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Home My WebLink About10816 �1 ----�('�`� -- CITY OF DiAMOND BAR -'1 I ��( � COMMUNI'1'Y DEVEL.OPM�NT DEPARTMrNT /r 21660 E.Coplcy Drive Suite 190 �' !'� � PRESS .- (9U9)860-3195 Fax(909)861-3117 � `'"^' I3UILllING PERMIT APPI.icArioN �--' , FIRMLY N JOBSITE 'j 7 ,� /� j APPLICATION f. PERMIT P/C �¢�' ADDRESS 9��.�_�Q:�- �'�U 7� .S��F��"-� �✓� �r �v•� _ I� NUMBER � I #-- � DATE__ o ISSUE TYPE OCC 'r° APN LOTT_ TRACT �V,�� _ DATE_,._ CONST. GROUP p OWNER l� I[=�P�/�'f, 7-5;i__��.f=J J _ LL " 3 � •,a r f � ( ZONING SETBACKS ADDRESS ;�. �,,. l:r' , �,,.k� f".,'c�"-.0 �'�e� (r f-:. �fSf� c.. oCITY��'1�(h0�.� �:rf�rLZIP .I�t�:: TEL.f_�1,�--�_6_�w� FRONT -- —� RW �-----.--= APPLICANT TEL. REAR CJ � — — SIDEJSIDE STREET ,_____ RW I�._._____,._ ¢ CON7RACTOR �,�� • ` S1DE ❑ ,__ p� ADDRESS_ _ ---- ,: pROPOSED USE f'� �-��f,) -- o' CITY -- — ZIP TEL.__ �-�-�� p�. •r��— ...- wo ARCH/ENG/ - - �z, DESIGNER__ NO.DWEL. NO. NO. 'a'• ADDRESS _ — = UNITS__ STORIES BEDROOMS__ �_ CITY, -- ZIP TEL.-- �� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O" OWNER-BI;ILDER DECLARATION SFR/ADD/FiEM .p I HEliCBY AFFIRM UNDEH PENALTY OF PERJUItY ThIAT I AM EXEMPT FROM THE CONTRACTORS LI� Gefe J@/CBf�JOf� W CF.NS[;LAWFORTkIEFOLLOWINGREASON(S[f..70315BUbINE55ANDAROFC-S.SIONSCODE�,�NVCITYOR _(/� U COUNTVWHICHRE�UIHESAVFPMITTOCANSTRLICT,ALTEF.IMVIIOVE.�EMOLISH,OFREPAIRANYSTPUC- •W Patio/Deck Z TUHE,PRIOFi TO IT�ISSUANCE.ALSO NEOUIRES TH[M�LICANT FOF SUCH PERMIT TO FILE A SIGNED 'W �� STATEMENT THAT HE OR SH6 IS LICENSED PURSUANT TO THE Pf10V151ON5 OF THF COYTqACTORS Lb �, CENSELAW�CHAPTEH9(COMMENCINGWITHSECTION]Oon)OFpIVI510N3OFTHEBUSINESSAN�PRO� {LL PDDVSp2 -FF.SSIONSCOOE)ORTHATHEORSHEISfX[ldPTT11EREFftOMANDTFiEBASISfORTFIf.ALLEGEUEXEMP� .(!f � TION.ANVVIOLATIqNOfSFCTinN�n3159YANYAPPLICANTFOFiAVeR411TS115.IFCTSTHEAPPL{C0.NTT0 z Re-Roof ��', r ACIVILGENNLTYOFNO(MORETHANFIVEHUNUHED�DLlAHS(SSJO)J, � f.11,ASOWVEflOfTHEPROPER�Y,OHMVEMPLOVEESWITHWACESA,?HE�RSOLECOMPENSATION, '❑ Commercial � WILL(X7 TNE WOHK,ANn THE STRUCTURE IS NOT INT[NOEU Ofi OFFERE�FOR SALE(SEC]0:4.f3U51- J NE55 Ati0 PROFESSIOIvS CO�[:THE C/JNTRArTORS LICENSE LAW 00£5 NOT ApP1Y TO M:OWNER OF � PAOPERTYVlNOBUIlO50NIMPROVF.STHEREON,ANDYVHUUOfSSIICHWORKHIMSELFORHERSELFOR � � [C THROUGHHISOHHEROWNEMPI.OVEES,PROVNEDTH�75UGHIMPROVEMENTSARENOfINTCND[OOH m W OFFERcDFORSALEIFhIOWEVER,THEBUR0INCORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- 0 TION,TH[OWNLIi�Bl11L�ER WILL HAVE SHE BUfl�EPS OF PFlOWNG THAT Ne OR SHE DfD NOT Bllll�OR Z R.IPHOVEfORTHEPURPOa'EOFSALF). _ ;�I,ASOWNEPOfTHEPHOVFRTV,AMEXCLUSIVELVCO\TRACTINGWITIILIC[NSEUCONTPACTORS � TO CONS�RUCT THE PROJECT(SEC.7044,9l1SIYESS AND PIIOFESSIONS CODE.THE CONTRACTORS LI- VellJafl�fl A�,I.AREh W CENSEf.AW�OESNOTAPPIYTOAhOV1NtiHOFAPROPEATYWHOBUILDSORiMPRWFSTHEREON.AND � WHOCOMf7ACTSFURSUCHGHOJECTSWITHACONTRACTOf1(S)LICENSEDPUP.SUAN770THECONTRAC- QUANTITY DESCRIPTION FEE Y .TOHS LICENSF,lqYl J. � J IJ I AM EXEMPT UNOER SEC 8.g P.C.fOR THIS REASON _ Q � _.-___ _ y ( - . .._.--------,. U LL' DATE J__' ' �� 06.NER .'r1.�k=._�.i-'=�r. U',;,{l i"I�. .� Z �'%-,."--.=::.`��-.�-- ::.� "=� U w � LICENSED CONTRACTORS D[CLARATION �j � II{�Fl[HYAFFiHMUNDERPENALTVOFPERJURVTHATIFMLIG[NSF.DUNUEFiPFOVI510NSOFCHAPTER � � 9(COMMENCINGWITHSECTIONIo(Hi)Of-UIVISION30FTHEBUSINESSANDPRUFf55!ONSCODE.AND Z `X MY LIC[NSE IS W FULL FOHCE AND EFFECT. m � LICENSE CLASS___._ , L'C.NO _..______ � __' J U DATE __'_'.... . CONTRACTOR' ____- d llJ � WORKERS'COMPENSATION DECLARATION � � Q � INEREBYAFFIRMUNOERPEYALTVOFPtiRJUfl70NEOF1'NEFqLLOVrINGDECLARATIONS: U � z Q � IHAVEAN�WILI.MAINTAINAC[RTIfICATEOFCONSENTTOSELF-INSUREFOFWORKFRS' _ � CAMPFNSATION,AS PHUVIUED[3Y SECIION 37000F THE LABOR CODE,FOfI TME PEq4UqM�NCE IU UF THE WO!{K FOH WHICH THIS PFPMIT IS ISSUEO. � � � _I I IAVE AN'�Y/'�LL'AAINTAIN WOF,KERS'CO4PEHSATICN IhSURA\CE,AS R'c.JI�ED BY SECTIOIr y p QQ 3N�OFTIIE4�60RCADE,FORTHEPERFORMANCEOFTNFWOflKiOiiWNICHIHISPERMITIS _»"^ �l (�� ^ _ ISSUFD.69Y WOFKERS'CAMPENSATION INSUR�NCE CARRIER NN()PO:ICY NU!df3[RARE: ONSTRUryT1VN .,_____ Y.�_ J ._'"'_" _._'_'_ `; caqivF�-- - --------- .------ PLAN REVIEW ---- y _...... � - - ZNoi_icvnuMeeH --'---�------ ELECTiiIC .•'�" ---_..-._ --__.._-_ ---�- ¢ _... 0 (IFIISSCCT10NNf'EUNOTCf[07h'I'LEiEDOFIiiCPEM�tiTISWflONEHU�DR'eD00LlMS($1IX1)ORLFSS) PLUM8ING � _..._ _.___._._. w MECHAN Z I CERTIFY 7HhT IN 111E 7EflFORUANCE OF 711E WORK FOft WHICH THIS PEFMIT IS ISSl1EU,I _..___._ _'_- �` SHAIL NOT EMPLOYANY PEFSON IN ANY MANNEft SOAS TO BECAME SU9JECi TO TI{E � WOIlKCt15'COMVENSA710NLAWSOF[:ALIFORhIA,ANDAGHEEIHATIFISHOULD9ECOMG INSPECTI� FEE . - ___-"'""_" __-_.�-�.._.._____"_ � SUDJECTTOTHEWORKERS'CO4PENSA710NPPOVISIONSOFSECTION3]a�OFThItLA�OR ' - � �� ` CA�C,1 SHALL FOHTHWITfI GOMPLY WIII I THOSE PHOVISIONS. (g�.� ~- � . .. ...."- ""__ ___'" 0 SMfP '( V ---- r� DATE: APPLICANT: __'"'.._ ."_ .T�°�\ __ ...._-.._. _.__..._ ...._- O WAf1NING:FAILUFETOSECUREWORKER5COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYPl��e' ______._ __..___._.. ...—_._ _.._. J � SUBJECTANEMPLOYERTOCRIMINAI.�ENAL7IESAN�CIVILFIN[SUPTOONEHUNDftEOTHOUSAND ENERGYPERMIT UC)LLAN5�310D,OOG),�NADD1710NTOTHECOSTOFLOMPENSATIDN.DAMAGESASPFOVIOE��URIN ' '- -"--'-' "--"'-' '-- � 5[f.TION370AOFTiIELA�ORCODE,INTERiST,ANDATTORNEI"SFEES. RETENTIONFEE: _.. ._ ,—.-. ...—_.._ [i� CONSTf�UCTION LENDING AGENCY PRE-ALT FEE: __._. _ _..- ._ _..-_......_. O � I HeREBVAFFIRbI f1k�LR FENALTY OF PERJURYTHNTTHERE IS ACANST(IUCTInN Lf:N�iNO AGENCY n-' FOF THE PLflFORMANC[OF T4L WORK FOR WHICH THIS PGRMIT IS ISSUEU(SEC.3097.CIV.CJ. Z W _.__---_. . _...- .._-.. _.' '—. _ � I.f:N�ERSNAME __ -- �-�--� — � L'eNUF.ft'SAOUHESS . _ .. ."_'"'_"_ "__"'--.- ...._"' '" _'"____ � 1 CERTIFY THAT I HAVE READ TNIS APPLICATION AND STATE THAT TH[AHOVE INfORMATION IS CARF[Ci TOTAL FEES /J w I AGRF[TO GOMVI.Y WITH ALL GITY PNU GOUNTY ORDINANCES AND STATE LAWS FELATWC 70 ESI IIL'JING �j�;?'a. � CON57qUCTION,ANDHEFEBYAUTHORIZEREPRESENTATN[SOFTtIISCUUVIVTOEN7FRUPONTHE T �� zABOVE-MGNTIONfD PROP'ePTY FOR INSPFCTION PUHVO5C5 GOMMENTS Q , . '._'__-' _ ' _-... ... _'_"'___ -� j!�� . A f4p>Iu, � . . .r ' � { � l=-� w �--_� _ . — --...- - - - - --- m PERMITTEENAMG(PHINT) " ' _'-' _" '.. .'__'___-"' _._ . . ..._'-___" Q , s ., t _ 6P- � �l�?..�c�,�,.� ��.�:`{��.,�� a i7..-.�-'��`e -- ,/�'_� - -- - r� y�`y� � � SIGNATUfiEOFP[F1MITfEE� �ArE RECPTNO. �/_�"_L- PAIDBYC.�..____�� VALIDATIO _ ,.._ i H � WMITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy.GREEN-Applicanfs Copy � ,.._ r ... __'.. , . . __ --r-- - -- - � �- � I ` i � � i � � � - , i � � i � I i � � - i ; . � ; I t ! : � � � ( � � � i . 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