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HomeMy WebLinkAbout13844 (16) �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� 21660 E.Copley Drive Suitc 190 � (909)86Q3195 Faa(909)861-3117 PRESS '���� BUII.DING PERMTI'APPLICATION FIRMLY o ADDFiESS �-+0.3 ��"� �/"�L� Iv�. DATEICATION'� Z� UMBER`� / If� ��� c� ISSUE ' " � .. PE '�' �= OCC APN�_LOT TRACT pATE CONST. GROUP � OWNER (�/Z t A/I/ZS ��i��. ADDRESS o3 � D�C.. ZONING SEBACKS W CITY IP TEL. •Q • 7- FRONT RW ❑ � APPLICANTAL H'A - Q�1� � TE - ¢ REAR p � + _ SIDE/SIOE STREET RW ❑ CONTRACTOR• ! SIDE ❑ � A�DRESS - PROPOSED USE " �-� O ✓- CITY J�//�Ll� ZIP�( TEL • � ARCH/ENG/�N�.= �jlT � 7tJ . DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEOROOMS � cmrL - z== ZIP TE '0 N DESCRIPTI�N Sa.FI: FACTOR PSF ADJ.AREANALUATION N OOWNER•BUILDER DECLARATION SFWADDIREM p I HENEBY AFFliW 11NDER PENALTY OF iER1UNY TMAT 1 AA1 ExCYPi FRdA TME CON7MCTORS LI� GBfdgB/C81p011 W CENSELAWFOR7HEFOl101MP14RFA50N(SEG7o71.68V5WE55ANDPROFE55iWISODDEANYCIiYOR (n � COUltTY1N11pIREd11qESAPERMRTOCONSTAl1CT,ALTE�I�P{iOVE.DCAqL15N,ORR[P�IHANYSTRl1G NNE,iRlOfi TO RS 159UANGE,AL50 REOUiRES iHE AVPLiCM/T FOR SUCM VEfiM1T TO FIIE A StCNED w Patio/Deck �T�� � ETAiEMEM THAT HE di SHE IS LICENSED VU0.5UANT TO iNE DpOVI510N5 OF iHE ODMRACTORS L4 � CENSE UW(OUPTEH i ICpAYMCWO MnM SEC71ON 7ooa)OF DMS�ON]OF THE BUSINESS utD PRU u' POOVSpB FE..SIONS COOE1 a17NAT HE OR SHE IS E%E4P7 TNENEFi10M AND 1N[&lS15 FOR iHEALLE06D E%FJAP• TION.M(YYqLAT10NOFSECilON7ca1.68YMn'MPUCANTFORAVENaliSUB.fEGTSiHEAPPLIGANTTO Z Re•Roaf � A GVIL OFNALTY OF N01 MOHE 71/AN FNE MJNDflED DOLURS(f50o).1: � � p�ASONRIEROFTNEGROFERTI;ORMYEMPIAYEESWITHWAGE5h5THEIR50LECOMvENSATqN, 0 COmI11BfCI01 � MMLOO 1TIE 1MORK,MA TNE STAUCTURE IS NaT�MENDE�OR OFFERFO fOR SALE(SFG 7W�.BUSb J NESS�NO VRO�ESSIOHS CODE TNE COHiMCfORSIICENSE LAW DOES NOTAPPLY TO Ml OWNER OF � PIqCEHiYYA10BUlD9WIMifqVE47NERE01yANDYAiODOE55UG1WOHKHIMSELFORHERSELFOfi � � TMRC%IONMSORHEROWNEYPLOVEES,VN�NDEOTUTSUtl/1YDHOVE4ENTSARENOTNTEkOEDOA m OFFEPED FOR SALE IF,HOWEYERiME BUILDiNOOR MPHpVEMFMlS SOID w.T1�x10NE YEAH OF COMPLE� � TqH,TNE OwNER�UILDER YALL MAVE iHE BUROEN O�PROVOJU Tlui NE OA SME Di�NOT BU�LD OR MPRDVE FOft TME VtJRPOSE OF SALE1. 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B.i P.C.FOR THIS REASON J U � � . � D1UF OWNER V � LICENSED CONTPACTORS DECLARATION —� � w INEqEBYAFFW11lM0EN7ENAL7YOFF[0.R1fiYTXIRIAAILILENSEDUNDCHPROV15qNSOFpUPTER V. � I(COYYENCWOYrtiHSECfqN70oo)OFDMSpN9CFTNEBUSINFSSANDPROFE55�ONSCOCE,IwD Z LL� W LICENSE 6 N NLL iONCE AND EiFECi. /�� � 110EN5E CtASS B L1C.NO.�� V � ' � �"j a�� cor+r�ucton���_s� ' a � WORKERS'COM�Qnor,��no�y��N� • OFDiAM FiAR � ` ��(• N IHEREBYAFFlPMUNDEFPENA:TYOFPEitMYION[OFTMEFOLLOWwGOEGUM7lq� �` Z � DING AND SAI'L'1 Y . � _�lNVE/VqWI�{,MAIMNNACERTIFIWTEOFCONSENTTOSELF-INSUREFORWqL(ERS� _ ' ' 1 : � �� � � �. � aEN6+lT�ON.AS FHOV�OED BV SECTION 97Do OF THE UBOH CODf,FOR iHE 7ERFOiWANCE 'U HO I lllE WORI(FO(1 WNlpl iV115 iENd�T IS ISSUED. � 2 � 1 YNVE AND ri1LL�NTAW M�ORKEAS'OdAPENSATION W SUNANLE.AS NE W IHFD BY SECTKK: �� 4 77ooOFTHCIIBO�tCOOE�ORiNEVEAFORYUJCEOFMEN'�PXFOHWN�CM7HISPERMITIS , , ISSUE�.MY APKERS'006�FEN5 TIONINSURANCELARft�ER�NDPOUCYNUA+ER�C.�{� CONSTRUCTIO ( � GRiUER� � '�"" � 9 PLAN REVIEW� . � iOIICYtNYBER OL ELECTRIC 0 (1�SfCiKwtaEmr+O'fBEOCAsIE�mOFT1EPERMT6�iOr�E�D�R1�uuRtm)OH�E55� PLUMBING W MECHANICAL � Z ICERTIFY7HATHiHEPERFOM/ANCEOFTNEMVf7KFORNMidiTHISGERMIT�5155UEC. �3 51iALLNOTEUPLOYANYVE0.50NINANYMANNEH50l�5TOBECDME5V8JECTiO7NE (n WORKEA5CdA�ENSATIONUM�50iCALIFOflNIA,JWOACREETHATIFISHOI.IDBECOME INSPECTIONFEE S SUBJfCTTOTHfWOIiKERS'C06�7ENSATqNOqON510NSOF5ECT10N77000FiHELA80R �SSUANCE COOE.1 SMAl1 FORTHWITM COMP�Y WIIN TMOSE PROVISqNS. 0 SMIP p DATE: A7PLIC/.M: . w ENERGY P/C '-� WARNINO:FAWRETOSLCUREKORKERSCOMPENSATIONCOVEHAGEISUNUWFUL.ANOSwLLBE � SU&IECTINENPIOYERTOCfUMTULVENALTIE511NDCMLFWESUPTOONEHUNDRED7TKKISAM� ENERGYPERMIT DOLLMS(itao,DOD),IN/�D01110N TO iHE GOST OF COUPEN5AT10N.DM�AGES AS PFOVIDED FOR IN � SECTIUN�70sOFiHEU00RCO0E,NTEFEST,ANDATTORNEY5FEE5. ' RETENTIONFEE: � a CONSTRUCTION LENDING AGENCY P E•AlT F � O Q IXERE9V11FFlPMUNOEPPENALT/OFpERNRYTIATTMEREISACONSTRUCTIONLEND�N011GENCY dZ FOATMEPERWWMVCEDFTMEWOPICFORWHICNiHi50fRUITISI55l1ED�5EG�oa7.CIV.GJ. � (17 ' � LENOERSNALIE C LENDER'SII0DRE55 WICERi�FYh1AT11U EAD7HI MPLILATqNANDSTAlEiMAT7H4 � FORYATIONISCORRECT. TOTAL FEES � t � � IACREETOCdA N7TH AN�COUN7YORD' �5 DS EUwSRELATWOTOBVILDI CONSTRUCT OMEN AUiHOR EAEPRE •t�7 Oi OEHTfRUPONi� L ZAOOVE�YE EDVRO HTYF ECT aro s. COMMENTS � / � m CER1AffTEE WWE RRIM) c�i� � � n A _ I _ I � N sIGNANNEOFPERMITTEE DAIE � R[CPT.NO. � PAID BY VALIDATION _ _ WHITE—Ueparlmen[Copy.YELLOW—Finence Capy.PINK—Asseasor Copy.GOLDENROD—Fib Copy,GREEN—Applicant's Copy I , . " . ` . . ' . � ... . . .. . .n . , _. .� •....� . .. . - .� ' .. .. . . ;f.•. . . ".%' � ' � . . . .. , . .. .��i.� .. ..Y.'•.. _ � CITY OF DIAMOND BAR . . ' � � . •,' : : ' It�SPECTION REC�RD . 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Lf�TH,�SIDING • - ` � � POOLFENCING � ��:`:f1LL lN5UL1�TION - � - - - � POOL'FINAL �CEILIPJG IFlSUL:ATtOtd OFFSITE IMPS. �AY'r•I:,LI:iJA1L1PJG � DEDICATIOiJS SE4"Jtr'�-. - FINAL EWG. S�F7lC Tr'1NK LANDSCAPE/IRRIG. S�'Er r 1T/�.L_ „� ON SITE IMPS. G.^�S AIR TEST FIN/',L ZONIhG ;�i":F,L C0�1ST. _ ���p n� FIRE DEPT.FINAL � f t"ii•eA_.FiF�ATING� -� �`. - � — — HEAL7H DEPT. FINAL , f � �•� r i , � �'� ELE.,TR,C - � DEV. �EES?AID _ -fi• �''_PLU",18!hdG � ENERGY , ._._._`.. ...._._. .. .. I �— �___ ----.. . _. i . J ..a-.,-„�..-s.�._�_.._.-_ ��� '.r. r,.� ;.�_--� ;.<�r:1,^� :.}u:,}Ys.,. .. •J' 'J j,Ci7i,���-1EhTS _ .. . - _ __ __ , -_.:,_ _ , .- . , - : �_-�/_�_/_y� • ,�-o���y _,�p -r_� - ���:.���r�� �-- � ;- , ,. .,.,;;:-__. . �_ .,,. ., , .�. .� .. . ; . , , _ - . -- I:-.-- . .; , 3: . �: - _: � _ �.-� � - SEP i iC T�,NK SIZE ; .. S�LP�PiTJU SIZE — � � �. . . ` ,���, __-_- : . ! f,� _.. ._. _ . . . . : ; � � ;r,.. .. - I . � ; . : �.; ,J ;:�: - - , f . . _. . .. 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