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_�� _ CITY OF DIAMOND BAR i I I I � DEPARTMENT OF COMMi.JNITY&.DEVELOPMENT SERVICES � _ 21825 E.Copley Drive (909)860-3195 Fax(909)�61-3117 PRESS '`'%H��'� BUILDINGPERMITAPPLICATION FIRMLY o ADDRI SS �I% ����� ��"� " DATECATION � �'� �-�� NUMBER � Y �� #/C m ISSUE TYPE OCC � APN� LOT ��T�ACT DATE CONST. GROUP p OWNER ��!L'� �� ``' ADDRESSC�� ��d�' � ' ZONING SETBACKS 0 z CITY�i���^'� �� ZIP�'I'7�Y' TEL� O ' FRONT RW ❑ o APPLICANT TE .�j'��rsJ�/ REAR ❑ z � ,� � SIDElSIDE STREET RW ❑ Q CONTRACTOR �f �S C � p�t. SIDE Cl � ADDRESS,�%7 ,.� !.�'-f�Y�✓"� ' a�✓`�. �:.a%!f �" � CITY L�s��`z� ' ZIP� TEL j'���Sf�O PROPOSED USE o ARCH/ENG! �z DESIGNER NO.DWEL. NO. ' NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF A�J.AREANkLUATION � OV�UNER-@UILDER DECLARATION SFR/ADD/FEM � � O i p 1 HEREBY AFFIRM UNDER PE�IALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gd�HJB/CBfPOfI � W CENSEL4WFORTHEFOLLOWMGREASON(SEC.7031.68VSINESSANDPROFESSIONSCOOE:ANYCITVOR (n � U COUNTVWHICHRE-0UIRESAP£RMITTOCONSTRUCT,ALTER,IMPROVE,DEMOUSH,ORflEPAIRANYSTRUC- ' w� TURE,PRIOR TO IT3 133lJANCE,'ALSD REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNE'J W PdtlO/DBCI( STATEMENT iHAi HE Ofl SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- �, CENSE LAW ICHAPTER 9(COMME�IqNG WITH SCCTION 70o0J OF DIVISIDN 3 OF THE BUSME55 AN�PRO- V' PoOVSpa . Q � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROIAANDTHE9ASISFORTHEALLEGE�EXEMP- (7 �. TION.ANVVIOLATIONOFSECTION o31.5BYANYAPPLICANTFORAPERMITSUBJECiSTHEAPPLICANTTO Z R0-ROOf '� A CIVIL PENALTY OF NOT MORE 7H�N FIVE HUNDREO DOLLARS(5500).): ❑I,ASOWNEROFTHEPROPF�RTY,OtiMVEMPLOVEESWIiHWAGESASTHEIR50LECOMPENSATiON, Q O Commercial Z WILL DO THE WORK,AND THE STfjUCTURE IS NOT INTEN�ED OR OFFEflE�FOR SALE(SEC.7044,6USi- J � NE55 AND PflOFE5510N5 CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF = PROPERTYWHOBUILDSONIMPR ESTHEREON,ANDWHOOOE55UCHWORKHIMSELFORHERSELFOR Q'�� THROUGHHISORHEROWNEMPL YEES,PHOVI05DTHAT5UCHIMPROVEMENTSARENOTINTENDEDOR m � 0 , OFFEREDFORSALEJF,HOWEVER;jHEBUILDINGORIMPROVEMENTIS50LDWITHINONEYEAROFCOMPLE- Z.� TION,THE OWNER-BUIL�ER WILL YIAVE THE BUROEN OF PROVING THAT HE Oa SHE OID NOT BUIL�OR �, IMPROVEFOFlTHEPURPOSEOF5�LE7. W. ❑I,ASOWNEADFTHEPROPERTI;AMEXCLUSNELVCONTRACTiNGWITHLICENSE�CONTRACTORS �„ TO CONSTAUCT THE PROJECT(SEC.70b4,BUSINESS AND PROFESSIONS COOE:THE CONTRACTORS LI- VdI118I1011 ADJ.AREA W CENSEL4WDOESNOTAPPLYTOi1NOWNEROFAPROPERiYWHOBUILD50RMPflOVESTHEREON,AND Z WHOCONTRACTSFOftSUCHPROJ�CTSWITHACONTRpCTOR(S)LICENSEDPUFSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LIC�15E LAW.J. � '�, �� ❑IAVA E%EMPTUNDER S�C.�' B.8 P.G FORTHIS REASIXJ J � � U �i ¢ LL DATE � OWNER __.. V � . z W � LICEN ED CON7AACTORS DECLARATION W � . � IHEREBYAFFIRMUNDERPENALT�OFPERIURYiHAiIAMLICENSEDUNDERPROVISIONSOFCHAPTER � . �d e(COMMENCINGWITHSECTION] 0)OFOIVISION30FTHEBUSINESSANDPROFESSIONSCOOE,AND Z X MY UCENSE IS IN FULl FOftCEAN EFFECT, " � LICENSE CL45S "` ��� LIC.NO, ��� / �/ __ � W�� DATE �"��J�"C�.J� CONTRACTOR��5���� � d �' WORKEyS'COMPENSATION DECLARATION��ra���l•% � U A , ������ �, „�.����� _ ,�� N IHEHEBYAFPIRMUNDERPENALT�IOFPERJURYONEOFTHEFOLLOWING�ECIARATIONS: Z � Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFOHWOFKERS' _ ¢ COMPENSATION,ASPROWIDED6VSECTION37ooOFTHELABORCO�E,FORTHEPERFORMANCE �U OF THE WOflK FOR WHICFiiTH15 PERMIT IS ISSUE�. � � I �� _I HAVEAND WILL MAINTAI WORKERS'COMPENSATION INSURANCE,AS REQUIflED BY SECTION Q 3�ooOFTHELA80RCODE FORTHEPERFORMANCEOFTHEWORKFOflWHICHiHISPERMITIS ISSUED.MYWORKEAS' MP SATIONINSUFANCECARRIERAN�POLICYNUMBERARE: CONSTRUCTION j cnRRiER � �v�� . _ PLAN REVIEW � POLICY NUM6ER !J ' ELECTRIC Z i <C � (�FiI55EC'fqNNEmNOTBE�'IJMPLETEDOF7HEPERMRISFORONEHUNOREDDOLIARS(510o;�ORL6S). PLUMBING � �+ Z �CERTIFYTHATINTHEPEJRFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUE0.1 MECHANICAL _...._ �^A^^•^-"� ��`_�' ���,�' C,'3 SHALLNOTEMPLOYANV�ERSCININANYRIANNERSOASTOBECOMESU6JECTTOTHE �� ✓\'� ( i � � � Uj WORKERS'COMPENSATIO LAWSOFCALI=ORNIA,AN�AGREETHATIFISHOULOBECOME INSPECTIONFEE � ��'—`��'v .�����`*-.I '- �-....�� F SUBJECTTOTHEWORKE S'COMPENSATIONPflOVISIONSOrSECTION3]o00FTHELABOR I C�, �` CDOE,I SHALL FORTHWIT COMPLY WITH THOSE PROVISIONS. ISSUANCE � � �g j �'"�e �'Ai�� O I SMIP � & �i� C p DATE: A�PLICANT; . J WARNING:FAILURETOSECUFEWQI�RKEfl5COMPEN5A710NCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C _ � � SU&IECTANEMPLOYERTOCFIMiNALPENALTIESANDCNILFINESUPTOONEHUNDREDTHOl15AND ENERGYPERMIT DOLLARS�S700.000�,INADDITION OTHECQSTOFCOMPENSATION,DAMAGESFSPROVI�EDFORW �'�°�r F' y SvA�e --� � � SECTION 3708OF iHE LABOR CO E,INTEREST,AND ATTORNEY'S FEES. .,,,_..__,v_„_„_,.__-.-...--a;.'^. - N RETENTIONFEE: �-�--� - "---� �-��� q ���� ' � � ' CO STRUCTION LENDING AGENCY PRE-ALT FEE: � � I HEREBYAFFIRM UNOEF PENALT OF PEflJURV THAT THEaE IS A CONSTRUCTION LENDING AGENCY FORTHE PERFOFMANCE OFiHE�JORK FOF WHICHTHIS PERMI7151SSUED(SeC.3De7,CIV.C.). . Z w � LEN�ERSNAME � 1— LENDERSADDRE55 � W I CERTIFYTHAT I HAVE READ THIS��'qPPLICATION AND STATElHATTHEABOVE INFORMATION I5 CORRECT. TOTAL FE ES �� ��. � .� IAGREETOCOMPLYWITHALLCITyAN�COUMYORDINANCESANDSTATELAWSRELATINGTOBUILDING � CONSiRt1CTION,ANDHERE8YAU7HORIZEFEPRESFNTATIVE50FTHISCDIINTYTOENTERUPONTHE .Z ABOVE-AAENTIONEDPROPERiVFORINSPECTIONPURPOSES. , , p � �� . � � � COMMENTS - '--� G E��C..a �. � �.�i�i� y ' m ¢ PERMITTE[NAME �A,,,�,...�� j �n �'�/°'G�/ A , � SIGNAT OA7E � _ ✓"' �, RECPT.NO. �a PAID BY � VALIDATION ~ � WHITE—De artment Co YELLOW—Finance Co PWK—Assessor Co GOLDENRbD—File Co GREEN—A IicanYs Co P PY. PX PY. PY. PP PY , _ , - � t . ��� , $ .. . .~,:; � � � , �� � � . ', , .. .t -g�,.rr a�. ,.�`R a.h' ti T & c I y; v,P # K x .t: ��'e �' ' '�; 9 & a * - 4 .� #°� M1 y t"� � f�. r a: �; � �'� s�' � r k �y �. a, �,� � �'� � � � .�d y �a� €�+.a � �� � f � � w � a��r a "�a �t ;���a" �'� ��n„�,,_�,�a.m..��� +x..`.....'��n.. r�`..e.' ,. , . 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