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HomeMy WebLinkAbout16334 (20) J� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� , 21660 E.Coplcy Drivc Suite]90 • (909)860-3195 Fax(909)861-3117 PRESS ��'�� BUII.DING PERMIT APPLICATION FIRMLY o� JOBSITE /�.,- APPLICATION/1, /� PERMIT P/C AODRESS ��Z�� ! �'A�C CDU� DATE /1��U '�J NUMBER � ff � A TRACT ISSUE ��-/ TYPE OCC DATE �� D' 1 CONST. GROUP � OWNE�u-� //ti4ti �1'N/c /cu��F ,�0� Gt�.rT-s LL ADDRESS � J�- LD �G �?. .�7�/3G � ZONING SEiBACKS "' �CITY �� y�G�K 21P 9 007I TEL. z� F'79?l FRONT RW ❑ � TEL T REAR ❑ ' ��r���'^ SIDFJSIDE STREET RW D CONTRACTOR �. . - - ----�� SIDE ❑ g CD�DYRESS ZIP TEL PROPOSED USE �% t NSZ I�E �',fLIV���$� �(, �S'✓� -s-�1 IJ � ARCH/ENG/ ..�.,� - -- -- - - DESIGNER NO.DWEL NO. NO.� ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL � v� DESCRIPTION SQ.Fl: FACTOR PSF ADJ.AREANALUATION ¢ OWNEF-BUILDER DECLAFiATION SFR/AD�/REM O p I NEREBY AiFRM/UNDER VEWVLTY OF VERAIRY THAT 1 MI E%EMPT FROM iHE CONTMCTORS l4 Ga2ga/CarpoR � CFNSEUWFORiHEFOLLOK7NOREASON(SEC.7071.68USMESSMIDPPAFESSIONSCODE:ANYqTYOR (n CaVNTY1N11CHRE0URE5ACERIARTOWNSTAVCT.JLLTEiLWPROYE.DE1A0U5HORREPAIRAN`ISTMIG W P0Ii0/DeCk IURE,7RIOH TO R8 65UANCE.�L50 REWiRES THE AP7lMJJJf FOR SUCH VERYR TO i1LE A SIGNED W E7A7FMEM 71/AT HE OR SHE IS LICENSED GU0..UMrt TO 7HE PROVISIONS OF THf CONTRACTORS U� � C£NSE UW(QUPTER Y(COMMENCWQ WITH SECTION 7000)OF DIVISqN]OF THE BUSINESS AND PRO- u' PooUSpa iES;IONSCOO�ORiIiATHEORSHEISE%EMPTTH[REFROMMlDTHEBASISFOqTNEALLEDEDE%EMP• (� T10H.ANYVIttATIONOF5ECT10HT0.71.6BYANYAPVLIGWTfORAGERMiTSU3JECTSTHEAPPI.ICANTTO Z Re•Roo1 � ACIViLGE�MITYOFNOTAIORETNANFIVEHUNDRED00LUA5(fso0).X � OLASOVVNEROFTNEPROPERiY,ORMVEMPLOYEESWIiHwA6ESASiME1q50LECOMPENSAiDN, COfl1rt18rC181 . - Wlll DO THE WORK,AN�THE STRUCTUNE IS NOT INTENDm OR OFFERED FOR SALE(SEC.)Wl,BU56 � � NE53 AI�iROFESS10N5 OOOE:THE CONTMCTORS 110ENSE UW DOES NOTAPPLY TO AN OtYNER OF iROVEHTYVAIOBVILD30RIM7ROVE5TMEREON./NDWFIODOESSUCHWORKHIMSELFOi1HER5ELFOR = � THROU6HWSOFHEROWNEYVLOVEES,DROVIOEDTUiSUtl/WPROVEMEMSARENOTMEN0E00R m OFFERED�OR 4ALE 6 HOWEVE0.IME BULD�NG OR MPROVEAIEM IS SOID WITMIN ONEYEW OF COAIPLE- Z TION,TME OwNER�BNLDER NnLL HAVE THE BURDEN OF PROVWO THAT HE OR 511E DID NOT BIAID OR � IMPHOYE FOfl 1ME VURPOSE OF SALEy O l AS ONNER OF TME PROPEHTY./W dICLUSNELY CONTMCTN6 Y/I7H LICENSED COHTMCTOR3 TO CONSTRULT TME PRO.IEGT(SEG 70��.BUSINESS AND PROFESSIONS LODE:TME CONTRACTORS ll• V811laIlU1 ADJ.AREA CENSE UW DOES NOT MPLY TO AN OWNER DF A PRDPERTY MT10 BU0.D3 OR W PROVES THEREON,AND y � N'/qCOHTRACTSFOfISUCHCNQIECTSWITHACONiMCTOR(3�LICENSWPURSUANTTOTMECONTMG pUANi1TY DESCRIPTION FEE � �� � TOfi`St/lCETISEUW.A . . . . . / pyM1IXEMMUN0ER4fC r^ B.1V.C.FORZFIi5REA50N Q � �� �• � ' � /, l A,i�� u_, � ` T� ¢ �� i� �. � �- tlt(�. � o�TE � v . ,�. � UCEN$ED CONTRACTORS D CLARATION W `,�// � � w / �i�/ I HEREOVAFF1A/1lNDER PENALTV OF DERtt1RY TNAT IAA1 LICENSED UN�ER PROVISIONS OG C/UDTER V. /� �lJ� �;,\ � s •(COMMENCUq WITN SECf10N 7000)OF DMSiON!OF 7HE BUSINESSAND VROFESSqNS CODE,�JJ� Z �! �C YC W�ICENSE IS N FULL FORCE AND EFfECT. LLJ CLI � �1� �1,.' . � LICENSE CLASS LIC.N0. j / � \ �1✓/ V pATE CONTMCTOR d /� W / � � � � WORKERS'COMPENSATIONDECUIRATION Q � � � t/ � �,/�/ ` � IHEREBVAFiIR1AUNDERVENALNOF7EiWRY0NE0FTHEFOLLOWiNOOECURATqNS: Z , � �� � _IHAVEANOVALLMAINtAMACERTIFICATEOFWNSEMTOSEtFaNSUREFORWORKERS' _ � � [DNPENSATION,ASPROVDE�BYSECTtOH]7ooOFTNEUBOliL00E.FORTHEPEHFORAIANCE U OFTFWd1KFORW/11ClITMLSVEtIM1i4SI5SUW. � / G _IMAYEN10YnLLWVHfANWORI(ERS'COM'ENS�710NINSURANCE,ASREWiREDBYSECTION /y , J Q 9'/000FTHELIBOHCOOE.Poilh1EPERFORMANCEOFTHEWORKFORWHICHIHISPERM1T15 / �J� // �/���1 � ISSt1ED.1RYWOWCEAS'OOAADENSATI01tIN5t1FUNCEGRiUERMlDiOLICYMIIABE0.ME . CONSTRU ION ff ��+� ! �y y c�wwcA PU1N REVIEW � � POLICVNU4BER ELECTFitC • ��' � (fHIS5FCI10N1EF�NOT8EW�4lETE�OF7/EPEW.ff6iORCNEFl.MRED0011MSR��lO�iLFss} PLUMOING _ Z ICERTIFYTHATWT/EVERFOR1dANCEOFTNEWORI(fORNMICNiMISOERMITI5155UED,1 MECHANICAL „ (J SWLLLNOTE�PLOYN7YPERSONNANI'/AANNERSOASTOBECOMESVBlECt70THE N WOPoCERS'COMPENSATANIAWSDiCALIFpRN1A,ANDACREETHATIFISMOULOBECOME INSPECTIONFE � S SUf3JECTTOTHEWORKERS'COAIPENSATIONYRO'f1510NSOF5ECTqN91000FTNElABOR CCDE,I SF1ALL fOftTMY1TN GOMVLY N17M THOSE PROVISroNS. ISSUANCE • � SMIP � .... -- — ����, p OA7E: APPLICANi.� W ENERGY P/C WARNINO:FALl1RE TO SECURE WORKERS'COMPENSATION COVEMCE ISUNUVJFU�ANO SHALLBE , � SUBJECTANEMFLOYERTOCFIMINALPENI�LTIESANDCMLFINESUPTOONENUNDREOTlqUSMIO ENERGYPERMIT � u�" '�'G OOILARS(f loo.o0a�.IN/�DDITION TO TNE GOST Oi COMFENUiqN.DAMAGES AS PROV�DEO FOR W �yT'� � SECTION]7oe OF 1HE UIBON COOE,M7EFEST,M1DI1TTOfwETS FEES � RETENTION FEE: � U!�J a CONSTRUCTION IENDING AGENCY PRE-ALT FEE: O ( � I HEREBV AFFlRM UNDER iENALTY OF VEfiNRYh1AT iHERE tS A CIXiSTHUCTION LENDPM IAENCY . Z fOH iME iEflFORMANLE OFTHE YIOiL(FON VMIGI TNIS YERMIT IS ISSUED(SEC.fo97,CtY.CJ. �� _ � ^ W , . � IENDERS NAME � � � LEI�ER'SADDR:55 � � ICEi1TIFYTHATIHAVEREAD 4AGVLICATIONANDSTATETUTTIEABOVENFOitMATqNISCORRECL TOTAL FEES �, w IAGREETOCOMMYV.7 CI COUNTVOqDINANCE5ANO31ATEUWSREUTIPqTOBUIL0INC � CONSTRUCTqN,ANUH EBYA ZEREPRESEMATIVESOFT/USCOUNT/TOENTERUPON7ME � ZABOVE-MENTqNED G ERTY FOR W..ECTqN PURP0.5E5. COMMENTS � � �.L�'cL '�5 �;� r�,c,c.�,r�_�.—�- , c_�� o�, c�-�.�.,c�.,,..t; m M11TEE HAIAE(FRI n � ,.�^ O/ ��f�"'. _ N . Q S(/ . � �V N NANREOFGE ITT E OA '� � RECPT.NO. PAIO BY ALIDATION HITE—Department Copy,YELLOW—Finanee Copy,PINK—AssessaCopy,GOLDENROD�ile Copy,GREEN—ApplicanPs Copy . -- CITY OF DItiN`iQND B�►R . . . ; � � - ��.�:. �ItvSPECTlO�; F�ECOR�? . . � , r . _ � . - ,� '':�+(yr�.�:��"e;��Tm'.I,�� �r�1�� !I�`���..��``II��R�� '���E�'�:��c`��G►�'�l.!� ■' .���,��: i��.E-��=�`���,�'� ..� � iSETBACK .......__ . - ..,......._._...._,._....._._._._ rFL00RJ015T~--�, .\���, _�4\_ --`.,`. ..c`..\;.`.,.,,...,.�.. _.. i. .-- ,�,_ �FTGS/FORr�1S.fSTEEL • � • � FHA REQ��dTS - _ ,ELECTRIC GROUNQ _ i . UND R.FLOOR DUCT - � I.., � .. '-�.----ts�ir�-t ..:.;c�-T=:.::P-•�-�:—„ _-- :GROUND PLUMBING Ut�iDE�•FLQpR-G�UP,IUUIT-;,�- . dt,�;-•�;. � �1,��. 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