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tl CITY OF DIAMOND BAR � — ��'— DEPARTMENT OF COMMUNITY&DBVELOPMENT SERVICES �,� . 21660 E.Cop]ey Drive Suite 190 (909)860-3195 Fax(909)861-3117 P R ESS ''�M� BUILDING PERMIT APPI.ICATION FIR LY o� JOBSITE ^: ��� �� ��,.� ,� APPLICATION � t,r� PERMIT �' 1 P/C ADDRESS�=z^-J-[-�`L-11tc.f�/ t� �•• DATF NUMBER # � ° ISSUE� � TYpE OCC APN ,� L-OlT� TRACT_., DATE CONST. GROUP p OWNER „�,Z�1�-���]��---���r� o ADDRESS�� '� L� � , ZONING SETBACKS gCITY �� IP�(�TEL. � FRONT __ RW C 1 APPLICAN7_.__ TEL._,_ REAR �-j � --- SIDE/SIDESTREET___ RW [� _ CONTRACTOR � � :Er SIDE n__ 1 ADDRESS Cs � �CJ' /" — ` O C�Ty if�, Z�P ' ,-1fE� _ PROPOSED USE__^ w ARCW�7i i � DESIGNER_ � - NO.DWEL. NO. NO. a. ADDRESS us - UNITS STORIES__ _BE�ROOMS � CITY ZIP„ TEL. �2 DESCRIpTION SQ.FT. FACTOR PSF AOJ.AREANALUATION p� OVJNER-BU7LDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDLR PFN/ILTY OF PEflJUHV THAT 1 AM EXEMpT FqOM 7HE CONTRACTORS 11� G3fe9e/C9�pofi CENSELAWFORTHEFOILOWINGREASON�SEGlo3tSBU51NE5SpNDPHOFESSI04SCO0E:ANYCITYOfl (J� �3. 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T1iAIX7OHHI50RHEflOWNEMPLOYEES,VROVIDEDTHRTSUp11MPROVEIAENTSANENOTIMEN�EDpq m Q ,OFFEflE0FOR5ALE.IF,HOWEVER711EBUILDINGORIMPROVEMEN'IISSOLDWITHINONEYEARO�WMPLE � Z TION,THE OWNER�UIL�ER WILL HAVETN'e 9VRDEN OF PqOVING THAT HE Oq SNE DID NOT DUILD Oq --- � IMPROV:PJP THE PUflFOSC OF&ALEI. w ❑I,ASOYMEROFTNEPFlOPERTY,AME%CLUSIVELYCANTflACTINu'YtIT}ILICFKSEDWMFACTOR$ � TO CONSTpUCi fHE PROJECT�SEC.7044,PUSINE55 AND PROFESSIONS CO�P,THE GONiRACTORs U� VBWeCIOfl _ADJ.AREA � GBd3ElAW�OE3NOTAPPLYTOANOWNEflOFAPROPEqTVWMOBUII.OSORIMPRqVESTNEREON,AN� --. '--"-'"-- --------- — '.NMOCONTRAC7'SFORSUCHPROJECT6WITHACONTRACTOR(5)UCENSEDPURSUANi'TOTHECONTliA4 QUANTITY �ESCRIPTION TORSI.ICEN9ElA%). FEE O ❑IAME%FMPTUNOERSEL.__.,_„_,__,.___„_,�_,__B.RP,C.FDHTNISqEASON Q 7„ U � —���-O - - - --- ---�---- U �4 LICENSED CONTRACT RS DECIARATION~ ' w OC IHEREBYAfFIpA111NDEitPENA17YOFPEJUURYTiAT1AMLIC[.NSEOUND[RFROVISIONSVFCHA�TER � -- � 9(GVMMENCINGWITH6ECTiOli70W�OFD:VI$IONJOFTHf��USME55ANDPHOF';SaONSCO�E.ANO � ___ W IICCNSE LS IN fUL�FC�GEAAD EFFELT L m d� LICENSE CLA.55,(�+�0 ,_�,.LIC.hG,yJ'�U�.�`�._.__ _ j � � UATE^..,_ '� J �. „_...._CONTRACTOR_..�1��_�___..�.___ n- - � WOAICEAS'COMPENSA710N DECLAHATIUN �� � I HEqEBYAFfIRM UNUEfl PENALTY OF PFNURY ONE OF TNc'WLIOWWF OECLpRRTIONS�. � � _.IHkVEi,NDWILLMAI�'TAiNACEf1TIFICATE�FC(:;15ENTT09ELFdN9UHEFOFWORKeRS' _ _� � "�a- COAIPGNSAfp,y,A5 Pe^,JViI�E�8Y SECTION 3f�0(]F THE tA80R CODF,FOR TI-{E P:PfORMANCE W�__ OFTHf'WORK FOR WNIGN TH;S PE'HMIY IS!SSV[D. nW 2� -- — _,.1 HAVE AND WILI.MAIMAIN WORKENS'CAMPENS�TION INS�IRANCE.AS flE�UIPED BV StCTICN 3iW OFTM(l.eBiJq C0.�f,J OR 7H1:PEi1FqpMAhCE OF 1 kie WOHK FOR WHICH THIB PERMIT 15 ISSUED.ASYWOAKC:RS'CqMPENSAiiON;NSURANCELAliR1ERMl�POI.ICY1:l1MBEflA�E: CONSTRUCTION ,.__'_____—__'-__"__'__'___._..___..� � CARNIEfl,..___'__'__'__......�._.'__'_'._.�..._.._.._.. PLANREVIEW _...—__—'_'_'________'_._.__—_'_"_"__ � ax:cvNuuo[a_..----,-------------._._.�....�...—....�__- ELECTRIC � � ----- --.._—..—_..—..—._---'-�—�--- d . � (tH4SSECtI0N4Cl'�N]7nE[CYreLE1FDo:7:,Eltiw.rTlSiaHOtJE1A4+DqEUIXtINi�(S�oo)Oq4Ess� Pf.UMBING __________,.^__— � Z I CFRTIFV THAT IN?HE PERFUnMANCE OF 7HE WORK FOR WHICH THIS PEiiM!l'IS ISSUED,I MECHANICAL __,____________ _ __��� (;} SH�LLNOiEidPLOYFNYVEfI50NiNANYMANNERSOA5T09EWM.i5U0lF.C7T0(IIE � �— � WOqKcfiS'f,OMFENSATIUNUWSGFCAi�FDRNIqANOA(;REE7NAiIF�SHpIJip�3ECOME �NSPEGTIONFEE ___`_____.,___ \ ? SUf3JECTiOn�EYVORXEFS'C(MiPFNSn'fION:kOVu"IONSUFSECTION37000FTMGlh80R �� }/ � CODE,I SHALL FORIHWI7'H COMVLY WITH TFiOSE PROVISIDN3. ISSUANCE 4..1' � SMIP ��..�����--�� —'------- p DATE:,�_'.___ APPLICANT._.___'_____'—'._..—'_'_'_—_.— —_--'--_. ._.,_—__—__ � WARNING:FAILUflETOSELUREWOflKFRS'COMPENSATIONWYERAGE!SUNLAWFUL,ANDSHALLBE ENERGYP/C LL, SV&IECTANCMPLOYEqTOCRIMINALPENAI.T1[SANDCIVILfINESUPTOOYEMUN[1REDTHOlISAYD ENERGYPERMIT _���� ' OOLLAR^o(f100.oao�.IN.M0ITIONTOTHECOSTOFCOMPENSATION,�AMA(,FSASPROVI�GDFORIN ��� ' ¢ SECiION 3106 Of THELABVR CODE,MTERF.ST.ANO ATTORNEY'S FEES. RETENTION FEE: _____„__ OCONSTRUCTION LENDING AGF.NCY PRE-ALT FEE: BY._ __ __ __ _ ,_ ~ � IHEREBVAFFIRM4NDEfIPENAL7YWPERJUpYTHATTNEHFISAlYlN5T1iI.ICTIONLEN01.VGnG6NCY ____ _______J_______ _ FOii THE PERFORMANCE OF THE WUFK FOfl WHICkI IHIS P[HMIi IS ISSUED(SEC.3n�7,CIV.CJ. --- Z W _._.—.___—_.--'_'—__'._'—'— . � LENDER'SNAMI_..__._'__"'_""_"'_--"___'__ F- LENOffi'SADDAESS__.__'__'_'__ __"___""____ "__— _'__"__________ "' __. W� �� TOTAL FEES ICERTIFViHATIHAV[REAOTIIISAPPLICATIONANDSTATETHATTHEA�OVEMFORMATIONISCORREGT. d IA(3REkTOGOMPIYWRHA4lCRYpNDCOVNTYOROINANCFSANDSTATF.lAWSRRATI.YGTOBUILAING . � CONSTHIICTION,AN�H&HEBYAUTHORREREPRESEN7ATIVESOF'fHISCWN7YTOENTFfll1WN1'HE ABOVE�MENTIONFO PflOPGflTY FOH INSPECTION PUIiPO&E5. GOMMENTS J ' _`-. "_—�'_'__'___,___� � .��,�__�_P.:SS��--L------- -- m PERIAI EENNSEI�PWT ---�"------_—'_—'—_` _—_-- a �.,�...� -—-- --��� �-- — — �, - - -���-n-- ----�- --- �t�_--�'��- - -�_- (n O PEflAII [E DATE = RECPT.NO. PAI�BY VALIDATION_.. ~ WHITE—Department Copy,YEILOW—Finance Copy,PINK—Assessor Copy,GOIDENROD--File Copy.GREEN—ApplicanYs Copy ; _ e. - , , �.. - , . _..�_.... , , , ., � �t ._....._ .....�...; ....._,_ ' ._ ,_._...t .,; ' .. _ .i # � r � " i �4 � T ';'i i ; � { �i " _ ' y ' �j 1 P � � �l � I �I �' . �_ � f ' i ` � , n, '' ry �, , . �i � � . i .. I E I 7,' �� 4 I ,�I ��' �k i� 'j _ _ 1 � _.1 f �', . i t .. ..n . 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