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Home My WebLink About17542 (26) _ . i CTI'Y OF DIAMOND BAR /� ----�� -- DEPARi'MENT OF COMMUNITY&DEVELOPMENT SERVICES � � 21825 E.Copley Drive -,"`..w � PRESS (909)860-3195 FaY(909)861-3117 '''%.v��' BUILl3ING PEIgMIT APPLICATION FIRMLY o AGDRESS�� C)�CU�� DATE CATION � �_�� NUMB R �� #/C �� `"�� m ISSUE TYPE OCC APN LOT TRA T DATE CONST.� GROUP p OWNER + P 4 o ADDRESS ZONING SETBACKS z CITY ZIP TEL. FRONT RW O ZAPPLICANT TEL. REAR ❑ SIDE/SIDE STREET RW ❑ ¢ CONTRACTO �-` �3 f SIDE ❑ � ADDRESS ` PROPOSED USE � �� .Z- �' � �'9t � CITY� � ZIP��TEL.�( .,� � � .� w ARCH/ENG/ �� z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES _ BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION cn � OWNER-BUILDER DECLARATION SFR/ADD/REM � O p I HEREBY AFFIRM UNDER PENALTY OP PERJURY THA71 AM EXEMPT FROM THE CDNTRACTOFs LI- GBfage/C8fp0lt W CENSELAWFOPTHEFOLLOWINGREASON(SEC.7031.56USINESSANDPROFESSIONSCADE:ANYqTYOR (n . U COUNTYWHICHREQUIRESAPERMITTOCONSTFUCTALTER,IMPROVE,DEMOLISH,ORFEPAIRANYSTPUC- W palio/Deck � Z TURE,PFIOR TO ITS ISSUANCE,PLSO PEQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W w STATEM'cNT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS trF hIE CONTqACTORS LI- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION�oDo)OF�IYISION 3 OF 7HE BUSINESSAN�PRD- LL' PooUSpa � FESSIDNSCODEJORTHFTHEOfl5HE15EXEMPTTHEREFROMANDTHEBA515FORTHEALLECaEDEXEMP- �� TION.ANYVIOLATIONOPSECTION7031.58YANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICAN77o z R@-R001 � A CIVIL PENALiY OF NOT MORE THAN FIVE HUNDRED DOLLAFiS(SSOo).): 0 ❑4ASOWNEROfTHEPROPERTV,ORMYEAAPLOVEESWIiHYJAGESASTHEIR50LeCOMPENSATION. ❑ COrt1fI18fC12i - z� .WILL DO THE WORK,AND THE STRUCTUFE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.7044,BUSI- J �. NESS AN�PROFESSIONS CODE:THE CONTflACTORS LICENeE LAW DOES NOT APPLV TO AN OWNER OF � PROPEHTYWH08UIL�SOFIMPROVESTHEREON,AN�WHODOESSUCHWORNHIMSELFORHERSELFOR m [[. THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THATSIJCH IMPAOVEMENTS ARE NOT INTENDED OR � Q, �OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPIE- Z �TIDN,THE OWNEfi-BUILDER WILL HAVE THE BURDQJ OP PROVING THAT HE OR SHE DID NOT eUILO OR � IMPROVEFOPIHEPLIRPOSEOFSALE). ,,,,� ❑I,AS OVJNER OF THE PROPER7Y,AIA EXCW SIVELY CONTRACTING WITH LICENSED CONTRACTORS �' TO CONSTRUC7 THE PROJECT(SEC.7044,BUSMESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V81U3110fi ADJ.AREA W CENSELAWDOESNOiAPPLYTOANOWNEROFAP0.0PERNWHOBUILDSORIMPROVESTHEREON,AN� � WHOCOMRACTSFOFSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPU�iSUANTTOTHECONTRAC QUANTITY �ESCRIPTION FEE Y TORSLICENSELqW.). � ❑I AM EXEMPT UNDEFi SEC. B.&P.C.FOR THIS REASON � � O ,,,q ;a, � a�s6d � � CC f'� °`'�. � DATE OWNEP V A W � LICENSED CONTRACTORS DECLARATION �j � - � I HEREBYAFFIRM UNDER PENALN OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � . p_ . 9(COMMENCINGWITHSECTION70oo)OFDIVISION30FTHE8USINESSANDPROFESSIONSCO�E,AND Z �,X ' MV LICENSE IS IN FULL ORCE AN�EFFECT. m � LICENSE CLASS�LIC.N0. �P� � 1— /� - V �ATE I I�'7(�� CONTRACTOF a . W o� WORKERS'C�MPEN5ATION DECLARATION � � ¢ � 1 HEREBY AFFlFM UNDER PENALTY OF PERJURY ONE OF7HE FOLLOWING DECLARATIONS: � C/� Q � _IHAVEANDWILLMAIN7AINACEFiIFICATEOFCONSENTTOSELf-INSURE'rOIiWORKERS' 2 CAMPENSATION,ASPROVIDEDBYSECTION3�aoOFTHELABORCO�E,FORTHEPERFORMANCE C� Q OFYHE WOPK FOR WHICH THIS PEftMIT IS ISSUED. � � � �IHAVEAN�WILLMAINTAINWORKEflS'COMPENSATIONINSUFANCE.ASREQUIRE�BYSECTION �� °�� Q 37000F THE LABOR CODE,FOR7HE PERFORMANCE OFTHE WORK FOR WHICHTHIS PERMITIS �, ISSUED.MY WORKERS'CpE�PE1 SATION INSUF�E CAfiRIER D POUCY NUMBEPARE: CONSTRUCTION a CARRIER �1 PLAN REVIEW �.'�e�~� � �'�, ,r�� f � POLIC7 NUMBER �� p _ "��:��O ELECTRIC � `�'� � Q � (fHISSECTKKJNEmNOTBE00MPLEfEDOFTHEPERMfrISWRONEHUNDRm00LLM5(E1a0)ORLESS). PLUM6ING �, ICERTIFYTHATINTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED,1 MECHANICAL C'3 SHALLNOTEMPLOVANVPERSONINANYMANNERSOASTOBECOMESUBJEC7TOTHE N WORKEFS'C0IAPENSATION LAWS OF CALIFOPNIA.ANDAGREE THAT IF I SHOULO BECOME INSPECTION FEE SUBJECTTOTHEWORKE(i5'COMPENSATIONPROVISIONSOFSECTION37o00FTHELABOR � - n{L�� CO�E,ISHALLFORTHWI7HCOMPLYWITHTHOSEPROVISIONS. ISSUANCE �' � SMIP y..�� p OATE: APPLIGANT. �� ' ENERGY P/C J WAFNING FAILURE TO SECURE WOFKERS'COMPENSATION COVEfiAGE IS UNLAWFUL,AND SHALL 6E � SLIBJECTANEMPLOYERTOCRIMINAIPBJALTIESANDCiVILFINESl1PTDONEHUN�REDTHDUSAND ENERGYPERMIT DOLLARS(Slaa,a00),IN P.DDITION TD THE COST OF COMPENSATION,DAMACES AS PROVIOE�FOR IN J� SECTION370BOFTHELA80ftCODE,INTEREST,ANDATTORNEY5FEE5. RETENTIONFEE: �. � d CONSTFUCTION LENDING AGENCV PRE-ALT FEE: � IHEREBVAFFIRMUNDEFPENAI.NOFPERJURYTHATTHEREISACONSTRUCTIONLENDINGAGENCY d FOR THE PEFIFOFMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.309�,CN.C.). ' � Z w = LEN�ER'SNAME � I_ LENDER'SAD[]RESS - .�j /� I W ICEFTIFYTHAiIHAVEREAOTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMAT10Ni5CORRECT. TOTAL FEES H ^� �� a �S � � IAGREETOCOMPLVWI7HALLCRVANDCOUNiYOR�INANCE5AN�5TPTELAWSRELATINGTOBUILOING CONSTFUCTION,ANDHEREBVAUTHORIZEREPRESENiAiIVE50FTHiSCDUNTYTOENTERUPONTHE ,s+g*%�� ABOVE-MENiIONED PROPEflTV FOR INSPECTION PURPOSES. � Z � � COMMENTS �j"" � � w"" . � PERMITTEE NAM P N P{ C:d'� � � �� Q � �0 � SIGNATUREOFPERMITT E . OATE = RECPT.NO. 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