HomeMy WebLinkAbout14422 �� CITY OF DIAMOND BAR � • ��'
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
_ � 21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRE$$
�..��.f BiJdDING PERMIT APPLICATION .__. FIRMLY
...�.
� JOBSITE APPLICATION PERMfT L P/C �L�
o ADDRESS�O 9 �b .,d L jl �.Lt bi� I��, pq� �� � NUMBER��I!
$ ISSUE - _ .- , TYPE, - . '; OCC
-- APN LOT TRACT �'7r`�' ( DATE � � � CONST. GROUP '
°C OWNER �.O �.�C Cl � C •
o ADDRESS ���L 2�- G v►. t�• ZONING SEBACKS
� CITY ZIP /�' TEL �t(o- 6L FRONT RW O -
APPLICANT C � (,`L-DL'►Z Z/�EL'•Z ft�'-��S[fl y REAR p
� v--► SIDE/SIDE STAEET RW ❑
CONTAACTOR .t� SIOE ❑
� ADDRESS U�fl U — � _
� CtTY 4 Z�tiL tx ZIP ' TEV�'/•iZ9 5s-S�'(g� PROPOSED USE
o ARCWENG/
DESIGNER�'�C7rrv C�++-� r
ADDRESS r % NO.DYVEL. t� . � NO.
, � CT' ���� ZIP TEL7��f x�15�3l��J . UNITS ' •STORIES -' BEDROOMS'
u� DESCRIPTION 'SQ.FT. 'FACTOR PSF ADJ.AREANALUATION
p� . OVYNER-BU�LDER DECIARATION SFR/ADD/REM -
O ' _ '
���er�csue�ur+oen vEwun ov veauar nur��w Ex�ravr r�nrt cwrtrucTORs u Garage/CarpoK .
A CENSFUWFORiMEfQ10WRqNEIISOH(SEG7WI.SBUSMESS�WDPFiOFES510N4CODEANYGliYOR (n
U fdN}yWF11CMREGME9A�ERM(TTOCON4TRUCT.ALTE0.MDROVE,DEMOUSH,OqREVAIRANVSTRUG W PatlolDack �
� TURE,PRq(110 RS ISSUANCE,A150 HEOUIRE9 iHE MCLICAM FOR 9Up1 PERMR TO FlLE A SKiIED W _
� STATFMENT TH�T ME Ofi SNE iS 110EN5ED PIMSUANT TO TME PROVI510N5 OF TME CaNTMCTOi15 LY . LL. .. . . .
� coise uw�nu�p��muuerice+o wm�sEcr�or��oeo�ac oms��os n+E eusn�ss uro rao. PooVSpa -• � . .:.
FESSqNSCOOE�ORITU7HEOR511EI50CEMPTiHEREFiIOMANDT71E8A514PoRiHElLLLEOEDEXEMP• , (!i
TION.AN'/VqLAiANOFSECip117W7.S8�ANYMRICANTFORItVEFadiTSl1B1ECi5TF1EMRICANlTO Z p9.qpp( r! .1_
. � A CIVG PENALTY Of NDT MOFiE 711►N FNE MINDRFD DOlUR3(fseq.y. _. . .. - - � '� -
O Ol���fROFTHEPROPERTY,OR�IVEMPLOYEE9WITHW�CESIl4iHE1RSOlECOMPEN4ATICN, 0 �me�dal 1y J.t -
� WRL DO THE YfORK MA THE STRUCTURE t3 NOT IHTENDm OR OFFERED FOfi SALE(SEG 70u,BU54 J
� NESS NO Pf10FESS10N4 OOOE TNE CONTRACTOR4 LICENSE UW DOES NOT APVLY TO AN OYMER OF � - ,
PROPfHfYW/qBURD�OAIMPqOVEStFIEREdN.AHD1M7000ES5UC11MORNMMSELfONHERSELFOR � '-r`i'-; � ? ��.f•�•.
[L 7f1R0VOFile40RMEH0YMEMPLOYEES.ifqVDEDTIUTSUG1I1.roROVEMENfSARENOTMENDEDOR Cn . .' ' . .
Q .OFFEAE9WASN.EIF.1qWEVERTHEBUlDIN00RRAPROVEMEM1350lDWITMNONEYEAROFC0uPl6
Z TION,i)iE GWNER-0URDEfi WRL HAVE TNE BURDEN OF CROVIMO 1//AT NE OR SME DD NOT BUM1D Oq .
� MPRCVEPDftTMEPURPOSEOFSKF} . ,
� ❑4ASOwNEHOFTMEPROPEHTI;JIME%0.USIY0.1'COHTRACTlN3WfT}IL�CENSmCOMMCTOR3
TO CONSTRUCT THE PiiO.1ECT(SEC.Mal,BUSINES9/UA DROFES410N4 COOE THE CONTMCTOFiS L4 Valuation- �ADJ.AREA
CENSE UW DOE!NOTAPPLYTO AN OVMER OF A PROPERTY W1q BUpD30R IMPROYES tF1ERE0N.AND
� wnocartn�crswnsua�rNa�crsmm�axrrrucroAcsiuc�+sEvnmsu�wrron+ecor�rtruc �VANTITY ESCRIPTION FEE
� ror�sucer+sEuw� ` , I, .
� 0 O I NA IXEMPT UNDER SEG B.l V.C.FOR 7HI5 REASON Q � �L�" � � � O
3 � .
� OATE ONMER � � � '
W �" - _ _ b
� UCENSED CONTRACTOfiS DECLAMTION W � y
42 i�ar uxew umEn vn+uTr or vE�tum nuT i w tK�+sEo urmEn vao�nsaws os auv�n � /
p� ��OOw1ENtfqWffN5ECT10N7oo0)OFDMSION70FTHEBUSMESSMAPFiOFE55lONSC00EAND Z � �
X An FUtLFoaCEu+DEfFECL
� �� �C l S-�Y L ��.�. 2�S 3 � � � _ ' -
U DATE ��`3�^�1 -- eormucron��Fi7�R G•+.t7j� a �
�L
___„.___ � _: _ _ _ .____.__WORKER5 COMPENSATION DECLARATION
-- - _ . .. . � -. ._. _. - - - ---- - -- -
i
NIHEAEBYIIFFlPoAUNDERVENALTYOFCE0.VitYONEOFTHE�OIWWINODEQARAiqN4: � � Z .
� �I HAYE fN0 MAL►UMTIJH�CERTIFlGTE Of CONSEM 10 SElfdNSURE FOR YNRKERS �
COu0EN5A710N.F]OROVIDEDBYSECf10NS7aoOFTHEUBOHCOO�FORTHEFERFORYxNCE �U
Q OF T1E wORN FOR wMiGl THq PERMR t9133Um. �
O =1 HAYf MA WILL AURlTIIM WOiKERT Cq.�PENSATqN IN9URANCE AS REQnRED BY SECTION �
�700 0F iNE IABOR COOE FOR TNE VERFORMMICE DF Ti1E WORK FOR WNIpI TflS VEf1MR 15 . � . �.. ... . � �.� '
� ISSUED.MYNC)fV(FASClO�MPENSATIONINSUiUNCECARRIERMAPOIICVM/1ABERARE CONSTRUCTION ��
GRRiER C(-/�U�f� _ PLAN REVIEW
� POLICYM1MBEq��- - - ooa 3��-� E�E�,�� _ a.
o �nusEcnd+r�IDNoreEmMt�moanEOEw.�rswaa��u'�[noatusRiaa�ontan PLUMBING O,
Z I CERTIFYTHAT IN iHE PERFORMANCE OF TNE WDRK FOR NMldl THIS PERMIT IS ISSUE0,1 MECHANICAL' ��
' �} SII/QINOTEMPLOYMf4PER50HNAN'/MANNEqSOASTOBFCOMESUBJECTiOhIE �
� M9MERSCOMVENS�TpNUw90FWUFOFiN�A��pEETNATIFISNOULOBECOME INSPECTIONFEE O
' SU9IECT TO THE V/ON(ERS COMCENSA710N VRONSqNS OF SECTqN]7 OF TME UBOR �
Qcoo�,�sruu�mrnv�nicaar�rvn��sio.is.c � ISSUANCE �� y�l'� d'�
� V
DATE: �I ' ACPIIGWf: ..0 SMIP r �
� W1RMN4F�RURETOSEQ1NEwOFiKEN4'CdAPEN5ATI0NCOVEMGEISUtdAWFIA,AND5HALL8E ENERGYP/C �
� 5t91ECTANEMPLOYERTOCitIMMKPENt1T1E5ANDCNRFVJESUPi00NEM1NDREDTH0U5MlD_. - - -ENERGYPERMIT----. . . . . �1��___�l
pOLtARS(tlao,oaoJ,M�DpTp/TO THE COSTOF COMPENSATqN,O�AQES AS PROVIDEO FOfl IN
J SECTION770lOFTNEUBORCOOE,NTEREST,MlDATfORNEY5FEE5 RETENTIONFEE: •7^ �,0�
� CONSTRUCTION LENDING AGENCY pRE-ALJ FEE � �
�' 1 HEREB`/AFFlRM UNDER PENALTY OF PEFWRY THAT iHERE IS A CONSTAUCi10N IENDMO AOENCY �� ' -
FOq 711E PERFORUANCE OF/TH�E WOPo(FOR WHICM TYilB GENd1T�9 ISSUED(SEG]OB7,CIV.C.).
� IENDEH'S WJAE f-/� r��I�''Q� � . .
.• C LENDER'9 ADDRE4�
� ICERTiFYiHATINIIVEREMTH19AiPlICA710NAND5T�TEiTiATTHEIIBOYENFONJATqN1$CORRfCT. TOTAL FEES �o� � y'/ //�
w IA(3REF.TOOOMOLYWRHALLUTYANDOOUNTYORDtt1INCFS/WDSTATEUWSREUTNlOTOBULDINO �l / /�Vl
� OOHS7RUCT10N,MIDHEREBYAVTNORiZEREDRESfNTATNE40FTMSOOUNTVTOENfFRUPONiHE � ( �R-�
� /�BOVE-MEMqNEDPiWVERTYFOH�NSPECT10NVURPOSES. COMMENTS �
� ,� � - G.� .
m PEFMfTT�f (P
� � �/ '�Q
y SqNAN EOFPEFWTTEE E �
� . .. . _ RECPT.NO. PAID BY VALIDATION
VYF11TE--DepaRment Copy.YELLOW-Ft+enee Copy,PINK-I-sessorCopy,GOLDENROD-Fib Copy,GREEN-ApplicanPs Copy
� /
/ -�� -
, ,
cnin .�ii � i n -n � TT � cnv� �nvc� � mvi9 � � � � zig -im � m � ri� i �
m m . � z z z z a m m m � m D x o 0 0 0 � o a m � � r rt�
:"m0-�-� ,- I i � � � D D D D � "m0 -�-I `2 � r r � O C C C O � O m � � O n � `� I
r n r, r
� . � � � 'a m 2 (��� "0 (� 9� D � Z � m 2 2 2 n Z (n 31 � C�i z � 'n A � - -
'aC) � � � '- Dz � � � Zc � � � � m � � mm � n � n7�o � ' "
, �C D ' !, �'" , Z '�.' � n _i ar cmD � 2 ' Z ln r [n C c m y m m D�37 m o �r Ll � �� ,e,I • .
-i - -I < +
� D U7
Z w X �� D "' (7 -1 C 7]
Z -i _ C y �
O W - 37
-{ --I Z �
(!�T. - (n z � � � r � Z � m � Z - � = c� � O (n
- �
_ �
c� zm mc 1
Z
0 0
�N Cl�. - L� -i m Z - L� ' r .
G� m ' �
mm .,-,_ � � Zz -�'i � � -��i � cziorm-
_
�^ - z :I �
Il� �� I � d � � s� a ::i
1 i � .-ND � � � t
, � ' �. � ' � bs '
r : � ��
I'�.. �-
- ` - _ ` f i
, ' � . C�' .. ` Z i \�J j , . .
� \ - - � -: � ..
. , �J � ' _ � _ _ - �' ,.,� .
i � �. � _
, , ,�
. . ,
- � '
- '
_ ; - i � Rt 0
C� 'n
' - ' - - T O 2(7I T '�l Q T O O ��� � T �7 W 'O 'TI O� 7� T T C C "�l T � � �
_ _ ._ _ _ . . __ _ �� - RI < D m y � Z y � T O O O Z �C Z m y � � m m � � D O O D
- - - -- - - - - - -. .. ' - 77 -n -r-I p � .� C�n � (� CA r r r = � n L�, r U� S. v 'o m m �7 O z� �
�' Rl S R1 N m n 171 D -i T T Rl 2 2 � � p -i r 7J 17 m �1 .
.r. � � -G m v O z -i m m r L� Z D O z m D.���n -n O � � �7 �
� � mm ;-iz � vG� o - Dzm � pG� ozoo mm � � � d m Z
° % ;�� y � -nz � � � � � � Z -�ioo " z � wom -ri0 Ok�ii -�i n 0
. -1 Z �i � � .. . � 31 Z � L� w m O O��3] 7] � ��0
. _ : � � Z � � n n' L� �.' � ��D. O Z�Q C:��. ' • �� !D
O ❑
. i . , r ��� r�i'I'� p -�I �.: _ :� .
I ' . C ,r;� O C - .
' . i� . .�, � ! �Z 1 .
�� .i / I, � C� ^ .
. � � . ., � . � , . �. �
i i � i ' C
r' - ' S� 'i I
j " ` i• ..
61
. 'r - R
1 I
'_ __ .... ._ ._ "_ _' , E ' . .. ;.
�
- �F