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. . .� --��```�--- CITY OF DIAMOND BAR � � COMMUNTTY DEVELOPMENT DEPART T '�-;„..� � 21660 E.Copley Drive Suite 190 PRES•S• (9D9)860-3195 Fax(909)861-3117 '"""�` BUILDINGPERMITAPPLICATIOIV FIRMLY } JOBSITE 1124 DIAMOND BAR BLVD. APPLICATION �� "' PERMIT�Z�� p/C -� o ADDRESS DATE � NUMBE # � ISSUE TYPE OCC APN LOT TRACT DATE_ CONST. GROUP p OWNER " ADDRESS�TKK[� C'�TTAT. CnRP_ ZONING SETBACKS 'R�'D Z CITY T�TF.WP(1RT R('H ZIP A�H,��fEL�4�3-HSZ-nF) � FRONT RW G � APPLICANT $IG.�4 EXPI�ES� re�. 626-44�-3 pEAR ❑ � SIDEISlDF STRE=T ^ � m CONTRACTOR SIGNS EXPRESS SIDE _ � J � A�DRESS _244�j Mgg[�,'�jZ]�.uF , r p PROPOSED USE U ' � yrn,f o CITY C FT. M(1T�iTF ZIPA1 ?'2� TEl6'�F_dd�_'�3 � � w ARCH/ENG/ � � z DESIGNER L' � ADDRESS NO.DWEL. '`_ � NO. UNITS STORIES BEDROOMS � CITY ZIP TEL. u� u� DESCRIPTION SQ.Fl: FACTOR PSF ADJ.AREANALUATION � OWNER-BL:ILDER DECLARATION SFRiADD/f3EM C p I HEREBV AFFIRM UNDER PENALTV OF PERJURV THA?I AM EXEMPT FPOM THE CONiRACTORS LI- G8f896/CBfpOft W GENSELAWFORTHEFOLLS]WINGREASON(SEC.]031.SBUSINESSANOPROFESSIONSCO�E:ANYCITYOR (n U COUNNWHICHREQUIRESAPERMRTOCONSTRUCT,ALTER.IMPROYE,DEM0415Ff,ORREPAIFAIJYSTPUG W Patio/Deck W TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIqES THE APPL�CANT FOR SVCH PERMIT TO FILE A SIGNEO W � 5TATEMENT TNAY HE OH SHE IS LIGENSEO PUFlSUANT TO THE P90VISIONS OF lHE.CONTMCTJRSL:.. - . .....- .._........_._ . .._..... ....... . ... � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000J Of DINSION 30F THE&1SINESS AM1D PRO- � POOVSPd � FESSIONSCODEIOR7HATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� � TON.ANYYIOLATIONOF5ECTIOM7031.5BYANYFPPUCANfFORAPERMITSU&IECTSTHEA?PLiCANTTO Z RE-ROOf A CIViL PENALTY OF NOT MORE THAN FIVE HUNDRED DOL�ARS(55oo).j: C I,AS OWNER OFTHE PROPERT',OR MY EMPLOVEES WITH WAGES AS iHEIR SOLE COMPENSATION, Z 0 Commercial __ WiLL DO 7HE WORK,AND THE STRUC7UqE I5 NOT INTENDED OF OFFERE�FOR SALE(SEC.7a44.BU51- J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICEtiSE LAW DOES NOT APPLY TO AN OWNER OF � Pi70PEFiV W40 BUILDS OR I.UPROVESlHEREOY,ANO WHO OOES SUCN WOFK HIMSELF OR HERSELF OR � THAOUGH HIS OR HEq OWN EMPLOYEES,PROVIDED THN75UCH l!APROVEMENTS ARF NOT INTENDED OR m w OFFEREDFORSALEIF,HOVJEVER,iH'eBUILDINGORIMPROVEMEN71S50LDWITHINONEYEAROFCOMPIE � TION,THE OWNER-9UILOER WILL HAVE THE 8l1RDEN OF PROVING THAT NE OR SHE�ID NOT 9111LD Ofl — Z IMPROVEFORTNEPURPOSEOFSALE). _ ❑I,AS pWNER OFTHE PROPERTY,qb1 EXCLUSIVELYCONTRACTING WI7H LICENSED CONTRACTORS W Q 7D CONSTRUCT THE PR0.IECT(SEC.7044,BUSINE55 NND PiiOFE5510N5 CODE:THE CONTRACTORS LI- V81UaIiOf1 ADJ.AREA W CENSEUIWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUIL�SOflIMPROVESTHEflEON,AND - = WHOCONT.�,4CTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUANiTOTHECONTRAP ~ TORSLICENSELAW.). QUANTITY DES_�N FEE Y J � C I AN.E%EMPT UNDEri SEC. B,H P.C.FOR THIS REASON � U --t— � — CC DATE OWNefl U Z W � LICENSED CONTqACTORS DECLARATION w ¢ � I HEREBV AFFIFM UNDER PENALiV OF PERJURV THAT I AM LICENSE�L'NDER PROVISION50F CHAPTER � d 9(COMME�CING WRH SECTION]000)OF DIVISION 3 OF iHE Bl15WE55 AND PROFESSbNS CODE.AND Z 1X MV LICENSE IS IN FULL FORCE AND EFFECT. � � LIGENSE CLASS C 4 5 ���.No. 5 5 2 0 9 7 a V DATE 9/2 1 J 9 S CON7RAG70 � d . W � WORKERS'COMPENSATION�ECLARATION )� �.� U � I HEREBYAFFlFAI UNOER PENALTYOF PERJURV ONEOFTHE FOLLOWING DECLARATIONS: Z , Q � _IHAVEANDWILLMAINTAINACERTIFICAiEOFCONSENTTOSELF�INSUFiEFORWORKERS' � ¢ COMPENSATION,ASOROVIDEDBYSECTION3iooOFTHELABORCODE,FORTHEPERFORMANCE �U Q OFiHE WORK FOR WHICH THIS PEIiM1T IS ISSUEO_ � � _�I MAVE AND WILL MAINTAIN WORKEFS'COMPENSATION INSURANCE,AS REOUIRED BY ScCTIIXJ Q37000F THE LA90R CODE,FOR THE PERFORMANCE OF THE WOflK FOR WHICH THIS PERMIT IS � / _ ISSUEO.MYWORKERS'COMPENSATIONINSURNJCECARRIEFANDPDUCYNUMBERARE: CONSTRUCTION �� l� l J ¢ .',?f 1 ..� ..�...,.. � CARRIER �m ', �vr17 � PLAN REVIEW :, � --... . _ ........ _.._.._.. � POLICYNUMBER ^i r .Z -...... . . P / / ..... ..._........__—._ ._'-__'__' _ '. .. Q �L°v-3� �-e. � ' ELECTRIC a � (THISSECTIONNEmNO'TBENh1.0.EfEDOFTI$PEfUM15FORONEFLNDREDDOLI.PAS(S70D)ORLESS). PLUMBING _� Z I CERTIF:THTi IN iHE PERFORtdANCE OF THE WORK FOR WHICX THIS PERMIT IS ISSUED.I MECHANICAL ,_ �J SHALL NO7 EMPLO�ANY PERSON IN ANY MAVNc'R SOAS TO BECOME SUBJECT TO THE (n WORKERS'COMPENSAiIONLAWSOFCALIFORNIA.AN7AGREETHATIFISHOUL06ECOME INSPECTIONFEE .� SUBJEGT TO THE YJORKERS'COMFENSATiON PROVISIONS OF SEG:ION 3700 OF T IE LABflA � CDOE,ISHALIFORTHWIiHCOMPLYWITHTHOSEPROVI510N5. ISSUANCE , � O M7E: 9 21 9 8aPP�,�ANT: LAVENDER FUN ' � SMIP � __ "„JJ WAflNIN6:FAILURETOSECUREWORNERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANOSHALLBE ENERGYP/C ._ � SUBJECTANEMPLOYERTOCRIN.INALPENALTIESpNDCIV:LFINESUP700NEY.UNDREOTHOUSMI� ENERGYPERMIT OOLLARS(5100,o00J,IN A�DITION TO THE COST OF CONPENSATION.PAMAGES AS PROVIDED FOR IN � SEC710N 37080f TME LA60R CODE.INTEREST,ANDATTOFNEY'S FEES. ' RETENTION FEE: _ i � OCONSTRUCTION LENDING AGENCY PR -AL F ✓!� _ �� � IHEFEBYAFFIFMUNOERPENALTVOFPERJURVTHATTHEREISACOIVSTRUCiION�ENDINGAGENCY �� / _ FOR THE PERFORMANCE OFTHE WORK FOR WHICH TH?5 PERMIT IS ISSUED(SEC.3097.CIV.C.). Z / w W —aeusY � LENDcR'S N0.ME . 1— LENDER'SADDRE55 � �-7 � ICEFTIF1'THATIHAVEREA�THISAPPLICATIONANOSTATETHATTHEA90VEINFORMATIONISCORRECT, TOTAL F�S J `� � IAG4IEETOCOMPLVWITi1ALLCRYANDCIXINTVOR�INN�CE5ANO5TATE WS ELATINGTOBIJILD:NG � [[[��� J� � CONSTRUC7'ION,ANDNEREBYAU`HORREREPRESENTATiVESOFTHISC NTYT EN�ERUPONT�E �/Jj�n 1�,� ,�l� � y�� ABOVE�MENTIONEDPROPERTYFORINSPECTIONaURPOSES. /`J'�b���Vv�' �„� o � � COMMENTS ' � � �, � �, � - - - m PERMI7TEE NAME�PRINn n(� a ,� , u� �- . � SIGNATUHEOFPERMITTEE � �TE = RECPT.NO. PAID BY VALIDATION ~ W —Department Copy,YELLOW—Finance Copy.PINK—Assessor Gopy,GOLDENROD--File Copy,GREEN—Applicant's Copy :. .,y. .,.,' ',•� . � .s� ;:'. f ::>:� -ir s�li�- t z @.* b vr't�' � .'� .'e`�i+'l�"�''a�C�'i"� '� '�:��`. �� � � ' '�.,;,,.� . ;:� . . . ��...���,... , .,,- � -,-� . a ^ r �,�' L�i.�-•Y�<: ��,�w^: �..itr k i.-x.� *�'' .i.r �7.'vrx_ :.rk��'�,���=x . . .�- < ..� : .:_ �,. �r . �' � , .. .. . � . _. , .. . �.��, � , �.. � �.:r , , .�.. 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