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HomeMy WebLinkAbout16666 (37) J� CITY OF DIAMOND BAR ` �\�'J DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Faz(909)861-3117 , PRE$$ '�>�'! BUILDING PERMTI'APPLICATION FIRM Y 0 0 RESS �IO( 7 -/ W1J(!//v[l�O� �" DATECATION � � �( NUMB R �G( �(�L.�� g issuE rvPe occ APN LOT TRACT DATE I � CONST. GROUP p OWNER UU� ,1' Lli o ADDRESS ZONING SETBACKS � CITY �L/7 U� ZIP � TEL. � I S R�RT Rw p� APPLICANT TEL. SIDE/SIDE STREET RW p � CONTRACT S C. SIDE p � ADDRESS � ✓ CfTY Wd ZIP TEL �_ PROPOSEDUSE P�+ ARCHlENG/ • � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CIN ZIP TEL. N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.ARElWALUATION � OWNER-BUILDER OECLARATION SFR/ADD�'REM � � ` —• O � 1 HEREBY AFFlPAI UNDER fENALTY OF CERRIHY THAT 1 MI E%EMPT FROY 1HE CONTMCTORS L4 Garago/Carport W CENSEUWFORiHEfOLLOWNOREAXIN�5EG7071.6BU5NES5ANDVROFE55qNSCODE:ANYCIT'OR (n AX ZCAII�lTYN411GIREOUIRESAFCRNRTOCONS7RUCT.AL7ERMPROVE,DCMOLISH,OnqEPAIRANYSTRUG W Peti01D6Ck u� 7UHE,VNOfI TO R4155UANCE I�150 RCaU1RE5 TNE APVL�Cl1NT FOR SUL11 iERMIT TO FILE A SIGNED w � SUTEYENT THAT NE OR SHE lS LICENSED PURSU/Nf i0 THE PROVt5iQV5 OF iHE CON7MCT0R5 LI• � CEHSE Uw�CfU.PTER C(COYI�EHCNO Nn7H 5[CTIDN 70001�ONISION 7 OF TME BuS�NESS AN�VRO� LL' POOUSp2 FESSIONSCOOEI�ITHATNfOR5�1EISE%EUP7iNER[FpOuu�THEB�s'SiORiHEALLfGE�EXEMo. (� TION.ANYViOlAT10NOF5ECT10N7071.6BYANYAPPUCA1fTFOqAVERMITSUBJECTSTHEMPIICANTTO Z Re-Rool � A GML VEN�LTY OF NOT MOaE TUN ilvE HUNORED DOlURS(SSoo)): � OL�aWNEROFiMEPfiOPERtt,OHMYEMVLOYEES�nMWAGESASTNEIRSOIECOMPENSAT10N, 0 COIIfmOfCI�I - . M/ILL DO TH[WC)fIK,AND THE STRUCTURE IS NO71N7ENCED OR OFFERED FON SILLE(SEC.T01�,BU56 J � NE53 AND DNOFESSIONS LOOE:THE CONTMCTO�iS UGfNSE Uw pOES NOT AFPIV TO/JI OWNER Oi = PqOVEHTY WNO BU4D5 OH IYPMNES T1IEREON,AND YM110 DO[5 SUCH NORK H�MSEIF OR NERSELF OFl ('L THROII�H HIS OR HER dNN EYROVEES.VROViOED TUTSUp1 WOROVEIIENTS A3iE NOT MEN'�ED M m � OFTEREDiORSAIEIF,MOWEVERINEBU0.DNQORMPROVEUEM6501.OWfMYJONEYEMOFCWIRE- Z 710N,THL OWNEREUILDER YALL NAVE iFiE 8UfL7CN OF GROV WO TTUT NE OR SHE�ID NOT BURD OFl _ �AVROYE FOR iHE PURf'05[OF SALE). O l���ER OF 1HE VROPERTI;dM fX0.U5NELT CONTMCTNCi YA7M LILENSED LOMMLTORS Q TO CONSTRUCT TT1E VRO.IECT(SEG 7o1a,BUSINESS AN�VR0fF5510N5 CODE.h1E CONTMCTOR3 Ll� V.71U8IICf1 ADJ.AREA W LEHS[LAWDOESNOTMPLYTOFNOW'1EROFAPHOVERiYWMOBUIlD50RIMDROVCSTHERf.q{A`7J � VAqCOMRACTSiOfiSUf]�7RNECT5IMTIACONTMCiOR(5)LICENSED%1RSUANi70TNECONTRAC pUANTITY DESCRIPTION FEE � 7C)RS LICENSF UW.). � ❑IM1D(EMPTUNDERSEC. B.tV.C.FORTHI5REA50v U 3 DATE OWNER r W �` UCENSE�CONTRACTORS DECLARATIODI W . . . Cr IHEHCBYAFFIIitAUNDERPENAITYOFVER1UMiNATINALICEN5E0UNCEIIPRJ`nSIOf:50F�HAPTER U. G �OU � � �(COMMENCINOWIiMSE^.TION70oo)O�OMSION]OFTH[BUSINESSIW�PROFESSIONSCOOE.IWD 7 �� YY LlCENSE IS W fULL fORCEAND EFFCCL m � UCENSE U 31'� IIC.NO. � a✓ � V pqTE"�I CONTPACTOR . I. d W � WORKERS'COMP[NSATION DECLARATION —� = d N IHEREDVAFFIRu1MJERVENALTYOF0E0.NHVONEOFT1EfOLLONnNGDECLAfUTqNS: U N Z a O _INAVEMIDM�LLMAIM�WACEfiTIFlGTEOFCON4EHTTOSELF�NSVREFOqN'ORKEHS' � _ '. • � Cq��ENS�TION.AS iROYD[D BY SECiION 77Do OF TME UL'OR CODE,FOR TME VERFOWdANCE W OF i11E MIORK FOit VA11C)17M5 VE Wa1T IS ISSUED. . � , � . . Q _I MAVE�ND YALL MNNTAW YIOR1(ERS'CdAPENSATqN HSUMNLE,AS REOL'IRED BY SECTION 77ooOFTHEUnORCDOCiORTMCPe�FORMINCEOFTHEWORKFOFYAnp/TMISPERM!TIS � � ISSUED.MYWOf1N 0.SCOi{PEN4ATqNWy:MNCECARRIiRANDPOLICYNUM3ERME: CONSTRUCTION I,/w�/y � C,wRiEn �f�'T I 7 !v _ PLAN REVIEW O poucyrniuern_ � ELECTF7IC 0 (fYs55'cCfIUiNCmNOieECl�.f'l£fE➢OFM7CiXt•'6i0i10NEFv0�[7WL1AR5(i�071pitES4l PLUM�ING � Z I CERTIFYTHAT N 7Y�E VER�ORAV..4CE OF TNE YJORK�OR NM1/Ip1 TMIS PERM!T IS LSSUED.I MECHANICAL � SNALL NOT EMPLOY ANY vERSON IN ANY uAhNER SOAS TO BECou[Sll�lEMTO iNE . � WORN[R5COMPENS�TqNUWSOFCALIFORNI,IAhDAGRCETNATIF151/0UlD8ECOME INSPECTIONFEE S SVBJECTTOTMCWORKCRS'CpAPEH5AT10NPROV1510N5OFSECTION�7ooOFTHELABOR coo[,iswucoanommcoe�rtrvnn�rHosePAohsia+s. ISSUANCE � • � SMIP p DATE: APPIICANT: . � ENERGY P/C wMNiNC:iMURE TO SECURC v:ORKERS'COMPENSATION COVEMGE IS UNUwFUL.AND SN.�LL BE � SIAIECTANEMPLOYER70CRIM:NALGEN/�L7�E5M1�GIVIIFIN[SUPTOONEM1tiDRCDi1KK15AND EN[FGYPERMIT DOIUFL(L100,000),N ADDITION TO THE COST OF C01.1PENSATqN,OIIMAGES AS PROVIDEO FOR IN J SECTDN97oeOFTNELA00RLODE.WTEREST.M:DATTORNEY5FEE5. RETENTION FEE: Q � CONSTFlUCTION LENDING AGENCY PRE•ALT FEE: O Q I MEREBVAiFlMI UNDER PENALTV OF iEfiNRY iHAT TNEF[IS ACONSTRUCT�ON LENDING AGENCY nZ- FORiHEPER�ORMANCEOFTiI[NNfiKFORWHICH1HI5iERMITI5155UED(SEC.70i7,CfVCJ. W „'L LENDER'S HAME S F— LENDEA'SN'DFE55 � ICERTIFVTHAiIHAVER[ADi1115APPUGTqNA1:DSTATETMATTME/�80VEWfO�ATqN15CORRCCT. 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