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Home My WebLink About12253 (13) CITY OF DIAMOND BAR ��.___ r�....\ DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES�' , , � . 21660 8.Copley Drive Suite 190 � (909)860-3195 Faa�(909)861-31 t7 /C_� PRE$$ '��'�^' BUILDING PERMTI'APPLICATION FIRMLY � JOBSITE /O�� N • �L S�L rC.N. APPLICATION l„7)_ 1�,_,��S NUMB R �' �� #/C a ADDRESS DATE `�� ! � APN LOT TRACT D TEE_� "� I/ '� I 9 CONST. GROUP p OWNER S OH I L� ��iQ,l�.14/l1O o ADDRESS �p�. �V• 1>CL SO�C.. � ZONING SETBACKS gCITY�JArMdN ZIP TEL. O� FRONT RW ❑--- APPLICANT J• O�FIN G� C� •TEL�'j� d' REAR � �___ � SIDE/SIDE STREET RW fl____ CONTRAC R (�j- �. SIDE U ADDRESS ' !/• � CITY�j-SEP7� ZIP^ S� TEL. -- � PROPOSED USE Q�? r/(/U � vARCWENG/ S L � C X (, sJt� DESIGNER �_C`"�1r�a.r2 1]�K4��t .��i14-6. t'H/.t.lC�L� � ADDRESS NO.DWEL. NO. Np, u� UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECiARATION SFR/ADDINEM O 0 I HEflEBY AFFIRM 11N�ER PENALN OF PERIURY THAT I AM EXEMPT FfiOM THE COMqACTOR5 LI� GdfeQ9/CBfpOfl � W CENSEUWFORTHEFOLLONIINGHEASON(SEC.]0.'f16BUSMESSANDPROFESSIONSCODE�ANVCIiVOR � U COUNTVWHICHREGUIRE5AP6fl1ARTOCONSTflUCT,ALTER,IMPROVE,DEMOLiSH,ORREPAIRANY9TRUG JJ patio/Deck W 'NP.E,PRqR TO ITS ISSUANCE,AL50 REQUIflES 7ME APPLICANi FOR SUCM PERMIT TO FlLE A SIGNED W _, STRTEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVI510NS OF THE CANTFACTOR5 Lb � . � CENSE LAW(CHAVTEN 9(COMMENCINd WITH SEC710N 7a00)OF DIVISION 30F TNE BUSMESSAND PRO� POOU FES$pNSCODE)OR7HA7HEOR3HEISE%EMPTTMEREfflOMAN�TNEBASISFOHTHEALLEGEDEXEMP� (3 "�..I�� 7pN.ANYVIOLATIONOFSECTION7037.5BVANYAPPLICANTFORAPERMITSl1BJECTSTHEAPPLICAN770 RB-R0o} �j Q A CIVIL PENp1TY OF NOT MORE THAN FNE HUNDRED�OLURS(SSoOj.�: ( 0 ❑I,ASOWNEROFTHEPROPEflTY,ORMYEMPLOYEE5WITHWAGESASTHEIflSO�ECOMPENSATION, � COR1RIBfC18i � Z N7LL 00 TME WORK AND THE STqUGTURE I5 NOT IMENDED Oq OFFEFED FOR SALE(SEC,70dd,9USI� J � NES4 ANO PpOFE55KKJS CODE:THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF = PROPERTY N'Fi0 BUILDS OR IMPROYES TMEREON,AND WHO OOES SUCH WORK HIMSELF OR HEflSELf OR � � THRIXIGHMISORHEPOYVNEMPIAYEES,PROVI�EOTHATSl1CHIMPpOVEMENTSARENOTINTENDEDOfl m ' Q ,OFFEfiED�ORSAIEIF,HOWEVER1NEBl11lDINGORIMPROVEIAENTI550LDWITHINONEYEAROFCO\1PLE- Z TKKJ,THE ONMER�BUIL�ER WILL HAVE 7HE BURDEN OF PROVIN�hIAT HE OR sHE DIU NO7 BUIID OR � IMPppVE fORTHE PURPOSE OF SRLE). ❑I,AS 06VNEROF THE PflOPEHN,AM EXCLUSIVELV CANTRACTING WITH LICENSED CONTFACTOqS , � TO CONSTRUCTTHE PROJECT(SEC.7044,BUSINE55 AND PROFESSIONS CODE:THF.CONTRACTORS LI� VaIU0U0f1 � �._,.y __AOJ.AREA_.. � W CENSEUWDOESNOTAPPLYYOANOWNEROFAPFOPERT'WHOBllIL0.50RIMPROVESiFiEREON,FN� — - � WNOCONTRACTSFORSUCHPHOJECTSWITNACONTflACTOR(S)LICENSEDPURSUANTTOTHECONTflAG QUANTITY ESCRIPTION FEE TORS LICENSE U1W.�. � 0 ❑IAM EXEMPT UN�ER SEC. _ B.&P.G FORTHIS REASON Q T� U � ---- ¢ DATE OWNER 1— O "'_""--'_ W � IiCENSED CONTRACTORS DECLARATION �� g � � 1 HEHE6YAFFIRM UHDER PENALTY OF PEflJI1RV hiAT 1 AM LICENSFD UNDER PHOVISIONS OF CHAPTER � i � i(COAIMENCINO WITN SEC710N 7o0o)OF OIVISION 3 OF THE 6USINE55 AND PROFESSiO4S CODE,AND � MY LICENSE IS IN FULL OR EFfECT. /' z 0 UCENSECLASS �� LIC.NO.M��. j , , V DATE�� q� GON7RACTOR J o. _....._�N_ 2 W � WOpKERS'COMPENSATIOM DECLARATION ¢ � IHEREBYAFFIRMUNDEHPENAL7YOFPERJURYONEOFTiEFOLLOWING�ECLARATIONS: z � . /L.If1AVEANOWILLMNN7AINACERfIFICATEOFCON5ENT705ELF�INSUREFORWORKFRS' y Q COMPENSATIOY,AS PROVIOED BV SECTION 37000F THE LABDR CODE,FOR Tf IE PE(1FOI7MANCE U__ Q OFTHE Y/OflK FOH WNICH 7HI5 PF.flMIT I5155UED. � O..W,. ___I HFVEAND WILL MAIMAIN WORKEflS'COMPENSATION INSUflANCE,AS R[OUIREO BY sEC7lON O 37000F THE LA60R CODE.FORTHE PERFORA6ANCE OF THE WOIiK FOH WHICN TH�S PEFMIT IS ISSUED.IAY WORKER9'COMPEN9ATION INSUHPNCE CARRIER AND PDLICY NUMBEfl APE' CONS7RUCTION _��_ ,� i� ""'_'—__' ' . j caaaiea....-�� . N`f PLANREVIEW — ------...---- ..—_..._ �. G ---— .._ � VOLICYNUMOEfl ' � v- �� . ELECTRIC � """' 0 (tHLSSECfIONNE�NO7BE01'11l.ETEDOFTiEPEfY.YTISFORONEFnXJIXiEDWLIARS(51a0)ORL65} PLUMBING _ --.-_.— —'------_ �"' ' Z ICEHTIFYTHATINTHEPERfORMANCEOFIHEWORKFORWHICHTHISPEFiMITI5155UED.l�� MECHANICAL - C� SHALL N07[M7LOYANY PERSON IN ANV MANNLR SOAS TO BELOME SUBJECT TOTHE � ---- � WORKERS'COMPENSATIONLAWSOFCALIFORNIA.ANDAGHEETHAT!FISHOUl.DE3ECOh!E INSPECTIONFEE ..____...,, �... __—_. -- S Sl18JECTTOTHEWORKERS'COMPENSATIONPP 4510NSOFSEC710N37000FTHFLABOR - —�a OE,I SXALL fORTMWITM COMPLV W THO v,�6owsioNs. . ISSUANCE _..,....______ _ _ ___ ��Gt/ � 0 .'___"'-- _ . p DATE: '�� APPLICAN7 �_' __'__ C SMIP — _.'____ f� :�. J WApNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,ANU SHAIL D[ ENERGY P/C _._____, __ �y„ SUBJECTANEMPLOYERTOCNIMINALPENALTIESANDCIVIIFINESUPTOONEHUNOREDTHOUSAND ENERGYPFRMIT DOLLAFiS(5700.000).IN ADDITION TO TfIE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN ...'_—"'_ .. � SECTION37080FTHELABOHCWE,INTE(iEST,ANDATTORNEV'SFEES. ' RETENTIONFEE: ___ __ ___ OCONSTHUCTION LENDINGAGENCY pqEALT FEE: _ ___ ..__. _ � I HERE9V AFFIHM UNDER PENALTY OF PENJURV THATTHERE IS ACONSTRUCTION LENDING AG[NCY ___ __ __ FOti THE PERFORMANCE OF 7HE WORK FOR WHICH 7HIS PERMIT IS I&SUED(6EG 3097,CIV.C.), - Z W ____'._ _.' � IENUF.RSNAME__. ____ I"� lENOER'SADDRESS _. __,_ W ICERTIFYTHATIHAVEflEADTHISAPPIICATIONAN�STPTE7HATTH[pBOVEINFORMATIONISCORflECT. TOTAL FEES � � � � � � 1 AGREE TO COMPLV WITH ALLCITY ANU COUNTY ORDINANCES AND STATE IAWS RELATING TO BUILDING �F, �� CONSTRUCTION,AND HEREBY AUTFiORIZE REPFlESENTATIVES OF THIS COUNTY TO ENTEfl UPON THE Z RBOVE-MENTIONF/DP'fl�OPCRTYFORINSPEGTIONVURPOSES. � _ ��►�`tL��'� � /TV'"0 I• COMMENTS--.,-- - � Yti� --- I — m PERMIT7EE (PAINi) � � � 9-/ �' --- �'��'.. y SI ATl1REOFPEHY1TfEE �ATE � ��— ---- �''��- = RECPT.NO, PAID BY _ VALIDATION_ ~ WHITE-0eparlment Copy,YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Ca GREEN— py. py. py, ApplicanPs Capy � _ i._. � : i 1 1 r r � i, ..i��t � ,' � :�. �� '�� ' #b�u# �. ,,. � � � � i � i E �7 � q�,;� v r �` � ta � t � , ' I� ;� � � � v �m.J � '� ^x� �. 7 r q � � t �a y � � � I � ( �13 � � � , ' -� �� s �� `` , l � � ; � �i ^ , �,�- r , r �� I � � t i r ;� � I ' �, �� ;� � ! �� : � - ; r I � �; y �� r , I i �� i _ � i ' ' �,I i '; g �� i j - I " � i � � � � i I � �� i �" ��f �, ; i � i I � ;— - �� '��'�� , i � : , � ( ! r F 7 I , � �� , � ; i � � �,;.�a;��a � .E �r� _,` ` - : � ' ` �� 1, . % �� _ �� - I � �w��.: , , I r- "�� i i �. ., C 1 � � �ti � i i , - =� ' I � : �� I j ro'`�- ."l�`y ' �t� � � � S ' ' , � � � � I � � �I ' I � .`�y\� � � ��a � ' ' � ; i��r , � � .!' 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