HomeMy WebLinkAbout14350 1�_ CITY OF DIAMOND BAR
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� : � � 21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
�"9�'` BUILDING PERMIT APPLICATION FIRMLY
� o ADDRIESS ���0� ���1����� v�EI� . DATECATION%�� - J � NUMBER� r ✓�� #/C
� � ISSUE J TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER `�
" ADDRESS Z�L`�C�YZ� �i}J�5A'F--� . ZONING SETBACKS
�0 �'"-� �-
CITY_�.±i.c��,�iiJ is l�-(;2. ZIP TEL.�q",Z�=e � FRONT RW _ C7_ -
APPLICANT TEL. REAR f�
� SIDEISIDE STFiEET RW f-1___
� CONTRACTO�ei C � � •C;; e �- i�1d. SIDE _ !�
ADDRESS /��'7 �`.. /�'!9���i ' '' 1 ` ^ -� y�
p C��, •�ry�����` � PROPOSEDUSE � a��- /` �F
� � ZIP 1' (9 TEL.'1!'�=5�72'� � . ,.,, �
o ARCH/ENG/
( z DESIGNER _.
! a ADDRESS NO.DWEL. NO. Z NO. �
� N UNITS ( _ STORIES BEDROOMS
� CITY ZIP TEL.
g cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� p� OWNER-BUILDER DECLARATION SFR/ADDIREM ��
O
I HEREBY AFFlRM UN�ER PENALTY OF PERJURY THAT i AM EXEMPT FROM THE COMMCTORS LI-' G8f8QB/C2fpOfl
� W CENSELAWFORTHEFOLLOWINGflEASON(SEC.7U31.SBUSINESSANOPROFESSIONSCODE:ANYqTYON � (n
U CdJNTVNMICHRE�UIRESAPERMITTOCON5TRl1C7,ALTER.IMPROVE,�EMOLISH,oRREPAINANv5TRl1C- W pgflD/DBCk
W TURE,PRIOR TO IT6 ISSUANCE,ALSO REOI11FE6 THE APPLICANT FOR SUCH PEHMIT TO F7LE A SIGNED W
�� � STATEMENT TMAT ME OR SME IS UCENSEO PURSUANT TO THE PHOVISIONS OF THE CAN7flACTOflS LI•� �
S CENSELAW(CHAPTERB(COMMENCINONAT}iSECTION70D0)OFUIVISION30FTHEBUSINESSANDPFO-� POOVSpB
'� 7� FESSIONSCO�EjORTHATHEORSHEISEXEMPTTHF.REfflOMANDTHEBASISFORTHEALLEGEDE%EMP-, � --
jj �� TION.MlYVplAT10NOF5ECT10N7031.58Y0.NYpPPLICPNTFORAPEflMIT5l1&IECPSTMEFPPLICANT70' - Z Fie-Roof
;i r ACMLPENALTYOFNOTMORETHANFNEHUN�REDDOLLARS(5500).):
1 0 (:]I,ASOWNEROFTHEPROPERTV,ORA1vEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � Caf11111BfCi81
'! Z VALL DO THE WORK�1D TNE STRUGTURE IS NOT INTENOED OR OFFEREO FOFi SALE(SEC.7044,BU51-,. . _1
f NESS PND PHOFESSIONS CODE:THE CONTRACTOR5 LICENSE LAW DOES NOT APPLV TO AN OWNER OF
I � PAOPERTYNM1iOBUROSORIA�PROVES7HEREON,MIDVYHODOESSUCHWOPKHIMSELFORHERSELFOR �
` Q THflOUGHHISORHEROWNEMPLOVEES,PRWIDE�THATSUCHIMPROYEMENTSARENOTINTENDEDOR, m /
1 W pFFEqEDFORSQE.IF,HOWEVERNEBUILDWGORIMPROVEMENTISSOLDWITHINONEYEAHOFCOMPLE=
1 Z TION,7HE OWNER�BUILAER NMLI HAVE THE BURDEN OF PROVING THAT HE Oq SHE OID NOT BUILD OR
� IMPROVEFORTH�PURPOSEOFSrLLE�.
w f.]I,ASOWNEROFTHEPflOPERTI;AME%CLUSIVELYCANTRACTINGWIiHIICENSEDCOMRACTORS� (
•� TO LUNSTRl1CT TH[PRQIECT(SEG J016,Bl1SINE55 AND PROFESSIONS CO�E:THE CONTR0.CTOR5 LI-. V81U8�10� ADJ.AREA
I 'W 6ENSELAWDOE6NOTAPPLYTOPNOYMEROFAPROPERTVWHOBUILASORIMPROVES77iEREON,AND --�-----
� � riFIOCONTRAC75FOR5ULMPROJECTSVf�THAGONTRACTOR(S�LICENSEDPUHSUANTTOTHEWNTRAG- QUANTITY DESCRIPTION FEE
� TORSUCENSELAW.).
u I AM E%EMPT UNOER SEC._ _B.8 P.C.FOR THIS REASON Q
� "--_ "—_"__"_"""'__'_ U
W �
DATE_ OWNER V
oQ LICENSED CONTRACTORS DFCLARATION W
2 IHEHEOYAFFIHLIIINDENPENALTYOFPERIl1HYTHAYlA41LICENSEDUN�EFPROVI510NSOFCHAPTER , � � �
d 8(COMMENCINO WITN SECTION 7000)OF DNISION 30F THE BUSINESS AND PROFESSIONS CA�E,MD Z
X MY IiCFNSE IS IN NLL FOflCEAND EFFECT. m
� I,,, g
O LICENSE CLASS ��� _LIC.NO. �✓Q� . �
� I J
V DATE� � � CONTRACTOIi.- ------ __-.-- d
W
� WORKER�COMPENSA710N D RATION a
�
'.�� IMEflEBYAFFIflMUNDEHPENALTYOFPERJUflYONEOFTHEFOLLOWINGOECLARATpNS: , Z
� _IMAVEANDWILI.MAINTAIfdACEfiYIF!CATEOFCONSENTTOSCLF-INSJREFORWUHKERS' _
COMPENSpTION,ASPROVIDEDBYSEC710N37WOF7HEU80HCWE,FORTHFPERFORMANCE �W
'� �OPTiE WORN FOR WHICH THIS Pf.RMIT IS ISSUED. �
IHAVEANDWILLMAINfAINWOPoCEflS'COMPENSATIONINSURANCE,ASREQUIFlE�OVSEC710N y
�O 37000FTHELA80RCADE,FOR7HEPERFORMANCEOF7HEWORKFORWHICH7HISPERMITIS -- /_.{��/ /�
.�.� ISSUEO.MY��[j R�N.E.RS'CONqPE�NSRTKKJ INSl1FANCE CARRIER AN�POLICY NUMBER ARE: /��� CONSTRUCTION `� J V �.d
�j CARRIER_°-Ti�-1 I'S�C.� �i P3.#i �..� �..�.AJ�� dS✓. ' �
PLAN REVIEW =
�� POLICY NUMBER �I7a�Ia Ci l��.� ' (,� --..........__._
; . � ; : — i
ELECTRIC � � "
� (�HISSECiaD7N�NOiBE0.�MPLEtE00FTHEPERApftSFOROnIEMNDRE�OowRS(51ao�oaLEsS). PWMBING _..---------.___...------ •
w ..... .."__—'_'._"._ '11``Ri�
z I CER7IFY THAi IN THE AERFORlAANCE OF THE WORK FOR WHICH THIS PERMI715 ISSUED.I MECHANICAL ._..._.._._—s�.3�_,.:=_.i� _'���a
('3 SHALLNOTEMPLOYANYPFASONINANVMANNERSOAST09ECOMESUBJECTTOTHE �!•� ��' �
(n' WONKEfiS'COMPENSA710N LAWS OF CALIFORNIA AGHEE THAT IF 1 SIfUUL�ULCAME INSPECTION FEE __ _ ___
.'? SUBJECT TO THE WORKERS'COMP[NSATION PROVI NS OF 5 TIqN 3700 OF 7HE LA90R "`,��j"¢' :%=��''? "�--=-_, . „ .•.,��� 3 0 �
•
CODE,ISHALIFORTHWITHCOMPLVWITHTHOSEP VISIONS ISSUANCE _ ___
�O i - �' _ . . . • .. _.. F�'.
'p DA7E: 1 Z�Z t , APPlIc,4N7: " SMIP '_""_'__ °
� ENERGY P/C __ _
J WARNINO�FAILUPE 70 SECURE WORKEHS'COM, ATION EflAGE IS UNLAWFUL,ANO SHALL BE
!� SUBIECTANEMPLOYERTOCRIMINALPENALTIE OCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
OOLLARS(5��.�D)�IN AD�ITION TO THE COST OF COMPENSATION,DAMAGES AS PFOVIDED FOR IN ------ --
�.r_I SECTION37o90FTHELABOfiCODE,INTEHEST,ANDAiTORNEI"SFEES. RETENTIONFEE:
� _ '_--_"_"'_'__—"__......._
, a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ._.., __„___,,,____,____,.
0 ----
� I HEREBYAFFIFlM UN�ER PENALTY OF PERJURY TMFT THERE IS ACANSTRUCTION IENDING AGENCY
�- FORTHE PERFOHAAANCE oF THE WORK FOR WNICFI THIS PEFMIT IS ISSUE�(SEC.7097,CIV.C.�. �---— — � —
W —"'---_ .'_—__—' —"'_'—
'•�• LENDER'SNAME _._ ____
F— LENDER'SADDRESS___ .._...___.__—_______..._..__.
¢ ICER7IFYTHATIHAVEREADTMISAPVLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES
W IAGREETOCOMPLYWITHALLCITVANDCOUNTYORDINANCESANDSTpTELAWSpEUTINGTOeUIL�ING
�'� CONSTPUCTION.ANDHEREBVAUTHORIZEREPRESENTATIVESOFTHISCO�INTYTOENTERUPONTHE �
Z RBO E-MENTIONED PFOPEHN FOR INSPECTION PURPOSES, '
COMMENTS
� - C� �5� ---- ---------- _ ---
o . �- � -
..N PERMITfEENAME(P IPIn ,� IZ � `�� .�� ��/� � ---'/J/�/� /
y SIGNAN OF �ATE v� G'��
= RECPT.NO.(�PAID BY VALIDATION
'~' WHITE—De RmentCo YELLOW�inanoeCo PINK—AssessorC
pa py, py, opy,GOLDENROD—File Copy,GREEN—ApplicanCs Copy ,
. \
.,. ._...._� __ j _
a �r�c ' r - i � ... r � i i: 1 ��r� J �., � ��� � � �
� . . . { `��i . h. / 1 5' il i- .n .
�y� ur's%t�.t � a 1!i� P i .� � � ��'S � 1 .� �'l �,i_l � .I�� r�
° �'t«�$�` �g�g � � �
� I � � 3
f �t n- i � � �� )i "i�4) t -"'�i I 1 0
I' � � a � a Y I ..� . r i �,_'� a� #
�C 4 ) ' ;
t y q I Er
kp,a f �n � � - � i �3 . � 7 ` � �'- � � � -.r �t i � ����
+��� � z ` , � �
� ���u r�?� ti� • , I � r• t I � t � �, �� �
t �;�a�:�,�` pt#. rr� , � i i ` f . _ . � ;� r��'. ,, �i- r � :1 �r
E `� �'��..L '� s t -v : ��. . '� ,
'¢f , � I � :��� k�. ,� t i ,�. � r� , � a�y
� ;�'��'S#� f� �.' I . ` � � ,t< I^� . Y t7 I. - ; { t �`�'
� �� � �� ; ` ( � � � �� � ` - � � � � I� �k�d
i �`�{k� � i � � i � � I � - I ry ��`
� � T 4�4�S' �"i ;.5 . I ' ; � � , . I , . . . I I ' � - I
. !
,
,����� � , � z � ; ; � , � , � ; j �� _
� ' , ` `�
. , � i
� c�`,.¢ f ,.. " .µ ' . , ' ' , . _ _ .' _,. . .- ..,__1 _.'...._ � t�1 � ` _
� I
.t�' �a'.,..�.' . �_ ( I � ' i (Q_ � � t � - � ( � � 1 � �
i
j ' ; I I � 1 � . 1 � � �i j �
� � , � i i '�; . �� � i : '� � i !. � io('i � i � i '�'c
{ � . . . ' ' i ^ � ' ` 3 i I � I � ( ,�' . 4 ' ��.
� .
� ' � � � ' ' �: . �. I � _ ' __' '�� � � .' ��' . L _'..i. "_i� {" __
� �'_ '' - � � '_ � _�
� � . f � i � ; �. , j . 1 � . + �,�, � . i�� �� I'I i I , gv
� � , . � � ' . `�
; � ; ; � I ; ; ; , ; ; i ; i� ; ' ; r�
� � i � � ; a ; , ; ; : ; � ; , � � , � � � � �� � N�
� � i i ! ' � � i� � ' , ; , � , � ,� : � =�
i ; , ,
i ( �
� i i � f
, , , i �
�
�
� '� ' � ' i ; ! s I ! � . _{ l ( - - i� � ' I �.. '�T",
I �
�
I
i '' . � 4 . , : � z . ,� y . . .P � � � � �__� �
� ! � i � , i � ���`� ,t" � i�`r�V 3�) � i„ t i r 1 ' ri , �i (5. �� ��j.`� �i ��
^ I � � I , I �W�, r � �� r,i G I , � �`i 1` 3 � � _I � � i��f I� � �a
k � I � � � f �}s t �..: 5 I � � f t C �(� �y j^j �, �' � S. 'j-{qy f" f1-� ri C'J � �
r � ; � � � � � i ; Y��� �<� r� t. �' c ir i,� �i� -i � r � i� s�' �� ri � � � �
� � ' � ' i � i � � _ i I I U' i' i� i-� y I.: tl"-` ''R J i,:.3 �' �i,..i i`a L„I Cs f"� s`�i �����G'� � �
a � � � ( € i ! � � I i_� ,13rf �i � i`'i ��P �n � Ca'"n - � �
. , � ' 3MY �.,_ i ��� � ,r-t� z I�� i .r�,. �"i Gw�'-�� '`;7�: . 4'°� �
�
' i 1 �7
� . � i � . i � - � 1 j i •�, _..7I i_ ,. ; ,,. � fC7� .�1�_`� I � I�I'�f�lr �.,'. ; � � �
s I i : i I� � I , �� I ' I � j I ( ' � � �, { I .�.�;D( .�,' � �
( € I � ( � � � . i i � 3 i I i I � . � ( : , I�' ry I ' � i
� � � , � ; ' I ( i � i � i � _ .I..__ .i.. �, � _.�._._�....� i � ' � I� r
f
� � � I - J -> . I �__J _ ...I_ �.__—� ' __� I �__ I i _� i.
� � I � � i � I � I . ? � � � � � I � � ( , � � ," � —�' —r--
` I � � � , � � � , , i ' i ; �
' . . 4 'I I �.. � � . I � i I , I + I � i F i �
( � I
'
i i t ` I � d I
, ,
, ,
, • i I ; � � � � r
i I I
� t
.
, I , � i � , I ; � .. . � � - - ��- -- e _ ..7. __. 1
i � ;
�
� I ' I : _ I '.� ; : j '_ . ' � i i �._. ' �
�-
�
(
' ' , ! � � ' , , I ; ' � i � � i I � � � I
_1. �_ i �..
,
� ' � ,
� I t ; ( ' � : i I , j i I i
I . I �
� , i i i I
� I ' �; E � , � , I . " � �� � i I . I i . ! , � I � � ( F � ; � f
f � . � � i : i I : i � "� ; � � � i I '1 ' � _ � � . i i e
�� i � � � t I , ; � : i I � I I . ', � ' ' � I � � E ,�
y � i i - j '.. I � " ( � � � I + I I . : .. i � { ; j , ..
' . . � � � : I � - � � . I
' .I._._ ._.----. ! I .;...1.e.�,n,..._ .. . ..,'. . ._ �............ ...__._.. .,_.'. . �._._. _I_.�_._. :�
z... .'._. . .� .�.._:_a. i.. . .... ._a ._. _. .__.� . .c.._ . ..�_. ._, , ._ � 1
, ,.... .. ....____�. _w. .�;,�,..,�. . ..._ . � .. - �,-