HomeMy WebLinkAbout12303 1
�� CITY OF DIAMOND BAR
���� �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
� (909)860-3195 Fax(909)861-3117 PRESS
"��', BUILDING PERMIT APPLICATION FIRMLY
N JOBSITE /� �+ W
a ADDRESS ����tiL�L�� �✓7L(�P�GIS�/NI �l� D APPLICATION /a�`_�/PERMIT P/C
p -� DATE 7 �l �� NUMBER�Z� #
� APN LOT TRACT ISSUE TYPE OCC
--�� DATE �"�'�'�� CONST. GROUP
g OWNER SK�NAG,D Ne �'J��,Til/Y'A/G J U�'
q ADD S5�/�JG�J�./aI� �L It'I � �' ZONING SETBACKS
W ' FRONT ---- RW CJ
z CITY ZIP '/7(o� TEL. /-%��.3 —
p APPLICANT D/fI1/N'Ee.d, e,Q�piyi'EL. � �-73I SIDE/SIDESTREET RW u
� CONTRACTOR T/U�S `/' SIDE n .__
Q ADDRESS_ ' � �1 Cj` �
� CITY�/C`�N/b'�r•� ZIP�f��TEL.)�i/ �- � PROPOSED USE �/�T/L C`d Gr£ �_ _
pARCH/ENG/ -
�z DESIGNER N0.DWEL. NO. NO.
a ADDRESS
� CIIY ZIP TEL. UNITS S70RIES BEDROOMS,
y
v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I HEHEBY AFFlRM UNDER VENqLTY OF PERIURY TF1AT I AM EXEMPT FROM 7HE CONTRACTORS u� GdfagB/CdfpOR
W CB�lSEUWFOR7HEFOLLOWINOREASON(SEC.7o31.58U51NF.55ANDPFiOFE3510N5CADE:ANVCITYOF (J�
U ��.RyW�{�CHREQUIRESAPERMIT7ppON5TRUCT,ALT�R,IMPROVE.DEMOLISH,ORREPAIRANVSTRUC-
� � TUpE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICPM FOR SUCH PEflMIT TO FRE A SIGNED W PatiolDeck
c STIREMENT 7HAT HE OR SHE IS LICENSEO DURSIIANT TO THE PP.OVISIONS OF THE CON7RACTORS ll- �
CENSE LAW(CHAPTEfl B(COMMENCING WITH SECTION 7000)OF OIVISION 30F THE 9USINESS ANO Pp0- PODUSP3
a FESSIONSGODE)OR'RUTHEOR5HEISEXEMPTTHEREFROMANI)THEBRSISFOHTHEALLEGEOEXEMP- (�
L� TION.MIYVpLqTIONOFSECTION70.97.5BYANYNPPLIGANTFOflAPERMITSU&lECTSTHEAPPLICAMTO Z {3B-RO01
F A CIVIL PENALTV OF NOT MORE hIAN FlVE HUNDREO DOlLAR3(S5o0).):
� ❑I.ASOWflEROFTHEPROPERT/,OflMVEMP�OVEfSWI7HWAGF.SASTHEIRSOLECOMP'cNSATION, CommBrCial �
WILL 00 hiE WOpK,AND TNE STHUCiURE IS NOT INTEN�EO OR OFFEHED FOR SALE(SEC,�09a,BU51- �J
� NESSAND DiiOFE5510NS CODE:7HE COMRACiCAS LICENSE LAW CCGS NOT APPLY 70 AN OKTIER OF �
PPOPEH(Y YVFiO 6UIL030R IAIPROVES THEREON,ANO WHO DOES SUCH WORK HIMSELF OR HEP8ElF OR
CL THFiOUGHMI50RHEROWNEMPLOYEES,PFiOVIOED7HATSUCHIMPROVEMENTSARENOTINTEN�E00R �
qOFFEflEDFORSAIEIFHOWEVER7HEfiUILDMGOqIMPflOVEMENTI550tDW17'HINONEYEAROFWMPLE�
� TION.THE OWNEH$UILOER WILL HAVE THE BURDEN GF PROVING THAT HE OR SHE DID NOT BUll,p OR
� IMPROVE FOfl THE PURPOSE OF SRI,E).
�yJ O 1.AS OWNER OF THE PROPEATV,A1A EXCLUSIVELY CONTRACTING WITH LICENSED CON7RACTORS
(s TO CONSTRUCT hIE PRQIECT(SEC.706d,AUSINFSS AND PROFESSIONS COOE:THE CONTNACTORS LI- Va1118tI0f1 ADJ.AREA_..____....,._..
W CENSELAWDDESNOT�PPLVTOIINOWNENOFAPROPEqTYWHOBIlILD50RIA1PqOYESTHERCON,AND '—
� N?1000NTflACiSFOR3UCHPF10.1ECTSWITHACONTRACTOR�S)LICF.NSEDPUPSUANTTOTHECOMqqG QUANTITY DESCRIPTION fEE
Y TOR3IlCEN3E4AWJ.
� �
p ❑IAMEXFN,PTIINDERSEC.,__,__,___ B.flP.GFORTHiSREASON
� U
� ��y �
OATE '.a(.7�SF OWNE �y„fr_ �' '_�—� U
Z W
. � � LICENSFD CONTRA S DECLARATION W
I HEREBY AFFIRM UNDER PENALTY OF PER.�UPV THAT I AA1 LICF.NSF.D UN�ER PROVISIONS OF CHAPTER �
a, 9(COMMENCINOWITHSEC7AN7000�OFDNISION30FTHEOUSINF.SSAN�PqOFE55fONSCODE,ANO Z
X MY UCENSE IS IN NLL FOqCEAN�EFFEGT.
LLI m
� �
� LICENSECLA55_ _ LIC.NO.___________ �
� J
V DATE CONTRACTOFI _________ d
W
� WORKERS'COMPENSATION�ECLARATION �
a
� ,IHEREBYAFFIRMUNDERPEVALTYOFPEfUURYONEOFTHEFOLLO}yWGOECLAFATIONS: � Z
� ___IHAVEMDWILLMAINTAINACERTIFICATEOFCON5ENTTOSELF-INSUpEFORWORKERS' _ � , � .
COMiPEN3ATION,ASPR�VIDEDBVSECTiON370DOFTHElA90RCA0E,FORTHEPERFORMANCE � �U
OF THE WORIC FOR WHICH THIS PERMIT IS ISSUED. �
�
� �,__IHAVEPNDWILLMAIMAINWORKERS'COMPENSATIONINSUPAM10E,ASREOUIREDBVSECTION
Q 37ooOFTHELA80RCODE,FOR7HEPERFORMANCEOFTHEWORKFORWHICHTHISPF.FiMIT15 � � �y
� ISSUED.MVWOFiKEflS'COMPENSAiIONIN5URANCECARRIEtiANDPOLICYNl1MBERARE O ."' _..____.,...._____...._ ��`J
'_.._'— ""4"
� CAPqIER"" � ^ �_"_'
--------------- - ------_._._..---- REVI ' .j Z
._..----------�•�-__�-
zaoucvnuMeEa--- ----------- — ELECTRIC __._.__`_....... ----
Q
Q (fH6SECfiDNNEWPiOTBEOJtrtllFfEDOFT}iEPEPfMGFORONEkNWf1F.DDOLIMS(510o)ORLESS} PLUMBING
W _......_..'-_._"_' .
.._.._..
Z I CERYIFY THl1T IN THE PEFiFOftMANCE OF THE WORK FOP WHICH TH!S PF.RAIIT IS ISSUF.D,I MECHANICAL __,.,___..,_. ,. ___
C3 SHALLNOTEMPLOYANVPERSONINANYMANNFqSOAS'(O�ECOMGSUBJ[CTTOTIIE
(/) WOfiKERS'CAMFENSATIONLpWSOFCALIFOR�IA,ANDAGREETHATIFISHOLIL�BECOSIF INSPECTIONFEE __.___....,__
F SI/&IECTTO THE WORKERS'�MPENSATION PftOVI510�S OF SECTIOY 3IOOOF THE LPdOq '
� CO�E,ISHALLFOIiTHWITHCOMPLYWIhiTHOSEPROVI5AN5. UANCE , , __ ':-^�
__-...'____
� /M9
p OATE'_ _ APPLICANT. SMIP ........_" ._...'_"___ V' _
__—__'
J WARNING:FAIWRETOSECUflEWOHKERS'COMPENSfTIONCOVER�GEISUNLAWFUL.AN�SHALLBE ENERGYP/C __.._,...._...___.. __. .._.___...___..--
� SUBJECTpNEMPLOYEflTOCRIMINALPENALTIESANDCIVIIFINESUP'fOONEHUN�RC:DTHOUSAND ENERGYPERMIT
DOLLAHS(5100.000).IN ADDITION TO THE COST UF COMGENSATI94,DAMqGES AS PROVIDE�FOR IN ---�------�—
...__'_—__'.........
� SECTION37080FTHElA00HCODF,INTERESi,ANDATTOFiNEY'SFEES. RETENTIONFEE; _..____
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE' ...___.
p ....... ..----�—
� I HERE6YAFfIRM UN�ER PENALTY OF PERJUHY THATTHERE IS A CONSTHUCTION LENOING AOENCY
FORTHEPEFFORMANCEOFTHEWOFIKFORWHICH7HISPGRMITISISSUED�SEC.JOB7,CIV.C.). '"---'---� �----'� -�-"---'""-"'"-""---
Z
W _— —_——._. -— . —__"_"_ �—
� LEN�EF75 NAME....___""""_ _' _'——__'"'— '"_'_'
"'.....""""_'___'—"'_
{,= LENDEFf9 ADDRESS ' "'_'_—_'__"'_"'."'"""_ _—'—"_"_ �''���
� TOTAL FEES
� ICEHTIFYThIqTIHAVEREA�THISAPPLICATIONANDSTATETHATTHEABOVEINFOflMATIONISCORRECT.
W IAGPE�TOCAMPLYWITHALLCITYANDGOUNTYOROINANGESANOSTATEUWSFELATINCTOBUILDING
� CONSTRUCTION,ANDHEFEBYAU7NORIZEREPRESENT�TIVESOFTHISCOUNTYTOENTERUPONTHE
NlOVE-MENTIONE�PFlOPERTY F Fl INSPECT N PURPoSE& --_—_ �
Z �. COMMENTS_� ,____.___
� � r/L°/Id`��- >'� .-------- __..— ___._..._-- --�---�-��
m P ITTEE N Ilfn A '
� L. � ��l<�"�� ----- ----
� siarum PEflMITf OATE RECPT.NO.�y� PAID BY L' � ��'S� VALIDATIO I
F " I
� WHITE--0eparlmenl Copy,YELLOW�inance Copy,PINK-Assassor Copy,GOLDENROD-File Copy,GREEN-ApplicanCs Copy ;
i
... . . .�. � ..
���tx �, ; i � � — — � _� . — � ;
� ���� � ( i _) �
, � � �
I I ' (
��"°� �I ' I � ' t ' � I, �' ; �
� j ,
���� I � � , � i ' ( . l I � �j i i �
� � � I �I � s
. _ ak€ � I � , ; [ , � �•t� I i ` ;
��� �� � � I � ' i � �' , � ' � � � i i �
�
i��� i i � ( � i I I �i � ' i i ' f ' r
� � —�;— � � � ' � i I
- �+�� i � ti _� � � I ' i � I
. ��� _i y'..—. I. _ ;_ � � i � I
%� p � � �� ��
���= ' � � � � ; � '� � � � � , ' , % � , ; ;
� ( I 1 � I i � ' ' , � '+� ' � i ,
�� �r� , ; � � � �
. . 3
i � � � , � , t �, I t i
� '� ,
�h ';t I.. � _L- ( _.. � � � i - i— ����i ,(� , f , i � ' i �' i
�� � "- �; t I i � �
�m � � � � �
� r i I : � ' i ' ' i i i � � ���� � � i i � I i
. � � '� ��� i � , ' ' i � � r� � � ��� �, i I I � � _ [
�� ' , �, ,, . -
� °� ,��� > '�� � � i., � ��� �� � i � ! � � ' ?
��i ! i 4 . i � � � � a i .' I �tf� � , ! :
� � �' ����'�iy t ��r � (� �a��u� � ta � � - ���� � � i i r�.. �� o � ' I � � � � �
� ^r }�j I
r t t . ( � I
�' �.1F �A :jr�, C7� i� i,.' .i f.;�� - �.= i � f��, J�" . ' 1 i _ �, � �;s
,� � ���� ` i �� , �- �i �� � I ; r I I '^�s ; j � � ; 1
?� h �� � � � I #
�} �� £J "'' ' �'�r ' i-t '�' �' ,r i � � �I � � ; '
~ ��
[ �� rne � � i ) '� t �;�� CL� � Aa!i i L ��' I � � � � j I i
�3 i�� '— I : � — f — — _ — k tj . � ;
�
�
�
' k'� . aw y q � � k ; � f ; f � "" ' � ' � i i
�. 3 r' .
.,_._ au:4 � . ,:.. .� c�•
'i r>. i � ' i t � � ; � ` I �1' I � ' ' ( ' S
. a3 r y 5'�j s � � � 1 � � ' (. � 1 �
� �^, �an i i . � � i � � ; i d! � , i �
r. € I � ' , � ���� j i .. , } I �
' �� � � �� � .. � I :. a � � � I �
- 4�"C� I i � �. � 1 , i �I,., � ' ', ', '
i� � � � i I � I � I �; i � '� i i . �
������� ; � ; � � , _ � ,,_ � ; ' , , , ��; � � _ ; , � � �
�� � �� � ,
� # ' , , � , ,r; � m! � ` � ; � ,
� � � a j j � i 1 � � i �� � � �� '- j � '
, i € � � + ; a j y
� �
�
; I 3 i
: ���� i ., �. � p - ..�._..... .. . .. i t _ �_ i i #,��,����r.� .f"�,.� d
. . .... -,�... ��...... .
� � I
� ; � �
�����s i` i � E _1 � o! C7, i ! i j � i �.������������`����a �s �
�� � � �' � ` � � � � � .I � � �:� � � i � _ ����� � � �k
�+, ` i' . [ , : � � i > � , � a� ,�'� �+��.�a^!�8;' e'��
_ y� I � � 1 ". � - .,. ., I ; I . � i . 3��lsi#p.[����" �
� �1 �
#�1 I . 1 E .-��) � .f i._ r . T .
�F`-r i f 1 .. � t � �j,Y'+^ rl �y � �t ..
: � �'°� .�� .. �'t I , A t � , � � � � . F���i'���� � ���4 r s���, ,.
E �� � 1 ! � Ik _I� :' I . • ; S '� � � ��' � z 6
� `t � t�� l � �`' ! � 4����"��^� +�������s'� "'��
. � p , i �""1 ; a � �,, ��_ �� ' � `�, ' , i i � ����i�s o-e J".�'� � �
.:. - " � . i i �: Y � i �s �� '�1'�s t�3#�?��'�� :
� ����} .1 ` ; s' 1 ar � 'i � � i � � j y .� � � rs�����'��� ���r� �n� �� .
�w..�._.m�., __i_ w_. . __..m__ _.� ..=_._i .�_,. _...__�._.,..� .�,...m_ _�_��_., ,�. . .1._.�._i_._......,�. � _ .._.t._. . .__ N .
.... .._ .�.... �...m ,._..__�.._..._ .,..__ __ _