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HomeMy WebLinkAbout16822 (39) �` CITY OF DIAMOND BAR � i DEPARTMENT OF CONIIv1UN1TY&DEVELOPMENT SERVICES \\`� 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS � BUILDING PERMIT APPLICATION FIRMLY ¢ ADDRESS Ib S• [r C APPLICATION I� f� � PERMIT ,(nU !� P!C p DATE < < NUMBER `� �� # � APN L T TRA�T� DATE �q � TMPE OCC o OWNER �s CONST. GROUP p ADDRES .�Q+Y I�/ s�L� 20NING SETBACKS Z CITY ZIP TEL.7�� ZT� FRONT RW ❑ � APPLICANT TEL REAR ❑ � ' SIDE/SIDE STREET RYJ ❑ � CONTRACTOR IL SIDE ❑ ADDRESS � � CITY ZIP�f TEL.��� P�OPOSED USE � ARCHlENG/ W DESIGNER__���, NO.DWEL. NO. 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(7 V TION.MIVVIOLATIONOFS[Ci�ON7071.S8YANYAPPLICANTiOR�PERMITSUBJECT4T+[MPLICANTTp Z Re-Roof � A pVIL iENA�tt OF NOT MOflE TNAN FNE MVNOMEO DOLLAAS(SS00)): ZOlA50NMEROF7HEPfiOPERiY.ORMYEMPLOYEESMnTMWAGESASTHEIRSOLECOIAFENS�TION, � (`qmm�rtial N7LL DO THE WORK,AN�J TME STRUCTURE IS NOT INTENDED OR OFfERED FOR S�LE(SEC.70��.BU51- J N NESSIWDiROFE5510N5CWE:THECOM�RACTORSLICENSEUwDOESNOTAvpLTTOANOwN[ROF � OROPENT`/1M10 BUdO50R W PROVES iHEFEON.MD VMO DOES SUd1 WORK MIIASELF OR HERSELF DR [L THROl1GHFII50RHEROYMEMPIOYEES.VROVIDEDTHAT5UCM9APpOVEMEMSAR[NOTIMTENDEDOR m w OFFEREOiOFiSILLE.6.FqWEVERTMEBVILD�NGOflRAPROVEMENTI550lDWITMNONE�EAROFC01.1PLE� � TION,TME OWNER�BUILOER 1NLL MAVE THE BURDEN OF GROVWG THAT NE OR SNE�ID NOT BUILp OR Z WVROVEfORTHEFUflPO5EOF5ALE�. Q= OI�lSOWNEROFTHEGROPERTY.AAIE%QUSNELYCONTRA�W6WITHLICENSEOCONTMCTOfiS TO CONSTRUCT TIIE PR0.IECT(SEC.70a,,BUSINE55 AND PROFESSIONS CODE:THE COHTMCTOi25 LI- V81U81iOf1 / ApJ,AREA 41 LENSEUWpOESNOTAPG�YTOM/OWNEHOFAPROPERTVWMOBUKD50NIMPflOVE9THEFEON.AND � NM1qCOMMCT5FOR5UU1VR0.1ECT5WITH�CONTHACTOR�S)LICENSEOCURSUAMTOTHECONTMG QUANTITY DESCRIPTION FEE Y TORSUCENSEUw.). � O I A1A E%EIIPT UNDER SEC. B.L VG FOR TNIS RE/SON Q � U , �. � Z DATE OwNER U O� � LICENSED CONTRACTORS DECLARATION W J � IHERLBYAFFIRIIIINDEN7EN/LTYOFPE0.1URYiNATIAMLICENSEDUNDERDROV�SION50FCHAPTER V. � / O d i(COMMENCWC'MiHSECTION)OOD)OFDIVI510N]OFTMEBUSINESS�NDPROFESSqNSCODE.AND Z � MY I�CENSE IS N FUI.I FORCE�ND EFFECT. � �t7 m � � LICENSE � � IIC.NO. ���`� / � V DATE CONTRACTOR� _ � a .. W � WORKERS'COMPENSATION DECLARATION -� = U NIHEAEBYAFFIRMUNDERVENAITVOFPERIURYONEOFTMEiOLLOVA4C0ECUAATqNS. Z 4 � �IMAVE/WDNnLIIMINTNNACERTIFICAiEOFOONSENTTOSELiaNSUREFORWOfU(ERS' _ � CAMPENSATqN,ASPROVIDEUB�SECTON]�OOOFTNE UBORCODE,FORTNEPERFONMANCE W � OF 1HE WOPK FOiI WNICFI TNIS OEPA'.T IS ISSUED. � G ` — w �IMAVEANDWiLI�.UINTAINWOFNERS'CWPENSATqNINSV�iANCE.A5RE0U�REDBVSECTIDN � Q J7o00FiMEU80RCOD[,FORTHEPERFORMAh'CEOFTHEW KFOflWHip1TN15GERMITIS I�I . � n�� ISSUED.M'�WORKF ' /dDE ATIONINSURA NRIER +�VOIICYMIIABCRAR[' CONSTRUCT�ON � j uaa,Ea ' PIAN REVIEW Z oaicwNweER�6,� ��_!� . 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W IAGREETDLOMPLVWITHALLLIiY/JlDLOUNTYOR��NANGESMASTATEUNSREUTINGTOBUILDINO � CONSTRUCTION,ANDMERE8IIAUT110R1ZEHEPRESENTATIVESOF7Hi5tOVNTYTOENTERUPONTHE ZABOVE�MENTIONf00ROPERTVFORINSPECTIONPUFGOSES. Q ��� COUh1ENTS � m PERMi7TEE E1� � �Q� ¢ � � � � SIGN tEc1 VERMITTEE C fE � RECPT.�O. 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