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--1__ -- ___-- = CITY OF DIAMOND BAR � ----��""-- DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES I �:: � 21825 E.Copley I3rive (909)�60-3195 F�(9G9)861-3117 PRESS ""'%�����' BUILDINGPERMITAPPLICATION FIRMLY � JOBSITE ' � APPLICATION �„ PERMIT P/C o ADDRESS� DATE � NUMBER�� f # o� ISSUE TYPE OCC � APN LOT ' TRACT DATE CONST. GROUP p OWNER " ADD�--3���� ZONING SETBACKS 0 Z C��, r � E � FRONT RW ❑ � APPLICANT � TEL, .- � REAR ❑� � SIDE/SIDE STREET RW � � CONTRACTO � '"� SIDE ❑ � ADDRESS p PROPOSED USE .Br CITY ZI TEL. � �K s.,.�,�/ o ARCH/ENG! �, ���`"�' z DESIGNER NO.DWEL. , O. NO. �� = CT RESS , Z�P TEL. UNITS STORIES BEDROOMS '�-�" ,� � c� DESCRIPTION SQ.FT. FACTdR PSF ADJ.AREANALUATION p� OINNER-BUILDER DECLARA7iON SFR/ADD/REM - O I HEREBY AFFIRM UNDER PE ALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTOAS LI- G21dA@/CdfpOh W CENSELAWFORTHEFOLLOWWG EASON(SEC.70.91.56USINESSANOPPOFESSIONSCO�E:ANYCITYOR (n U COUNTYWHICHfiEOUIRESAPERM TOCONSTRUCT,ALTER,IMPROVE,�EMOLISH,ORREPAIRANYSTR'JG W PatiO/�ECk TURE.PRIOR TO ITS ISSUANCE,ALSD REQUIRES THE APPLICAM FOR SUCH PERMIi TO FILE A SIGNED W STATEMENT THAT HE OR SHE IS LYCENSED PURSUAN7 TO THE PROVISIONS OF THE CONTRACTORS LI- W � CENSE L4W(CHAFTER 9(COMMEf�CING WITH SECTION 7o0oJ OF DIVISION 3 OF THE BUSINESS AND PRO- LL POOUSpB ' FESSIONSCODE�ORTHATHEOR�SHEISEXEMPTTHEREFROMANDTHEBASISFORiHEALLEGEDEXEMP- � TION.ANYVIOIATIONOFSECTION 031.5BYANYAPPLICANTFORAPERMITSUBJECiSTFiEAPPLICANTTO Z Re-Roof ',. ACIYIL PENA47Y OF NOT MORE TH�N FNE HUN�REO OOLLARS(5500).): o ❑I,ASOWNEROFTHEPROPEFTY,ORMYEMPLDYEESWITH4NAGESPSiHEIR50LECOMPENSATIDN, � Commercial -� Z ��� WILL�O THE WORK.ANO THE S7FiUCTUPE IS NOT INTEN�E�OR OFFERED FOR SALE(SECJo44,BUSI- J � NESS AN�PROFESSIONS CODE:TfiE CONiRACTORS LICENSE LAW DOES NOTAPPLV 70 AN OWNER OF PROPERTYWHOBUILDSORIMPpC'�VESTHEPEON,ANDWHODOESSL'CHWORKHIMSELFORHERSELFOR � � THFlOUGHHISORHEROWNEMPLOVEES',PROVIOEDTHATSUCHIMPROVEMENiSARENOTINiENDE00R m QOFFEREDFORSALE.IF,HOWEVEP,'(HEBUILDINGOflIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE- z. TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PFOVING THAT HE OR SHE DI�NOT eU1LD OR , � . IMPROVEFORTHEWRPOSEOFSYILE). w ❑I,AS OWNEROFTHE PROP�RN,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS � TO CONSTRUCTTHE PfiOJECT($HC.7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- ValUation AOJ.AREA � CENSELAWOOESNOTAPPLVTO'q�NOWNEFOFAPROPERTVWH09111LDSORIMPROVESTHEREON.AN� , .WHOCONTRACTSFORSUCHPROJ�CTSWRHACONTPACTOR(5)LICENSEDPURSUAMTOTHECONTRAC- QUANTITY DESCRIPTION FEE � , iORS LICENSE LAW.). �'i � ❑1 AM EkEMPT UNDEF SEC.��, 8.6 P,G.FOR THIS REASON Q � U LL �I � DATE OWNER U � I W � LICEN9ED CONTRACTORS DECLARATION W � IHEREBYAFFIRMUNDERPENALTI�OFPERJUflYTHATIAMLICENSEDUNOERPROVISIONSOFCHAPTER � � � 9(COMMENCING WITH SECTIIXJ 7000)OF DIYISION 30F THE BUSINESSAN�PR�FESSIONS CODE,AND Z `X. MY LICENSE IS IN FULL FORCEAN EFFECT. ��„ m � LIGENSE CLASS ��n LIC.NO. � ~ DATE��`����[/�,� � GONT CTO � I a W - Z J � WOfiK�RS'COMPENSATION DECLARATION a � tp U � IHEREBVAFFIRMUNDERPEI�AL OFPERJUPYONEOFTHEWLLOWING�ECLARATIIXJS: Z �,Z _IHAVEANDWILLMAINiAI ACERTIFICAiEOFCONSENTTOSELF-INSUREFORWOFKERS' _ � COMPENSATION,AS PfiO�DED BYSECTION 37000FTHE LABOR CODE,FOR THE PERFORMANCE �U OF THE WORK FOR WHICk{THIS PERMIT IS ISSUED. � � I W _IHAVEAN�WILIMAINiAI WORKEflS'COMPENSATIONINSURANCE,ASREQUIREDBVSECTION ;Q 3�aoOFTHELABORCOD�,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS 'C>� �� ISSl1ED.MVWORKERS'C EN IONINSURANCECARRIERAN�P�LICVNlJM6ERAPE CONSTRUCTION V J �„¢y cqqRiEa PLAN REVIEW �� POLICV NUMBER ,Z ELECTRIC Q � (�HISSECiIONNEmN0T6 OJMPLEfEDOFhiEPERMITISFORIXJEHUNDRED00LL1R5(Si0010RLESS). PLUM8ING Z ICERTIFVTHATINTHEpE�1FORMANCEOFTHEWORKFORWHICHTHISPEflMITISISSUED,I MECHANICAL (,'} SHpLLNOTEMPLOYANN ERSONINANYMANNERSOASTOBECOMESUBJECTTOTHE (Jj WORKEftS'COMPENSATIaNLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULOBECOME INSPECTIONFEE SUBJECT TO THE WORKERIS�'COMPENSATION PROVUIONS OF SEC710N 370o OF THE LABOP � CO�E,I SHALL FORTHW�Try COMPLV WIiHTHOSE PROVISION ISSUANCE t �� p DATE: ���APPLICANT: � SMIP ��� J WARNING: AILURETOSECURE�RKERS'COMPENSATIONCOVERAGEISUNLAWFUL,AN�SHALLBE ENERGYP/C iy SUBJECTANEMPLOYEflTOCRIMIi ALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(5700.000),IN A�DITION TO THE COST DF COMPENSATION.DAMAGES AS PROVI�E�FOR IN � SECTION3]OBOFTHELABORCOOE,INTEREST,AN�ATTORNEY'SFEES. flETENTIONFEE: d CO�STRUCTION LENDING AGENCY PREALT FEE: O � IHERE6VAFFIRMUNDERPENALT OFPERJURVT:-IATTHEREISACONSTRUCTIONLENDINGAGENCV FOR THE PERFORMANCE OF THE ORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.309],CN.C.�. . W I S LENDERB hAME � � � I— LENDERSA��FESS � � I CERTIFV THAT I HAVE REA�THISIAPPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECL TOTAL FEES ' � � I AGREE TO COMPLV WITH ALL CI AN�COUNTY ORDINANCESAND STATE LAWS PELATING TO BUILOING - � CONSTRUCTION,ANDMEHEBYA�HOflIZEREPRESENTATIVE50FTHISCOUNTVTOENTERUPONTHE Z ABOVE-MENTIONEDPROPERTYF�aiNSP cTioNauaPoses. COMMENTS - � I � m� PERMI'fTEE NAME(PRIN � �� Vj SIGNANREOFP TTEE , D iE _ ' RECPT.NO. 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