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HomeMy WebLinkAbout16971 (1109) �� CITY OF DIAMOND BAR i DEPARTMENT OF COIvIIv1UN1TY&DEVELOPMENT SERVICES (� 21825 E.Copley IJrive' J (909)860-3195 Falc(909)561-3117 PRESS ����� BUILDING PERMIT APPLICATION FIRMLY } JOBSITE [' ' APPLICATION PERMIT p/C Q ADDRESS S W ClOC o � �n' DATE � �7 A � NUMBER��l„ �1 � APN LOT TRACT I ISSUE TYPE OCC DATE CONST. GROUP p OWNER G f4� � I " ADDRESS ' ZONING SETBACKS gCITY ' �� ZIP�1���T �I�,�J�J (� FRONT RW ❑ APPLICANT `C TEL�J�'�1'�.}t4--�:57 S DE/SIDE STREET RW O � CONTRACTOR SIDE p ADDAESS � CIN 21P TEL. PROPOSED USE ��- �� '�/U � Ct ' o ARCWENG/ , W DESIGNER � NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS�, N CITY ZIP TEL. N , DESCRIPTION S4.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p �, SFR/ADD�REM p I HEREBV AFFIRM UNDER PENALTY OF PERAIRY iHAT I AM EXEMCT iROM TM[CANTMCTORS LI- G3f29B/C2fPOfl W CENSEUwFORTMEFOLLOWINGREA50N(SEC.70.71.SBUSINESSIwJGROFE5S10N$CADE:ANYCITYOR (n � COUNTYNMICHREOUIRESAVERMITTOCANSTRUCT,ALTERIMPROVE.OEMOLISM,OqREPAIRANYSTRUC• W patiol�eck TURE,VRIOH TO RS ISSUANCE,ALSO REOUIRES THE AFPLIGNT FOR SUCH VERMIT TO FILE A SIGNED W � STATEMEHT THA7 HE OR SME IS LICENSED PURSUANT TO THE PROVISIONS CF THf CONTRACTORS LI• � CENSE UW�CHAPTER Y(LOMMENCINO WITH SECTION 7000)OF DINSiON]OF TNE BVSINESS AND PRO- � POOVSP2 GESSIONSCOOE�ORTNA7HEORSHEISE%EAIPTTMEREFROA1/wDTNEBAS'SFORTHEALIECEDEXEMP- (� V TION.ANYVIOlAT10NOF5ECTION7a'l1.6BYANYAPPUCANTfORAP[RMITSU&IECTSTHEAPPUCANTTO Z Re-Rool A dNL PENALTYOF NOT MORE T/VW FNE MINDRED DOLURS�SSaO)�: � 04ASOWNEROFTMEPROPERTY,ORMYEMPtOYEESWITHWAGESASTMEIR50LECOMPENSATpN, � COf11rt18fC12I ,Z WILL 00 THE WORK�ND THE STRUCTURE IS NOT IMENpED OR OFFEAED FOR S/�l.E(SEC.70��,BUSb J � NE55 AND VROFESSIONS COOE:THE COHTMCTORS IICENS[UW DOES NOT APPLV TO AN OVJNER OF ? 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