED FJCFMV• (�
TIDN.ANYV10lAT10NOF5ECT10N7a11.SBYANYADiIICAttiFORAVEiWITSUBJECTSTMEMPLICJJVTTO qpp�
� ACIYiI iEN►LTY OF NOT MORE ITUN FME/AINDRED DOLtAM1S ISSooI.): - � .
� O�ASOMfIEROFiH"eGR07ERTY.OqMYEYPIOYEESVATHWAGES/STNE�RSOLECOAIPENSATqN, ..
NYL DO iNE WOR�C A!O TNE 6TWJGIURE LS NO7 MErDED OH OFFERED FOR SALE�SEG toa�.BUSb �J
NFSSMO PROFESS�GIS WOE:7NE CONiw�CTOK4 UCENSE UW OOES NOiAFVLY TO AN VNlIEROF
� N FiYJ7ERfYVl11�BU1D90H4VROVESTNERECMI.AND1NqDOE55UO1NVRKWYSELFORMERSELFOq =
. . . . [L i11Rou0H wSOR MERowN EUPLOYEES.GROVI�m T11AT SULN MPROYEMEtRS ARE NOT W7ENOEA 0R m ,
� OFiEREDFOR3NEF.HDwEVERi/7E8URDu�GOqIMPfqVE�ENTI550lDWIT1aNONEYEAROiCqAPIE•
� TION.THE WMEFFBU4DEA WRL HAVF TME BUFIDEN OF PROYWO T1Ni ME OR&1E GD NOT BUND 0!i . .
MPNOVE FOR TME PUNPOSE OF&tLE} �
� 04���MNEROFTHEOROVERTV.MiE%CLUSNEIYCONTR�CTW6MrtTNLICEN5EO00NiRACTOiLS — '
i0 COKSiAUCi T/ff VP�IECf(SEG 704.BUSIhES4 ANU PRDFESSIONS f�DE T1E GONTRK.TORS LL �Id�U2G011 ��./��1
CENSE UW DOES NOT MGLY TO AN OVMER OFA PNOPERTY WFiO W LDS OR MAPROYE91T1EPEON.MI�
NTDCONTMCTSFORSUr91P1iWECi5YA1NACONTHACTWqS)UGENSEDWFiSUMITTOTMEWNiqAG pUANT1TY UESCR�PTION FEE
� iORSUGFNSEWV.}
r
O IAY EKEAWT LMIDER SEC. 6!G.G FaA Tl11S PEASON 6 1 � I (� (�
�+ [L ' `� _' . > 17,J
LL MTE OYMER -
z W � gr � IL
� LICENSED CONTRAC70RS DECLARATION w 1 V E
� IHEREBYAFFW4Ui�E(iPENALiYOF7EiWRYTHATINAIICEN5E0UNDERPfqVI510NSOFGiAPTER Vr , � . .'
p, a1�wENCWOWIMSECiqN70oalOFOMSi0N90Fi1fE&15M1ESSNIDPROFESSIONSCOOEM�D Z
X W UCEHSE IS N FUI.I FOfKE urD EfFfCL I m
� uc�«,�ss G— `�! uc.No. S!E1(�'%–f �
� d.. 2 ple d-
� �j D�TE � � carrrw�croq' d g
� WORKERS'COMPENSATION DECLARATION Q � � "'
� U
� IHERFBY�FFIiWUlOERPFNALTYOFPEKAINYONEOF1MEiOLLOwwGOEClAHA7qN5: -�--' - ' - '- ' '
N Q
0 �_IHAVEMIDWILLMAINTAWACER11fIGTEOFLONSFMTOSELFINSUfiEFORYAFKERS' _
- � (;puGp�SATpN,A$PROVBFDBYSECTION7TooOFiMEIIBORCA�EFOflTNEPERf9RM�NCE U -
� /-�
oF n+E woarc coa wwa+tws vcaurt�s�ssuEo. �
Q �IHAYEANDWILLY4IHTAWNORKE3LS'CpAPENSATIONINSUMNCE.ASREWIREDBYSEGTqN ?jO i �V �
]700 OF iHE LABOH CODE FOR TME DERFORMAMCE OF TME WOPK FOR WM vERMIT IS
� �swEp,wrv�cEa ouao+s�r�wwAwrc RIERANODD�CY� CANSTRUCIION
� 1 fT PLAN REVIEW
� �Y�A�=�� u�c 1�� , , ����� � n
0 prssEcin+r�notsEootirr�t�IDOFn��.Rswr+on�r►a�oou�+t�u�tEss� ��' ^ G
Z �LE0.TIFYTHAT N TME PERFOqMANCE OF iME WOHK FOfl WNiGi THIS PEflMR R ED,i•�� �MECM �,���4,y�� A
('J SIMILNOTE�17LOYAMfiE:�iNANYG NrvER50A5TO8ECOMESUBJECTt T - T-� � �N (1 (� i ��
� � WOPoCERS'CdAVFNSAT�W1UW50FCAL arn�, �caECT t��s�au sE E � >INSPECTIONFEE ��-�U,�TiC — —
' SUBJECTTOTHENfORKERS'COMFENSAT VROYI SOF -C qN1)o00 E R, TY o��� ,x � -
-rj CaOE.ISFWIFORTMMiMCOMPLVN7M SEpR V15 �� SSUANC
`p DATE: �+ " APRMJ.NT: 4 � �•"1- tm
WANHING:FA.IURE TO SEW RE NV W(ERS'WMPENSATtlN COYEfUGE 1S UtUAWFlA..iWD SMM18E
E flG�YPlCv�D���JK-E'FSI -
� (-'y SUBJECTINEMPIOYENiOCWA1wKVENKTtESANDCMLFWESUPTOONEMUNDREOiFqUSNrO ENERGYPEAMIT --
DOLIAqs(f�m.000�,w/�DolilONTO TME COST Of COYPENSATION,OAMAGES A4 PfiOVIDE�FOR W
¢ SECTqN37aOFTMEUBOfiWDE.NiEREST,MiDATTOFWEYSFEES �7ENT�ONFEE:
a CONSTRl1CTION LEN�INCi AGENCY PRE-ALT FEE
O
CC IHEREBYAiflWAUNDERPENK7YOFPEWUiiY7/1ATTNEREASACONSTRUGT10NlENOWc]AGENCY
0. FOHTMEPERFOWAFNCEOFI}1EWW�KFCRNMICNTWSVERANTISLSSliEO(SEG7oV7,CIV.C.}
z
w
� LENDEq'SWWE �- -
� IENDER'SADDRESS -
� ICEHi1FYTNATIHAYEAFAD7W5MPLKATI0NM7D5TATETHATT1EA80YEWFONAATIDNISCURRECT. TOTAL FEES �� '
p IAGREETOOOMPLYN7M/11C7TYAHDCOUITYORDViNiCESANDSTATEUwSRELATWOiOBUlDW6
CONSTM1GilON.AND MFREBV AUT1qR�ZE REDRESENT�TNES OF 7 W$COUNTYTO ENTER UPON iHE . ..
� nppy6.►+crrtpHEpvaov�nwr+wsvEcrqr+wn�oses. COMMENTS
� a �� �
¢ PEfiwui ENhME 1 � ��^��
�
� OFPEpM1T1EE OATE
x RECPT.N0. PAID BY VALIDATION
~-- ' WHITE—Oapartment Copy,YELLOW—Finance Copy.PINK—Assessor Copy.GOLDENROD--File Copy,GREEN—ApplicenCs Gop�r • -
, •
, � . . ,
, _
�. _ __ .. ._ . . _ . _ _. _.. _ _ _. .
_. . __
e _ -- - - -
'' ' " ;:�
_ `;: i
��.•- = �� - -
, - , -� _
,-
, . ' _ = - ;
., - -- ,
� _ ��-;, �•- -
, _ - - _, ,
• : .� �-, •�." '' ;
� - _ . _ � f.;
: . � _. . - .
';: ;, ' �' ;� � ," " ,
; � F- o � w— y , , �1 --
.. Q � , 0 y. ? o Z mQ-ar � � ': � J z !, ( `'' \i.
m � ; oo � zm,� � zzo � ¢ . Q ,� o I - .
,p � ¢ �'oo.ou, mc� o ¢ z �' u� � � � z ,� f �`� -, ,� •
� "U ��� o owtmi� zmo ? ¢ av �j � � z u7 � zi+- aa � i �_
z w - oo � i �QQmzoaz � � � w2w � z ¢ � o4 � wy �;'. `. ��° `'
.
O :� " ¢ W CL Q .J J � O 0] � _ = W LL 11 F- Q W V � N W 2 W �r � ', ' - � .
,.
.. S` ' � CC W W d d = m J (.7 U C.7 = J J J [q U J � F- J O F- LL . . ' -' -'- - -
Q p ° = z z ¢ � o � z � w o z o o °o k w z z z z � W w Z i'r .1. -
_ � � LL � alL1l � mLLam ¢ � aaa'Oo � � Oti � sO w � i _
� .w - I . _C - �
F- Z � _ � � a ;
U .. y; _
. - '� � - �� � � - :
�. �; �`, _ -= .: �, -
� � i �: --
� .�" �: -`: :
, �� s � , . ��� �� - ,_:
' a 7 fl -,� :r �� ' ' :.-
�� �. �� - r, _ ;�� I ii�
� o �
�wQ �; F F . Z ��` f ` rJ r,� W
Z , ¢ � � O ! � N W '
¢ Z � �� V �l ' �N I�
� � � � ¢ 7 W � j H Z [[ F= U � m � ~ � Q , Y � F= Z � m ,I— Y� _
J W W W Q W � � � _I (n H . Z 1 '�
'� Y CC U 0' Q � W W Z � W J J � � � Z J � Q -� �-W- Z ~ W ' '. W � , H� �.
U O � CLOtq2 (.705 W n. = a7 J ..� �
, ¢ w ¢ 2 � a ¢ rnzc� x2zW ~ ? � a [tUar� O � W a ; � �;, Ua
• m cn U � m �- w � � LL C7 C7 c7 3 g � ? tu F. a 4 J J J J : � � F��
r r� w � � t- O ¢ O � a � O � -' � � aw �na ¢ a a aw _
, uwi ri W c7v�ir"'- 3 � u�- ¢ � ¢ ¢ ai � 3UOu�i, a"icwncs � u. ti u'. j �U ' cn.cn