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._.__._....--...._______. ... .. _L._.—,."'____. . . CITY OF I)IAMOND BAR � �'� — I3EPARTMENT OF C�MMUNITY&DEVELOPMENT SERVICES I I I � - Z 1825 E.Copfley I3rive - �404��6o-sissF��9o9>s6i-sti� PRESS `°'��K4��' BuyLvnv����T�rPLica�oN FIRMLY � JOBSITE ; �" `��' ,, �' ��� APpLICA710N PERMIT ' r � P/C o ADDRESST���a F`��%""lV��(di:� DATE � � � NUMBER��/ # o ISSUE �° n �`,, /�f TYPE OCC °-° APN LOT TRACT pATE �( i�'L'� ��1 CONST. GROUP p OWNER �ti�,iv'{���.i"� �"', " � � ADDR SS ZONING SEfBACKS ' oCITY N ZIP� TEL.�1���:�� FRONT RW ❑ APPLICANT TEL. REAR � � SIDE/SIDE STREET RW ❑ ¢ CONTRACT„ � SIDE � p� ADD SS a ,� � PROPOSED USE �°- � �+. � CITY ° r. , ZIP�TEL� 'r ._.... ._ . - • 4 • � oARCH/ENG! � � � ��� � iz DESIGNER NO.DWEL. NO. NO. n� ADDRESS UNITS STORIES BEDROOMS � CITY ' Z1P TEL. � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � � � OWN�CA-BUILDER�ECLARATION 5PR/A�D/AEM � � O s p I HERE9YAFFIRM UNDER P�NALT�V OF PEFJl1RY THAT I AM EXEMPT FROM THE CONTRACTORS LI� � GaragelCarport � . 'W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSMESSANDPROFESSIONSCODE:AMlCITYOR � COUNTYWHICHREOUIRESAPERMITTO�ONSTRl1CT,ALTE3,IMPROVE,�EMOLISH,ORREPAIRANYSTRUG W patio/Deck - . W ',.TURE,PRIOR TO Ii5 ISSUANCE,ALSO REQUIqES THE APPLICANT fOR SUCH PERMIT TO FlLc A SIGNED w ' �STATEMENT THAT HE OR SHE IS LICF1JSEa PURSUANT TO THE PROVISIONS DF THE CONTRACiOftS L6 �I � CENSE LAW(CHAPTER 9(COMNENCIIVG WITH SECTION 7000)OF DIVISION 9 OFTHE BUSINE55 pN�PRP � PooUSpa � �FESSIONSCODEJORrHATHEOR$HEI$EXEMPTTHEREFROlAANDTHEBASISFORiHEALLEGEOE%EMP- � V �TION.ANYVIOLATIONOFSECTION7031.59YANYAPPLICANTFORAPEHMITSUBJEGTSTHEAPPLICANT�O � R2-ROOf - � ACIYILPENALTYOFNOiMORETHANFINEHUNDRED00lURS155a0).): Q OI,ASOWNEROFTHEPAOPERTV,ORMVEMPLOVEE'sWiTH:WAGESASTHEiRSOLECOMPEN5A710N, � COrtlrtlefClfll ` Z ',WILL DO THE WORK.PND THE STflUCTURE IS NOi INTENDED OR OFFEFiED FOR SALE(SEC.7D49,BU51� J , � 'NESS AND PROFESSIONS CO�E:iHE CONiRACTORS LICENSE LAW OOES NOi APPLV TO AN OWNER OF ? �PROPERTYWH09lJIL�50RIMPRQVESTHEFEON,ANOWHODDESSUCHWORKHIMSELFORHERSELFOR '� � "THRWOHHI90RHEflOWNEMPLOYEE6,PROViDEDiHATSUCHIMPROVEMENT5AF7ENOTINTENDE�OR m ', QOFFEREDFORSALE.IFHOWEVER,�THEB,�ILOINGOflIMPROVEMENTI550LJWITHINONEYEAROFCOMPLE z TION,THE OWNER-BUILDER WILL',HAYE;'THE BURDEN OF PROVING TFIAT HE OR SHE DID NDP BUIL�OR .� IMPROVEfOqTHEPURPOSEOFSALE).�i r " W ❑I,ASOWNEROFTHEPROPERTY,+AMEXCWSIVELYO�NTRAGTINGWITHLICEf7SE000NTflACTORS , „�.-r � TO CONSTRUCT THE PROJECT(SEC.1d'A4,BUSINESS AND PROFESSIONS CODE:7HE CONTPACTORS LI- V8I118Si0�� ADJ.AREA CLJ CENSEL4WDOESNOTAPPLYTOANOWNEROFAPFO?ERTYWHOBUILDSOF{MPflOVES7HEREON,AND � �WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S�LICENS'c�PURSUANii07HECONiflAC- QUANTITY DESCRIPTION FEE Y TORSLICENSELAW.J. � ❑IAAA ExEMPf IiN�ER S�C. &4 P.C.FOR iHIS REASON � 'S — V IL � ' DATE � �, '�'� OWNEfl . U Z W � LICENSED CONTRACTOAS DECLARATICN w ¢ , � IHEREBYAFFIRMUNDERPENALTYOFPERJURYTHATIAMLICENSEOUNDERPROVISIONSOFCHAPTER � � 9(COMMENCING WITH SECTION 7doo)O�DIVISION 3 0F THE BUSINESS AND PROFESSIONS COOE,AND Z �X MV LICENSE IS IN FULL FORCEAND EFFECT. ( �� y� m � LICENSE CLA55_`���_ LIC.NO,�! (�� � U DATE �� CONTfiACTOR 0- W � WORKERS'COMPENSATION�ECLARATION ¢ N V � IHEREBYAFFIRMUNOERPENALTYOFPERJl1RYONEOFTHEFOLLOWINGDECLARATIONS: Z Q � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELFINSUREFORWOflKERS' _ COMPENSATION,ASPFOVIDEDBYSECTION37o00FTHELABORCODE,FORTHEPERFORMANCE U a OFTHEWOflKFORWHICHTHIS',PEPMITISISSUE�. � � W IHAVEANOWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREQUIREDBYSECTION ",� Q 37ooOFTMELABORCOpE.FOR�THEPERFORMANCEOFTHEWORKFORWHICHTHISPCRM1T15 � ptl �� ISSUED.MY y(OFjKE.4'COMP\E�I$,r�A�T�ION INS RANCE CARRIER AND POLICY NUAABEpARE: CONSTRUCTION 4� A � CAqRIER ^�:�,��n��+3'�� PLAN REVIEW Z POLICYNl1MBER ELECTRIC ¢ Q (iIiSSECTh7NNEmNOTBECCMPLEfE�OFTHEPERMffISFORONEHUhDREDWLLARS($100)ORLESS). PLUMBING z � I CERTIFV THAT INT4E PERFORr;tANCE OFTNE WORK FOR WHICH TNIS PERMIT IS ISSl1ED,I MECHANICAL C} ' SHALLNOTEMPLOYANYPERSONINANYMANNEFSOA5T09ECOMESUBJECTTOTHE � WOPKERS'COMPENSATION LAW$OF CAUFORNIA,ANDAGREETHA7IF I SHIXiL�BcCOldE INSPECTION FEE � .. SU6JECT i0 THE WDF:(ERS'COIv7PEN5ATION P.aOVISIONS OF SECT�ON 37o00F THE LABOFl j CODE,I SHALL FOR7HWITH COMPLY WITH THOSE PftOViSIONS, ISSUANCE �� � � '�': SMIP � � p DATE: APPLICANT: _— w �''� ENERGY P/C J , WARNINGFAILUftETOSECUREWOP,KEF15'COMPENSATIDNCOVERACEISUNL4WFllL,ANOSHAL!_8E J . SUBJECTANEMPLOVERTOCRIMINALP�NAL7IESANpCIVILFIM1ESUPTOONEHUNDREDTHOUSAND LL �� DOLLARS(51aD,00OJ,INADDITIONiOTHE"COSiOFCOMPENSATION,DAMAGESASPPOVIpEOFORIN ENERGYPERMIT JSECTION3]OBOFTHELABORCODE,INT�REST.ANDATTOHNEY'SFEES. �� � , RETENTION FEE: Q � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: , 4 � I HEHEBV AFFIRM UNDER PENALTVOF P�RJl1RV THA7 THERE IS A CONSTHUCTION LENDMG AGENCY FOR THE PEftFORMANCE OF THE NlOPK FOR WHICH THIS PERMIT IS ISSU[D�SEC.309],CN.CJ. Z LL1 � LENDER'S NAM= F_ , LENDER'SA�DflE55 � __ �� T07AL FEES ���,�(� ; ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEA60VEINfORMATIONISCORRECT. � I AGREE TO COMPLV WITH ALLCITV AN�COUNTV ORDINANCES ANO STATE LAWS REIATING TO BUILDING � : CONSTRUCTION,ANDHEREBVAUTHORI�EREPRESENTA7IVESOFTHISCOUN7YTOENTERUPONTHE Z 'ABOVE-MENTIONEDPROPERTVFORINSPECTIONPURPOSES. COMMENTS - o �{�, ��C�\ �1 � 'CI�.Rs` ��°�`T 1� m P M EEN`�E(PFINT, - �" ,a'6'!�'�,��� � � _ t'' � '� $IONA URE PERMI �A _ � RECPT.�'O. PAIDBY _ VALIDA710N ~ WHITE—Department Copy.YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GFEEN—A licanfs Co PY, qY, PY� PP PY � _,. __ .. ,„��r� -�� •- �. x . � , '; �' � � � � ., , . ,� w .. _ ,. �a��"�:s�s m�' "�,e F,p���" `�.�..'� aµ', ro �` x "� �`..,, �` a 's.;; a .., � "�;�.j e �..� a�.t r �.? s ;s� p _ �, a-' a � y + € � y;�'�� �"' ..'# i �{",. ;"i 4 � 5 v * F k Y:`, L 5 �" � �•�'.:�� � � € l � r h "B :.,� �: ', .�xi'�� `�,';�e'�x ;�...::�� .�"�M�.�' . '. 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