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HomeMy WebLinkAbout10487 � � - CITY OF DIAMOND BAR � � COMMUNITY DEVELOPMENT DEPARTMENT :,.,: 21660E.Copley Drive Suite 190 i PRESS (909)86a3195 Fax(909)861•3117 '^" BUILDING PERMIT APPLICATION FI R M LY N JOBSffE . APPLICATION PERMIT O � P/C /`� o ADDRESS 7iS� ������� � DATE �NUMBER N � APN LOT �b • TRACT 11-7R�I ISSUE TYPE OCC DATE CONST. GROUP °C OWNER eS O • . p ADDRE�$S Z� NoGL .e ZONING SETHACKS • . � CITY �//� 0�/d � ZIP TEL. � 18� qEAR pw O APPLICANT TEL. SIDE/SIDESTREEf RW ❑ � CONTRACTOR !' SIDE ❑ p� ADDRESS WD � PROPOSED USE, 7/O En.G+-oSU�eE cN F�e'� �i�+ o CITY�//4�i�� ZIP TEL.�7 53/: wo ARCFUENG/ , � DESIGNER �'�/E�'�6'� NO.DWEL. ' • NO. . - '��. • NO. ADDRES� 3�00 C�/9/ .R._7" � UNITS STORIES � BEDROOMS � , � ciTM rC�NO ZIP TEL. OL �7J� N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-B�ILDER OECLARATION • SFR/ADD/HEM O p I HEREBV pFFIRM UNOER PEW�LN OF PfR1URV TMAf I/ld E%E1APT FROM THE COMMCTORS W G8f89C/Ca�Ofl ' W CENSEUWFORiF1EFOlLOW�NdREA+ON�5EC70.7t.S8u5wES5ANUPROFE5S10NSCODE:ANYMYOR (n ZCOUNiYYMIpIREOUIFESAiERMITTOCONSTRUCT,ILLTERM�VR01/E.DEL10L151lORREPAIRAM'STiR1C• � W P8I�0/DBd( � W TURE,PRqR TO ITS ISSUANCE AL50 REOUIRES TME M7LICAM FOR SUGM PERMiT TO i1lE A SIGNED W � STATEMENT TUT HE OR SHE IS LICENSEO PURSUANT T07HE PRONSIONS OF TNE COHiMCTORS Lb . , � CEMSE lAW(CHMTER 0(COYYENCN6 W1TH SECTqN 7000)OF DMS�ON 7 0F THE BUSMESSlWD VRO- V' POOVSPB FESSIONS CODE)OR THAT ME OR SHE IS E7(EMP7THEREFP0II AND TNE BIlS�S FOR THE ALLEGED E7fEYP• TION.ANYVIOLATIONOFSECTION707f.6BYANVAPPLICANTiORAVERMIT6VBJECT3TM[APPLICANTiO Z Re-Rool �„_ A CML PENALTY OF NOT MORE T}/FN FNE HUNDIiED DOLURS(l500)� � � ❑1A50WNEROFTHEPROPER7Y.ORMYEMPLOYEESWITHWA�ESASTHE1i150LECdAPENSATqN, 0 CpmmBfCl81 � N7LL D0 iHE WORK ANO THE STRUCTUNE IS NOT WTENDED Ofi OFFERCD FOR SALE ISEG 70u,BUSb J NESS AHD VROFESSIONS CODE:TNE CONTMCTORS LICENSE UW DOES NOTAVR►TO AN ONa1ER OF !._� / N � /ITC/�/YC! " VNOPENTV N410 BULLDS OH MDR�VES iNEREON.IUJD WHO DOES SUdI VIOHK HIAISELF OR HERSELF OR � TNROUGH MIS OH NER OVM EYPLOYEES.GRONDED THAi SUCH NPNOVEYENiS ARE NOT MEFOE�OR m . , � OiFEREOFORSMEF,IqWEVEqTHEBUIDINOORiMPqOVEMEMIS50LDWITMwONEYEAROF00MPiE• Z TIDN,T/E OWNER�BUIDEH YALL IIAVE TME BURDEN OF PROVINO T11A7 NE OR 6HE DID NOT BURD 011 MAVROVE FOH TME WRPOSEOF SKF). W 04�OWNEROFTHEYROPEHTY,/UdE%CLUSIVELICOMFiACTN6MAMLICENSEDCONTRACTORS _ Q i0 CONSTRUCT iHE PRQIECT(SEC.1W�.BUSINESS AND PROFESSIONS CODE:TME WNTRACTORS LI• V81U911011 AD.I.AREA W CENSEUWDOESNOTAPPLYTOANON'NEROFAPROiERTYN7/OBUIIDSORWPIqVE9MEREd1,N10 � WIqCOHiqACTSFORSUCV10RQ1ECTSWITHAODNiiUCTOR(SJUCENSEDPUfISl1AMTOTHECONTMC QUANTITY DESCRIPTION FEE � TOi15 LICENSE Uw). .,J � O IIM IXEMPi UNDER SEG B.l V.C.FORTHIS RE • Q / Cr1�T 3 � � �r �'1� T4�,1' � OATE OWN[H , � Z W W T�� . ' . . � LICENSEDCONTRACTORSDECIARATION ' W � IMEREBYAFFlRAIUNDERPENALTYDFVEIWRYTII�TIMILICENSEDUNDERiROV1510N50fCNAGTFR Vr p_, Y(Cd.M/ENdNO WITN SECTqN 7000)OF DMSqN 70F THE BUSINESS I�NO VROFESSqNS GOOE,M/D Z X W IICENSE 6 N FUIL FORCE AHD EFFECL . m . . . ,Q 7 � 0 LICENSECLASS �/ LIC,NO. 73 � ' 1--- J V OATE 7- �LONTRACTCA ' a W i/✓ w/Yt��� � WORKERS'COMPENSATIOND GLARATION � � U � INEREBYAFFlRMUNDERVENALTYOFPERRIRYONEOFTNEFOUAWWODECUiUTIDNS: . � � � `—" a , � �INAVE/�NDIMLLY.UN7AN►GERTIFIGTEOFCONSEMTOSEIFJNSUiIEFORWORKERS' S � Cp1APENSATqN.ASPROVIDEDBYSECT10NJ7ooOFiMEU80ROD0E,FORTHEOER�ORMANCE W , OF THE WdiK iOR WMldi iM5 iERMR IS ISSVED. � • � - �� . � � � � _J�1 HAVE MD WILL►u�MAN WORNERS'tOYPENSATqN INSURANCE.AS PEOURED BV SECTION O 97ooOFTHEUBOHCODE.FOR7NEPERFOiWANCEOFTNEWOPI(FORNMICHIHISVERYRIS � ISSUED.WYIOiiKERS'COMPENSA�"PlSUMNCECARRIERANDPOLICYHUMBERME: CONSTAUCTION � j CMRIER R' t GG� ��✓S PLAN REVIEW T � pacrNUMeEA_,f _ �S • ELECTRIC � � �nassccnor�rE�Noree�moFn[�w.rrsror�acH�wr�noxunsR+�l��} PLUMBING �(�� z ICERi1FY7HATNTHEiERFORAUNCEOFTHEMIORKiORWHICHTHI5PE1W1T6F'i5UE0,1 MECHANICAL C7 SMALLHOTEu7lOYANVVER50NYl11NYMMINERSOASTOBEC011ESUB1ECT70THE . uJ WORKERS'COMPENSATqNUw50�CALKORNt�ANOAfiREETu71FISHOIADBECOME INSPECTIONFEE S SUBJECTTOTHEN'ON(ERS'CO�APENSATqNPROVISiON50FSECT10N770oOFTNEUBOR 1 cooe. aonrmnrneornv�rwin�naseraohsar+s. / ISSUANCE � � � -`7 SMIP p DATE: � AGPLICAM: � ENERGY P/C WARN11p: ALVR TO SECUHE Md1KER5'COMPENSATqN COVENAGE IS UNUHKIA. 6wLLl Bf � SUBJECTANEMPIOYERTOCWMiNALYENALTiESANOCMlFwESUPTOONEXUNOREDTHWSAND ENERGYPERMIT DOUARS Ii100.00D).N ADDITION TO TIiE COST OF COMPENSAiqN,DMIAOES IlS VHOV�DED FOR IN ¢ SEtt10N770eOFTMELABONO�DE,WTEREST,ANDATTORNEYSFEE3. RETENTIONFEE: �7+���—hiT– �nA� �� d CONSTRUCTION LENDING AGENCY PRE•ALT FEE: `�u L' � ` ��' O � INERCBYAFflPLUNOERPENAL7YOFPERIURVTHATTHEREISACONSTRUCTIONLENDINO�GENCY � n- FOR T1E PERFORMANCE OF iHE N'Oi1K Po,R�W�WC}I TIi15 iERMIT IS ISSUED(SEC.]OY7,qV.C.} � LENDER'S NM�E /-'•'�� � IENDERS�DDNE55 � � ,^ � ICERTIFYTNATIHAVEREADTIISMPUCATIDNM105TATETUTTIEABOVENFOR1/ATqN15CORRECT. TOTAL FEES `� � � IA6REETOCdAPLYWITHALLGTYANDCOUHTYORDPLWCESANDSTATEUV/SPEUfW6TOBUILDING • GONSTRUGTION,ANOMEREBYAUTFqRRERECHESENTATNE50FiH15COUNiYiOEMERUPONiME . , , S� 11BOVE#�EN710HED iROVERT/FOR R15CECTION PURPOSES. , COMMEIJTS = K�.�!//.✓ Ch� / % . � OEIiMI NAME�VRI . . � C!) � r [ y s W�NREOFPE D E RECPT.NO. PAIDBY VALIDATIO � � . WHITE—Departmant Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—Fib Copy.GREEN—Appnanfs Copy �.,.rww-�.�;..w.+'.?.E"•ti.r._....,n�.i;�;�.�...,..n..ya....�.xv.se..�: r�4.,.� • � -- tiii-r (� 1_ STr�;;O:��`.1:.7):•.LL"'4�, �7. •.'�c. ar��...vyt;,:...»r��•.,�:r...r:.. .n.yw+i.+�.'a�- ti7,r, , .iz', `�-.v...,,. 'C'' '�i 1� j'-'•�i .•f 1. :`j=-'I: ./ 'C: • , . � CIT�' OF.DIAMOf�D [3!�►R � ''� ���� � ` . • . ... �,: -- ;.. ,,.� , .. :,�. . �:.,_ .-, IhlSPECTION RECD�Ri3; '� :''; ._ �'� � . ... �:- ,; .. . . . . . ; . '� . �._ . , .. . .. . . , , . ���. ��� . ''�i!�-�.�1;��'�f��l � . I�s1���� il��..�;���'1���'.... � :�_�►�E-�.����C�a�l ,� ��':�'I'��= �1►�F-�.�7o��c�;��� � ' _ _ _ �— - _... __ _ :w�: __`.�_.ti.�. ..�..___�. .... � '�. -�- ..�� �..� � .1. _ _...����_ ... _ _ � - ti�� . w.. ". _ _ SET BACK•.-, .. - ..__. .. . T ._. . .,. .. ,, FLOOR JOIST---.; __ ...._. _ .._... .... .._ _.-. -..--------- -- - --� . . 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LANDSCAPE/IRRIG. , �� _ SEPTICTANK--=-__:. :__-. .:'_.. .__:". - -- , ;. , .., , � .. . SEEP�IT/L:L:-.•-'------- -------- ---- -- ` ._!.. ---� -: -ON SITE IMPS.� �: .: . ; : . �'' '-` ' _. _._ _ FLJAL'ZONING .. , „, ' � : GASAIRTEST- ----- ---- --- - -- - --- - � , _.._.. . . _ . ..___ :. ---- - _ , FINAL-CONST:-;------ --- � -�'--: -� - '• FIRE DEPT. FIN�',L �� , : � �INAL-HEATING- - -- ._ ...._.. ----- ._. :_ ; .....--- - � .HEF,LTH DEPT.-FINAL_ -.. . --- � --. . _..- ----- . . .; , . FINF,L-ELECTRIC---...-- - - - ..__. ..--- ----... . .-� ----- DEV. FEES PAID :, . .. , _ ' �, . ,. , , � :.; FINAL PLUMBING ------ ---------� -- - ----- �---; -�--- - � ENERGY , _. ., . _. ..:.,, � :: �. . ' ... _. , . , _ .. , . .. • .. _. I � ` _ .. • . • . --..- - � li �;C���'.L)f� _ ,�' � �' ����--- i � , � i ,._.._.� .__ ,.... --- - ----. _ ._.. -- --.-...._ ._.... .- -------• -.. ....i . ---...._ .. � -- .. . --- . . .. ..._ . . ; , ... ... .. COMMENTS_ ._ ; ��,; i , �- , . 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