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Home My WebLink About14284 CITY OF DIAMOND BAR �- DEPARTMENT OF COMMUMTY dc DEVELOPMENT SERVICES � 2166a S.Capley Drive Suim 190 (909)860-3195 Fax(909)861-311'7 PRESS � '�' BUQ.DING PERNIIT APPLICATION FIRMLY a DDRESS� o p d- ! � �`7'�L/�^� DA�CATION " (� NUMBE #� � APN LOT TRACT ISSUE TYPE OCC °C OWNER �� OATE CONST. GROUP oADDRESS � LR�A'- ZONING SETBACKS � CtTY �/,(�a�Jv /3h�ZiP QC��TEL. FRONT RW ❑ APPUCANT TQ, REAfl ❑ � SIDEJSIDE STREET RW ❑ CONTRACTOR SIDE ❑ ADDRESS � � CITY f7.r e�7q/6/'a ZIP �[ TEL PROPOSED USE O � �' t o ARCFI�NG/ � DESIGNER NO.DWEL NO. NO. O ADDRESS UNITS STORIES 2 BEDROOMS � CITI( ZIP TEL. � v� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.ARFANALUATION Q OWMER-BUIIDEA DECURATION SFR/ADD/REM O p I HEREBY AF�1 UNDER PENALTY OF PERAIRY TNAT I MI EXEMM FPOM TXE CONfMCTORS LI- l� CENSEUWFd1iNEFOLIOWlX3/IEA9ON(SEC.7IXf1.58U5ME53ANDPROFE5SIQJSCODEANVCRVOR � Ge1R96/CBfPOR ZOOIIMYNRHCNREOUNE511PENMRTOCONSTRUCiALTE0.9APROVE.OE1tlLI5M.ONREPAWANYSTRIJG W P81b/DBd( 4J �E'P�TO IT9�AH�K80 REWIqES THE APPLIC�WT FOfl SUCM PERMR TD i1LE�SIONED W � BTAiENEM TW�T HE qi 3HE t3 IJCENSED PUR3UANf TO 1HE PROV1310N3 OF THE CONTRACTORS LI• CEMSE LAW(QNFTFR Y(COMMENCNW WrtFI SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRo- V' POOVS�.18 FE5910NSCODEjOqi}iATNE0A3MEISD(EIAPTTNEREFROMANDiHEBA51SWRhIEALLEOEDEXEMP- (� TION.ANYVpU1T10NOF5ECTION7W1.6BY11NVAVPLN;AMFORAVEiM11TSt1B.lECTS7NEADGLMIMTO Z Re-Roof � ACMLiENALTYOFNDTMORE7WNFlVEMM�REODOLLARS(t5oo�.): O ❑AASOMMEROFTHEiROPEHiY.ORMYEMPLOYEESWI7HWAGESA57HE1R50LEWMPEN511T70N, (�`pmTBfCial - Z YYA.l001HE WOR141WD TME STRUCTURE IS NOT INTENDED Oq OFFERED FOR SALE(SEC.7oM,BU34 �J � NE88 AND M10FE8810N3 COOE:7F1E CONTRIICTORS LICEI7SE UW DOES NOTMPLY M AN OWNEii OF � %qPEp1V MIFiO BUlp50q MPROVESTMENFON.MlO WIIOOOES SUC11 WORKHIMSElFOR HERSELFOR Q 7lW011[MIMSORHEROWNEYROVEES.PHOVIDEp7{UTSUCNMVROVEMENTSARENO7MEPDEDOR m � ,OfFEREDPoRSILEIF,IbM/EVER7Y�N11LOW1[ia1MPROVEMBtiBSOLOWITWNWEYEIIHOFWNPIE � TIOK iNE OWNER-0UMEl1 N1LL NAVE THE&/RDEN OF PROVINf3 TMAT HE OR 8NE DID NOT BU0.D OR MWiDYE WH7HE PURPOSE OF SKE� {yJ O l A80NNER Of TiE PMPEHfY,AM EXCLI�NELYCQNiMC1Mfi Y/fTli LICEMSW OONTMCTOHS ¢ 10 CONSfRUCT iME GRO.lECT(SEC.70N,&151NES3 MID OROFESSIONS CODE:THE COHTMCTORS lJ- 81U8t� � ADJ.AREA W CB/9Ell1WWEslqTA�LYiOANOwNEflOFAPPOPEHTYWiqBURDSORNIPROVESTHEREON,AND WNOOONTRIIGT3 WNSl1G1 PNO.IECTB WI7MACOHfAACTOR(S)IICENSED PURSIW7lT07l1EOONTMG r�uc�nsE uwa. QUANTRY DESCRIPTION FEE i � o i�ExEuar urnFn sEa e a r.c.r�niis nEnsoN ¢ U i LL ¢ I y �� U i � w LICENSEO CONTRACTORS DECLARATiON W I/ERBYAFFYUiUDERVENIILTYOFVE1USiY7MAT1A1llICEN5Wl1NUEPVflOY1510fJ50FCHAV�ER � I'. � •(COAWEMCRIO WRN SECTION 7000)Of DM310N�OFTHE BU51NE55 AND PROFE5510NS CODE,AND Z lL iRYUCEN3ElRtlVRR1.idHCEM4fFFEC7. � �«,� u�.�.�513 7,G m � �..� T }a , � DAh � CWRM�TOR t . . � WOHKER5 COMPENSATION DECLARA710N - ` 4 � � 1 HEPFBY�FFIPoI lN�Efl PENKTY OF PER.AIRY ONE Of h1E FOLLDtNNG DECUMTIONS:C� Z . � _IFMVE/d1DWILtMA91TNNACEIifIFlCA7EOFCONSENfTOSELNNSUREFORV`ON(ERS' _ � CONPBd3AT10N,ASPF10VI0EDBY5EC710N37ooOFiHEUBORC�E,PoRh1EPERFOi1M�iJCE U Q OF WORI(FORWHN?iiFuSPERM�Ti5155UED. � � � _�/�Ip Wtl,�MAMryW Wpp�(EpS CqM�15ATION INSUAANCE.AS REOUIRED BY SECTION �� ^ � 77ou OF 7!�LABOp COD�Poq 1HE VER WRMMICE OF TiE WORK FOH WHiCFi iHIS PERMA 1S L / � I5�1�.MY WOItlCEF6S'COMPENSATION INSURANCE CAARIER AMI POLICY NUMBEfl M1HE: CONSTRIJCTION �l� � c�qr�Eq � N� PUN REVIEW � �� ELECTRIC � (M55ECIIONN�Pa78E00AFiEi�oF7liEVEaMfBWHOPEH.1M11�0otiNSlsta%onL6SS} PLUMBING y 1 CERI7F/7HAT N THE VEAFOAMANCE Oi 7HE WORK FOR wHlpi Ti1S PEPo.IR IS�SSUED,I MECHANICAL (� SH+1LL NO'T EMPLOY M1Y PERSON W N1Y MMNER SOAS TO BECOME SUBlECT TO THE ! y WOqNER5COAIVENSATIONUYVSOFCALIFORNIA,AN�taNEETHATIFISHWlDBECOUE INSPEC'T�ONFEE S SIRJECTTOTNEWOiMERS'U�IAPENSATQiPFmY1SpNSOfSECT10N37000Fh1ELA90R caoE i s�uLLcoaTHrnrn caur�r mrn rnows�7�!�- ISSUANCE � � DATE�� N��Ppi�A rM�.�/rGV�•� SMIP � WMNINLiFAWRETOSECUREWt7RICER5COMPENS�TqNCOYERAGEI3WLAWFUL.NASHALL9E ENERCaYP/C LL SI�JECfANEMPLOVERTOCRIMINALPENALTIE9MIDCIYILi#aESUVTOONEHUNONEOTIiWSM/D ENERGYPERMIT � DOLLAIiS(f10o,000),N ADDITION TOIHE COST OF COMPENSA7qN,DAMAOES AS PROVI�W FOR IN ¢ SECTION�7M Of THE UB011 OODE,MEREST,AND ATfORNEY'S FEEB. RETENTION FEE: � d CONSTFiUCTION LENDING AGENCY PRE-ALT FEE: O —` Q I HEREBY AFFlRIA tX�qER PEN/�L7V OF PERJURV 7HAT7HERE I8 ACONSTRUCTION IRXNNG A6ENCY z� WRTHEPERFOiWM10EOFTHEWORKF�RWMICN71N8PEPMRISISSI�D(SEC.30�.CN.G). . W _ � LEImEH'E NMIE � LENDER5/�DORE33 � 1 CEIITIFY THAT 1 HME READ 7HIS MPLICATION M10 ST�TE TMAT TIE ABOVE INF-0RM�TION IS CORRECT. TOTAL FE ES � d I AGREE TO COIdVLV WRH Nl CrtY NJO C�WTV OR�MIANCES AND STATE UN5 RfUT#!G TO BUkDMq � CONSTPUCTION.AlDNEN�YAUiiIORREfiEVRESENTATNE50F7HI5WUNTYttJB7�EqUVONTME �eove.�.�srrtonEnonovERrr insrEcrar+Pur�rosEs. COMMENT5 � �' .t.�+rQ, �74.t�. s m ,� ,,�, " ..,r/.. � �. _ � � / y SIONA E RMITTEE DA7E 7� � RECPT.NO. 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