Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAbout12865 (14) CITY�F DIAMOND BAR • _- ---•.
-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES% �'
„.T� . 21660 E.Copley Drive Suite 190 .
(909)860-3195 Faz(909)861-3117 � ' PRES$
��� BUII.DING PERMIT APPLICATION FIRMLY
o DDRESS..�3S33 Gn�-� �ClS1�_L121t1E pA�CATION . �� NUMBEF� � � tt/C
c� ISSUE TYPE • OCC
APN LOT TRACT �ATE CONST. GROUP
°C owruER C3.4.��'�S'�E�L�L
� ADDRESS�3S�� fCLD�c�llStl IY'IL�E • ZONING SETBACKS
�w CITY pttLhJn1�1 £3� ZIP Q/7��^' TE REAR RW O❑
APPUCANT��ir,jlcaD } !t TE SIDE/SIDESTREEf RW ❑
� CONTRACTOR C�nC. /�...�ZIL SIDE ❑
ADDRESS �� PROPOSED USE ���F�JnNJ+��� V�
o CITY C�J�LL�EJ�Cr;S' ZIP L�2. 7�L 'k�Y�f3'�S�.A9 3'7'V.V G�/�.
wo ARCH/ENG/ • Y./�ilf
� DESIGNER - NO.DWEL. NO. NO.
a ADDRESS UNITS- STORIES BEOROOMS
� CIT7 ZIP TEL.
- y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
— OWNER-BUILDER DECLARATION "'� '
__Q _ .. SFR/ADDRiEM - � -
O
I HEREBY 1�F'F7RM UNDER PEN�LTY OF PERURV THAT I MI E%EMPT FHOM T1E COMRACTOR4 LF .GHr9g9�C9rpOR . .
8 CENSEUWPDRTMEFaLL.Owa70REASON(SEG7m1.68U5ME551w0VROFE5510N5CO0E�M/CiVOR (n
U CaU1RYWH�CMRE-0URES�PEPoURTOCONSTRUCf,KTERMP0.WEDFAqUA(011REPAn1ANY5Tq1,IG W p9ti0.�D9Ck
'-� 7{,IqE ppqq Tp�T9�59U/NC�/�150 pC-0U1qE4 iNE AYPl1CAHT FOR 51M71 PEPoAT TO FILE J151GNED w - -
� STATE4ENT iMAT ME OH 91E IS UCENSED PIIRSUMfT TO THE CFqV15�ON5 OF TME COHTMCTdt9 lF
� CENSE UW(CHMTER i ICdAMENCNO wiT115ECT10N 7000)OF ON�SqN]OF TNE BIA�NE55 AND PFIO- LL' P��PB
FESSiONS COOEI aR T7u7 NE Oq SHE IS E%EEIPT 7HEREFilOM►NDTHE Ba515 FOR 7HE FLLECED E%E1AP-
Tqy.A1ryV10lATIDNOFSECT10N7W1.SBYANYAPPLIG�MFORAPERfAITSU&IECT97NEMVLICANTTO . z R�Roof
� ApvdvENALTYOCNOTAqi1E1�UWFNE1RMOREDoaW+51s5oM-k-- , .,
� p�ASOMMEROFTHEPRDFERT7.OHMVEMPIOTEESNtTNWAGE4/S7NEIRSOLECbMGENSATK)N. ❑ �merNal -
W41 DO iME WOfUC IND 7HE SiRUCTURE IS NDT I`RENDfD OR OFFENED fOR SALE(SEG 7oN,BU54 , J
NE53 NA PROFESSIONS OOOE 7NE COMMCTOR9 LICENSE UW DOES NOT AVPLY TO AN OWNEN OF� �
� PRpPEHfYWHOBULDSORMPfqVESTHEREON.M'OM?pDOE93UCMWOIiNH�M5E�F0t1NER5ElGOR � ' . .
[[ THIY7UaHMSOqHEROMR7EL�PLOMEE5.7iqV�DEDIHATSlC11MPRpVEIAENT9MENOTMEN�EDOR - m .
L11 OFFEAm iaq SAE 6,/IOWEVERiME BUlDiNO oF YrtiWEUENi13 SoIL wtTWNoNEYEI�HOF COMPIE•
0 �TUN,iME ONT'ERAUIIDER WILL NAVE 7ME&1HDEN OF PROVwO TMJ1T HE Oq SNE OD NOT BUiID OR -
Z MvfqvEFORiMEPUHPoSEOFSMF). . . � .
W �IASONNEROFT71EpilOVERTY,AMEI(CLUSNELYC�ONTR4CTR10WRHl10EN5EOCONTRACTORS .
pC io cOksTnucT nrt onoJEct(sEa 7a�,eus�NEss 1V+D PROFEss�oNs cooE n�E cart�ucioas LL Valuatioil ADJ.AREA
Ll] �HSEUWDOESNOTAVPLYTOANOVMENOFAvqO�ERttW�QPUlD50RIMPROVESTHEREON.AND
� � wwcartrucraconsun+vao.rtcrsvnn��ooirr�ucron�s�i�+senPunsu�wrromeoarriuo pUANT1TY- DESCRiPT10N .. . FEE ...
� iOP3 UCENSE IAW} . . J . . . . .
� ❑I MI El(E�.�PT U'AER SEQ B.t P.G FOR iH�4 RE�SON� Q
3 �' -
¢
u-- o.h ow++cn V ,
� LICENSED CONTRACTORS DECLARATION � - W " ��
� IMEREBYAFF6NtRt1ERPENILLT1�OFiE0.Alfi1'1HATIMIL�CENSEOUNOEqVROV�5KK190FCHAPTEA Vr
p� �(COYMEMLsqrifTM5ECi10NTW%OFDMSION70FTMEBUSMESSANDPROFESSiIXJ5CO0E,�PA _ Z
x EfY LICENSE q N FULL�ORCEMA �FECi. �+q///L m
"' UCENSE CU55 Z O C 7 LIC.NO._4'_L�iw��d �
V DATE � CONTTUCTOR�W�L.�r—E�jZ_�L 4.
W
� n� WORKEF5COMPENSATIONDECLARATION � �- -- � �"-�-""�'
_ _—. _
- Q ----- ------- — 0
-�---�� _ ----------�—�-- --
- ----'�-----�--�--�--___.__ _._. .
IHEREOYAFFlRMUNDERPEN�ITYOFPENUINONEOFIHEPoLLOvmJpDE4/1RA7K)NS V
�n � J �
O �IHAVEMAWILLiAAIMA1NAtER7K1C�TEOFfZx15CNTTOSElFaNSUREFORWtlR1(ERS' 2
� ppMiET1SAT10N,ASPAOV10EDBY5ECT10H]70nOFTMEI/BOROO�E.FONTMEPERFORMANLE W
pF THE iMDfi!(�Oq NM111CH 7M5 GEw.11T q ISSUED. �
, � �IHAVEMIDWILLIAAMTAMWO�CEHSCOMFENSAiIONIN5VR11NCE.ASREOVfRED9Y5ECT10N ... - _ .
Ol7D0�iME UBOR C006 FOR TNE GEHf�PoA/wCE OF TNE wORK PDR YMlpf TFIIS GEFUMT IS
^ ISSVED.WNOM(ERS[DMPENS�TpN�ECAAR�ERNi0P0UCYMA�B�RME: CONSTRUCTION _
a ��'T'� F�C�V
> WtR�ER PLAN REVIEW
O ppllCyµJMBER �i"7��r^ )C� � ELECTRIC ..
¢
o �assEcrn�r�rArsem.at�maneear.�rsrvnor�MrrnEooa�sR+�laat�ssl PLUMBING
' Z I CEFTIiY 7XAT N lllE PENFOPo.IANCE OF iME wDRK i0i1 N'XiCM TH13 iERMIT U ISSl/E0.1 M CHANI L � ' 1'1 j M - �
(J SNIIINOTEAIPLOYMIYVEN30NNANYMIINNERSOASTOBEOOMESUBJECTTOTNE � —� y�--��/-
� N9fMER5tOMPFN$ATIDNUri90FCJ�LiFONMA,NroACR F 1UTIFISNOIADBECOME INSPECTIONFEE _ — — — — _ _ / .
S A'BJEMTO THE WOitl(ERSCdAPENS�TIDN P . E 7�a00i TME U80H ISSUANCE �<�v�'-
cooe n�oa.+a�rvnnrnas
o sM�a__ n�v n�(1 if10Q
p OATE:�Z � APPLIGM: . . . . .
� WA1WM10:FA�VAETOSEWkENOAKFR4ca.�PEN4�T�ONCrn'FH�GEISUNUWFU..ANDSMALLBE EN�RGYPlC
5U8lECf/J/EA1VlOYEN�OCRnJwM.vENFLTIESIWDCNilFlNESUPTOONEMUNONEDTF1U19NID �ERGYPERA�{,T'IT�OF DIAMAND RAR
� OOU.ARS(flm,000�,R1ADDITIONTOTMEW5TOf00MPEN4�T10N,D�AUCE5A5PilOVIDEOfORIN
� � SECfIDN�IoeOFT1EU�iCOOE�AEST,ANDATTOiWEYSFEES RETENTIONFEBUILD[�IG3'ANL�_SAF�TY " � � �
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE
� � IMEREBI'AFFlRMUNDERPENIV.ttOFPENURY7FUTiHEREI4ACON57PUCTIONLEND�NOACENCY . ..
FOfl TNE PERFOFMM�CFOf 1ME N�ORN fOR WHICNTH�S 7ERMIT IS�SSUEO(SEG 90Y1,CIV.CJ.
� LENDERS NAA7E - - . . � •
F- LE/AERSADDAESS
� ICER71FYiHATIHAVENEIDTHi4AVVLICAT10NMASTATETW�TTHEABOVENGORUATqNISCORRECT. TOTAL FEES � - �� � � r
� IAGREETOOOMPLYwITH/ilI.CRYAMDCd1MYORDIfUNCE4.WOSTA7EUN5REU7r�o7oBU�O�NO � . �
CONSTRUCTIDµANDHEREBVAUT/10RRENECPFSENTA7NE50FTM5tOlMTYTOEMEHUPONTHE . -_.
� AgpyE.GEMqNED01qVERTYFOqINSPECTIONPUR703ES COMMENTS -
9 � �C�� ��j✓!S
�
- Q VEiMTfEENNA ./� � _ .. . _ _
y
� � SIONANRE F TT ATE '
. RECPT.N0. PAID BY VALJDATION
-- �' WHITE-0epaRment Copy,YELLOW—Finence Copy,PWK—AssassOr Copy.GOLDENROD—File Copy,GREEN—Applicenfs Copy - �
r— � � o n � m � � � � p � O � � � p m� � � I '
'_C�" z z z D � m v m �� � � � � � � � � a � v � z � o a s
� CAu� �',C.� � � rr � �0 =im yZ � m Z = viO n �u x �
mm . � , �oc, � � z � xxxoc� n � �
m� . � , v m x n 7] � -1 . � [n � � � � _�tt < 2 T s' p `z o r�- c) '� �a+�.`��� .
�-i , .-._7�,', r' rm0 � q '. ZCN CrttDtnRt -51�CmmC 7J �
.'0 n �'�. � ', ' m.. � � ,�, � [%i i- � D C � p � � -n-1 Z � -ZI Y.C� � ;. � � ..{ �p �
'�Z � z -i -i � -{ _ 9 zm m
y;�a ..{' z � � . i z � o � m Z � f7' C {,� Z p m
�:� �CZ _ CA..- - � n � Oz , � � . _D� : � Gf r .
��
j N fl) . � � ', , _ Z ..� Z . ; � .
I m IV '
.� m !. �, 1 v��I .
`,,
`
., E � j }� 1 . .
� 'l,
.. � � h- 14 ' � ` _ ' `I
'� % n
� I L l:' , �.1: il �' J .
`' � a (n '
_ �� n i � m O
.. I �
r Q
f�' . ' 'O 'O 'D T � W 'D ?� � � T �.Z Z' S Q O � .
zmm � Z � zZoo OooN � � 9 r- � svvmm � o Z. �
w z m y .
' '.�i i� m < � m � m o r � tn r r-.r-y i z � m O � �•�n�-n �n fm_S � [Ii Z
M - � T -1O =i � mD =l '� mrm- G) ZDO �° n,C� r r' 3, �
- ,_- - . - _ __ . ' � mxm �`+ mc� z -{ mz ms� � c� ozoo �m.00 -� m � . O i7
_ _
_ __ - ... -
� �, mo -Do _ ac� o — a � � DD o � z � �., 00cn �
_ . -- ��.,� tA m -I 2 � v • Z � r � � Q p � � pJ � p.0 37 7J �Q�
4 ` � D � Z� cn � �' � � � � Z � � � mvzoc J• ' .Q .A
. ,.^ Q T D A � ' � ' � � D 7 � .. .
� �- � D� c •--
j'`' � � � Z � -�
.` i'"�/ t � � Y� � .
f ,�/ �. 1 � y� � '
i/ . �l ' . . i� .. l" ' �
y ' .. c <,' . I,: r, '� �
',i r y�v . 'j � ' 1.
t /',� . .� _ � � '
1j; �1 ' �� ' '� \ � - � .
�� � �y �r
,i - _ ��
. � i' '��� i' .
.l. , .` ,t.. .
� �� � ' ''�' _ O ,. _.
Ju l: , l - ' ' " ' _
� _
.. . ..__ .- . _ . . _ .
...n. -. -. .
\
�1 .