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HomeMy WebLinkAbout14785 (1102) " �� ���_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEYELOPMENT SERVICES � , 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)B61-3117 PRESS '�^' � BUILDING PERMIT AFPLICATION FIRMLY r JOBSITE 0 APPLICATION PERMIT /�(J�-,L�= P/C o ADDRESS ���— �Ga �t,l i✓rd 1c/uOc-A_ DATE_ NUMBER k � APN �OT TRACT pp� �/-� o p a TMPE OCC / ��� CONST. GROUP � OWNER d�.. .� .l - -�-- 8 ADDRESS�g'(,��"+—I a�.-,h��� /V�__ ZONING SE'TBACKS � C�TY ,ZIP TEL.a�b—�Y�/y�tl FRONT qyy p APPUCANT TEL. REAR ❑ z�. � SIDE/SIDE STREET RW p � CONTRACTOR � • SIDE p ¢ ADDRESS � CITY� ZIP�[[ TEL._.�"� PROPOSED USE r - o ARCH/EN ' � DESIGNEFi NO.DWEL. Np. Np, ADDRESS UNITS_� STORIES '��BEDROOMS � CITY ZIP TEL. �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWN[R-BUILDER DECLARATION p SFR/ADDfREM p I HEREBY�FFlRM UNDER PENALTY OF PERIUM 7HAT�AM EXEMP7 FRou 7NE CaN7RACioR5 LI- GBfSgB/CelpOrt LLl CENSEIAWFONTHEFOLLDN'INGREA50N�SEC.7o31_6BUSINESSANDPROFESSIDNSCODE.ANVCIiVOa (n C7 �qJl�'yMICNRE0U1qE5APERMITTOCONSTRUCT,ALTER161PROVE,UEMOL15H2ORREMIqANYSTRUC- w Petp/�BCI( Z tUHE,PRIOR TO ITB 166UAHCE,ALSO REOUIRES THE�PPLICANT f-0R SVCH PERMiT TO FIIE A BMaNED W � STATEMENf THAT HE OR SHE IS LICENSFD PURSUANT TO THE GRqVIgIDNS OF TNE CONTRAGipHS LI• � � CQISE LAW(ClU1PTER Y�CqMMENCING NATN SECTION 7000�OF DIYISION 9 OF THE BUSINE55 AN�PHO- POOUSpB FESSpN5000E�DRTHATMEOHSHEISE%EMPTTHEREFROMANOTi7F.6A515FORTHEhLLEGEDE%EMP- (� iqN.IWYVI0LAT10NOFSECT10N70.11.6BYANYAPPLICANTFORAPERMITSU&lECf57HEAPPIIf.AN7T0 z Ra-Roof (� F, ACIVILPENJLLTYOFNOTMORETHANFNENUN�REU�OLLARS(f6pplJ'� � ❑4ASOWNEROFiNEGROPERTV,ORMYEMPI.OVEESWITHWSGE5h5THEIR50LECOMPEN6ATION, COfI1ffIB�CiBI - NIILL 00 THE WORK�TNE STRUCTUHE IS NOT INTENOEO OR OFFEREO FOR SALE(SEC 70��,B1151- Q � NE85AND VROFESSIONS COOE:THE CONTRACTOqS LICENS[LAW DOES NOTAPPLY TO AN 01NNER OF PROPEHfYMMO8UILDSORW�ROVESiHEREON,ANOriHO�0E95UGiWORKHIMSLLFOflHERSFLFOR � WTNiWIWHMSORHEROWNEMPLOYEES,PROV10ED7HA75l1CHIMPROVEMENiSARENOTINTENDE00R m � OFFEHEDFOFSKEFFqWEVER.7NE8ULOMCORIMPfiOVEMENTISSIXDWITHI.NONEYEAROFCOMRE- TIDN,TNE OWNEq-0UILDER W�LL HAVE THE 9UROEN OF PROVING TFUT ME OR SN�DID NDT BUIL�OH � IMPROYE FOH 1HE PURP0.SE OF SALE). �y ❑4ASOMMEROFiHEPROPERiY,AME%CLIISNELYODNTRACTINGWITNLICENSEDCOMFACTORS � TO CONSTHUCf THE PpOJECT(SEC.7W�,BUSINESS ANO VROFESSIONS COOE.TNE CON7RAC.TpRS LI- V81U8f1Of1 _ADJ.AREA W CENSEUW�OEBNOTAPPLYTOANOWNEROFAPROPERTVWHbBUILO50RIMPROVESTH£REON.AND � N?qCOM1UCT8FONBUCHPRQIECTSMATHACONTRACTOR�S)LICFNSE�PURSl1FNTrOh1ECONTRAF QUANTITY DESCRIPTION ioAs ucErasE uw.p FEE � ❑IM/E%EMMUNUERSEG B.iPC.FOPTHI,REASON � � � 3 �[�-' � OATE OWNER F' � ___'- ___ W � LICENSED CONTRACTORS DECLARATION � � I MEREBY�FFIRM UNOER PENALTY OF GERIVM THRT I�M UCENSi:�UNDEH VFOVifliONS OF CHAPTER � � Y�QOMMENCNIOWIT?ISECTqN7000�OFDIVI5lON30fTHE9U51NE55ANDPROFESSIONSCADE,AND Z NY LICENSE IS IN FULL FORCE AND EFFECT. LV /� rS� m � LICENSECLASS �^•^�� LIG NO. J �S� � �j DATE y� Dl�� GONTFACTOH��iy_ � W � WORKERS'COMPENSATION DECIARATION Q � I HEREBY�FFIHM UNOER PENALTY OF PERIURV ONEOF THE FOL[OWING DECLARATIONS: Z � _IMAYEMAYYILLMAINT�MACEfifIFICATEOFOONSENTTOSELFINSIJREFqqWOqKERS' a 2� COMPFNSA7N)N,ASPROVIDEDBYSECTION37ooOFTHELABORCOL7F.,F4RTHEPERFOAMANCE U �EMpHN FOR WHIp1 THIS PERMIT IS ISSUF.�. W: �i I HAYE AND MflLL MAIMAIN WOflKERS'COMPF.NSATION INSURANCE.AS RF.OUIRED BY s[CTIOY �'y���''''']]J /�n Q 9�00 OF TME UDOP CODE,FOR TNE PERWPMANCF OF THE WORK FDfi WHICH 7H15 PFPMIT l$ � 7( / v � ISSUE�.MY WORKERS' P NSA ON INS NCE CARPIE ND Ppl ICY NUMBER ARF. CONSTRUCTION _ �, / j c�aaiEa ___ __ � pLAN qEVIEW __ � POIICYNUMBER I C^/!/1 / _ ____ � ; ELEG7RIC __ b � (IHlSSECfICNDE�FpTBE00MR.ElFDOF7/¢PEFMT6FOAONFHNl7F`EDDq1PR5({tpp�pq�E55} I PLIJMBING Z I CER7IFV THAT IN 7HE PEFFORMANCE OF THE WORN FOR WHICH 7HIS GEHMIT IS ISSUk 0,I I MECHANICAL �' � • � SFULL NOT EMPIOY ANV PERSON IN ANV MANNFR SO AS TO BCCAMF SUOJF_C7 TO TNE �'i= (p WORNERS'COMPENSATIONLAWSOFCM.IFORPIIA,RNOAf:qEETHATIFISFK)ULDBECOMF. � INSPECTIONFEE SUBJECT TO THE WORNERS'COMPENSATON PRONSIONG OF SEGTqN 310o OF TNE UROR s CODE,I SHAIl FOWfHWY7NCOMPLY WITH TFKJSE PRnVI517NS. I ISSUANCE � /� � � � V 4 p DATE: APPLICANL __ � SMIP ♦ � � WARNIN(i:FALIIRE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWRX,AND SHI!L 9E ENERGY P/C �yy�,�' _A��A�$� r�a s va iu�F �y SUBJECTANEMPLOYERTOCRIMINALPENALTIESANOCIVILFINFSUGTOONENl1NOREDTNOUSAND ENERGYPERMIT 7f]T�TT TTAT/"� ART C � � DOLLAflS(t10o.o00),IN ADOITION TOTHE COSTOF COMPENSP1qN.DAMA�'c5 AS PROYIDED FOR IN —���I.���`�_��.,�_� � J SECTION970BOFTHELAffORO�OE,MTEREST,ANDATTORMFYSfEF.S. CC RETENTION FEE: OCONSTRUCTION LENDING AGENCY pRE-ALT FEE: � IHEREBYAFFIAMUN�ERPENAITYOFPFAJURYTHATTHERF.ISA('ANSTRVCTIONIENDING�CFNGY I FOR TME PERFORMANGE OF TME WORK FOR Wh11GH THIS�ERMIT IS ISuUEU�SEC.309],CIV.C.). Z W � LE#IDER'9 NAME __ _ __ I-� IENDER'SADDRE55 W� � TOTAL FEES l .�J(J IGERTIFYTHATIHAVEREADTHISAPPLIQ1TIpNAN05T11TETH�TTHEIIBOVEINFORM11T10NI5CORHE(:T. � IAOREETOCdAPLYWITHALlCI7VANOCOUHTYORDINANCE5ANO5TATEUWSFlFIATINGTOBUILDING � CONSTRUCTION,ANDHEREBYAUIHORIZEflEPRESENTATIVE50F1HISCOUNTYTOENiERUPON7ME ABOVE-1AEMTqNED PROPERTY FOH INSPECTION PUHP0.SE5. COMMENTS � J � �S. /Z � m PERMITTEENAIAE .n � • ���� � SIONATUR EE D0.TE � RECPT.NO. PAID BY VAI.IDA710N WHI7E—Department Cooy,YELLOM�--Finance Copy,PINN—Asu�ssa Copy,GOLDENR06--Fils Copy.GREEN—Applicent's Copy CITY O� DIk14ttOFJD BAR �`Y�' .� INSPECTiOtd RECORD c e � � - � s f � • t • SET BACK �. ,, ; ' ', ' � FLOOR J0,15T . . . -. �• , FTGS/FORMSiSTEEL FHA REGIM7S ELECTRIC GROUND UNDER FLOOR LZUCT , . ;� GROUND PLUMBING UNDER F1.00RGU�IDUIT .: ,� ,.�'�- _ r. •, , SLAB GRADE � FIREPL'AC��UIJNDATION • ' � � - TEMP P�WER FIREPIACE BOND B'EAM � '- WATER SERVCCE MID HT. 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