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HomeMy WebLinkAbout16259 (37) r • ` ' ` _�\ CITY OF DIAMOND BAR `� , DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES . � � `!• 21660 E.Copley Drive 3uite 190 � (909)86Q3195 Fax(909)861-3117 RES$ ������ BUQ.DING PERMIT APPLICATION FIRMLY y JOBSITE I 6�I '�`R�G �O�-�.L`� 7 � APPUCATION % .���UI NUMB R � � M� o ADDRESS DATE � APN LOT� TRA T O ISSUE TYPE " OCC � _ Sc DATE CONST. GROUP p OWNER I�{-Y� "- ZONING SETF3ACKS � C'DTMDRESS � �IP TEL. FRONT RW � APPLICANT TEL. REAR O � SIDE/SIDE STREET RW D CONTAACTOR �'1n 61..1 �L SIDE ❑ � ADDRESS �^ PROPOSED USE � CfTYr_.N-1 ►-1t'� ^ ZIP�/?G(7 TEL.�'fD�UZS ARCHlENG/� �� DESIGNER NO.DWEL NO. NO. ADDRESS �� UNITS STORIES BEDROOMS � CITY ZIP ' TEL. � DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER�ECLARATION SF WADD/REM O p I HEREBY AFi1iM UNDER PENA{.TY OF VERAINY THAT t AA1 E7IEYVT FHOrA THE CONTMCTORS LI� GdrBQe/CBfpOR 11J CENSEUWFORiHEFOLLO�MMONEASOH(SEC.7WI.6BUSWESSMIOFROFESSiON5C00E:ANYCITYOfl (n CJ OOIMiYMMk71REd1WE5AVERMRTOWN57Al1Cf.ALTEI�IMPROVE.DEA10LI5H.OHREPAIRMIYSTAUC• W PelKllDedc �� TURE.PRqR TO ITS IS6UANCE,ILLSO REWIRES 7ME�PVUCANT FOR SUCH CERu1T TO FILE A SIGNEO W STATEMENf TIUT HE OFl 9ME IS UCENSED PURSUANf TO 7NE PFiOVI510NS OF THE CONTIUCTORS LL � CE118E LAW�pUFTEN�(COMMENCPIa 1MiN SECTIIX�70D0�OF DIVISqN]OF TME BVSINESS AND PRO� LL PooVSpa fE55qMS GOOE7 Oq TIIAT ME OR SHE IS E%EMPT iMEREFFlOY AND TME BASIS FOR T1E KLEGEO EXEMv� TIOH.ANYVqUT10NOF5ECTION7W1.69YANYMPLICANiFOR11VEfWITSU&lEGiSTHEAPPLIGwTTO Z RB•ROOf � ApNLPENALTIOFNOTMOfiEIWWFNEHUNOREDDOlUlR5�t500).): � OLIl50NNEROfMEVROPERTY.ORMVE4�LOYEESWITHWAGE5A5THEiqSOlEC01AVENSATqN, � Cpmmercial - WRL DO iHE VIORK AND TH[SiRUCTURE IS NOT INTENDED OR OFFEHED FOR SALE 15EG 70�1 BUSI. 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DA7E OW1�ER U � W LICENSED CONTRACTORS DECLARATION W � IHENEBYAFFIRMUHDENFENACTYOFVE0.M11flYTMATIFMUCEN5C0UNDERVROV1510N50FCMMiER � � �(COMY[NCNO WfTM SECTION 7000)OF OM510N�OF TME BUSINESS AND VROFESSUNS COOE.IWO Z �� W LICENSE IS N Ml fORCEAND ELFECT. ^ � 110ENSECLASS G~ LIC.NO. �� H'�� m N �j/ ' ' �j DATE� O CONTMCTOR � ' � WOfiKERS'COMPENSATIONDECLARATION a � . � . � � � , . � U � IHEi�$7YAFFlRMUNDERPENALTYOFOEM1Fh'ONEOFTNEFOLLOWWCD[CLANATqNS � � A/ ¢ 4 '��INAVEANDIMLLMAIMASIACEHTiFIGTEOFO0N5ENTTOSELFdNSUREFONWORKERS' _ � GpIPEN5AT1oN,A5 7ROVIOED 9Y SECTION 770D OF THE LADOR CODE.FOR TNE GERFORAIANCE (J � OfJF1E w011K FOR WHiG1 THIS VERMIT IS ISSUED. � 0 � / V IMAYEANDYALLWUNTAINWORRERS'COA/PE45ATIONINSURANCE.ASREWIREOBYSECTION I�'�O 4 77000FTNEUBORCOOEfORTNEGERFORMANCEOFTHEWOPXFORWHILHTN15VER1AIT15 � ISSUEO.W WOiufE S'COIIPENSA710NJ�UMNCE GRIIlR�IJD POLICY NUMBER ARE: CONSTRUCTION I�_ 0�r � uqqiEq G 1� PUW REVIEW Z voucrHuueEn C. � ELEC7RIC ' � �' .Q 0 RFKS[Cf10NKIDNOTB[¢7.sLETIDCFMPCii.ffSFORCh£Ht1�0f1EDDCUNl56•d%ORlESS� PLUMDING Z 1 CERTIFY 7HAT W TiE PERFORUANCE OF iHE WORK FOR WM�pI THiS CE�U.�iT IS ISSUED,1 �ECHANICAL (,''J SMALL NOT EMPLOYMlY PERSON N AN'!MNINEfl SOAS TO BECOAIE Sl1BJEtT TO T � � " (/) WORI(ERS'COMPENS�TqNUW50FCAL60RNl ,ANDIIGREE7MATi1 DB . 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DOLLARS(f1oo,Dao�N M�rt10N TO T71E C0.5T OF COEIVENS�TqN.DAIMGES AS VROVIDED FOf11N � SECTION�70lOFTNELABORCODE,NTEREST,MPJATTORNEV'SFEES RETENT�ONFEE: d CONSTRUCTION LENDING AGENCY PRE•AlT FEE: � IHEREBYIFFIfiMUNDEROENALTYOFDE0.IUNVTHATiMERE�5ACd1STRUCTIONLEND�NOAGENCY FOq 7HE VFRFOW/AANCE OF THE WOR1(iOR WHitl�TMS VERYIT IS ISSUED(SEG]OV7.CIV.G). � � LENDER'S NAME � LENDEtiS I�D�NE55 /'�C � ICERTIFYTIATIHAVEREADTNISAPPLICATpNANDSTATETNATT11EA80VEMFOPIAATIONIS[DMECi TOTAL FE S ^ ' P� � � IA6REETOCd.�PLYN7TNALLCRVANDCOUMYORDiNANCE5ANO5TATEUNSRELATNOTOBUl01N0 ///��� �y 1 �r CANSTRVLTION,MKINEREBYAUTHOW2EREPRLSENUTIVESOFTHISCOUNTYTOEMERUPONiNE I %��1! ��I�I 1 � �MENTK7NEDVROC RTVFORINSVECTqNVURPQ5E5. COMMEr1TS V r � � v �� _ °O vEwu va _ 4 � a� �i � � UR OF PENJiTTEE OAiE � RECPL NO. PAI�BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD�ile Copy,GREEN—AppliranYs Copy r �� , CiTY OF DIAh9�f�lD BAR - , ��� � I��'SPEC�i"IOf�! 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