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CITY OF DIAMOND BAR �m'° ----�T'�``-- DEFARTMENT�F COMMUNITY&DEVELOPMENT SERVICES `"�� � 21825 E.Copley Drive � .�^' (909)860-3145 Fax(909)8613117 �,.,•�r PRESS ''`%.vri»'' BUILDING PERMIT APPLICATION F M L�/ � JOBSITE ` APPLICATION -r��y� PERMIT t� ', ?lQ o ADDRESS��/l�� ���d»Gi.1�F� L-*!�L DATE .7 NUMBER I # � ISSUE TYPE OCC APN LOT' TRACT DATE CONST. GROUP p OWNER ,�?'_� ' � � G�� tc.%'� ADDRESS�L i11I`7 �} A.-fM tLt� �t.e ZONING SETBACKS z CITY p �'it ' ZIP`�'f� TEL,�d�� fa`�'°�'� FRONT RW � � APPUCANT, •s- TEL.f'd��/Z�ff,S� REAR CJ � 9 SIDE/SI�E STREET RW ❑ z ! a CON7RACTOR��l1�F" C�C�� f.t� • , SIDE � , � ADDRESS � CITY ZIP TEL. PROPOSED USE o ARCH/ENG/ �z DESIGNER NO.DWEL. NO. NQ a ADDRESS UNITS STORIES BEOROOMS � CITY ZIP TEL. � u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ' �� � OWNER-BUILDER DECLARATION SFR/AD�lAEM O ' p�� I HEREBY AFFIRM UNDER PENALTV OF PERJUftY THAT i AM EXEMPT FRDM TiiE CONTFACTORS LI- Gafe92/CBf�JOf1 '., W ' CENSELAWFORTHEFOLLOWINGPEAS9N(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCINOR (n '�, U�, COUNiYWHICHREOUIRESAPERMITTOCONSTRUC7,ALTER.IMPROVE,�EMOLISH,ORREPAIRANYSTRUC- � ' w�:,'TURE,PRIOq TO ItS ISSUANCE,ALSO REOUIRES THE APPLICANT FO�SUCH PERMIT TO FlLE A SIGNED � PdS�lO/DOCK � � STAiEMENT THAT HE OR SHE IS LICENSED Pl1R5UANT TO THE PROVISIONS OF THE CONTRACTORS LI- ! ��;"CENSELAW(CHAPTER9(COMMENqN6WITHSECTION700o)OFDIVISION30F7HEBUSINESSAND?fl0- V' POOVS(]e ..�FESSIONSCO�E)ORTHATHEORSHEISEXEMPiTHEREFROMANDTHEfl4515FORTHEALLEGE�IX=MP- (!3 �,�,TION.ANYVfOLAiIQNOFSECTION7o31.5BYANYAPPLICPNTFORAPE�MITSUBJECTSTHEAPPUCANTTO Z Re-Roaf r� �A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(S50o).): Z. ❑I,ASOWNEROFTHEPROPErITV,ORMYEMPLOYEESWITHINAGE5R5THEiRSOLEGOMPENSATION, � Commercial - ';WILL�O THE WORK,AND THE STR�CTUflE IS NOT IN7EN�E�OR OFFERED FOR SALE(SEC.7044,BU51- J �'���NE55 ANO PflOF6610N5 COOE:THE CONTRACTOFS LICENSE LAW�OES NOiAPPLY TO AN OWNEft OF � �, ��PROPERNWHOBUIL�SORIMPROVESTHEREON,AN�WHO�OESSUCHWORKHIMSELFORHERSELFOR [L��I'�THROl1GHHISOFHEROWNEMPLOYEE$,PflOVI�EDTHAT5l1CHIMPqOVEMENTSAREN071NTEN�EDOR m '� W�, �OFFEREDFOR9ALE.IF,HOWEVER;�THEBUILDINOORIMPROVEMENTISSOLDWITNINONEYEAROFCOMPLE� � � �'i �'�:'�.TION,THE OWNER�BUILDER WILL NAVE�THE 6URDEN OF PROVMG THAT HE OR SHE�ID NOT B111L�OR � �','IMPROVE FORTHE PURPOSE OF SALE).�', ' � ( ❑I,AS OWNER Of THE PflOPEflTY,AM EXCLUS WELY CONTRACTING WITH LICENSED CONTRACTORS '�,'�','TO CONSTRUCT THE PflOJECT(S�G.7044,6USINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI� V81112110f1 ADJ.AREA '', ��'��,,��CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPEflTYWHOBU1L�50RIMPqOVESTHEREON,AN� , r,',.�WHOCpNTRACTSFORSUCHPRDJECTSWITHACONTRACibR(5)LICENSEDPURSUANiTOTHECONTRAG UANTITY DESCRIPTION FEE �,�TORSLICENSELAW.}. �.v- y'� �� CIAMEXEMPTUNDEflSEC.��. B . FORT EASON Q �A: ' p �C �' U � �,�.��y�---". , p� CL �I � ¢��� . LICENSED CONTRA S DECLARATION W �' �.'IHEREBYAFFIRMUN�ERPENALTYOFPERJURYTHATIAMLICENSEDUNDERPfiOVISION50 APTER ' p.,�., �,9�COMMENCINGWITHSEC710N7000)OFOIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z � 'X MY LICENSE IS M FULL FORCE AN�EFFECT. m � LICENSE GLASS LIG NO. j � r J ,�, " U ,DATE CONTRACTOR n- � . W � � WORKERS'COMPENSATION DECLARATION a ' � IHEREBYAFFIRMUNDEPP6NALNOFPERIURYONEOFTHEFOLLAWINGDECLARAilONS: Z � _IHAVEANDWILIMAINTAIN.ACERTIFICATEOFCONSENTTOSELFIN5l1REFORWORKERS' _ ¢ COMPENSpTION,AS PROVIDED BYSECTION 3�0o OF THE LABOR CODE,FOR THE PERFORMANCE W OF THE WORK FOq WHICH THIS PERMIT IS ISSUED. � ' Q W _IHAVEANDWILLMABJTAIN',WORKEFiS'COMPENSATIONINSLIRANCE,ASHEQVIREDBYSECTION �, Q 3700 OFTHE tABOR CDOE;FOF THE PERFORMANCE OF THE WDRK FOR WHICH iHIS PERMIT 15 , ISSUE�.MY WORKERS'COMPENSATION INSl1RANCE CARRIERAND POLICYNUM9ERARE: CONSTRUCTION ¢ �, � cnARieR PLAN REVIEW '�� � poucvniuMeEa � ELECTRIC _....— . ¢ (IFOSSECTK7NNEmNOTBE�COMPLEfEDOFTFIEPERMffISWRIXJEHU�DRE�Oq1AR5(5100)ORLESS). PLUMBING ""'�-��� � , "'S_r"'�'i'� rh, i� ,`_. . Z ICEHTIFY7HATINiHEPERFORMANCEOFTHEWORKfORWHICHT:iISPERMITISISSUEJ,I MECHANICAL I b� /r.^"��'—`•�� '. U' SHALLNOTEMPLOVANYPERSONINANYMANNERSOASTOBECOMESUBJ_CTiOTHE � ' �- . � Vj WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANOAGREETHATIFISHOULDBECOME �NSPECTIONFEE { / � � SLIOJECTTOTHEWOFKER6'WNIPENSAiIONPROVI510N50F5ECilON37000FTHELA60R �SSUANCE ' ��,,,IN� � �f h � � CO�E,1 SHALL FOR7HWITH COMPLY WIiH THOSE PROVISIONS. ' I c' ' sMiP � � [] � �ATE: AP,PLICANT. p � SUBJECTANEMPIOYERTO'RIMINALPE ENERGYP/C 9.,_-,..-r ' 'i, y S'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE :_f ' LL ' NALTIESANOqVILFINESUP700NEHUN�RE�THIXISAND `"� "� WARNING:FAILURE70 SECURE WQRKER § _ DOLLARS(51oo,000,INADDITIONTpTHE';COSTOFCOMPENSATION,DAMAGESASPROVIDEDFORIN ENERGYPERMIT � -.>----" ""— � � Qe � SECTION37a80FTNELABOR'CO�E,INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: __ I �/ . , p CONSTRUCTIONLENDINGAGENCY PRE-ALTFEE: _ , �' i � IHEREBYAFFIRMUNDERPENALTYOFPBRJURYTHATiHEREISACONSTRUCTIONLENDINGAGENCY FOR hIE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�(SEC.309�,CIV C.�. . Z W . � LENDER'S NAME F- , LEN�ER'SA�DRESS '' . � rg� W ICERTIF1'THATIHAVEREADTHISAPPLICATIONANDSTAiETHAT7HEA60VEINFORUATIONISCOFRECT. TOTAL FEES �iV ��� � � I AGflEE TO COMPLY WIiH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS iiELATING TO BUILDING W[ `h � � � CONSiRUCTION,ANDHEREOVAUTHORIZEREPRESENTATIVESOFTHISCOUNTVTOENTEflVPONTHE z ABOVE-MENiiONED PflOPERTV FOR INSPE TION PURPOSES. COMMENTS a � � °y-'�� f m MTTEE RINT) �q�] C� ��1[/� (/a 51 NAiU cOFPERMITTEE . DA E � � �� , RECPT.N0. PAID BY VALIDATION . WHITE—Depa ment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENR06—File Copy,GREEN—Applicant's Copy �., . { ., � , . . �.� . � i < .v... .F �.�... � _,.� S .. � . .�� b�v� � � a �:�. z^ . g 4 �•�" � .-�B �- �:� � 5 : 5 =�,�a � ��' '� �'; ' E �"x;� d �_�`� s �•�- . . t'e` r �'7 � � � ._. 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