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Home My WebLink About15155 (19)Crff OF DIAMOND BAR DEPARTMENT OF.COMMUNITY & DEVELOPMENT SERVICES --.--21660 LCojftDxiv&Su1w - (909)860-3195 FNtx (409)841-3117. -------- BUHMINGPERMITAPPLICA rinmor APPUCAM ESS --V,05114WQr APNICI#42- -"---0-'-f3rRAcT -fX4"-F1 NUMBER OWNER J UI ADD CITY APPLICANT T --&dA&Z CONST. CONTRACTOR ADDRESS ZONING SETBACKS CITY ZIP TEL ARCKIENG/ FRONT DESIGNER ADDRESS CITY ZIP TEL REAR 11 OWNER -BUILDER DECLARATION SIDE/SIDE STREET IHEREBY AFIFIRM UNDER PEN&TY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U ❑0 CENSE LAW FORTHIEFOULDWING REASON (SEC. 703111 BUSINESS AM PROFESSIONS CODIRANY C17YOR COUNTY V*§CH REQUIRESAPERMITTO CONSTRUCT ALTER. IMPROVE. DEMOUSK OR REAMANY STRL)C- SIDE TUAL PRIOR TOITS IGSUANOL ALSO REQUIRES THE APPLICANT FOR SUCHPERMIT TO PASA SIGNED STATEMENT THAT HE OR SHE IS LICENSED PUFMANT TO THE PROVISIONS OF THE CONTRACTORS U ---,Gas (OOMMRMMWTHS6CnOM?Q00)OFD1VISIOM3 OF THE SUSINESSAND PRO. Z:i AAT C-1 FESSIONIS OODE)CATHATHE OR SHE 0 EXEMPTTHEWROM NO THE BASIS FORTHEALLEGED E)MMPw TwKAmyvKxmmmcFaEcTioN=iAuyAmyAppurANT AoRAPEmw SUBJECTS THEAPPLrAwro ACIVAL PENALTY OF NOTMORE THAN FIVE HILINORPI)DOLLARS 050)),l: 13 LABOWNEROFTHE PROPERTY, OR MYEMPLOYEESWITHWAGESAS THEIR $OLE COK943MTMK WILL 00 THE WOOL AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEG 79K BUS NESS AND PROFESSIONS CODE- THE CONTRACTORS LICENSE LAW DOES MOTAPPLY TO AN OWNEROF -4fKWAWMF,OSUIDBDR&VW"JESTHEREDKANDWHGDOEBMC"DRKWAASE).F,DR HER&RFOR BEDROOMS THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFEr@PORSALE F.HDWMKTHEBULDMORWROVEMENTESMDWTDMONEYEAROFCOMFLE- FACTOR PSIF TOOK THEOWN-RWTHE BURDEN OF PROVING THAT HE OR SHE DID N" BU&n OR, IMORMFORTHE=0F SALE} SFRADDAEMI a LAS OWNEROFTHE PROPERIXAM EXCLUSIVMYCONTRAURNS MY14 LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SM 7041BUSINESS AND PROFESSIONS CODE.- THE CONTRACTORS U ca CENSE LAW DOES NOTAPPLY 110 AN OWNER OFAPROPERTY WHO BULDS OR IMPROVES THEREON. NO WHOOONTRACT51PORSUCHIPROJECTSWITHA PUFALMATTOTHECONTRAr- TOM LICENSE LAMI.), )(..ExEkWTUNDMSV- & F.C. FOR THIS REASON LLI MiE LICENSED CONTRACTORS DECLARATION. poovspa I HEAEBYAFFLTA LOOM PENALTY OF PERJURYTHAT I AM LICENSED UNDER PROVISIONS OF CHAPTER P (ODMMdNGYMG LATH BECTON 7000) OF DMBION 3 OF THE BUSINESS AND PROFESSKM COOL AND 111::: ISM UCBNSE IB N FULLFORCEAND EFFECT. Lwsmse aAss LIC. NO DATE CONTRACTOR WO.Rl� COMPENSATION DECLARATION R94W-- - I HEREBY AFFIRM UNDER PENALTY OFPERAJRV ONE OF THE FOLLOWING DECLARATION& CA ACEKrL9CATEDFCDMENTTOSELF4NSUFlr FOR WORKERS LC —IHIWEAMOWILLMAKTAIN COMPENIIATICKAS PROVIDED BY SECTION 3700 OF THE LABOR CODE. PORTHEPERPDRMANCE OFTHE WORK FOR WHICHTHIS PERMIT 0 HAVE AND WILLWINTAIN WDIWERS' COMPENSATION INSURANCE AS REQUIRED BY SECTION 370001THELABOROOOF IIWMIFOMANOI-.FT..IURMnl.PERhUTIS -5 ISSUE[IL MY WORKERS COMPENSATION MURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER MOSETIONNEIZ)NCIrKMWWMOFr*EPEFUTEFOR04EHJCRSDMUAF41CM"ORLEW LLJ z - I CERTIFY THAT LATHE PERFORMANCE OF THE WON FOR WHICH THIS PERMIT 18 ISSUED, I E2 SHALL NOT EMPLOYANY PERSON IN ANY MANNER SO AS TO BECOME SUEUrCT TO TNG WOFKERS COMPENSATION LAWS OF CALIF(WINUL AND AGREE THAT IF I SHOULD BECOME SLXLrcT TO THE (YOWLERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CQDE. I *I" FORTHWITH COMPLY WITH THOSE PROVISIONS. 0 QUANTITY DESCRIPTION DAM APFLKAW, . FAILURE TO SECURE MWERS' COMPENSATION COVERAGE IS UMLAWPUL AND SHALL BE 0ZX-CT AN EMPLOYER TO ORIMINN, PENALTIES AND CIVIL FINES UP TO ONE AWRED THOUSAND, DOLLARS (9109,010). IN ADDITION TO THE COST OF COMPU#SARON. DAMAGES AS PROVIDE) FOR IN SECTION Was OFTHE LABOR CODE INTERESTANDATTORNEY'S FEES. oJC CONSTRUCTION LENDING AGENCY I HEREBYAFFIAM UNDER PENALTY OF PERJURY THAT THERE IS AOONSTAUCTIOM LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. SM. CIV. CL). 63 LENDERS NAME LENDERS ADDRESS I CERTIFY THAT IH VE AM THIS APPLICATION AND STATE THAT THE ABOVE DFORMATION IS OORKC1, O. I AGREE To COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO MUM LU TOS CONSTRUCTION, AND HEREINREPRESENTATIVES OF S OoAdY To ENTER UPON THE ABOVE4AENTION P1E PURPOSE& E PFr fn E ONE wm I c--w4waninent vwy, T Q1iV— % W, 0 PRESS' - it A U11% rinmor APPUCAM PERm rF1C DATE NUMBER UE OCG DATE CONST. GROUP ZONING SETBACKS FRONT RW 0 REAR 11 SIDE/SIDE STREET RW ❑0 SIDE PROPOSED USE Z:i AAT C-1 NO. DWEL NO. No. UNITS' 'STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSIF ADJ. AREAIVALUATION SFRADDAEMI ca LLJ LLI ILL poovspa R94W-- - Commercial -5 Valuation 1i #IV ADJAREA QUANTITY DESCRIPTION FEE' U.1 LU n. CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE La ISSUANCE zw SMIP AN 2 3' 2000 sriiZ ENERGY PIC ENERGY PERL41T --CITY- OF DIAMOND --fAR RETENTION rEE:* BUILDING AND-SAn ME -ALT FEE -- TOTAL FEES I COMMENTS T REcp-r. No. 'I Lf' I -/— PAID BY I i ?J t J VALIDATION — \ \ /� \ \� \ � DIEM 11011m, +