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• - CITY OF DIAMOND BAR � COMMUNITY DEVELOPMENf DEPARTMENT ;,,� 21660 E.Copley Drivesuite I90 PRESS (909)86Q3195 Fax(909)861.3117 '""� BUILDING PERMITAPPLICATION FIRMLY oJOBSITE '} 1//� J (�1 APPLICATION PERMIT / O P/C ADDRESS � �1 IlJ �q"��-^�'� �r 1�`�� DATE NUMBER� t $ ISSUE TYPE OCC APN LOT-� TRACT DATE CO GROUP �j OWNFR / C'tiC . -C1[�vA � ADDRESS ZONINC3 SETBACKS � CITY -��•� - r' ZIP TEL flEART :7 [Q�i�-p APPLICANT �-C_.�. TEL � SIDFJSIDE STREET RW^ ❑ CONTRACT R G SIDE ❑ � ADDRESS � �' �- � �,oa� �PROPOSED USE vc rxu� �-..'��.�I CITY -� ZIP .(7� T �13'lir-a`�)1[7 ' .r„� �,. � r�a �: oARCWENG/ . _..,� .-,,.,.; , � DESIGNER NO.DWEL NO. , ' ,NO. a ADDRESS UNITS STORIES BEDROOMS � CITYJ ZIP TEL cii DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION Q OINNER•BI:�LDER DECLARAT�ON � �q��pp�qEM O p I HEREBY AFFIRM UNDER PENAITY OF PERAIRY T1AT 1 AY E%EMPi FROM THE COHTMCTOR!LL �n���� . , � W CENSEUWFOFiTMEfOLLOWNOREASON�SEC,70.7t.6BU5NE55MOPfqFESS10NSCODEAN'(Gil'OR (n U •COI.WTYNHICHREOUIRES�VERAl1TTOCON9TRlfCT.�LTE0.�PFMVGDEY0l.�9N.ON1�R11RANYSIAUf. ' . � 'TURE PRidl TO R9 ISSUlWCE/150 REWk1ES THE AVPIICAlfi FOR SUdI VERMR TO FILE A SIONpD• f+. W PatidDeck . . "S7A7EMEM THAi ME di SHE L4 UCENSEO RINSUAM TO 711E PROV1510N4 OF THE fDN7W1CTON9 LI. � . � CENSEUW(CHACiERO�CMIIAENCk1O1MTNSECT10N7W%OFDIVISqN]OFTIIEBUSINESSMOCRd u' POOVSp� . . ' FESSIONS CODk7 Of1 THAi ME OR SHE IS EXEYPT THEREFAON ArW THE 9ASIS FON iNE ALLEOFA F.IIEMP� A TpN.ANYV10lATqNOF9ECT10H7o71.6BVANYMPl1CMITFOR�AiERMITSUBJEGiSi}1EAPPLIGN/TT0 Z �'Rpp( V� �i �Qa �� � AGV0.VENKT110FNOiMORETXANFIVEMIWREODOLLM5�i5u01�k . � O1�50WNEROFTHEPqOVEHTV,011MYEMPIAYEESWIiMWA0ESA3iHEINSOLECOMPENSATpN, . O Cq���Ci�l � ' � VALL DO THE WORK AND THE STRUCTURE IS NOT WiENDED Oil OiFEREO iOti SALE ISEC 7W�.BUSL J N NE43 A!D GROFESSION4 COOE ME CON1fUCiOH4 LICENSE UW DOES NOf APPLY TO AN OMMER OF ? DROVERTY WVq BULDS OR MIVROVE3 711EPEON.AND VMODOES SUCM YANK HIAISELF Oq HERSEIF Oq WTHp0U0H1950RHERONNEMPLOYEES,P110VIDEDTIATSUCHIIAPROVEMENTSMENDTWTENDED011 m 0 OfFEREDWRSKE1F/qWEVERiNEBULWNGORMVROVEMEMbBOLDWITMWONEYFJIXOFOOMPLE Z TqN,TNE OWNEF�BUIIDER YnLL MAVE TNE BURDEN OF PXOViNO TNAi ME pi SME DiD NOT BUiLD Oq XO � MVROVEFORTHEPURPOSEOFSALE�. � • . Ll� ❑l1lSOWNEROFTHEVROPER7Y.AMEI(CLUSNEIYCONiRACTtJOM1ITXLICENSEDCONTMCfOR3 _ . (= TO fDNSTRUCT TME GROJECT(SEG 7a4 BUSINE53 AND Vi10FE:S10NS CODE rilE[ONiMGT0R9 LL � VSIWlI0f1 ADJ.AREA W CENSEUWDOElNOTAPPLYiOANONMEROFAVROVERiVNFqBUlD40R1uVROVE9iMEREd4M/0 F wHocanA�crsconsua�rnaecnNnn��corrta�cTor��s�uc�scnn,wsuu+tron�Ecornw� ��mr DESGRIPTION FEE.� � TORS LICENSE UW.} . , � O 1 A!I EXEYPT UNDER SEG B.i P.G FON TMIS REASON � � V � ¢ WTE ONTIER � Z W ' � L]CENSED CONTRACTORS DECLARATION W � IHEIIEBYAFFIRNUNDERVENALTYOFFEiUURYTHATIAA1LICENSEDUNDENVH0Y15qN40FCNAVTER V. � � d Y(G�O�MIENCINU N77M SECTION 7aoa)OF DMSIDN]OF THE BUSINESS AND Pi10FESSIONS(bOE AND Z X MY LICENSE IS N M.L FOiiCE Ml�EFFECL m . ..� LICENSE CLASS � �3� UC.NO. a � � 1�- V DATE r �^ S CONTMCTOR S � . W � � WORKERS'COMPENSATION DECLARATION � � 'IHEREBYAFFIfiAIUlDEHCFNALTYOFGEiWi1YONEOFTMEPoLLONINODECUMTIONA � � _IHAVEANDN'ILLMAINTNNACERTIFICATEOFCONSENiTOSELF-INSUREFORWOfY(ERS' OOMPENSATION,/SPfWVIDEDBYSEGTIONs7ooOFTMEIABGICODE,FORTF1EiERFORMANCE W OF THE WORK FOR WH�CH iH�S PEMUT 19155Um. � W 1 H�VE ANO 1MLL LWMAIN WORKERS GON7ENSATqN INSUiWlCE A9 RGOUIREC BY Sftt10N � 77ooOFTHELABORCODE.fORTMEPENFOHM/VILEOFT7EWOiYCFORWH�O17Ni3/ER1.tlTIS � ISSUED.WW�(dC RS'COMP[�,y_5ATqNI UMNCECARRIERAHOPOLIC9M,F6ERARE: CONSTRUCTION � uaaEn S��C(�'�� PLAN REVIEW_ 0 POLCV IAl1ABEP Q �/� �i �C� 7�G�� ELECTRIC .. 0 (n+ss�nnr+�noteEoo�.ermaFnErwRrs�a+eraronEnoal�nsR+mior+tFss1 PLUMBIN� z i cEancr nur wn�E oEncaauu�ce oF ni¢woau wa wwa+rHis oenurt�s�ssuen,i MECHANICAL (�} SHALLNOT EMPLOYANY PERSON W AH'/MANHER SOh4 TO BECO4E SU&lfCT TO THE . � N WORKERS'G06�VENSATpN UwSOF CAUFOMtlAµD AOREE TMAT IF 15110ULD BECOME INSPECTION FEE SUBJECT TO TME WOPo(ER5 COMPENSATION VFqV15qN9 OF SECTION 3700 OF THE IABOR -~j OOOEISHALLFORTHN�ATNCWPLYWI PHOV15qHA ISSUANCE � . � oATE� •�• S 7AFPLIGNT. SMIP r t � � � WARMNQ FAIURE TO SECURE Y�CMiKERS' ENSAT FACE IS UM.AWFUI.AND SMALL BE ENERGY P1C �y SUBJECTANE4PLOYFRTOCRIYPIALPENALTI SANDCJI/ILFINE9lJPTO0NEM1NDHmiNOUSANO E1dERGYPERMIT •��� } OOIURSIt1o0,0onAN�D01T10NTOiNECOSTOFCdADEN5AT10N.D/iMAGE4ASVROVIDEDFOi11N � SECTWN�70�OfiMEIABOqO00E,INTEREST,ANDAT70N1EY'BFEEA � R��n��� ��„� p. CONSTRUCTION LEN9INGAGENCY PpEALT FEE: O � IMEREBYAFFlRNUNDEHiEHALiYOFPEfUlRYT1UTTHENEt4ACOHSTRUCTIONLENWNCAGENGY - Z FOti TME PERfORMl1NGE OF TME WORK PoR WH�C/1 TH4 PE WMT 19�SSUEO(SE0.�Oa7.GV.0.). W � IENDERSNAME lENOER'4+1DDNE54 ICERTIFIITUTINAVEREAOTHISMPL�GTIONMDSTATETUTTIEABOVEINFORYATqNISCOMECT. TOTAL FEES /J /� , � � � IA(iREEiOCOAAPLYM7iHALLCITYANOCDUNTYOHONANCESANDSTATEUWSAEUTNOTOBUIlDINO � � � \// n ��1/ OONSiRUCTION,ANOHERE8VAl7T110qiZEREVNESEMATNE40FT1uSC0UMYTOENTERUPOHTHE V n i`(,JI�1 � � . 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