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HomeMy WebLinkAbout13-0612 ^ , C�����]� �noli4ion f ' • �,� _ • CITY OF DIAMOND BAR ` � �� (�(�y�0�� g � DEPARTMENT OF COMMUNITY &DEVELOPMENT�Q o ��8Q����p��� � 21810 Copley Drive,Diamond Bar,CA 91765 �"�"""U`" S (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(���,�1(�Q�(�j�� F� '����'� BUILDING PERMIT APPLICATION � o ' _ o a � JOBSITE ,( t!,{n� /u�Ap��1� �tl ` APPLICATI N PEFMIT � P/C o ADDRESS/� `'�'�� `1 DF'� �f 1 J� DATE �z� ( � � NUMBER � �Z# o ISSUE I TYPE OCC � APN� L������CT DATE � l Z ( I i � CONST. GROUP p OWNER •�rr��_.1 � ADDRESS S G T D�. ZONING SETBACKS z CIIY DI�W�10 RAQ.. ' ZIP S TEL. � — '�I6 FRONT RW � REAR � o APPLICANT TEL. SIDE/SIDE STREET R�N � m CONTRACTOR � CA �S � SIDE � d ADDRESS " p V E /��W�MM III�G �/ � PflOPOSED USEx� y � CITY �� ZIP TEL w ARCH/ENG/ a DESIGNER NO.DWEL NO. NO. a ADDRESS UNRS STORIES BEDROOMS � C�7y ZIP TEL `� DES�CRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cn Q OWNEF-BUILDER DECI.AAATION SFR/ADO/REM O I HEiiEBY AFFli7M UNOFA PENALTY OF VENURV THAT I A/I D(EMPT FPOu THE COMRAGTORS LI- GafdgB/C0lpOA W CEHSEUWFOR7HEFOLLOtN�NaAFA50Nl5EC7mt.59U5WE55INOViiOFES510K9CO0EANYQTYOH (� U COUNTYYMICHREWIAESAVER/ARTOCONSTAUCf.ALTERfA1PHOVE,OEMWlSH.OPREPAIHANY4TRUC W Pd�O/DOCI( Z TURE,7fl10R TO RS 155U/�NCE 1J5�AEOUIRES THE APPIICANf FOR SUfi/PERMIT TO FllE A SIGNED w w STATFJAEM TNAT HE OF SHE LS LICENSED PURSUAHr TO Tf1E VqOVI5�ON5 OF 7HE COMAACTOR4 LL ' � GENSE UW(OUGTEA v(COAINENCWC�M171i SECT�ON 70001 oF OIVI910N]OF THE BUS WESS ANO PHo- u" PooVSpa � FESS�ONs COOEI oH THAT HE Oq SHE 15 EXFIAPT TIEHEFROM AflO 7HE 8/515 FOH 7HE ALLEG�E%EMF- O Fl (} V TION,/�NYVqU1TlONOF5ECf10N7W�.SBYANYAP7l1CANTFORAPEANITSUalECTSTHEMPliGt77TT0 Z RaRool � A CML PENALTY aF NOT MORE h1AN FNE MUNORED OOlLAR3(iSoo1.F " � ❑I,/50YMEROFTNEVROPERi'I.OHMYEMPLOYEESVrtTHWAGE5A5THEIq50LECOMPEN5AT10N, � Cp�mBfGdl Z WILL W THE WORI(ANO TNE STRUCNPE IS NOT IMENDED OA OFFEAED FOH SALE(SEC 7oN,BU31- J � NESS INO PROFESSIaNS CrJOE'TNE CON7MGTORS UCEHSE UW OOES NOT A7VlY TO AN OWNEP OF � VFlOPERTYN�iOBNl0.50RW�R0`/ESTHEAEOfI/�NDNM11000ESSUOI�MORI(HWSELFORVIEASELFOR m [L THROU(:11WSORHEAO4MEAIPLOYEE5,7ROVIOEDTNATSUd/WPi30VEA/EHiSARENOTPffENOEDOR . W OFFEREDPoRSALEIF.HOWEVERT�BNLOWGORW7FOVEMBlT�SSOIDWf1NMONEYEAqOF � �T10N,7HE OWNER�BURDER YALL HAVE THE BUFOEN OF PROW�/i THAT HE OR SHE DIO WT BURD OR Z UAPROVEFOHiHEGURPO5EOF5/J_E7. ' . � O L�OwNER OF T71E PROPEATY,AM D(CLUSNELY CAMRACTWG WRH UCENSED COK�RAGTOHS w (?d ADJ.AREA [[ TO CANSrRUCT THE PfiOJECT(SEG 704�.BUSWE55 ANO 7i9DFE5510N5 COOE THE COHTMCNH9 11- �7a�U3�Of1 � W CENSEUWDOESNOTAPRYTOANOMlNFAOFAVROFERTYYlH08UlD50HIMPHOVE57HEAEIX{AND = WHOCONTiUCf5FOR5UCHPRQIEGTSWfTHACOMMCTOR(5)LICENSEOPUFSU�WTTOTriECON'TMG pUqN7�7y DESCR1PT10N FEE ~ 70fLS LICENSE UW.� � Y J � ❑I MI Of.EMPT UNOEA SEG B.a F.0 FOR TG HEASON � � �i ¢ lt' OATE _ OWNER . U W � IJCENSED CONTRACTORS DECLAAATION � �j CC I HEREBY AFFWAI UNDER PENALTY OF 7ERAlHY TMA7IAM UCENSED UNOEA iROV1570N5 OF CYfAP7ER � p. 9(COMMFNCINd VATH SECTION 7000)oF OM510N]OF iHE BUSWESS�NO PROFESSIONS COOE AND Z X I.fY LICENSE LS W FULL FORGE AND EFFECT. m LLI (�r � UCENSE ClASS �/2 LIC.NO. ��T 1 �� � J U �� ti corrraacTaa a w � WOFlKERS'COMPENSATION DECLAFIATION � � Q � U � 1 HER�Y hFF6iM UN�ER PENALTY OF VEiLIUNV ONE OF THE FOLLOWING OEClMA770N5: Z Q Q �HAyEµp K/�LL W1NT/Jl7 A CERTIFlCATE OF CANSEM TO SELF�NSURE FOR M'ORKER� _ � CpYpQlSATION.AS VROVIO�BY SECTOH�70o Of 7HE UBOR COOE FOR THE PEAFOHMANGE W OF TNE WOiiK FOR NM111tl1 7HI5�FAMfT 13153UED. � p \ w _I HAVE AND WILLMAWTAPI WOHKER..'COMPENSATION W9.UfiANCEAS i1£OUIRED B'/SECf10N Q ]70o OF hiE UBOR COOE.FOR THE PEAFORAUJICE OF THE WORK FOfl WNI(]/THIS PFAAYT IS ,�g,'O� LSSUED.LIy WpqKFJiS'COUPENSATION RlSUfUNGE UFW ER ANO POIIC/NUMBERARE CONSTRUCT�ON J /. > `, �`�lM IU O PLAN REVIEW ZX G0.1CYM1MBER �� ELEC'fRIC ¢ o �5s�cnc,.Nr�IDr+orgEca,qF�IDa�n+Ep��swqq�r�xa�moayu�smm�oq�ss1 PLUMBING w MECHANICAL Z I CERTIfY TNAT R1 TNE PEHFOMVNGE OF THE WORK FOF WM01 T1i6 PERNfT IS LSSUED,1 �j• - SHALL NpT ETIvIOY INY 7ERS�N IN M!Y NANNER 50 AS TO BECOME SUBJECT TO 7ME � � WpRxERSCOMPEN5�7iONUWSOFt'iLIFON+I/IANOAOREE7lUTIFISHWLDBECOME INSPECTIONFEE SUBJECTTOTHEWOWCEASC0IAVENSATIONPROVISIONSOFSECTON77a00FTHELA90R � � � coo�,i siwi warr+win�couv�v wm+nrosE aaov�sioHs. ISSUaNCE �r � - � SMIP ��f- � OATE APPLIGANT: , . r ' w ENERGY P/C J WAIWIN[1:FNWaEToSEalRE�wWCEASWMPENSATWr�cOVEMGEISVNLAwFUL�ND9iALL8E � SUg1ECi AN FJdP�OYEA TO CAINWPL PENALT�ES�NO CMl FWES U�TO ONE HUNOFlED TiOU-SAIm . E(JERGY PEAM�T OOlURS(S1aD.0aaG P1/�DDI710N TO iHE COSf OF COMVENSATION.�ANAGES A4 PHOVIOED FDH R7 "� J SECTION S1oe OF 7HE LA80R CDOE�NTEREST.ANO ATTOfiNEY4 FEES. RETEtJT10N FEE: .L��D Q . w CONSTRUCTION IENDING AGENCY PRE-ALT FEE a. � l�/�S�' �i � 0 � 1 NEAEOY AFFTRN WIDER PENALTY OF PERIUHY TNAT THERE IS A CANSTAU�TION LENOMO 11GFNCY , . FOR T}IE PEAFOFNANCE�F 7HE WORK FOR WHI017}95 PERMR IS ISSU�lSEC 7041.QV.G4 . Z W � ���E �e�SI F— LENDER'SAODREss � ,��,�„�„�,��,��,�,�,��,��T,,,,T�.��aF��n«+��+E� TOTAL FEES � � 1 AGREE TD COM➢lY N77H ALL CIIY INO COUHfY ORORUNCES M70 STATE UWS RflATiNG 70&RD W6 � CONSTAUCIION./�NOHEREBY�LLf�HORQEREPqESENTATiVE50FTH6COVNTYTOQlfEHUPONTHE Z �pyE.�,�Q�pry�p PqppEAr WH WSPERION PURP0.5ES COMMENTS � � � ^ NV '� QPEiUUT7EEN PWN�� � C�`_✓\ � � � �� t . y SIaNA7UFf OF PERM(17EE DA RECPT.NO. PAID BY VALIDAT]ON � � ' WHITE-0epartment Copy.YELLOV�F-Flnarue Copy,PINK—Assessar Copy,GOLDENROD—File Copy,GREEIJ--ApplkanCs Copy �n"�;` 4��' ����11�a i��.li� �rw,�� . y i's,:a��6�'�.`: � ��f'?; �'S���,�4�' • ' �y� -i .� . ��gs-k�f t��_ �.�'��G,_,. �.ar. �'i':_ ' . . 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J ��_�_. ---- SEPTICTANKSIZE SEEP PIT/U SIZE V - --