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HomeMy WebLinkAbout12486 (13) CITY OF DIAMOND BAR �� � �� ��A --_`� �RF DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Cag�ley Drive Suite 190 OC� O ;,,�.� BU)II.DING PERMiT APPLICATION 0����� FIRM Y ` N JOBSITE .r-�, ILPpLICATION PERMIT P/C I { o ADDRESS Z-21�2 ►-+1L. DATE 1 D^l S"�I � NUMBER �� # ! ISSUE �y TYPE OCC � � APN LOT TRACT DATE �� +��"�La CONST. GROUP p OWNER ��.dCA�S o ADURESS 22a21 j'31+ �jls.�fr'. �►L. ZOIJING SETBACKS Z CITY�/M.v.�.n� � ZIP TEL:�b'3 REART RW ❑ g APPLICANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR SIOE ❑ p� ADDflESS � v�' PROPOSED USE 1 � � CITY r�A'1� l.r r.►Nt" ZIP TEL"�l"]�I-2H QS o ARC�G/ �' t DESIGNER tQ.� � NO.DWEL. NO. NO. a. ADDRESS Z��=�*a�k � UNITS STORIES BEDROOMS � CITY ,�w'+�►����ZIP TEL.�iv2 �yy-36 cn DESCRIPTION SQ.FI: FACTOR PSF ADJ.AREANALUATION Q OWMER-BUILDER DECIARATION SFR/ADQ'AEM ¢ Q I HEREBY AFFIIW UIDER PENALTY DF PERAIRY THAT I NA EXEMPT FROM TNE CONTRACTOiS LI- `(�r9�/CBmDR � LI,! CENSEIAWFOqTH�CFOLLOWM70REA50N(SEC.7037.SBUSlNESSANOPROFESSqNSCODEPNYCITYOq (n U COWTVMMN71pE0U1RESAPEHYlTiOCONSTRUCT.ALTER���`�.DEMOLISN,ORPEPAIRANY8TRUC• W PatioJ�ecic � TIMiE,PiYOi17D 1T9 ISSUANCE,AL30 i1E0UIpE5 TNE APPLICIUIT FOR SUW PERMIT TO FILE A SIONED w STAlF4EMT 7HAi HE OR SHE IS LICBJSEO PURSUANi TO h1E Pf�VIS10NS DF TNE WNTMCTOR5 li- � C�lSE lAW(CNAPTER Y(CON4ENCiNO MATH&ECTION 70oo)OF DiY13pN J OF iHE BU91ME9$AND PflO� � PooVSpa �SSppBCOOE)Oq7HATHEOqSHE15EXEMPTTHEREFP.OMMIDTHEBASISFOqTHEALLEGEDEXEM�- C7 TIOM.ANYYIOL�TIOHQFSECTKK17W7.SBYANYAPPLICAMFORAPERMITSUBJEC75THEAGPUCANTTO � �-Rpp} � A CIVIL PEN�LiY OF N0T 1AORE THM1 FIVE HUNDRED 00LLAR5(5500)_)� � 04A90WNEROFTMEPROPERTY,ORMVEMPLOVEESkIITHWAGE3ASTHEIRSOLECOMPENSATION. � COfI1R1B(d81 ' ylMl pp 1HE WOAI(IND 7HE STRUCiURE IS NOT INTENDED OP OFFERED FOR SALE(SEC.701t,BUSI- J q�,4,Wp PROFESS�ONS CODE:TNE ODNTMC10R5 UCENSE UW DOES NOT APPLY TO MI OltlNER OF � PpOPEHTYNM1iOBUlD50RIMPROVESTNEREON.ANONMODOE4SUCHWORKHIA1SElFORHERSELFOR � (L 7Mq0UOl1 HIS Ofl MFR OMM ENPLOYEES,GROVIDED THAT SUd1 N.�PROVEMEHTS AFE NOT INiENDED OR m � OFFEREDPDNSALEIF.IpWEVERtMEBULD�N00�ilYPROVENENT�SSOLDWITNINONEYEAHOFCONPLE- 170N.S1Yc OMMER�BUIDER'�M�LL HAYE iME BURDEN OF VROVINO TH�t HE OR SHE DID NOT BUIIA Ofl � iIWiOYEFOH7HEPURP03EOFSALE� ❑L AB�MMEHOF 7HE PROVER'fY,NA E%CLUStVF1.Y CONTMCTMO Wfi}i LICENSED CONTRqCTORS Q TO COM..TRVCT T/E PROJECT(SEC.7041,BUSINESS AND PROFESSIqJS CODE:THE WNTMCTOFS U- VBIUBIIqf ADJ.AqEA W �fLAWDOEBHOTAPPLYTOANOYMEROfAPqOPERTYWMOBU1LD50RIMPROYESTXEREON,MID � W110CG/TRACT6FOASUq1PPOJECT5WITIACONTRACTOR(S)LiCENSEDPUF�UMITTOTHEWIJTRAO QUANnrv DESCRIP710N FEE � mits uc�+s�uw.). ❑I AM E%EMPT UNDER SEC. 8.8 P.G FOR TNIS REASON J O V � ¢ LL DATE ONMER F' Z � � O � LICENSED CONTRACTORS DECLARATION W � (,L��'N/� t � � 11#REBV�FFIWIUN�ERPENN.T'OFVEiUURYT/UTIAMLICENSEDIM�EflVPOVI510N50FCHAPTER -/- �y UN � •(CpWENCRN3YYRHSECT1ON7000)OFDMSN?N�OFTHEBUSWESSANOPROFESSIONSCODE,AND Z �� � r�-YGA..� � X W IN:EN5E IS BI Fl1LL WRCEAND EFFECT. � LLI � �t O 0 IICENSECIASS � LIC.NO. ����,Q,,�G♦l1�Z�__�__ J V DA7E�` —_� CONTRACTOR WM�%.�___o__I�S d tJ.l � WORKERS'COMPENSATION DECLARATION a � IHERFBVAFflRYUNDERPENAITYOFVE0.NRVONEOF7HEWLLOWMGOECIAMTiONS: � f� ¢ O _I/UVEANDN9LLMAIMAINACEHfiFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ � CddPENSATION,ASPROVIDEDBYSECilON37�00FTMELABORCDDE.FORTMEPEPFORMANCE �U OFiHE WORK FOR WHICH THIS PERMIT 191SSUED. � � W _I NAYEANO WILL MAIHfAIN YVOPo(Efl5'GOMPENSATION INSVflANCE.RS REOUIRED BY SECTpl7 � 37000F TME U90R CODE.FOR 7HE PER(-0RMMICE OF THE WORK FOR WNICH iNIS PERMIT 15 i55UED.MYWOFKEPS'COMVENSATIONINSUR.4NCEGAiiRiERANDPOLICYNUM6ERARE: CONSTRUCTION yGqpiEq PLAN REVIEW � POLICY NUMBER EI.ECTRIC I 0 �yggECl�piNE�rypTgEppMPIETEppFTtEpEp�iSWqONEVAMMEpp7LLM5(Etoo)oqLESs). 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Z W � LEN�ER'SNAME F"� LENDERSADDRE55 � 1 CEHTIFV THAT 1 HAVE READ TM�S APPLICATIDN ANO SiATE THAT THE ABOVE INFORMATION IS CORREGT. TOTAL FE ES / ) � ' �J /P1 I � 1 AGHE:TO CaAPLV WITH AU.CITY IND CDUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING / f'1 / / � CONSTRUCTION.M10 HEREB�AUTLqRRE REVRESEMATIVES DF THIS COUNTY TO EMERUPON THE Q``� J �i� ABOVE-MENrIONED PROPENTI FOH INSPECTqN VUR�OSES. COMMENTS � � ������ m PEqN �M (P � �y.•� � (n V � 9q REOFPERMITTEE OA7E � RECPT.NO. PAID BY - VAUDATIQN a WHITE—Department Copy,YELLOW—Finance Copy,PINK—Asaassor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy � i :'4. � ��l'11Y{V/�IiJ ��f7 � � . '...�'�•�,re . � ��a7��ir��V1Y Il�i✓V�iliJ � � R IF ♦ i � � "^ I S�T BACK ' � , ;. • , . FLQOR JOlST(_, •-- :, �. , : >, � . � + FTGu1FURfa�S15TEEL ! FNA REQNITS t � --__ �. 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