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HomeMy WebLinkAbout16985 (39) �� CITY OF DIAMOND BAR , •�� i DEPARTMENT OF COMMUN[TY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Faz(909)861-3117 PRES$ ���^�� BUII,DING PERMTT APPLICATION FIRMLY � JOBSRE � �p r �� �n �j, APPLICATIO PERMfi �P/C � ADDFESS��I� (�H aILTi�.�_�/• " �`� DATE_ �J-�-O� NUMBER n i � N �' $ ISSUE TYPE OCC� APN LOT TRACT DATE CONST. GROUP / o OWNER p A�DRESS � �Q ZONING SETBACKS �w CfTY ZIP TEL. REART RW OO APPLICANT / �TEL.'� • SIDFJSIDE STREET RW ❑ � CONTRACTOR SIDE ❑ A�DRESS � CRY ZIP TEL PROPOSED USE�� T•-Z-• � !�/.�,� � ARCHJENG/ � �fX' ��A!fi�_ Fln��i.��� DESIGNER �M � � ����� �� � Y`+!� NO.'DWEL. F10 �- NO. ADDRESS � UNITS STORIES BEDROOMS� N CITY _ ZIP TEL cn DESCRIPTION �`SO.Fi. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILD[R DECLAFiATION SFR/ADD,'F1EM �� O p 1 NEREBY AFFlRAI UNDER PEHALT'OF pE0.R1RY THAT 1 AA1 EXE�PT FROM TME CO'lTMCTORS L4 GefHge/Cd�pOR � lL CENSEUWFqi7HEFOLIOWMGREASON�SEC.7¢]1.6BUSMESSIINOGROfESSIONSCOOE:ANYL�TYOR (n �.� COUNSYMM610.EOUIRESAPEFWRTOCONSTAt1CT,ALTER�M7ROVE.DENOlISKORREPA:R/�NYSTRUC• uJ W T1HE pq�OR TO RS ISSUANCE,FL30 RLWIPES 1HE AD7LICMR FOR SUCN PERYiT 70 FlLE A SIGNED � Paiio/Dedc � STATEMQfT 7NAT HE OR SHE IS LICCNSE➢iURSUIWT TO TME PROYi510N5 OF TMC CONTMCTORS ll• LL � CENSE UW�QiAPTER i�COM1AEYtlFq K7TH SERqN 70a0)OF QM510N 1 OF THE BUSINE55 AND PRO- POOVSpa FESSIONSOOOE�ORT7UTMEORSMEISEI(EMPTTHEFEFRpIMlDiNEBA515FDRTHEALLECEDE%EMP- (� T10N.ANYV�OI/�TIDNOFSECTION70]1.6BYANYAPVIICAHiFOfiAVEi1MIT6U0JECTSTHEMPLIGNTTO Z Re-Roof � A C7NL VENALTY OF NOT MONE TNAN FNE MINDPED D011AtlS�tSaD).} � OL��NEROF7HEPROPERTY,ORMVEMrLOYEESYnTIiWAGE3A5THEiR50lECOMPENSATqN, CpmmOrGal � � . WILLDO T1E WORK,AND iHE 57RUCTURE IS NOT WTENDED OR OFFERED FOR SALE ISEG 7a�,BUSI� � N NE53 MO PROFESSqNS WOE:THE CONTMCTORS UCENSE UW DOES NOT��PIY 10 MI OWNFR OF ' . , , PROPEHTYM4qBUILD50ilMPROVESTNEREON,IVAMMO00ES5UCMNORKHIMSEIFORHEHSELFOR = - � �` • � � TIOiOUCiMN150RMEROYRIEYPLOYECS.PROVI�E�T1UTSlX71MPROYEMENi5P3iENOTMTENOE00R m OFiEFm FOH SKE G,/qYhVER7ME BUILDINOOR M�HOVEMINT IS SOLD WfT�aN ONE YEAROF COMPLE- 710N.TME ONNER-BU0.27ER V.'1LL 1uvE TME BU�DEN OF pROVWO iMAT HE OR SHE�D NOT BUIID Oq = W PfqVE FOH TH[PUltPOSE OF SLL�. �yJ 04�OWNEROFTH[PiqPEH'V,AMEXCLUSNELYCOHTMCTWCWITH�ICCNSEDCOHTRACTORS '� TO CONS7RUCT 7T7E GROJECT fSEG 7W�.BVS�[55 AND PROFESSiONS CCDE:1NE CON7NAGTONS 11� V81t13tiM ADJ.AREA CENSE UW DOES NOT MPLY TDAN O1N�ER OFA PROPERT!VN�q BULDS OR IIAPfqVES THEREON.IWD ' � 1MIDCONiMCi5FQ951X71VR41EC:f5YATiACOHTMC70R(5)IICENSE0PUR5UJIMTOTMCCONTRAC QUANTITY D[SCRIPTION �E � � tauuceHSEuwy. J q I IJ�E%EMPT UNDER BEC. 8.�V.C.FO�iM15 RUSON U 1 � F . DATE OYYNER V . . • � UCENSED CONTRACTORS�ECLAHATION W . . , �• . J � IHER[BVAFFlRIIUHDERVEN.LLT'OFPE0.IUMTMATIlU1LICFNSEDUNOEFiROV�SqNSOFCHAPTER U. , � � ��WMMCNC4/OYAMSECilON7000�OF�1Y1510N]OFiHEBU51NE55ANDPROfE55pN5CO0E.A\D � �� W LICENSE C'i M!FULL iORCE AND E�FECT. � � 0 LICENSE CUSS -^ �UC.NO. I� � V DATE � ' 1 V C0IJTMCTOi1 � �' d . .. W ��'._,,.; . � WORKEAS'COMPENSATIONDCCLAMTION -� � � � ¢ t: ..��,_ . � IHFREBYAFFIRYUN�ERPENALTVOFVE0.RIRYONEOFTHEFpLLDWWCOECLAMT10N5: z I !' �1 (' � O �IIUVEIWDWI�LMANIAI`1ACEHT7(IGTEOFCONSENTTOSELF-INSUREfOHM/DRKENS' _ � " ' � �pAo[HSATION,Ai P{�VIDE�BV SEC110N 3700 0F TNE UPOii CODE.FOR iHE VE��OF4ANCE W OF 1NE WO�UC FOR N1iIQi TMIi 7ERMIT IS ISSUEO. 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RETEMIONFEE:• .a CONSTRUCTION LENDINGAGENCY pREALT FEE: O '� IHEREBYAFLIiWUN�ERVENALTYOFPE0.NRYTNATTHEAEISACOYSTRUCTIONIEhDIN�ACENCY FOF T1E iENFORIIANCE Oi TNE WORK fOR WHIG17MI5 VERA1'�T IS ISSUED(SEG.]091.CIV.GJ. � �1:. � LEN�ERSNWE y.�� C LENDER'SnDORESS ' � 1 � ICERTIFYTUTINAVFR�ADTHISAPPLICATIOHANOSTATEnNTTMEABOVE�N�OfUlATIONISCORRECL TOTALFEES O ��� 1 � pw, IAGREETOCOMPLYWITNILLLCfTYANOCOUNTlOf101N1wCE5ANO5TA1EUVri'R[UTWCTOBU1,DtN0 p. :., � CONSiRUCT10N,1NDMEREBVAUiF�ORIZ[REPRESENTATNFSOFTMiSCOUNTVTOEMERUPONTNE �'�,�� � � Z ABOV�IAENTqHF�VROPERTYLORINSCEGTqNGVF705E5. COMNENTS � �..,� C�. l�OLc —��+,1 -- m V iT7EE NAME N � � �� N 'nA UN OF VERu cE D�TE `\ v�� Fl[CFT.NO. PAID BY VALIDATION � HiTE—Oepartment Copy.YELLOW—Finenoe Copy,PINK—Assessa Copy,GOLDENROD—Filo Copy.GREEN--,Applicam's Copy �• . .. . .. . _. ., , . .. . .� ... , - . ��. . �. - CITY OF DIAIIGOPJD BAR -,. 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