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HomeMy WebLinkAbout16893 (10) -- CITY'OF T}IAMOND BAK � DEPARTMENT QF C+f�MMUNITY&DEY�L(1PME S RYICES 21660 S.Copley Thivo Suite 190 (`'������j +�C,}7 (909)$b0-3T95Fa�c(969}861-3117 � �..7 �ft PRESS '^'� BOII-AING 1'ERMIT APPLICATIQN FlRM Y �� JOBSI7E ;1��2S3dSrj� T^���L� 3 �L}yJ APPLIGATK?N 'Z2 (� PERMIT p/ � 2 AODRESS bA- —���,1 � DATE ____iVUMBER ���� M�/ ' ��^' � APN OT TRAC7 �SSUE 7ypF �� o ���R t DATE CONST. GROUP � AODA S � ZaNING S�7BAGKS Z CITY ��,Y" 1Y1 Zlp y��„i,�TEL. � k FRONT RW ❑ � APPLtCANT� Tg.. ��Afl fl � SIpEJSlQE STREET Ryy � cor�rr�ncro�t s�ae � ADORESS � CiTY ZI T L PROPOSED USE o RRGWENGt �. � PESIGNER �����" NO.DWEL. NO. NO. 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' ' ' ". " _ ' J. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY I DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 E:44%05-3 ci<- (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICA jA°DBSDRIETSES 8.3 tc,70\ei-,19,..,,3-}co,rt ...:4"/A242_7_ APN OT ko. TRACT A OWNER P' Milt*a ADDFI S "Wiii---Dirnir Mr At'.At di CITY Lrv ZIP i .4,O,TEL. #Z2-5:74 APPLICANT .Aga TEL -"Fria" CONTRACTOR 4411111Mllllli1111111 ADDRESS imitismitla^ CITY Z 1 • IIII T ARCH/ENG/ 1 • •• .4, a DESIGNER LA a In ADDR S SzT.itailIntitiRIC2MIVAw gifig2b. 1011'M ..-- •- crrt' .A Pi :IA ZIP C ' TEL Nira )) i HEREBY AFFIRM CENSELAW FOR THEFOLLOWINEI COUNTYWHICH REQUIRES TURE,PRIOR TO ITS ISSUANCE. STATEMENT THAT HE CENSE LAW(CHAPTER OWNER-BUILDER DECLARATION FESSPNS CODE)OR THAT UNDER PENALTY OF PERJURY THAT I NA EXEMPT FROM THE CONTRACTORS LI- TION.ANY VIOLATION OF REASON (SEC. 7031.5 DORMERS AND PROFESSIONS CODE.ANY CITY OR ACME PENALTY OF NOT A PERMIT TO CONSTRUCT,ALTER.IMPROVE. DEMOLISH.OR REPAIFI ANY STRUC- CI I,AS OWNER OF ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED WILL DO THE WORK,AND OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS Li. NESS AND PROFESSIONS 9(COMMENCING WITH SECTlON 7000 OP DIVISION 3 OF THE susINEss AND pro. PROPERTY WHO BUILDS HE OR SHE IS EXEMPT THEREFROM AND THE OASIS FOR THE ALLEGED EXEMP- THROUGH HIS OR HER SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLIC.ANT TO OFFERED FORSALE IF, MORE THAN FIVE HUNDRED DOLLARS(9500).): TM,THE OWNER-BUILDER THE PROPERTY: OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, IMPROVE FOR THE PURPOSE SHE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044, BUS!. CIL&SOWER OF CODE.THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF TO CONSTRUCT THE PROJECT CENSE LAW DOES NOT WHO CONTRACTS FOFI TORS LICENSE LAW). Ei I AM EXEMPT UNDER OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR HOwEVER.THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COWIE- WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR OF SALE). THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS (SEC.Tock BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS U. APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON.AND Stk>i PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- SEC. B&P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION ' I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT/VA LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND MY LICENSE IS IN FULL FORCE AND EFFECT '—G UCENSE CLOS A. uC No .... , DATE_2..:�,,,"- CONTRACTOR MAI; IA. WORKERS'COMPENSATION DECLARATION I, PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. VI MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' ° I HER AFFIRM UNDER As PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE I • I HAVE AND WILL F014 WHICH THIS PERMIT IS ISSUED. COMPENSATION MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION . OF THE WORK LAEORCODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 4„--I HAVE AND WILL WO ERS'0;)MV.ATION• RANCE • RIER AND POLICY NUMBER ARE: . � II. I • •il ,A 3100 OF THE ISSUED. MY CARRIER POLIcy NuMBER 644,....i.:40ED I CERTIFY THAT SHALL NOT EMPLOY h.filltff 1110 VATI SUBJECT TO 161-4111101G.. CODE 411/41. ) .... , DATE: WORKERS COMPENSATION NOT BE COWIE-MD OF ThEPEIWIT is Fonct4E HUsDREDCCUARS(SIMORLESS). IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT To THE LAWS OF CALIFORNIA.AND AGREE THAT IF i SHOULD BECOME THE WORKERS'COMPENSATION PROVISIONS OF SECTlON 3100 OF THE LABOR FORT WITH COMPLY WITH 79t E PR IO SKINS. ..) . le C' 5 APPLICANT: WARNING: FAILURE So SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL.AND SHALL BE - SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS Lilo:Loon IN ADDMON TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN 3 SECTION Ma OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. , CONSTRUCTION LENDING AGENCY C I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A cONsTRuCTiON LENDING AGENCY I; FOR THE PERFORM,NC (..)Y/e OF THE WORK FOR IS RAVI iS ISSU D(EC 3007. ay.C.) L7I T - LENDER'S NAME e. ..s - LENDEFrs ADDRESS B C I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION is CORRECT L I AGREE TO cOmPly WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING To BUILDING ,.. CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE 5.... ABOVE-MENTIONED PROPERTY FO INSPECTION PURPOSES D L-cyy n PERMI E NAME(pR NT) --0 < C----i6577/ 0 Y44/ IeCt..fo'--- -Ae.l � E OF PERU)EE DATE Ek PRESS ^.--- . I NI AM 9 APPLICATION PERMITP/Ccr^ •1( # DATE NUMBER �"' # (--- di ISSUE DATE TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE/SIDE SIDE RW 0 • 0 STREET RW 0 0 N0. PROPOSED USE UNITS DWEL N0. N0. STORIES BEDROOMS FACTOR PSF IEHIIMIIIIIIEUIFIIISVWIMI DESCRIPTION SQ. FT. (3 ADJ.AREA/VALUATION reignmign SFRIADD/REM • 575 wismania; cl) Garage/Carport ww u. allialliMill 0 Ifiltri z - 11EINIESMILWIMINNI 8 -J Commercial 5 0- WM 11111MMIII i.,ADJ.AREA aa AI7 C, MM. .2 6 Valuation 'Weal Infillifill IPIPIIIINIIIIIIIIIIIIEIM alinam QUANTITY I Ct z G 5 I a- IIIINIIIIIIIIIMINENINEIMIIIIIIIIIININIIIIIIIII VIVIIIMI in LIMMILIIIIMIIIM smo ) z mIrmarsmrmnimasess tiv„ =maw= usumemmi-Olsl IIINEMINEMII•1111111111111111R11111111111 c)z < tm 2 Inniliarfagfiffital1111111111111MEM11111 aTv I I\ CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE 1(e 3 1 SMIP ENERGY PiC ENERGY PERMIT RETENTION FEE PRE-ALT FEE: ri "*"7--.-2..N0 Illi •U TIIIIIMIIIEIIIIIIIIIIIIIIIIIIIMW'... s C Y.-) 11Y.) \-.v, 11:),(e I I V-7)., •;rl. 1 sas -1-"S• 'CY-) , 'A- I 1 1 r t) ,. Vl " I 1,_.) 1 .--- ' . 1 TOTAL FEES ,--- . COMMENTS RECPT N0. ma PAID BY BUM VALIDATION WHITF—Deoartm ant COM YELLOW—Finance Copy,PINK—Assessor Copy. e Copy, EN— cant's Copy CITY OF DIAMOND BAR INSPECTION RECOFfI PE,roY PEcTION DATE :INSP ; FL OOP JOIST UNF:7P.I Lr)c.:Fq DUCT OCR r:111EPLArE FOUNI-lAT,O. N F'• r4F1-.Ki . r !J«:-)i'..,lt)BEAM �T-4-,.-^,7-,t•'' •_rt:T., 1 i.(v,7.-.3-IAL.r" !Nr...3 � . � 0 •" • ';I :R3 riz'S • fENCHNG 1 1- .- i • POT)1..17:LE.C.;TRr..... -I . ;AT' 1,IN. ^ 1_• PCC.�,I. FINAL , . !_ . . •��� tr-4.-;:::;::,,..,71;:_ir�i,- ...:N4.icz����_....,, . ,Pfup:.