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CITY OF DIAMOND BAR �� ^--�!�--� DEPARTMENT OF COMMU1vITY&DEVELOPMEN'T SE]tVICES � E : � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS � ���%m'�� BUII,DING PERMTd'APPLICATION � FfRMLY ¢ DDRESS �� !� `h./i}1Yf2c7f'+C���R - �/`C3 DATE CATIQN('�_"�,�1� NUMBER #C � �~�'�� $ ISSUE �-�--_i TYPE a OCC -- APN LOT T�iACT DATE CONST. GROUP p OWNER c..'s` '�2� ° �'j.4 �/uP '- o ADDRESS f�. ' � ��' *�,�� ZONING SETBACKS � CITY_11::',e�G.s"��:���tP � x TEL. � �"'� FRONT RW '�l APPLICANT��— TEL. SIDE'SiDE STREE:T RW C � CONTRACTOR_f LtJi� l� .� SIDE ! ❑ o ADDR F.11r'7 �'. G r�- � e ��r.� x�1�-��L��s`3 PROFOSED USE , �r'rrC.� sJ�3-�i4-1. i:�r},vJ-.��� �, w A WENG/ a� ZIP T �-,�-f 4'ha��- c'e'ac�.-��.r . aO DESIGNER ADDRESS NO.DWEL. NO. .. NO. UNITS STORIES BEDROOMS � CITY ZIP TEL. y � DESCRIPTION SQ.FT FACTOR PSF ADJ.AREA/VALUATI�N p� OWNER-BUILDER DECLARATION SFFVADDIREM i O I HEflEBY AFFIRM UNDER PENALT'�PERJNiV THAT I AM E%EMPT FPOA1 THE CONTqACTORS LI� G8fe90/Ce�pOfl W CENSELAWWRiHEFOLLOWNGfiEASON{SEC.7o9t.58USINESSANDPqOFE5510N500DE:AN�CITYOR (f� U COUNTYYNi1CNREWIflESAPEflMRTOGONSTAUCT.ALTER.IMPROVE,DEMOLISM,PRREPA1flA4Y5TRUC- U.I patio/Deck TURE,PRIOR TO ITS ISSUANCE,ALSO RC-0UTAES THE APPLICAM FOR SUCH PEi1MR 70 FILE A SiGNED W STATEMENT iHAT HE OH SHE IS LICENSED PURSUANT TO THE PAOV!SIONS OF THE CANTqACTOpS Lb W � CENSE LAW(CNRPTER B(COMMENCINO WITH SECTION�000)OF DIVISION 3 OF THE BL'SINESSAN�PRO� LL POOVSpH FESSIONSCODE)OflTHAiHEORSHEISEXEAIPTTHEREFFOMAN07HEBA5I5FORTHEALLEGEDE%EMP� (� TqN.AM'VKKATIONOFSECT70N703166YANYAPPLICANTFOPAPERMITSUfl7ECTSTHEAPPL�CANTTO Z Re-Roof F AqVILPEkILLTYOFNOTMORETMANFIYEHUN�REDDOLLARS(SSoO�.): — � ❑I,ASOWNEROFTHEPROPEHTV,ORMVEMPLOYEESWI7HWAGESAS7H'cIRSOIECOMPENSAT:ON, � CommerCi81 N7LL 00 7HE WORK,ANU THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.70e�,BU51- J � NE55 M1D PAOFESSIONS CODE:7HE CON'RACTORS LICENSE lAW�OES NOT RPPLYTO AN OWNER OF ? PROPERTY N?IO BUILDS OR MPRDVES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HEPSELF Oq Q THp01/(IHHISORHEROWNEMVIOVEES,PROVIOE�TNAT5IJCHIMPROVEMENTSARENOTINiEN�EUOA m � OFFEREDFORSALEIF,HDWEYERTMEBUILDINOORIMPqOVEMENTISSOIDWITHINONEYFAROFCOMPLE- z TION,THE OWNER-BVILDER NILL HAYE THE BUADEN OF PROVING 7HA:NE OR SHE aD NOT BNLD OR � IMVROVEFORTkEPURPO5EOF5ALE1. U 1,AS OWNEROF T}iE PROPERII;AM EXCLUSIVELY CON7RAC i ING W�7H LICENGED CONTRACTORS � TO CONSTRUCT TTIE PR0.IECT(SEC.704�,BUSINESS AND PROFESSIONS CO^E:TNE CONTRACTORS u� Valuation. . �;� � ,ADJ.AREA W CENSEL7IWDOESNOTAPRY70ANOYVNEFIOFAPROPERTYWH06lJILO50RIAiFROYESTl7EREON,PND . � N41000NTRACTSFORSUCHPROJECT6WITHACONTRACTOR(&)UCERSEDPURSUAai'T?OTNECONTRAC- QUANTIT'( DESCRIPTIO�V FEE Y TORSl10EN5ELAW.)_ � ( / J^ o ❑IAM E%EMPT UNDER SEG B.6 P.C.FOR THiS REAS Q � C N'Y � ! ' I— �' � -- V l � � D�7E oYlNER ,_. _, I U Z �y � LICENSED COP1TFtACTORS DECLARATiON W ---yyy--- I HEFEBYAFFIRM UNDER PENALTV OF PERJURY THqi I AM LICENSc'�J UNDEA PaDVISIONS OF CNAPTE� Ln � � e(CDMMENCINGW7THSECTION7000�OF�IVISION3GFTHEBUSINESSANCPFOFESSiD.'�'5CODE.AND Z _ 66J ���CEWSE IS IN FULL FOqC'c AND EFFECT. m � LICENSEC SS - L^I�G�LiC.NO. ��r� ���_ � V �,gp � pp J �j �ATE 'C""�, _ CON'fiACTOR../_�"<`.�-1.r�,-3�1yN„��.s� Q. W l� � WOAKERS'COMPENSATION DECLARATIOY �, �-��v- � � I FIEREBYAFFIRM UNDEfl PENALT,1'OF AERJURYONE Of TNE FOLLON.'ING DEIXAAATIqNS, Z I Q 0 _�HM/EAND'NILLMAINTPSYACERT!SICATEOFCONSENTTOSELF-INSU9EFORWORKER5' _ 'Z�- COMPSNSRTION,pS VFlOVIDEC BV SEC.'TION 3'!W OF THE LABOfl CO�E.FOR THE PERFGRMANCE � W __— Uf 7HE WORK FOF YdHICH TH5 P'cRMIT IS ISSUED. � ElJ q/� _bi_I HAVEAND WILL MAIMAI"r!WORNERS'COMPENSATION IiJuUqANCE,AS RE�UIREO BY SECTION ��� L / Q � 3]OOOFTHE11idOR�DE,i�ORiHEPERFORMANC�OFTHEWOFlKFORWHiCHTHISPERMITIS I. ISSUEO.MY RKEPS'WI�f.Pq�15ATION INSUFANCE CFR�9iEfl AND POUC! untecR awe: CONSTflUCTION ___ J a cnaRiEp �yy � ���� "" PLAN REV;EW � � ��� Z POLICYNUMBER („+� G�.�I�n 7�C� �� ELECTRIC _� _ � �� B 0 (TH55EGTYJNNE�N076ECOi`RL[fEDOFTFE?EM4fISF0?ONEFM1AQ)PE�CCiUSlSry1G.^�ORlESSl PLUMBING Z I CERTIFYiHA7 iN TNE PERFORMANCE OF iHE WORK FOR WHICH THIS PERA�R IS ISSUED.I MECHANICAL ,______ (� SHALLNOTEMPLOYANYPERSONIN/Nf�MANNEft50NSTOBECAME5U8JEG�TOTHE � WORKERS'COMPENSATION UWS OF CALIFORN10.AND AG E THAT IF I SHOU:D BECOME INSPECTION FEE _____ � SU&IECTTOTHEVJORKERS'COM�E45AT FiOVISlO'. FSEC710N37o00FiH=LABOR COOE,ISNALLFORTHWIiNCOMPLYW' TM SEP :CNS. ISSUANCE C_` E p �ATE:�9-�' APPLICA : ���- •'� ��"� SMIP � R � �-- ����-�-� � � WARNINGFpIWRETOSECUREWORKER�' OMPE � IOYCOVER0.3E�SVNIAWFUL.ANDSF7ALLBE ENERGYP/C ._ J � SUBJECTANEMPLOVEflTOCftIMINALPENALTIES CNIIFMESUPTOONEHUNOREDTNOUSAND ENERGYPERMIT , �' DOLIARS(f I00,000�.IN ADDITION TO THE COS'OF COMPENSATION.�AMAGES AS PROVIOE�FOR IM ---- ! J SECTION37080FTM'eLAB09CODE.�NTERE5T.0.NDATTORNEY5FEE5. qETENTIONFEE: � � "—_ �a CONSTRUCTIONLENDINGAGENCY PRE-ALTFEE: ___ � IHEREBYAFFIRMUN�ERPENALTYOFPERJURYTHRTTNEREISACONSTRUCTIONLENDINGAGENCY FOR iHE PERWRMANCE OF THE WOAK FOR WHlqi THIS PERMIT IS ISSUED�SEC.3CD'1.CIU C.). Z W — � LENDENSNqME _,_ F— LENDER'S ADDRESS � ICEFRIFYTHATIHAVEREAbTHISAFPLICATIONANOSTATE7FIA7THEA80VEINFORAlA710NI5CORRECT TOTAL FEES � IAGREETOCONPLYWITFIALLCINANDGOUNTYORD�NANCESANDSTA7ELAWSRElA79NGTOBUI:DING ����� ��( R CONSTRUCTION,AND HEREBVAUTNORIZE REPFESENiATIVES OF THIS COUN7V TO ENi ER UPON THE � � Z ABO IONED PROPERTY FOR INSPECTION PURPOS[S. COMMENTS_ 4 � � � �/1�� �J�� �jry y��/ J � V�� � `//`K-9�R.�/L_ � m PER N (?RINT) � ____ d � � GNATUR F PERMIITEE DA7E .� _ � RECPT.NO._ " ?AID BY _ y� VALIDATION ~' WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENR06—File�o�y,GREEN—Applicant's opy , ., : ..... . ,..,.,r . ._.. . ,.. ,, . , k . :, . , ..:. - . ,;. ,. „ .; ..., .�, . �.. , , . �, � , ;;. � , ,. �� �.'� � .`�. . 3 rk�;s Y � - y +r � � - "� ' � - ` � : .; �, .• � > :: t, .. �' d r:�' y �. s ,9 �::" � x,� H t� t� . ..-. .� �. �, .; S ., i '� "'4 � � d '.: . ..�•. ' ..4.• �k,.".• e x: Fi< . � -w � F.i..u.,.' ,.. s u . a .. 5 , t 1 . g y � � .:' i.c.'-. ... .:. - �rf ..: i v .... . .. .. . . . ` . . .. .. . .. .. : .... .. . i. .�. � ! �_. } :� ,..i�� . .. 4.:1., -... 3 ..',. _ . . ........ 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