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HomeMy WebLinkAbout18418 (880) - - _ _ .�. --_ . _._- - �� CtTY OF DIAMOND BAR ; DEPARTMENT OF COMMUNTIY&DEVELOPMENT SERVICES �. �x` 21825 E.Cop�ey Drive PRESS (909)860-3195 Far(909)861-3117 "'::�' BUILDINGPERMITAPPLICATION FIRMLY JOBSITE � APPLICATION PERMIT P/�O�, i L o ADDRESS 155o S. VALi,EY VI5TA DRNE DATE � '� UMBER N � c� ISSUE � � TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER o ADDRESS ZONING SETBACKS Z CITY 21P TEL. FRONT FW ❑ g APPLICANT TEL. REAR ❑ SIDE/SIDE STREET RW O � CONTRACTOR D���J,z+++ DEV� OPMENT CORPORATTON SIDE ❑ oADDRESS 9 l P $T ' H PROPOSED USE INSTAI,I, pREE'ABRICATID PAINT SPRAY o CfTYWFS'T'j� R _f' ZIP,��� TEL � �� wo ARCH/ENG/ g97�-�.57 � DESIGNER NO.DWEL NO. NO. ADDfiESS UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION cn p� OWNER•BUILDER DECLAFATION SFR/ADD/REM O 0 1 HEREBY AFFlRM UNDER OEN�LTY OF OERJURY hIA7 I AM EXEMPT iROM THE CONTMCTORS ll• Gdf89B/C01POR W CENSEUWFORTHEFOLLONAN6REASON(SEC.70]f.S8U51NE55ANDOROFE5510N5CO0E:ANVCITYOR (n � COUNi'lVAIICHREOURESAVERMITTOCONSTRUCT.ALTERRAPROVEDEMOlI5V1,ORREVAIRANYSTRUC• W patio/Deck w tURE,PRpR N RS ISSVANGE.ALSO REDUIRES THE APPLICANT FOR SUCH VERMIT TO FILE A SIGNED W � STATEMENT THAT HE OR SME IS LICENSED PURSUMJT TO THE PROVISIONS OF THE CONTMCTORS LI- � LENSE UW(CMAPTER Y(COMMENCINU YnTM SECTION J000)OF DiVISqN�OF THE BUSiNE53I1ND PRO- V" POOVSpO � FESSqNSCODE)ORTMATHEORSHEISF%EMPTTMEREFROMANDTHEB�SISFORTMEALLEGEDE%EMP- V TION.ANYNOLATIONOFSECTION70]1.6BVANYAPPLICANTFORIIPERMITSUBlECTSTHEAPPLICANTTO Z qe-Raof � �CMLVENAITYOFNOTAIOfiETHANFNEHUNDREDDOIIARSIS500).1: 0 04ASOWWEROFTHEGROPER7Y.ORMVEA�PLOYEESNATIIWACESASTHEINSOLECOMPENSATION. � COmrtl6fCi01 WILL 00 THE WORK M1D THE STRUCTURE IS NOT INTENDED OR OFFERED FOR S�LE(SEC.7ou,BU51• J Z NESS AND iROFE5510N5 CODE:TNE CONTMCTORS LICENSE UW DOES NOTAPPLY TO AN OWNER OF � iROPER7Y1MfOBU0.D50RIMPROVESTHEREON,ANDVrt10DOE55UpIVlORKHIMSEIFORHERSELFOR m Q THHOUGIIHISORHENOWNEMPLOYEES,PFOVIOEDTHATSUCH4APROVEMENTSARENOTWTENDEOOR W pFFEREDFORSALEIF,MOWEYER7NEeULDINGORIMPROVEMENTI550LDWI7MNONEVEAROfCAMPIE• 0 TqN,THE OWNERAUILDER WILL HAVE THE BURDEN OF GROVINO THAT HE OR SME DIO NOT BUIID OR Z MPROYE FOR THE PURPOSEOF SALEI � 04�OWNEHOFTXEVROPERTY.MIEXCLUSNELYCONTMCTIN6WRHLICENSEDCONTMCTORS Q M CONSTRUCT ME OROJECT(SEG)ou.BUSINESS AN�PNOFESSIONS CADE:THE CONTMCTORS LI• V2lllatlOfl ADJ.AREA W CENSEUWDOESNOTA7PLVTOANOWNENOFAPROVERTYNT100UILDSORIMPROVESTHEREON.AND ` Z NAIOCOMMCISFORSUdIPR0.1ECTSWITHACONTiUCTOR(S�UCENSEDDURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE F- TOit3LICENSEUW.�. �,T�e}� ��/y� ¢ OIAME7(EMPTUNOERSEG B.�V.C.FORTHISREASON Q X 11`IJlA 1�iV1OR � o X INSTA GHT UN S ��" OATE OWNER V �¢ LICENSED CONTRACTORS DECLARATION W CL I HEREBYAFFIftM UNDER VENAL7V OF VEiWRV THAT IAM UCENSED UhOER VROVISIONS OF CNADTEH � d Y(COAIMENCW6WRHSECTION70o010FDM510N�OFTHE8U5iNESSANDPROFE55�ON5CODE,AND Z MYLILENSE IS W iULI FORG/E�MiO EFFEGT, m � LICENSE C S � vl� u�.No. 510150 � V DATE COPlTMCTOR a . __ w . ._.._ . . . . . .. � WOFKERS'COMPENSATION DECLARATION U X INSTA PREF'ABRICATID � IHENEBYAFFIRMUNDEHFENALNOFFE0.NfiYONEOFTNEFOLLO'MNGDECUMTIONS: a pAINT SpRAY BOOTH � �IHAVEANDWILLMAINTAINACERTiFICATEOFfANSEMiOSELF-INSUREfORWJRKER5 2 � COMPENSATION,ASPROVIDEOBYSECTION�7000FTHEUBORCODE,iORTNEOERFORMMICE w �OFTHE WOFK FOR WHlp/THIS GERMIT IS ISSUED. � O _I HAVE AND WILL MAIMAIN WOHKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTIpN � O 97ooOFTNEU�BORCADE,FORTHEPERFORAIANCEOFTNEWORKf-0RNM1IILHTHISPERMITIS ISSUED.MYWOflKERSCOMPENSATIONINSUfVWCEGINR�ERANDDOLICYNUMBERME: CONSTRUCTION j . 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RETENTIONFEE: a CONSTRUCTION IENDING AGENCY� PRE•A T FEE: O - � IHEREBYALFIRMUNOERFEN/LLTYOFPERJURYTHATTHERE�SACONSTRUCTIONIENDIN6A6ENCY Z FOR iHE VERFORAIANCE OF iHE WONN FOfi WHiCM iNiS PERMIT IS ISSUED(SEG 7097,CIY.G). C1! � LENDER'SNAUE F- LENDER'SADORESS WICERTIFYTHATIHAVERFJWTHISAPP4CATqNM1DST�TETHATTiEABOVEMFORMATqNISCORRECT. TOTAL FEES 33 � IAGREETOCO�APLYWITMALLCfiYANDCOVNTIORDINMICE5ANO5TATEUWSREUTIN6TOBV0.OIN6 CONSTRUCTION.ANO HEREBY AUTMORIZE REPRESENTATIVES OF 7H15 COUNTY TO ENTER UFON TNE Z ABOVE�MENTIONEDPROVERTYFONINSPECTIONVUaPO5E5. � COMMENTS � AI,FRED JESLEE / AGENT � QVERUITfEE NILLAE(V 3/29/Oz � � SIONANREOFPER TEE TE RECPL MO. PAIO BY VALIDATION � T Department Copy,YELLOW—Finance Copy,PINK—AssessorCopy,GOLDENROD—File Copy.GFEEN—ADDlicanCs Copy � , . .. � �� ., f ........ ,. .�.. tr . .J ..- � . .. - , ��..T,�. � . ., . 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