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HomeMy WebLinkAbout12246 (14) f ! ! CITY OF DIAMOND BAR --��— DEPARTMEI�TT OF COMMUNITY&DEVELOPMENT SERVICES `y� _�> f � . 21660 E.Copley Drive 5uite 190 � � -,,,� (909)860-3195 Fax(909)861-3117 PRESS �.. BUILDING PERMIT APPLICATIQN FIRMLY - — � ___ � o DDRESS �"�} � ��C-��� �`�.4/� �s y�� � pAPEICATION/�'4..( 1„`�� NUMB R �d ��C� #/C �.y t $ ' ISSUE i�/ �) TYPE OCC APN LO TRACT ; DATE �'�" ! Q '""�°c� CONST. GROUP � p OWNER ��� S�i'�1�� ADDRESS � � � ' .�� ': ZONING SETBACKS � CITY ' ZIP � TEL.°W v - i � FRONT RW ❑ APPLICANT � TE ^CI REAR ❑ SIDE/SIQE STREET RW � � CONTRACTOR_ � t�p � (L SIDE ❑ � ADDRESS � ' � " PROPOSED USE� L� ��� �a ( -r�-`J. S�/�- o, CITY � ' � ZIP TEL. ? �L �„ .� w ARCH/ENG! S� �, � z� DESIGNER � NO.DWEL. / NO.' N . �; ADDRESS ' UNITS- k STORtES � `:- BEDROOMS '' ��" CITY ZIP TEL. '' DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION OOWNER-BUILDER DECLARATION " :_ SFRJADD/REM 1 HEREBY AFFlRM UNDER PENAL7Y OF PERJUHV THAT I AM E%EMPT FROM THE CONTRACTOflS L4 '� W�. CENSEUWKORTHEFd10WMaREASON(SEC.7o31.6BUSINE55ANDPROFESSIONSCODEANYCITYOR �w'� Garage/Carport � �� COUNTYVMICNREIXIIflESAPERMffTOCONSTHUCT,ALTER,IMPROYE,DEMOLISH,ORREPAIRANYSTRUC� ;W pgti0/DBCk � - �z 7UHE,PRIOR TO RS ISSUANCE,AL50 REW IRES THE APPUCANT FOR SUCH PERMR 70 FI�E A SIGNED W-- STATEMENT THA7 HE OR SHE IS LICENSEO Pl1RSUANT 70 7HE PROVISIONS OF THE CONTRRCTORS LI �w - - CENSE LAW(CHAP7ER8(COMMENqNO N7TH SECTION 7000j OF DIVISION 3 OF TNE BUSMESSANO PRO u'� PooUSpa �-. FESSIONSCODE)ORTHATHEORSHEISE%EMPT7HEPEFROMANDTHEBASISFORTHEALLEGEDEXEMP• �(�J �'y - -. 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Q 97000FTHE1.480RCO0E,FORTHE7ERFORMANCEOFTHEWOHKFORWMICHYHISPERMITIS �d� ,6's i�� ISSUED.MY WORKERS'COMPENSATION IN5URANCE CAflft�ER AN�POUCV NUM9ER AflE: CONSTRUCTION C�'� � j cAqpi� PLAN REVIEW - Z PIX.ICYNUMBER ELECTRIC Q . 0 (fFnSSECTIONNEIDN0TBE00MR.E7EDOFTNEPER�XfISFORaNEM1NDRED00L1Afi41S10D)ORLESSF PLUMBING Z ICEflTIFYTHATINTHEPERFORMANCEOFTHEWORKFOflWHICHTHISPERMR1515&UED,1 MECHANICAL (•j SHAL{.NOT EMPLOY ANY PERSON�N ANY MANNER SOAS TO BECOME SUBJECTTOTHE � WORKERS'COMPENSAT�ON IAWS OF CALiFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE p,/� � 3UBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000F�FIELABOR �SSUANCE - P`'°`" CADE,1 SHlJl FORTHWITH COMPLY W! 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