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HomeMy WebLinkAbout17140 (42) �--- __.....--- .^.._.. --•------. . �\ CITY OF DIAMOND BAR � � DEPARTMENT OF CONIIvfIJNITY R,DEVELOPMENT SERVICES r ��y ,� 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PR ESS '%:� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE 3 5 � � APPLICATIO w PERI�9IT P/C o ADDRESS • l� DATE�' +► DI NUMDER l � p � ISSUE TYPE OCC � APN LOT—}�s— TRACT DATE CONST. GROUP p OWNER �( � p ADDR�}S,�S��S� R �ToiL ZONING SETBACKS SCITY.Y�d�_ /ZZIP I G� TEL. �� FRONT RW O APPLICANT TEL. REAR � � SIDE/SIDESTREET RW ❑ CONTRACTO 51DE ❑ � ADDRES 3 ����,( � CITY 2 ZIP��ib LTEL(�1,fjZ3 5��73 PROPDSED USE �[�(�(, � o ARC G/ W DESIGNEFi NO.DVJEL. NO. NO. n. ADDRESS UP�ITS STORIES BEDROOMS � CITY ZIP TEL � � DESCRIPTION S�.Ff. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFFUADD/HEM O � I HEREBY AFFIRIA UNDER VENALTY DF PERAIRY L/UT I AM E%EMPT FROM TNE CONTRAC70R5 LI• Gef39&�C2fpOf[ W CENSEUWFORTHEFOILOWINGRCA50N(SEC.7a71.5BUS:NESSAN�VROFESS10NSCDDE:ANVCITYOR (n U CpUNryWHICHREOUIRESA7ERAlITTOCANSTRUCLALTE0.11IPR0VE.DEMOUSH.ORREG�:RANYSTRUG W Patiolpeck TURE.PR�OR TO RS ISSUAfItE,AL50 REOUIRES TME APFLICANT FOR SUCH VER4IT TO FIIE A SICNED w STATEMENT THAT ME OR SHE IS LICENSEO OURSUANT TO TME iROYISIOhS OF THE CONTqACTORS ll- W � CENSEUW�p1AP7ERG�COI��MCNCINOWITHSECTWN7000�OFDIV1510N90FTMEBVSWE5S11NDPR0- LL Paol/Spa FESSqNSCODE)OqTF1A7H[ORSNEISExEMPTTMEREFROA1AYDiNEBA5i5FORiHEAlLE6EDExEMP• � V TqN.�MlVIOLATKKJOFSECTION707/.581'ANYAPPLIGINTFOHIIGERMITSU&1ECTSTHEAPPLICANTTO Z FlB•ROOI A GML 7ENALTY OF NOT MOfiE THIW FIVE MINDRE�DOLUFS�SSOC).�: � ❑1�50NNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGE5A5THfIqSOLECOMPENSATqN, � COmmBfCi01 W:LL DO THE WORK AND TME STRUCNRE IS NOT iNTENDED OR OFFERED FOR SALE(SEC.701t.BUSI• J � NESS AND DROFESSIONS CODE i1/E fANTRACTORS UCENSE UW OOES NOT�PPLV 70 AN OWNCR OF ? PROPERTY 1Nq BUILDS OR 0.1CROVES TMEREON,M1D NMO DOES SUCH WOi7K HIAISELF OR HERSELF OR CL THfiIXJGHHI50RHCROWNEMPLOYEES.PRONOEDTMAiSUCMIMPROVEIAEMSARENOTINTENDE00R m QOFFERCDFORSKE.IF,IqWEVEi�THEBUILDINGORIMVROVEMEMIS50lDWITMNONEYEAROFCOMP�E- Z TqN,TNE OWNER�BUILDER WILL NAVE THE BURDEN OF VROVWG MAT ME OR SNE OID NOT BUILD OR W PROVE FOR THE PUHPOSE OF SALE). w OI.ASOMMEROFiHEPROPERTY,MIE%LLUSNELYCON7MCTINCWRHLICENSE�CONTMCTORS t�e-�..�. [[ TO CONSTNUC'i iHE PRQIECT(SEC.7ou.BUSINCSS/NJ PROFESSiONS CODE:THE CONTMC70R5 Lb V81U0UOn =S7y ADJ.AREA W CENSEUWDOESNOTAPDLYTOIWOHMEROFAGROPERTVW�qBU1LQ50RMPROYESTHER[ON.AH'D � VAqCONTMCTSFORSUCHPRQIFCT5WIT11ACONTRAttOR(5)lKENSEDPURSUANTTOTMECONTMG OUANTITY DESCRIPTION FEE � TORS UCENSE UW). � O I AM E%EMPT UNDER SEC. B.l V.6 FOR TN6 RE�50N Q OO U � � � DATE OWNER F' Z . W . _ . ._ ._. � —' FQ LICENSED CONTRACTORS D[CLARATION W CC IMEREBVAFFIRMUNDERPENILTYOFVERJURYTFI�TIAMIICENSEDUNDERGROYi5iON50FCNAPTER � d 9(C0IAMENCPIO WITN SEC�ION 70ooJ OF DM5101V]OF h1E BUSINE55 AN0 YROFE55iOf.5 GODE.IhD Z X AIY LICENSE IS IN FULL FO AND EFFECT. LL � J� � � IICEN5ECU55 _IiC.NO.�_{/ � � V DATE��� CONTRACTOR��1( ��L a W � WORKERS'COMPENSATION DECLARATIO a = U � I HEREBVAFFIPAI LRIDER VENALTV OF PfRNRV ONE OF THE FOLLOwMG DECURATIONS: N a 0 _IMAVEMDW:LLI.WN7AIN110ERTIFICATEOFLONSEMTOSCLF•INSUREFORYYURKERS' _ � COMPENSATpN.AS VROViDED BV SECTION�7DOOF iHE UBOR CAOE,FOR TME VERFOqMANCE W �ETTHE WORK FOR W111CH TH1S FERMIT IS ISSUED. � W 'Y I MAyE AND WILI MAIMAM WORNERS'COMPENS�TION INSURANLE,AS RCWiRED BY SECl10N / d �7000F THE UBOR CODE,FOR THE PERFOHMANCE OF THE WORK FOR WH�A1 TNIS FERMiT15 �F �O � lSSUE�.MYWORK RS'COMVENSATONIN5URA4CECARRICRANJPOIICYNUTADERAR'r: CONSTRUCTION � � CARRIFR�� ,�QI� PLAN REVIEV'! � V0.ICYNIIAAeER _ �.� EIECTRIC ---- � (1}i55ECf/JNNEmN07BEWr.fiEfEDOFTI[PC�lSFOFCNEF►.NJRC�OOlUR5fi�0o1«1LE55� PLUMBING �I�����'•�"� I I Z 1 CENTIFY THAT N THE FERFORAIANCE OF TNE�NOPK iOR W11ICH THIS PEHMIT IS 6511E0.1 MC'CHANICAL (J • L NOT EMPLOV ANV PERSON IN ANY YANNER 50 AS TO BEC0IAC SVB!ECT iOTHE � A � WORKERS'GWAVENSATqNUW50FCALIFORNI�,ANDAGRFETMATIFISHOlA08EC01AE iNSPECTIONFEE �� SUBJECTTOTHEYIORKERS'OJ/APENSATqnanr�yi5lON50FSECTION]70oOFT 1A60R I S (C�ODE.ISMALLFORTHWITHCOMPLYWI nu5 'ROVi 5. ISSUANCE p DATE:l�Z I• � I APPLIG. �/ SMIP �r' _ ( J /J _... ...""''��_—:_'—.—: WARNING:FNLURETOSCCUREWOPKERS'COMPENSATIONCOVEftA UNUWfUL .DS�IA.e[ ENEFGYP/C ' J SUOJECi AN EMPLOYER TO CRIMINAL PENILLTIES AND GIVIL FINES UP 7 V ONE MUNDRCO TIqUSAMJ u. ENERGY PERMIT pOLUAS(f 100.0OO�.INADDITpN TO TNE LOST OF CpA7EN5AilON.DAM�GE5115 PFOVIDED FOR IN � SECTIDN7�oeOF7HLLA[fORCOOE.INTEREST.ANDAiTORNEYSFEES. RETENTIONFEE: �� pw_, CONSTRUCT�ON LENDING AGENCY PRE•ALT FEE: � � IHCRCBVAFFIRAIUWERPENALTVOFPERNRVTIIATTHCRE�SAGONSTRUCTIONIEND:NGIIGENCY 4- FORiHEiENFORMANCEOFTHEWOiiKFOFiVn1iCHTHISFERMITI5155UED(SEC.90V7,CIV.C.�. Z W � IENDER'SNAME � F_- LENDER'SADCRE55 ��� � ICERTIFYTHATINAVERE/7T115ADPLIGTIONA.Y�STATEiHATTHEABOVEINFON�1�T10NISCORRECL TOTAL FEES � �7G• , W IAGRCE TO Cd.1PLV WITM ALL CITY AND COUNTY ORDINulGES AND STATE UWS RELATwG TO BUILDING � CANSTRl1CTION,ANDHfREOVAUTMORIZEFCDR[SENTATNESOFTH�SCOUNTYTOEMERUPoNiHE . ZAA NTqNEDVilOOERTYFOii1N5 ECTqNPVRPOSES. COMMC-NTS � �d„r ,��o� J m ¢ PE EE ME(P •) /n � V/�D y SiGN�7UREOrVEH1AITT DATE � RECPT.NO. PAID BY � VALIDATION WHITE—Department Copy.YELLOW—Finance Copy.PINK—Assessor Copy.GOLDENROP—File Copy.GREEN—ApDlicanCs Copy ...: . ., . . _ . .. ...... , , _. , , _ ...- •--- - . . ,. , . . ,... .. ,... -. .. , . .. .. ,• .. . .. . . .. . . . : .. .... .. , _. . . . : ... .. .. .. ; .,. . ,...... , _.,.. __ ..: - - ...... . . tiIi':•' O�= �'�ff'.f�.�Gi�D �iil� ![�'5�=�.Cs�;C���! f=���CG��v __��__.__�___ ._ . ---------- -- .,_ ._ . _. _-- - - It�!-'i�i='-,"�f�l►', �.icj:°-" �►`!-S'-�=;f.:E�1:� I�'E�''1:7-:�� •T'lel�'I �r�1:r� ���F.`i.l;e•.:�,e'1:� ....- -- .._...- ----- ....__...._.._. . .. .... ........ . ,. , . _ ..... ...... .. . _._ . .. .. ....._...._ .._.... ._._ .....----.._._---�-•-- SETE!\CK ! ! -- - . ----_, FLOU;�:JC)I�"� . ' �• --- - - - -- --- -- ---- - ' -�-------------- --------�-- --- ----------- _1 FTGS;FORP�"S,'STEEL � i Ffl��f3E�""TS ! ------ — --------- ---- -I--- - --- ELECTRIC GR�UPJD ; _ _____ _ , U�•J�rri Fi.00R DUCT .. } ' ' , GROUND PLUP,IBI�JG 1 I U�JD,=H FLO'�f;CO;•!QUIT I � --- _ _ _ . __ .^ - �----�--�..--- -- --'-`-------- -��-- ---- . . SL�'�6 GRP,DE I I ____ __� I FIREr L�1C�f�C�JN{7,';TIO^! �__ � I TEMP PO4"JER --�-- ------- : I FI��PL�;CE�O"�D E:F���t �--- � l•'JATCR SERVICE _ -- � � �:{ID HT. r D�dC E3E.,P.9 ----�. , , . ROOr SHEf1THING I o ' /r -i . -£i �". E3^v�i[",' n�:r"�:l •- - - � ---- ,/ � o! � ��/'f�a.Q�` - i —f----�-�- � — ------ • �- — -- - --- � ------- . FRAP�IING,NENTILIATIOI'd I I � ', �I�J;L E:���:�) E�F,�,1 j i __ __ ROOF C�VER � C' 'Z' � i I FR�-��ADIf��G-- -- � I �--�'�- --- — ----- ---- -- -- ROUGH HE�ITING _ I _____ I i Fi PiCNIidG ___ � � ROUGH ELECTRIC � ! 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