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Home My WebLink About12863 (11) � r ��_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNI'FY&DEVELOPMENT SERVICES 21660 E.Copley Ihive Suite 190 (909)860-3195 Fax(909)8613117 PRESS ��' BiJILDING PERMIT APPLICATION FIRMLY � JOBSITE (� APQLICATION _ �I PERM(T � a�� ADDRESS ��JI� l�I�r7 ��= DATE � NUMBE�_ � �O _. � APN LOT TRACT ��UE TYPE OCC � OWNER BP1'AIAreL�uS[�wu,► SlU �ATE CONST. GAOUP Q ADDRESS 2�'Za3i� �jtr�5�,� ZONING SETBACKS � � CITY �'�jn r' ZIP TEL �"'�+Z�� REART RW Q APP!lCANT TEL. SIDE/SIQE STREET RW ❑ � CONTRACTOR SlDE ❑ � ADDRESS CITI ZIP�.r 'Z TEl_ '1'K1"2Ll _ PROPOSED USE 6i1_��iT �i,t�{y�'�_�' �L� � ARCWENG/ DEShGNER IL�1 A1�f�Atl� NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY IP TEL.��'1�1�1`�6F4 � v� DESCRIPTION SQ.FC FACTOR PSF ADJ.AREANALUATION pC ONMER-BUILDER DECLApAT10N SFR/ADDIREM O � 1 HEREBY AfFlRN WOER PENRL7V OF PEIUUPY IHAT I AM E%EMPT FROM THE CONTMCTORS ll• ��9�C8�rt CEI4SEWMFORTFIEFOLLOWINOHEASON(SEC.7071.58USINESSAN�PROFESSpN5COOE:MIYCITYOR (n WIIHiYNIFYpiflEq11RE5APER1AfTTOCON5IAUCT.KTER�PROVE.DEMOLISN.ORRE?AIflMJYSTRUC- W P2fi0(DBCk iUpE,PWOq TO rt9 ISSUINCE,�1L50 RFIXlIRE31NE APPIIGNT WR SUCH PERAl1T TO FiIE A SIGNEO W STATENENT THAt HE OR SHE 19 LICENSEO W RSUANT TO 1HE PROVISIONS OF THE CONlRACTORS U- � �E LAW(d1APTEq 0(CQYMENCIN9 N7TH SECTION 7000)OF�IVISION 90F 7HE BUSINESS ANO PRO. � POOVSPB FFS8qN5 CODE)Oq 7HAT HE OR SHE IS E7(EMPT THEREFROMANO 7NE BA41S iOR THE ALLEGED EXENP- TION.ANY VIOLATION OF SECTION 7097.6 BY ANY AVPIICANT FOR�PEPYR SU6IECTS THE APPLICANT TO Z paq,�f � �CMI VEN�LTY OF tqi MOfiE 7HAN FNE HUNDREO DOLURS(lbao)J: � ❑4ASONMEqOFTHEPROPEq1Y,OpMVEN7LOYEESWITNWAGESASiHEiqSOLECANPENSATION, ❑ COTI11BfCIBI -� M�L DD THE W�RM,ANO THE STRUC7URE IS NOT INTENOED OR OFFEREO WR SA�E(SEC.7a1,BU91- �1 NE55 AND PAOFES610N3 WDE:7NE COMfMCTOf35 LICENSE UW DOES NOT APp�Y TO IN OWNEH OF � � PMIPEiqYypp9UW50RINPROYES7MEREON,ANDYMODDE55Uq7MqitKHIMSELFORMERSELFOR Q iMpd10H MIS ON HER ONM EMPLOVEES,PROVIOED TH�T SUCH NAPROVEMENTS ARE NOT IMENDED OR m W OFFFiEDfORSALEIF,liOYIEVERTME9U�LD�N�ORiMPROVEMENTISSq.OWITMNONEYEAROFCOMPLE- ZTION,TNE ONMEq�BUItDER WILL Vi�VE TXE BURDEN OF PROVING TH�T HE OR SHE�ID NOT PUII,D OR = MIPROYEfORTFiEPl1RPO5EOF3ALE). y� ❑L+ISOWNEA�fTHEPqOPEPTV,FYEXCLUSNEIYCONTR�CTM16W1THLICENSE�CONTRAC70pS ,y�. (r TO fAN37AUCf TlIE PRO.IECT(SEC,70H,BUSINESS AND PfiOFESSION3 CODE:THE COI�liMCTOR3ll- V81U31I �./ ADJ.AREA 111 CENSELAWDOESNOTMPIYTOANONMEHOFAPFOVERTVNMOBUILD50RpdPROVESTHERECMl,pNO F IMqCONTMCT5FOR5UCMPROJECfSWITNACONfR1CTOR�S)UCENSEDPURSUPNTTOiHE�NTMP pUAN717Y DESCRIPTION FEE � TORS LICENSE LAW.). O I AM IXEMPT lA1DER SEC. B.t P.C.fOq THIS RFASON U v r LL ¢ 7 D�� EA U L � LICENSED CONTRACTOHS DECLARATIDN W � 1 �u,, n �'t"; IHEqEBVIfF1iWUNDERPEN�LTYOFPEfWRV1HA71MAUCENSE�UNDERiROVISiONSOFCHAPTER � - � Y(C�11YENpNOWfiH5ECT10N7000)OFDMSpN30FTHEBU51NE55ANDPROFE5510N5CODE,PNO Z —' LLJ AIY IICENSE IS W FU1 FORCE AND EFFECT. m � � � IICENSE QASS_� LIC.ND. �iX�I. � � 7 v onrE �Z � '�,� —�'1� corrrfwcroa a t '`�l W /� � WORKERS'COMPENSATION�ECL4RATION.r U �„� � L/ y 1 HENEBY AFFIMI UNDER PENPLTY OF PEFLtt1RY ONE Of THE FOLLOWING�ECLARATIONS� `—" a Gl _IWNEANDVlILIMARtTAMACERT�F�CIITEOFCONSENTMSEIFINSUREFORWORKERS' * , � � f].j��,,,� * Z CqIPH13/,TqN.A50ROVIDEDBYSECTION37000F7HELl�90RCODE.FORTiEPERPoRMANCE U ��f«��'� QOF TME WORK PDR MMiCH THIS PERMIT IS ISSUED. � � i ��Hl1VE M41 YVILLM�IMAIN WOiW(ERS'COIAPENSICTION INSURANCE.AS qEWIRED BY SECTION � Q37aa OF THE U90R CODE,FOR TME PERFORMANCE OF THE WOAK FOq WHICH THIS PERMIT IS � ISSUED.MV WORKERS'CdAPENSATpN INSURANCE CARPoER AND FOLICV NUMB£R ARE: CONSTRUCTION � CARPoER PLAN REVIEW � POLICV MIMBEH EIECTRIC � RMsSECror+MEIDNo7eE0oMttEr�cFnEaEwxfSrdiaNFVRMNEboalMSMao)aFlIESS? PLUM8ING � Z 1 CERT�'I THAT N71iE PERFORMANCE OF iHE WORK FOH WHICH 7HI5 PERMIT IS ISSUEO,I MECNANICAL � SHALL NDT EMPLOV ANV CERSON M ANY IAM'NER 50 AS TO EECOME SU&IECT TO THE � WOflKERg'COMPENS�TIONlAW50FC+WFONNtANdDAGREETMATIfI3H0ULDBECOME INSPECTIONFEE S SUBJECTTOTHE`MORKERS'Cd.�PEN5AT10riPROVISIONSOFSECrlO� 7 F7HELRBOR �SSUANCE I COOE.ISMALLFORTHWI7HCOMPLVWI��P VIS NS � �' Q� �-��Q� �T � �p DATE:j� APPLICAM: SMIP � WMNW6:FAILUFETOSECUREWOPKERS'COMPENS�TpNCOVFMGEISUNIAWFUL,MIDSHALLBE ENERGYP/C � SUBIECTIUlEMPLOYER70CR!NIW�LVENALTIESANOqVIIiINESUPTOONENUNDflE01HDU5AND ENERGYPERMIT D011MS(S1o0,aoo).IN AOOI110N TOTHE COST OF COMPENSATION.DPIAAGES AS PROVIDED FOR IN (� �^�y +� J SECT�DN 3�oe OF TNE UNOR CODE,IN7EREST,MlDATTORNEYS FEES. RETENTION FEE: ��11 IY L� '�/ � LLl �—f D� � CONSTFUCTION LENDING AGENCY PRE•ALT FEE: � IHEREBY�FflWAUNDERPENALTYOFPEFiJURVTHATTHEREISACONSTRUCTIONLENDiNGAGENCY ��g,F nTAMOND B�R Z FOR THE VEAFOFAIANCE OFTHE WORK FOR WHICHIHIS PERMIT IS�SSUED�SEC.308�.CIY.C.). ^ A�^��e�qJ �,��,��a i J 1 S I � LENDERS NAAAE F— LEN�ER'S/�D�RE55 � � ICERTIFVTHRTIHAVEPFMTHISAPPLIGTIONMAST�TETHATiHEABOVEINFORYATqNISCORPECT. TOTAL FEES � � t � d IACiREETOCOMPlYN7THMLCT'ANDWUNTYOflUINANCESFNOSiATEUWSRELA17NfiT08UILDINO � I CQNSTPUCTION,ANUHEpEBYAUTHOi11ZEREPRESENTATIVESOFTMISCOUNTVTOENiERUPW�l7HE ��//J��f I � dBOYE•NEMIONEDPROGENNFORINSPECTIOtIPURPOSES. CO�MENTS '� ��`' , � t�k..tS � PEfUAITTEE E PRI � '� � -� � tblN PEp��iTEE DA7E � RECPT.N0. PAID BY VAI.IDATION ,y � YVHITE-0eQartment Copy,YELLOW�inance Copy,PINK—Masssa Copy,GOLDENROD—File Copy,GREEN—P,ppliani's Copy Gl�'Y OF i�tAt4i�i�N[) ��+el� [�SPi�CTtC3�1 ��t�F�t� i � - : a:�.�i`� � a � � s y � , k �, i �E3�BRC€i � � , F�C)OR JOIST - FT�aSIFC3t�t,�SFSTEEL Z �� ' �z�� -�FHA REQMTS ---- � �L�CTRiC GROUA3� ; UIVDER F�C70�i[3UCT � GFiCtJ�3J P�Ut�48ENG ' i � UNDER FLC10R CGEIDUlT _ � ! � SLf��GRnDE FIREPLRGE�{7UNDATION - ; l"�i�i'Pi.'34�IEt�- I FiREPLACE E30ND 6EAt�i �, �J�TER SERVIC� i M!D HT.60ND F3EAi� — _ __ i RCC3F SN�kTHEtd ,.fGIC-'r7vL/ j -�-- - �i 8 FT.BC1ND SEr�N9 , — ! • I FFf�`c;Lti6+iC�NE�TILI�TIt�i�J_I Zv ��' FlNAL BC3(�1C7 BEAM � ROC�f=Ct711EF Pf��-GRAD6NG I � i nf;l1��-i�-f�t'1�IP�lG j� � BENCHING � i RCU(a�-i�LECTRlC _� � � FtOl1CaH GRADING � �c�u��;��ne�;te� � - � ��is;a��a�tirs� i , SNt71�"JEr�/T'UE3 TEST .�O � i /� PO�L ELECTRIC :i �XT.LA�HI�IC}1N� ; POOL��JCiNG � ___ --__ —__-- ----___.__ __ , 4�lAl.L iiVSULA�'i0�1 ` r POOL FIf�AL ! 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