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HomeMy WebLinkAbout16163 (32) � _ _ . _. . . � � . ,s— . �� CITY OF DIAMOND BAR � �, DEPARTMENT OF COMMUNITY 8z DEVELOPMENT SERVICES - �-' 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 R�$$ � 4�� BUQ.DING PERMTT APPLICATION _ « ` z � FIRMLY � JOBSITE � � APPLICATION C1 �_�1 NUMB R � �P I ��►`���1� o ADDRESS�� E•?-.� C.t��.�•.�rrv �11ST"� DATE �� � ISSUE TYPE OCC APN LOT -U� TRACT SLZ C�� DATE CONST. GROUP g OWNER ' � �'� � ADDRESS jS� � A1t.�.1'1 ZONING SETBACKS � CITY I rJln+c�. ZIP TEL��IS"7�j�•YY FRONT RW ❑ APPUCANT ��►�P TEL `'�m E' REAR ❑ � SIDE/SIDE STREET RW ❑ CONTRACTOR C� SIDE ❑ g ADDRESS �` �� . CITY I ryi!l 0 ZIP�2�r 2._TEL�J�i rl -7q'7--4'1 rj PROPOSED USE—'��i�-Q ' ���c ARCH/ENG/ .t,� DESIGNER_I��i•lr,� L'�uS�' �' SS D C NO.DWEL NO. NO, ADDRESS tit' UNITS STORIES BEDFIOOMS � CfTY ZIP�Jj,�,�TEL�JVR-4"�1-'S'J� � DESCFiIPTION SQ.Ff. FACTOR PSF ADJ.AREANAIU TION Q OWNER-BUILDER DECLARATION SFRlADOhiEM � r. p I HEREBY AFFlqM UNOER FEwLLTY OF iERNRY TW�T�IUd ExEMPT FROII TME LONTMCTORS L� G8f8Qa�C9ryOR lll CENSEUWFORTHEFOILOWNOREll50N(SEC.70.7fABV57dE55ANOiRO�E55lON5COOE:AN`lCRYOR (/� (,7 ppU!(T7YN/1f]IREOUWESAVERMfT7DCON57fNCT,/�LTERMPROVE,OEMqlJSM.ORREPNRANYSTFUG W P8ti0/DBCk Z TUNE.PRqli TO R3 ISSUANCE./150 HEW�RES TNE AVOLICANT FOfi SIKM VERM17 TO i1LE A SiGNED �� SiATEMENT THAT ME ON SME IS IICENSEU Vt/RSUu(7 TO TME PROV�SqNS OF THE CONTMCTORS L4 W � CENSEUW�OUP7ER��COMMENCWOMA7HSECT%7N7000)OFOMSiON10FTMCBU5INESSAN�PRO- LL' PooVSpa FE5510NSCQOE)OflTHATMEOR5ME13EXEMPTMEREFROMANDTMEBASISFORTTIE�LLIEGEDE%EMP• (� TIDN.AN\VIOL�TIONOFSECTIOH7W1.6BVANVMPLMJWTFO(iI1PERYITSUBJEMSTNEAPPLIGNTTO z Re-Roat � ACMLVENK7YOFNOT►qHETMAHfIVE1MIDREDDOLlM5�i5001.1: � OLtiSWMEROF7NEPROVEHTI.ORMYEMf�WYEESVATHWADESlISTHEIP50LECOA�PFHSATION, ❑ COrt1rtI0fC12I - ' MA.L DO TH[WOfYC M1D THE 6710.1CNRE b NOT IMENOED OR OFfEPED FOR SAIE(SEC,7W1,&154 J NE55 FW FROFES^ S COOE:TME CONfMCT00.5 LICENS[UM�DOES NOT APPLY TO AN OWNER OF - � iNOOEfRY1M1�8ULDSORMPiqVESTHENEON.MIDY.��000E55UQ1NORNM145ELFORMF0.5ElFOR � ' � TFWOUCi11HI40RHENWNIEYPLOYEFS,GfLWDEDiHATSUCl/YPROVEMEMSARENOTNTENDC00R m LL1 OFFERED iOR SALE G.NOWEVER7ME BUIL�0IGOR MPRDVE4EMR 501D IM7MiN ONE tFAA OF W1ARE• � T�ON,INE OW11ER-BUILDCR MlILL H+WE 1NE BUi1�EN OF PROWb TMAT Hf OR SME DID NOT BUIID OR = Y7i1�VE FOR 1HE VUHPOSE OF 8ALE1 �1 w 040.50VMEROF1HEiROPEif'1'.AME%QUSNELYCONTMCTP7GWITHLICFNSEOCONiMCTORS [C TO CONSTRUC'T TME PR6IECT(SEC.70a�1,BUSINFSS ANO PROFESSIONS CODE:THE CONiMCTORS Lb V01U81i0R ADJ.AREA C1J CEN6EUWDOESNOTIPRYiOANONMEflOFAPROFERTYMAqBURD50RaPROVESiMEREON./WD � yAqCDNTRACTSFORSUCMPR61ECf5WI7NACONTMCTOq(SJLICENSEORJRSUANiTOT1EWHfMG QUANTITY DESCRIPTION FEE � TORS UCFNSE Uw). ...I O�NA EXEYPT UNDER SEC. 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RETENTIONFEE: . � pW., CONSTRUCTION LENDING AGENCY PRE•ALT FEE: O � IXEREBYAfFIR4UNDERiENALiYOPPERIURYiNATTMEREI3ACON5TRUCT10NlENDINf3AGENGV ' FOR TME P[RFOMIANCE OF TIf WORK iOH WM�CM TMIS GEpuIT IS ISSUED(SEC.7W].GIV W. � LENDERS NW E N��N�G� ���I��P �,,�D Mp� l�Yr ' / � �[NOER'SI1DDNf55 /�/� � ICENTIiVT1ATIMAVEREADTNISAPRJGTION/WDSTAiEiw�TTI�E/iGOVENiO(WATqNISCORRECT. TOTAL FEES V`t/ lO 1 d 1 AGREE TO C�PLY 1NTM ALl GTV AND COUkTY ORDwIWCES/�ND STATE LAwS REUTINC TO BULDINC � CON57PUCfION.MD HEREBY AUTTqPIIE REPRESENT�TryES OF 7NI5 COVN7Y TO ENTER UPON THE � ABOYE�MEMqNWPROPERTYFOFlMSPECTIONPVRPO5C5. COMMENTS O J � m iER�A�TTEENAIAE(vNNf) _ Q G7 y SiGN�iUREOFYERuiT1EE OATE � FECPL NO. ' PA70 BY _VALIDATION Y�HITE-0epartment Copy.YELLOW�inflnce Copy,PINK—Assessor Copy.GOLDENROD---File Copy,GREEN—ApplicanCa Copy . - , CITY OF DIAfJiOI�IID B�',R , � � -_� . •, '''' - : li,lSPEC�IO�d FECG�:D . .,_ . �� ��.. 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