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i - _ . _ _ ,._ - - --------_ ._.�. ._. .. . _ . . . _ � - CITY OF DIAMOND BAR . ' COMMUNITY DEVELOPMENf DEPARTMENT ..•C 21660 E.Coplcy Drive Suite I90 PRES•S (909)860-3195 Fax(909)861-3117 � . '�'� BUILDINGPERMITAPPLICATION FIRMLY o� ���E ��^� Q�,,,,„ ,q7_ +�����0 �QES APPUCATION (,� Z ; � PERMIT /C ADDRE55�F=w ��/tiv /lLL DATE NUMBER N c� ISSUE TYPE OCC • � APN LOT TRACT DATE CONST. GROUP p OWNER "" ADDRES ZONING SETBACKS � CITY ZIP TEL REAR . RW �p APPLICANT TEL SIDE/SIDE STREET RW O ' � � CONTRACTOR • �1C• SIDE ❑ � - � ADDHESS • � ' PROPOSED USE � � CITY �A�..�_�.E�G���= TE ' o ARCFUENG/ _- � DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES � BEDROOMS � CITY ZIP TEL. , � m DESCRIPTION SO.Ff. FACTOR PSF ADJ.AREANALUATION Q OWNER-BL'IL�ER OECLAHATION _ SFWADD/REM O p I HERE9V AFFIR41 UNOER VEtULT'/OF iEiWRV TNAT 1 M/E7fElAPT FROY THE COMMCfORS L4� GefOQB/C.lIpOA - - � W CENSEUWFORTHEFOLLOVAN6RE1150N(SEC.70.t1.68USiNE55ANDPROFE55iQ44CODE1WVqTYOR ,, (n � � ' � U COUNTYWHICHqE0U1RE5�0EMIRTOCONSTRUCf,AITERMPpOVE,pEMOLISH,OHRERURAN'/STRUG � W Pefi0lDBtk - � - - - � `- � TUHE PRIOR TO RS i55UM10E,AL50 REWIRES TF7E APFLIGJai FOH SUCH PERAIIT TO FiLE A SIGNED W - - , � STA7EMENT 7NAT ME OR SME IS LICENSED PURSUANT TO TME PROVISIONS OF ME CONTMCTORS LF, � _ � CENSE UW(CHAPTER i(C0IAYENCIHO WI7H SECTqN 7000)OF DIVISqN J OF THE BUSINESS AND ifiO � POOVSpY _ _ FESSIONS CODE)OR TNAT NE OR SHE�5 EJ(EMPT THEREFROAA MJO TME BASIS FOR TME ALlEOED El(EMP• � TION.ANYVIOLATIONOFSECTION7071.68VAN'/ADPL1CANiFORAVERMITSUBJECTS111EAPVLICANiTO Z R8-ROOI ' - -' � � "A CML PENALTY OF NOi IAORE THAN FIVE NUNDREO DOLlARS(l500).): • � OI���EROFTHEPROPERTY,ORI.IVEMPLOYEE4VniHWMESASiHEIR50lECOMPENSA7KN, 0 CqpmefClBl � � � ' � � WIIL DO THE WORK ANO TNE 57AUGTURE�5 NOT IHTENDED OR OiFERED FOR SALE(SEC.7oN,BUSH J . N NE55 AND PROFESSqNS CODE THE GONTMCTOHS UCENSE UW DOES NOT APPLY i0 AN OMMER OF � _ �� _ VROPERTYNTqBUILD50RMPROVESTHEREON,ANDNMODOESSUp1VARKHIMSEIFOHHERSELFOR � - . � THROlN3HHISORHERON?lEMVLOYEES.VROVIDEDTHATSUd11MPROVEUEM3/AENOTWTENDEDOR m . . � OFFEREOFORS/LEIF,110WEVER7HEBULDINOORIYPROVEYENTISSOlI1WITMPIONEVEAROFO0M7LE. � . � • _ Z TqN.TY�E OWNER-BUILDER VJiLL NAVE TME BURDEN OF PROWNO T/IAT NE OH SNE OW NOT W0.D OR � MAPROYEFORIHEPURPOSEOFSALE). � � . . W OL�OWNEROFTNEi1qPEHtY.AMEXCLUSNELYCONTMCTINON7TMLICENSEDLONTMCTOqS. . . , Q TO CONSiRUCT iT1E PNOJECT(SEG TOs1,BUS�NESS AND PROFESSIONS CODE TME CONTMCTDRS 4• V81119fid1 AQI.AREA W CENSEUWDOESHOTAPPLYTOANOWNEROFAGROPERTYNT108URD90RIMPROVESTHEREON.AN� � 1MfOCOMMCTSFORSUCMOROJECfSWITHACDNiMCTOii(S)LICENSEDPUIiSUANTT07HECONTMG ounrmTv � oEscaianoN FEE�- � TORSLICENSELAW.J. .. .. _ _ _. .. . . . . . . _ . � O IAM EXEYPT UNOER SfG B.t P.C.FORTMIS REASON . � - � V u" OATE OWNER ' � Z �U _ _ ¢ UCENSED CONTRACTORS DECLAAATION W [t IHEREBVAFFlRMUNDERPENALTYDfPERR1RYTiAT1AMLICENSEOUNDERViiDVISIONSOFCNMTEN Vr p. �(CpM1ENpNO WITN SECTION 7000)OF DMSpN]OF iME BUSINE43AND VROFESSiONS C00E,Mq Z �L W LICENSE IS N FULL FORCE AND EFFECL m � IiCENSE 55 LIC.NO. j V DATE � . . CONTMCTOfi ' - d W � WORKERS'COMPENSATION DECUIRATION � � , � IHEREBYAGFlpMUN0EF0ENALiYOFiERR1RY0NEOFTHEiOILOWMODEQ.AfiATI0N5: � �. . � _IHAVEANDWILLIAANTAIN�CERTIFlCATEOFWNSENTTOSELNNSUREFdiNCIRNER5 COMVENSAtION,AS DRONDED BV SECTION T/oo OF TME lABO(i COOE,FOR THE PERFOR4ANCE W OF THE WORK FORNMIGI TMIS GERMIT IS ISSUED. � � � _IHAVEANDWILLMAINTAINWORIfER5COMPENSATIONINSURANCE,ASRE0U10.EDBY8ECTqN d� 77a00FTHELABORCODE.FORTHEPERFOR1AlWCEOFTIIEWOHKFORMMItlITHI3VERYRIS � � ISSUED.MYWORKERS'COMGENSATIONINSUMNCECARRIERANOPOIICYNUMBERME: CONSTAUCTION - � unaen PLAN REVIEW Z oaicvruMBER _ ELECTRIC CT 1� d � (nassfc�u�mHoieEoo�aFimaF7�vw�rsroaa+E��a+mootw�s6+�1�+�Fss1 PLUMBING . Z ICERTIFYiMATN7HEiERF0fU/�VICEOFiHEWOHI(FORWHiCMTM5VEIWITSISSUEU,I MECHANICAL . C7 SHALLNOTEMPLOVANYiEfi50NINANYAUNNERSOA5TO8EC0A1ESUBJECfTOTHE , � WORNERSCdAPEN5AT10NU1W50FCALIFORNI0.MlDACREETHATIFISIIOUL�BECOYE INSPECTIONFEE � - ' � SUBJECT TO TNE MIORNERS'COUPENSATqN VRONSIONS OF SECTION A00OF iHE UBOR cooE,�stuurormm+n�coMa�rwmi7�9�[�ROv}j aras. ISSUANCE O '/ .�, /�/ �/(�Q� � — 'p DATE:7��� APPLICANT. �Y'7 i�dwL/ SMIP — � ENERGY P/C WMNIN6:FALURE TO SECUi1E VmDRICERS'COA�PENSATqN COVEM6E IS UNUWRIL,IWD SHALI.BE �y 6UBJEGTJU/EMPIOVERTOCRiMW1LLFENALTESANDCIVILFWESUVTOONEMUNDRE0T/IOUSINO ENERGYPERMIT � DOLLARS Ii1ao,0oo).IN ADOrtION TO TME COST OF COMPENSATION,DAMA6E3 i15 PHOVIDED FOR IN -�¢ BECTION]70!OF THE UBOR COOE,NTEREST,IINDATTOii4EYS FEES. � � RETENTION FEE: � - �� � �� - � ' OCONSTRUCTION LEND�NG AGENCY PRE-ALT FEE: " � IHEREBVAfFIRMUNDERVEN�LTVOFiERR1RYTHATTHEi1E15ACON5TRUC710NLENOWOAOENCY FOH THE PERFORAIANCE DF 7HE WOF1K fOR WHldl TWS PERAIR IS ISSUEO(SEC.70Y7,CIV.C.} , � � . . . . . . .. . . ' . � . � LENOEFS NAME . . ... � . ' � IENDER'SADDRE55 � - ��� - � W I[EHLiiFYTMlITINAVEREADT/pSA70LIGT10NANDSTAiETMATiHEABO`/ENFOiWAT10NISCORHECT. TOTAL FEES �� O�•���" � IACREETOCOMPLYWITHILLIUiVANOCOUNTVORDWANCESANDSTA7EUw5REUTWOTO8U0.0�NG� �- � � . . � CONSTRUCTION,ANDHEREBYAUTlIORREAEPRESENT�TIVESOFTHi500UNTYTOENTERUPoNTME � � - , . ABOVE�AEMqNED7ROPERttFOR WSPECTqNVVRPOSES. COMMENTS J � �� m PERAIITfEENMAE1pWNn ..—.._.-. . . . . . . . . . . . � . � ,,��''.____----�v?/q> � - � ,S�ONATUREOFPERAUTiEE, \ . .DATE - - - � � • •. �- � "': .-. < <--`.— �_ RECPT.N PAID BY VAUOA - WHITE--0opartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,OREEN—AppllcanCa Gopy i 'J,'�.i���:7i•'llS�y.lr1,yK..fD,T���-"�4".�i(�:.•..��,i::�tt:,rr-;c',�n;- ,w �ry:vR.ry�4y,r',� ,�.4v ,r4 r mj: n.a�...., r n •r, �� �r wv ..,.�� �,� .. ..7� ,1 �'= .�;� .-�:l �w. �t,1� ':t�' 'i .11 ' :C` 4?,•'4v t"� L! r'��...'�'1:�..J 'G'1.�.!'!�'.r�:,� .� ;y��.Y^t.'1:, c�,.,.k�r•.1wu.��. e+�r�,Y .S . •,.i';r '4,�, .H ta _.(:L$ .�1A�,�,�.��� .4'.ri�'� r����'": . .?.,`y ��!.�. P . . . . .. ,:. , !fi. - ,. a ..� . r F .,,. ., r�,�..: ,.f'r:�.� • , r:,: ,i ,;, 3°. CITY OF DIANIOND.'13AR � `''�"''r'":� � ��, , � ,, .,, V�,..�:.t.: ,,�;,.,,,, _ :� .. . . : INSPECTIOt�! REC�RD"`� �, .�°;�:: `�;. 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