HomeMy WebLinkAbout15935 (21) � '�
��_ CITY OF DIAMOND BAR �
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
> zi�oE.c���yna�es�ui90 pRESS
(909)860-3195 Faa(909)861-3117
��� BUII.DING PERMIT APPLICATION FIRMLY
� JOBSITE �'R` F'�il�i77 APPLICATION �}(`� PERMff q P/C
o AD�RESS � pATE � � �+v NUMBER I 1 � tk
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
� OWNER "
ADORES ` ZONING SETBACKS
� CfTY ZIP �L L' REAR � O
APPUCANT TEL SIDE/SIDE STREET RW D
� CONTRACTO SIDE ❑
� ADDRESS PROPQS D US �
CffY ZiP� TEL b,5�l��
� ARCH/ENG/ S��� �� _�
� DESIGNER NO.�WEL NO. � . ND.
ADDRESS UNITS STORIES BEDROOMS
� CfTY ZIP TEL
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUIlDER DECLARATION SFR/ADO/REM
O
p i�r�er u�u+o�vEwuTr ac vErauAr nur i u.�ExEx+vr rna+n�e wrrrucTons�F Gerega/Cerport
W CENSEUWWNTMEFOIION'RWRFASON(SEG7W1.68USalESSANOPiqFES5qN5CODE:ANYdiYOR (n
C� �OINRYWFACHqE0U1RE5AF6WRT�QMJSTHlK.7.11LTER���.�F1AOL1S7L�NREP�IflAN'lSiHUG W PdI�D9CK
�j nm�,vnan ro rts asutivc�,Kso aeauiaes n�e�vr��curt wn sucH Pe%�R ro��s�u w
� st�h►rort nuT�oA sue rs uc�sEn rurcn�urt ro n�E vnrnnsar+s oc n�e cartrucraAs u
� CfHSE UW(CMAPTER Y(LOMMENCRIO MnTH SECTION 7000)OF 0!NSqN 1 OF THE BUSINE53 AND PRO- �' PooUSpa - .
FESSiONS COD�qiTUT HE OR SME IS IXEMPi THEREFROIA ANO ME BA514 FOR THE ILLEGE�EYFA1v.
TION.+1N'IVIOUTqNOFSECTION7NI.SBYNtY�P�IGANTFORAPERMiT5UB.IECTSTHEMPUGwTTO Z Re-Raof
�,,, �avarEHKtrallorwoaenw+crvEwuoNEooauAslssoot.t. .
� ❑I�SO�NiEROfTMEPfIO�ERTY,ORM�EMPLOYEE5NIT�WAGE5A3TNE1R501EC01APEN5AilON, 0 �mmereial
WILL DD TtE M+DF1K,ItATHE SiRUCNRE IS NO7INTENDED OR OFFEFED FOR S/LLE(SEC TDN,BU54 J
NE43IND FROFESSIONS OODE TME OVtTMGfORS UCENSE Uw DOES NOT AVPL1'TO AN ONMER OF �
N OlqFERTY1Nq0UlD9diMPNOVESiHERCd{MAVFqDOE4"11Q�1KMNHnASELFORHERSELFOq m .
2 iHR0U0HM90RHEROVlNEAIPLOTEES,VROVIOEDT4lT5W1�M7ROVE/.1ENTS�FENOTME1IDmOR
�}1 ,OiiERmPD115�LEIF,IIGYEVE0.7NEBUlDMOOAMPROVEMENTI350lDVA1/4NONEVEAROFCOAIPLE
V TION,iHE�MNEiL8U0.�ER WKI.N�VE THE BURDEN Oc VROV WO 7HAT ME OR SME 010 tAT BURD OR
Z MGR]VEFOR7HEPURPOSEOF9ALE). �
� OlA30NMEROFTNEFiq7ER1Y,MtIXClUSNEIYtDMR�CIN�K7TFIl10EN5mLOHTfUCTORS
TO DONSTFiUCT Tf1E iROJEtt(SEC.7oN,HUSINE93 ANO iR0�E5310N3 COOE TNE CONTMCTORS LF ValUetion AQI.AREA
CENSE UW DOE!NOTAVPLV TO AN OVRJER OF A CRO�ENTY wND BUl.OS OR R1PiloVES TFIEREOf(/JA
� WfqCONiMCT5FON5UCMP�iWECfSWITN�WNTPAGIOF(SILICENSmPUR3UAHTTOTNECOHTRAG pUANTITY DESCR�PTtON FEE
� TONSl10EN5EUW.� .
❑IM1 EXEA�PT UNDER SEQ B.l V.G FOR TYMS REASON U
Q
"—' o�rE owr+en V
� LICENSED CONTFACTORS DECLARATION W
F J _.
� W
INEFEBYAiFIR4UNOERVEMKTYOFpE0.1l1RYfNAiIAr.�LICENSEDUNDERPROV1510N40FCFUPTER �
s •(CO,.�MENCNONTTHSECTqNfi�)OfDM510N]OFiHEBU5ME55ANDPROFE5510N5[OUEAND Z
LLl �LKENSEISNitA1FORCE/WD FFECT.
m
� LICENSE dASS G LIC.NO.��� J
w� — — cartrucToa��y;le/f ff�iyr�Q�1e� a
� /�y 1�' 1 WORKER5COMPENSATIONDECLAFiAT10N Q
� ' 1 U
N I MEREBY AFFlAM UNDER VENALT1'OF PERR1RY ONE OF TNE FOILOW�N�DEQAMiION^z Z
C _�IHAVEMAYNLLMAMTAMIACER7�FlCATEOFOdtSENTTOSELFdNSUREFORYYORICERS = .
� OONPENSATqN.ASVqOV1UED8'f5ECT10NTC00FTNEUBORCODE.FORTNEPERiOR1AANCE W .
OF T1E Y/OR%fOA w1/i0�TMS CEM.ni M31S"UED. �
O
__I N1rvEANO wM1l MANT�M wqMER3'CONVEN5AT10N 1NSUR�NCE.AS REd1�RED BY SECTqN Q/► .^�
Q i9pp pF}NE UBOq COpE,FOR THE PEHFORMMICE Of TME MIORK FOA'NMid1TFM3 PERMIT IS' ' " . � . `�.' .- � Y
ISSUED.MYNOiIICERS PENSATqNINSUAANCEGANR�ERMAPOUCYMIMBERARE: . .CONSTRUCTION��` � � � o J
� �,,,�, (�—Dt�D/ PuwR�nEvv �A Yna
z Pa�crnween1 .�'�r''��.7 ELECTAIC
4
0 (}I��y�CNNEFpHp7gEQ].i1FTE�ppFTEl�EFi.IigppRonlE�fU�E1DpolMs�stoo�oql6S�, PLUMBMG
� �CEliTIFYTUiNTHEPERFORMM7CEOF7MEWC7RKFORMMi01i11i9PE0.MITI9i33VED,1 MECHANICAL J
SHµ�IJOTEMPLOYANVPErt50NNMlr��NNER50R5TOBECOUE�1fCTTOTNE_ .. _ _ _. . _ __ -.._ .___ C'��� ��y'� -- --- �
� - � � NORKERSCOMVENS�TIONUw50FCAUFORMtiAND�GREETw�TIP151qVlDBECdaE INSPECTIONFEE �F-�T^�'Al�f(1ATT}A� y.��W
� Su8.1ECTMTHE�WrMERSCOIIPENSATpNVqOV1510NSOiSEGT10N]7000FiHEU80R �+�+ • �/j"�I�TIiTOT��DYYY��
S 000�,isuticoan+vntHwuv�rvnn�nasEraovisa�+s. ISSUANCE
� SMIP ��
p DATE APPLIWM!
� ENERGY P/C
WFf0iIN0:FAIURETO SECURE WORKERSCONPEN9ATpN COYEM�E IS VNN�R.MA SW�LL BE
LL SUBIECTANfAAPLOYERTOCWM4�1�17ENALTtE4M1DCNILFNE3UVTOONEMINOREDtNWS�ND ENERGYPERMIT
DOLIARS(flm.oao�N/�DDITION TO iHE CAST OF WMPENSAiION,O�MAGES�S VROY�DEO FOR IN
—}i SECT10HifoeociNEU80RCO0E,s/iEaEST,M�DA7Tonr+EVSFEEA RETENTIONFEE:
� CONSTRUCTION LENDING AGENCY pqE-ALT FEE
� �NEREBYAFFFWUNUERPENALTYOFFERA1RYTiUTiNEREtSACONSTPUCTIONIEN�INfi�GENCY �
FORTNEPERWHMNICEOPTNE� A� aANM�diTM� ERMi7�SISSUED(SEQ7on,C1V.C.�.
�
�Z lEN0Eq5 NAME
i
� LENDER'31�DORE55 -
u' iec�Ero�ar�ui"ar ro��rro�n±wcEs'Ti�a"osr�Euw"'FOsp�uT�roeu�'ioE'�ia TOTAL FEES � �.�.
� �pNSTPUCTbN,AM7NEREBYl1UfMORIZEREPRESEMATNE50FT1115COUNTYTOEMERUPONTME �
� fBOYE�MEMpNEDPAOPER7ViORINSPECTIDNPUN00SE4. L'QMMENTS
� �� —�7
¢ PER/AITTEE WWE(PR � /` �� V_.
tn \ / / U � r
(� SIGNATUFEOFPEFW �� DA F
� FiECPT.NO. PAID BY VAUDATION
WMITE—Department Copy.YELLOW—Fhencs Copy,PINK—Assessa Copy�GOIDENROD—File Copy,GFEEN—ApplicanCs Copy
- - -__----- - --- � -- — .-- - - - j��� --- -- --- --
-^�--^-^^ -,� cn tn - ('�:�- , +� -n -n �'cn cn cn o c� { m cn z� � � � zr.a s -i cn c� m � tn -'a _-
' � m m �. �� U ' �I � : � ,,n m m m A m y x s O o o O�i1�t. � m � D.m � -mi '�' .
^.;., ' : �-i �. -. I �S' i . I Y.I+. �}�.�C� fa � � � r- � "'� O C C C U A ' m � W �I C� UJ p7 I� ..
� � v c� I, ,� I '�O � S 7.;A 'D n JJ a � � � m x 2 S c��Zim � � � Z' � -n D �! _.
- m c� � -i �r".., m � � � m x o cf��� cn o D d C� � x .::�'.I.
. _ , 1� . - .� .�77 ��, 1 '�� c m D -i i= D � 7 C -�, r r rn < �:f m m � p v:
D i I yna m Z � �^ in � cmym z� m r�� �
: C` ; .Z� i i W -i z � � r tT. D C Y `p m ? n 1 7J L I^% 'C 31 m C' � � �':
.Jrp, (l�T. ' i ,� i i � ?� �} � "� � � G � -a � cu "� --1 7; c� � O tn
lri m N � i . C n � i :, � Q p � � � � � �: �.�� m mi D m o ..
� � � � Z - - �l � � �;
� '� I � 'Z'�✓ � �
���� ` i — � ��` i j
_,...._...... . ', . Q ;. - t ' �� i 'q:�j ..
r J � G `�O � ;"'�
,�-
` - 1 �,i� ';
�1, i;
'. ` i ' ���:�I � ��� -
S _ '� ' -:� t .
- °'�� ' , i �, ' �� t'� � _C
' , `,c I '� m O
- n TI
� � �' �� � �� �� �''�oy ftt D �2 'n T Q 'n D O � '9 '9 T 7J m 'O "ry'p y T 'il'CI� C = � �
� ... ._. ' .:
,o� z m m - - z � m �n O O O z o 9 z'� - a � O =y
_.,k m� ;� rmD- U' o �.ncTn �_� �u' cCinm � ' xvv � r" � � .�I Z
-- -- - - -- - _ _ 1 y
.^._ . . —. . .--� - — ---- -- ---�- - -� "�a ,� 'T� �-"� o -� cn -n -n m = _ ? 9 m p�� 37 77 m �7
� . � ; y iid { Rl S T N R7 C� m .n-1 m m r +n < Y Q' �7 � � 'fl T Q .js� � 0
- -r i� cmn � .-�i � � v � o a z m � � G� o z o O m m-� p � � �T Rl�_Z
� '�� v � T z -o L r t ' z � � n � p n z �? m � m 'n O O [�i� -�'i dL� -C):-p
�.�x,,� a r+ ZG� � 9 � � � � Zg G� mm � OD•� � �", O.
L% � , �c# � "� � � . O G) � D-z m � y� n o i �i .��_��
i 1^. }' - � G� � '/� m'S c � �, �:=�I7
� D q p
t� ^'} c: � pC I "
� / � !J. � •. �� Z�.� �✓i � �{I .
� :y, p i r'�".J 1�. ��' !. .
`�} i�Y •J •�{ ( {, �l 5 �c�� � ,.
_ �,/_ _I ' �(' e l��l .
� I
r. �.`�� t� �
�i I % � . �-�� ' � , �' j, �
-•� �". f _� � � ( , Lr + �i,
�, _ - .r' � :��I
� , �
- � ' � n !
I
�•
_
._ , . ! -• -
,.
,_ _ _ _._._ __._._. _._ _ . _ _. ---. .. ._ . ._ ._ _ .-. --- . _ __ . _ ._,_ :_ � - -
_ _ _ .
.
, . _ , .. . -
( �'_ _ , - ' ' _...� • . ._
,,. , � _ , . . �,:, . - i _. _. �