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HomeMy WebLinkAbout16056 (9) _- I _ , .._ .. . , .__... _. ....__. .. . , J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY dr DEVELOPMENT SERVICES 21660 E.Copley Drive Suiu 190 (909)860-3195 Faz(909)861-3117 PRE$$ ���� BUII.DING PERMIT APPLICATION � FIRMLY A ADDRIESS 2 0 9 5 S �Q-�-�1����. R� �¢tu�OD DATE CATION ! �2 a NUMBER • M����C/`� $ ISSUE TYPE OCC APN LOT TRAC DATE CONST. GROUP g OWNER "' ADDRESS n v ' ZONING SETBACKS � CITY ZIP TEL 0 • fl�RT RW ❑❑ APPLICANT _� �pnv�� _ TEL SIDE/SIDESTREE7 RW ❑ � CONTRACTOR . � SIDE O � CDDRESS � ZIP TEL PROPO� P�� P CP � RC NG/ [� � DESIGNER�,g� �s �� NO.OVlEL N0. NO, ADDRESS � UNITS STORIES BEDROOMS � CIN ZIP TEL3f.�,�� u�,3 N DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADOlREM O Q 1 NEREBYAFFlM UNDfR PENALTY OF VEiWRY iMAT I W E%EVPi iROM TNE WNTMCTCAS LI• G2f0g9/C91pOR W GEHSEUWFOR7}IEFOLLO�MMOREASCN(SEG70J1.SBVSNESSMlDiROFE5510NSCODE:ANYCITYOR (n . _.� OdlNi'I1M��REO�1WE511PEiWTTOCONSTBUGT.ALTE1tMPROVEDEMOUS�i.ORREPNRAN75TAUC- - W PetiO/pBCk' , . _ "'.. "" - - "-�-" "--. . .. TUAE,PRqA TO R9�SSUAHCE,/160 REOUIRES THE APPLICANT FOR SUCH PERMIf TO iILE�SIGNED W , � STATEMENT TlNT ME OR SME 6 UCENSED VURSUANT TO TME PROVISiONS OF TME CONTMCTOFS U• � CENSE UW(dUPTER 0(C0IIYENCWO WITH SECiION 7000�OF DIVLSION]OF iHE BUSINESS AHD PHO• V' P006�$p3 iESSqN9 CaOE)Oit TW�7 HE OR SHE IS IXEUPTT/EREFROM AND THE BASiS FOIi iHE Al1EGE0 E%EMP- TION.AHYVKKATpNOFSECTION70.11.6BYANVIIVPLKANiFORAPERA11T5UBJECT57NEAPVLMJNTTO Z Ro-Roof r ACML PENALTY OF NOT AqRE 71UN FIVE HUNDRED D01.LM5(t5oo)1: J O OIASOWNEROFiNEiROPENN.ONMYEMPLOYEE3VniHWAGESti:TNEIR50lECOMVENSA710N, O COfIIrtIBfCl31 Z YNLL DO TME WORK.ANO THE STRUCTIJRE IS NOT INTENDED OR OFFERED FOR S/�1E(SEC.70N.BU51• _1 � NESS ANO PROFESSIONS COOE TME CONTMCTORS LICEHSE UW DOES NOT IIOVLY TO AN OwNER OF = p{qPENTT M�10 BUIDS�ONN MPROVES iMEHEON.ANO 1N10 DOES SUCM MYJI�K HIMSELF OP NCRSRF OR (= 7Hqd)OIINISdIHERONrNE4vLOYEES,iROVI�EOTUTSUCHMPHOVEMFMSARENOTttlfENDEOOR m � OFFEAmFORSFLE1F,110WEVERTMEBNIDIHO0RW7WOVEUFNT1550L�WRMNONEYEAROFCpAFLE- TION.THE OWqEFI-BURDER N"LL FUV[T1iE BUR[7EN OF pRDVINa TMAT ME OR SME UO NOT BVILD OH � tAPROVEFORTHEMINPOSEOFSALE} W Olti`O'NNEROFIHEPROPERTY,IIME%p.�NELYCOMMCTINONTTHlICE115EACOMMCTOR9 � TO Cd15TRUCTTHE PFIdIECT(SEG 7W1.BUSIHESS IVA VROFESSqNS COOE:TME CONTRACTORS U• ADJ.AREJi CENSE UW OOES NOiAPPLV TOAN ON'N[H OFA opO�ER7Y NMO BUttDS OR MPIqVE$iNEREDN,M1D � W1qGONiMCiSFOHSUCNVROJECT5W17HACDNf11ACiOft(SJLILENSEOPURSUANT70TH[CONTAAC- pUANTITY DESCRIPTION FEE � TORS LICENSE UW.} O I AA1 E%EMi'T UNDER SEG B.i V.C.FOH THIS REASON U � t . 3 ¢ . 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ISSUANCE _ � Z�^O� �VPL�CAPR: SMIP p OATE: � � ENEFGY P!C I � • W�qMNU:F�WREiOSECURExURKEHS' ENSATIONCOVEHAGEISUNUwFUI.ANOSHAILBE � 5{AIECTANEMPLOYERTOCRINMALPEIJl 'ANOCMLFN[SUPTOCNEHUNOREDiN0U5AND ENERGYPERMIT D0.LM5(i1W,00a),NMOITONTO7HECOS OFL0IAPENS�TION.DAMACESASPROVDEOFORIN J SECTION]70t OF 7HE U�eOH COOE,NTEA[ST.AND A7TOqNEY'S FEES. � RETENTION FEE: � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � INEREBYAisIRA1U1J0ERVENALTVOFPE0.IUMTHAiTHEREISACONSTRUC710N1F1:DN1011GENCY Z FON TME PERFORMANCE OF THE WORK FOH WHICN 7Ni5 PEIW�T IS�SSUE'J�SEC.�OG7,CN.C.� W � IENDE�MS NAUE - / � LENDER9�DORE55 W ICERT�FYMATIM�VEREADTHISMPL1CATqNANOSTATETNATTHEAeOVEPliORMATIDNISCORRECT. TOTAL FEES ._ ., . � IAGREETOCOIAPtYWITMAI�CT'ANDCOUNTYORDiNANCES�NDSTATEUWSNEUTNGTOWILDINC CON57RUCf10N.M1DNEREBVAUfHORIZEHEPRESENTA71VE50FTwSCOUNTYTOENTERUPONTHE � ,e)/l.C�r.�J _ '� I.I � ,O � ABOYEJ.IEHf10NEDPROPERTYFONMSOECTIONRJRPO6E5. �! 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