HomeMy WebLinkAbout12729 (13) ��,
�,� CITY OF DIAMOND BAR =
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
�� 21660 E.Copley Drive Suitc 140 . .
(909)860-3195 Faz(909)861-3117 PRESS
'^"� $UII.DING PERMIT APPLICATION ' FIRMLY
-'� JOBSITE ' � \ APPLICATION p �/ PERMIT nC�P/C
� o ADDRESS_ �37.�.� �0�.4��'�C�YY.1 OY� llr' DATE 1�' �^ !r7 NUMBER ��`/ � �
� APN LOT TRACT '-' ' ' DATE j Z'" j '� I J ONST. GROUP
°C OWNER �t..
o �
� ADD ESS ��a �O Q11 r � ZONING SEfBACKS
� � � FRONT ' RW ❑
CITY� �.yi �IIY' ZIP R11Y9 TEL -�'�1 REAR ❑
APPIICANT TEL. SIDE/SIDE STREET RW ❑
� CONTAACTOR h S�DE p
ADDRESS ---- � ' '
- .
PROPOSED USE �-�- _ _ .._-_ -- - -
� CITY r`� ZIP �a�;�o TEL 12�U-44q�2 -. --���� ,
an�c c� ' :, � _ _ ,
Afl �, @� 1 `,
DESIGNER ,�Gh1 `�\biGC�T'
t�ii N0.DWEL N0. ,. NO.
a ADDFESS � ��u�, ml1 W\'� UNITS � ��STORIES�'�' S � UEDROOMS
� CffY �ekf'S ZIP�� TE r
tn DESCRIPTION SQ.FT, FACTOR PSF ADJ.AREANALUATION
p� _OWNER•BUILDER DECLAFiATION _ __ _ ' ' �q�ppp�EM
O
Q I NERE6Y 11FiUW lHOER VENALTY Oi VERAIRY iHAi l AIA IXEYVT Fiq4 TME COHTiUCTORS LL GaragefCa�port
� Cll CENSEUWi011TNEi0UDWWORFA50N�5EG7m1_6BUSWESSIw�DROFE5510NACDDEAN'ltliYOH (�
W1MTlYniKMREOUIftESADERANTTOWnSiRUGT.KTERIMVR�YE.DEAqUSH.OFiPEiNR/,NYSTRUG � W peliOlOBCk
IUFlE VWOR TO rt9155UANCE.AL50 REOUWES iME AGKICA1fi FOR SUpf YEHMiT TO F0.E AS�fiNEO W
� 67ATEUENi iliAT ME ON SHE IS UGENSED PUiLSUHfT TO THE PROV4510NS OF TNE COHiRAGTOHS L4 � �
� CENSE lAW(QNPT£R i(CpAMENCpk7 VATH SECTpN 7oao)OF DIVISION]OF THE BUS WESS N�D Pq0- Dd .
fE55qH5CODE)ORM4TMEOHSHEISEXEIIPTTHFREFqOAIANDTNEBA$ISFORTHEALLEGEDE%EM0. (�
TION.IVIYVIOIATi]NOF6ECTION7m1.6BYANVAPVUCAN7FpRAVEiUA1T5U8JECTSTHEINVUCANiiO {�e-
� AtlVILPENALTYOFlqTL10RE7lVNFIYEMINDRED�oUARsltsm).l:
� � O1A30'MNEROFTHEPROPEHTY,011YYEMPLOYEESY.�TMwAGESASMEIR50LEtOMDENSATiDN, � Cp�7T8fC1dl - �
M11LL DO TME WOqK AND iME STRUCiURE IS HOi NtiFlUED Ofi OFFERED FOR SALE(SEG 10a�,&15f J
N NE55 FNO PROFESSiONS CODE:iME CONTRAGTO{LS LIGEKSE UW DO'c5 HOT FDOLY TO AN OWNER OF � ? , ,
FiqVFATY W1q BUIDS OR MPqpV65 iMEREON,AND VFiO DOES SUGI WORN INMSELF OR HERSELF OR
. Q 1NROULHWSOqNERQWNEYPIOYEES,DROVI�EOiHAT5UL1/M/PqOVEMENTSARENOTMENDEDOR m - -
O OFEREOFORSALEF,MOwEVER7)iEBIR➢vx70RMVROVEYfNiLS50lDWfTwnONEYF/1ROFCOMPIE � _
. Z TION.7NE OriNERbUM.DER WN.L INVE TME BUi1DEH OF Pi10Vw0 MAi ME Oq bitE DID NOT BU4.D OR . .
� MPRDYEFORTNEPURPOSEOFSALE� . . . , .
W ❑IASONMEROFtHEPFlOVEfiTY.MIEXCLUSNELYOONTRACTNitiWiTHLICENSEDWNiFiACTOHS
Cr TO CONSTpIiCT THE PHO.IECi(SEC.7oa�.BUSiNESS Mm FROFESSiONS CODE THE CONTiUCTORS LL. �VdIU2ti0f1 AQ1AFiEA
i� CENSEUwDOEBNOT/WVIYTOANO1�MEqOFAipOVERTYNT108U4D50qWDq0YEST1EqEON,/.1A
wwomNrw�crswRsuaiPAaEcrswirn�cor�rw�cro�{s�uc�+sEowa.wuirTon�cartw�c. pUANTITY DESCWPTION FEE
� Tans ucEt+sE twwd .. .
OIAAIEXEYPTUDEPSE4 . . .. .- &iP.G.FOflTWSRcAaWi � Q . . .
3 � =. J' =z - t`. _;�°
� °� _
z OAiE OWNEfl U ^, n
O �,
� LICENSED CONTRACTORS DECLl�RATION w �`
� INEPEBYAFFWIIUIIDERPEWLTYOFPERJUM?W1TIudUCENSEDUNDFRPROv�5qN50FCwWiER V. C' ' �
p. �ICOAWFNCWON7i115ECilON7000lOFDM5�ON70FiHE8U5�NE55INOPROFE55lON5CO0�AND Z ��C� ��
X 1AYlICENSE15NfUlFORCEANDEFFECL
tL m
� uc�+sE«�ss C 3`t uc.Ho. `'� �
►�j w��-$���1{' wrtTrucToa a
w
' � WOHFCERS'COMPENSATION DECLAFlATION �
� •IHFAWVAFFIRAIIJNDEpiENALTYfJFPE{WHYONEOFiHEfIX.4AWWG0EClARATIONi . Z . . � .. .
� (n �,� i. r � . '.: � , ... .. `.. . Q ' �. :
� �_.� �.�I HAVE NA VMLL►UVNU�W A CERT7FIGTE OF CdNSINiTOSELFaNSURE FOR WO(iKEFS ..: i. _ , .� � _.. I . �,i _ .. - .
COIAPFlISATqN,ASVflOVLL1mBY6ECilON]7000GTNEUEO�iCOOE,FORTNEGEAWFUAMICE �U +
�7 OF71$MroAKCORMM�TW9PERAUTiSI55UEA .:S - ti i -�(- � , '
� - 'i, � s . - � - _ '� � a! !. .
. W ��IHAVEANOMALLAWHTAINYYORKERS'COMPENSATIONBiSUNW�CE./SREWWEO8Y5ECiqN -., - - � - - /) �/7 w�/ '
O : 5700 0F iHE l/�BOR CODF.fMTHE VEFifORMANCE�E WORK fOR WHIGM iMIS VERMIT 15 ' '� f, � . � . ' / �G.�� / U
- - �ssuE0.ury�oaccAs� Hw cE Eau+qooucrwn.�e�u�:�, CONSTFUCTION � � _�
� ����4 � . , : ,� , , . ' .- ` i , �. . • .
�v VIEW
� GRfiIEN� '��j���[►� . _` ; .
� vaicYra»�eER � �
, , � , _ _ ,-
, .� . _. - - ._ ' - . _ - - - =- - - -
, .. �� , ..
_ . : _. . � � . .: �. _ : _
� o
: � _ � �
_ _ _ ' �
�
� -'�
' _ � �` 1
� ; i
- � z ._ ; - -
� - � o � - . �
.: ' F- Q Q W _ ' _ ' J .
- � �- - � � � p p m Q ' � �� -_ � ' : . � . Z � � -
a '� - o .c� � zm � W ' ZZ � � ' rL ¢ � p o a0
• � O., i= v� 0 000mpi�'mmZ � ¢ oF ? J °' z u7az �- aa �o � . -
Z �. : o � o o � � oozac� � ¢ wzz � oc� Q � zaom i!�,. �`p ,
�'� O ,� • � O Q Q � J F O tl] � _ _ � W lL LL F" Q W U W � W 2 W � � � l_ .
_ . Q W W�d �. = m J U U CS = J J J y U J � F- J � JQ LL7 [L . . . .
Q :O � = Z 2 CL fL � � Z CL W O Z O O O LL � Q Z � Q W W W Z -� �r,' � . .' ' _ _ . ' _
-: _ O O O � W z Z Z ¢ . .. ' ' __
0 �. � � » u. � � cou. am ¢ LLaaa � ❑ � ou. � xo w � oo '
, � � g � ,. ��� , _
W �
� a � - - ,
z � �, �
U " -
j
��
�i
- I -
-- ; �. �.
t
i i �I ' � �� c- ;-.;..
_ '; �I .CmF, :.:�1,
f 'v tl
.. � �. I V' . r`�` "_ `.. � !�
:. _ �� a � � ��. * �"' �� cj n' !'
, -�Z — _ rl` �y
' � z w��
, jm �'V� O � �,U = Z -�. Z ¢ m � Z � � J � C7 U Z � { (A.N
- i �" � � a ow ¢ au' w ¢ wj � u�—igv�iZ �: z � W � � c~� � Z , <� �1J Q� 'p-
y� CL (J C � W W Z > 2 W R � _ � Z -� Q N Z C W � L7.1��,�` F-F-
❑ CL O [n S C7 O J - F- I_ O w J J '"�
' • U O �. �/J ��z U 2 2 2 w r z � a ¢� U a � U x w d � l .�: � U a
Q LL � Z (� n. [[ Z W - Q .J J J J F--d
`'`� � w om � � o ¢ o � a � og -�-� -' � � awcn ¢ aa a ' � � - aW _-
cn � w � ugiH � ¢ t°Ci- � ¢ � ¢ c=» w3c�iocWr, cWnvwicQ7u�— LL � uZ—. O - vWivi