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HomeMy WebLinkAbout10201 (5) .. ....... ...... _.. . .. ..__. _..� ___ . ..----__._._ - - - - -------.. ....._-- _----- _-__ --...-- -- -- ---------. _... _-`.. �,�=� 3��� � � CITY OF DIAMOND BAR � � COMMUNTTY DEVELOP ENT DEPARTMENT ;..� . 21660 E.Copley Drive Suite 190 • PRESS (909)860-3195 Faa(909)861•3117 ' �'�" BLTtLDING PERM IT APPLICATION FI R M LY � JOBSITE APPLICATION PERMIT I p/C � � ADDRESS •� �� DATE � NUMBEFi O N � ISSUE TYPE OCC APN LOT Tfl CT DATE CONST. GROUP p OWNER -� '� LL ADDRESS . � ZONING SEBACKS Z CITY - N �, FRONT RW ❑ g APPLICANT TEL REAR ❑ • � S�DE/SIDE STREET RW O � CONTRACTOR . SIDE ❑ � AD6RESS - � CITY ZIP TEL. PROPOSED USE w ARCH/ENG/ � DESIGNER a ADORESS NO.DWEL NO. NO. � CITY 21P TEL UNITS STORIES BEDROOMS N DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION p� . OWNER-BI;ILDER DECLARATION SFRlADpVHEM O p 1 HEREBV/FFIRAI UNDER PEWLLTY OF PEiWRY TVIAT 1 AY E%EYDT FHOA1 THE CONTRACTONS LI• Gereg�e�rt � W CENSEUWFORTIIEFOLLOWINaREASON(SEC.70.77.SBUSNESSAHOPROFESSIONSCODE:ANYpTYOR (n U CIXINTYMMIWqEOUIqESAVER►��TTOCd�157AUCiAlTE0.MOROVE,OENOUSN,ORREPAIHANV$TRUC. �(J patldDeck � TURE,PRIOR TO ITS ISSU�NCE.AL50 REWIRES iHE MPLICANT FOf1 SUd/PERMIT TO Fl�E A 9M,NED W � - STATEYEM THAT ME OR SNE IS LICENSEU R10.5UMfT TO THE VROVISIQVS OF THE COHTRACiORS LI• � CENSE UW(puPTE11�(COMIAENC7IW 1NRM SECTiON 7aoo)Of OMSIPV]OF iHE B�SINE55 ANO PRO- LL' PW USpa FESSqN5CO0ElOH7)MTHEORSMEISEXEMPTTMEREFNOMANDiNEBA5�5FORTMEALLEOE�E%EYP• (� 710N.ANVVqIATqNOFSECT10N707f.6BYANV/.PPLICANTFONAPERMITSUBJEGT57MEAPPLICAM70 ' Z RB-ROOI � AGVILVENILLIYOFNOTMORETMANi1VENlR10REDDOLURS(i5o7)J: � 04�dMflEROFTMEPROPENTY,ORMYEMPLOYEESYATMWAGFSASTHEIRSOIECOMDENSATIOH, 0 L'pmmBfCldl � . �' N7LL DO iHE WORK,AND THE STRtICiURE IS NOT iHiENDEO OR OFFERED FOR SILLE(SEG 70a�,BU56 J . � NESS ANO VROFE5510NS COOE:iNE CONTMCTORS LICFNSE UW DOES NOi AOPLY TO lW OWNER OF j � . P�EHTY YA/O BUM1DS Oi11MGiqYES iHEREON.AND 1NW DOES SUCH WORK MIMSELF OR HERSELF OR [= THqOUCHHISORHERONMEMVLOYEES,DPOVOEDiHA75ud11YPHOVElIEMSAAEl1�TWTENDEDOR m _ � OiFEREDfOqSALEIF,NOwEVER1I�EBULDWGORYGROVEMEMI550lDVn7HINONEYEAROFCOMPLE• � Z iION.THE OWNER�BIJILDER WILL HAVE iME BUROEN OF VROVItJd iHAT HE OR SNE D�D NOT BUIID OFi = WPROVEFORTHEWIRPOSEOFSALE} . - W OL�OVMEROF7HEPROPEHTY,MIE%QUSIVELYCONTMGTNOYATNLKENSE�CONTMCTDR$ � TO LONSTRUCT iHE PROJECT(SEC.f0u.BUSINE53 AND PROFESSIONS CODE THE CONTfUC70R5 Lb VelUitl0�1 ADJ.AREA � W CENSEUWDOESHOTMPL�TOANOWHEROFAVROVERTYNTqBVILDSORMPROVE9T11ERE01�lWD � VAqCOMMCTSFOHSUCHPq0.1ECf5WITNACONTMCTOR�S�LICENSEDCURSUANTTOTHECCNTMG pUANTITY DESCRIPTION � FEE . � �� � TORS LIGENSE UW�. � O OIAAIE%EMP7UNDERSEG B.{V.C.FOHTW9p[ASON J � � V" OATE ONMER 0 � �' � �¢ LICENSED CONTRACTORS DECIAAATION [L IMEREBVAFFIWJUlOERPfNALTYOFFERR7RYTUTIAMUCENSEDUNDEROROVIS10NSOFCNA7TEq �r . d •(OOtN1ENpNOYVIT115ECT10N7000)OfDIVISqN]OFTMEBUSINESSANDGf10FE55�ON5CDDE,AND Z X YYUCENSE6NiULLFORCEANDE«ECT. m � . - LL � 0 IiCENSE CLASS � w �IC.NO. 7 . , V DATE CONTRACTOR a W • � WORKERS'COMPENSATION DECLARATION ��r —� � � � IHEHEBVIIFFWYUNDERVENALIYOFPERRIRYONEOF7NEiOLLOMnNGCEClAMT10N5: . y � _INAVEMIDWILL►4VNTANACERTIFICAiEOFCONSEMTOSEIF•WSURLFORWORI(ER5 OdAPENSATqN,ASPRONOEDBV5ECT10N77ooOFTMEtABOqCOOEFORTIIEVERCOiWMICE W OF iHE WORN FOR WH1GI 7W 5 OERYI714 LSSUED. � � C Q _I WIVE/�ND NnLL YAINTAW WORKERS'COMPENS�TION INSUW�NCE,AS REOUIRED BV SECTION ]700�FTNEUBORCOOEFORiHEPERfORMM10EOFTMEYNfiKFORW19p1TNISiERMRiS 0 ISSUED.MY E 5 C PENSATIDN 4�7CE CAR�ER AND POLICY NUTABERARE: CONSTRUCTION � c,�AaEa�_ . � PLANREVIEW Z poucwnuMBER IC�_��7 ,$� ELE ¢ � (I}KSECifOUPE�NoiBEa0ARE7mOfTEP[ri.tisRJa0NE1lf�Df�EDOCYURSRiO�IORIEss? 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