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Home My WebLink About16220 (22) �� CITY OF DIAMOND BAR - DEPARTMENT OF COMMUNITY&DEVBLOPMENT SERVICES 2]660 E.Copley Drive Suite 190 �� (909)86p-3195 Fax(9D9)861-3117 PRESS '��^° BUILDII�iG PERMIT APPLICATION FIR LY ,yN,' JOBSITE ? `�i G�1�,b��• ��Y' � � APPLICATION, � � PERMIT .Q j��P/C Q ADDRESS / DATE NUMBER(� / # � � ISSUE TYPE OCC APN! L_OT TRACT " DATE_ . CONST. �'�t'"'b GROUP p OWNER _._ p ADDRESS ZONING SET9ACKS W CITY y ZIP _ TEL. FRONT RW f_7_ � APPLICANT _ TEL. REAR f7 ' SIDFJSIDE STREET RW_�❑ � CONTRACTUR�7 � _ �o-._ � f' (�_ , SIDE ❑___,_ ADDRESS - � Cll'Y � Z�p 'l�_ �, ` PROPOSED USE o. ARCH/ENG/ � z, DESIaNER — ± NO.DWEL. NO. NO. �. ADDRESS — ' UNITS STORIES _BEDROOMS �' CITY �ZIP TEL. � -� DE5CRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFRlR�D/REM � C] 1 F7EREdY AFFlPM UNDER PENPITY OF PEHJL�RY THAT I AM EXEMPT FROM THE CONTRACTORS LI- GBfagB/C8lPOfi W CENSEUWFORTH[FOLLOWII:GREASON(SEC.7o31.58USWE3SAN[1PROFESS�ONSCA�E:ANYCINOR ` (n C� CqJMiVWI{�CHREQUIRESAPERMITTOCOld3TRUCT,ALTER,IMPHOVE,OEMOLISH,ORPEPAIRANYSTRUC� � ; W Palio/Deck Z NRE,CRlOq TO ITS�SUANCE,QSO RE�l11RE5 THE ACCIICANT FOR SUCH PEFMIT TU FILE A SIGNEO W� BTA7EMENT THAT HE OR SHE IS LICENSED PUPSUANr TO 7HE PROYISIONS OF TNE CON7RACTORS U- ` W �S' CENSE LAW(CNAPTEfi 9(COMMENCINO WITH SECTION 7a0oj OF UIYISION�OF THE BUSMESS AND PFO- ' � POOVS(J8 7S FESSIONSCODE)ORTHATHEORSHEISE%EAIPiTHEHEFPOMANDTHEBA515FORTHEALLEGEDEXEMP- :(� �j i1DN.µYypUTIONOFSECTION7031.59YANYAPPIICAMFORRPERMITSUBJFCBTHEAPPIICAN7T0 �•z Re-Roof � AqYil PENALTY OF NOT KiOqETHAN FIVE NUN�flED DOLUIRS(35Do).): � UI,ASOYMEqOF7HEPfiOPER7Y,OAMYEMPLOYEESWITHWAGESASTHEIRSOLF.CAMPENSATION. ❑ COR1rt10fCi81 ' N7LL DO TH[WORK,ANO 1HE STIiUCTURE ISltOT INTENDED 00.OFFEAED FOR SALE jSEC.7C44,9U5!- J � NESSAND PpOFESSIONS CODE:iHE CONTRqCTORS LICENSF LAW�OES NOT APPLV TO AN OWNER OF '� PHOPERTYWFIOBUNDSOPIMPflOVESTHEREON.ANDWHODOE55UCHWORKHIMSELFORHERSEIFOR m � hiROU(3NH190RHEflOYfNEMP1AYEES,PROVIDEDTHATSUCH�MPROVEMENTSARENOTINT[NOEDOR QOFFEREOf-0RSALf..IF,FpWEVER,7HEBUIlA1NGOflIMPROVEMENiISSOLOWITHINONE'/EAHOFCOM7LE- Z TION,THE OWNEH�BUILO[R WILL HAVE TH[eUROEN OF PROYING iHAT HE OR SwE 010 NOT BUILD Gli � IMPROVEFORTHEPURPOSEOFSALE). (yJ ❑41180WNEROFTHEPROPEitTY,AMEXCIUSIVEIYWNiMC11NGN7TH�iCENSFACONTRAC7UR5 ()[ TO CON6TRUCT THE PRQIECT(SF.C.704A 8L151NESS AND PPOFf:S510N5 CODE THE CONTRACTORS ll- � VaWation '�,_��9 `.Z�1�_._.,,_ADJ.AREA W CENSEUWDOESNOTAPP�Y70ANOWN[ROFAPROPER7YW1{OB�IL�SOf11MPROVE57H[(iLON,AND J � WIIOCONTMCTSFORSUCHPNOJEG?SWITHACONiR0.GTOR(S)IICENuEDPUflSUANTiOTMEGONTftAG QUANTITY DESCRIPTION FEE TORS LICENSE IAW.�. ,�-�--- � _I '9 '!]�. 'j I l / . � p f]I AM E%EMPT UNDER SEC. ,_..___--.... .__8.g P.0 FOR TH�S REAS�Id U y^ � — '__"__ _"' _-___ -"_ � . . . . . . . LL OATE__.__— .. OWNEA__'___'_"_ _ _- ~ �. � — W �d LICENSED CON7RACTOFS DFCIARATION �� , CC IHEREBVAFFIFIAUNDEAPENAITYOFPERJURYTHATIAMIICEN5EDl1NU[fIPRGVI51�,Y50FCHAPTER 'f' � �- 1 � 9(COMMENCIN(iWIT17SECTIQY]000)OFDIVISiONJOFTHEBUSINE55ANOPP,OFES5WH5t'AOE.AND Z '0� Eij!'yr'E�"`� [ao ' {' ' MYIILEH5E�5MFUlLFORCEM1DEfFFCT. m �+.� ( ,+ /'`� ��,' IL n . ��LL F � [ J (c� �•d s c��;7 � � Q UCENSE CLASS_,,__ � LIC.ND..��_i`� _ � J / H' UC �CON7PACTOR... � �- W DATF_______�__ �� WORKERS'COMPENSATION DECLARATIQN � '> 'g � � .� i vs[ '4-�C �Q4i t' .,, , � INEREeYAFFIRMUNDERPENALTVOFPERJURYONEOF'fHf.FOLIOWiNGDECIRRATIOk& � - y,11'� �� + h � __IHAVEANDWILLMAINTAINACERTIFICATEOFCOMSEMTOSFLFMSUflEFOftWORi(ERS' Z � COMPEN3ATICN,lw^PRGVID[D BY SECTION 37000F1HF.LAdOR CODE.FOfi YHE PERFORMANCF IU OFTHE WURK FOfl WHICH TNIS PEFMIT IS ISSUE�. Q: � __ _ w __�HAVEaN�WIIAMA:NTA�NWURKEFiS'COMPENSAiIQNINSUqANCE,ASRLOUIHEDBYSEC710N � 37000F iHE L1BGR I:ODE,FOR THE P[RFOF!AANCE OF TIIE WORK FOR wHICH 7HI5 PEFMIT IS �' ISS�EU.MYWOF�i(EFiS'LY,MdPENSATIONiNSURPNC[CAH1R,I�ERANOPOLICVrNUM9EFiARc CONSTRUCTION ___._ _.__.. .___ _-._ .___. _ j - �:�-� � , J��. �=i �� t PLAN REVIEW -..-'--.'--' "-'-----' cx CARftIeR _. . � PO�ICYkUMBf.fl____ / ___ . .___ E(.�C7'fll(,' � "�-�-. _- - -- __"_ _ --_-�_��,��'�'��"'- 0 ,R1165F.C^�ONNE�MJYOCCW�LErEDOFT±!EaLP1NTISfOHadEMMDFi[:D�aW151EtcolOFlLEss1. PLUMBING ,.,-'----''------"--'- y W �..�..�....s..� __� � ICENTIFlTW1TIY'lHEPERf�ORMRNCEOFTMF.WORKFOAWHICHTHISPERA1�1i5155UED,l MECHANIC ._ (�J SHALLNOTEMPLOYANYPERSONINANYIAANNERSOASTOAF(:OMESUOJ[CTTOf11E � � N WUAKFN�COlAPENSATIONV.'NSOFCALIFORNIA.AN�AGREE NATIFI3HOL'LURECOME INSPECTIU F�_____�_RR SU&IEGTTO'fHEWORKEHS'COF.PENSATIONPR SION9 F ECTWN3�OOOFTHEt�AOR � ISSt1ANCE �---�- °��_- (:ODE.IS FORTNW11'NG061PlYWITHTHOS�' OVIS . . (�}�--{}-�...�-Q-�-...'-"-r—'------'- S L r ' SMIP �H�"S � '4" !_�it�� p DASE:._..1 '�• APPLICANT.J y -.'.i'______. _._��._-_'. '_-_ O �„� { -'� WAPoJING:FAILUHETOSECUREWURKFRS'COMPENSATIONCOVF3IAGEISUNlA�l1.AN SNALL4E ENERCYP/C _.._.,_ _._._... �-. __..__. ____. � 5U&IECTANEMPLOVERI"OCfiIMINALPEN0.LTIE5MDCIVILFINESUPTOONENU ED OUSAND ENERGYPE _ - DOLLARS(E1CO.Ooo),INh7DIT10NTOTHF.COSiOFCOMoENSATION,DAMA0E5ASP OV!�F.UFORIN ��-""-:-��-' '-' ' '-"-' � SEGTION S7oB OF�HE LA90H COOE,INTEREST,ANO Al'fC1RNCY'S FEES. RE7ENTION . ,.__,____.._._ _.________ ,_._-- a CONSTRUCiION LENDING AG[NCl' PqE-ALT FEE: .__._ .._.__._ __ _- O CC 1 HEREBYAFFIpM UNDER PENAI.TY OF P[RJURV THp77HFRE IS ACONSTRl1CTION LEN�ING AGENCY �^ FOR THE PERFaRMANCE oF THE WORK FOR W111G7 THIS PEFMiT IS ISSUED(SEC.3087,CIV.C.;. �--� �� w '_-_ "-' _-__"-_ '_— � LEN�ER'S NAME_'_ _,.._"'_.. .__'___ .' ."'_' "''_"___ __' P= LENDEi'SADDP.E55""'_ _--..._... "'-'- --"- . � I CERTIFY TIiAT I HAVE READ THIS APPLICATIONAND STATE THAT THF A80VE MFORMATION IS COflRECT. TOTAL F�ES � � IACREETOCCN.IPI.YWITHALLCI NDCAUNTYOH�INANCESANDSTATfIAWSRF.IATINGTOBUILDING CONSTAUC710N,RNDHEREBYAU ORIZEH[AftESEIJTATIVESOFTHI5COUN�YTOENTERUI'UNTHE zABOV ENTIONEO RC1P[ Y RINSPF.GTIONPUflPOSES. COMMENTS _ � ` . 1 � ""_" __"" _""_ � ' . . : C/`�'�_ ' __ '_- "-"'___..._-._ __' "__- � ERM FE NAME(�''-�-' /1 y /� -- " -'-- _ ' ' '_ _ -"_ .�.. .'-' � `+ �E� / � _ '� _^ '� —_'__ ` � � __ I . . . _ "" _'_ 1__ �J.-(%'- - DAiE -' ' _ � 54 ATUREOF � ( • HECPT.NO. PAID BY VALI�ATION_____ ~ WHITE-0 arl t Copy,YELLOW�lnance CoVY.PINK-Assessor Copy,GOLDENRO�Fiie Copy,GREEN-Applicant's Copy k . : � . � � ; � . ;.. . , _ , ' : ' � , , - ; - , . • , , , . f . , . _ , ; � � � , ; ; � �-; , � � . � , , ; � � ;� � ' � � , � � � . � . , , , , � - - - .. . , . , ._ . , . � _. .. .., - - , . . , � , , , . . ; . . r ; , . , , , ! , , . . � � � � �� , . � , ; � , ' , ' . ; , i , ; , . , . • , � � � _ : _. �i — — —`- '' i i — , � i I � �' � a � ' F)' i : ' � " — � ; . � � , , fl , ; � � � � � ! , � � � " - . '— — l`,1 , ' ! . — �, =. �. ; ' b. _ . . - ' . ' � . . . � � � . . . . f " . . . . ' � � . " ' _ . . -F `J: . ' - . ' , r . �.. ., g i . - . . . ._ E"' ' . . _ . .. . , . ._ . - , ; _., _ .. � ., � .. "' "'. _.. — .. � - �: . . � � ...c. !3 - _ ' . _...... 1 i ' �� , . �� .. , . � i . ; � �� . . - �� ' _ - , �.a �� i � � � � _ � ` �� ' � � � I i i� ' s i � _ � �i ' � � ' , a . ; : ;. .�; i _ � ; �, � . . . _ . ... 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