HomeMy WebLinkAbout15173 (15) !+
CITY OF DIAMOND BAR 1
' � DEPARTMENT OF COMMtJNITY&DEVELOPMENT SERVICES '
� 21660 E.Copley Drive Suite 190
(909)86Q-3195Fez(909)861-3117 - PRESS
���� BUQ.DINGPERMITAPPLICATION FIRMLY
� JOBSfTE a�yD 3 Go�,� �US'H ��J�. APPUCATION a- PERMfT � I� P/C
o ADDRESS DATE NUMBER #
$ ISSUE TYPE OCC
APN LOT TFiACT DATE CONST. GROUP
� OWNER J�/.r� f/�9W
� ADDRESS �/�fS�/ �ATQiS� �/U/ • ZONING SEfBACKS
� CITY,Sf}N/�/�CO ZIP�4 r/ TEL�� ' /3 c � FRONT RW O
APPLICANT TEL. q_ n 0�_Oi�vv REAR ❑
� f�a�"a*DQ SIDE/SIDE STREET RW ❑
CONTRACTOR SIDE ❑
ADORES Z f/ t4 c �
g CIT`( ���aN� ZIP 7/ �L O • •C�'j7 �OPOSED USE' ' D�sNf�C _� 2 G/ - a �
Pu ARCH/ENG/ . �fi�t%/�LL� o
. . '
� �ESIGNER NO.DWEL NO. NO. y d
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFH/ADD/REM
O
p ��aeer u�rtw u+oen Pexritt oF venuar nuT i w exeurT�ou n+e ooxtrucToas u� Garape/CaTort
W CENSEUWFORIHEFOLLUWN�REA50NISEG70J1.68115ME55J1NDPROFE5510NSCODEl1NYCIiYOR (n
Od1RYWNIMIIEOUIRESAVEiWRTO00N4TRUCT,ALTERAIVNOVE.DE1lOL151lORRFDAIRANV57RUG - W PLfIWDBtk
T/RE,PAqR TO IT9 ISSU�NCE,ILL50 REOUIRES T1E AFCLKAM FOR SW�PEFlMIT TO FILE A StGNED W -
STATEMIXT T4lT HE OR 3ME IS LICENSED PURSU�Nf 70 7ME PROVISIONS Of TME CONTRACTOR9 U�
� CE1�SE LAW(QUFTER�{C�VFNClq W�7N 5ECT10N 7�)OF�MS10N!OF THE BUS�NE39 AND ORO. � PooVSpa - �
FESSIONS COOE)OR TFUT HE OR SHE IS E%EMM iHEREFROM MA 7HE&lS15 FOR 7HE ALLEOED E%EMP-
T10N.NiTV10lAT10NOF5ECT10N1m1.sBTAHY11VPlICA�fTFOR�PERMrtSU&IECTSiMEMPLICMITTO Z Ro-Roof �
�„� AC7Vl GEHnITY OF NOT MORE 71UN FIVE MMORED DOLIAR4([Sa0).r
� 04�aN�EAOFTHEPRDPERTY,ORWEMPLOYEESWITHWApE5A5iHEti150(ECOMPENSATqN, O (`,pmmBlLiBI '
WILL DO TME WOfUC NA iME STRUG7URE 15 HOT ttlTEND W OR OFFEHED FOR SI�E(SEC.7a1,BUSF J
N NESS AND iROFE5510N4 CODE:THE CONfRACTOR4 LICENSE lAW DOES NDT AOOIV TO AN OMMER OF ? . .
PROPEpT'N4q BV4D9 OR MPROVESTHEREON,MA WHO DOE9 SUCHNORK HIMSELF OR HENSEIFOq
(� THROUONIQSORHEROWNEMPLOYEES,VRDYDEDTHATSUd1MVROVEMEMT$MENDTMENDEDOq m
�l� OFFEAmFORSALEIF./iOWEVfR1HEBU4DM00tIMPROVEMBli15501�VrtTMNONEYEIINOFCOMPLE-
Z TION,THE OWNERSUIIDER WILL NAVE T11E BVRDEN Oi VROVMO T11AT HE OR SNE O�D NOi BVILD OH
� MPMYEF0/1TIEPURGOSEOFSAIE}
W ❑t1�40NMEROFIMEPPOPERfY,AME%QUSNEU'CONTRACENONTTHLICENSEDCONTMCfORS
� TO OONSTpUCT T1E OROJECT(SEC.7o4L BUSINE541W0 PROFESSIONS COOE:THE COMNACTOIiSII VelueSi0f1 ADJ.AREA
CEHSE UW DOES NOTMPLY TO AN DwNER OF A PROP£NiY MTq BULD9 OR MPfqVE4 THEREON,AND
� mooavrn�crswnsuca�vr�crswm�Aaarrn�croncsl��+s�rimwtivrronrtcorrtruc pUANT1TY DESCRIa7lON FEE
� mas uccxsE uw.�. . . _
O I AM D(EYPT UNDER SEG e.a v.c.ron rnis A�sa+ U
u. �
Z o�re owr+ea V
F LICENSED CONTRACTORS DECIARATIO�J w
� i HEREHYAFTGnJ INDER PEN.LLTV OF Pf0.UR'/TMR I A41 LIGENSED UNOEN VaDVi510N40F CNADTER V, .
� �(Od.MENCNOWIMSECTqN10oo)O�DMSqN�OFTHEBU5INE55ANDPROFE55lONSCODE,AND Z
W UCENSE�9 N FUL FORCE IWD EfFECL —
_ o �E«us���.�. -6s2y7v`-- - m _
� wre �-2 8•O o carrueroA D /�t f i i
_ . . _ _ � _.. _ _.._. WOAKERS'COMPENSATIONDECIARATION _ . _7��✓ � --- -. .— --. . _- - _
V __ .. -.._ _ __.
� 1 HEP.E9Y AFFlRIA IMDER CENALTY OF PEFLRINY OF1E OF THE FOIIOWRlO DEQ11MT10N4: V
N Z
� _IHAVEl1M)WRLMRMIUNACEHTIF7C�7EOFODNSEMTTOSELFiNSUREFORWORKERS =
OOINElISATION,A4VROVIDEDBVSECTION7fo00FiHELIBORCODE.FORiHEFEFFORM4NCE W
OFTTIE WOWC FOR WMCq Ttt4 iE�:T tl ISSUED. �
0
�I HAVE AND WILLMAMAM W�DPoCERSCOUPEN4AlqN P75VNwCE.AS REWIRED BY SECTIDN
Q 7MOOFTHELABOROOOEWRTMEPERWRMMlCEOFTHEIYORKfORWNIpITM9PER4RIS ,
�ep,wy vqNcens oaap¢rrS�raN INsurnuicE cu+RtEpµp poucr ruMeER u�E , CONSTRUCTION
� cuwta S f�-�� /r��G�/V/� /1.� PUW REVIEW
Z voucrr�eER�/��i�t��G'—r����� ELECTRIC
4
� (MSSFCIl77NEIDFpTBEopl,p�EhDpcnEPES�.fiSfaaa7EHtl�DfEDDal/JS4fS+ao�ORLESn PLUMBIN�
Z ICERTIFYTIATNiHEPEtIfORMANCEOF7HEWORKFONWHIG4ITNSPERMRqISSUED.I MECHANICAL
_ (� SHALINOT EIAPLOYANY PERSON M!M7Y AIANNER SO AS TO BECpAE SIRJEtt TO TNE '
N - �WpP)(ER5C0�1PENS�710NUw50FCALffONNi1ANDl1GREETMAT615MOUlDBECOME� � -INSPECTIONFEE� � -��� �-- � � -- -
SUBJECT70THENVHKER3'COAIPENSATqN ROVISIONSOFSECTION77000FTMElA80R �
000�.is�uuFoannv�n�cor.�r�rwm+ er9ovisior+s. ISSUANCE
p OATE: � �'0� IIPPIICANT. � SM1P ` •
� WAPNMG:FAILURE TO SECURE M10RKER4'COMP NS�T�1 COYEMGE 14 UMAWFLIL,AND SHN.L BE ENERGY P/C
� u�r�crµ¢rnr�orEntoeart.�eu�rcru�n M10dVIlFINESUPTOONEMMDFEOTqUS�ND ENERGYPERMIT
DOl1AR41t1oo,000�N AODITION TO iHE COS OF COMPENSAiqN,O�AOE$AS PROVTED FOH M
� SEC710N770tOFT1ELA80RCODE�ER T,��TTORNEY'SFEEA p��ONFEE:
Q
� CONSTRUCTION LENOfNG AGENCY PRE•ALT FEE
O
� IHEREBYALFlfWIRJDERPENALTYOFPEFUUNYTUTINEREISACONSTRUCTqHIFNOMO�GENCY � �
FOR iME FE0.�ORUANCE OF 1HE WONK iON MMICH TH�S DEHAItT IS ISSUED(SEG 70Y7,CN.C.► .,
�
� LENOERSN1u1E �
. � LENDEftSAODftE53
�' W IAOREE m�u"oi�r"Ewm�EJDiularvuo��+rro�niwc�sTia+'"osu�ruwsR�"��roe�'utoi� TOTALFEES + ��t �D
� GONSTitt1CT10N./�1AHEREBYAUf1qRIZEHEVRESENTATIVE50FTHi4COlMTVTOEI+TERl170NTV1E � � � - �
ZPBWE�MEMqNEUPROPEH7YFORMSVECTIONPURPOSEA COMMENTS -
� � � �S'
m rEaMm� �v
� �"Za�•
� SqwINRE rERMITfEE DATE
� RECPT.NO. PAID BY� VAl1DAT10N
WHITE—Oepertment Copy,YELLOW--Finanee Copy.PINK—Aesesmt Copy.GOIDENROD--FIIe Copy,GREEN—AppticanYs Copy
-_ ���,._._. �� - - -- 1- _i . .C)_"_ I'�;'T, L�� vivi'-G, o � �min�A �ov-� �g � iriGi.m -n cn r .
- -�
��t ' m m �� _ ' I ,� �' ��'� �n m m m 9 m y Y. x O o O O � O-a m r � r -i m _
' . � � . � fil� � � � . �,�;• � D'(P Rl � t � r- r' :�i P C C C p > p � S W O� n � � .� .
� -p-i .� { S� � r r �._ r. q :o � m z z r C' � G� G� G� -n � T�m ,v �, ,� o0
ivC� � ' f �� ' ro mx �� pvc� v � � Z � mzsxnzus.� � G� z � -na
� � � �� � -f=1 � � fll �� c m � O -i �1 y ,, r � tn � � v m S O �7 =i'�n O � o � � �������
� � � ' m . D � C'1 31 S.
� D I ; i Iz I ? O .� �m [- Z i z � c in � C Rt y t�n Z D � m O � � ; 1
,�"� �� cn � � I ! - i '-{ ' �' � z`' � r � ; Dc � p �' � -�iZDt� = � Dms o � rl
� � � �.. � . . � I N m . 'i - �• c� n � ' z � � � m z � G� ��.�.��rn °' z m ',�I . .
, � . i fil N � , � i ! � G� Q Z i � � n :� ._ � � p � _ ��
lll� m _.._ I 1 I � �I I 1 z� �
- -- I � ��J i -
V , y� �
� ��I
f
��i -
-" - -- - � � c :�.:� � �� �:
- --;
- �.
,
� ' � �� ' �
�� �
�
;;
- ; . � � � � �� z �
. ` , G �� - '�' � -G
�
m o
. - n -rt
, .�
-
�. _ j �l,e m � y � z � Zzo � 000Z � Zma � � mmo oD o - � D
� . _.._. ._.... .._ .- -- �- -.. __.. . . . :���. � , � m r�- � � � (n r r r � � (� r = v v � � � � �, Z �
--- L -
--� _ -_.. ,~ -- L7 � � � O � Z Z � m r � n � z p � � � � � �
_ .. _ - _ T � r" i' ` � o � � m m � o o cn � {
°''c -n -i � -i cn n 2 2 � -1 r m 7J -
fil 2 �f1 N fn D =1 T 'rl fn 2 �.7 W
� � '''�' ' j tn m -i � v L� O � rD- z n D 37 � p � Z R1 rn O O � � i��I� .::C� a
- � �•�k p � � � � � � G7 Z Z m b m O O�77 77 a i . 0�...W
; :,r`,) Z � v c� G� � nsma .., c� o p :U
� ,�i-: r � � � � o;° n ..- `�! �i�
� ; ..:� t- D N�,p -i _
. t .1J -` Z -i ,I -
/ I
. � � .. - - } . -
/. ' 1' ✓ ��'� ._
{
( � y�I
� i
i; � ( - ;1, i � /' �.� ...
' ,� � �II' _
(' I I � / � � I.
_ _ - - -- - - _ - - - - -
. , .
.. . _
-
� _
1
I I. '�