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HomeMy WebLinkAbout10788 \ � � _ ' - CITY OF DIAMOND BAR � COMMUNITY DEVEL�PMENT DEPARTMENT ;.-C 21660 E.Copley Drive Suite 190 (909)86o-3195 Fax(909)861-JI17 PRESS ^'"', BUILDING PERMITAPPLICATION FIRMLY o� ��I� DATE CATION 9 Z��� NUMBER/a��� N� ADDRESS $ ISSUE TYPE OCC APN T TRACT DATE CONST. GROUP p OWNER "' ADDRES � y ZONING SETflACKS 'Pz' CITY A ZIP TEL. REAR RW O g APPLI ANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR � / SIDE ❑ O C DRES Z�pf/_?�b 2 TEL. 'C C(' PROPOSED USE o ARC G/ � DESIGNER NO.DWEL. NO. NO. N ADDRESS UNITS STORIES BEDROOMS � CI7Y ZIP TEL. � �n DESCRIPTION Sa.Fi: FACT�R PSF ADJ.AREANALUATION Q OWNER-BI:ILDER DECLARATION SFR/ADDIREM O 1 MEREBV AFFIq41 UNDEH pENALTY OF PERURY THAT 1 M1 E%EAIPT FROM iHE Cd1TMCTORS LF W CENSEUWFORTNEFOLLOMnN6HEA50N(SEC.70.77.6BUSINESSMIOVROFESSIONSCODE:ANYGTVOR � G818�SR,8fpOR V WIMfYNM1GINEWIRESAVERMITTOCONSTRUCT,ALiERwP��E.0EY0U5H.OHREPAIphNYSTAUG W PBtIdDBCk � TURE.VR1OR TO RS ISSIIANCE.A150 fICWIfiES THE AiV�IGNi FOR SUfil iERM1T TO FRE A SIGNED � � STA7EwEM 7NAT HE OR SHE i5 LICENSED PURSUMR(O THE PROVISIONg OF THE tONTiiACTOqS LF� � � CENSE LAW(dUOTER 0(COMUFNdNU W1T11 SECTqN 7000�OF DMSION 7OF THE BUSINESS AND PRO� POWSpB FESSIONSCOOEI�NiHATHEORSNEISE%EMPi7HEREFRDMANDME8A515FORiMEALLE0EDE7CEMP- C7 TION.ANYVIOL�TqNOFSECT10H7a71.6BYANYA�PLICANTFWIAPENArtSUBJECTSiMEMPLIGNiTO Z Re,Rool � ACMLVENALTYOFNOTFqRETMANiNEHI.NDREDWLUR51i5o0),I: O��S OVMER Oi THE PPAPERTY,OR YV EMPtOYEESN'ITH WACES AS THEIR SOLE COMPENSATqN, Z IMLL 00 TNE WOfIK.1WD THE STRUCTIlRE l5 NO7IMENDED OR OFGERED FOR SALE(SEG 7W�,BU56 � CM1rt16fCi81 � • � � NE55 AIA VROFESSIONS COOE:THE CONTMCTOIi9lIGENSE UW DOES NOT MPLY TO AN OVMEH OF ? . 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V DATE � � � cOMRACTOH � W � WORKERS'COMPENSATION DECLAHATI N � � IHEREBYAFFIRAIUNDERiENILiYOFPERIUMONEOFTYIEFOLIOWWGDECUM7qN5: Z � _IHAVEANDMnLlYA1N7AHACERTIFlCATEOFCON5E1RTO5ELFdNSUR[FOi1WORKERS' ¢ Q CAYPENSAi1DN.ASVAOVIOEDBYSECT10NT000FTMElIIBOHO00E,FORTNEVENFONYMICE w Q OF ME WOi1N FOR WHIp/THIS PEiWIT IS ISSUEO. � � _IMAYEAFAW!LLMAVtTAINWOqKERS'004VENSRqNINSURINCE,A3REd11REDBVSECTION � 7�OOOFT7EUlBORCOOEroflTHEVERFOHM�NCEOFTMEWOFKiORYn11p171p5PERMRIS � ISSUED.GYK'OFl1(ERS'COMPENSATIONWSURANCEC+IRRIERANDPOLICYNUUBERME: CONSTRUCTION � uwacA PLAN REVIEVV � GOIICYMIYBER ELECT . `�SS' �p (fl65EchwlfIDNoie[m.PLE7maF7VFPEH.Rswaa�EHroriEnOouuLSa�m)aiLESS� LUMB ��c. . �J�O � ICEHTIFVTHATNiF1EVERFOIWANCEOfiMEMANKFORWHiCMTHSPFRURtSISSUEO.I MECHANICAL (7 SNMLNOTEMPLOYANYVE0.50NNANYLIMlNEfl50A5T09EC01AE5UBJECfTOTME Vj WOPoCERS'COIAPENSATIONUM50FCALliORNI�,ANDAGREEi/NTIFI5Y10ULDBECOAIE INSPECTIONFEE SUBlECT TO THE YJORKERS'COh�PENSATqN 7ROVISIONS OF SECiION]70o OF THE UBOR �/ �j GODE,ISH�LLiORTHYA7NCp.�PLYWITMTHO5EV1lOV15qN5. 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