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,�--�'`,�� CTI'Y OF DIAMOND BAR — �`'-- DEPARTMENT QF COMMUNITY&DEVELOPMENT SERVICES I I �. T� 21825 E.Copley Drive (909)8643195 Eax(909)861-311'7 PRESS '"'-va�� ' BUILDIloTG PERMIT AFPLICATION FIRMLY � JOBSITE � �°- - I � � APPLICATION ����. � MIT �7,�" P/C o ADDRESS�� �� `a ��� � ���'� �� `�C°�'� DATE � NUMBER�/d�� # � ISSUE TYPE OCC � APN ' LOT TRACT DATE CONST, GROUP p OWNE����C>3���}- ��Q " ADDR�SyS,�� ��� �'~ ���'s� �/�'��T �� ZONING SETSACKS gCITY �./(�t��c�+-- tl�t 1rZIF�G�� TEL�II°�'J�S�+G' FRONT RW ❑ APPLICANT °�S �+l"� TEL. " REAR ❑ SIDE/SIDE STREET RW p m CONTRACTO, �R @..^ �^ G��-n'ry °cn Y SIDE ❑ a ADDRESS '"'� �p ��-�, Z�P ��}- PROPOSED USE � �- oARCH/E ! � �"' iz ,DESIGNER NO.DWEL. NO. NO. a ADDRESS _, CITY ZIP TEL. UNITS STORIES BEDROOMS � u� DESCRIPTION SQ.FT. FACTaR PSF ADJ.AREANALUATION �p� � � OWNER-BUILDER DECLARATION SFWADD/REM O ' ''p�. � I HEREBY.AFFIRM UN�ER'PEMALTY OF PERJURY THAT i AM EXEMPT FFOM THE CO4TRACTORS LI- Gdl'e JB/C2fPOR 'W"� �GENSELAWFORTHEFOLLOWING'REASON(SEC.�ai1.58USINESSANDPROFES510N5CO0E:ANYCITYOR (n �,C)�' '�COUNTYKRIICHREC7UIRESAPERMITiOCONSTRUCT,AITER,IMPFOVE,OEMOLISH,ORREPAIRANYSTRUG � . W"� �;�TURE,PpIOR TO ITS ISSUANCE,ALSO FiE�U1RES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNE� W Patio/DeCk •�STATEMENT THAT HE'OR SHE I5.LICENSEO PI�RSUANT TO THE PPOVISIONS OF THE CONTRACTORS LI- ,'�.� �,CENSEI.AW(CHAPTEF9(COMMENCINGWITHSECTION7000)OFDIVISION30FTHE6USINESSAN�PfiO- � POOUSPB ,,,0 '�.FESSIONSCADE�',ORTHATHEOFiSHEIScXEMPTTHEREFROMANOTHEBASISFORTHEALLEGEDEXEMP- �� . �U ',;'TION.ANYVIOLAT,IONOFSECTION7o31.58YANYAPPLICANiFORAPEflMITSUBJEC75THEAPPLICANTTO Z Re-Roof �,�� 'AqYILPENALiYOFNOTMORETHANFIVEHUNDREDDOLLARS(E50o).): „Z i, .❑I,ASOYlNEROFhiEPROpERTY,OFIMYEMPLOYEESWITHWAGE5A5THEIR50LECOMPENSATION, �� COmrt10�Cldi - ,�WILL�O THE�WORK,ANO THE STRUCTURE IS NOT INTENOED OR OFPERE�FOR SALE(SEC.7044,BU51- �J �^N", �I�.NE55 AND PROFESSIONS CODE:�TNE CONTRACTORS LICENSE LAW�OES NOT APPLY TO AN O'NNEF OF = - '�,ppOPERTYWH08111L0$ORIMP(I(7UESTHEREON,AN�WHO�OESSl1CHWORKHIMSELFORHEPSE�FOR ,'CG '�;.TNROUGHHIS'ORHE0.0WNEMPLqYEES,PRDVIDEDTHATSUCHIMPROVEMENTSARENOiINTENDEDOfl 'm '�,'�Q, 'OFFEREDFORSALE.IF,HOWEVEF3,THEBUIL�INGORIMPROVEMENiI550LDWITHINONEYEAFOFCOMPLE- �TION THE OWNER�BUILDER WI�.L HAVE THE BURbEN OF PROVING THAT HE OR SHE�I�NOi 6UILD OR ��,',�. ��.IMPROVEFORTH�PLIRPOSEOF'�.SALE). .�I,ASCIWNEROFTHEPHOPERTY,AMEXCLUSIVELYCONTRAC7INGW;THLICENSEDCONTRACTORS �,I��. 70 bONSTRUCT THE PROJECT:(SEC.�D44,BUSINESS AND PROFESSIONS CODE:THE COYTRACTORS LI- Valuatlon ADJ.AREA �W I.CENSELAWDOESNOTAPPLYTOANDWNEROFAPROPERTVWHOBUIL�SORIMPROVESTHEREON,AN� �_. I�.WHO CONTRqCT$�'FOR SUCH PFOJECTS W ITH ACtlNTRACTOR(5)LICENSED PURSUANiTOTHE CONTRAC- '� !'rods�uceNs��nw.�. � � QUANTITY DESCRIPTION FEE Y, , ��� ' � ❑IAM�E%Etv1PTUN�ERSE,C. ' B.&P.GFORTHISREASON J �,0 '� . . . �Q � U ..u... ��. �� ' DATE ' OWNER U , � W �,�����, LICENSED CONTRACTORS DECLARATION �W Q '� '".i IHEREBYAFFI(iMUNDEflPENALTYOFPERIURYTHATIAMUCENSEDUNDERPflOVISION50FCMAPTER ��� ;.,p„� 9(GOMMENqNGWITHSECTIpN7aoojOF�IVISION30FTHE8U51NE55AN�PROFE5510N5CODE,AN� Z �X MYLICEN$EISINFUCLF(gy•1 CEAN� fF T. � �� ��� m .� LICENSEGLAS � „""'��� L ��,� � IJ .� DATE T 'a. W . .� -� WORKERS'COMPENSATION DECLARATION Q ^� �M ��,'� IHEREBYAFFIRMUNDERPENALTVOFPERIUFVONEOFTHEFOLLOWINGOECLAqATIONS: �Z ���'., _IHAVE'.ANDWILLMAIN7AINACERTIFICATEOFCONSENiTOSELF-INSUREFOFWORKEflS' ¢ ¢ '. 2 COMPENSATION,AS PPCVIDED 9Y SECTION 37ooOF iHE LABOR CODE.FOR THE PERFORMANCE U Q �. OF TH€WORK FOP WHICH THIS PEFMIi LS ISSUED_ �.� � '. _IHAVEANDWILIMAINFAINWORKERS'COMPENSATIONINSURANCE,ASREQUIREDBYSECTION Q �� 37o00FTHELABORCODE,'FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS - � ISSUED.MYWOq��ycFAS'COM NSATIONINSU_RAPN,C CARFIERAN LICYNIIMa�aaae CONSTRUCT�ON 'j, ��,'� caaaiEa� �o:A�'�'� ��y _ PLAN REVIEW �.�,Z '; rouCv NurnaE� , ELECTRIC ¢ .�.p �., (iHIS5ECT10NNEED60TBECOMPLETEDOFTHEPERMTISFORONEHUNDRED�OLLARSIS7W)ORLESS). PLUMBING �Z "' I CERTIFYTHAT IN TH6 PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL _ '�� '�� 5HALLNDTEMPLbYANY�FERSONINANYMANNERSOASTOBECOtAESI1BJECTTOTHE .-.,,_.. � [n i WORKERS'COMPENSAT�OMLAWSOFCALIFORN�A,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE ��i:""" � ', SUBJ�CT $'COMPENSATIONAROVISIONSOFSECTION37000FTHELABOR ��!- ' � a '"'�r f � TOTHE WORKER �'� �� � . CO� I SHqLk F�TNWITH COMPLY WITH THOSE PROVISIONS. �SSUANCE - ey {� O � DA7E: 4�� APPf:ICANT. SMIP ..'S�9"� SP �, f��G t R�� t W WARNINGFqILURETOSECUReWtlRKERS'COMPENSATIONCOVERAGEISUNLAWFUL,AN�SHALLBE �ENERGYP/C 4gg`��Y � � , SUBJECTAN�MPIOYERT�CRIMINA4PENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND FNERGYPERMIT �� ),INpdDI�71�ONYPTHECOSTOFCOMPEN5AT10N,DAM0.GE5A5PPOVI0E0FORIN J . SEOCTIORN�➢O80FhTHELABOR�Cjp€,INTEftE57,ANDATTORNEV'SFEES. '2��'+� __..--� RETENTION FEE: r;��_Y __ - �- ....:�. .... ��;d� �. C�pNSTRUCTION LEN�lNG AGENCY PRE-ALT FEE: �� ,'�,�', I HEREBV AfFIRM 11NDER PENi�LTV'',OF PEFJURV THAT THERE IS ACONSTRUCTIDN LENDING AGENCY FOR7HE PERFORMANCE,OF?HE WO{iK FOFi WHICH iHIS 7ERMIT IS ISSUED(SEC.309],CIV.G). , Z' 11J '. �.I�,�'�,�� LENDEii'SNAME . � . �.�';F-'' LENDER'SAPOflE55 �� TOTAL FEES (��!°��'� �' ICERTIFViHAiIMAVEAEADTHIS/IPPIICATIONANDSTATETHATTHEABOVEWFORMATIONISCDRRECT. 'W '. IAGREETOCOIJPLYWITHALLCRYANDCOUNTYORDINANCESANDSTATELAWSRELA7INGTOBUILDING '� �. CONSTLIUC,TION;ANDHEflEBYAUTHORIZEREPRESENTATIVE50FTHISCOUNTY70ENTERUPONTHE � I ABOVE-MENiIONED PflOAERTY FOR INSPECTION PURPOSES. '�^— � � q p�� COMMENTS � '�� !'�-'/T� � IiJ' � �� � P I T ENFN�'.IPRI ) 4 ^6, �'".; �''!�'', -5 NATUREb P, ,MIttEE� DATE RECPT.NO. PAID BY � � � VALIDATION �' �� WHITE—Depadment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applica�t's Copy �';> � . .. . �� s���� .. . . .._. €;�"��'.,;.,6.? � � ; .. . . .�.. ., '.�: �, ...r.'t., . �,., '� i �"'S�'e" ,��7 4 � ;• ,� a �� x s a -� x � - ¥ q � - � '� � r � e ^-� �u# � ��' � �� a s � I �€ � d 7 4 '� � �P R� » � s . g ., ' � �� � � � ., ;^ a I '�u� a P� .S. �..s.a.��.�. :.,.,�..^'��.",�;,�n.n..��'..::, . � r.�.�.� , �:, .:.. ��, x .; # � � �. � �h. � k�y X.b � s .. a"�'..n�" � � _�,s��� ��� x �.�'4 a > ".�,.;�1 f nxi.. .�����i'i F ``a I � �. a §`' "'' � € w i c ,� q t r•, ��� � �. 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