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Home My WebLink About12073 (11) _„� CITY OF DIAMOND BAR '�%' � -��- DEPARTMENT OF COMMUNITY&DEVELOPMBNT SERVIC 'f� �w 21660 E.Copley Drive Suite 190 ,r,... (909)860-3195 Fax(909)861-31t7 • PRES$ ��'�"'. BUII,DING PERMTl'APPLICATION FIRMLY } JOBSITE APPLICATIo N PERMIT ,� /C < ADDRESS7✓ L �� v DATE NUMBER # $ ISSUE TYPE "`"' OCC APN LOT _ TR CT DATE_ CONST. GROUP p OWNER O "" ADDRESS 0 _� �r�2i, ZONING SETBACKS z C�N ZIP TEL. FRONT Ryy L___ g APPLICANT � TEL. REAR n__ � SIDE/SIDF STREET RW ❑ __ � CONTRACTOR 0 SIDE L p� ADDRESS w A w� ZI/a/��l'� TEL. � PROPOSEDUSE �b ppo SS �U',r•f `�—� .�rr��- z DESIGNER �1��'!' ��6(� r�- d ADDRESS NO.DWEL. NO, p, u� UNITS STORIES BEDROOMS N CITY ZIP TEL. - � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER•BUILDER DECLARA7ION SFR/ADD/flEM O Q I HEREBY AFFIRM UNDER PENALTY OF PER.IIJRV THAT I AM EXEAfPT FROM 7HE COMRqCiORS LI� � Garage/Carport W CENSELAWFOR7HEFOLIOWINGREASON(SEC.7037.SBUSINESSANDPROFESSION3CODE:ANYCITYOp C� COIHJTYM711CHREWIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,OEMOLISH,ORREPAIRANYS�RUC� W TURE,PRIOR TO iTS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCM PERMI770 FILEASIGNED W Patio/DeCk � STATEMEM THAT HE OR 3HE IS UCENSEO PUFSUAN7 TO 7HE PROVI510N5 OF 7HE COMRACTORS LI- CENSE LAW(CNNPTER 9(COMMENCINQ WITH 9ECTION 7oao)OF DIVISION 3 OF TME BUSINESSAND PFO� � POOUSP2 FESSpNSCODE)OR7HATHEORSHEISEXEMPTTHEREFROMANDTHE�ASISFORiHEALLEGEDEXEMP• �(� TION.ANVVIOLATIONOFSECTION7o31.5BYANVAPPLICANTFORAPERMITSU&IECTSTHFRPPLICAN7T0 Z Re-Roof � ACIVIIPENALTVOFNO7MORET}1ANFNEHUNDREDDOLLARS(ESoo�.): Z ❑I,ASOYrtiEHOFTHEPROPERTY,ORM7EMPLOYEESWIhIWAGESA5THEIRSOLECOMPENSATION. 0 Commercial �� N/ILL DO THE WOlUC,ANO THE STRUCTURE IS NOT INTENDEO Oq OFFERED FOR SA�[(SEC.704d,6U51� J � NESS NW PqOFE5510N5 OJDE:hIE CANTRACTORS LICENS[LAW DOES NOT APPLY TO AN OWNEfl OF � PROPERiY NRiO BUILDS OR IMPROVES TIIEREON,RND WHO OOES SUCH WOHK HIMSELF OH HLRSELf OR � THROUGHHISORHEHOWNEMPLOVEES,PROVIDEDTHATSUCHIMPHOVEMENTSARENOTINTENDEDOR m p OFFERFAWRSILLEIF,HOWEVER,7HEBUILDINGOflIMPROVEMEMISSOIDWITHINONEYEAROFCOMPIE- a TION,TF1E OWNEfl$UILDEP WILL HFVE 7HE BUHDEN OF PROVING THAT HE OR SME OID NOT BUII,D OR = IMPqOVE FORTHE PURPOSE OF SALE). ❑i,AS OVMER OF THE PROPER7V,AM EXCIUSIVELY CON7RACTNG WITH LICEN6ED CONT0.ACTORS � TO CONSTRUCTTHE PRQIECT(SEC.7asa,BUSINE55 AND PROFESSIIXJS CODE:THE CONfflACTORS LI� V2W2fi0t1_ ____�,_�'Y ADJ.AREA W CENSEUWOOESNO7APPLYTOANOWNEHUFAPROPERTVWHOBUILDSOfiIMPROVE57HEFEDN.ANO -- - --- ......... .. .. � WHOCONT0.4CTSFOHSUCHDHOJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECOMRRG pUANTITY DESCRIPTION FEE � TORS LICENSE LRW.�. ❑IAM EXEAIPT UNDER SEC. B.6 P.C.r'ORTHIS RFASON Q O� ---- V � _....---- ¢ oarE owNea _„_,,,._ _ V � LICENSED CONTRACTORS DECLARATION � � ;renesra=F;r�.��,;;aere^�e::trr cr aer.:unr;k��;.ra�;cetis,c ur:cea�;,cv�s�cws c�c�,�area �— i � 9(WMMENCIN(iWITHSECT10N70W)OFOIYISION30FTHEBU5INESSAN�PROFESSI�NSCADE,AND Z __ �?�� MY LICENSE IS IN FULL FORCEAND EFFEC7. m � LICENSE CLA 5� __UC.NO,��b�L � ��'j DATE _CONTRACTOR��,��{i'�� R�. W � WORKERS'COMPENSATION pECLARATION � � IHEREBYAFFIRMl1N�ERPENALTYOFPERJURYONEOFTHEFOLLOWING�ECIAflATIO:VS: Z 0 _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUFEFORWORKF.RS' z Q COMPENSATION,ASPROVIDEDBYSECTIONa7ooOFTHEU90FiCO�E,FORTHEPEfiFOPMANCF W Q OF THE WOFK FOR WHICH THIS PF.RMIT IS ISSUED. � QW i HAVE AND WILL MAIMAIN WORKEHS'WMPEN3ATION INSURANCE,AS RE�UIREU BY SECTIOY J � 9700 OFTHE LA60R CODE,FORTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715 ��r� a � ISSl/ED.MV WOP.KERS'COMPENSATION INSUfl�CARRIEH ANO POI.ICY NUM6ER ARE', CONSTRUCTION �.,/� a , _—_.__-- "—... : ,aj CARHIER._� �-� �U 7J PLANHEVIEW .------._......._._ -�---- , O ��"�`-------'---- � ;:. Z POLICY NUMBEfl._/_/!�2_p__ ELECTRIC __.,.._ ¢ � c�r-�,/ - —.._— ------ 0 (IHl55EGIpNNEFDNOTBECOMRETEDOF PER4Yi6PoFiIXJEMH�AFiED00I11JiSryt0�OR1.E55} PLUMBING _____ _ __ _ w i CEflTIFY THAT INTHE PERFORMANC[OF THE WORK FOR WNICH TNIS PEflMIT IS ISSUEO,I MECHANICAL �.. .."__"'_ _'___ .. ';� C!3 . SHALLNOiEMPLOYANYPEFi50NINANYM�NNERSOASTOBECO:/ESUBJECTTOTNE . i; � WORKERS'COMPENSATIONLAWSOFCALIF'L�RNIA,ANDAGflEETHATIFISHOULDBECOME INSPECTIONFEE . .� __......" '__—' __ "�� SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3lao OF THE UBOF7 'o' C�AD)E,I HALIFORTHWITHCOMPLYWITM OSEPROY I 5. ISSUANCE ______ �. -p DATE: Z5 APPLICANT.� _____'...__.._— SMIP '_'___—.__ "_1.. k�� : J� WARNING:FAILURL TO SECURE WORKEfl3'COMPENSA N CAV[RAGE IS UNaWFUL,ANU SHALL BE ENERGY P/C ,______,_._ __ �� SUBIECTANEMPLOYERTOCRIMINALPLNAL7IESANOCIVILFINFSUPTOONEHUNDilEDTf{OUSAND ENERGYPERMIT DOLUtRS(floo.000�,IN MDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION37080FTHELABORCODE,INTEflEST,ANOATTORNEY'SFEES. RETENTIONFEE: _. ___ � _ a CONSTRUCTION LENDING AGENCY PHE-ALT FEE: qR, � y � .Q '"n l�:� ��,�i i' _.., ..------�' --- I HEREOYAFFIHM UNOER PENALTV OF PERJURY THATTiERE IS A CONSTRUCTION LENDING AGENCV �'$• Y• }� � FbR THE PERFOPMANCE OF THE WORH FOR WHICH THIS PEflMIT IS ISSUED(SEC.9087,CIK C.J. ,,,..,�.,.,w . •� ' ---' Z t.. W --_ - � LENDER'SNAME '�F=- LEN�ERSAUORESS_....____._ __ � � ICEFTIFVTHATIHAVEREADTHI5APPUCATIONANDSTATETNATTHEABOVEINFORMpTpNISCORflEC7 TOTAL FEES �� IA4REETOCAMPLYWRHALLCRYANOCOUNTYOflDINANCESANDSTATELAWSREIATINGTOBUILDING � CONSTfiUCTION,ANDHEFEBYAUTMOHIZEHEPRES[NTr171VESOFT111SCOUNTYTOENiERUPON7HE .!_ Z A80VE•1AEMIONEDPROPERTYFOfl SPECTIONPl1RPO5E5. COMMENTS � � 0. � . _"_— " __ � . _ ____- m P N (p iQ�. 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