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Home My WebLink About16124 (22) ��_l CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ! � �w � 21660 E.Copley Drive Suite]90 PRESS (909)860-3195 Fax(909)861-3117 � ��'�� BUII.DING PERMIT APPLICATION FIRMLY � JOBSITE . APPLICATIO PERMIT I f_ �•Z� #/C � ADDRESS ��J'9�,�ji„��r� �+�':�.�t'r �A�'� DATE � �' � � _NUMBER �`� � ISSUE � � � TYPE OCC APN LOT TRACT_ DATE ��I" _CONST. GROUP °C OWNER OO ADDRESS ZONING SETBACKS z CITY ZIP_ TEL. REART RW n— g APPLICANT _ TEL. SIDE/SIDE STREET RW Li___ CONTRACTOR � •d` •ti/� ' S1DE I_l ADDRESS��f�� 'c '� (2R-j�� CITY ,�,j�� ZIP �v1� TEL. ��'1-y� PROPOSEbUSE � �l'� ' �'-��_l�- � O�.1 c� R l' ✓�' w ARCH/ENG/ ��---- /� � � e z DESIGNER . �`r�� f_i_.. ��E�E� }�=•t��— . � ADDRESS NO.DWEL. NO. NO. E UNITS___ STORIES BEDROOMS E N CITY ZiP--- TEL._ � - y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION f � OWNER-BUILDER DECLARATION SFR/ADDlREM k O f p I HEREBY AFFIRIA UNDER PENALTY OF PEHJURY THAT 1 PM EXElRPT FPOM THE COMqACTORS L6 Gil/AgB/C8fp0lf W CENSELAW WRiHEFCLLOWINGREA50N(SEC.70d1.5BU51NE55ANDPROFFSSIONSCADE.ANVCITYOR (n � ' U COUNTVN7iICHREOl11RESAPEHMITTOCONSTRUCT,ALTER,IMPROYL.DEMOLISH.ORREPAIRANYSTRUG W P2fi0/DeGk �ZNRE,PHIOR TO ITS ISSUANCF.,ALSO REOUIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � STpTEMENT THAT HE OR SHE IS LICEYSED PURSURNT TO THE PROVISIONS OF THE CONTRACTORS U� � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7W0)OF DNISION 3 0F 7HE OUSINESS AND PRO� � PoOVSpe FESSIONSCOOE)ORTHATHEORSHEISEXEMFTTHERF.FfiOMAN�THEBA515fORTHEAIIEGEDEXEMP� (� s /� ) V 710N.ANYVqIATKKJOFSECTION)031.SBYANYAPPLICANTFOfiAPF.fiMIiSU&IECTSTHEAPPUCAN7T0 Z Re-Roof ZJ(/d �� , � ACINLPENALTYOFNOTMORETIIANFIVENUN�qEDOOLLARS(SSCo).): ^ C:I,ASONTlEROFT{iEPP.OPERTY.ORAAYFMVLOVEESWITHWAG[SASTHEIPSCLECAMPENSATION, d CGrt1m0�Clal ____ • � WILL DO THE WORK�D THE STNUCTIIRF:IS NOT INTENDED OR OFFEREU FOR SALE(SEC�odd,BUSI- J NESS AND PROFESSIONd ODDE:iNE CON i RACTORS LICENSc LHW OOES NOT APFLY TO AY OWNER OF � DNOPERNWHOBURD30RIIAPAOVESTHEREON,PNDNM1{000[SSIJCHWORKHIMSELFORHERSELFOR m , � h1RWGHHIStlRHEROWNEMPLOYEES,PROVIQEDTHATSUCHIMPROVFMENfSAFENOTINTENDF.DOF QOtFEREOFORSALEIFHOWEVEP,lNEBUILDINGORIMPROYEMENTI550lDWITHiNONEYEAFOFCOMPIE- __ i Z TION,THE OWNEN-BUILOER WILL HAVE THE 6UFDEN OF PROVING THAT HE:OH SHE DID NC�BUILD OR � IMPROYE FOR THE PURPOSE OF S�LE). f Il 1,Il5 ONMER OF THE PROPERfY,AM E%GI.USIVEIY CANTRAGTING N'ITH IICEN3ED CANTRACTORS $ � TO CANS7Rl1CT 7HE PROJEC7(SEC.7o36,BUSINESS AND PROFF:SSIONS CO�F::7HE C:ON7HACTOflS LI� ValualiCn _ _.__.ADJ.AREA___.____..____- W CEn'SELAWDOESNOTAPPLVTOANOYMEROFAPPOVERNWHOBUILDSORIMPfiOVEuiHF.REON.AND - � Z W1fOCONTiiACTSFORSUCkIPROJECTSWI'fTiACONTFRGTOR(S)LICENSEOFUR.UANTTOiHECONTRAG QUANTITY DESCR{PTION FEE ~ TORS 110EN5F UW) ----- � �` � � , �.. ' 0 ❑IAM7 E%EMPT UNDEN SEC. ___._,__—.-_B.d P.C.FOfl TriiS REASON U -�C�2 G' j 3 --�--- --�-- � 3 � OATE_ .._-- ---_ ONTJER.___ �, .._'— i, z - - -- ----------- � -� ��- � � LICENSED CONTRACTORS DECIARATIOh �� w E - r I 1 HEREBV AFFIRA!UNDER PENALN OF PERILIRY THAT I AM LICENSE�UNDEfl PROVISIONS UF GhIAPtER �' "L � 9(COMMENCINO WITM SFCTICN 7000�OF DIVISIGN 30�THE BUSiNESS ANU PFlOF'cSS�045 CODE.AN� Z � X MV LICENSE IS IN FULL FOFCE AND'cFFEGT. � W g ��i J � � LICENSE CLASS..� LIC.NO. _ f � �--- --- —-- H ,� A � UDATE ,,�.,�_.�_ CONTRACTOii_ J✓��'�''`�� a ,„ ---�� _ - j � WORKEHS'COM?ENSA710NDECLARATIUN Q _— � U � 1 HEREBY AFFIRkI UNDER PENA�TY OF PER.IURV ONE OFTH'c FOLLOWING pEClAM7:OtiS: Z -- Q � INAVFANDWILLMAI�TAINACEHTIfICATEOFCONSENTTOSF.If-INS4HEFORWURKFflS' � S ; � COMPEN3dTION,ASVRCVIDFOBI'SCCTION37UOOFiHF.IADOFCO)E,FUHfHEPERFOP.MpNCE � _ ._ ; OF THE WORK FOR WHICHTHIS VERMI7IS ISSUED. S I w _ i— _ __IHAV[.ON�WIILM�INTAINWURKCRS'CAA!P[NSATIOVINSUHANCE,ASREOUIRED6ySeCTION �LO� I O 37000f TNE LAHOR CODE.FOR THE PERFORMANGE OFTN WORK(�OP Y/HICH ffIIS PEflMIT IS - - ��s_-_ i ISSUED.MV WORKER��PE�.'$ATION IRBL&LtiCE C�ANti VOLICY Nl1M8CR ARE. � CONSTRUCTION � _ ' .. � i!�''. �v�L.i.- -�---�---�--�-- PLAN REVIEW ----- I CARRIER_ —_�� 4..-- -- '---"-----'— !: � OOIICYNUMBEfl_.__.—_ �-+-�/-----.--- _--..__.____.__-. ELECTRIC o (IF!'SSECf%XJNCkT)NOTBEOOR�I.F�F.DOfi}IEF[P1M5FORQ1'EH'.ihARF.UUOLlAFtS(51tC1�LESG) PLUMBIiYG .____.._'_-_'-'_._"._ , � ICERTIFVTHA'fiNTHEP[flFORMAhCE0fTf1EWOflKFORWHICHif115PEFlMIT151S�U&U,I MECHANICAL _ _. __...—.---._._— '� '�} SHAILNOTEI.'PLOYANY�ERSC\IN�NYMANNLfi':l'AST08ECOMESU�JFCT(OfH[ INSPECTIONFGE � WORKEHS'CnMPFNSAT!ON IAWS OF CALIFOPNIA D ACRF'E 1 HRT I�I SHUULD B OME /y� ,v� -- � SU3JECT70THEWJ'iKERS'COMPENSATK:NP ISIONSOFSCGTION3'! 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RETENTIONFEE: . � -"____ ' .._..._-"__'_"" ' "_"....._. ___ _'— ' _ W CONSTRUCTION LENDING AGENCY PSiE-ALT FEE: cL -- -.....------..__ .. . --- � � IHEREBYAFFIRMUNDERPENALTYOFI'EftJURYTHATlh1EHF�SACONSTf1UCTIONLENOINGAGeNCV � � � -__"__-'""" -_'-"'.......— _-_- � FOH 7HF.PERf�ORMANCE OF(HI:WOFlK FOR WHICH 7HI5 P[f7Ml'�IS ISSUED(SEC 3097,CIV.G.). � I W � .-_..._ __---..._ — I � � IENDEft'SNAME_._..._._ _""-"- -_""'__- i _"'-" -""""—_—_'-"- � F_ LENDER'S�D�RFSS_._-"_' __"__'__ .. ...__'"_-"" , � IGF.RTIFYTHATIHAVEfitMTHISAPPLICATIONANUSTATETHATTHEA[30VEINf'ORMATIONISCARRECT. '1 OTAL FEES ��`� �[,�� IAGREETOCUMPLYWITNALLCITYAY�COUNTYORDINMIG[SANDSTATEIAWSRELATIN(iTOF7UIL[11NG � �A ^ ' � CONSTRUCIION,ANDHEPEBYAUIHOHIZF.RFGRESENTATIVF OFTHISCOUNTYTOENTERUPONTHE � �}� �.1 I Z A130VE�MEMIOYED PROPERTY FUR INSPECTION PUH�OS . y� _ ___ CDMMENTS ____ -___. � p �,�j(.,�Fc• � �. ` %�C._c'�� ---�---------- _� ----�----- -�--------- - -- --- ------- � - ---- m PERMITT N (VHINTJ G -"_'_ "_"'_"' ' _'__—'--'__- - I „.�W . N ' ' L 'J`' ------ -��`�-----`��f— G y 51 A7U =0F P ITTEE "- DATE -- ��- - -�-'--��- -- � = RECPT.N0...______. PAID BY ..,_.__...—.. VALIDATION_____ �' WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assesscr Copy,GOLDENROU—File Copy,GREEN—ApplicanYs Copy � ' .., . . � . .. . � . . . - i . , . , ,, ' , i ' ' . ' . . � ' - � ,. , � , , ' j . , . _ � � _ � ' � � ' . , - ' � , ' . � , ! - . ' i , . I . . � _ . . .... .. .: ,. � . _ . ... .. _ � _ � . ' . ` . . ' � ' ' i . . ' . . . - , • . � . x; ' . . . ' "' ' - ` . .'�. . . , ' .' I ; . . . 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