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;-1 -----��i'`�-- CITY OF DIAMOND BAR. j�'� COMMUNTI'Y DEVELOPMENT DEPARTMENT -,,� 21660 E.Copley Drive Suite 190 PRESS , (909)860•3195 Fax(909)861-3117 �`"y""Y BUILDING PERMIT APPLICATION FIRMLY � N^ JOBSITE Q. APPLICATION PERMIT�� /C o� ADDRESS �2� Q� �� C��'C- ^�� DATE 2 �� NUMBE # o`. ISSUE TYPE OCG °-°" APN LOT TRACT DATE CONS7 GROUP � OWNER Oi p_' ADDRESS `7_ZLT(l YVJ C�.�,'C. ZONING SETBACKS Z CITY VJ� (�i'..re--. ZIP i9 1'Ib�TEL. U� �� FRONT RW ❑ APPUCANT TEL, ftEAR ❑ z' SIDE/SIDE STREET RW ❑ m CONTRACTOR S�DE C �; ADDRE S `Z-- - "�r � PROPOSED USE �� J�-� 'eT 1 S 1 G/+°'�'1""5� q� w� ARCH/ENG/ � ZIP �FEL. � CiV�ti.�`r.,� �Z� i�P.�__/L_ F' IA frA/1nll � E� W' DESIGNER ��v�"�-- NO.DWEL. NO. NO. a.; ADDRESS ` UNITS STOR�ES BEDROOMS � CITY — — ZIP----- TEL. _ g �- DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ' ��� - . OWNER-BCILDERDECLARATIDN . SPRlAD�/REM � � O � p:. I HEREBY AFFIflM UNDER PENALTY Of PERJURV THAT I AM EXEMPT FFOM THE CONTRACTORS LI . G2l2J2/CBfPOR� W� CENSELAWFORTHEFOILOWIhGflEASON(SEC.7031.58USINESSANOPROFESSIONSCODE:ANYGTYOR t' (n , �, .COUMYWMICHflEOUIRESAPEFMITTOCONSTRUCT,AITER,IMPROVE,DEMOLISN,ORREPAifllJ�YSTRUC W PatiolDeck - . -W. 'TURE,PRIOR TO ITB ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED ' W STATEMENT THAY HE OR SHE IS LICENSE�PURSUANT TO THE PRDVISIONS OF THE CONTRACTORS LI- . �� CENSE LAW(CHAPTER 9(CAMMENCING WRI�I SECTION]000)OF DIYISION 30F TI1E BUSWESS AND PRO- i LL' DOVSPd - � -FESSIONSCODE�ORTHATHEORSHEISEXEMPTTHEREFqOMANOTHEBASISFORTHEALLEaEDEXEMP- - � TION.ANYVIOLATIONOFSECTION7031.SBYANYAPPLICANiFORAPERMITSUBJEGTSTHEAPPLICANTTO --� RB-ROD( � ACIVILPENALNOFNOTMORETHANFIVEHUNDREDOOLLARS(qSOD).); ' Q_ LJI,ASDWNEROFTHEPROPEPTY,OFMYEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, -❑� COIT711181C181 Z- .WILL DO TNE WORK,ANO THE STRUCTURE IS�OT INTENDED OR OFFEREO FOR SALE(SEC.7044,BUSI J NFSS AND PROFESSIONS CODE THE CONTRACTOFS LICENSE LAW DOES NOTAPPLY TO pN OWNER OF I:_ � PROPERTYWHOBUILDSORIMPROVESTHEftEON,ANDWHODOESSUCHWORKHIMSELFORHERSEIFOfl ` � - � fC- , THR�UGHHISORHEAOWNEMPLOYEES,PROVIDEDTHATSUCHIMPPOVEMENTSARENOTINTENDEDOR � �' OfFEREDFpPSALE.IF,HOWEVER,THEBUiLDINGOFiIMPROVEMENTiS50LDWITHINONEYEAROFCOMPLE �- � ' TION,7HE OWNER-BUIIDER WILL HME THE BURDEN'OF PROVING THAT HE OR SHE�ID NOT BUILD OR � . �- IMPftOVE FOR THE PURVOSE OF SALE). W OI.ASOWN[ROFTHEPRORERTY,AMEXCLUSIVELYCO4TRACTINGWITHLICENSEDCOMRACTORS � TO CONSTRUCT THE PROJECT(SEC.7046,BUSINESS AND PROFESSIONS CADE:THE CONTFiACTORS LI- : VeI112tI0I1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPEFNWHOBUILDSORIMPROVES?HfiAEON,AND � � WHOCONTRACTSFORSUCHPRQIECTSWITHACANTRACTOF(S)IICENSEDPURSUANTTOTHECONTRAP �- QUANTITY DESCRIPTION FEE Y 7oRS LICENSE U1W.1. � .. - d�. J � ❑I AM EXEMPT UNDEIi SEG ._ - .9.b N.C.FOfl THIS NEASON � �Q"' �- � V � � ff : DATE ONMER - U _ � W �- � ,. LICENSED CON7RACTORS DECLARATION , W 4 CL :.i HEREBY AFFIPM UNOER PENALTY OF PERJUpY THAT I AM IICENSED UNDER PROVISIONS OF CHAPTER� ''- � d- '9(COMMENCMGWITHSECTION7000)OFONISION30FTHF0t15INE55AN�PROFE5510N5GO�E,ANO Z X -MY LICENSE IS IN fULI.FORCE AND EFFECt � m . � .�LICENSE CLASS e_3� LIC.NO. �l �"�� � I�- . j � V��DATE 1 O `� 4'� BL I CONTRACTOR_ .:' � �- W. �� WORKERS'COMPENSATION DECLARATION��r��-�� ��� Q �� = U � IHEREBVAFFIRMUN�ERPENALTVOFPERJURYONEOF7HEFOLIONlINGDECIAR I NS �. Z a � �.. IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-MSUREFORWORNERS' 2 ' Z� COMPENSATION,ASPROVIDEDBVSECTION37o00FTHELABOf1CODE,FORTHEPERFOflA1ANCE U � Q OFTHEWORKFORWHICHTHISPFf1MITISIS5UE0. g � . W- �IHAVEANDWILLMAINTAINWORK[fiS'COMPENSATIONINSURANCE,ASREWIREDBVSECTION y�JJ��� 4'- 37ooOFTHEI.ABORCODE,FORTHEPEFFORMANCEOFTHEWORKFORWHICHTHISPERMiT15 `'j y� � �- ISSIIED.MV WORKEflS'C,OqMP-ENSAI ION INS CE GP�RIEft PND POLICY NUMBERARE:� CONSTRUCTION �^'�`� j� CARRIEP ' I/ ' � PLAN FiEVIEW _._ 0 POLICYNUMBER E�ECTRIC Z Q 0 (1}iISSECTK)NNEmNOTBECOA7P�ETE�OFTHEPEWARISFORONEHUNDRE�DOLU3iS(SiCO)ORL PLUMBING Z. I CEFiTIFY THAT IN THE PERFOHMANCE UF THE WORK FOR WHICHTHIS PEFMIT IS ISSUED,1 MECHANICAL (!$ SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESUBJECTYOTHE � . (n WORKERS'COMPENSATIONLAWSOFCALIFOHNIA,ANDAGREETHHTIfISHOULDBECAME INSPECTIONFEE � - " "O V"�+ � � SU&IECTTOTHEWORKERS'CON�PENSATIONPROVISIONSOFSECT�ON37000FTHELA60R q�,,� �J` � CODE,ISHALLFORTHWITHCOMPIVWITHTHOSEPROVISIONS. ISSUANCE ��Y g,,�� _�__A —G�/ i p DATE: _ APPI.IGAM: _ SMIP ��V J. WAHNING FAILURE TO SECURE WOPKERS'COMPF.NSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C p � SU&IECT AN EMPLOYERTO CRIMINAL PENALTIES AN�CINL FINES UP TO ONE HUNORED THOUSAND ENERGY PERMIT ?�� ,a �OLL4RS�5100.000).IN ADDITION TO THE COST OF COMPENSATION,D0.AAAGES AS PPOVI�EO FOR IN J- SECTION37080FTHELAHONCODE,MTEREST,pNDATTORNEY'SFEES. RETENTIONFEE: - 2 d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: __ � - ..- ._-------- . _ � IHEREBYAFFIRMl1NDEFPENALTYOFPERJURYTHATTNEPEISACONSTRUCTIONLENDINGAGENCY FOR THE PERFORMANCE OFTHC WOfiK FOR WHICH THIS PERMIT IS ISSUE�(SEC.3o97,CIV.C.). . Z. W �- LENDER'S NAME - - V_— LENDER'SADDRE55 � W ICERTIFYTHATIHAYEFEA�THISAPPLICATIONFNDSTAiETHATTHEABOVEINFOflMATIONISCOFREGT. �OTAL FEES , , � �AGREE7000MPlYWITHALICITYANDCOUNTYORDINANCESANOSTATEIAWSRELAT�NGTOBUILDING , . {B � CONSTRUCTION,ANDHEREBYAUTNORIZEREPRFSENTATNESOFTHISCOUNIVIOENTERUPONTHE Z A60VEME IONEDPROPEflTVFORINSPECTIONPURP05�9. . COMMENTS � � S � �L1V- ` . .- . " . � __ _ _ ¢ PEFMITTEENAME ) � .���/��'7 � � �� 1 � SIGNATURE FP ,ITTEE DATE � �� - ' ' = RECPT.NO. PAIO BY VALIDATIO __.._.... ,-..,��.� ._._�,. ..._.____ ._ _� . .. F- .. . . .. . . . . ._... �.. . .-- - - - --' .-,._,.--- ...._ . . : � f i I ; : � i } j � ' � • I � � f I � � , , � � � I � � , f j 3 � � a t ; � � � j � i ( � � ( i � j ' � I E � i i I � i ' i , � � ! . � + � � .� 1( � � � � _E � � i i 3 ,� ' � � � I � � C � � � € f � I � �� � I ' ' E i � � � �: ' � � � , � � � ' i � I ' � � � I j ; ! � ' � 3 I I � I i � j � � , � 1 � � ' I � � � � � � ji � � # j � � - � �,'�. 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