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- - --- -,_ _ _ � � � �.__ CITY OF DIAMOND BAR � ^� � � �EPAR'I'IVIENT OF COMMiJNITY&DEVELOPMENT SERVICES � 21825 E.Copley Drive (909)860-3195 Fas(909)86I-3117 PRE$$ '��'�Yr°� BUILDINGPERMITAPPLICATION FIRMLY , o� JOBSITE p� p/� APPLICATION i (�`� PERMIT °"� P!C ADDRESS_ �'i��� C�r7'i� ECC��/� e\d�/ DATE '�f�V�/ �NUMBER r� # � I5SUE NPE QCC APN LOT TRAC7 DATE CONST, GROUP p OWNER � - o ADDRE S � v22 " p ZONING SETBACKS Z CITY � ZIP r TEL. %°J��^ s e��O� FRONT RW ❑ � APPLICANT � TEL. REAR ❑ � SIDE/SIDE STREE7 RW ❑ z Q CONTRACTO I , L..,t� /'�w SIDE ❑ o ADDR SS �ex c� '� PROPOSED USE_f����f2-7..,��[3�,a+�? c'� ^ �/�¢�,�' d' o CITY ' L%f" ZP� TEL. �'�,�/'�%/'�"�`/ t�" � wo ARCHlENG! � �'K e�arfi� ia a.�5 z DESIGNER w NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. UNITS � STORIES �,.____ BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BIJILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNOER PENALTY OF PERJUqY THHT I AM IXEMPT FROM THE CONTRACTORS LI- Gdf2JB/C8fp0ll W CENSELAWFORTHEFOLLOWINGWEASON(SEC.7037,SBUSINESSPNDPflOFE5510NSCODE:ANYCITYOR (f� U COl1NTYWHICHREQUIRESAPEHA1ITTOCDNSTRU;GT,ALTER,iMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W W TURE,PRIOR TO ITS ISSUANCE,qL50 REQUIRES''�,THE APPLICANT FOR SUCH PERMIT TO FILEA SIGNED W Patio/Deck � STATEMENT THAT HE OR SHE IS�ICENSED PUR$UANT i0 THc'PROVISIONS OF THE CONTRACTORS LI- � , � CENSE LAW(CNAPTEFi 9(COMMENCING WITH SE4TION 7000)OF�IVISION 3 OF THE 6USINE55 PN�PRO- POOUSpB � FESSIONSCADEJOpiHATHEOR�$HEIS'EXEMPT�HEREFflOMANDTHEBASlSFORTHEALlEOEDE%EMP- (� V TION.ANYVIOLATIONOFSECTIONn031.59YANYqPPLICANTFORAPERMI7SUeJECTSTHEAPPUCANTTO z Re-Raaf A qVIL PENALTY OF NOT MORE THAN fNE HUNDRED�OLLARS(5500).�: 0 pI,p50WNEROFTHEPROPERTY,ORIAVEMPLOYEESIM1'ITH_WAGESASTHEIRSOLECOMPENSATION, � Commercial - WILL DO iHE WORK,FND THE 5Tf1UCTURE IS NOi INTENDED OR OFFEflED WR SALE(SEC.7044,B1151- J � NESS ANO PROFESSIONS CODE:TNE CONTRACTOFS LICEN6E LAW OOES NOT APPLY TO AN OWNEP.OF � , PROPERTYWHOBt11LD50RIMPRCfVESTHEREO�,IAN�WHO�0ES5l1CHWORKHIMSEL'rORHERSELFOR ' � � THROUGHHISORHEROWNEMPLOVEES,PROVI�€D?HATSUCHIMPROVEMENTSARENOTIN7ENDEOOR m w OFFEREOFORSPLEIF,HDWEVER,tHE8l11LOINGOPIMPROVEMENTI550LDWITNINONEYEAROFCOlAPLE- � TION,iHE.OVJNER-B1111�ER WILL HAVE 7HE BURDEN OF PROVING THAT HE Ofl SHE OID NOT BUILD OR _ �IMPROVEPoFTHEPURPOSEOFS�LE). ' W ❑I,AS OWNEROF THE PROPERTY.AM EXCLUSNELY CONTRACTING WITH L'CENSE�CONTRACTORS � i0 CONSTRUCT THE PROJECT'�S�C,7a44,BUSINESS AND PflOFE5510N5 CODE:THE CONTRACTORS LI- V01U2tIOf1 ADJ.AREA W CENSELAW�OESNOTAPPLI'TOANON7JEROFApROPERTYWHOBUIL�SORIMPROVESTHEREON,AND � WHOGONTRACTSFORSUCHPROJ�CTSWITHACqNTflAC70R(5)LICENSEDPURSUANTTOTHECONTP,AG QUANTITY DESCRIPTION FEE - Y 'TORS LICENSE LAW,), ', � �I AM EXEMPT UN�ER SEC.�'�. B.9 P.Q FOR THIS flEA50N Q � U � OATE � OWNER� � Z -- U I O W � LICENSED CONTRACTORS DECLARATION -� ¢ W 2 IHEftEBYAFFIRMUNDEflPENALTYOFPERJURYiHATIAMLICENSE�UNDERPROVISIONSOFCHAPTER � � 9(COMMENCING WITH SECTION 7000)OF DIVISIDNS OFTHE BVSINES5 AND PROFESSIOM1'S CODE.ANP z W MY LICENSE IS IN FULL FORCEAND EFFECT. m � LICENSE CLA55 l'�A� �� LIC.NO. b�d J��p,�� � U DATE I CONTRACTOR ��F�f7 d W ! � WORKERS'COMPENSATION DECIARATION Q � 1HEREBYAFFIRMUNDERPENALTYOFPERJl1RYONEOFTHEFOLLOWINGDECLAFATIONS: Z � _,IHAVEAN�WILLMAINTAINACERiIFICATEOFCqNSENTiOSELF-I�'SUREFOqWORKEflS' a ¢ COMPENSAiION,AS PROV14ED BY SECTION 3loG Oi THE IABOR CODE,FOR THE PERFORMANCE `U � OFTHE WORK FOR WHICH.iHIS PERMIT I5155UE0. � QW �IHAVEANDWILLMAINTAIN�IORKERS'COMqE�SATbNiNSURANCE,ASREQUIREDBYSECTION 370oOFTHELABORCODE;FOftTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMIiIS ISSUED.MYWORKERS'COMPENSp,TIONINSURANCECARRiERAN�PoLIGYNUMBERARE: CONSTRUCTION � j c.4RpiER � ^'�" PLAN REVIEW z POLICVNUM6ER ,� EA�B '�'�.� ELECTRIC Q � 0 (I}iI55ECT10NNEmNOTBECUMPLEfEDOFiHE?ERMffISFORONEHUNDREDDOLIAFiS(S100jORL6&). PLUMBING .� � � ICERTIFYTHATINhiE�PERPLORMANCEDFTHEWORKFOFiWHICHiHISPEflMITI515511E0,1 MECHANICAL � SHALLNOTEMPLOYANYPErySON1NANYMANNER50A5706c'COMESUBJECTTOTHE rp WORKERS'COMPENSATION�AWSOFCALIFOFNIA,ANOAGPEETHATIFISHOULD6ECOME INSPECTIONFEE !"'s "�'i�*'e'*a.�-- � SUBJECTTOTHEWORKER5COMPENSATIONPROVISIONSDFSECTION37ooOFTHELABOR �'r=a-`-�, [ _� � CQ�E,I HALLF RTHWITH�OMPL,VWITHiNOSEPROVISIONS. ISSUANCE � � � DATE: - fS v' APP�LICANT � � 'i -�"'�""'"� SMIP I e � WARNING:FAILUflEYOSECUREWOf{�KERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGVP/C � �� � �' I _ �y SUBJECTANEMPLAVEPTOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUN�qE�iHOUSAN� ENERGYPERMIT ` ! DDLLARS(E100,000),IN AD�ITION'TO THE C�Si OF COMPENSATION,�AMAGES AS PROVIDEO FOR IN � ` � SECTION3]080FTHELA90RCODE,IINTEREST.AND',ATTOqNEV'SFEES. RETENTIONFEE: !� � OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: —� � � � � 0. I HEflEBYAFFIRM-UN�Efl PENALTV OF PERJVRY THAT THERE IS ACONSTRUGTION LENDMG AGENCY FOR THE PEflFORMANCE OFTHE WORIC FOR WHICH�THIS PEHMI7IS ISSUE��SEC.3cW,CIV.C.J. Z W � LENDER'S NAME , F— LENDER'SA�OflESS W ICERTIFYTHATIHAVEREADTHISAPbLICATiONAND5TAiETHATTHEABOVEMFORMATIONISCORREC7. TOTAL FEES � ��/ 0. IAGREETOCOMPLYWITHALLCINAr1DCOUNTYORDINANCE5ANO5TATELAWSRELATINGTOBUIL0ING 1�� � � CONSTRUCTION,ANDHEREBVAUTHOR2EFIEPRESENTAiIVESOFTHISCOUNTYTOENTEflUPOry7HE , Z pBOVEMENTIONEDPqOPERTYFORINSPECTIONPLIP�SEa". COMMENTS � � � �a. �y m �'!�^� ��'r� — ¢ PERMITTEENA.AE PRINT , ( ) � SIGN Tl1REOFPEqMITT2 ', , , p;qT ����— � . RECPT.NO. 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