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�ITY QF DIAMOND BAR ��� f-----`��` --- DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES I 21825,E.Copley Drive - (909)8603195 Fax(909)861-3117 PF{ESS '�"���y" �UILDING PERIIGIIIT APPLICATION FIRMLY o DDRIESS� / I � �% DATE�CATION � � �6°� NUMB R�� #� � ISSUE �y TYPE OCC APN LOT TRACT DATE � V CONST. GROUP p OWNER -' p ADDR S n ZONWG SETBACKS z CITY ± ZIP � TEL FRONT RW ❑ o APPLICANT � ' 4 1� TE �P��,��N�y+�' S DE SIDE STREET RW O. z a CONTRACTOR SIDE ❑ ADDRESS PROPOSED USE o CITY ZIP g�TE . o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. d ADDRE$S = CITY ZIP TEL. UNITS STORIES BEDROOMS � us DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION' � OWNER-BUIL�ER DECLAfiATION SFR/ADD/REM � O 0 I HEREBV AFFlFM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FPOM THE CONTRACTORS LI- Gflffl90/CflfP011 W CENSELAWFOqTHEFOLLOWINOREASON(SEC.7C31.581151NESSAN�PROFES510NSC�DE:ANYCITYOR (n C.� COUNTYWHICHHEQl11RE5qPERMITTOCON57RUCT,ALTER,IMPROVE,DEMOUSH,ORREPHIRANYSTRUC- �,J.J patio/Deck W TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIi TO FILE A SIGNEO � � � STATEMENT THA7 HE OFi SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTOFS LI- � � . � � CENSE LAW(CHAPTER 9(COMMENCING WI7H SECTION 7000i OF DIVISION 3 OP THE OUSMESS AND PRO- POOUSpB � O FESSIONSCDOE)ORTHATHEORSHEISEXEMPTTHEi7EFROMAN�THEBASISFORTHEALLEGEDEXEMP- t7 , ,V TION.ANVVIOLATIONOFSECTION7IXi1.68VANVAPPLICANTFORAPERMRSUBJECTSTHEAPPLICANTTD Z Re-Roof � � A qVIL PENAL7V Of NOT MORE THAN FIVE HUN�RE�DOLLAHS(SGoO�J: , � ❑I,ASOWNFAOFTHEPROPEFTY,ORMYEMPLOYEESWITH:WAGESHSh1EIFiSOLECOMPENSATION, O Commercial . - WILL 00 THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEPED;=OR SALE(SEC.7044,6U51- J � NE55 AN�PROFESSIONS CODE:THE CON7RACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF = PROPERTY WHO BJIl�50R IMPflOVES THEFEON,AND WHO DOES St1CH WORK HIMSELF OR HERSELF OR � iHF10UGHHI50RHEROWNEMPLOYEES,PROVI0E0THATSl1CHIMPROVEMENiSARENOTIN7ENDE00R CO � Q OFFEREDFORSALE.iF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOIDWITHINONEVEAROFCOMPIE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PRDVWG THAT HE OR SHE DID NOT BUIL�OFl � IMPROVEFORTHEPUfiPOSEOFSALE). , W ❑�,ASOWNEROFTHEPflOPERTY,AMEXCLUSIVELYGONTRAG7INGWITHLICENSEDCONTSACTORS � TO CONSTRUCT THE PROJECT(SEC.7044,9USINE55 qND PROFESSIONS CA�E:THE CONTRACTOFS LI- V3I113t10f1 A0.1.AREA W CENSELAWDOESNOTAPPLYTOqNOWNEROFAPROPERTYWNOBUIL�50RIMPROVESTHEREON,AND ��� WHOCONTRACTSFORSUCHPROJECTSWffHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE ' �Y TORSLICENSELAW.). �� �I AM EXEMPT UNDER SEC. _e.&P.C.FOR THIS ftEASON Q � U � � oarE ownEa H p w _ — - .�; LICENSED CONTRACTORS DECLARATION W ¢ � I HEREBYAFFIRM UNDER PENALN OF PEPJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPiER � � p;, 9(COMMENGINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINi:35AN�PROFESS10N5 COOE,AND Z X � MY UCENSE IS IN FULI FORC N F Ci. }' 0' LICENSE�CjLA S LIC,NO. Gi�� r�%�� �„ � ~ DATE P I J V CONTRACTOR � d W a—'�d WORKERS'COMPENSATION DECLARATION Q � IHEREBYAFFIRMUNDERPENALTYOFPEFJUflYONEOFTHEFOLLOWiNGDECLARATIONS: Z � _IHAYEANDWILLMAINTAINACERTIFICATEDFCONSENTTOSELF�INSUREFORWOqKERS' a ¢ � COMPENSATION,AS'�,pROVIOEDBYSECTION37000FTHELA60RCOCE,FORTHEPERFORMAN� U Q OF THE WORK FOR WHICH THI6 PERMIT IS ISSUEO. � W I HAVEAND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION Q 37oaOFTHELPBOR�CODE,FORTMEPEPFORMANCEOFTNEWORKFORWHICHTHISPERMITIS ISSUED.MYWOHKEpS'COMPENSATIONINSURANCECARRIERANDPOLICYNUMBERAPE: CDNSTRUCTION � j cnaaiea � PLAN REVIEW � POLICY NUMBER � Z ELECTRIC ¢ � (iHIS5ECT1qJNEmNOTBEOJMPLEfEDOFTHEPERMITISWROVEHUNOHE�00LLAR5(d100)OfiLE55j. PLUMBlNG i Z I CEPTIFYTHAT IN THE PERFORMANCE OF THE WOiiK FOq WHICH THIS PERMIT IS ISSUED,1 MECHANICAL C.�J SHALLNO7EMPLOY,ANVPERSONINANYMANNERSOASTOBECOMESUBJECTTOTHE (/� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,AN�A6flEETHATIFISHO LDBECOME INSPECTIOI�IFEE� � SUB,I6CTT0- EWQRKERS'COMPENSATI PROVI51 �SOFSE TION3�qO�FTHE R � = CO�,I S A FO TMWITH COMPLY WIT OSE PR ISIONS. I �y � ISSUANCE Q �5 p DATE: ���� /�� � APPLICANT: �� SMIP J WARNING FA0.UfiE TO SECURE WOftKERS'GOMPENSATION COVERAGE IS LINL4WFUL,AND SHALL BE ENERGY P/C � SU9JECTANEMPLOYERTO'�CflIMINALPENALTIESANOCIVILFINE5l1P70ONEHUN�FEOiHOUSAND ENERGYPERMIT DOLLARS jS100,o00),IN ADDITION TO THE CQST OF COMPENSATION,DAMAGES AS PFiOVIDED FOR IN J SECTION370HOFTHELABOR�.CODE,INTEREST,ANDATTORNEY'SFEES. y � p� RETENTION FEE: pCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMUNDERPENALTVOFPERJURYTHAT7HEREISACONSTRUCTIONLENDINGAGENCY FOPTHEPERFORMANCEOFTHEWORKFORWHI(7iTHISPERMITISISSIJED�SEG3o9],CIV.C.). � . Z L1i' � LEN�ER'SNAME F LEN�ER'SAD�R'eS5 � TOT/�L FEES ��. �� I CERTIFYTHAT I HAVE REAO THIS APPLICATION AN�STATE THATTHE AAOVE INFORMATION IS CORREC7. � IAGREETOCOMPLVWITHALLCITYANDCOUN7YORDINANCESANDSTATEL4WSRELATINGTOBUILDING d �'. CONSiRUCTION,ANDHEREBYAUTHOftIZEREPRESENiATIVESOFTHISCOUNTYTOEMERUPONTHE Z. AB VE-MENiIONED PROPERTV FOFi INS TION PVRPOSES. � 1� � COMMENTS �' ''AA 7� m� R EENAM�INT) ' � ` � �Q H� �p (, � �! .��.a� � A F O MITTEE ATE _. RECPT.NO. PAID BY VALIDATION ~ WHITE—De artmeMCo VELLOW—FinanceCo PINK—AssessorCo GOLDENROD—FileCo GREEN—A IicanYsCo P PY� pY� PY� PY, PP PY . . � . ,. _.. - ... , _ __...._ ,,� .� _ ...: - ,' .. . . • .'-. �.�,;.r ::,_..hT F��Np�:.iE i}g i+:..'ti:.�: .,............. ... ....y....�..-. .. .. ........... ........ tl , f>' `,k §5�" �' € �'a . d ., , € ,.�'.,... ,. 't 9 �. ... 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