HomeMy WebLinkAbout10117 (5) CITY OF DIAMOND BAR
�, � ' COMMUNITY DEVELOPMENT DEPARTMENT
,,.0 21660 E Coplcy Dme Suite 190 PRESS
(909)8643195 Fax(909)861-3117
""". BUILDINGPERMITAPPLICATION FIRMLY
�N JOBSITE /' �I APPLICATION � r � NUMB R1 L(—"L M/�C `
ADDRESS�� I� L7'!� ��cS�-�' �,�� DATE
$ ISSUE ,�TYPE � OCC '`��
APN��O TRACT DATE ` ' ',CONST ' GROUP
p OWNER I� � ,
p ADDRESS ZONING SETBACKS �•i',
� CITY/,�f�/)�JYL� ZIP���TEL FRONT ^`; -,. � �.\._._V RW �
APPLICANT El. REAR ❑
� SIDFJSIDE STREET' RW ❑
CONTRACTOR SIOE ❑
� ADDRESS �tl,"-,�L �=E�.T. ,�f •h
� CITY_[��f ZIPq�� .,�, TEL�r�r�� PROPOSED USE
oARCWENG/ ♦-�- � "T�� `' �
� DESIGNER �,��}'l1�I(� NO.DWEL NO N0. ,.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
�
cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.ARE/WALUATION
� OWNER-BI;ILDER DECLARATION
0 SFplADOlREAA � �
p 1 HEREBY AGFWIA IWDER GEtUliV OF PEiWNY TMAT 1 A11 f%EMVT LRON TME CONTHACTOpS LL Ganpett'.arpat " ' '�� - \�
W CENSEUWFO(1THEFOIIOWINOREA50N�SEG70.1f.5BU5M1ESSMIDPROfE5310N3CO0E:ANYGttOq (n . . .
CJ COUHTYVhYCNREONRESAVER1UT7000NSTRUCLKTERYPROYEDFV0U5M.ORREWWANYbTip1G w P,���
Z lUHf,VRiOR TO ITS ISSUANCE,A150 REOUWf4 TME APGLICMIT FON SUCN VEfLdT TO FILE A bKJlEO
LL� S7ATEMENT TFNT HE OR SHE IS UCENSED GURSUMlT TO THE GROVISIONS OL iHE CONTRACTOfiS 1� W
� � CFNSE LAW(OIAYTER�(COYYEl/CPKi MIIiX SECTqN 700010F DIVI510N]DF i/1E BU5WE55 AND VfiQ LL POO{l$pi . . .
FESSIONS CODE)ON TMAT NE OqSHE t5 EkEMVTTHEREfH0�,1 AND ME BAS�.S FOq ME ALLEGFD E%EY0.
TqN.ANYVqLATqNDFSECTqN70.1t.6BYANYMVLICANiFOAAVEHM1iSUBJECiSTHEAPPLICAHTTO � Z R6�R001
AGVLLVENALTYOFNOiNOHETIIANFIVEMAIDRE000L1AN51i5001.k .
0 OI�OwNEROFTHEGROPERTI.OqY�E4VLOVEESWITMWAGE5A5TNEIRSOLELOMPENSATqN, � O r,pmmgtCi3l �
�Z MnLI DO iHE WOAK ANU iHE STiWCTURE IS NOT IMEN�ED OR OFFERED fOA&tLE(SE0.7ou.BU54 J
, � NESS ANO PROfE55�ON5 GLOE TNE CONiMGTORS LIGENSE LAW DOES NO7 AP7l�TO AN OWNER OF � �' . �
VROVEA7Y Wlq BURDS ON W DROVES TNEREON.AND MAq DOES 6UC11 VYOqK NIYSELF Oq HE0.5ElF Ofi
Q iNqOlX1NW50RHEHONR1EUPlOYEES,PROYIDEDTNAT5lK11WPROVEMENTSARENOTWTENDEDOq m
w OFFEREDFOqSALEIF,HOWEVERiMEBU0.DWGOFiwVROVE�dEM1550lDWIT19NONEYFAHOFCOMPIE- .
. ..___._.. p . _. ...
Z TION.iME OWNE0.Bl11lDEF WILL NAVE iHE BURDEN OG VROVWO T11AT NE Ofi SME DD NDT BULL�ON
� MIPROVEFOHTMEWRPOSEOFSALE} �
w O4�SOwNEROFiNEPROPEHI'Y.IwE%CLUSNEIYLONiRACTNOMniHLILE715EDGp(fHAGTOHS
(L TO CONSTRUCT illE GRQIECT(SEG 70ar.BUSINE55 AND VROFESSIONS COOE THE COHTRACTORS LL V11U3UOn ADJ.AAEA
t11 CENSEUWDOESNOTAP�LYTOANONMEROFADROYERTYW1qBUlDSOAYiROYE4TMEREOKMID .
F_ wHoconrw�ctssonwa�ariaeasMnrn�cant�on�s�uc�nsmvuruunnTron+ecoKraw OUANTITY UESCRIPTION FEE
.I TOli4 UCFNSE IAW.� .
� O I/�u E%EYPT IX+DEN SEG 6�7.G FOq T�uS RFA�ON � D�C�
� U �
� F . !
DAiE ONNEN V �
�¢ UCENSED CONTRACTORS DECLAFUT�ON W •
K IHEREBYAFFIRYUNOERPENALTYOFOE0.R/HYTUTIAYLICENSEOIM�DERPpDVIS10N50FCHAPTEp V, '
p. �(COA/uENGw6W1MSECT10N70ao�OFOMSIDNfOFTMEBU51NE55ANDPROFESSqNSCODE,ANO 2
YY LICENSE IS H FULL FORGE MD EFFEGT. m
O CS'.3 J�' �
�� �.�. �
� a+� cor�tw�cTor� �0 a
w
� WORKEAS'GOMPENSATION DECLAFiAT10N �
� U
N IHERFBYAFFWYUNDERVENALTYOFVERRIRYONEOFTHEFOLLOWW(iDE0.I3i�ilONS: Z r �J
� _]!IWWENWWLLLMAa1TAMAGENTIFICATEOFCONSENTTOSELfd115UFiEFORqDR�(ERS � �
COMPEHSATqN,A5 PROVIDED BY SECi10N 770o OF TNE LABOIi LODE,fOR THE PFRfORMANCE U
� OF T/1E WOFIK iOR WMiCN TWS PERwT IS ISSUFD. �
O
Q �rave um wui wwr,uN woaucAs•oo+.wcruAT�wsuwwc¢.�s aeouwen er sscrar�
]7oa OF TXE LABOA CODE FOfi TME PEHFOfiMMIGE OF TME WORK fOR WMIQ1 TMIS PERWT IS -
J ISSUE0.W/NORKER$' OYP,E�NSAT/gr+WSUMNCEW1piE POLICYNUMBEHANE: CONSTRUCTION
a caawEw L�/ � v,� � �}'� PLAN REVIEW
o raucr tiuuesn �S•�=0� ELECTRIC� .
0 (n+ss[cna+rEmrioTeEawt�necn�vFaetswaaraewnn�ntatusR+ao�oa�ssl PLUMBING� a I /
Z I CERi1FY TWR N TME iERFOR4�NCE OF TME NORN FOR NMICN T111S PERW T LS LSSUEA,1 MECHANICAL N
(7 SFWINOTEMPLOYINYPERaONINANYAWrNERSOASTOBECOYESUB.IECTTOTME
(q WOWCER5L0►IVENSAiqNLAW50FCAlIFORN1A11NOAGREETIIATIF151qULOBE E INSPECTIONFEE
S SUBIECTTO EV.I'XiNERS'COUVENSAi�ONVijOVi5nN5 SEGTION 7000F H.
� Fpi�TM��y�TM ISSUANCE '
O � .�
p DAtE: ' I�PPLMaWi. � :�L�I SMIP _ p._�
� WARN �LAIIURETOSEWREMORKFR5C01APEN5ATqNCOVEHAGEISUNUWNL,M105W1LBE E�'1ERGYPlC
� � SUBJECTANEMPLOYERTOCRIUNKCENAITIESANOCMLFY.E4UPTOONElIIRdDHEATF10U5AND ENERGYPERMIT
OOlU0.S If f o4000�,IN AODRION i0 iHE COST OF C011PFNSATqN.DAYAGES AS PHOYWFD FON W
J SECTCN�7aOFTHEtABOFiC00ENTEREST,ANDATTORNEYBFEES � -
Q
d CONSTRUCTION LENDING AGENCY •ALT FEE
� IHFRFBYAfGUYAUN0ER7ENAtTYOFiERA1RYT11A1iMEHflSA00N57RUCTiONIFNDWfiAGENCY �
� fOR iNE VERiOiW/JrCE OF iHE WON(fOR NM�CH TM PERW T IS 4SSUFA(SEC.�aGT.Cril.C.�.
� IEHDER'SNAYE � �� / /
` � LENDElt3 ADOtiE55 �
�� � 1 CERT�FY TMAT I HAVE READ lia4APDLICaTiOl1 AND STATE TIIAT TNE ABOYE INFORMATqN IS WHHECT. TOTAL F , S . , � ,
� 1 AGlIEE TO COMPLY VATH ALL UTY ANC GOUNTV ORDUUNCCS AND STA7E UN5 RELATMO TO BUILDINO
� OOHSiRUGT INDHEREBVAUi/qNZEF1EGiiESENTATIYE5OF1w5COUNTTTOfNTERUPONiME
ieove++ Eo �nvEarr vECiqrr �5. �� / COMMENTS
� �/ %`f
�
m PERMt E �� . .
� , --- 4 . . . .
� OFPERWI7EE - OATE-
� RECPT.N0. PAID BY VAUDATION
NMITE-DapaAmenl Copy,YELLOW--Finante Copy,PINK-,Assessot Copy,GOLOENROD-File COpy,GREEN-l�Qpl�anCs Copy
Y
t n I I ' I
1I 1F I � ' _I 1
� .L-i n i C 1 A i _� � U. '- �. _ " �' � �11'.- _ _,- -_ _ __ . I . � _ _I- . . ' �
` T Y I_. _l _ ' '
� �.1 , t ,, �� , � ; ; ; V`y � - �- � ;= , ;-I ; i f ,,j�,
Y� , t: � �. � ; � , � �
i �� T �; r i ' � CI ' �i ; ' , . �: f � ::��
;� �'��; � �� � �� � ��� �I;�� I �I= � _ ��.� � � i �< < �� , a ;, w i
i / T. I'' � _ - ' �
r � ' , �'1 � � � .J, � � :�
� �r, i.�� ;IA�' , '�� II, .f .. I, .I �1 i . / .i: I I � ,
_i 1{ �i j�ii'���✓,� ��' �� �'.� _ i� � � - �� _ � i � ! .�{���� � ' I
_ (� �' � �+���-- ! � ' 'I' i� �� �. �f1 � _� �� I`�,'��'.,I 'a� I
} �� ..r�r'J ��,. � �I� ' � \�` I � '� I . � I i ' }/�`"I - �• �� !
�_ � r � �L� �� � - � '; � �%"� � � _ _�� �:
� �i ^.i" )/�,"N�' ' � �� _{ �\ \ �. �' � � .
� - : � ! ' \O I _ � ,� '� �� ' � ��s � •� �. I,
�� i r1i�J� 1 �� �� i _� �� � �� � �iJ i ��� �I ��� � �� �: �-�' �� ��
� C '-r "• �.11��� � � �_,� �� � � I � -� '�'� �- � � -� �}. .•�� �; .�'i. � ✓ (1�
� , j � i I I I 1 ; I ; . ' J � ,
(�" ,�� ��r� L"�Q_O cfl�� � . _ .T I ,� �� - , _ I� �i ;i .c, / � �-
-_ .:� � -�� , q . � 'I; I . � J II . .. I "� I 1, '�. .
;: a �- � '�.��, o .�; �" � 4 � � "'� ` �_ i ._ �. ,;. � !
r, �_'�� �J-�'.I . ��1;� � �,�!h11Q W ' Z z U � � 'ctl LL p I� I ' . a: I .. � �j' ' I I
`>" 0 .(, i�y;vi ��� g pY� ;z m 0 ? ' � � � � � S�Z w c z LL d a' � � ' � % � {�� t;
� � � ,,_7 p � a�.� �,I�' �:o z o 'cs ¢ ¢ w Q -�o c� �-' � z t- +=� cn� 1. � i .; � ,
� �;� � LL � r� m��0 c� ¢ Z L � w � u. �.J Q Q � �_D r=- iwi. ^ . t�,�. -- . .�� /� —-��,� I I �., _ _� t
�..� lt� �-. C7 z w ¢ a � ��I
w
t � -�' C crw'� '���a''. = m J-c� v_� s - � cnr J� �I � - - � _-� -- - -
� Q � __l0 < o e. wl w ol_ t w�-z � ��o o O � n Z c_�> �} �� -- --� --- -- -- -
p ,= z_zi�� - �iz�¢�w o��- o 0 o u: w z Q z z rt w,w zI � � I -i_ -- --J,
Q' `LLlLL � �I li I.` �.L CC .L74. m 2 LL d a a G O.li.:J � LL li.�5.��'{iI - _ _ j _ _- �
5. 0..� .,�I� I. 'j I��I _1_ i i ~ ' j .I' ~I � •� � .
� d I�:�, �� �� I '.� � � � . :� � i
'� �� � 'Z i�, -r = � l� �f ; j,�,wl� � I 7 . I _ ; �
�. � II.�"...y.A�'I � I I i � --` �I� _ _ . � I � c 1 i,
5 U I�V/ � � _�� '� I � ':� I � �� �I� �, I. 'i. � . I . ,' ,
ry{y 1
I••F��� �. I 'q� I �' /. ( i ' (�-- ' ` '1 .
��'�� � I :.J`I ��-� � � i I i �{ 4 i I � �.
��
� i � I� I E_ , l.
\ ,I �
r � , �I I� I II ��r � —__ _ I , -, I' , ' I i���� �� �I _'I �.. '�. � .�,
. ���� I �' i I ; � .'I � + � I .j ', , c`t �'3 ' . '( ,
'a"�q'� .I� �� . �I I �� i �" I � � (^ il , ��I . - � s'
� " �% +� �� � �� � � ��� � � � _ � I ,S .j i � . , � . � �,
. �I�\11. i � .�" � �11:� �I I ! \I^ '/ i I ' �I; � h
� I � OI" I' I -- i � ' '1 � II� I I i I . } Y�!
' � J � ��yr . � �, -_-•'. .-- . 2 'i I � � , i W; � , �'�I
'�'^�� r
= �,J I� FW- � �] � .W.C7 J ' � U I Z W � Z O Z �.I � ` i �, 1�� ' ,'`. I � .I , N W ,. '.
, �� Z � g ' ., � '. _{_� U Z .'� . . . �. , i , �N '�' .
; I�''' , Cn CC � lyj � � FZ- W ¢ 1- U � m 0 ~'� Q I Y � �" F_ Z � m ,� j � �' � ' i I, Y ln �#,. . . � ��,
,� � � a o W ¢ ¢ w ¢ W � � �'g � z !z � N � U z . 'Z I� r,7L •1 � Z�' � ��
f �.T"��X ¢ V a � w 2 (.�7 O s w a ai Z � �`t �_F-W,-. z W w ��� � j W I , .� i :� ,, I FQ-F=. . '', . .
Z: � ¢ O �n � � - � � U �, u -� � � ,,, /7 .�" ,
f1�Y._Q � ¢ zc7a ¢ cnZU222w ? Z ¢ ¢ Ua.� U = wc}�F '� � , , 1= - Ud
�..h C7 W O m g � O Q O � � � O � J W F- a Q J _l J J !� I �, . ..I.. I� I"',a �, , � '.,.
lJ � r� SW�< os0000x ¢ W � WWWazz `zz�� �!o. f` , �4-�� �i, l� �_ ww
;� `�" - cn � u, c� cnr-�3cr � ¢ ¢ ¢ av� w3 c� orn �nwc� ll. 11 � �+...' C3 � i I1"� �� -
, . .. , , " , � ' v�cn .�--�----'
�
c " �' '