Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
11473
l --�`�-- , C1TY OF DIAMOND BAR '� � � COMMUNiTY DEVELOPMENT D�PARTMIsNT � Ilf 21C,fi0 E.Copley Drive Suite 190 PRESS (909)860-319,5 Fax(909)861-3117 �'�`""' B UILDING PERMIT APPLICATION FI R M LY '� JOBSITE � �� � �� " '`�'"" APPLICATION PERMIT /C �j 'o ADDRESS_.�^� ' � O'���.-_�__-_,_—_____ DATE __����NUMBER�_�•� ��j �l_ o� ISSUE TYPE � OCC APN_____ LOT._. TRACT__________ DATE____,,.,_________ CONST. GROUP ______ p OWNER 1-�9 R�41 ql ��'`a � --- - ---- p ADDRESS :2�i rjd �_��/� , '��. ZONING SETBACKS OCITY�fA Q�3 h 1L ZIP � bS TEL��y-I-��1-°[�t`��. FRONT -------_�- RW ❑-----..._.--- o APPLICANT G'�.K�"+.• iZ.es L't)i-�R- TEL °1 i�I4.'T�T REAR U-----.--- z ( SIDE/SIDE STREET AW _,_ fl _ � ' SIDE —_ ._ !;. .._.._— CONTRACTOR���Q2_��Z-`--- 1---s'-1...---.--- _ ADDRESS � ° " �� S� PROPOSEDUSE . �°, � o CITY d1Ga, 7Q�' A/L�� C�:►- ZIP� TEL:71 - "�7'7 y -- �°'�. w ARCH/ENG/ � • -"-' -'— z DESIGf3EF1�ti/t LKLtClb���✓y1� � ----- w NO.DWEL. NO. NO. a ADDRESS_I'3�'1'_ __%/��l b�_ N CiTY _ �f3� z UNITS STORIES __ BEDROOMS �t L��i�F) ZIP� `� TEL�'Il1�^�'�lI���� � DESCRIPTION S . T. FACTOR PSF ADJ.AREANALUATION Q OWNER-BI:ILDER DECLARATION SFR/ADD/REM O I HERE6Y AFFIRM UNDER PENALTy OF PERJURY THAT I AM F%[MPT F'fiOM l lll'CON7RACTORS LI- G8f892/C2fPOff W CFNSE LAW FOFl THC FOLLObYING REASON(SEC./037.5 BUSINESSAND PROFESSIONS CO'JE:A4Y CITYOfl (n Z COUN7YWNICHqEQUIR'eSAV�HMIi�OCO�S?HUCI,ALIER,IMFFOVE,�[M1!Ol.ISH,ORREPAIRANYSTHUC- W pgi10/DBCk . W TURE,PRIOR TO IT8 ISSUANCE,ALSO REOUIflES THE�PPLIC�NT FOF SUCH PERMIT TO FILE A SIGNED W � STATEMEN�THAY HE OR 5!1[IS LICENSEU PUHSUANT 10 111E I'HOVISIOVS OF TH[(:ONTfIACTORS LI- � CENSE LAW(CHAP�eH 9�CO�AMENCING WITH 5ECI'ION]000)UF UIVISION J O�THf AUSINLSS AND NflO� � POOVSp2 FESSIONSCODE)OfiTHATHEORSHFISEXEMPTTHEREFROMANDTHEBASISFORTH'cALLEGEDEXEMP- (� � TIOY.ANYVIOLATIONOFiEGIlON7031.5[3YANYqP1'IiCAYIFOIIAPEHMIT5l18JLCT57HEql'PLIGqNTTO Z Re�Haof A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRE��OLLARS(5500).): � fiI,ASOWNEF10FfHEPFtOPLRfY,OFlMYlMPLOY[:I:SWI�Hy/pGL5A5(IIEIflSOLECOMPL'NSAiION, 0 Commercial Z WILL DO IHt WOftK,ANU 1NE SIHUCTUNt I5 NOf INIENUtU ON OhFtHtU FOH SPLE(StG 7044,E3U51� J _ NESS AND PRO�[SSIONS CO�E�THF.CONTF7ACTORS LICf.NSC I AW�OfS NOT A7i'LV TO AN OWNff7 Uf � PFlOVERTYWHO�UILUSOHIMVFlOVLSTH[(7CON,ANDWHODOfSS�C1IWOHKHIMSELFOHIIEFlSFLFOfl � 2 THROUGMMISORHEflOWNEMPLOVEES,PROVIDEDTHATSUCHIMPflOVEMENTSAFENOTINTENDEDOR m � QOfFFREOFOFISALCII;HOWE-V[FjTHE0l1iLDiNGORIMPROVEMENTISSOLOWITHINONEYEAflOFCOM.PLE� Z TION.THE OWNER-�UILDER WILL lIAVE Tf IE�UFDEN OF VHOVINC THA'f H[OP,SHE DID Nnl OUILD OH �" � IMPROVEFORTHEPL'RPOSEOFS�LE). � �y,� IiI,ASOWNEHOFiHEPHOPERTY.AMEX0.lJSIVELYCUNTRACTINGWI7Hl.ICENSEDCONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.�041,BUSINESS ANO PROFE5510Y5 CODE:Tf{E CONTRACTORS U V£1I118tiOf1 ADJ.AREA_.____ W CENSELAWDOESNOTAPPLYTOANOWNEflOFAPROAERTYWHOBUILDSORIMPFOVESTHEREON,AND `��--- _ - � WHOCONIRAC.TSFORSUCHPROJECTSWITHACONTFlAC70R(5)I.ICf"45FDPUHSUAN7'1'D'fIIFCONTRAC- QUANTITY ESCRIPTION FEE , � 70RS LICENSE LAW.). __ __ � � ❑I AM EXEMP7 UNOER SEC. B.R P.0 FOR THIS REASON Q / ��G" ,� W � � . ------------- -'- -------...------- - ' , . LL ¢ � _��LGJ i. ��. 4 . , - UAI'E_--___-_' ._........ _.- OWtJER__'_'_.._..._-'_ ""'_. ._.._...'_"_-'__ � — / ••C.� Z W .� �� �f.' 1���� �.i � LICENSED CONTRACTORS DFCLARATION W � �� � 6�L'j � I HEflEBY AFFIflM UNDER PENALN OF PERJUiiY THAT I�M LICENSf:D II�DEfi VfiOVi510N5 OF rIA E � I �{f��•� /�; r!) I � 9(COMMF.NCI�G WI7!i SECI'ION 7aR'J)Of DIVISICN 3 OF TNE BUSINESS AND PflOFE5510N5 C DE, Z 'T �� -C" X !AY LICeNSE IS IN FULL FOHCE AND FfFECT. m G•�,�L•^' , r Lll . �j , e.. �./ � J _ J 6 � LICENSE CLASS. _._.�_'. LIC.NO. ++��r-Sy y�j 6:+° J �I�/��.�f't+�ti/���. � ~ DATE � c� .__.__ CONTRAGTOR�F�I"./(��`.�. ._�. �? d W _._ " .. , / -/✓f�'e�I� �i/j...e [Z1 WOHKERS'CaMPENSATION�ECLARATIOiJ J • � � V '� aµ'/rL+. P_i'%�� L=//cl�,� N I HERE9V AFFIRM UNDER PENALTV OF PER.Il1ilY ONE OFTH[FOLL�WING DECLARATIONS: (� z �p 0 I HAVC AND WiLL MAINTAIN A CERiIFICATF OF CONSENT TO S[Lf-INSUR[FOR WORKERS' _ �� I L-./1 g Z CqMI'ENSA�ION,ASP(70VIDEDBYSECTION37000FTHLLA�ORCODE,FOHTHEPEHfbfiMANCE U � t���� . i �P /C.� � ¢ OFTH[WORKFOIiWHICHTHISPEHMiTI5155UC-U. W yy �/ 'v r � p , rL _ ��'��3��j"la.. ' �.i'�7.H'/., / �' + � ? , � GOMPENSAIION INSUM�CC,AS fi[OUIRED BY SF.CTION H ^^^��� ¢ �RFORMANCE OF THE WORK FOF WIiIC11(Ii15 PEHMIT IS ��Gj, � �� A J NINSUflANCECAHHIEHANUYOLICYNUMBERARL CONSTRUCTION � _ � _ � ¢ ppqRl�p Y W�oEr�U�llc$AII��J . .-------._.... ..-- /--'------�---�- PLAN REVIEW t���-.�_-_ ..__ Q .+� ��.� � POIICYNUMB[f�_. � +� ""' ��� �� �j. (a(� �LECT 1 / l 9 Q 1 {� <`__. _....--- ------� . Q (iHISSCC.7ICNNEF.DNOT8E0PNVLEiEDOFTHEYERMI11SF011(NJEIiIMARCDDC%lARS(S1��ORLESS) � UMBIN _'_____"'__'"""'.._.._____"_ Q� z I CERTIFV THAT IN THE PERFORMAI:CE OF TIIE W(N7K FOR WHICFI TIIIS PEHMIT IS ISSUf�,I NtE6F7AN� ��j / ..------"-- ----'-'----- j t � )/� CJ SkIALL NOT EMPI.OY PNY PLRSON IN ANY MAN4ER SO�5 TO BEGOME SUiiJEGT 70 T11E -" . � WOf7KFRS'COMPENSATIONLAWSOFCALIfOfiN1A.ANbAGRf-ETHATIFISHOIJLDB[COME INSPECTION�EE ___.__.____... � �. SUBJEC7"TOTIfEWOHKERS'COMPENSATIONPROVISIONSOtSECT104370 �TH[LAUO(i / �.J� , � COUF,I SIiALL FOFTHY/ITH COMPLY WITH T E ovisions. ISSUANCE .. ., ____.._____._..___...,..-_- /l.�6'G°V 0 '] { ������� � p �ATE: M 7 APPLICANjr_ � .['p_.s � SMIP _ _, __ :U� J � ENERGY P/C �' �''� .�--._ ' WAFiNINGFAILUFlETOSECUf1EWORKERS'CAMPENSATIONCOVEHAGEISUNI�WNL,ANOSHAI.Lf3E ----� --- ��(} LL SUBJECTAN[MPLOYERTOCRIMINALYtNALTIESAN�GIVILFINCSUf'TOONEHUNDRE�iHOUSANO [NERGYPEFIMIT ���" �- UOLLAIiS(S��x�.non�,INADOITIONTOTHECOS70FCOMPENSAiION,�AMAGESASPROVIDE�FORIN - .. .-�------���-�- J SECTION 91oe Of THE f ABOR CODE,INTEREST,AND ATiOHNEY'S FFES. � � RETENTION FEE: ______ __ __________._....,.__ i pW., CONSTRUCTION LENOING AGENCY PRE�ALT FEF: r�� , ,� . ., .^---�r�..J�y� ------------..__.. �� I HEREBYAFFIRM UNDEfl PENALTY Of VERJURY THAT THERE IS A CONSTRUCTION LEND!NG AGE4CY �'�`'' ��' %'yS�.� � FORTHEPERFOflMlVJCEOf�NEWOftKFORWHICHTHISPERMITI5ISSUED�5EC30J7,CIV.C.) -----�--�---��--���-- - � , �����'�-�--�' ��----------'- Z W. __-.-. ._- . . ..._.-...__—_-__.__ ' ' � LENDEH'SNAMf___._.._. __ _ _ __' H IFNOF.R'SADOPESS � . ..._- ...'_-'" —'_"_' -_"_ '---" ' �' ICEHi1FV71{q71NAVEHEADT1115APPI.ICATIONANDSTATETHATTHEABOVEIhGORMATIONISCORRECT. TOTAL FEES � �' IAGRCETOCOMPI.VWITHALLCITYANDCOUNIYOFiUINANC[SANUSTATCIAWSRF.LAfIN(iTOBUILOMC . CONSTRUCTI(IN.ANDIIEREBYAUTHOFREREPRESENTAT!VESOFTIIISCOUNTYTOEfJTERU ONTfIE z ABOVE�MENTIONEO PROPEHTY F�R INSPECfION PURPOSES /'��V�Ti� ` ����' � COMMC-NTS o ��. ,�`���` " ��- '"' -------- - — �f.. .J� �. � v . Y . . +.^'� __ _ _; ...� ., ��f,..-!` � v, � ' ' __.-_ _ __.._. ... --"' __" ' "' __ _-"-" m PERMI E( NT')�'r�/� ' "__ _...._ .. � '� � � >` �• ' �� / ' � � .y_._ ._ .lr^* __ � l',)!_�_-... _.4���- N 51GNATUR OF PERMITfEE �AT� � pAID BY � " � VALIDATION L _ . RECPT.NO. ~ WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy _ . ._.. . _,. _ ���,__� i � i .._. , ' _ � 1. __.. � ( ,.__ .,m -� ,�.� � ;��� � ����� � ` � ' i � I ' ' � e�' '� � � � � i ,� i � � � � �� �� � ' � ', , I I I I � ! ( i � ��i�� i�� �� ���� I i I i � ! � i � � � I ; � i � j� 'n .,� C� � ; G � �� ( � � � � � . � I � ( '� �� � i� rt � I ; ; i I � i � � � �:� i� i0 �;� i\�� � ; � � ' ; � � I I ; r ; ' I ; i \ :j � �,� �[ �: �� ����-- �. �. .�M� . ( �� 4 .. .. �. �_ �'. � � """ .r_�-__ _� ._�__ _'1 � "; � � � I � � � � I I ( I � ! �$�� I �� i . . 4 � � ( , � '�� ' ,, � I � ' � a �' � �� � � ���� � ' !�, i ', � ; ; I i � � � � � � ' ! ' I � i i ; ��� : � , � i ���� j i� � z ; � ' _ I.... � ;- � � -- � - ; . � 4 i I ` `�� � i i . _ _.� ......_ ,._i i I I i i � �� � � � i I ` � , i : � (� a���', I ; k : � � ' r � I i .; � ' i �,. , � � : P'g�°� s ,�� ji _P � � i i i � � � � ; i I -j �� � ( , # 1 i ' � � . i .I i - �` , �� � � ��� �It-� �� �� i i ; .�s� � �" � < � � i i � � ; � , �� � � } � I � �� � . � � : I �,'v �r s4' Ft ""� L:� I 7 ; � i :.x � _ � �i � � ,�'�� � � j � I k ° i i � ' ' � i � �E h l��,n �I -a z , a - la • Y - "p' , E � ��`�. �t �C J �t �a � .-�, LT � a = t � n( , � I � � � � . I i r � •"3 ��' {e %. ' C I �.i_ f _:Y3 ( j ,I ( �e��t _ I t,i � � . �t f , �`,4` � �. { I I , � i : , � o � '�[i iT�� i. Q ii:_ ) 1� ,q ��I i : i � � il�� � i �"�.'. , � , � � . -_ c,� �;. �fr.��', . ��.tti � i._�.� i✓I� t i . j .jt; � . � 7 ii ,' ; l �. . � ' � ! � ; �. � � � - r.. r ir ��i,. � @ a i � � ( 1 t a a�� 1 � � : c i � � _ i � � 'c _ ; 1 � , � � ' �;.� ( � I �: � � � . _ __ �-� ���_�t .._.. � �__( ,_._ � � f '-- -- � 1 � . j � 1 � f � � I � � � � ' � ' � I ( �� � ' ( � � � i � � � � � ( I i � 1 ' � � � � �,� ��� . � � � - . , I ' ( i I .i � � '' �, .. � I I � � 4 ; � r�` fi b � ( � : : � . �� �� ��i, , � ': � ��� �� i� i � � ( �1 i � R i I ' � $ ..t �;`a",'.- G , I -�� i. i a � } j �. I ( � ' : i � i � i � ��- , ! , � , . , ! � , � � � � � I a� � ' � "�' { � � � � � . � � � � . - ���j� i . � i� ��.�'��� � , i ' � I� � � t � i i ( i �. ' .. . � � ' % ; . : s � � .. �' . . � ' � f . : �� �' � j � � e � yyy;;; _ . ` . .. , i � . . . i � � : -�.��� ��� I� �� '' �lI���..� � ...� _� .� �.-.{ � C � � �. I i � � '� ' ,' I 1 3 � \ � i ��ci �� �� I ���.:�� � � :\} ��� ;\ ' � 4 C' I �� ° � , i f I j 1j �,�_ �nl 4,1 '^ l-_.f�� 3, f� !� �`4�,. � � .� � F.�. `� � � ; : ' �� �� � f .. � � � � I t : E ( � � � � � � i i I � � i � � , ( �� , z�, � � �. ' ; I � � i � : 3 � � a.r �, �� i i � � � � . � 6 � � � k ���� � � t �� . � � .�. 7. $� � � � � . .� � ��1;� �� _ �� i i: t- k �,% C7.; � .. s t -�� .r�� � � F��� � I I I ( I. �. �y�� _ � . . x i i, � u 1 'J" ,j . . ; 7`t ,. � {i �' ! � L 1' I � ' ! 7' � 74�� - ' 3 ` i ' +,f' �+ � .. t>I � X � �r ���� i "� "� i i . � : i ; ��`J .1'.. � C '� L �� � .,�� � S �r r ; . : . J .,, ��,, �f�,S� � , �.!,. �, '. �1 c { ��. I � t , ��"^ � E (t, �.� @.. , k '�d f!+ � L : + C,� G. ::i � f �., � �., `1 i,�. 3 C �v1ij._.�".; .... .l, ... .c ',...F .. ..1, �...�... ... ... ..�....""""_� ..__....... . .. � ._"'", ,..,�. .. . ...... � . � 1�"'._.x._._._ ._...___� _._ Q _..._, H _...,.: �