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--- __ .._. _�.. . . - � ....__....�_________ _.. . ; �� �� CITY OF DIAMOND BAR ' DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ��^�'� BUQ.DING PERMIT APPLICATION FIRMLY � JOBSITE �>� � �' � APPLICATION PERMR ��O P/C - Q ADDRESS <<' ��- � ���L//��� �/ •' DATE � NUMBER I v ' _ A 0 ISSUE TYPE OCC � APN LOT � 5 r/ TRACT j n R+ � DATE �� CONST. GROUP p OWNER /' (" •�/�c o " ADbFiESS c"3 yS� nid<.i S�:G%��� � ZONING SETE3ACKS � CIN �Or,ac••.r /,'['i� . ZIP f%'r) TELjOi S�/f��� REART RW pp APPLICANT TEL. � SIDE/SIDE STREET RW p CONTAACTOR_ �/�/c P ���'��%^��_ SIDE ❑ p� ADDRESS /'�J•ri'� ti3•/ . � CITY �/f!�'i��N�y ZIP %t �;'7EL"7r/�n'/F�/Gi:S. PROPOSED USE�v�l ARCFUENG/ DESIGNER_ C//�'L��'-' ADDRESS / r%t �c c7 NO.DWEL IJO. NO. � (`,�7Y /,uij���r . Z�p �%},{t, 7EL j'C"''' ��-Q UNITS STORIES BEDROOMS � u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWN[R-BUILDLR D[CLARATION SFRlADDlREM � L O p 1 HEREBV AiFIftlA UNDER PENALTY OF FE0.NRY THAT I AM EXEuvT iiWAI THE COrfTMCTORSIF Gar�go/Carport lL CENSEUWiON1HEFOLIOWWORFASON(SEG7tt11.S8U5W[SSANOGROFESSIOh5CO0E-M1YqTYOR (n V OOUItiYriT11G1RE0UIRESA►ENdRTOCONSiRUCT,/L1ER�MPROYE,DEMOlISH.ORR[PNRANY57RUC• �Z il1HE,VR10q TO RS ISSUANCE,ALSO RLWIi1E51HE APPI�CAM i0R SUCH PERuIT TO FILE A SIGN[D w Pa���� S�3 � STATEMENT Tl1AT ME OH SHE IS LICENSEO PU0.5l1ANT TO TNE iPOV1510N5 OF iHE COHTMCTORS LI� CENSE UW�CHAPTER Y�COMMENdNO WITH SECTqN)000)OF DIVI510N]OF iNE BVSINE55 AND PRO� LL Pao'JSpa FE551DNSCmE)Oq7MATHEORSHEISEXEUPTTH[REiROM41DTHEBAS15FORTMEi1lLEC[DExEMP• (� TqN.Ml7VIOLATIONOFSECTION70]1.6BVANYMVUWMiORAPCfW175U0.;ECTSiHEAPPLICM7TT0 Z Re-Roof F A CML PENK7Y OF NOT��dlE TMNI FNE M1NDqED DOlURS�lSaO).): � �4��mEROFiMEVI70VERTY,O(1YYEMPLOYEESWITNWACESASTHEIHSOIECOMPENSATION, � COT(i10fCI�l - WKL DO TNE WONC AND iHE STRUCTURE IS NOT MEN�ED OR OFFEfiEO FOR 3�LE(SEC.7Wt.BUSI- J N NESS�ND CROFESSIONS CODE:TME CCNTRACTORS UCENSE�AW DOES NOT AOV�V TO AN OWNER OF � iROPEfiTY 1M10 BVILDS Oti IYVROYES TNEREON,INO W1q DOES SUCH NOFK MIMSELF OR MCRSELF OR (L T}1RIX10MMISOt1N[RONNEMPIOYEES,FROVi�E�T1UT5WiWP�py[IA�SAqENO7WTENDEDOR � l�1 QiFEREDFOHSAIEIF,IqNEVE{L7HEBUlDP/QOflA/Pf10V[IA:MI3501l1WRMNM:E'/FAqOFCpARE- � T1ON,7ME OWNEH�BIJ�IDER YALL NAVE THE BUitpLN OF PROYNO THA7 ME OR SNE D�D HOT BNID OR � WVROVEFORTNEPURPOSEOFSAIE). � OLASOMMEROF7HEiROPERTY,MIE%CLW^IVF:YCOMMCTIA�VrtiHL�CCNSEDCANTMCTOR3 TO CONSTRUCT 7HE PROJECT(SEC.7al B�/SiNF.:S N1D PiqFESSKKJS CODE:THE CONTMCTORS U- VdIU9IWf1 ADJ.AREA � CENSEUWDOESNOTMPL�'TOIWOVMEROFAPROGEHT/YA10B:1i050HINPROVE9TNEflCON.A4D NTqCOMMCTSFORSUO�PRO.JCCTSY.�THACONTMCTOR(S�LICENSEDPURSW�MTOTNECONTMG pUANTfTY DESCRiPT10N FEE � � TC%34 LICFNSE UW.�. � OIAIA ExEMPT UNDfR S[G B.t V.G FOR THIS FE�SON Q �O�I C S � �j •� 3 ¢ ror4-C'L,/4-� <Y7 t O � D�TE �:R � / L�-��S 5� . 20. � � LICENSED CONTRACTORS OECLAHATION � • � • � w � ?A.6a INERCBY11FfIAMUNDERPENALTYOF0E0.1UR`/TMATIAI�L�[ENSEDUN�Eq7ROL".SIONSOFCN�PiER � . � •(CqAMENCWOWfiHSEGTqN7000I�01Y�5qN70FTT1EBU5INE55�N�PROFE55iON5COCE.IV�D L MY UCCNSE IS W FULIFORCE MO EfFECT. 11J O � ucENsccuss �r'/C� uc.No. ti SS�--c;>"�/ � v oArE �c' 'f'�n corrtrucron /'�.,.n.e 1rl�c:�,c_ d w � WORKEFiS'COMPENSATION DECLAFiAT10N -� a � IME�IEBYIIFFIRAIUNCEHPEN�LTVOFDE0.NRYONLOF7NEFOLLOWINODEGLARATIDNS: z Q C _INAYEMRIYALLMAINT�MACENTIFICA7EOFCONSEMTOSELF-�NSUf1EiORWONCEHS' Z { COMPENSRTION.AS PROViD[D BY SCCTON]7000f 1HE UEOR COOE.FORTMC PFPFORMANCE U � OFTMCWONKFORVlM!CHTII14PEpN�'ISISSUCD. � � �1 NAYE ANO ri1LL VNNTAW WORKERS'COM7ENSATION INSlJi1ArvCE,AS PE W�R[D BY SCCTiON Q i7D00F TH[111F10A ODOc,iOR THE PER�ORIJANCE OF iME WOf7K FOR NMICN 7HI5 PEA.47T IS ISSUED.►f'lWORKERS'CGAPENSATION WSURAhCEGAA�E0.�.4DDOLICYNUUDERARE CONSTRUCTION . y �,,,,,,,Eq �P C��..c�, PLAN REVIEYI . � pOLC'/M11ABfR 'v�y� n��s �5��� — n/ ELECTRIC ; � Q �ncsccrnnn�rarecmr.s�rmoFne�rurt6roaasNu+rnmoau�a+oo;on�[sst PLUMpING , Z ICfRTIFYTHATN111EPERFOPlnh4CEOFIHEN�ON(LMW���CNiHISPERUITL°ISSUE�,1 MECHANICAL SMALLNOTEMPLOYIWYPERSONPI/iNYMANNEfl5011S708ECOMESU[UELTTOTNE (� ��O � N'ONlERS'C01.�PCNSATqNU'NSCFCALIFOqNItiiVlD�GREElHATIFI5NOl1lDBCCOMC INSPEC710NFEE SUBJEC7 TO THE WONY.ERS'COIJCENSA710N ViON510N5 OF SECTION]700 OF TME LA90R cooE.iswiucoanm�rncoua�rvnrnrroscv vis s. ` ISSUANCE CI�-6F��iv!-- pD�TE: �i.'/i-�'b APPLICANT: ♦. `7 �. ` SMIP B Tv . � ENERGY P/C ���� i 1 WAflNiNO'FA4URETOSECUREM'ORKERS'COM^EN. iON vEMCEISUNLAYlFUL/iNDSHALLBC LL SU&IECTANEMPIOVEHTOCWIJINILLPENALTiESANDCIVILFWCSUPTOONEMUNDACDi1qU5M1� ENERGYPERMIT OOLUIRS(f t0o,0001.W I1�DITION TO TXE W 5T OF CpAPEN5AT10N.ONAAGES AS PNOV'UED FOR IN � secTan noe ov n+e ueon caoe.irrtenesr,u+o�rrar+ers vEEs. RE7EN710N FEE: 2 qW. CONSTRUCTION LENDING AGENCY pRE-ALT FEE: O � �HEREBYAFFlfiMUNUERPENALTYDFPERIURYTHATTHEREtSACONSTRUCiqNLENDINOACCNCY iOR THE PERFORM�NGE OF THE WDFiK fOR WMlpl TMIS PER/A�T IS ISiUED�SEC.709�.CIV.C.�. � � LEND[R'S NA4E S � LENDEfYSADDR[54 r ¢ I CER11iY 1)1AT 1 NAVE READ TNIS MPL1CATqN 1ND STA7[TNAT THEMOVE NFORM�TqN IS COi1RCCL TOTAL FEES V UJ 2 �� � IAQ0.EET0004PLYN'IMILLLCRV/WOCOUNTYOHJWANCE51NOS7ATEU'NSREUUwCTDBU401NO T • � � CONSTRUCTION,ANDM[REBY�UTIqRRERF.PFESENTATNE50FTW5CWHTVTOEHfERUPONTHE , ADOYE-MENT10NC0 iROPFRTY LON iN57ECTqN VUHPOSES. COMMENTS _ /r'�!°^,, ���'� 3 PERMRTEE NM�E(P�RI v¢i tS n/ /'l� /C/��� (A 6iGVATUNEOFPERMITT�[/ DA1E � i RECPL NO. ` PAID BY y_VAlJOATON WHITE—OopanmeM Copy,YELLOW—Finance Copy,PINK—Assessa Copy.GOLDENR06—File Copy.GREEN—Aypican s Copy CITY OF DIAIViOfdD E3/�R -, :, IP�S��CTiO"�! 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