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HomeMy WebLinkAbout14752 � ��'� ^ �,� CITY OF DIAMOND BAR {. � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES�� _ _ � . 2 L660 E.Copley Drive Suite 190 (909)86Q-3195 Fax(909)861-3117 PRESS � '�'�' BUII.DING PERMIT APPLICATION ___ � FIRMLY o� JOBSITE / ��..�i�^'r-t-� APPLICATION �,� PERMIT /C - ADDRES���1� � � �ATE "��� NUMBER��� �� ISSUE '�� �� ONST. I "-� GROUP � � APN LOT TfiACT DATE p� OWNER _._ lY^ �/1�C.� LL'-C t�va i` � ADDRESS .�'ir� ZONING 5ETBACKS ��� � CITY /7lr.u��'r/►t���sar ZIP /�i�t TEL. � •ut RE�ART f RW � APPLICANT TEL. �� SIDE/SIDE STREET�� RW ❑_ � CONTRACTOR SIDE �/ U ADDRESS / 0 CITY ZIP TEL. PROPOSED USE /¢c�Of ff2-e•-Cs{G►�+�I �Gh�.i lr.� /�c+J� w ARCH/ENGJ z DESIGNER ' G e�n�c'�� �'u'7���— w: � NO.DWEL. NO. NO. Q ADDRESS �Z3 l-: ,l+r� ��-�e• y cin,_NeY vr�� Z�p c„�,-�- TE����� UNITS t STORIES �BEDROOMS� J'� vi DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER�ECLARATION SFR/ADD/REM � O 1 HEHEBY AGFlRAI UNDEF PENAL7V OG PERJURY THAT i AM ExEMP7 FROM THE CIXJTRAC70R5 U �aragelCarywrt - W- CENSELAWFORTiEFOLLOV/INGpEqSqy(SEC.7031.58USINESSAND.PHOFESS�ONSCODE:ANYCITYOR .� (n - . V COIAJfYWHICHp[-0UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOUSH,ONflEPAIRANYSTflUP ` W Patio/Deck _ W- TURE.Pfl1OR TO ITS ISSUANCE,AL50 REeUIRES THE APPL�CANT FOR SUCH PEFMIT TO FlLE A S�GNED - W �_ 6TAT�IENT 7HAT NE OR SHE IS LICENSEO PUqSUANT TO THE PROVISIONS OF hIE CONifiACTORS LI- - � - CENSELAW(qiACTERe(COMMENCINOWITNSECTION7000)OFOIVISION3OFTHEBUSINESSANOPRO. - POOVSPB - - _ '�_. FESSIONSCOOE)ORiIiATHEORSMEiSEXEMPTiHEREPflOMANOiHEBA515FORTHEALIEGEDEXEMP- -- -(� --V_ 710N.Al1YVqLATIdVOFSECTION7081.5BYANVAGPLICANTWFAPERMITSUBJECTSTHEAPPLICANTTO ' -Z Re•Roof - � �: ACMLPENALTYOiNOTMOpE7HANFIVEl7UNORED00.LAR5(f5u0)J: - . ❑I,ASOWNSROfTHEPqOPERT;ORMYEMPLOVEESWITHWAGESASTHEINSOIECOMPENSATiON;.-_ �0. CommeiCi31 = w-. .�- WILL 00 iHE WORK,/INUTHE 5THUCTURE iS NOT IMEN�ED OFl OFFEflED FOR SALE(SEC.7o4d,BUSI- - .J " y-. NESS ANO PROFESSIONSOODE:TNE CONTRACTORB LICENSE LAW OOES NOTAPPLY70 AN OWNER OF � ' , - PROPERTVWFiOBUIL0.SORIMPROVEShiEREON,ANDWHO00ES5UCHWORKHIMSEIFORHEHSELFOR - - �- - - -�; THAOU6HHISORHEROYMERIPLOYEES,VHOVIDEDTItATSUCHIMPqOVEMENTSAPENOTINTENDEDOR : 'm � Q ..UFFEPWFORSAL6IF,HOWEVER771EBUILWNqORIlAPROVEMENTISSOIDWfTHINONEYEAfiOFCOMPIE - _ � `TqN,Tt1E OWNER�BUIlOER WILL F1AYE THE BIJRDEN Of PpOYINO THAT HE OR SHE�IO NOT BUILD Ofl . �- tMPPOVEFORTHEPURPOSEOFSALE�. . - �: ❑I.ASOWNEflOFTHEPflOPEflTY,AMEXCLUSNELYCONTRACTINGWitNLICENSEDCONTRACTOqS ¢_ _TO CONSYflUCT THE PROJECT�SEC.70H,BUSINESS AND PflOFE5510NS CODE THE CANiRACTOR3 U� _ � V81118110I7 � ADJ.AREA - til CF3JSEUIWDOESNOTAPPLYTOANONMEROfAPROPERTYWHOBNIOSORIMPROVESTNEHEON,AND- : zs WFIOCONTRACTSFOftSUCtiPROJECTSWIiHACOiJTRACTOR(5)L�CENSEOPURSUANTTO7HECONFflAC •-_ QUANTIN DESCRIPTION FEEs - - r�•. TORS IJCEAISE LAW.). - _ Y. ! ��� ❑IAM EXEMPTUNDER SEC. B.8 P.C.FORTHIS PEASON -- Q W�"� DC!/� � - Q; a�1s p' y,s� ..�ia � B (7f-�+ y�i�I �13 - .. �' --DATE OWNER H t - � W 2 5�i�'e>��a �� LICENSED CONTRACTORS DECLAPATION � - W ' �� IHEREBYAFFIflMUNDERPENALTYOFPERiURYTHAT1AMLiCEN5EDt1NUEflPROVISION50FCHAPTEfl � • _ --a,- B(COMMENCINLSWITMSECTION7o0o10FD��SION30FTME�USiNESSANDPPOFESSIONSCo�E,ANp -. Z �C_ MY LICFNSE IS N Fllt.l FORCEAND EFFECT 0: LICENSE CLASS � LIC.NO. .. /��v I� - � -�.; DATE��. a'�LtJ�' CONTRACTOR�..j��' C �. �..- a' - � . �: � ��, _.e, - . _ � [�-- WORKERS'COMPENSATION DECLARAT - '"� � - _ __._ _ ' ._.:�_. . _ . ._. _ _ _. ._. . . _—c"'. . �._ . _ . ,.�a , . .. -. _ __ __ . .. � . . . .. .__ _ '.___' - ' � � �. IHEREBYAFFIRA7UNOERPENALTYOFPERJURYONEOFTHEFOLLOWINa CUFlATI : z � � � - - � - �,-- � .��- _IHAVEAND�LLMAINYAINpCERfIFlCATEOFCONSENTTOSELFIN REFORWOflK`cR5' _ .- -! - . . -. - - _ COAiPENSFTiON,pSPflOVIDED8Y5EC710N37DOOfTMELPBORCOD FOR711EPEqFOPMANCE W 9 - �'- OFTiEYJOflKFORWFiICHTHISPERMITiSI6SUED. - 0 --w- i HAVE ANU WILL MhIMAIN WOPoCEflS'COMPENSATION INSURANGE.AS RE�UIREO BY S - ��` - G 970o OF THE LABOR CODE,FOR7HE PEqFOpMMCE OF TNE WORK WR WHICHTHIS PERMI IS 0- ISSUED.MY WORKERS'COAiPENSATiON INSURANCE CAqRIER AND POUCY NllldBERARE: - -CONSTRUCTION_. j:- c,uRiea - PLAN REVIEW � �_- pa.icvrauMeER ELECTRIC � - fl:- fnuss[cnotar�rt�reeca�ETEooFi�aewr�tswaoriernx�onmoa.uws�aiau)oR�ss�. 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CONSTRUCTION LENDING AGENCY PRE-ALT FEE: :�-; IHEREBYAFFIqMUNDEfiPENALNOFPERJURVTHATTHEREISAfANSTRUC710NLENDINGAGENCY - fOHTHE PERFOflMANCEOF THE WORK FOfl WHICH THIS PEflMIT IS ISSUED(SEC.30W,CIV.C.). Z W- : �_ LENOER'3NAME_ __ r - - f---- IENDERSADDflESS �-- ICERTIFYTNATIHAVEREMiH15AVPLICATIONANDSTATETHATTHEABOVEINFOHMATKKJISCORRECi TOTAL FEES � - d-- IAGREETOCOMPLYWlTHALLCfTYANOCOl1NTYORDINANCESANDSTATElAWSREUTINGTOBUILDING � - �/� /� `��_ � ��- COMSTRUCTION,ANDHEREBYAUTHORREREPRESEN7ATIVESOFTHISCOUNTYTOENTERUPONiHE lJi� Z NBOVE-MENTIONEPPflOPEfliYfORINSPEGT URPOSES. COMMEIVTS � o `�"�.rn�+�, ��v�(�- � �: PERMITTEENMIE(PRINT) - �� ' � �, �� 0 �_ SIONANREOFPEAMfTTEE DATE :_. RECPT.N0. 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