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HomeMy WebLinkAbout15900 CITY OF DIAMOND BAR � `"' ''' ---�� -- DEPARTMENT OF COMMUNITY 8�DEVELOPMENT SERVICES � 21660 E.Copley Ihive Suite 190 � (909)860-3195 Fax(909)861-3117 - , PRE$$ '�N'+ BUQ.DING PERMIT APPLICATION FI �Y o� JOBSITE . APPLICA N � PERMfT ��0� /� P/C ADDRESS OATE NUMBER_) � X � ISSUE ' OJ� TYPE OCC APN LOT �TRACT DATE V CONST. GAOUP � OWNER " p ADDRESS -{— � ZONING SETBACKS W CITY DI�1k_f���� ZIP TEL.'���i_ l�� FRONT RW ❑ � APPUCANT (�rS�?4 ��s�lce, TEL�.��'�� REAR ❑ � SIDE/SIOE STREEi RW � CONTRACTOR - 1�lLFz� 1 SIDE ❑ � ADDRESS 35��1 �n/�t•W�� 1ft/P PROPOSED USE CI7Y�'„( lit,�,- �t'1Z/ ZIP �.�2'� TEL ARCH/ENG/ DESIGNER NO.DWEL NO. NO. ADDRESS UNITS STOFiIES BEDROOMS � CITY ZIP TEL N DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION � OYYNER-BUILDER DECLAHATION SFRIADO/REM O Bt HEREBY AfFGW UNDER PEW�LTV OF VERAJM THAT I/J.�f%EMM FPAA1 TME CONT(UCiORS L4 GaragelCarport � CENSEUWFOi1TMEFOl10W1NOREF..OH(SEC.7a71.6BU5ME55ANDiROFESSIONSC00E:ANYCIT`/OR (n COVMTYWFpCMRE0URE5APEMIRTOCONSTRUCT,ALTER�PFlDVE.DEMOLISH,ORREPAIPANYSTAUG W patlo/Deck NRE.WiIOR TO RS ISSUANCE.AL50 REOUIRES 7HE MPLICMIf FOR SUp1 FERMIT TO FILE�SICiNED w � 6TATEMINT lFUT ME OR SHE IS LIGENSEO PURSUANT 70 TME PROVISIONS OF TNE OONTMCTORS LL CENSE UW(�PTER i(COMMENdNO WITH SECTION 7000)OF DIVISION 7 OFTHE BUSMESS M10 PRO � POOVSpa� FES9tlNS tDD�OR iHAT HE OR SNE IS EXEMPT T1IEREFROM ANO TME B1lSIS FOR iHEALLEdED EXE1dP- TqN.IW'IVIOLA710NOFSfCT10N7071.6BYANYAPRICA�lTiOfilIVERAIITSUB.IECTSTHEAPDLICANTiO Z qe.q�� F ACMLVENALTYOFNOTMOHETWJFNEFIUNDREDDOLLARSpsooj.�: � 04�ON�NEqOFTHEPROPEqT'/,ORMYEMPLOYEESN1THWA6ESASTHEIRSOIECOM7EN5AT10N, 0 COR1rtIBfCl81 ' WILL 00 TME MIOPoC AND THE STRVCiURE IS NOT IHTENOED OR OFFERED FOR SALE(SEG.7a1,BU54 J y NESSANU iRDFES510NS COOE il1E CONTMCTORS LIGENSE UW�OES NOTA➢PLT TO M!OWNER OF = VROPEIITY WF10 BU4D3 OH M7ROVES THEREON,AND MMO DOES SUCl1 WOFK HIAISELF OR HEitSELF OR TWi0U6HM50RNERONMEMPIOYEES,OROVIDmhL1T5UCVIMPROVEMfNTSARENOTNTENDE�OR m OFFERED fOR S/LE 6,NOWEVER�B�L.DRW ORMAPROVEAIENT IS SOID WITHIN ONE YEAR OF W4PlE• TqN.TME OYMER-BLMDER N7LL HAVE 11/E BURDEN OF PROVINO THAT HE OR SME DID NOT BURD OR IMFiqVE FOit TtE PURPOSE OF SA:EJ. O l�aWNER OF T/1E PR07ERTY,M/ExttUSNEIY CONTMC71N6 YATH LICEN9ED QDPlTMCTOHS TO CONSTRUCT iHE VNOJECT(SEC.7oN,BUSINE55 AND PFqFE5S10NS CODE:THE CONTMCTORS U• V81U8SWfl ADJ.AREA CBISE UW OOES NOTAPPLY TOAN WMER OF A PROVERTY Wlq BUMDS Ofl M7110VE9 THEREON,AND WHOCOMMCf9FORSUCHPHOJECTSWITMACONTRACTOR(S)LICENSEDVURSUANTTOTHECONTMC QUANTITY DESCRIPTION FEE � TOFS IICENSE UW� O IMI IXEMM UNDER SEG B.t V.Q fORTHiS REASON U 3 DATE OWNER � � w , LICENSED CONTRACTORS DECLARATION W � IHEREBYAFFGtl.IUNDERiEW1L7YOFPEiWRYTFIATIAA1lICENSEDUNDERPROVISIONSOFCHADTER Ur ' � s f(WMYENCNOWITNSECT10N70o0)OFDMSION70FTMEBUS;NESSANOFROFESSIONSCODE,AND Z X W UCENSE R IN FULL FORGE AND EFFECT. m � LICENSE CLA55 LIC.NO.�Q 1`1�5� -� j �j DATE CON7RJICTOR�.Q(LGE `)."aM�1 a . � WORKERS'COMPENSATION DECLARATION a � U � IHER�VAFFlWALNDERPENALTVOFPERIURYONEOFTHEFOLLOWINOOECUMTIONS: t� 4 � _INAVEANOWiLLAIAM/UNACFRTIFICA7EOFCONSENTTOSELFaNSUREFONWOHKERS = OdA0EN3AT10N.ASVROV:DEDBY6ECTIOH]7000FiHEUBQRC00E.FORiHEPERFORMANCE W OFTNE WORK FOR WN1G1 TN�S VERMIT IS ISSUm. � O �I HAVE AND WILL 1uR(TAM WORKERS GOMPENS�TION INSUNANCE.AS RE WIHED BY SECTION Q ]700 DF TIIE UBOR COOE FOA THE VERFORMMICE OF THE WORK FOR WHICH 7HIS iERMR 15 � SSUEO.IAY�°RKEFSC0y10CN5AT10N NSUP 10ECARFIER1w/D�VOLICYNUNBERARE: CONSTRUC1lON � CARRIERI'��!� ` .[� • PIAN REVIEW 0 POLICYNUABER�O_�L�� ELECTRIC o �sccrcNr�uo�eem.n�oovn�vew.rtswaaaeruaa��aursRiarioa� PLUMBING � Z ICERTIFYTNATINTHEiERFOHtlANCEOFTHEWORKFORYMICHTHiSPENAITIS155UED,1 MECHANiCAL (,� SFULLLNOTEMPLOYANI'PEHSONINANYMANNER50115TOBECOMESUB1ECfTOTHE � (n WORKERS'COMPENSATqNUW50FCALIFORNU�ANOAGREETlUTffISMOULDBECAME INSPECT�ONFEE SU&IECTTOTME WORKERS'COMPENSATION PROViSiON50F SECTION]7000F THE UBOR .S caoE,i swui coanann�coua�r Mnn+r�c vno s. ISSUANCE C OF DlA MnNI�R,e�g � �� Q��/f�1^ � ! � �o o„�: I�-l O APPLICANT. "�^+'.'L�J��a�_o_ SMIP BUILDTN[; AtJp�A�' � ENERGY P/C WARNINO:FAWRE TO SECURE WORNE0.S'COMPENSATION COVFRAOE IS UNUWFUL ANO SFtAII BE � SUBIECTANEMFLOVERTOCPIIAWALPEN►LTIESANDCMLFWESUPTOONEH4NOREOT110USAND ENERGYPERMIT pOl1AR5(it00,0o0�,M ADDRION TO THE COST OF CW�oENSA710N.DMIAGES AS VROViDEO FOR IN � SECTION�IoeOF111EUtBONCODE,RlTEFESLAND�TTORNEYSFEES. RETENTIONFEE: � CONSTRUCTION LENDING AGENCY PRE•ALT FEE: O � IHEREBYAFFiRYIM�ERPENALTYOFPERIURVTNATTHEREISACONSTRUC71dJlENDWO�CENCV fOR iHE PERFOIiMANCE OF 7HE WOHK FOP WHICH TUS PEfwIT IS ISSUED(SEC.aoo7,pV.C.). � � LENDER'S NM1E � tENDER'SAODRESS � IGENTIFYTHl1TIIUVEREADTHISAPPLJCATqNANDSTATETM�TTIEABOVENFORMATKK115CONREGT. TOTAL FEES p„ I AOREE TO COMPIY WfiM ALLCfiY AND COUM71r ORDMlW CES AND STATE Uw5 HEUT1Na TO BUILD�NO � CONSTRUCTION,ANDHEREBYAUiY1DR2EREPRESENTATNE50FTHISCOl1�i7YTOENTERUPONTHE ABOVE-YEMIONEOVHOPERTYFORINSPECf VURPOSES. 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' ' - ' �'.-� f ;BRYV+LALt-N!',ItIiJG- � - ----- - - - DEDICATIONS , ,. .. . , , . j — :. . . ��,. .' : :, ' � �� 'SEt�'�'EA----- -- i- - — - --- _ _ ..- --- FINAL ENG. . 'SEPTIC TANK ; LANDSCAPE/IRRIG. '' = ' ; ` . .SEE�_P't_T/L.L--- -- - ---- '_. � �,. � �ON 51TE Ih1PS. : ,� ' � � , � _ �.,. ,GAS AI.�,TEST ! I , . , , ,.- � �., FINI`,L'ZQMPJG � • �;. ' . ; _; - - � --. . - - ;FiiJ,4t.C��VST. ;-- ---- -----. .-;----,--..._ FIRE DEPT.F(NAL - � - , a, i �; - - -- - - -- - lFlivA�HckTING------ --. .. . MEALTH DEPT.FII�lAL -- - ------ - ' -- ---- - -- --- -- - ,. . I �� � --._..._ .._ DEV. FEES PAID- - - ------'� ..-; Fi;J�,LELEGi RIC----- --- - - -- - - � �., . ?�r�•�:'.L-PLUhA$iN.ra --;--,-- L ..o ti_ ,-, --- Ef�ER3Y, j . ;�—=- ---- --- - - -- - -- --•- �- - --- � , ,. . i - ; .� --.__ . ---------- -- ---�_, _ _ - �- - --- ��y -- - - - -� tra:��",��:I�p�:+.�..,� :. _ � _ � r. --c��c>:.._._..K..:,.s '.��. 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