HomeMy WebLinkAbout13114 (16) �. �
.
CITY OF DIAMOND BAR
DEPARTMENT OF COMMiJNITY k DEVELOPME S
_ � 21660 E.Copley Drive Suite 190
� (909)860-3195 Fex(909)861-3117 ES$
��'�^'�. BUII.DING PERMIT APPLICATION FIRMLY
Q ADDRESS Z� q � �- APPLICATIO (�G� PERM(T f 3 I l P/C
o DATE � � ` 1 NUM8ER6 #
g ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
� OWNER �/¢�1�K
w ADDR/SS � ZONING RO�CKS EX P I R E Q
� cmr �mrrc�+u.� z�P ��3�o S•b3��o w ❑
APPUCANT TE�, REAR ❑
� SIDFJSIDESTREET-n r�ORW ❑
CONTRACTOR V E ` f SIDE � ❑
� ADDRE S , .
� �RY Z�P •TEL Z c PROPOSEDUSE
DESIGNER �. �t3ill� �f1' SSO�
ADORESS NO.OWEL NO. NO.
UNITS STORIES BEDROOMS
� CfTY ZIP TEL
�n OESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATI
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
� ���ar ucnw u+oen v�rutn a verwr+r nuT i�ra ex�ravr rnora n+e carnucrons u Gare e/Ca rt
CENSEUWFORiFIEFOLLOWINOpEA50N(SEG7W1.S�15BVESS/�IA7ROFFSSqNSCODEANYGTYOH (n 9 �
fbUMTYWItlU1REWWESA�EAYfT7DCOf14TAUCf,AlTE0.MDROVF,DEAl0US1{pqREPNR/�NYSTHUG W PatldDedc
111FlE PRqR TO ITS�33UANCE.ALSO REOUIRES 7HE APPLICANf FOR 31K11 PERMR TO fILE A SIGNED W
STATEMEM TMAT HE OR SME iS LICENSED R1Rti11J1NT 10 iT1E PROV1510N5 OF i11E CONfMCTOR3 LL
� CFNSF U�M�(dU71Ei1�(CDYMFNCRIO NnTN SECTION 7000)OF DMSIDN f OF THE BUSME54 AND PRO� � POOVSp2 .
FESSqNS C00�011 i1Ni ME OR SME IS O(EMPT THEAEF'F10M AND THE BA513 FOR THE NIEOED EICEMP•
i�W.ANYVI0lAT70NOFSECT10N7o�1.68TANYAVPIICMlTFORI1VEfNRSUBJECTSTHEAVPLICANfTO Z Re-Rool
F,., AGYRVOJALT/OFNOTMOHE7HANFNEMI�AREDOOl1AR3p5ao).r
O 01�3�EROFTHEPHOPEN7V.OR61YE1A1�OVEESM7TMWACESASiHE1q50lECOMFENSATqN. � Commercial -
� MLL DO TME WOFK/�fA TME STRUCTURE IS NOT ttfTENDED OH OFFERED FOFi SAI.E(SEG 701a,BUSF J
N NESSANDiROfESS10N4000E:TIECOHfRACTOR9L10EH5EUWDOE4NOTA7PLVTOANOVaNEqOG�
PAOVENTYVRIOBVLD90qIYPHOYEBTHEREON,ANDM!lq00ES5UCF1MlORKNIMSEIFOqHER50.FOR �
� ilN10UGHM90RNEHOVME�/PLOYEES.PROVIOED7NATSUC/IIMPROVEMEHT9MENOTMENDEDOR CO
OFFERED PoRSFIE 6.lqWEVERiHE BUlDM00R IIAPROVEIAENT I9 SOID W!TMNONEYEAR DF Cp.tR6
Z -TION.T/IE ON7JERbULDER WILL W WE TME BURDEN OF PROVPIO iNAT ME OR SHE OID NOT�/RD OR
� MPi1fNE PoRTHE PURP'OSE OF SHE}
w OIIISOYINENOFTHEPROPERfY,AF1IXQU5NElYCOMRitCTNON'RliLICENSEDCONTMCTOR3
[Y TO CONSIWICTTHE PHO.1ECf ISEC.7aa1,B1731NE54 M1D CROiE5510N5 CODE THE CONTMCTORS U- Valuatbn ADJ.AREA
[li CEN.EUWDOESNOTAPPIYTOANONNEqOFAPHOFERTYNTpOVItDSORP.IPROVEStHEREON,MA
� ��E wronsucnvaa�crsmnucarrw��croncs��rc�s�rimsuurrron�cartwic QUANTITY DESCRIPTION � FEE
� O IIM EXEMPT IRDER SEG B.t V.G FOR Tn5 REASON � � 1�U O (J��Q �f��
,y � / ZS w+ C Q
� D.� �a � I I
UCENSED CONTRACTORS DECLAFiHTtON W
� H SZ. a
� 1 MEREEY AfFR741 UNDER FEiU1TY OF VEiWiiY TUT I.UI LICEAISED UNDEA PROVISIONS OF CH�pTER . V, _
�(OOFWEHC�M3WRIi5ECT10N7000)OFDMSiW710FTHEBU5MES9ANOPROFES510NSCO0E,AND Z
W UCENSE 6 H FULL fOfICE ItA EFFEGT. m
o ucasE«Ass G— uc.No. Z Z Z =
� . 0
o�� carrn�croR �L�j� �. °- z > t t�
= WORKERS'COMPENSATION DECLAHATION ¢
� I HER�Y AFFIRGI UNDER PEIULTY OF iEiWM ONE OF THE FOLLOV11N0 DECIAMT10N5: Z
O �I IUVE ANO YMLL MANIAN A CERT6ICATE OF CONSENT TO SELNNSURE FOR NV1aCER5 2 .
Q COMPENSRqN.AlVHOV�DEDB'/SECTIONl700DFTNEUBORCOQE.FORTHEGERFORMANCE W
Q Of iHE YNRN FOR YYH�p1 T16�iEin.tti i3 ISSUED. �
"�V �IHAVEMAN".LLMARRAPIWOPoCERSCOMPENSATIONINSURANCEASREOUIREDBYSECTKKi
O 9T00 OFTHE LABOq OODE FOq THE PERPOPAIANCE OF 1HE NK70.K FOR MMICH IH!4 PERMR IS
= iSSUED.WNO�MCEL��ss Wt.�1vEN�SATqe��1t15�Uq�u��c�,/c�nq IERANOMl1CYM1MeERME CONSTRUCTION
j euanEn��K,-✓r'V VL`•- PLA^N REVIEIN
� Pd.ICNMI�.BER LT.[7��-7 �I� �..F'n1
fLLL41l7W�
o (n�st�ena+t�taieEmr.s�Docn�rEn.+rsFcaa¢Hr�oauu�sR+oo�oq� PLU�ABINC, PA��
Z I CERTIFYTNAT IN THE PERFONIANCE Of T1E NqPot Fdi WFIICN Tn5 PERAM IS t55UE0,I MECHANICAL
L'j SMALlNOTEMPLOVMIYPERSONMINYMNMERSOA3TOBECOMESUBJECTiOTNE
.-.-_ '-_ (n . _- YARKERSCOMPEN5�7qNUW50FCAlIFORNIAANOAGREETUTIF151qUlDBECOME. . .�NSPECTyONFEE. _-__-_ _ --_--_ . ._ .__-_'-_ -.__._- __..__._-_.--_ _
S SUBIECT TO lHE NtfiUfER5 tOMPENSATqN PROV1510NS OF SECTION 3700 DF T11E LABOH
000�,i swui.Fatnrmn�corav�r wm�nase vAo�nsar�s. ISSUANCE �
DATE: � AaPUC�M: SM�P iTc,p.-.�. . . ..-.�..t,,.
�� C+1 1 Vi LlHi�1V1VL I3flT
WFRNM4FAILURETOSECURENORKERS001.10ENSATIONCOVEM�EISUNUwR1L./�N091ALL8E ENERGYP(C B
� SUB1ECfANEMPLO`rtRTOCRIMMALPEN�LTtESANDCMIFWESUPTOONE1M�DfiEDT1qUS�ND ENERGVPERMIT � ���
OOUMS(itoo,0ao),N rt7DIT10N TO 1HE COST OF COM�ENSATION,DAMACES AS PROVIOED FOR IN
J SECTION�7MOFTHEUBOROOOQNTEREST,UAIT70RNEY'4FEE9.
HETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� I HEREBY 11iFiRAI IRAER FFHALTY OF pERA1RY 11UT TNERE�5 A CONSTRUCTION LE1V�rti0 AGENCY
FOq TNf OER�OHUANCE OF TME WORK FOR HMIG1 iHl4 PERAIR IS ISSUED(SEG]os7,tlV.G}
�
� IENDER'SNAME
� IENDER7ADORE31
� ICERTiFYTMATINAVEREADTM9MPLIGT10NlU7D5TATETHAT7NE11BOVEMFOPAl11TI0NISWHRECT. TOTAL FEES �
p� IAOREETOCOMPLYN7TNILLlC117ANOCOUNTYORDMiWCE3ANO5TATEUN5REU7WOTO8UlDINO
� CONSTFIUCTlON,ANDHEREBYAUT1qRREAEVRESENT�TNE50FT114COUNTYTOEMEAVPONiHE �
Z /�BOVE-MENTIONEDiiqiERT/FORMSPECT10NPURPO3ES.
9 � � COMMENTS '
�
� PE NAME(PRllln ,
� ^
� S REOF PEfCMTTEE O�IE .
� REGPT.NO._ PAID BY_� VALIDATION
WHITE--0epaAment Copy,YELLOW—fhance Copy,PINK—Asussa Copy,GOLDENROD—Fite Copy,GREEN—ApplfcanYa Copy
�._-.-�" .'.r--��_._,_�� ..._ ._.. ;... .._ -..` _. .. . �. . �i -ri -n -r7 L� (n (n t!� � m � m [n � O Z 9 �n SJ t � cn L7 m � � a
�� I `i��� , � m m _ . ��, Z 7. p fi� m m p 7C S O � O O � O D � � 21 t- fn � - .
m� �' • ,�r S�� � � �° � � r � o c c c o r o -� . r p m G7 -{ �,�
, � � I' S � '.. � r` r. r�, y �n � m � � G) G� � 'n a �t m � � C n � �
_ �.� 1'' , �a�r � C� � -oc� 9a � z � m �x � C7 � cn � � t) z.� ,� D ..7-+`4.
�D � rY` m ��,. � rn [p C Tm � � ' � Zc = � *"O � m � Zmm � ro -o c� � � �'�L'i �..
��.,.. � .'+.,>`iL�': C� . "�'�r _ �,�, �'� Z � Vj � ZT. D C � p � �� -�_-1 7rnJ Z = � 7ml m c � cn '�'�ji��
. � Ln X �i -� � _ - � r � cn z . � C) s O rf� �^4
N� CJ� � c� - z � O �-�j N Z � c� _ r � m m c m '�l
mm � � � ° -+ � -Di c�i.orm- '- r�i
. , � . - ��- p _
4tN Z _ � i
...�.�..._._ �, ' ,' C I � f
� �
, _ � � 1
_
- wr�':I
� � I
f. �
�
— — r' � I�ali T�,
� t; � -- ��
, -i - . ;7�'I
. - � ,� ' �'i . n
_ _ ��; G �
�' N �
�.1 �
'�.: , � m o
� ,T'; m+ ax � iiO � � oOvvv -n � wv � m ; � ,ic cT T -{ Q
- � �� y,� z m m � z Z Z m T O O O z O m � Z � p � � z z = � - 0 �
. . . _ _ . .,.*, m C D m D (n Z > � T O O O c Z m D m m o o D D D
_ �^� 7l T � d r � � r n (n r r r = � C� � r � 2 v � m m ap O =P�, Z �
'n fil 2 fIl N Rl C) Rl D -i T T fil 2 i 7J Q7 Q � � � � 9 m � T .0 O
. f'I . { m "p O -i m z R1 f' C� Z D O Z C D T T L.� �.�
•�9� N � -1 Z 'S � .n O D Z m � � G) O Z.p O m m '- r � � ��l . m.Z �
�� i -"'o -n z � TL' ' � � r" z -�i o o z � m a m T O O ai -�'i il4` _t7 p ,
5. o � z � • n v� � DZ � � � � oo � �o ' �{7 � �
� �� i � � o � � a ; mpzc� o )'�. � D
, - y . c� � Dm � zc�i =�� C7
. . . � i �'` r s m � ❑ � �°� �J
L�� _ _ � � �� i
�: - -
�
� - -
m;;
_ _ �;;
- - - r �:�I�
-' �. - -
.(, . ± . _ _ _ �,\� � �� .
' _ . . (1 � � 't ,� .
��
J ; I F�
i
,'c
,� _
��
-
_ _ .. -: ( ._ - - - - .. - - - - - - - - - - - ��
_ �
,,. _ , _ . _
_ _. _ .
:
.
_
., ..� . .. ; .�... ! :. .. ,� .
, I