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HomeMy WebLinkAbout14142 (17) � y � '��01 , CITY OF DIAMOND BAR - DEPARTMENT OR COMMUNITY&D VELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3145 Fax(909)861-3117 PRESS � �� � BUILDING PERMTl'APPLICATION � � FIRMLY � JOBSITE � _ .: � %, ,� ;.`'' � j. y � �,r;S'_ �`)������ j'� APPLICATION�, v � f/ PERMIT � /1 '� P/C o ADDFiESS�„ 6�L� �'4��r/ +�`Y� DATE '' ` NUMBER= - ' # c� ISSUE TYPE OCC APN LOT TF3ACT DATE CONST. GROUP � OWNER ADDRESS ZONING SETBACKS � Z CITY ' ZIP���EL. " REART RW o g APPLICANT TEL. ' --. � � SIDE/SIQE STREET RW ❑ CONTRACTOR SIDE ❑ ADDRESS ` � CITY F ZIP TEL � '`— PROPOSED USE o ARCWENGI _ — Z DESIGNER NO.DWEL. NO. NO. � AD�RESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTiON SQ.FT. FACTOR PSF ADJ.ARE,�/ALUATION � s 01NNER-BUILDER DECLARATION SFRlADD/F9EM O - -p 1 k1EREBY AFFRM UNDER PENALiY OF PEfUURY THAT 1 AM EXEMPT FROM iHE CON7RACTORS LI- Ga�6g8/CarpDrt W CENSEUWWRTNEFOLLOWMGREASON�SEC.�o3tS0U51NESSANOVFOFESS'ONSCODE:ANYq7YOR- _(n - . -C�. OOUNT7WHICMREOUIRESAPERMITTOGONSfRUCT,ALTER,IMPROVE,DEMOLISH,OF7PEPAiPANYSTRUG =W- P81i0/DeCIC W iURE PRIpR TO ITS ISSl1ANCE.AL50 REIXJIRES iHE APPUCANT FOR SUCH PERMIT70 FILE A SIGNED : W __� � �: STATEMENT THAT HE OR SHE IS UCENSEO PURSUANT TO THE PROVISIONS�F THE CONTRACTORS LI- � CENSE lAW(CHAP7ER 9(COMMEtJqNd WITH 9ECTION 7000)OF DIVISION 3 OF THE OUSINESS AND Pfl0- � � PoolSpa � ' FESSIONSOODE)ORTHA7KEORSHEISEXEMPTTHEflEfROA1ANOTHEBASISFORTHEALIEGEDEXEMP- TION.MIYYIOLAT1qNOF5ECT10N7a37.56YANYAPPLICANTFORAPERUITSUB.IECTSTHEAPPLICANTTO 3 Z RB-R001 _.� , : ACMLPEfiA!NOFNOTMORETHANFNEHUNDREDDOLtARS(SSoa).J: � ❑I,ASOWNEROFTNEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSRTION, -• � Commercial L. -NALL DO 7HE WORI(AND iHE STRUCTURE IS MOT IN7ENOEO OR DFFERED FOR SALF(SEC_�oad,eUSI- --J __� NESSAND PROFESSIONS WDE:THE CONTRACTORS LiCENSE LAW aOES k0T APPLV TO AN OWNER OF � -PFqPERTYlNH09U1LD50RIMPROVESTMEHEON.RNL'MMOOOESSUqiWORKHIMSEIFORHEflSELFOR �_ �.: THPIXI6HHISORH'eRONNEMPLOVEES.PRO`✓ID�THATSUCFIIMPROVEMENTSARENOTINTEN�E�]DA -m. __�_ ,OFF[AEOFORSALEIFHOWEVER7FIEBULDINGOPIMPROVEMENTISSOLOWITHINONEYEA�OFCAPFPLE ` TION,iHE OWNEfl-BUILDER WILL kiAYE THE BUflDEN OF PRO'/ING THhT HE Ofl SHE D!D NOY BUILD OR � Z iMPRbVeFOR'fHEPUPPOSEOFSALEy. - Y �(J�-� ❑I,RSONA.7£ROFTNE?ROPEHTV,A}AEXCiUSNELVCAMiiACTINO\'/li}+UCENSEDCCtJTRACTOfiS . 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ISSUANCE ��� CODE, H ORTHYATNCOMPLVN7THT PROYISICNS. g9 �p DATE:,(,f�Jc-� APPLIGANT. P -�����Q . �- ENERGY P/C '"� WAflNING:FAI�UR 70 SE URE Y.'OR%Efi9'COMPENSATIOY WVERAGE IS UNIAWNL,ANO SHALL BE F T� �$- '-�:�- SUO.IECTAtJEMPLOYERTOCRIMiNALPENALTIESANDC1VIlFlNESUPTOONEHUNDREDTHOUSAN� ENERGYPERMIT �� �i�"�' "'�"^'�� -_�__ DOLLARS(5700.000),IYAODITIONTOTHECOSTOFCAMPENSATION,OAMAGeSASPROVIDEOFO�IN Y➢ p ..J�__ SECTION3700OF171ELABORGO�E,INTEREST,AN�AT'fORNE1"SFEES. RETENTIONFEE: �a -_�`-��.�`�`���s �:�-: CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � -�-�- 1 HEREBYAFFIRM UNDER P[PlALTY OF PERJURY`HATTHERE IS ACANSTRUCTION LENOMG AGFNCY - --�-- FORTME PERFOFMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3091,CIY.G). ,:Z.._ -_--___--- _ W- � LENDER'S NAME --------- - -F--, LENDER'SAD�RESS _____- _-�--_W�-- ICEftTIF1'THATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEA00VEINFORMATIONISCARRECL TOTALFEES ��a :� I AGREE?O CAMPLY WITHALI CIN RND COUNTV ORDINANCESAND STATE LAWS RELATWG TO BUILOING _�_ CONSTflUCTION,ANDHEREBYAU�MORRERE ftESENTA7IVESOFTY.ISGOUNTYTOENTERUPONTHE . Z- ABOVE-MENTIONEO PROPERN FOP INSPECT N PURPOSES. COMM TS / �Ot .. ' / ./ ( . .�- ._:¢_ PERMITT�!�i A-M[(PRINT� C ..Cn-- \/ \�. __� . � � SIGNATUR F PERMITTEE D E RECPT.N0. 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