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HomeMy WebLinkAbout14278 f------ ------ ----- ---- _.. —.-�..�_�_ —. �,� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY d�DEVELOPMENT SEFVICES �� 21660 E.Coplcy Drive Suitc 190 (909)86Q3195 Fax(909)861-3117 PR ESS ���*���� BUQ.DING PERMTT APPLICATION FIRMLY � JOBSITE APPLICATION� _./ 1 � PERMIT /5/�7 P/C o ADDRESS �� �`� �'JI/t(�"�i�� DATE � NUMBER M $ ISSUE TYPE OCC APN LOT--�— TRACT DATE CONST. GROUP p OWNER �C f1N11 �✓l�'(� �JL(,�a-/f( \ "' ADDRESS r ��j � ZONING SETBACKS z Cmf,[�������vn ✓InnZIP �f�7G� TEL.f ' �z REAR Rw D g APPLICANT TEL. SIDEJSIDE STREET RW D � CONTRACTOR '�f'✓ v� �V � SIDE O g ADDRESS l.�/ /=- ✓AiCJ ,/1 t2r-'v� �� pROPOSED USE 7 ����-�-Q�7_ CfTY ,_.���TNf� ZIP �/72,z TEL/�ZO�C 2e n�.� � �. � ARCH/ENG! � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CIT`( ZIP TEL y DESCRIPTION SO.Ff. FACTOR PSF ADJ.AREANALUATION ti Q OWNER•BUILDER DECLAFiATION SFR/ADD/REM O 1 MEREBY AiF6M UNDEH PENALTY OF PEIWRY 7FNT 1 NA E%EMPT FH01A TME GONTRACTORS L4 Garega/Carport 8 CENSEU�MFORTMEFOLLOWWOREASON(SEC.T0�1.68USwE5511NDVROFE55iONSCOOE:ANYCITYOH (n �..7 COUHTYNHICHpEd,JIRESAVERA1RT00CN57AUCT,ALTERM�ROVE,DfA10lJ5H2ONREVAIRANYSTRUG W P8ti01DeCk �ZIUNE,VRqfi TO RS ISSU�NCE AlSO RE W IRES THE APPLICAF7T WR 6UG1 VEi1MIT TO FLLE A SIGNED W � 6TA7EMEM i11AT HE OR SME IS UCENSED VU0.5UANT N 7HE GROVISIOrL4 OF TME CON7MCT00.S lb � CENSE UW�CHAVTER i�COYMENCWO MiTM SECTION 7000)OF DIVISiON!OF TME BUSINE55 AND PRO- LL' PooVSpa fE6SION3 COOE)OR TIN7 NE OH SHE IS EXEMVT 7NEREFROM AND iHE BASIS Fql TME ALLEDED EXEMP- TqN.ANYV10UUlONOfSECT10N70]7.6BYANYAiVt1CANTFOfiAPEN.aT5U8JEGT3iHEMPLIGN7T0 Z Ro•Roof F A CMl VEN/LTY OF NO7 MORE iHIW FrvE MUAREO WLURS�fsm�.�: � OlA40VINEROF7HEPROPFRTY.ONMYE�PIAYEESWITHWAG[SASTHEIq50lFCOMPEN5AT10N, � �mmorcie� - WILL 00 THE WORK AND THE STRt1Cfl1RE IS NOT INTENDEO OR OFGERED fOR SALE(SEG 7M�,BU51• J NESS ND VROFFSSqNS COO[:7ME CONTMCfORS IJCEN4E UW DOES NOi A7PLv TO AN OwNER OF � PROPER�YV.HOBU�lD90RMPROVES711EREON,NAYNIODOESSUCNWONKMIMSELFORNERSELFOq m � ('L ft7R0UGHHSORMEROYMiEMPLOYEE5,PA0VIOED7WUSUCMWPROVEMEM3MENOTWTENDEDOR _ . � �OOFFEREDPoRSALEIF,NOW€YER��QORN1Pf10VEMENi13SOLDYnTMNONEYEAROFCOMPLE- Z TIOH,TNE OM�NEH�6URDEH YYILL NAVE iME BURDEN OF PROVPI�iHAT NE OR SNE OID NOT BUIID OR . = YPROYE FORTNE%1RPOSE OF SALE� �y,� OlA4DMMEROFiHEVROPERTY.A4EXCLUSNEIYCONTMCTC7�WR11l10EN5CD00NTMCTORS (= TO CONSTRUCT7HE ORWECT�SEC.7ou.BUSINESS A1tl VPOFESSIONS LODL TXE COffTRACT00.414 Valuation � ADJ.AREA lU CEN6EUIWDOESNOTMPLYTOANOMIEROFAOROVERttVAqBUILD50RIMiRDVE57NEREON,AND z WIqCONTMCTSi0f75Ud1GRDJECTSWIMACONTMCTOH(S�LILENSEDPUPSUN1TT07HEC0lITMC- pUANT1TY O[SCRIPTION FEE � raas uc�+se uw.�. O IAA1 EXEYPT UNDf R SEG B.�P.G FON THiS REASON U � u" DATE OYMER F' � W LICENSED CONTRACiOFlS DECLARATION -� � w � INEREBYAfFRWN10ERPENKTYOFPCRIURYTMATIAMUCEN5E0UNDEHPROVI5lON50FCMAPTER � ��COMNENCaX1N7TH9ECi10N700a1�DM5�ON]OFTHEBUSINESSANDPROFESSiONSCODEMID Z � W UCENSE IS N FUl FORCEIHD EiFECT. m � o uc�sEcuss r,�l �y? u�.No. 7-v�ysy.2 _ J ., t� w� corrtrucron/!rJ!✓7J /7 �+ a _ � c � \ WORKERS'COMPENSATION�ECLARATION a � INER�DYIIFFIRMUNDERVENALTYOFiEiWMONEOFTHEFOLLOYANGDECUMiqN4: � � Q � _IHAVfAND4MiLLMAMTAMACERTIFlUTEOFCONSEMTOSElFaNSUHEFORWOiL(ERS' S C�0IMENSATI0N,A9PROV�EOBYSECTqN]7ooOFTNEUDORCOOE.FORTIE7ERFORM�NCE U Q OF ORK FOR WHiG17T1I5 PERM�T 19�SSUED. � O G 1 HAVE AND WiLL►IAMTAN WORKERS'COYPENSATION WSUFLW CE.AS REDUIRED BY SECTION ^ Q �70o OF TNE LABOR CODE FOq 111E PERFOa1AANCE OF iHE WORK f-0H N�NICN THIS DEAMIT IS //�D 0 S1�0.1RYWORKEttS'COE�PENSATIONINSIhW�CECARRIERMAGOIICYNUMOERME: CONSTRUCT�ON (S-�._ � `C+ _ �Ea /U��G7 �+'A/!2R/f�l'�k �'.-�t/Un PUW REVIEW T► . > � � P0.ICYNL ra irl��� Q���7 __ 1�k�� ELECTRIC r. J � , � (rtss[ciloNNEFDr+oiBECOMLEiIDOFn[PEw.fi6roaadwrL%�m0a1.u3s6+m10aLE55F P,LUMCiING 7 L Z t C[RTIFYTUT N THE PERFORIAFNCE OF TME WDRK iOR wHICH 1MI5 PERMITI5155UED,1 MECHAN CAL �7+,,,-r, r 7 . (� SV4LLLNOTEMPIOYANYVEfi50NINMIYMANNERSOASTOBEC0AIESUBJECTTOTHE �� � nn N WORKERSCOMPENSATIONIAWSOFCALIFORNIA,IWOAGREETHATIFISHOIAD [COME INSPECTIONFEE SUBJECTTO TIE WOR1(ERS'COA�PENSATION GROV1510NS OF SECTION]7000F HE U�B00. v �S /TO CODE,ISHILLLFORTIWT1Cp.�7LY ISSUANCE _�►a�. �A+._ c/ 0 SMIP 4•v�A.��n on�: !I I/? 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