HomeMy WebLinkAbout11388 �xP���D �
—/'T'""`�— CITY OP DIAMOND BAR �
�~ I I COMMUN[TY DEVELOPMENT DEl'ARTMrNT p�T p 5 2000
II(` =..,w . 21660 Ei.Copley Drive Suite 190 PRESS �
(909)8C0-3195 Fax(909)861-3117 �
,� "'':°"",� BUILDINGPERMITAPPLICATION ,, FIRMLY �
� JOBSITE � r� '"7 � ��y��� \' APPLICATION PERMIT P/C
o ADPRESS ��^�� r _�"" "y-"��7_�'� DATE `� � �� NUMBER���_ #
� ` ISSUE TYPE OCC
APN LOT TRACT _,. DATE CONST. GROUP �
°C OWNE�C'�.�T, Clk��a1A
� ------- �r
ADDRES��i�1.�V�, ZONING SETBACKS i.
� ---- -- �
z cirv��r��. � ZIP`jC�- T�,�� FRDNT -�-- RW — �........_.�
� APPLICANT TEL. REAR ,._____ �_:1 _ �
Q SIDE/SIDE STREET--------- RW_.....----- ❑.----....._ `:
dp`.�..�n -•-�-; SIDE _,__._,___._ L' '
Q CONTRACTOR r!�t-�.1�'Ci"`,�� "�A.���C�h7Y, __ _l.-- !
ADDRESS �?�����9?'�::t,'�'tLy�� �
� CITY f����=.%t� ZIP E�-I�Z TEL`� ���.'jl PR�pOSED USE ,___ '
w ARCH/ENG/ ---- -�--------- < < `•:
W DESIGNER - �
i.
NO.DWEL. NO. NO.
n_ ADDRESS --------- UNITS STORIES BEDROOMS t'
� CITY�---.--.�_ ZIP_.. TEL.----------
� - DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� i�.
O OWNER-BCILDER DECLARATION SFR/ADD/REM '
i!
p I HEREHY AFFIaM UNDER PENAITY OF PEFJURY THAT I AM EXEMPT FFOM THE CONTRACTORS LI- � Garage/Carpo�t ��'
W CENSeLAWfUHffIcFOLI.OWINCH[�SOV�SEC.]o31.5AL1SINFSS0.NDPflOFESSIONSCODE:ANVCITYJR __ ('
zI:Ol1N'lYWHICHRE�LiIflESAPERMITTOCONSTRL'CT,ALTEfl.IMPRGVE.DEM.OLISH.OflHEPNRNVYSTflUC- W PdfiO/O6CK �''
w TUHE,PRIOR TO ITe ISSUANCE,ALSO R[OUIl1[S THE AFf'LICANT FOR SUCH PERNIT TO FILE A SIGNED W __ _ _ _ �;_
STATEMENT TI IA'(IiE OH SHE IS LICENSEO PUFiSUANT TO THf.VIlOV1510Y5 Of 7 HE CONTRACTOFlS LI- �•
� CENSE LAW(CHAPTER 9(COMMENCINO WITH SECTION 7000)OF OIVIS��N 3 OF THE�USWE55 ANU PHO- � PooUSpa {�;
FESSIONSCO�F)OFlTFIAI'1{EOHSHf:ISEXEMPI'iIIEHEFR2UAN�TH[BASISfOFlTHF.ALLEG[DF%EMP- (� f�'
� TION.ANYVIOLATIONOFSECTION7031.SOYANYAPPLICANT�ORAPERMITSURJ(:CTSI4!EA1'PUCANI'TO Z Re-Roaf j;
� A CIVIL VENAITV(1F N��T IAOf7F THAN FNF HI1N[1fi[[]OOLLARS(5500).): — :;
� L4ASOW4EfiOFTHEPHOPERTV.OHMYFMP!.OYfESWIIIIWACESMSTHFIIl50LEC0"AVE'NSATION, 0 Commercial 4,
Z Wll.l.UO THG WQRK,AND THE STRUCil1RE IS NOT iNTEYDEO OR OFFEFED rOR SALe'(SEC.7J66,6U51�
NESS AND PROFESSIONS GODE:1'I IE CON'R�CfURS I.ICCNSi:I.AW�U[S N()T APPL'/TO pN OW�Gii Of �.
� PROP[RTYWHOBUILDSORIMPROVESTHEREON,AN�WHUUDESSUCHWOf7KHiM5�LfORHERS[L�OR � _ f
� TIiHOUGHNI50FlHEFlOWNEMALOYEES,f�fiOVIC]EDTHATSUCHIMPFlOVEMENTSARENOTINTENDEDOR m C
W OFFEREDFORSALE.IFHOWEVER,T11E6UILDINGORIMPROVE.MENTISSO:DWITHINONFVE'AHOFCOUPLE- S�'
� TION.THE OWNER-RUII�Efl WILL HAVE TME BURDEN O:PftOV!NC TH�T HE OR 511E DID NOT BUILD OR ���
Z IMPROVEFORTHFPt1RV0.5FOF5ALF�. �`
� �71,ASOWNEROFTHEPROPERTY,AMEXC�USIVELYCONTfiqCTINGWIfIILIGENSEUWNfHAG�OHS �'
W
(� f0 CONST�UCT THF:PROJECI'(SEC.%na4,A1151NfS5 AND PROFESSIONS COOE:THE CONTRACTORS LI- Vdlllatl0fl ADJ.AREA . ..._.__.______...,____.,.._ r�
W CENSELAWDOESNDT�PPLYTOANONMf:ROFAPIIOP[FlTVWHOBUILDSORIMPflOVESTHEflEON,AND
� WHOCONTt1ACTSFOflSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTH[CONTl7AC- QUANTIII' DESCRIPTION FEE '��
Y TORS UC[NSF LAW.1. I�
� J �O O I AM�X[MP7'UNDER SEC.._.,...,.._..— B.&P.C.FOR THIS REASON U ,'
� .___'.._.....'_—__._.. ............._" '_ � _ �
� DAiE , OVlNER '
_"___..._._....__ ._..._....________— ——' U n
Z W
Q LICENSED CON7RACTORS DECLARATION W / r
Lr IHEHEUVAFFIH41U4D[f1PfNALfvUfP[f7Jl1RYTHATIAMLICMSEDUNDERPROVI510Y50FC11AVTEH � � �/� ,�,�y,i�._a,.�.,�.p.. ��
� 9(COMM[NCING WITH SECTION 7000)nF DIVIiION 30FTHf.BUSINtSSAND Pf10FE5SIONS CODE,AND Z vs'ea�y,+
X MY LICGNSF IS W LULL FOFiCC AND EFFECT.
4 � m ` �
� LICENSE CLASS��� ,�._,_....._ LIC.NO. _��A��`�� �fi.,` � �
VUAiE ����`�_.__ CON7HACTORi�YYf.LAY�CI-?•�+.� d
w n �
� WORKERS'COMPENSATION DECLARATION �^��' � ¢ �
� \ U y
� I HERLBV AFFlRM UNDER PENALTV OF PER.NRV ONF.O�THF fOLIOWING DECLARATIO4S: V Z �
f.� JIHAVEANDWILIMAINTAINACEH�IFIChi[OFCANSfNTTOSELf-INSUREFORWORNER6' _
'z COMPENSATION,ASPpOVIDEDBVSECIlON370oOF7NELAU0�7C0�[,fORTHEPERFORMANCE U t
¢ O�TH[WORK FOfl WHICH THIS PFHMIT IS ISSUED, � �
O �W I HAVE AN�WILLlAAINTAIN WORKERS'GOMPFNSATIO.N INSUNANCE,AS fIF:Ol11pED 9Y SECTION
Q 3700 OF 1'l1E LA60Ii GODf,FOR THE PERFORh1ANCE OF 1'h1E WOfiK fOH WNIGI I fFIIS PERMIT IS
ISSUED.MYY,/�OFi�N�EFi�3'�CA,N�PEN�S TJIO�hINSUNANCEC�Ft�11ERANUPOLICYhUMB[(7ARG: CONSTflUCTION ______._._.._........___.._ Y
j cnn�iEn ��l C�SU[`R'�� Kl�-`� _ `� PLANRFVIEW ....... ..................- t
�+ 3 ---
Z aoucvr+uMoer�...�.�� at7����1 .�(�v..---_---. �-- - ELECTRIC �
t
. ..�-- ......._..-............._.------._.....'--..-'........--------� �
¢
Q (iHi55ECTANNEEDNOTBEIXNdFLEiLUOFTHF:PFFIMfTISFORONFHUMJRFD0.YLAF5(5100)ORLES:). UMB�N� ____ �
w I CGRTIFY THAT IN THE PERFORMANCE O�TH(WOHK�OR WHICH THIS P[flMI71S I55UED,1 MECHANICAL
Z �
Cj' ShWLLNti�[MPI.OYANYPERSONINANYMANNEHSOASTOg[COMLSUUJEC7"fOTHC.
� WOFiK[RS'COMPENSATIONLAWSOFCALIfORNIA,AN�AGfiEETHATIFISHOULDBECOME INSPECTIONFEF �'�'
j Sll[iJECT TO'f41E WDIiKEflS'COMPENSATION PROVI51(1NS UF SECT104 3]o00F THE LABOR � ¢
(:OIIE,I SIIALL F'URTHWRHCOMP�Y WITH THpSF PROVISIDNS. ISSUANCE > �
O °",� 'o� .. t`�'�"� c--.,t� C. R
p DATE: -S"'��J �... /aPPLICANT: • I�x�. ��"'A`'�^`d`�� ... SMIP
w � ENERGY P/C � �
�. . /p
WARNINO:FAIWRETOSF.CUHFWORKEflS'COMPENSN710NCOVEHHGEISUNI.AWRIL,ANf1SHALLBE '�- -;�` ��-- -'--
� Sl19JECTANEMPLOYLRTOCRIMINALP[NALiI[aANOCIVILFINESUPTOONEHUNDREDTF10U5ANU ENERGYPERMIT ���� � �� �A��
UOLLAHS(E 100,OnD),IN AUDITION TO THE GOST Of(.'OUPI:NSATION,DAMAGES AS PROVIDED FOR IN —�-''--""-�-------"'-"------��-
� SECTION3lO80F'f11ELA90RCODE,INTEHEST.ANUAIIORNFNSFCES. RETENTIONFEE: __._,_._
_.. _.... ...._..._.__......_ ..._.....-- ._.
w CONSTRUCTION LGNUING AGENCY PRE-ALT FEE�
�
� 1HF.FlCFVAfFlflMUNDERPENnI.TVUfPERJURVTHATTHEREISAt:ONS1HUCTIONLL�.NDII:GAGCNCV $j.
FOR THE PERFORMANCE O�7'Hc WORK FOR WHICH THIS PERMIT IS ISSU[�(SE(:,909],(AV.C.). �
Ld.l
� LENDER'SN�ME_..._—__._ —""—_.._._......."'__" -- — _ — _.
_—...._... _... .....—._._..'___'__... __._._......_"_'—_'_'__'_ . �
F— LENDFR'SADUHf:SS __..___._--...... — �— — �
� ICERTIFYTHATIH�VERE�UiHISHPPLICATIONANDSTATETHAT'flItA30V[INFOHh1AI'IONISCOfifiFCT. TOTAL FEES „i
w IAOREETOCOMVI.YWITHALLCITYANDCOUNTVOIIf)I.VANC,ESANOSTATELAWSREIATINGTOBUILDINC
� CONSTRUCTION,A�f7HCHE�VAU(HOiIZEFEPRESENTATIVE50F11115COUNTVT01'.NTfIIUPc)NTHE
z AE30VEMENTION[OPROPERTYFORIN&PLCI'IUNPIIR�USES.
COMMGNTS---..... -. ......... . ...
o � _......... ......._--._....------.._—...--
� ��-�.€��?:►��!�,`-►
---_..__._
m PERMI(IEF ME'(PRINn'�-�.••.•• —'__'—_—__'"_.._......_...__ �
Q
�, �.._��_�..._._ � ��--�,-,� � __ -
- --- - _ _ -)------- y
SIGNA'(llflfO�P[:Fih11TTE�—�:'— • DATE 'L`�—A— -.... _._ . _.. .. _ .. ^
� � �_VALIDATION��
= RECPT.NO. PAID B _._:!'...__._, -
~ WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENAOD-File Copy,GHEEN-ApplicanPs Copy
.. _.... ..._., ,_ r .." i ._.. .. , . _. . _ �.
� ..� .. _.., i � :,' � � _'� . . I . .... ..�
.�� . � � __ __ _
� �
^ ���� I j � ' I ' I ' _I � I .I i. ,_. �
�K I ; ,
� � ' � '
- � , � ' ' ' , ' i � I � � , i � � I ' � �
��� i f ' ; � , ( ; ; i i ( ; � , , i I �
���m',s j � � ' I � ' ' � ! : i ( ' � '. 1 i ! � � ; �
�.�; ; ' � � I I j ' � ' ! I � i � �. , , , �
- �5�x� �� I i � � . � i I . � � i � ( � I .. i , �
�� ) � � � �. ���_ �_... � ._��__ i � � I � � ! � i ��
; �� i . ' _ ' �',. ;
. '� � ..__ ...._._ . . r � ,
.. p T�'� i � I I � 7 _ �I I i , � � i � � � I �
v�, a' , � I : I , { i ; � I i � ; ' � '.� . I I
��# � '._� � !.___� ' r L i ' �__ � � 3 1 i 1 I I
�� } , ; . � i ' � } , , � _ , ` + i i � E �1�
I � i � � � i I i � 4 ( � � �
�. �i i , � � i � , �
I � i i
� ��� i � i � r
, i � I , � ,
!
I
� � �
� . �'�6 I _ I i � � � I � i ; � i , ( I � � i I � �,. i .. i � � �
? � � 1 �:, i , � � ! � + �
Y � �' � �.J ,r! z .. � ! I �! -� � � � � � I f � ! � � �±
d � 3 �r • � t � i � i I i .
,��fi a �V�.n � i �� �1I l ,� ti ' t . { E['� � i l e I I i I '�� � I � h
� ��T � l� i `� C-' i � C[ .�. i , I �,
i r J � - � � LS. . i � I
� p �a � � � I
G1n, � C , .� Q �
� a� �m#��t� �� t�) ,� _ ,��� ,• c � .,��� I,� _r �.� � , � , � :
_ F3� 4 �, i _� �� i :� > > � P -�-- _ C f�. .�� � a�� - ' � i �. I �
r i�'�;_ � � :t a 3�. � ( � I �
,"� Y �'�:c � � t ; � k I �� j � ',� .� � i � �� � f � �,�� i _ . . '� � � � r
,� �, W c ,. � 1� :..1 � �' � z; 7 r� _� � = ' � I
� • i , i i � - {'� ; ! i � �"
�g� r �t�.... � �� i I 1 d � .. �L � _I � C"�i L t �� � � � � � � � �
e � "- i
j .�3 ' ��G ;l � ' I �" c _ L �L� ( l._� '} � y ° ; ; I i
�°� �� � } ._t , _ f ... _I. . _ _ ' i._!'�s; . ; ., , I ( � .
.,.'
i �� "_ "' �
. _ �._. � � ... _f.... �
�. R ... ._ ., �_ .. i ,.. 7 i �
.. t��� .° -. . , ,� .._ .. ...... _
i � I
� � ��f � � � � � � � � � � � f � � � � � � � � ` ��
� �� n�� � ( I � � � � i � � � � ; � i I �
.. � � � � , I ; ( x ; i I : �'';,. ' i . �� � � ' ,; � . �
a a ' i I
7��'� : i i � I . : t
��� �� �S° 4� i i i i i I i � ; � . { �'�, ' '; f � ' ; i � � + 1
��� ' i I i I i I I ' ,. I J I � _
[ 1 ' I 1 i i - ji
`�. f� � � '' ' .'..._' .__1. � 1.. i ' � I ' i � j ���� , ' ' I
,
� i • I 1 I
� I
:: ,. [ ' �_' _
_' _.._ I .._ � .
, , � � f . I I
� � ;� i ! � i � � �
.
�, — ��� � i ! � . i , � , ; ; � � 'j ' � , � � , . , < <
, , I , � . � ., � �� .�' � (
;. � ; � ; i , ; + si �
j �� . , � , ' I , �
:: _. � � ; , ; , � � i
.. �� �'" j � I '' 1, '� . 1 3 I i j III ( I , �
I : ' � �
� r �� � � ,
;
, a �
, _. .._ - ._ — — —
.
� ,i .� n. ' ' � I ' ,•� � ' ' �� � � i � '� �: � . ���;;
_ . _, ! �.. .
' � i
.T� ��, �c.} �� ��.I � � � � � i ' �x.� �
i ; � sw( , , �.h. 6 �
� ����� ��i A � t j r.� 1 - I .-,: I � s�� E I,X I � � i �� �� � 3' � . i i a l*,! �� � ., 1
� i _i i� � ; � i— :r i+ � I � t I � ��� � .S f
� t ,_ � �t a � E �� r � � ��v i ; i '; � i�i I � � � �_ � " !
� ��F Y t '; f i { J._ I ` I � ;-I l � i � i I ' � ' ( � � �� �
I -C 1 ' I -" ' . �° �
} . � i !
; � ��. � � .. I i i {� i , 1 ., 1
���s, � � 3 r C � �� y ' �� � l I � � � � 7 i ��� a `� T t
���.�_�i �.� � " ` i � � � � �.L_.Lf -.�..� � � I � � - r i � � U'F�m._ �'��._.��.
�,._ -___.._e. . �_.!-__�._� __._..a_.�.W�._.! l_.�.._.t_. .�_....._ _�. .. _ ....,.,_ `. .___..., ..._.�..�_�_ :._. 1_.___�._. ._�_.:..._ .._..__. _._,.. .,_�._�_