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Home My WebLink About14942 (8) -- ------ - I. - -- ' - ,. _ .__ _�_ _ _ . . � J� _ CITY OF DIAMOND BAR' ' • ' " ' - " � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � . Zi66o�,c�i�Ynr;��s�u i�o . PRESS (909)860-3195 Fax(909)861-3117 . '^�'�� BUILDING PERMIT APPLICATION, . � FIRMLY � JOBSITE p � /;�� APPLICATION PERMlT /C o. ADDRESS �I 8�D ��/�J�� DATE •d� NUMBER.a, _ # � ISSUE TYPE OCC , APN LO� TRACT DATE CONST. GROUP p .OWNER � � ' " ADDR S !�U ft�i ZONING SETBACKS • • ' � CtTY ' ZIPqa4,C?(t'•fEl. �p�a'ir1� FRONT ' � � RW O � APPLICANT I-$ G. G�b tc 1�,,.-.cf- TEL. �`�[9 L 17y _ REAR ❑ � SIDElSIDE STREET RW O CONTRACTOR �.r7+t �O.r+'�l� SIDE ❑ � ADDRE S�'�—E r •�n�Crvt a� ' � � CfTY ZIP�q.o[^TEL'��'� �n� 117� PROPOSED USE - o ARCH/ENG/ • . , � . z� DESIGNER - NO.OWEL. N0. NO. o. AbDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL ' � � OESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION _Q OWNER-BUILDER DECLARATION SFRIADDlREM � O Q I HEREBY AFFlM1 UNDER VENALTV OF OERIURY TUT I JUA EXEMPT FROM 7HE CONTRACTOqS LI- GaragelCerport ' � W C£TISEUWFORTMEFOLLOWPIOREASON(SEG70.71.68USWESSANDFROFESSIONSCODEANYCITYOR (n " C� ppJNryWHIG�qEpU1qE4A0ER1AfiTOCONSTAUCT.ILTER�PROVE.DEMOUSH.ORREDAIRM1Y5TiiUG � W patiol�edc Z 711RE,iP10Fl TO fTS ISSUANGE,AL50 REWIRES 1HE MPIIGWT FOR 6UGI PEfWIT TO FILE A 61ONED �l� STA7EYEM T11AT HE d1 SHE IS 110EN5ED VURSUANT TO iHE DPI7VISIONS OF 7HE CONTMCT00.5 L4 W � CENSE UW(pU7TER 0(COAAMENCPIO N71N SECTION 7Doo�OF DIV1510N]OF iME BUSMESS ANO PqO� � PooUSpa � � , FESSIONS GOD�ORTTNT HE OR 511E IS EREMPT 7/1EREFROM MA THE BA515 FOR 7MEALLEOED E%EMP• TqN.J1NYVI0lATIONOFSECTION7o77.6BVANV/NVLIGU1TiORAVERAIITSUBIECTS111EMVUCtNiTO Z Re-Root � F AGYILVENALTYOFNOTMORETHANFIYEMMDREDDOtLARSfiSool.Y . . � OI��EROFTHEPROPERTV,ORWEIADLDVEESWITHWA0E5ASTHEIR50lFCOMCENSATIDN, � � �mmercia� � - WLL DO THE WOPoC ANO TtE STRUCiURE IS 11�T IMENDED OR OFFERCD FOFi SALE(SEG 7W�,8U51� . .,.I ' NE53 MO iROFES5IONS CDDE 1ME CONTRACIORS LICENSE Uw DOES NOT APPL1 TO MI OWNEH OF � PAOPEA7YMRIOBUtD40RMPi00VE3TNEREON.ANDNMODOE55UC/1NqiiKHIYSELFORHERSELFOR = . (Z T1q0U6NMI50fiHEROYMEYPIAYEES.PROVIOEDTUT6UCMMPROYEMENTSMENOTRRENOEDOR m QOFFERFDiORSN-EIF,/1DYVEVFR7NEBULDW00NMAVROVEYENTLSSOIDWRl9NONEYEAROFCOMRE- Z ��TqN,h1E OriNERAUMFR WILL HAVE THE BURDEN OF PROVIN�1NAT HE OR SHE DID NOT BUILD OR . = MPROVEFOft7HER1RPO5EOF8ALE7. - ' � yy� atllSdANEROFTHEPROPERTY,IWE%CLUSNELYCONTRACT4MWfTHIICENSEDCONTMCTOR4 � TO CONSTRUCT TME iRQIECT(SEG 7oN,BUS�NESS IJ:D iRDFESSI0N5 COOE:7HE CONTMCTORS U• V81UflfI0f1 ADJ.AFEA� - " CENSE LAW OOES NOT AFPLY TO AN ONMER OF A 7H07EHfY Yh10 BUIDS OR IEIPpOVE3 THEREON.AND , � WIqCOf(TMCfSFOi13UpIPRWECTSWITHACONTMCTOR(S�UCENSEpPURSUNJTTOTIECONTRAP p�qN7�7y DESCRIPTION FEE � toRs ucExsE uw.l . . + O IAM D(EIAPT LNDEASEC. B.i P.G FOR THIS REASON U \ OO / 3 � - -- "-- o�rE owr+en . r- , � W F UCENSED CONTRACTORS DECLARATION W , , , �� , . r��.� � IMEREBTAFFlRMIRAERPENAITYDFPERR/RVTHATIAMLICEN5E0UNCERPROV1510N50FCNAPTER � Vr ' - � �(C01/uENC4q NrtiH SECT10N7Doo)OF DMSqN 70FTNE BUSMESS MID VROFESSqNS COOE ANO Z �� NYLICENSE6WFULLFORLEANDEFFEGT. � 0 LICENSE CLASS��LIC.N0. . .��^ ��_ � �"j DATE 4• II�S • (� O . . -CONTMCTOR d W � WORKERS'COMPENSATION OECLAFL4TION 4 � U � IMEREBYAFFIPAIVNDERGENAITYOFVENURYONEOfTHEFOLLOY�INODECLAAATqNS: � -� ' � y Z Q � IHAVEMAN9LLM�INTMNACERfIFIGTEOGCONSEMTOSELF�NSUREFORWDRKERS' _ COMPENSATION,ASGROVDEDBYSEC710NSfoaOFTHELABORCOOE,FONTHEiERFORUANCE W Of THE WOHN FOq WNipl TNIS iERA1R�S ISSUED. � � _I HAVE 1W U WILL WINTAM WORKERS QOMPENSA710N W SURNICE,AS REOUIRE�BY SECTION 4� J70oOFTHELABORCODE.FORTMEVERFORIAANCEOFTHEWORI(FORWHIp1iHI57ERMITIS _� = ISSUED.IAYNORKERSCAMVENSATIONWSURANCECARRI MlDPOLICYNUABENARE; CONSTRUCTION j GHPIER ��P �c +.. � � PLAN REVIEW_ . , . - _ � POIICYMIAIBER_ �[� � t�aD c�.s `Z, `-l- e�craic � (ISESSECIIWNEIDwTgEUJ1.REIFnanEaEwRi6Waa+e�u�DP£�DOl1ut4R+mlORLESS? PLUMBING Z I CERTIFY THAi N THE PERFORMM7CE OF 7HE WONc FOR VMICN 7H15 VEfUAR IS LSSUED,1 MECHANICAI - - --- (s SHALLNOTEMPLOYANYPEFtSdVHANYWWNER50A5TOBECOMESUBJECTTOTNE , � WOpKER5 COMVENSAT70N UMIS 0F CALIFORNIA,M1�AGREE THA7 F I SHOULO BECOME INSPECTION FEE - � SU0.IECTTOIHEWORKERS'tOMPENSATIONPROVI510N50f5CCT10N77a00FTMEUBOR ISSUANCE �� COOE.I S W11 FORTNVrtTH COMPIY Yn7M iHOSE PqOYI510N5. � SMIP �-.— `p Dl1TE:- APPLICANT. - � � V�' �l ' � WARNIN(7:CAlURETOSECUitEW01iNE0.5'CpAPEN5A7qNCOVEMCEISUMJ�N'FLM1.MIDSHA�,�BE ENERGYP/C 6UBJECfFNEMPLOVERTOCRIAIPUI.FENALTIESANDCMLFINESUPTOONEMINDRE�i110U5MA - ENERGYPERMIT DOLUFiS(f 100,000),N 4D�fT10N TO iHE COST OF CpAPENSATION.OMUO��AS PROVIOED FOR 1N • J SECTION]7oe OFTME UBOR COOE,MEREST,M10 ATTOANEYS FfES. pF,jENT1ON FEE: - � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � . � IHfREBYAFFIRMUN�EHP ALTYDFPE0.1UIiYTHATTIEPEISACONSTRUCTIONLENOMaAOENCY, Z FORh1E PENFOPAUNCE 0 THE WORK iOR WNIpI THIS GERMIT�5�55UEO(SEG 70VT,pY.C.�. W - � �ENDERSN�WE � �- - ' � lEN0Ei1'SA�DRE53 WICERTiFYT1�TIMAVEREAD1NtSMVLK.ATIONANDSTATETNATT1EA80VEWFOi1MAT1ONtSCo11RECT. TOTALFEES �-� ' � � IMREETOfbuPLYWITHALLCRYANDO0l1�JTYORDIWWCE5INO5TATEUYVSREUTNOTOBUlAINO CONuTRUCi1CN,ANDHEREBVAUTHOfUZEHEPHESENTAT1YE50FTHLSCOUNTYTOENTE0.UPONiHE . . .. _ _ ' - � S� �BOVE•MENTKINEDVPAVER'il'fORINSVECTIONYURPOSES COMMENTS ' _'_ '� "" ` �. � ` . m FEiWiTTEE WW Wlfn . .Q ._ .. _ . . . - . ._ . . � (/j 81ONANREO I DATE _ � _ _ _ _ RECPT.NO. _PA1D BY W W DAT WHITE--Depenment Copy,YELLOW�inance Copy,PINK—Aseessor Copy,GOLDENROD—File Copy.GREEN—Appicant's Copy � � �- �� .