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� � �,�_ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&I�EVE C _w . 21660 E.Copley Drive Suite 190 � (909)860-3195 F�(909)861-311'7 PRESS ��""' BITILDING PERMP!'APPLICATION _ FIRML.Y o ADDRESS ���,f,fj' y�JA�S(G'/-��+� �e�" ° DATE CATION��/���NUMBER� p/C � D TEE I�- �C�"�� CONST. GROUP APN LOT TRACT � � p. OWNER _ 2E w�' ADDRESS ' ' ZONING SETBACKS ` � CITY �Ha�„QrL;'��,zIP TEL. FRONT � RW ❑ ; APPLICANT � TEL. REAR � SIDElSlQESTRE RW ❑ �; CONTRACTOR SIDE � ¢= ADDRESS � �` C�TY ZIP�F,�TE PROPOSED USE o' ARCWENG! � z:° DESIGNEfi a; ADDRESS NO.DWEL. NO. NO. �� • UNITS STORIES BEDROOMS �; CITY ZIP TEL. q � �ESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION _ Q,` _ ... OWNER-BUILDER DECLARATION Or SFR/ADDlAEM Qy-� 1 HEREBY AFFlRM UNDER VENPLTV OF PEPJURV THA71 AM EXEFAPT FROM THE CONTRACTORS l4 � . Ga�d 8/C8 Oft � W �CENSELAWFORTHEFOILOWINGREA30N[gEC.70.91.60U51NE55ANDPROFESSIOMSCODE:ANYGTVOR (n; 9 � ' . �. -.,-C�;.COUNTYNRi1CNAEQU1pE5APERMITTOCONg7qUCT,AGTEfl.IMPROVE,OEM�USM,ORAEPA1pANYS1AUG ��� � (jj� Pa�lO/DBCI( - W,� .NRE,PRIoq TO ITS ISSUANCE,ALSO REQUIRES?NE APPUCANT FOR SOCH PERMIT TO FILE A SIGNEO >� W � . �.� S7A7EMEM THAT HE OR SHE 1S LCENSED PURSUAN7 TO THE PRDVISIONS OF THE CONTAAC70R5 l4 ' �� CENSE UW(CHA�TEfl B(COMMENCIN(i WITM SECTION 7000)OF�IVISION30F TME BUSINE55 AND Pfla ��� U'- POOVSp9 FESSqNSCODE)ORTHATHEORSHEI5E%EA1PTiHEREfROMANDTHEBASISFORTHEALLEOEDEXEMP• (� rs 710N.ANYVqLATqNOFSECTIpN7Uc{7,SBYANVAPPUCANTf-0qAPEflMITSUBJECTSTNEAPPUCANTTO �� z Re-Raof . �; ACMLPENILLTI'OFNOTMORETYIANFIVEHUNOREDDOLIARS(S5ooj.): � OI.ASONMEROFTHEPROPERTv,ORMYEMPLDYEESWITHWAGESASiHEIR50LECOMPEN5ATI0N, � 0 CommetC(e! �.;��.WILL DO TFiE WOFII(,ANO TNE STRUCTURE IS NOT IMENDED OR OFKEREO FOfl SALE(SEC.7aa,BUSI-' J �� �-._-.NESSANOPHOfE56WNSCODE:TNE(pMiRqCioRSUCENSEtAW�OESNOTRPPlYTO qNOWNEROF �: _� � ;� PAOPERTVWF{oHtllG➢SOR111PROYESTHEREON,ANDK'F10DOESSUCHWORKHIMSEIFOqHERSECFOR ` . 0:=��TNHOUGHHISORHEfiOWNEMPLOVEES,PROVIOEDTMqTSUCHIMPROYEMENT5AqENOTIN7ENUE�OR ' � - - W" OFFEREOWflSAI,EIF,FqWEYE{�tryEBU1lDINGORIMPROYEMENTISSOLDWRHINONEYEAROFCOMPLE- ' - Z? ��TION,THE OWNER$UIIDEfl N7LL HAVE THE BUfiOEN Of PROVMG TMq7 ME OF 5HE�IO NOi BUIID OR . - - _� iMPROVEFOR7HEPURPOSEOFSALE} � - �yJ� OI,ASOWNEROFTHEPflOPEHTS;AMEXCLUSNELYCOMMCTINGWITHLICENSEDCOMMC70R5 [[:. TO CONSTqUCi THE PHOJECT(SEC.7044,9USINESS ANO PROFES51(N�IS COOE:THE CONTRACTORS Lb � V21UetlOf1 A�J.AREA � �' CENSEIAWDOESNOTAPPLYTOPNONMEpOFAPROCERT/WHOBUILDSORIMPROVESTNEREON,ANp �. N7IOGOMMGTSFORSUC#1PR0.1ECTSW(TIIACONTMCiOR�S)UCENSEDPURSUA4T70TNECONTRAC � . QUANTITY DESCRIP7ION FEE � - � TOHStJCENSELAWJ. � - Q' ❑!AM EXEMPTUNOER SEC. B.S P.C.FOR THIS REASON � . �`s I�- 3 � & u'� OATE OWNER � F- - r - �� Z U s � � LICENSED CONTRACTOFS DECLARATION W ,r� � ' k � , T � . �.7HERE8YAFFtFMUN�ERPENAL7YOFPERJURYTNATIAMLICENSEDUNDERPqOVlSIONSOFCHA7TER ` p��, -r9(CpMMENCINOWiTHSECTiONT00o)OFDIVISION30FTHEBUS�NESSANDPROFESSIONSCADE,AND ,Z � f � .:'MYUCENSE IS IN NLl FORCEAND EFFECT, � - j � �..LICENSE CLASS__�LIC.NO.� .�s�'�' �/ � � +71 � E - �j �;DATE �L^"��i " CONTPACTOR p�, W ::. � � � ' WORKERS'COMPENSATION DECLARATION � j � " V � �.��:IH RE8' MUNDEpPENALTYOFPERJURVONEOFTHEf-0LLOWINa�ECLAMTIONS: Z ' � , IHAVEAMDWILLMAINTP.INACERiVICA7EOFCONSENTTOSELF-JNSUAEFORWOAKERS' _ . - . �PENSA710N,AS PROVID@D BY SEC710N 37000F THE LABOR CODE,FOR THE PERFOqMANCE U � /OPTHEWORKFORWHICHTHISPERMITISISBUED. � , W Y Q �I HAVEAND WILL MAIMAIN WORKERS'COMPENSATION INSUFANCE,AS REOUIRED BY SEC710N �_ 37000FTNELABORCODE,FOATHEPERFORMANCEOF7HEWORKFORWHICHTHISAERMITIS �n� . . ISSUED.MY WORKEAS'COMPENSA710N INSl1RANCE CARRIEfl AND POLICY NUMBER AfiE: CONSTFjUCT (� J : l -_ ? : CARflIEfl °C�!(/"j�'1 �� ,_. N flE�/tEW � .. . . Z� � FOLICYNUMBER ���1/'�i �, °-� ELECTRIC , Q - � - (MI3s[cTiONnIE�NOTBEQ7f.1PLEiEDOF7lEPERMRISFOnoNetur�ClREoaXials�g�ao)oaLEss). PLUMBING W Z� I CERTIFYTNAT MTHE PERFOflMANCE OF THE WORK FOFi WHICM TNIS PERMIT IS ISSUEp,I MECNANICAL - (S SHAI.(,NpTEMPLOVANYPERSONItJANYMANNERSOAST08ECOMESUBJECTiOTHE (A WORKERS'COMPENSATIONLAWSOFC0.LIFORNIA,ANOAGREETHATIFISHWLOB COME NSPECTIONFEE � SUBJECTTOTNENIOflKEfl5'COMPENSATIONPROYISIONSOFSECTION3700 OR � CODE,ISHALL�FO}RTHWITHCOMPLVWITHTH ov�sro'��/y�j CE '[DA7'7l � wy p DATE�� (a M< APPIICANT:��p�/�����11 /qLra�- � � SMIP'. ��;� ___a�T �' ENERGY PiC J�. WARNINO:FRIIURE TO SECUflE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALLBE �y SV&/ECTAN EMPLOVER TOCRIM!NAL PENAUIES AN�qVIL FINES UP TOONE HUNDREDIMOUSAN� ENERGY PERMtT - � �}�(' j (� 't � �r DOLLARS(S��AOo),INAODITIIXJTOTHECOSTOFCOMPENSATION,OAAAAGESASPROYIDEOFOqIN --Q � � SECTbN37080F7HELABORCOUE,WTEflEST,ANOATTORNET5FEE5. � RETENTIONFEE: n �. O� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: LITY OF DIAMCDN�R R _��'-:z; .�. IHEREBYRFFIRMUNDEqPENALTYOFPERJURVTHATTHEREISACON5TRl1CTIONI,ENDINGAGENCV �U�D� ���AC�A�yT�J . 0- FORTHEPERFORMANCEOFTHEWORKWRWHICHTHISPERMI7151SSUED(SEC.3o97,CIV.CJ. �==- L-1 W � LENDER'9 NAME - . F- LENDER'SA�DRESS � � -___�_ W ICERTIPYTHATIHAVEREADTHISAPPUCATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECL TOTAL FEES ` � p_, IAGREETOCqMPLYWITHALICITYANDCAUNTYORDINANCESANDSTATELAWSFELATINGTO8U1L01NG ��� /�� - . � CONSTRUCTtON.nN�HEREOYAUTHOflt2ERePRESENTATIVE50FTMI5COl1N7Y70ENT£qUPoN'!HE A / Z ABOVEdAEMiONED PROPERTY WR INSPECTION PURPOSES. / / COMMENTS �� � � �� s � ¢ PER NAME(Gfll p � � G� ' :. I ( � '__' . � 'tUREOFPERMfTTEE DATE - . . � � ' RECPT.NO. PAID BY � VALIDATION . WHITE-Dapartment Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-ApplicanYs Copy ��--,----�.._..=�_-o° ; �----�-- �--r---�-_-----� � I � " �i�� ` _ � � , ����--r'�'.; I � � � f i � f � � � � � i i ! i ����� � � i � � I E � �'',� i f � f ' � k � I € ! I � ( I i ! ! 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