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— ------ __ .. - .._..__. ._ �� CITY OF DIAMOND BAR �� `�t'`^ /� DEPARTMEM OF COtvIIvIUNITY&DEVELOPMENT SERVICES 21825 E.Coploy Drive '� (909)860-3195 Fax(909)861-3117 P ESS '���- BUILD[NG PERMIT APPLICATION + �p� IRMLY y�, JOBSITE n 1 � � APPLICATION �„�11 J /�l PERMIT p� 1 � o ADDRESS " � �� �- DATE d�i"�� NUMBER N � � aPN LO TRACT �SSUE TyPE p�C Q ^� ��— DATE CONST. GROUP p OWNER ti � ��I�LT � p ADDRESS 41 F3 L O � ��d �ely� 20NING SETBACKS z CITY.I���s�,�,�p� ZIP � -` FRONT pyy � g APPLICANT TEL. REAR � � SIDE/SIDE STREEf Ryy � � CONTRACTO S p,L� SIDE � Q ADD S� � C�N ZIpQ��_ TEL. PROPOSED USE o ARCH/ENG/ �L� DESIGNER NO.DWEL. NO. NO. �n�". AD�SS � � UNITS STORIES BEOROOMS Ci 1 L�'�Jtii11�6� ZI TE� � DESCFIPTION SQ.FT. FACTOR PSF AOJ.AREANALUATION p� OWYER-BUILDEq DECLARATION O SFR/ADD�AEM p I HfREev/1FFIqu UNpER pENALTV OF DERAIRV THAT I/UA E%EMPT FROY THE LONTMCTORS l4 Garege,'CarpOfl U CENSEUwFORTHEFd.LOWINOREASpN(SEC.7o]1.6BUSINESSANDVROFESS�ONSCODE:INYCITYOA (n � COIMTYNki�CHREOUtRE5A7ERMITTOCdN51RUCt,ALTE0.MPRpy[,DEMOl15M,ORREGAIRANVSTRVC. W Patio7Deck W NRE,GRqH TO RS ISSUMICE ALSO pEWIRES TNE APP�ICAM FOR SUCN PERMiT TO FILE A SiGNED W � STATEbtENi iNA7 H�OR SME IS UCEHSED PURSUMT f0 THE PROYISIONS OF THE CdliMLiOf35�I• CENSE UW(CHAPTFR Y(CAMMENCWO NATH SECTqN 7000)OF DIVIS�ON 70F THE BUSiNESS AND VR0- u" PooUSpa FESSIONSCOOEIORTHATNEORSHEISEI(EM7T7HEREFROAIANDiHE9A5ISFORTHE�LLEGEDExEMP- (� V TqN.ANVVIOIAiIONOFSECfION7071.SBYANYAPP�ICANTF0f1APERMITSUBJECTSTHEAGPLICµTTO Z Re-Roof F A CML OENALTV OF NOT MpRE TMAN FNE MJNORED DOLURS(f500�.�� Q ❑LASOWNEROf7NE0ROPERTV,ORIJVFM�LOYEESWITHW�CESASTNEIR50�ECOMPENSATtlN. 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O IAu ESE4PilMDER SEC, J `1� O B.d VC.WR THIS HCASON v � U � � OATE OWNER � �Q LICENSED CONTRACTORS DECLARATION W CL IMEREBYA�FWUUNDERPFNAITYOFDEAA/RYT11AT1AA1lICEHSEDUN�ERPROVI5�ON50FCNAPTfR � p., •�COM1A[NCINaWIT115EGTqN70o0)OFDNISiON70FTMEBuSIN[SSANDVqOFE5510N5CO0E.AYD Z X MV LIGENSE IS N F11LL FORCE AND EFFECT. �� UCENS CUSS��,�_LIC.N0.�,]�i..�_S '�^►� � f-- _ W DATE �Z�,CONTRACTOR_���� a � WORKERS'COMPENSAT�ON DECLAqATION a � � IHEREBYIIFFIHA1UNpEHVFNALTYOFPERNMONEOFTNEfOLCOmNGOECUIRATqNS. 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