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HomeMy WebLinkAbout14470 ' � - � �_ . . _ r• - _ � . . ' � " ' �� CITY OF DIAMOND BAR� n _ DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES ,�� 21660 E.Copley Drivc Suitc 190 . (909)860-3195 Fa�c(909)861-3117 - � . PRE$$ �^�' BW.DING PERMIT APPLICATION FIRMLY • JOBSITE APPLICATION PERMIT (� ��/C-��'� o ADDRESS_���� QAT��F-I���YZ. DATE '- �2rLIo� NUMBER�I l ��"A g ISSUE TYPE OCC , . -- APN LOT TRACT DATE CONST. GROUP g �OWNER �U5 � `p ADDRESS 2323_,,, ��`' '��kQ__ ZONING SETBACKS CITY�_ ZIP°'IZ'iOL TEL�- FRONT RW ❑ APPLICA '� TEL�E+B"L�..40 REAR O . SIDE/SIDE STREET RW O CONTRACTOR J< SIDE ❑ g ADDRESS r PROPO D SE�l�u GnI.KT!� ��,���C . p►bn CRY G ZIP�_ TEL. 9 S/�/�t/ ]�/� w ARCWENG/ t� • ��F�_P�4�1Z1�'y��1 � DESIGNER� �•�W�?_�.�Ao.��VL N0.DWEL NO. N0. ADDRES � UNITS STORIES BEDROOMS N CITY ' 21P� TEL - � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION Q OWNEFi-BUILDER DECLARATION . SFi�/ADDhiEM O �ppp 1 HEREBY AFFIRM UrAER PEN�L7V OF iEM1AV THAT 1 MI EXE1nPT iROFI TXE C0IRMCTORS L4 Garaye/Carpon CENSEUWFORTMEFOLLAwN�REA50N(SEG70.71.68USwE55ANDVROFF55�ONSCODE:ANYGfTYOR (n COUHTYYR11fi1RE0Uli1E9APERMRTOCONSTRUR,ALTFR�PRa1E.DEMOUSH.ORREVAiHANVSTRUC• W Pfl�lO/DBCk iURE,iRpR TO ITS ISSUMICE,i1L50 RCWIRES THE A7PLICAflT FOR SUCM PEfWIT TO FLLE 1151GNED 6TATEYENT T1UT HE OR SME LS UCENSED VU0.511M1T TO iME DROVISIONS OF THE CONTMCTOR9 LI• , � GEHSEUW(C�uMERY1COMMENpNOMAiHSECT1Gv?WoIOFDIVISIONlOFiHEBV5iNE55IWDPRO- u' PooUSP� - ' FESSqN5000�OFtiHATMEGR5MEI5EXENPTTMEREFROMANDTMEBA515FOfITMEKLEOEDE%EMP• (� T�ON.ANYV10lAi10NOFSECT10N7o71.6BVMIYADPLICANTFORAPEPuiTSUeJELTSiNEM�LICANTTO z Re-Rool � �GMI PENAL7Y OF NOT MOHE 7MA"1 ifVE MIMDRED OOlLARS(i5o0).): � OtILSOWNEROFTIEPROPERTI:ORMYEUPLOVEESWI7HW►GESISTNEIRSOIEODMPENSATION. � (�,pmmBfCi01 G Y � WILLDO htE WOPK,AND THE STRUCNRE W^NOT MTENOEO OR OFLERED FOR SALE(SEC.7D1�,BUSI- J NESS MD PROFESSIONS COOE:TME CONTMCiORS LICENSE UW DOES NOT AFR1 TO AN WlNEROF N PROPEHTYNF�OBUILDSORMPi10VC5THElIEON,INDMR�ODOLSSUCN�NORNHiMSELFORHERSELFOR � (� T1IROUGHWSORMEHOMMEMPLOYEES,PROVqE07HATSUCH�APROVEMEM3�11ENOTMEI�DEDOR La 0 OFFEREDfORSN.EF,MOwEYER��14DP1�ORMPRDVEYEMI550LDWfTV11NONEYEAROFCaN0.E- Z T�ON.T1rE OWHER�BUIIDER WILL H�VE THE BIMOEN OF GROYiNO iHAt ME OR 6HE DID NOT BVIID OR = tlJPiIOVEFO(tiHEPUNPCSEOFSALEI �y,� ❑4��M'HEROFiHEiROPEHTY,AMEXCLUSMLYCONiMCTwOM'I7NL�CENSED�ONTP�CTOP4 . ¢ TO CONSTRUC77T7E VHOJECT 15EC.7wa,BVSiNE55AND PROFESS�ONi CODE:THE CON'MCTOfi5l1• VdIUBIi �� i ADJ.AREJ1 LLl CENSEUWDOE3N0'iAFVLYTOANON'N[AOFADRODERTYY111OB��lDSOR�.IPROVESiNERCON,AhU � YAqCOHiMCTSFOR3UCHGRQlECfSNniHACONTMGTOiVS)I�LENSEOVURSUANTTOTNECOHRNG QUqNTITY DESCRIPTION FEE � T00.SLKENSGIAW.j. , O 1 AA�EXEMPT UNDEN SEG B.a O.G FOR TH�S REASON U 3 ¢ _ . . LL- o�h ovmca v � J � UCENSED CONTRACTORS DECLARATION w � IHEREBYAFFIPoJl1NDERVENALTYOFPERIUH'ITHATIAMLICENSEOUN�ERP�70VISiONSOFLMAPTER � � �(OOV4ENCwOWRHSECfION7oo0)OFDNIU�ONlOFTHEBVSINESS�NDOROFESSIOI�SCOCE,AND z � MY UCENSE R IN fULL FORCEANO CFFECL / m � UCENSE CLASS LIC.NO. >y V � / J V pATE J I � d CONTMCTOR � a W � WOFKERS'COMPENSATIONDECLARATION /J,U � V ' O N ��/ N IHENEBYAFFWMUNDERiENAITYOFVE0.1URY0NE0FTNEWLLONINGDECUMTqN4: z Q O _IMIIVEMAWILL11AP1TNHAGEHT�FICATEOFppNSENTTOSELFdNSUREFORXOpKERS' - $ '� Cq1PEN5ATqN.ASPROViDEDBYSECT10N7/ooOFTNEU9MO00EFORTNEPEAWRWINCE �U OF THE WOfM FOR WNIG1 TMIS DERIA�T IS ISSUCD. .� � �IH�VEANDNnLLYANlfAWWORKERS'OOMPENSATqNINSUMNCE,A5RE0UIRED8Y5[CTION � �� �� Q 7700 OF iME LA30R COOE,FORTHC GEHFOM1ANCf OF THE M'ONK FON WVi�CNTHIS OERAIRIS LSSUED.WWORKEA.SL'COAIPENSATqNWSUR�. G RIEA�NOPOLICYMIM F.NMG STRUCTION � � , ►'�I �`� V' � PLAN REVIEW �� '� j u�uu£n � � � WLICYIAIL�BER � � ELECTRIC �A �� - _ � � (n655tCIlONr2�1rJTBECp.RFTEDOfTEPEPMtSfOf+ONEHI�[Mm00WASK+�% 1 PLUMBING ,�� ? /� � ICEHTIFYTHATINT;EPEFiFORA1ANCEOFTHEY�ONK�ORWMiCN7H6PEM11TI5155UED,1 MECHANICAL L •`� 5 WLLL NOT EAIPLOY A"lY PENSON N ANl'MANNFf150�i TO BECONE SL'OJECT TO THE N NORKEAS'COMPENSATqNUW50fCAL�FORNI/�ANOAGREETNATIF15NIXq_DBEODME INSPECTIONFEE . A� n �1 �I�� S bVNEGT TO T1E WOiiNERS'COMVEN4ATpN AOVi510NS OF SECTION 77 bF iHE UBOR cco.i s Fummnn�couv�r wm+1 s¢vaovis�avs. ISSUANCE �� � � � I�J� OCJ SMIP ����'�A�u[3H[C yi'-!� p DATE: APPLIGNL � —�rr7T1�-i�7�T � . J ENERGY P/C `�"�''vu���v���1 Y WAfV1iN4:FiVIURE TO SECURE WORNERS' PENSATION OOYE �IS 11NUWFUL.AN�SHILLBE � SUBJECTANEMPWYERTOCR:MINALPE ESANDCMLFINESU NONEINNDRLDTlIWSMlO ENERGVPERMIT OOl1�RS(ll00.000�,N I�DDITICl1 TD THE COST OF COMPENSA7IJN,�AMAGES AS PROYiDEO FOR IN � ¢ SECTION77DIOFTMEUUORCO�E,INTEREST,I1NOAiTORNEYSFEES. RETEPJTIONFEE: d CONSTRUCTION LENDINGAGENCY PRE•ALT F ��� � IHEREBY�FFIR�IUNDE�PENKTlOFPE0.IURYTHATTHEREIS�GONSTRUCTIONIENDINCIICENCM � � Fdi THE VERiOqAW�LC OF iT1E WORK FOR WHICN TMIS VER41715155UE0(SCG 7DGt,CIV.G�. � ^ �� � , .-, . G��; tl �n - � � �ENOERSNM�E CS LENDER'SADDRE55 � � , �. � W ICENTIFYTHl1TIHAVEREADT1115l1VPULl1TIDNANDST�TETMATTNE�BOYENFOfU1ATqNISCORREGT. ` 'TOTAL FEES` , . s��OO�/ � � � IAGREETOCOMPLYWI7NNA,CRYANDCOUN7YORDIWWCESANDSlATEUWSNEUTHOTOBUILDING LONS7RUCilON.ANO NEREB�AUTMORIIE REPRESENTATIVES OF 1N15 COUNiY TO ENTEil Ui'ON iNE n � 1BOVE�VENTIONEDCROCER7YFOPMSPECTIONPURPOSES. , COMMENTS �� �� � � '.�f fl . �►� ���— _�, , . s-- m ve r uee�vawtl l y ^ �� �- �. � • •.'��Sl� � � _ y NA7 Of 1 E2d� ` - � DATE S RECPT.NO. PPJD BY VALIDATION ~ •• VYHITE--Dapartment Copy,YELLOW—Fnance Capy.PINK—Aasessol Copy,GOLDENROD—File Copy.GHEEN—ApplicenCs Copy i . . . , , . _. . .. �. _ , . . .. . ., , . . . ... �,,. . �,. . �, - . r .. ... ..�. . . .. ., . .. .. . _. .. ., .. .. . ;- � . ;: , , _; � '. CITY OF DI/��JIO�D,BAR - • = � k. � . . , � . , � ;,-�%'•': � �INSF�ECTIC?f�!�RECORa. ... , .:' � - . , . - .. , . _ . ,. ._ , ��, � . �. -.: . . 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