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HomeMy WebLinkAbout11899 (5) �� CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � . 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ������'£ BUILDING PERMIT APPLICATION FIRMI.Y � JOBSITE �� � ,(� , 1 �1 APPLICATIOfr /� PERMIT P/C o ADDRESS ���� �arn�n K �dq2.��G• DATE � NUMBER q c� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP •p OWNER ` � N LL ADDRESS ZONING SETBACKS �"' CITY 1'�ZIP G 1�/�gTE . REART RW Ll= ' APPLICAN���j� U1J,4T3nY� TE�.� M SIDE/SIOE STREET RW ❑ � CONTRACTOR�pfhu a5 /4� SIDE L] p�> ADDRESS — ROPOSEDUSE Y�G�'+� r �1L� S ei '�" �, o CITY ZIP TEL. n r `�� o ARCHlENG/ � s' Z DESIGNER , NO.DWEL. NO. NO. � ADDRESS ^ UNITS STORIES BEDROOMS ,�- CIN ZIP TEL. �_ DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O. OWNER-BUILDER DECLARATION SFR/ADD/REM , , .,,, ��' GeragelCarport p I HEREBV AFFIRM 11NOER PENqLTY OF PERttIRV THAT 1 AM EXEMPT FROM THE CON7MCiOR5 .: ,.: ��i. UCEN, �� . , .V' S • i 'C/) tUS r�'.r;,,.':�;�:?.,`�-i�.,�. M;��':S DPURSUANTTO V 4 OFTHE� � � RS #LlJ w ...r!'�,4.���N'�,:�•.. l�.J.•�`n�'i...•��' ' � . . • . . Z �'' .... .�, - � � . �''`. .'. ., � ... � � , : ...,.�,�� � Patio/Deck � TATEMENT 7HAT HE OR SHE IS ,E THE PPO SION CONTRACTO I� '�W �, CENSE LAW(CHADTER 9(COMMENCINO N7TH SECTION 7000)OF DIVISION 30F THE BUSINE55 ANO PRO� '.LL �POOVSpB FE5SIONSCODE)OqTHATHEORSH�ISE%EMPTTHEREFfiOMANDTHEBA515FORTNEALLEGEDEXEMP� } TION.ANYVpLATIONOFSECTIDN70A15BYANY�PPLICANTFORAPERMITSU&IECiSiHEAPPLICANTTO � Z e-pppf F� �� ,_ O ACM! Fv�!h Q{Y(`TW'o�,..,A4 N'cui�NnPc,... aocif..n ,. ., . M .. . ,. a . • . ' M� 11 h . . - n Z ,nrl1!'•:�Y�1--f�.� ..'�'• . . ti:. �... '. , . : . � • J N '� ` Commerctal � \-���A\:1:,:�;.:':.•�l�'.�!�:•.: . .��..\��•.�'.. �� L� .h ..� .� . :.•.'�.h•. i:� ? PROPERTY W110 BUIlD3 OR IMGROVESTHEREON.PND WHO DOES Sl1CH WORK HIMSELF OR HCqSELF OR �Q THqDUGHHISORHEflOWNEMPLOYEES,PROV10E0THpT5UCHIMPROVEMENTSARENOTINTEN�EDOR m W OFFERE�WqSALEIF,FIOWEVER�MEBUI�DINGORIMPROVEMENTISSOLDWITHINONEYFAROFCAMPIE- � 7pN,THE OWNEfl�BIIILDER WILL HFVE THE BURDEN OF PROYING THA7 HE OR SHE DI�hOT BUILD OR Z IMPROVEFORTHEPURPOSEOFSALEI t _ � xt W � ' � • ^ � ' . Vaivation ADJ.AREA ,.� � VApCONTMCTSFOHSUCNVNOJECTSWITHACONTRACTOR(S)LICENSEDPUASUANiTOTHECONTMP QUANTITY DESCRIPTION FEE � TORS t10ENSE UW) � ❑IAMEXEMPTUNDERS�C. BBAC.FOR7HISlSEASOY U � '_ ce � LL" DATE � i UWNE U Z � ' —'_ "_—"__ W � LICENSED CONTRACTORS DECLAflATION W � IHEREBYAFFlRMUNDERPENALTVOFPFRIURVTHATIAMLICENSEDUNOERPROVISIONSOFCHAPTER � d B(COMMENCINO WITH SECTqN 7000�OF DIVISION 30FTHE BUSINESSAND PROFESSIONS CODE,ANo Z X MY LICENSE IS IN FIH.L FORCEAND EFFECT. ll.l m � LICENSECLASS _lIC N0. ___ , � " �j DATE COMRACTOR_ _____ a W � WORKERS'COMPENSATION DECLARATION Q � IHEREBVAFFIPMUNDEFPENALTVOFPERJURVONEOFTHEFOLLOWING�ECVRATIONS U y Q � IHAVEANDNALLMAINTA�NACEFTIFICATEOFCONSENTTOSELf-INSUREFOqWORKERS' Z � COMPENSATpN.AS PqOVIDED BV SECTION 370o OF THE 1A60P CoOE,FOR TNE PERFORMANCE W OFTHE WORK KOR WHICH THIS PERMIT IS ISSUEO � W I HAVE AND WILL MAIMAIN WORNERS'COMPENSATIIXJ INSUMNCE AS REOUIRED BY SECTION � Q 37040F THE LABOR CODE,FOR7HE PERFORMANCF OFTHE WOHK FOR WHICH THIS PEqMR 15 �� ISSUED.MY WOP.NERS'COMPENSATION INSURANCE CANNIERAN�70LICY NUMOER ARE CONSTRUCTION _ _ _ ___�___ f �� jcaaaiea _. __ __ PLAN REVIEW ZaouCV NUMBER_'_' —�-- ELECTRIC "' —_'__ '--____ -"'---'__ Q Q (IHISSECf10NNE�NOTBE00h5�LEfE00F7FEPEfVMISWR01.'EFfiN�DRmDCXIl�S(S1oo)ORlESS) PLUMBING - -'---'- ----- -.-"-- Z ... � MECHANICAL _,. ____ _ , \ :'V••. .5'�4 � � �� V� .ti��. � •. U..,.� . � � � :.��..,• ,..�o••. t : . :.,.���,•. � •, . ; . '.. •. INSPECTION FEE � SUBIECTTOTHEWOHKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHElA90R � � CAOE.I SHALLFORTHWITNCAMPLY WITM THOSE PROVISIONS ISSUAP7CE , _ ____,__ � SMIP �' p DATE: _ APPLICANT ,___ -- .._—'"— '__" _ ___" � W ENERGY P/C J �,•...1',. � . „ � � � . .�. " � .:.t ' LL r;, v•. . . . : � , ' ' , ENERGY PERMIT I I t 1 !1 Rn — s�. . � 1 , . .� � �".` .. � ; , ` . .••• . . . RETENTIONPEE: �II�TI-�� -'-- �-- -- OCONSTRUCTION LENDING AGENCY pHE-ALT FEE: C�ry�•1{��7Q�}��}�p{�,���{�VyfV��__ __ � IHEREBYAFFIqMUNOERPENALTYOFPEFJURYTHATTNEREISACONSTRl1CTIONLENDINGAGENCY 73�1k.fii.k2Vl`37�Vt7���_ , ._ � fORTFIE PERFORMNNCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3091,CIV C) --� Z _ _— ""—_' w � LEN�EP'SNAAIE __"_'—'_'____'—' . _.' —. .._'__._' __ � LENDER'S.1�DRE55 _--____.— --�� W ICEfl71FVTHATIHAVEREAD7HISAPPLICATIONANUSTATEhIATT1IENBOVEINFORMATIONISCORRECT TOTAL FEES � � 1 AGREE TO COMPLY WITN ALLGITY ANU COUNTY OR�INANCES AND 3TATE LAWS RELATING TO BUILDINp f CONSTRUCTIDN,PND HEREBY AU7HORIZE REPRFSENTATIVES Of 7HI5 COUNTY TO ENTEfl UPON THE Z ABOVE�MENTIONEDPflOPERNfORINSPECTWNPURPOSES COMMENTS _ ___—_.— — � i I/vG�+S�_-- - -- - - - m P MI N E P�� '__ '— -- eC �" (!J ._.— — �--� �) / _ ) N SICNATUREOFPERMITTEE DATE l ,J q�D6Y ✓_ VALIDATION RECP7.NO.._..—_-'— - --- -- F -- - WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOIAENRO�File Copy,GREEN—ApphcenYs Copy J `� � �� ,;�� ..,n a � � --� -i�`-. v � .3 � � ���,.``�'.�\ .y v� " 5 ��� .ti, _..,�� � v ' v � '� ,�� �-•. ` . , py �,� 1 � � � ` � . \ "� . -Y r T �;, ' -'�,'d`.�, ;fN�' . . 1 . . .. . ��.��-1 � .- . � � ::x ' . i . •, � . . � '�;*'� ' ., . ` ' V -1`,1-`•• • ,'•�, ", -•' -'� ' � %- �ty.. w. 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