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---� ---- i .--- --. . . - - - -- - --- - CITYOFDIAMONDBAR ' • • , EXPIRED COMMUNITY DEVELOPMENT DEPARTMENT :,,.� . 216b0 E.Coplcy Drive Suite 190 ��JO V 2 9 1000 PRESS (909)860�3195 F�ax(909)861•3I17 �''�" BUII.DING PERMITAPPLICATION FIRMLY Q DDRESS Z���J uA/�1A��� DATECATION S'_�_C�-7 NUMB R/OZZ��� / � ISSUE TYPE OCC APN LOT �RACT DATE s/l Z��"7 �J CONST. GROUP p OWNER � ADDRESS �� ZONING SET9ACKS �• ' � CfTY ZIP TEL S FRONT RW ❑ APPUCANT ?� /11i►O/S�e'l/TEL REAR ❑ � SIDEISIDE STREET RW O � CONTRACTOR �� ��'� L r C 6. SIDE ❑ ADDRESS _�'�� C_ �-- pROPOSEDUSE o CITY� L/yJf ZIP=� TEL �l/�s'�7 o ARCH/ENG/ ' � DESIGNER NO.DWEL NO. ' NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � UESCFiIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION m � OWNER-BLYLDER DECLARATION SFRlADDIREM O p I MEREBV AFFIRM UNDER PENALTY OF PERIURY THAT�AM EXEMDT FROG TME CONTMCTORS l4 GBflQB�CefpOfl W CENSEUWFOtiiHEFOLLOMNORE�50N(SEG7a71.68U5iNE5SIWD7110FE5510N5C00E:ANYGfI'IOR (n U OOUN7YYM1GiHFOURESAPERMITTOCONSTRUCLALTERW�FiOVE.0Eu0U5H.ONAEDURANYSTAUG W PetiO/DBCk . � TVRE.VRIOR TO ff5 ISSUANCE.1LL30 R£OU�RES THE APiLICNfT FOR SUpI PENA�T TO FRE A SIGNED W � ETATEYEHT 7NAT NE OR SME 6 UCENSED VURSUAHf TO 7ME PHOYISICNS OF TME CONTRACTORS LF , � CENSE U'N(QUPTER Y(�MMENCIN6IMM SECTqN 1000)OF W NS�OIJ]OF THE BUSINESS ANO ORb V" POOVSpB FE55qN5 COOEI DN T11A7 HE OR SHE IS E%EMPT iMEREFROM AND TME BASi3 fOi1 TnEALLE0E0 E1lEt1P- T10N.IwYVqtATqNOFSECT10N7o]t.68Y�M/APPLK'JLYTFd1APERMITSUBJELiSiHEMVLICAN7T0 Z ROOf ZOOd' F, ACIV4.iENALTYOFNOTMORETHANFNEHUNOREDDOLURS(i5colk "_ � ❑I��MJEROFTHEPROVEFT:OiiMYEMPLOYEESWiTHWAGESASMEIRSOIECOMPEN5A710N, � Cpm111BiCJ91 Z WILLDD THE WOPo(ANO TME STRUCTUNE IS NOT INTENDED OR OiFER[D FOR SALE(SEG 7W�.BU51� J NES$ANp iROFES510N5 CODE:TME CONTMC70H5 LICENSE UW DOES NOTMPLV TO!W O'MJER OF � CROGERTYNRIDBUILDSORM7ROVESTHEREON.ANUWNOOOESSUCI7NVRKNiMSCIFORMERSELFOR = ' � � THROUGHWSORHEROwNEA1PLOVEES,PHOV�DE0TWT5UC11MPR0VEUENTSANENO7MEN0EDOR m , . , QOFFEREDFqt3KE.IF,MOWEYE0.iMEBULqN�ORWPROYEMBiTI550lDWR/YNONEYFIIHOFCO4PLE• Z TIDN.TME OWNEF�BUtIDER 1MLL HAVE TME BURDEN OF VROVWQ iHA7 NE OR SME�ID NOT BInLD Oq = M�AOVE FOP ME iURPOSE OF S1LLE). . ' O L 0.5 OwNER OF 1ME PfiOPENTN.AM EXLLUSNELYCOMRAGTWO YATH LICENSED CONTRACTORS W �ENS�EUWpOESNOTAFJPLY70ANOWNEROFAVROPERTYWF,OBU DSO�RMPRDYES�M AEON,NdD VlI11811W� AQI.AREA � YWqCDHfRACfSFORSUQIVNW[CfSYATMIICONTMCTOR(S�LICENSEDPUitSUANTTO7HECaNfRAG p�q�7y - DESCRIPTION FEE � TORS LICENSE Uw.). .,J O IAY p(EUPT W�ER SEC. B.�P.G FOR 1MI5 pEA50N Q 3 � / O � u" pATE OWNER Z W �d UCENSED CONTNACTORS�ECLARATION W G� L� 2 INEREBVAFFIfUAl1N0ERiENALTYOFVERNMiHATIAML�GENSFAUNDCRVROVIS�ONSOFC�TER Vr p„ �(COYAIENCINON1tHBEC710N7aoo)OFDIV1510NlOFTNEBUSIHESSINDVROFESSi0N5CO0E./J�O Z �( X YYLICENSEISNFULLFORCEANOEFFECL � +���� m �jL/l.�S lL � � LICENSECUSS 7 LIC.NO. / j S' /�j V pATE SIZ��/7 CONTMCTOR � d W . � WORKERS'COMPENSATION�ECUTAATION � � U � IHEREBYAFiIiWUNDERPENAITVOFPE0.IUMONGOFT11Ei0UAWNODECLAMTqNS: � y Z � �IHAVEANDWRL�7NNTAINACERTIFlGTEOFCONSEHTTOSELFJHSUREFORWORKE0.5' 2 CdIPEN5A7qN,A5PROVOEDBY5ECT10H77aoOfiMELABOfiCODE,fOR7HEPERFORAIANCE �U '�. �THEWORKFORNMICFITHISVEFIAITISISSUED. � _ .. _� . 0 Q �I NAVE AND WILL�N�tiN VlORNE0.S'OdAVEN5AT10N INSUMNCE,AS RE�aED BY SECTION „✓� ]T00 OF TME LABOR COOE F0�1 TME VENFORMANLE OF TM[WONK FOR WM�CM 7M�3 PERMIT 19 (/� '� ISSUED.MYWWiKERS' PENSA WSURAN�j CARRIERMNVOLICYMDABERIHG ' � � GMIEH �T/�N" _ PLAN REVfEW .. � POIICV MIYBER / O 7 U � E�(�'�IC�., Q p (I1�SSECTICNFE�rqiBEfAMrLEiEpOFMfEq.IrTSPor101EH.eaFimOCllARsff+aqCRtEss� PLUMBING�" W CAL Z ICER7IFYTHATNTMEiERFOiWANCEOFTHEN9PKFORMA11CHiHISPEfwITISRSUfD.I (7 SFIALLNOTEMPLOYANYVERSONW�NYMMTlERSOASTOBECONESU&IECTTOTIIE � �� � vj WORKERS'ODUPENSAT10NUw50FGLIFdWt.�IwO�OREETUiIF1511DULOBECOME $PF,�f�LG E �-�A� SUBJECT TO TNE WJiiKER5 C�pEN5�T10N PAOVISIONS OF SECTIDN 7700 OF THE I/�OR �R�— • COOE.16HAt1FOHTMMiXCOA1PLYWITHTHOSEVPOV1510NS. ISSUANCE � "�—_— � � SMIP � .. .�:C''�.�,v'i�l% �'rV � -t� 0 p pATE: AVRICAM: � � ('1� � �.�r}�j.�. �- WAiWiN@iA1WNETOSEd1NENlORKERS'COMVENS�710NCAVERAOEISUNUWFUL.IINDSH/LLBE ENERGYPlC � SUBJEGTANEMPLOYERTOCRiA1iNALPENI�LT1E4AhDCMLfNE5U0MONENUNDFEDTH0U5AND ENERGYPEHMIT �`1��'l ��"' D0.lAR5 p I Oo,0oo1,N IDDIiION i0 TME COSi OF COMPENSATqN,DAMAGES AS iHONDED FOH IN ..}J SECTWN77oeOFTMELA80RCO0E,INTEREST,FND�T70iWEY'SFEE4. � RETENTIONFEE` � � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � IHERFBYAFiIRYUNDEROENALNOF0E0.1URVT1UTf11ERE15ACdN5TPUCTIONLENDINOAGENCY ' ' ' � Z FOR THE VERFOR4iv+CE OF TNE WO�K iOR WHid/THiS PEAMIT IS ISSUEO(SEC.]on,CtV.C.). W - - � LENDERSNA4E ' � LFNDER4AOORE55 � ��) �CEqTIFY i/UT 1 NME RE�LD TM�S MVLM.AT�ON AND STATE TUT THE AB��E�NFORY�TION IS LOfU7ECT. 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'SEPTICTANKSIZE-..------ - - �- - --- --- .. . :... .. : � I i------- ---------- - --� --- -------- ---- ----- - i � t . , . .,. . •� j SEEP PIT/U SIZE . , . . . _ . __ .._._.. �,-- - ---- �--- ---... _ ..._ . .. - , .,. . . , . � . . , . , � �v -._. _ . _ . � � � � , ►� � I � ....--- . .. _._. - -. . . - ------ --- . . ; _ _ . . -- - -- _ _.. i _ . _ ._ _ _ -- _ _.. - . , .. � - � - --- � - _... _.._ , • . � „__._ � ---- - -� - -- --- �- - - - --- --- -------- . • �.- _-. �,.';,_ -; , � ._. _ . �,,r'`� � � I , ,. . • . . , ... , , : . , � --. . .. - � ,-_ . -. . . .,. . � I � ,. '. . . _ , . - , I . . , . .. .. ........ . _ �.._.._. .... - ---------- --�--- ------- � ` �,� � � _ _ i . ... .- - - - -- - _ i i �` `` -�_\_ - - `` - - _ ., I .. .� ,,.� � , „�. . .�, . . , i � �.. , - _ . _ . . .. •. , • --- �'b � --- -- � - —- �-- — ------•— ---...---------------- ---�• -- - - - - . _ �...� ...-- - -� --. ..---- —•----- -�- - -• ------- -- .
