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HomeMy WebLinkAbout16042 �,: �.� �� CITY OF DIAMOND BAR / - DEPARTMENT OF COMMiJWITY 8c DEVELOPMENT SERVICES �� 21660 E.Copley Lhive S uite 190 . � (909)860-3195 Fax(909)861-3117 . PRE$S ���� � BUILDINGPERMITAPPLICATION ' FIRMLY yy, JOBSITE �� APPLICATION �PERMIT I\L P!C o ADORESS 3D3V �srl� I2a�GIC �- DATE I— �� NUMBER v I k � ISSUE NPE OCC APN LOT TRACT DATE CONST. GROUP ' p OWNER $M 1 f'h o ADDRESS ��3� C✓�srLF oG�`' � ZONING SEfBACKS Z CITY � ti ZIP 2i��r TEL.904-S9'�'S3 3 FRONT RW ❑ g APPUCA TEL. REAR ❑ � SIDFJSIDE STREET RW O CONTRACTOR �ia//f7NlE .,G�rtFae�lE�.J .T.NC _ SIDE ❑ ADDRESS 3f"z3��_/f � �� PROPOSED USE � CffY liia _ wc�r�t ZIP 9�Zz TEL.S�2-Sd'G-SS"�/ o ARCFVENG/ � DESIGNER NO.DWEL NO. NO. ADDRESS UNITS STORIES BEDROOMS NN CITY ZIP TEL. DESCRIPTION SQ.Ff. FACTOR PSF AW.AREANALUATION ¢ OWNER•BUIIDER DECLARATION SFRIADD/REM O p I 11ERE8'!AFi1RM UNDER FENALTY OF PERlURY TH�T�M1 EXEMPT fROAI iNE CONTMCTORS LF Garaga�CarpoR W CEl15EUWFOq1MEWLlOWN�NEASOH(SEG7a716BU5WE5SANDVROFE5510NSCODEFNYCfTYOR (n � COUHTYN79GIPEOUWESAFERMRTOCONSTFKICT.ALTER7�PROVE.DEI.V�USM,ORREPAIRN7VSTRUP � W Patio/Deek . . _ . 7UpE.Vp10R i0 R9 65UM+CE.A150 REQI�RES 7HE APPLIGNT FOFi SU�i PERMIT TD FILE A SiGNED .� 6TAlEMEHT Tu1T HE OH SHE 6 LiCEN5E0 PURSUAH7 TO THE PROVISIONS OF 7ME CONiPACT00.4 L4 � CFNSELAW(dUPTERO(COMMENCNOY/ITl15CCTION70o0IOFDIVI5qN70FTMEBU5ME55ANDPN6 � PooVSpa FES9qN5 OODE)ORTMAT HE OR SME 19 E%EMPT iHENfFROM ANO THE B.�3�5 iOR 7HE ALL£CED E%EA1P- TION.ANYVIOLATIONOFSECTION7af7.6BYINYAVpIK'ANTiORAiEHMITSUBJECTSiHEAPPLIGN7T0 Z RaRaof � ACIVIL PFNALTY OF NOT MORE T1UN FNE IUNDRED DOlUHS(f600).F ' � O1�.4�NHENOF7HEPHOVENTY.ORYYEMO�OYEESN'I7MWAGESti57HEiR30lE[OMPFHS�TqN, � (;pmmeft471 � � YML CO THE M'ORK,/ND TME STRUCTURE�S NOT IMENDED OR OFiEREO FOR SALE(SEG 70W,BU54 J NESS ANO iROFE5510N5 GODE:TNE CONTMCTOiiSl�CE/M'E Uw OOES NOT APPIY TO 1W OWNER OF N p{qPEp}yWFp91J�$pqIMVpOVESTHEREON.ANOMMODOESSUCHWORKHI45ELFORMERSELFOR - m � TFWOUWMISORHEROwNEMP�0YEE5,FROV10miNATSUpfMPROYEIAENTSARENOT47TENDEDOR W .OFFFRmWRSALEF,HOWENER7ME&1RDING0111MPROVEAIENTISSIXD'NfMNONEI'EANOFCp.IPLE Z TION,THE dYN1ER8UiLDEA WILL Fu�'E THE BVRDEN OF PROVP/O iMA7 HE Oq SME DIO N�T BURD Ofi ^ MiROVE�ORTM[PURP0.5EOFSALEI y, OL1�40YMEROFTHEpROPERTV,AME%CIUSNEIYCOMPACTINGWRHIC[NSEOCONTMCTORS LL ElKEUWDOFSNOTAPOLYTOANCMTIEROFAi OP RTVE wHoaun.oSo��aaovESn+REon.u+o ValUallon ADJ.AREA � vmocarrn�crsaonwcnvxa¢ersmnueartrucron�s���ceNseoruaswurtron+¢c«+rn,�o pUANTITY DESCRIPTION FEE � roasuco+sEuw�. O I AY D(EYPT UNDER SEC. B.�P.C.FOR THIS REASON U Q LL" OATE OWNER V �.� � � � W _.. . � ' . UCENSED CONTRACTORS DECLARATION W � � IHERCBYAFFYUINDERPENALTYOFVERRI�IYTHATINALICENSEDUNDERPROVISIONSOFCHAPTER U, • � -�� ' - - � d �(COYMENCN�WRMSECf10N7000)OFDMSION70F7MEOUS:NESS/WDPROFESSiON5CD0E,11ND Z MY LICENSE IS N FLLL FORCE AND EFFECT. �C Z_ � � IICENSECLASS C' � LIC.NO. y2� �..j o�� 3i oZ corrrrucron !/f+�hs�1M lE�f w � WOAKERS'COMPENSATION DECLAHATION � U � I MEREBYAFFlRM UNDER VENALTY OF VERlUFiY ON[OF7T1E fOLLOwINO DECLAMTIDNS: U' a � _IIUVEANDWILLMAINTNIACEHTIFlGTEOFCONSEMTOSELF•RISUREFORYrORNERS' 2 � WMPENSATqN,ASPRONDEDBVSECT10N77ooOFTMEUBOiiCODE,FOi1TNEDEA�ORUANCE W OF1HE WORK FOiI WHltll THIS VERMI715155UED. � � _IHAVEIU�D WiLL►MRf1A1N WORKER5COA1PEN5�ITION WSUMNCE.AS REOUIRmBY5EC710N Q 77W OF7F1E LABOR CODE,iOfi T11E PERFORMM/CE OF ME Wd1K FOH VAiICHTHIS 7Ei1MIT15 ISSUED.MVNORKERS'COraPENSATIdJW,UM.4CEUHfiIERANOPOLICVNUAIB[NARL CONSTRUCTION � uwuEa En'�J�r2F CO. 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O � IHEREBYAiFIRMUN�EHPENALTYOFPEIUURYTIUTTIIEREISACON5IRUGTqNLENOWOAOENCV nZ- FOR iME PERFOIWANCE OF THE WORK FOR WHICM THiS 7Ei1MIT IS ISSIlEO(SEG 90V7,pV.G�. � W � LENOER'SNAAIE � LENDER'SADORE55 \'�� � ICERTIFYTHATIiWVEREhDiH15MPLICATIONFrASTATETW�TTNEABd�ENFORAlAT10NISCORRECT. TOTAL FEES � �� V w IAGNEETOCOII7LYVAT/IILCITYANDCOUNTYOFDMANCESIWOSTATEUWSREUTIN�70BURDINO � CONSTRUCTION.ANDHEIIEBYAUTMOR2EREPRESENTATIYESOFTHISCOUNTYTOEMENUPON7ME Z /BOVE�4ENTKNEDYPOPERTYfORINSPECTIONVUN705ES. COMMENTS 0 = SCO/ �E �� m PERMI [(P �`,/�/ ' . (n ' /{�-�iG% � 7. � IONATUREOF ERYfTTEE �T � FECPT.NO. _PAID BY VALIDATION WHITE-0epartment Copy.YELLOW—Finance Cop�.PINK—Assessa Copy,GOLDENROD—File Copy,GR N—ApplicanCs Copy ^ ... . . ' . . , i , � . . � .. �I' .. - . . . . ... �1 . " . � .. .. . � .. �l., rr w . � . � ' . ' . . . � . ' � . i - CITY OF DIAMOND�BAR ., ,,.... . ,, ; , . , , , , � . .^.�•.r,..,.... .: . . . . . , f�r� _ :� . � �.,__ .. _, � . 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