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HomeMy WebLinkAbout13439 (16) CITY OF DIAMOND BAR �� --��"��— DEPARTMENT OF COMMUNTTY&DEYEEAPMENT SERVICES � a � 21660 E.Copley Drive Suite 190 � pRESS - (909)66Q3195 Fax(909)661-3117 ' �'� � BUII,DING PERMIT APPLICATION FlRMLY � JOBSITE �^ f� APPLICATION PERMIT P1C o ADDRESS �V �� A��(�� �/�(�� DATE NUMBER 3 3 ! � ISSUE I TYPE OCG APN LOT ACT DATE �'� t�� CONST. GROUP p OWNER ADD S ZONING SETBACKS 8 CI ZI TEL. " FRONT RW ❑ APPLICANT TE -� REAR ❑ SIDElSIDE S7AEET RW ❑ CONTRACT R ��- SI�E ❑ � ADDR PROPOSED USE �- Cf'fY ZI TEL. Q ARC NGJ ��.•��� � DESIGNER ���"��� NO.DWEL NO. NO. AODRESS UNITS STORIES BEDROOMS � CITY 21P TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECGARATION SFR/ADD/REM � Q I NEREBY AFFIRN UNDER GENAL7Y OF PERNRV THAT I AN E%EA1M FROM THE CONTRACTORS LI. G8/dBB/Ci1POA CL CF116E UW FOR 1MIF FOLI.OWINO REASON(SEC.7031.6 BUSINE53 ANO PROFESSION9 CADE:ANV CT'OP (/� � COUNTVYlHICHREOUIFESAPERMfTTOCONS7Rl1CT,1�L7ER�.7PROVE.DEMOUSH,ORREMIRNJVSTRUG W p8I10/�6Ck iURE,YRIOR TO RS IHSUANCE,ALSO REGUIRES THE�VPL�CAM FOii BUCM PERMI7 TO F0.E A BIONED � 6TATEMENT 7MAT NE OR 8HE IS 110EN5EC PURSUANT TO THE PROVISIONS OF THE CONiRACNRS L4 CENSE UW(Q�MTER Y(COMMENCINO WITH BECTION 70�01 OF OIVISION a OF T1E 9USINESS M1D PRa POOUSpB FESSIONS OODE)��T ME OR SHE IS EXEMPT7HENEFRDM M1U THE BASIS WRTNE ALLEDED E%EMP- TION.ANYVIOLATIONOFBECTION70.71.6BYANYAPPLIGMIfFORAPEHMITSUBJECfBTHEAPPLICANTTO � R8-ROOf � 11CMLVEN/�I.IYOFNOTMORETIANFNEHl1f�NEDOOLlAR3(i.riW�.): 04���NNEAOF7HEPROPERTY,ORMYEMPLOYEESWITHVMaESASiHE1RSOLECOMPENSATION, � (�`pmT6fClfl� Yi�L 00 THE 4YORIC 1WO THE STRUCTUHE IS NOT WTENDE�OR OFFERF�FOH SALE(SEC.7o�I.BUSI- �.I NE93 NiD CIGFESSIONS CODE:h1E CONTMCTORS LICEN9E lAW DOES NOT MPLY T�AN OWNER OF N PROPEHTYYYF108ULD90fiIMPROVESTHEREON,ANDWNODOE58UCHYYDRKHMSELFOHHER9ElFOR � � TMiOUfiH NIS OR NEH OMM EMPIOYEES,PROYIDE�iHAT W1CM IMPROVEMENTS ME NOT IN'TENDED OH m OFFERm PDR SAIE IF,lION�EVEFl ME BUIL.DING OR NA7ROVEMENT 19 SOID VIA7FON qVEYEAROF COMPLE 7qN,iNE OWNER�BURDER NIILL HAVE 7HE BURDEN OF PROYWO ill�i HE OH iH@ DID NOT BUILD OH IMPROVE FOR T/IE PURP09E OF BALE} � OI.A5014NEROFh1EPFiDPEfiTY.MAIXCLU5IVE�YCONTRAC71NONfI7HLICENSE�CONTFUCTORS TO OONSTRUCT 1}IE PRO.IECT(SEC.7ou,BUSINESS AND iROFES31dJ5 CODE:7HE CONfRACTOH5�i� V81118t1011 ADJ.AREA CENSE UW DOES NOT 11PPLY TOAN OWNER OF A PROPERTV WFIO BUILDS OR IMDNOVES THEREON,ANO YYFIOOONTMCT8FOR9UCHPRQIECTSWIiHACONTMCTDR(6)LICEN6EDPURBUAHfTOTHE00NT141G QUANTITY �ESCRIPTION FEE � T00.SIlCENSEIAW.�. � O I AM EXEYPT UNDER 6EG 6.i P.C.FOR THIS REASON � � iI �'�" DATE OWNER V - � UCENSED CONTRACTORS DECLARATION +� � �S�. 1 HEREBYAfFlPM INDER PENAL7Y OF PE1i1UM iH�T IAM LICENSE�UNDER PROVISqNb OF CHAPTER � �(COMIAENCMIG 1MTN SE��N 7000)OF OMSION 7 0F TME BUSINESS IWO YROFESSIONS GOOE,MID z MY LICENSE 6 W FVLL� AND EFFECT. m � LICENSE SS � IIC.NO. � ,yj � OA ` CONTPA - � WORKERS'COMPENSATION DECLARATION 4 � I MEREBY AFFIRM UN�ER OENILTY OF PERIURV ONE OF TME FOLLOWING�EfURAT10N5: U �j Z Q � �IMAVEAHDWILLNhNTMNACERTIFICATEOFCONSEMTOBELF-IHSl1REP�RVYOHKERS' _ OOIdPEN5A710N,A5PROVIDE[1BY6ECTIONJ70DOFTMEUBOflCOOE,FOR7NEVEHFORMANCE W Q OFTFiE WORK FOR WHICHTHIS PERMR IS ISSUED. � jFy� �1 W1VE MID WILL MI11NfNN WORKER3'COMPENSATtON INSURANCE,MS REOUIRED BY 9ECTION O 97000FTMELABORCOOE,WHTiEPERFORMANCEOfTHEWORKFORWHIWTHI9GEHMITIS ISSUED.MY WO AI¢'COMPEN3ATION INSU RIER �P0.1GY NUM9EHARE: CONSTRUCTON � CARRIEP N i �� PLAN REVIEW � POLICYNUABER . 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RETENTIQN FEE: � CONSTRUCTION LENDING AGENCY pRE-ALT FEE: � I HEREBYAFFIRM UNDER PENALT'OF PERIUHY THATTHERE IS ACONSTflUCT10N{.�NOING A(3ENCY FORTNE PERfORMANGE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.�oBl,CIV.C.). Z W � IENDERS NA1JE F- LENDERSI�UORE55 � ICEfiTIFYTW�7IHAVEREADTHI9APPLICA710NM1097ATEhiATTiE/�BOVEINFORMATIONISOONRECT. TOTAL FEES �P � IAOREETOCOMPIVWRH�lA.CfTYANDCOUNTVOR0INANCESMID9TATELAYVSRELA7INOTOBUIL�ING CONSTRUCTION,Ml�XEHE9Y MJ�i101iQE REPHESENTATNES OF 7)US COUNTV SD ENiER UVON ME � /1BOVHAEMIONED PROPENTY FOR INSPECT70N PURPOSES. COMMENTS 9 -���'-.-��-�'-�r�2.1� �� - m PEiWITTEEN � � // � vj OWITUREOF ENM DATE ' � � RECFT.NO. PAID BY �VAUDATION WHITE—Depertment Copy,YELLOW�inance Copy.PINK—Asaesaor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy . . - i � . . • . � - , - ., . . �� . . ;r..! . , . i.' . 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F FINAL ZONlNG i 'F1NAL�ONST. • --' - . ` ., � � ' . , 't•FIRE DEPT. FINAL --__� FIf�tAlkiEA7lNG "' ' ` '`�'� "' " j ,I HEAITH DEPT. FINAL � FINAL�ELECTRIC .(3-�t i, DEV. FEES PAID � F1NAL PLUMBING ; ENERGY I ' j � � � 6 - • COBVINIEf�TS ' t •;>;=` �4' . � � t•� � '. �i , � , �. - —.�------ - - ._ ,�� ,�a ^ ... , _ _, :, � . . . _ :��-;-�,- - .. . � -� � SEPTIC TANK SIZE V � --� SEEP P!7/U SIZE ;� � � �' � , . , _ . . �'��_ _ � � 1 , • i + , , , , ._ , - � � , : ,