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HomeMy WebLinkAbout16486 _ _ _ , . ........._. CITY OF DIAMOND BAR ��G �� � �� - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ' � 21660 E.Coplcy Drive Suite 190 (909)860.3195 Faz(909)861-3117 PRESS ��^� BUQ.DING PERMIT APPLICATION FIRMLY o ADDRESS � ��•� ���; DATE CATION 5,C._0` NUMB R '�� *�I� �� U c� - ISSUE ' TYPE % � OCC APN LOT TRACT DATE CONST. 7� Il-� GROUP P p OWNE�� 'e v.� CO " AD�RESS �rIC �I�(Z.o� S �le 00 tONING SEfBACKS � CITY 1 nP ZIP A�IO��TEL.77` 7�1 REAR RW p APPLICANT TEL. SIDFJSIDE STREET RW ❑ � CONTRACTOR SIDE O � ADDRESS CI7Y 2IP TEL PROPOSED USE ��� ` n � ARCH/ENG/ /�,��,� � DESIGNER Tri c i o� PI CI'''�'O �"-""- � �' ��� ADDRESS ( '7Z �tC_��_ (n�- � - " � p NO.OWEL. NO. NO. UNITS STORIES BEDROOMS � CIN �fJ��C 21P`�2l�IZ TEL. 1-7,?�- � - •- - N DESCRIPTION SQ.FT.��. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECLARATION SFR/ApDIFtEM O p I MEREBY AiFiRY UNDER iENALT'OF PEiWRY THAT I hM ExEMPT�ttOA1 ME CdRMCTORS L4 Garage/Carpart W CENSEUWFORTHEFOLlO1WK.NCA50NlSEG70.11.6BUSINESSANOPROFESSIONSOODE:ANYCI7YOR (n �7 �TyWMp{qEpUW[SACERURTOCDN57i7UCT,ALTER����E,0E1.bL15N,ORRE7AIRANVSTPUG W PatiolDeck � TURE,YRqR TO 1T9 ISSUANCE,A.50 REWINES TME AVPLKANT FOR SUG1/PERMIT TO F0.E A SICNED � STATEYENT THAT HE OR SME l5 LICENSEO PU0.5UANT TO THE VROVISIOKS OF TME GONTMCTORS l4 � CENSE UW(pUPTER 0(C01AMC4qNU NrtTV/SECTION 7uo0j OF OM510N 7 OF TXE BUS�NESS AND PR0. �" Paa�P� fES5UN5 LDDE7 OR TW�i ME Oii SME IS E%E V PT iHEREFRpA AYD THE BA5i5 FOR TNE ALIEOED ExEMP• TqN.ANYVI0�AT10NOF5[Cf10N70]1.68VANYA7PLIG."fTiOHAPERYIT5U61ELT5TNEAPPIIGIMTO z Re-Roo1 � ACML PE W1LTY OF NOT MORE 11W1 FNE MINDRED OOLUAS(f500�.): D � Ol/SOMMEROFTM[PROPERT/,ORMYEYPLOYEESYViTHwACE5A5TNEIRSOLfCOMiEN5AT10N, Q COmmBrtl21 ' YALI DO TNE WORK,AND TME STRUCNfiE IS NOT INTENDEO OR OFFEREO FOR SALE(SEG 7ou.BUS�. NE55 AND VROFESSIONS CODE:TME CONTRACTORS LICEN9E Uw OOES NOT A7GLY TO AN OVlNER OF N V{100ERT'NR1OBUlD90RIlA0A0YESTHERCON.ANDN410�0ESSULNWOfiKHIMSElFORHERSELFOR = Q TMROUOF1111SORHERWN�EIJPLOYEES,VROVIDEDTMAT5�ICMM�FFOVEIACMSAf1ENOTINTFNDEDOR m x1 OiFERCD fOi15ALE�F 1qNEYEfI iNC BULD�NOOR MPROYEAIEM IS SOLD WrtHiN ONE YEAR OF OOMttE• � TtON,ME OWNEREUIDER VNLL HAVE TM[&1RDEN OF OROW10 iMAT NE OH SME ON NOT BUILD Ofi � MPRaNEFORINEPURPOSEOFSALEI w ❑I,ASOMNEROFTMEPROPERi1,AME%0.USfVEL�COf1iNACTNOWITHUCEN°EDWNiMCTORS � TO CONSTRl1C'f iHE iRO.IECT(SEG 70��,BUSINESS 11ND VROFESSIONS CODE:TME CONiMCTON5l1• VeIUatlWl /�Q�./w�/1 CENSE LAW DOES HOT APPLY TO�N ONT�ER OF A 7ROPERTY�Nq BUIIDS OH IMPROVGS TNERLON.AND � WFIOCOHTMGTSiOFiSUCNPRQIECTSMATHACONTMCTON(S�LICENSEDPUR�UANTTOiHEGONTMG QUANTITY ESCRIPTION FEE � � TO(15lJCENSE UW.1. _- " Q ❑I W E%EY7T 11NDER SEC. 9.i V.C.FOR iM15 RU50N U LL" pA7E ONMER � � W LICENSED CONrRACTORS DECIARATION –� � W IHEREBYAfFlfWUNOERPENALT70FVERIUNYTHATIAML�CENSEDUNDEFPFOvi5iON50FCw�PTER U. � �(COId11ENCH0 W�TH CTION f000)Of DMS�ON�OF TNE BUS:NF55 ANO VROFESSIIXJS COCE,ANO Z . - ` �� MY UCENSE LS W RCE ANJ EFFCCT. m i';�_, � � LICENSE S� UC.ND.����r � � �j p/�TE��1�.yL CONTiLIC'TOfi�.�_�5� � W �' � WORKERS'CO�dPENSATION DECLAFATtON 4 N 1 HEPE6YAFFIRIJ UNDER DENALTY OF PE0.IURY ONE OF iNE fOLLOWING DECURATqNS: � � z a � ��IMAVEANDYVILLWuM�EJ►CENTIFIGTEOFLONSEHTTOS[LF-�N^aUREFORNORKERS' _ � �' CDYPENSATqN,ASPRCV�UEDEVSECTIONJ/o00FT1�ELABOfiCCD^.,FORTHEPERCORIAANCE U � OfiNE WORK�OR WHiCM iw5 CENA�IT IS ISSUED. LL� C / � l/I HAVE ANO lNLL WIMA'N WORKERS'CO�ADEY.^sA71CN INSURANLE.AS REOUIREO BY SECTqN Qi1onOFTHEIABOfiWOE.FORTHEPERFORMANCEOFTM[WOpKfOHWHICHTHISPERM'TIS � � ISSUEO.A1'/ iUCER�pbOu�ENSAT10NW5UR/J:CECARR:ERA7NPOlICYhUMBCRME: CONSTFiUCTION �l�(� C�n�uEA�•�1VI\�U G'L��V��frC_4 __ PLANREVIEW � � � DOLICYHUTAB[R C_ C L. �� L�GZ R[CTRIC Q �nsscc��cmr+or¢[oa.�T[noFncv[rowrsra�or.e�nm�d�celoaiEss� PLUM�ING . --..... W ICEI7TFViMATINTHE�ERFORMANCEOFiHEWO�KFORWNICHTHISPERMITI5155UE0.1 MECHANICAL SM/�11 NOi EMPLOY INY GE RSON W MN 4ANNER 50 AS TO BECOM[SUOJFCT TO THE � NC]Pi(EHS'CdAPENS�TiOH UWS OF GLLiFOPNII�♦ A R iM�T IF I SMOULDBCCOME INSPECTION FEE � �� S SuuJECTTOTMEN'ORMF.RS'COUPEHS�TIONV �i'J SECTION77ooOGiHEUBOR COOE,16HAlLFORf}NATHCONPLYN1TMT •EP �SSUANCE � 0 . � SMIP p DATE:�� r V _ APPLICANT: �� . . � ENERGY P/C � WARNINa:FA4VitE TO SECVRE��KER�COG�7ENSA7IDN LOYEMCE IS UNUWFVL.ANO SHKL BE ' �y SUBJFCTANE47LOYERTOCRIMIWLLPENALTIES�NDCNI�FWESUPTOONENUhDRC0T110V5AN0 [NERGYPERMIT DOLURS(31oo.00C).�N IDDiT10N TOTHE WSTOF COMVENSATqN.DAMAGES AS VRONDEO FOA IN ¢ SECTIDN�70lOFTHEUBORCOOE,IN7ERESt,IWDATTORNEYSFEES. F7E7ENTIONFEE: I �'Or� � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O ' � IHEREBYAFFIfiMUNDERVENALTYOFpERNflYT1/�TTM[REISACANSTRUCTiONLENDMCAGENCV fOF TME VERLORIAANCE OF 7HE X'ORN FOR WMlpl TMIS PERMIT IS ISSUED(SEC.7oY7,Crv.C J. � � / � IENDER'S NAME _ � LFNOER'SADORE53 � ��// ' ,!� , T � ICERTIFYTXATIIUVEREIDTNIS�PPLICA7qNANDSTATE�TTHEABOVEN�ORiA�110NI5CORRECL TOTAL FEES ?I/ / J v W IAGFEETOWI.IPLYVlITMALLCRYANDCIXINTYOAOWANCESANDSTATEUw5REU1wCTOBULLI1iNC � � CONSTRVCfqN.�NDNCRLdY11VTHORREREPRCSENTATNfSOFTM15COVNNTOENTERUPONTME C�� �..�j� � �1ppVE�M[NTqNCD PHOPENTI'fOft MSPECTON PURPOSEg. COMMCNTS , � 'f�ti�e.� Ti mrv�s �-- a�.�- . � - ,�` '-� m veaum �y..�E(PRINTj � ����� '��iivv,�vS 5�$'C�t � — . 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