HomeMy WebLinkAbout12-16 i \ — 1 _ . _ ' -. _T — . ' �— �/
, . CITY UF DIAMOND SAR , /
' --��-- DEPARTNIENT OF COA�In�IUNITI'R DEVELOPAIENT S�RVICES � ✓
' . - ______ `I� 1 �
� �� w 21826 Cople��Drive,Diamond Bar,CA 9176�
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 �E$$
� . '���9�' BUILDING PERMIT APPLICATIOh FIR�flLY �'�
� DDRESS ��7�� ^� �V� � ��' DATE CATION � � � Z. NUMBER I Z' z/C���1 �
ISSUE TYPE OCC
`r APN St'1 G( LOT D " TRACT ���,�,. DATE � CONST. GROUP
p OWNER +�2 f� a��. fT,in:n ---
fl ADDRESS - . ZONING SETBACKS
Z CITY � �rh �M�v�c, �K�P �i �l s'1`e�.bN� 4-k l bl4 FRONT RW O
REAR ❑
o APPLICANT � TE' �� SIDFJSIDESTREET RW ❑
� CONTRACTOR G' SIDE D
� ADDRESS PROPOSED U� w gl+ G7l
� C�Ty ' ` ZIP TEL
w ARCH/ENG/ p� ,,� `' R R p.,
Z DESIGNER �1` '`I ir1lh� U/�A r1�_ NO.DWEL � NO. � NO. 7G'�'�
� ADDRESS �-`'� � � �' - UNITS I STORIES rL BEDROOMS
� CITY l��C C�WDq�. ZIP .7 ISTEL.
� !� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
O OWNER-BUILDER DECL4RATION �Q��y1 1 SF D EM "�[q �
v V
� I HEREBY AfFIRM UNDEP PENALTY O�P�RJURY THAT I AM E%EMPi Fq01A THE CAMRACT as u� GaragelCarport .
W CENSEIAWFORTMEFOLLOWINGREA50N�5EC.747i.50U5WE55AND7ROFES510N5CADE�NYGTYOR (n
U LOUNTYWHICNFEOUIF'c5APE0.MITTOCON57AVCT,py.TEi�VA➢RpVE.DEMOLJSH,ORREPAIPAMV57PUG W Patio/Deck � �
w Nr7E.PRIOR TO ITS ISSl1ANLE./LL50 REOUIRES THc A.'PLICANf FOR SUCH PEAMIT TO fILE A SiGNEO w
STATEMENT THFT HE OF SHE l5 LICENSEO PURSUANT TO THE CRONSIONS OF THE COMRACTORS LI- .
� CENSE tAY1(CHnPTER B 1�lAIAE4C'.NG YnTH SECT�oN�CAo)O�DtW540N]Oi THE 6USW e55 N:D?RD- � PooUSpa �
� FESSIONS CODE)OR THAT Hc OR SHE IS EXEMPT THEREFROIA AND TME BASIS FOR THE ALLEGED EX'c7.IP- �
V T70N.ANYViOLATIONOFSECTION7N�.58��wYAPPLICAI7TFORAPEFMITSU&IECTSTHEAPPIIGANTTO z Re-Rool
� q CM�PENALTY OF NpT MORE THAN FIYE HUNDRED DOLV AS�SSo6).):
Q ❑I,ASOYlNEROFTHEPROPERTY,Or7MYEMPLOYEES\'nTMWAGESASTHE�R50l.ECOMP'cNSATION. � Commercial
Z WILL 00 THE YlORK,MID THE STRUCTUFE IS NO7 INTcNDED OP OFFERcO FOA SA�E(SEC.70�+,BU51- J
NE55 AND VROFESSIONS CADE 7HE CANTRACTORS UCENSE uW DOES NOi APVLY 70 AN OwNER OF a '�'
� PHOPEHTYWHOBUILDSORWPROVESTHEilEQY.ANDWHO00E55UCHtVORKHItASELFORHERSEIFOR � �
[t THAt%JGHHtSORHEROVlNEI.tPLOYEES,PAOV10E�T1/ATSUCHiMaqOVcMENTSARENOTW7ENDEDOR ,
W OFFEAEDFORS/LLEIF,HOWEVER7NEBUILDIN60qIMPHOVEMEMI550lDVllTMwONEYEAROFCOVPIE•
0 iION,THE oWNEP�BUILOER WILL W.VE THE BVR�EN OF PROVING Ti4T HE OR SHE DID NO7 BVILD OR
Z UIPROVE FOR THE PURPOSE OF SALE�.
= Ol/SOWNEROFTHEPROPEf(�V.AMEXClUSNELYCAMRACTINGYrtTHLICENSEDCOMRAC70R5 • '� - ' -
W
[L TO CONSTRUCT THE PROJECT(SEC.70��,9USINE55 AND PROFESSIONS COOE:TME CANTMCTOfl9 U� V8IU0lIOP .�����_b ;�'ADJ.AREA
W CENSE LAW DOcS NOTAPPLY TOAN oWNER OFAPqoPERTY WHO8URD50R IIAFROVES TNEREON,AND - - -- --
� WHOCAtJTMCT5FOR5UCHPROJECTSWITHAGONTMGTOR(9�lIGEN5E0PUH5UANTTOiHE00.YTRAG QUANTI DES�RIPTION FEE
� TORSIJCENSE LAW.).
� r,
0 ❑I AM EXElAPi UNDER SEC. 9.8 P.C.FOR THIS HEASON
� ¢ � �
� DATE O�'rt1EA ~
2 w
�Q IICENSED CONTFACTOfiS�ECII+RATION W �
CL I HEREBY AFFIRM UNDEFi PENALTY OF FERJIIRY THAT I AIA LICENSED UNOER PROVISIONS OF CHAPTER � A '
d D(COMMENC W6 YJRH SEL710t1 I000)OF DIVISION 3 OF TH'c BUS WE55 AND P.lOFE551DN5 CODE,AhD z �L
X �.11'UCENSE�5 w FULL FORCE ANO EFFECT. //' m �
llJ // (1
� LICENSE CLA55 � LIC.NO. ,{V J � G n. .,I • J,.
V•�DATE�i 71����� Y CONTFlACTOR d "C
W
� WORKERS'COMPENSATIUN DECLARATION � G
�
N I H'cqcBY AFFIiiM utiDER PENALTY OF PERIU.T'OfY_OF THE FOLLOW WG DECUpA7fON5:
� Z
Q
��ap � �l'� IHAVE.V�05'ALIAW�JTAINACERTiFICAT'eOFCOhSENTTOSELF�IIJSUREFOr7Y/ORi(ERS' _ �
COMPENSATION.AS PROVIDED 8Y SECTION�700 OF TkE LRBOR LOOE,FOR 7HE GERFORIAANCE U
¢ OF THE VJC.7K:OA YlHICH THIS PER!AIT IS ISSUED. � ' . � �
d -
w I HAVE A/:D 1'nLL IdA1MAu�WORKEAS'CO!APENSA710N INSU�AliCE,AS REOUIiiEO BY SECTI04 ' �' �
Q �7000F THE LA60R COO`c,FOR h1E PERFORMN:CE O:TH:YfOH1(FOA YlHICH THIS PERM�T IS {
QISSUEO.ldY Vlolfaxe � �eaEysayot+insu cngai�nr+�OtJLY ttUiA9ER MiE CONSTRUCTION ' .F ���C���' .
� CAHRI'cR A / ` "' /� (� PLAN REV�EW 1��. SS
ZPOIICY NUMBER !'/ " �',� ELECTRIC ' � , '
Q � �
Q (Ilussec'�a�nE�rv�ia=_carrZErmanEaEtu.Srsr�A7a�H�Lr��D7uAas(S,rola7lEssl PLUMBING
W
z I CERTIFY T!�AT IN THE P'cRFORI.!ANCE OF THe V70RK FOR 1'MICH THIS PERAIIT IS ISSUED,I MECHANICAL
(�} SHA!LnO7El.t?LO'r,WVPER50NIt7ANYlAPN.`:cR50A5700ECOS�ESUBJECT70THc INSPECTIONFEE
� Y,'ORNERS'COI.!PENSATtONIAW$OFC/LLIFORNIhA�DAGREETMATIF15HOULDBECAIAE
SU3IECT TO THE WORICERS'CA1.IPENSATION Pa0`/IS�OYS OF S TiON]]oQOF THE 1.43 �
� CAOE,I SMA+.I FORTM��11VAT''M COMPLY WITN SE PROVISION / lSSUANCE �
� �/ SMIP
p OATE:�C-�'�� APPLICANT: .
� ENERGY P/C ��� ��'
YlAPNING:FAILURETOSECUflEVlOGiKERS' .7Et75A710NCAVEAAGE15UNLAYTULANDSMALLBE /� 'C.�
� SU'W�C7 rV1 EM?I�VER TO CRI641NAL PEN 1�5 f.t:0 C�`nL FU:ES U�TO OHE MU4OPE0�YOUSA.ND ENEFiGY PERMIT ���+� v�
p0�1 AHS(S10o.o0�I.IN ADDITION TO 7HE C 5T OF COMPENSATIOY,DAh!A�ES AS PR041DED FOA W �
� SECTION]708 OF THE LABOR CODE,�NTEREST AtlD ATTOANEY'S FEES. RETENTIQN FEE: � ���
OCONSTRUCTION LENDING AGENCY PR -AL7�EE: � �
Q 1 HEREBr AFFIRI!UNDER PcNALTY OF P'cRNRY MAT THERc i5 ACONSiRUCT10N IENDIN(3 AGENCY � � O • � � '
d FOR THE PE.7FORt1ANCE OF THE 1'lORK FOR VMIC1i 7H15 PENd�T lSISSUED(SEC,]097.CIV.C.). , � 1�_ y,��_ () �
Z �1/\l.�!`i.a�J
W
S IENDER'S NAtA-
�
F_— LENDER'SAp�RE55 _
� ICERTIFYTHATIHAVEFcADTMISACPLICA110NAN�5TATETHATTHEA90�E1NFOR1AA7qNI5COfiRECT. TOTAL FEES �� � � �;,. �ti.�4� ' �'
w 1 ApREE TO fAl.1PLY Y/ITH ALL CRY AND COUN7V O.ipWnNCES ANO STATE UWS REU7WO TO 8U0.DING "
� CONSTFUCTION.N:DHEAEBYAUTHORIZEREPRESEMA7IVESOF7HISCOUNTYTOEMERUPONTHE ' . �
� A90VE�MENTI0.4ED PqOPERTY FOR iNSPECT�ON PUi1PO5E5.� CO�+iMENTS � ' .
� Z9�� �
�
� �
m PERMIiTEE NN.1E IPRINn . .
Q
�
N SIGNANRE OF PERMn"fEE DATE
� RECPT.NO. �a�� PFUDBY ���� ���\a VALIDATION �-y�
WHITE—Dapartmr3nt Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—F'lle Copy,GFiEEN—Appticant's Copy
�n[J
4 Y
/
' .J_�._..7.•
p-� YI
S "�"'T t� �,V1,� ���G.r� � �-4' '��' GL.�
� a�I��
�,+� �� 3 � � �-- l , -���
� � � ���
U ��. �� O�-- �� I�
���,� ��' P �Q
, , ��
� 3 /Z �r a� a���C� :.
31 �a��-�--�
,
�a..�� �,� �� ��Z.2' 1�,..—
�� . � U� � `�'k �. . ��.� . ��. _
c�2� �,c`�'
-�--o, ��+�`b� � t.� � V►����" �''`��� ����� ��::��,
� �
f �.�¢�'r"�1l� G�- �f�jl'z' �ixl�.
�
�, c �N a �o�r �C' c.ow''a`'k � �u�
��r �► i�-� � W x,U c.� �*'��.-�.� a-����,,:�...� t
a ta�.l�
l'� �����' Y �r,�� ��- �
�� �'���� � � t��
�
� ����Sr��� d�� S�1r�r� �,�-
_ r
� t� ��
`�.
�