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HomeMy WebLinkAbout10554 I� �, � t - CITY OF DIAMOND BAR ; �� ; COMMUNTI'Y DEVELOPMENT DEPARTMENT \� ',,:� .,,.� . 216b0 E.Copley Drive Suite 190 '" PRESS � , ,,,. (909)860.3195 Pnx(909)861-3117 � '""' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE 29 ZZ`i E. DOESICI N P�-�C� APPUCATION ' ��'Z�--�j"� PERMIT /�,�^ /../ P/C �f o A�DRESS AI PtMON� C3 AP� ��A °I l]/oS DATE � NUMBER/ ��/ a 1 o� ISSUE TYPE OCC F APN LOT TRACT DATE__ � �� �CONST. GROUP � p OWNER N1iKE boi NGUYEN � p ADDRESS Z�IZ�q E. DDESKL �--ACE ZONING SETBACKS � oCITYI�IAM�ND BbR ZIP �7�oS TEL. �9 � q FRONT RW LJ � APPLICANT TEL. REAR I�_. z SIDE/SIDE STREET RW ❑ f � CONTRACTOR� _ SIDE _ L]�__T ! a ADDRESS___ PROPOSED USE ��T O CO�E .�..-- C�..��l �V� ! � CITY ZIP _ TEL. j ow ARCWENG/ �"— i iz DESIGNER NO.DWEL. NO. NO. a ADDRESS - UNITS STORIES BEDROOMS I = CITY ZIP _ TEL._ � `n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cn � OWNER-BI;ILDER DECLARATION SFR/ADD/REM 6 p I HEREBY AFFIRM UN�EH PENALiV OF PEflJURY THA7 I AM EXEMPT FHOM THE CONTMCTORS LI � Garage/Caryon �' W CENSEUWFORTHEFOLLOWINGREASON(SEC7o3158USINE93ANDPROFESSIONSCODEANVCITYOR � U COUNTYWHICHPEOUIflESAPEflMITTOCONFTRUCT.ALTER.IMPROVE.�EMOLISH.ORREPAIqANYSTRUC- W PeI10/DBCI( `� � WTUAE.PRIOR TD IYS ISStIANGE,ALSO REQUIflES TME APPLICANT POH SUCH PERMIT 70 FILE A SIGNED W � / i, .�,r 8TATEAIENT THAT HE OR SHE IS LIGENSE�PURSUANT TO THE PflOVI510N5 OF 7NE CAMRACTOR$l b �' � CET15E LAW�CHAPTEH 9(COMMENCIN6 WITN SECTION 7000)OF DIVISbN]O�TME BIJSIhESS AND PRO- LL PooVSpa �'' FESSIONSCO�E�ORTMATMEORSMEISE%EMPTTHEfiEFFOMAN�THEBA515FOflTHEALLEGEDEXEMP• (�} k � TIONANYVIOIATIpNOFSECTION703156VAYYAPPIICANTFOR0.GERMIT5l1BJEGTSTHFAPPLICPNTTO Z Re-Ruof ggg F . �� � . � . ��i• . � z ^ 0 Commerciai � Pi70PERTVWHOBU�LD50RIMPROVeSTHEREON.RNOWMO00E55UCHWORKHIMSELFORHERSELFOR � � fHAOUGHHI50R/1EHOWNEMPLOyEES,PROVIOEDTHATSUCHIMPROYEMENTSARENDTINTENDEDOR m � � OFFERE�FORSAL6IF,HOWEVER,THE�UILDINGORIMPROVEIAENTISSOIDWITHINONEVE4ROFCAMME { � [ION,THf.OWNEp-9WLDEp WILL HpVE THE 6URDEN OF PROVINC THAT HE OR SHE 01�NOT BUILD OR P IMPROVE fOR7HE PUFPOSC-OF SALE� • W ❑I,ASONRJEftOFTHEPROPEflTV,AI'AE%CLUSIVELYCANfIIACTINGWITHLICENSE�CONTPACTORS � ,` g (r {O CANSTFiUCT TIE PROJECT(SEC 70<4,BUSINESS AND PROFESSIONS CODE�THE CANTRACTORS LI� 91Ufl�10f1 a � r t/+��_ADJ.AREA_ k� W CENSELAWDOESNOTAPVLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND E = WHOCONTRACT9FORSUCHPRQIECTSNATHACONTpACTOR(S)LICENSEDPURSUPNTTOTHECOMRAC- QUANTITY DESCRIPTION FEE � ~ lORS LICENSE LAW) F � J r O I 11 AM EXEMPT UNDER SEC ___._._____B 8 P C FOfi 7HIS REASON U � � '_'"' W u" DATE �' ��"'_OWNER' ' _�_ U E O W LICENSED CONTFACTORS DECLARATION � '� � . . �• . ro � .. ,� "� V, R ....• �� � �� .•,:, '„'VV.•.,,'. , ', ''. � �.�. . ~., ,�;,.. .�� .�.. 1ti, Z WJ ' '. •. . , :•. � � � UCENSECL0.SS____._ LIC NO ___„__ _______.__ � J j ' � pATE_,__._,._ CONTRACTOR____ 4 }; W �' � WORKERS'COMPENSATION DECLARATION -� � U � � I HEREBV AFFIRM l/NDER GENALT!OF PERJURI'ONF��T�iE FOLLOWCJO DECLARATIONS. � 'z ¢ � _IHAVEANOH'�LIMA�NTAINACERTIFICATEOFCONSENTTOSELF�IN5t1REFORWORKEHS' _ � COMPENSATION,AS PflOVIDED BY SECTION 37000F THC 1A80P CADE,FOR THE PERFORMANCE U a oF THE WOFlK FOH WHICH THIS PERMIT IS ISSUED � � w __IHAVEAND�LIMWNTAINN�RKERS'COMPENSATIONINSURANCE.p5pEO111RE0BV5ECTION p370o OF THE LABOR CODE,FORTHE PERFORMMICE OFiHE WORK FOR WHICH THIS VERMIT IS `_�_�'�� �"�� ��� 'i W J ISSUEO MY WORXERS'COMPENSAiION INSURANCE CARRIER AND POLICY NURIBENAFE 7 GARRIER_ __. '_'_—"—"_' � saa,w�=• Ci` � 7 ZPOLICYNUMBER_____- -____.-_-- ' � ____. ¢ (I}IlS5EC7KlNNEmNOTBECCh1PLE7EDOF111EPERMTlSFOfiONEFM1N�F7E�DOLVAS15�00)ORLFa55} PLUMBING . _ __ p .� � . �, �••. +. . h • �� , MECHANICAL � � � • •. Y '.;.,.. . ,,.,... �...:..,'�., .• • INSPECTI�N FEE i � �, . ., o •. • '•. •.:. � ., . ,.. .. .. ., y} r SUBJECTTOTY.EWORKERS'COMPENSATIONPROVISIONSOFSECT�ON31ooOFTNELAeO� .+s'°� �F � GOUE.ISHALLFORTHWI7HCOMPLVWITH7HOSEPHOVISIONS PISSUANCE ______. � ._ _- � + � SMIP � p �ATE. APPLICANT. '_'__'--_�_ '_'"_"_'___ _'____.._"'� - � ,, , , , , , ENERGY P/C � h:...�� , .� h�,.� . ;V. � � �,�:f v..� • �� �v•... � � '',�.�'• •v� � . �. ,� . ENERGYPERMIT � ' . ..• •� . . � ' . . � � ..... . " .� RETENTION FEE� --_--�--- � CONSTRUCTION LENDING AGENCY 3 O PRE-ALT FEE. � I HEREBY AFFIflM UNOER PENALTY OF PEqJUflY THAT THEFE IS A CONSTRUCTION IEN�ING AGENCV ,___ __t}_�,�,zT ~ _ - � FORTHE 7ERFORMANCEOF LHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3a61,CIV C� � W � LENDER'6NAME ,_. _�_—_-__ �( F_ LENOER'S AODRESS_ "_—'"__'_ "'""'--"' --'---_'- 7 � ICERTIFYTHATIHAVEREADTHISAPPlICA710NANDSTATETHA77HEABOVEINFORAlAT10NISCORRECT TOTAL FFES ��7 �� p w I AGREE TO COMPLY WITrI ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BU�LDING ' � �' � GONSTRUCTION,ANDHEREBYAUTHOHIZfREPRESENTAT14E50FTHI5COUN�VTOENTEFUPONTHE ZA60VE•MENT10NE0 PROCEHTV FOR INSPECTION PUR�OSES COMMENTS_ ___ O J _ — ___ QMI77EE NAME(PRINT ��-��'�^' I _. N L-��.� �./ p N U P NMITfE �TE T � RECPT.N0.���'? ! 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