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HomeMy WebLinkAbout11529 I • ---���- ----, CITY OF DIAMOND BAR I I � COMMLJNiTY DEVELOPML'N'I'1)I'sPARTMP.N 21660 F..Coplcy Drive Suite 190 �yREs� - (909)AGO-3195 Fax(9D9)RGl-3117 UILDING PERMIT APPLICATIUN FIRMLY � JOBSITE S r � [�,,, _ ( _n' APPLIC O PERMIT P/C � ¢ ADDRESS�� ' � 'V_ � � �Ll�1�lv�� DATE__._ - NUMBER ��_,`�_._ # r -�-- - --- � ISSUE X OCC -- APN LOT_. TRACT__, - Z Y � C __,_.__ GROUP —.. DA7E---y---- --�---- ��D o OWNER S��{. r _..----- �� �tJ� f ZONING SETBACKS QC I n 3 ?OOO � ADDRE S__ � .�'i e /�L ��� W - -- ...- FRONT RW_------- �-� � o CITY__� S.�ZI P q TEL._.__ --- --. -- APPLICANT _ __ ___ TEL.__ REAR ._..._____. ____. I I _ ' o ----- SIDE/SIDE STREET _____,__.___ RW____ Cl ; ¢ CONTRACTOR. _ � -- <S�— SIDE ---------...---- __ - ---- � ADDR SS �-�--�{� -- PROPOSEDUSE � _ '� o' CITY��e�' Z ���3� TEL�`-�O� �� -- - � w ARCH/EN -� � (2`' /�� ' �z DESIGNER '_____� v L-�.-�-- NO.DWEt.. NO. N0. � ADDRESS ____._ _.__._.. -�--- UNITS..____.___ STORIES __._____.,___ BEDROOMS_ �. CITY__.._...— ZIP---- TEL.------- � � - DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � O OWNER-BI;ILDER DECLARATION SFR/ADD/RF.M -- � p I HEREBY AFFIFlM UNDER PENAL7Y OF Pf HJURY TMAT 1 MA L%EMVT�fiOM�IIF.CUNTRACTORS LI- G�fO(JL/Cdf�Dl� � � W CENSELAYJFOftTHFFOLLOVJINGREASON(SEC.70?1,Sf3USIN�SSANDPROFESS:CNSCOUr:ANYCITYUR (n � ZCOUNTY\N111CHREOUIRESAVEHMITTqCONSTftUCT,ALTER.IMPHOV�,DLMOI.ISM,ORflEPA7RANY5THUf;- W pa6o/Deck I T � w TURE.PRICR TO lif ISE�ANCE,AlSO RF.QUIqLF 74{[ppp�ICANT FpR S!1CH VFH!A�I'lU F�II.(:ASIGNCD . 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O f:I AM EXEMPI UA:�C.R SEC. _ __ . __ _P d NC FOR i iilS PEASON Q ' ? �-� i y J —__ "—_ . . —_ ... _..._. .. ""_ '_—" __— � I � _ E � — DATE______. .. . OWNfR .. __" _".... ._ V --� Q Z — __ W � LICENSED CONTRACTORS DF.CLARATION -� F— -�� -- -._._.. _... . - --. _... _._ . . ¢ -� .. . .. . .. .. ...-�---�- � IHrp[gyAFFlFMl1N�[NPCNALTYOFPEP.JUI�YTIIATIAMLICENSEDUNCf:tiVF?UVISIONSOFCHAPTER �-----4.v.� i—�.-_-�-_ _ d 9(CON.MLNCIN�WITHSECTION��00)f)f�YI5tON30F1HLF1UEWf.SSA�DPROFE5510�5C0:]L,ANO _ �X MY LICENSE IS IN FULL FUPCEAND EFFECi �'��,�s_(_�—LIG.NO. V L 4 �� � T-- j � LICENS[CLA55 r � w DATE.__�_`_`L 0 _ (:ONTRAGTOR ��~ ' ___ „_'_ ` �_ _ � � WORKEHS'COMPENSA'I'ION DECLARATION � � , � IHEH HYAfFIRMUN�ERPENAI.TYOFPERJURYONf.OFTH�FOLLOWINGDECLAFlAt10��5: j � �_I IIAV[AND WILL h1AInTA1N FCf HTIFICATE OF GONS("Ni TU SeLF-INSURE FOR YdURKi"!i5' � t� i Z COMP[NSAiION,ASPROVIUI[JI3YSECTION37000fiIlEiABORCODE.FOR711EPf.litiOFlUANCC- � t ¢ OI�iHG WORK FOR'NH�CH THIS PERMITIS ISSIIEU. 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Z � — ___ _ ._ '_.. ___ � � I.rNuenSn�tmnE___ ... . _. — .. . - --. � H LEN�EP'SA�[1HE`i5 �__ _" "_" ___ '— _- ___'_"'_—_" '—_..._ _—_'____''� . � ICE1lTIFYfHATIHAVEREM1[1Tf11SAPPLICAiIONANf)STATf.'f11ATTY.[ABOVF:NFOHMAiIONISCURRECT. TOIAL rEES �C T • �" I w IAGREETOCOJPI.YWITHALLCITVANOG(1UNT70ROIN�NGt5n41)SIATfLAW5REUITINCIOt���illllNt; I� � CONi11iUCTION,ANDHEHEI3YAUT110RREREPHESINT.AT!ViSOFTHISGOUNIYTOlNIFill;f'ONTHE ZABOVE�UEN'fIONEfI PROPEqTV FOfi IVSPCCTIOY PUHP().SCti. 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