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Home My WebLink About13809 '� ��/ �� CITY OF DIAMOND BAx DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES .,,',� 21660 E.Copley Drive Suite 190 (909)8643195 Fax(909)861-3117 PRESS �''�" BUII.DING PERMIT APPLICATION FIRMLY o� JOBSITE � CJ � APPLICATI PERMIT ,� L-�; �/C C�'� ADDRESS �� d� �L��I "�rL D1� DATE ' �� NUMBER�_ / � ISSUE � TYPE OCC -- APN LOT TRACT DATE CONST. GROUP p OWNER ��'►'✓1�1� (JL�"hr (�j. p ADDRESS_� �UI �S�'G'YL'V �T-�= ZONING SETBACKS W (`,17Y LpS y}/Lr^ if(� W�/p FRONT � —�_ ZIP� TEL RW ❑_ APPLICANT TEL. REAR � � SIDEISIQE STREET RW ❑ CONTRACTOR �L•�•WL7VTZ SIDE �_ � ADDRESS�,} LTUA/ rQ,((�_�;,vl�y �R ✓�� C�TY I I � ZIP �l2LL+6 TEL.�f�1�7i1I76 27� PROPOSED USE l��'r� J W ARCH/ENG! z DESIGNER ?AGL� CNLZ PR�� " N0.DWEL. NO. p. � ADDRESS� � UNITS STORIES BEDROOMS � CITY in� ZIP�_ TEL.�I N�1-72-5/- � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O 1 MEREB'/AFFlFVA UNIDEfl PENAL7Y OF PE0.NRY THAT I M/EXEMPT FROM THE CONTRACTORS L6 Gefd B/Cfl W CENSEUWFOR7HEFOLLOWINGqEA50N(SEC.7031.58USINESSANDPROFESSIONSCADEANVCITVOR (n 9 �rt � CWNTYWMICHREOUIRESAPERMITTOCONSTRl1CT.ALTER,IM7ROVE.DEAfOLISH,ORREVAIFANVSTRVC- W patio/Deck W NRE.PRIOR 70 ITS ISSIIiWCE,AL50 REOUIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNED W � STATEMENT THAT HE OR SHE IS IICENSED WRSUANT TO THE PROVISIONS OF THE CONTMCTOFS LI� � CENSE L4W(CFUVTER B(1%1MMENCINO WITH SECTqN 1W0)Oi�IVISION 3 OF THE BUSINESS AND PRD� LL' POOUSPa FESSqNSCODE)ORTHATHEORSHEISEXEMPThiEREFqOMANDTHEBA515FORTHEALLEGEOEXEMP- (� V TION.ANVVIOLATqNOFSECTIIXi1031.5BVANVRPPLICANTFORAPERMITSU&lECTSTMEAPPLICANTTO Z Re-Roo! � �CML PENALTY OF NOT NIOqE THAN FIVE HUNDflEO UOLURS(5500).): O OI,ASOWNEROFTHCPflOPEiiTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 CommefdBl ,� O Z M�LL DO 7HE NroRK,AND(NE STRUCTURE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.7oaa,BUSI- J �`•� � NESS M!D PROFESSIONS ibDE',THE CONTRACTORS LICENSE lAW OOC-S NOT APPLV TO AN OWNER OF PiqPEfiTYWFqBUILD5Q91MPROVES7HEREON,ANOWHODOE55UCHWORNHIMSEIFOHHERSELFOR � CL THROlN3MHISORHEROWNEMGLOYEES,PROVIDEOTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m O OFFERE�FOqSALEIF,HOINEVERTMEBNLDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE- Z TpN,THE ONMER-BVIIDER WILL MAVE THE BUflDEN OF PROVING TFIA7 HE OR SHE OID NOT BUILD OR � IMPROVf FOq TME PURPaSE OF SALE�. W ❑i.ASONTIEROFTHEPROPERTV,AME%CLUSIVELYCONiMCTINGWITMLICENSEOCOMRACTORS ? � TO CONSTRUGT THE PRO;�ECT(SEC.�oH,BUSINE55 qNU PHOFESSIONS CODE�.THE CONTRACTORS U- VelUetiOfl 4 ADJ.AREA W CENSEUWDOESNOTAPPLY7oANONMEROFAPROPERTYWHOBUILDSORIMPpOVESTMEREON,AND — � W1qCONTRACT5FOR5UCHPR0.IECTSWITHACONTPACTOR�S)LICENSEUPUHSUANTTOTHECONTMG QUANTIN DESCRIPTION TORS LICENSE UW.). FEE � J O ❑I AM ETEMPT tINDER SEC.__ B.b P.C.FOR THIS REAu"ON Q 3 � � o�rE owNER � � IICENSED CONTRACTORS DECLARATION w � 1 HEREBY AFFIRM UNDER P'ENALTY OF PEiLIUPY THAT I AM UCFNSEO UN�ER PROVISIONS OF CHAPTER � � Y(COMMENCINO WITN 5ECTIGN 7000)OF DIVISION 3 GF THE BUSINESS AND PROFESSIONS CODE,AND Z — �t MY LICENSE IS IN FllLI LCHCE ANO EFFECT. m LL1 /� / � LIGENSE CLAS'�J UC.NO.. _�/��`b�9/_ � V DATE dI'�L"` �`�"� ____ CON?RACTOH +�L��✓I�L d W �� WORKERS'CUMPENSATIQN DECLAHATION ¢ � U � I HEfiEBV AFFIRM UNDER PENAITV OF PERIURY ONE OF7HE WLLOWING DECURATIONS: Z � __IHAVEANDWIILMAMTAINRCERTIFIf.ATEOFCON5ENT7C5ElFINSUREFORWOqKERS' a _ � IXM/PENSATION,AS PPOVIDED AV SGCTIIXJ 3700 OFTHE LC6(M CODE FOR TNE PF.PFORMANCF U O OF THE 1VORK WP�..WHICH THIS PERMIT IS ISSUED. � W �I HAVE NiD WILL MAMTNN WOHKERS'(:OMPENSATION INSURANCE,AS REQUIRE�BV 5[CTION Q a�ooOFTHELAHONCWE,FORiHEPERFOHMANCEOFTHEWORKFOFWHICHTHISPERMITIS �J ,�� „.�� ISSUED.MY WORKL=RS�''C^CAA^PEN,S•AT�ON INSURANCE CARR!ER ANO POLICY NUMBER ARP CONSTRUCTION _ [ � CARRi�p.�ri��J'CY'�J 'Sa�C.^C PLAN REVIEW Z va.�crHUMBEe_l�_/}�/?��-' ��/} a�- . ELECTRIC a - 0 (n+s:,�cmavr��noreec�va�ooFn�ve�r,nrr�sroaoNEruror+e000uarasgim�a��Ess�. PLUMBING r' w ��f3c�:: I CER7IFY THAT IN THE PERFORMANCE OF THE WORK FOR WNICH THIS PEAMIT:S ISSLIE�,1 MECHANICAL � SMALL NOT FMPLOV ANV PERSON�N ANV MANHER SO AS TO BECOME SUBJECT TO THE (n WGRKEPS'COIAPENSATION UWS OF CALIFORNI0.,ANO AGREETNAT IF I SHOULD BECOME INSPECT�ON FEE � SUAI£�TTOTHEV1fiRK[RS'COIAFENSATIONPROVISIONSOFSECTI043100OFTHELPBOFl � • �r�y� � CODE,I SHALI FOFlTHWIiH COMPCr WITH THOSE PROYISIONS. ISSUANCE ] L� O � � . � DATE:_____.. APPLICANT� SMIP f"�prj. . �. � '�� ., W �Jd A .. � J WARNINO:FAILUFE TO SECURE WOPNERS'COMPENSATION COVERAGE IS UNL4WFUL,AND SHALL BE ENERGY P!C ,R. �r�y�-'� +[��1'� �� . SU6IECT AN EMPLOYER TO CRIAIINAL PENALTIES Ml�CIVIL fINES UP TOONE HUNDRED THOUSAND �U�.1lh 1V��- 1 � ENERGY PERMIT DOLLARS(S1oo.000�,IN PD(tITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOfl IN J SEC710N 3708 OF THE LABUR COD'c,INTEREST,AND ATTOflNEYS FEES. /� w _ RETENTION FEE: -�`qC O CONSTPUCTION LENDING AGENCV PRE-ALT FEE: � 1 HEREB�AFFIRlA UNDER PENALTV OF PERIUFV iHAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PEflFORMANCE OF iNE WORK FOR WNICH iHiS PERMIT IS ISSUED(SEC.]09],CIV.C.). -��-- Z ��' _,��1� �� LENDER'S NAME `' F-- LENOER'SAODRE55�,,yr ��4� ��'�'u N�� I CERTIFV iHAT I HAVE READ THIS APPLICAiION AND STATE THATTHEABOVE INFORMATION IS CORRECT. TOTAL FE ES i " �� dW I AGREE TO COMPLV WITH ALL qN pND COUNTY ORDINANCES ANO STATE UWS RELATING TO BUILDIN� ` � CONSTRUCTION,AND HERfBY AUTHORIZE REPRESENTATiVES OF THIS COUNTV TO ENTER UPON TME Z ABOVE-MENTIONED PROFFRTY FOR INSPECTION PURPOSES. COMMENTS � SV�-C'-oN�tJJL•� -- � -_ - -- m PERMITTEE NAME�Pqq��(77) � ��. — –_'__ ,% '' f� " SIGNATURE OF ITTEE DATE � -!�R,��t � yV1/ � RECPT.NO. PAID BY ALIDATION WHITE—Department Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD---File Copy,GREEN—Applicant's Copy a � , �,.�" _, � �, ,P;. . s��r ��.��'� ��,:'�� d��?�i�a ��; � � � � _.. � � ��,��*e., x� � * .��? �,`�»" `� "I �� .,k �«� �w � � � ■ � ' � � wsh� .� � R g . � �.' �E' � u ��y r 9 . . y,, . . .. ... . � �'�d . ... .i. _ . .�P�..: �� f , .P . . . �� . 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V� .�'^y�5�' .. ._. . � �`� _. _. � _ � ��` �n:: ri .._.. ._... ..... . ........ .. ... ...... .. .... . .... ....... .. ... .... .. . ..... .. �. � ��}g.�.,L��t'� . x` F iry �I (� �ly�.t'�� .�.a R ...._ . .._.... ...... .. . ..... ...... ..... ...... ....... ...... . ... . . . ... .... ° ....... h�+s:....,� .�°��,. .,�.� �; �� _ CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� 21660 E.Copley Drive Suite 190 (909)860-3195 Fau(909)861-3117 PRESS � "°M BUILDIIVG PERMiT APPLICATION FIRMLY a ADDRiESS Z��<�� G�L L.ro�`J �.C,�1Z � APPLICATION PEAMIT �Z yT/� p/C o DATE ��I� �� NUMBER �� Jt--�� APN I_OT TRACT ISSUE 7ypE � DATE CONST. GROUP p OWNEA �4�tr'�/ Gdd _ p ADDRESSy�� S%h+q— N 1�I.G�" ZONING SETBACKS � CITY f! !fl iL�1(Q ZIP'1LL'' � TEL. FRONT RW ❑_ APPLICANT _ TEL. REAR � � SIDElSIDE STREET RW ❑ CONTRACTOR L,.E-(y�,�Jj'T� SIDE � ADDRES �� Lf'�tJ.V �1/LCt.,r}�! � CITY �Vli1.C:; ZIP �UYo TEL.'r��-Y76�L�Tn� PROPOSED USE N R ' � G / c{ w ARCH/ENG! n � DESIGNER sP��` L'�'N��I rl�fi NO.DWEL. NO. NO. N ADDRESS I R 7� M�L' �YLi2- ��— UNITS STORIES BEDROOMS N ciTv t cs�.�ci ziP !L TELq�r�i-725�- g � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDEF7 DECLARATION SFFVADD/REM O p I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMP7 FROM h1E CONTRACTORs LI- Gdra 9/Ca oR W CENSEUWFORTHEFOLIOWMCaREASON(SEC.7031.5B1151NES5ANOPROFES510N5CODE:ANYCINOR (n 9 � G7 COUNfVNHICHREOUIRESAPEFA1fTTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREVAIflANVSiRUC- W Pdt10/DBCk W TURE.PRqR TO ITS ISSW WCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT THAT HE OR::HE IS LICENSED PURSUMIT 70 THE PqOVISIONS OF THE CONTRACTORS LI� � '� CENSE LAW(GiAPTER e((XMIMENCINO WITH SECTION]000)OF DIVISION 3 OF THE BVSINE55 AND PRO- POOI/SPd FE591DNSCOOE)ORTHATHEORSHEISEXEMPT7HEREFFOMqN�THE8A515FORTHEALLEGE�E%EMP� � U 710N.ANYVIOL�TpNOFSL=CTION�oat.56YNNVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO z qe-Roo1 � A CMl PENALTV OF NOi MOfiE TIi�N FIVE HUNORED DOLURS(t500�.): O ❑I,ASOWNEROFTHL=PqOPERTV,ORMVEMP�OYEESWITHWAGE5ASh1EIL150LECAMPENSATION, � Commercial � 'NkL DO THE WORK,MID fHE STRUCTURE IS NOT INTENOm OR OFFERED FOR SALE�SEC.�o�d,BU51- J � NESS AND PROFESSIONS IA�E 7HE CONTRACTOPS LICENSE UW DOES NOT APPLY TO AN OWNER OF j PROPERTV Vh10 BIIILDS OH IMPROVES THEREON,AND WHO DOES SUqi WORN HIMSELF OR HF.RSELF OR � TFIROUt3HHISORHEROMANEMPIOVEES,GROVIDEDTHATSUpiIMPqOVEMEN7SARENOTINTEI�EDOR m QOFFEREDFORSALEIF,HO\VEVERTMEBNLDINGORIMPROVEMENTISSOLDWITHINONEVEAqOFCOMPLE- Z TION,THE OWNER-BUIIDER WILL HAVE iHE BUflOEN OF PROVING THAT ME OR SHE DID NOT BUIID Ofl � IMPROVE FOF THE PURP03E OF SKE�. W ❑I,ASOVRIEROFiMEPROPEff�Y,MiEY.CLUSNELYWNTflACTINOWIiHLICENSEDOJNTFACTORS Q TC CONSTRUCT TH[VR0.IECT(SEC.7al,BUSWE55 ANO PFiOFESS10N5 CAOE:iHE CONTRACTORS ll- i/31UeilOfl ADJ.AREA W CENSELAWDOESNOTAPPLYTOMlOWNEROF�PROPERTYWHOBUtt.DSOHIMPROVESTHLkEON.AND � -- � WFpCONTMCTSFOflSU(:HPR0.IECTSWITHACONTRACTOR(5)LICENSEDFJRSUANTTOTHECONTRAG QUANTITY DESCRIPTION Y TORS UCENSE UW.). FEE O ❑IAM EXEMPT UNDERSEC. __ B.S F.C.FOfiTHIS REASON Q 3 � ZDATE ___,__ _ OWNER_ U � LICENSED CONTRACTORS DECLAHATION W � I HEREBYAFFIRM UNDER PENALTY OF pENL1RV THA71 AU LICFNSE�UNDER PROVISiONS UF CHAPTER U, � Y(COMMENCINO WITH SE[TM7N 7000)OF DIVI510N 3 OF THE BUSINESSAND PROFESSIONS CODE,AND z �� YY LICENSE IS IN FVLL FnUNCE MiD EFFECT m � LICENSE CLASS__1�,� LIC.N0. �u�b�/ �1 7 � � V DATE__�I-3 v- �� _ CONTRACTOR �"W� �C.. _ d W i � WOF3KE(�5'COMPENSATION DECLARATION Q NI HEREBY AFFIRM UNUER PENNT'Or PERJURV ONE OFTHE FOLLOWING DECURATIONS: Z a � I MAVE,ANU W!:L 67�INTAIN A CERTFlCATE CF CONSENT TO SELFINSURE FOR WOPKERS' _ � CpMVENSATION,Ai FFOV.DED BV SECTION 37W OF THE LABOR CODE FOR THE PEPFORAAANCF. U O OF THE WORK FOF�,WNICH THIc pERM1T IS ISSUED. � Q �I HAVE AND WILL MNR�RNIN WORKERS'GOMPENSAiION INSURANCE,AS RE�UIRE�BV SEGTION 3�Da OF THE LABON CODE,FOF TNE PERFORMANCE OF THE WORK FUR WHICH 7H15 PERMIT IS J� ISSUED.MV WORKERS'COMPENS TION INSURANCE CARflIER AND POLICY NUMBER ARE CONSTRUCTION ��(J�,�-�I L� j � c�aaiEa�JuA2uuC,� � E,lL� '�I C�J PLAN REVIEW Z aoi.iCYHUMeEa_ � O 7 L'Z _ ELECTRIC r*.A'�`�',l �¢ t f�rST- --- � (nassEcrtorvNEEorx�reE�r.v�En:aoFn+ePEroxrawaavEr�Eooav,cas�iim;ora�Essa PLUMBING ___ � Z I CERTIFV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSt1F0,I MECHANICAL CS SHALLNO'EMPLOVANVPERSONINANVAIANNEFSOAtiT09ECAMESUBJECTTOTHE �_�--- � WORKERS'CdAPEN5AT10NI.AW50FCALIFORNIA,ANDAGREETHATiFISHOULDBECOME INSPECTIONFEE SUHIECT TO THF VJORKERS'COMVENSA710N PROVISIONS OF SECTION 3�00 OF THE UBOR ^ � (:ODE,I SFIALL FORTHWITH COMP�Y WITH iHOSE PROVISIONS. ISSUANCE q� �jp �'�U � ��"�'4��1`�d T�'�-- OA7E:_ APPLICANT SMIP � o — �I) ��x__� ... . �- -i ENERGY P/C' _�,�_.� . �- J WAPNINO�FAIWRE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ---�-- � SU&IECTAN EMPLOVERTO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUN�RED THOUSAND ENERGY PERMIT �� DOLURS(_��.�).�N PDIlIT10N TO THE COST OF CAMPENSATqN,ONAAGES AS PROVIDED FOR IN J SECTpN 3]ae OF'HE LA&�R CADE,MTEREST,AND F?TORNEV'S FEES. ,�,.y1�q� W RETENTION FEE: �� O CONSTRUCTION LENDING AGENCY PREALT FEE: � I HEREBY AFFIRM UNOER PENALN OF PEFUUPV THAT iHERE IS A CONSTRUCTION LEN�ING AGENCV FOR THE PERFORIAANCE OF THE WORK FOR WHICH THIS PEfiMiT IS ISSUE��SEC.9091,CIV.C.). Z �`aNlv✓� /�/,hK -- � LENDEF'S NAME 1- LENDER5ADDRE55 ��1 �-"C��" �� IJI�V •`�" �I Vv w 1 CERTIFY 7'HAT I HAVE REP.D TNIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. TOTAL FEES � ��'�.j'�/ d 1 AGREE TO COMPIV WITH�4LL CfIY AN�COUNTY ORDINANCES AND STATE UWS RELATING TO BUILDINO � CONSTFUCTION,ANDNER"L-8VAV7FIORIZEREPRESENTATIVESOFTHISCOVNTVTOENTERUPONTME Z ABOVE-MENTIONED PROVI:RTY FOR INSPECTION PVRPOSES. COMMENTS � �/�'�� _� T�n-� /��I'� _ m PEHMITTEE NAM (PRINT) - Q N � SIGNATURE PE ITTEE' DATE � � RECPT.NO. PAID BY VALIDATION � WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENRO�File Copy,GREEN-ApplicanYs Copy sw�� '�' ��' . '."� � �.�� a��.Sti • � �� w�r�� .ti E,..� e �� ,�� -- . '� � �� . ..#. � � � �. ..� . � d b � �+�`��t V W �v. s . Pd n ,, <' ... ... .. . ., . . $.w ,.`�. €) ' .,1�. ��. C�i p� . . . ... . .. . .. _ ., .. ....._. _... ... , _...... ..._. w..._ . .... ._....... . _....�,. 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" �-9 I•r� - .�i . �� ; , � � ��. __ _ _ _ _ _ _ � �:n�; �� ' � �, �� __ "�' __ _ � � ,�.�c , � ��. � _ ��. : � � � �� ,` � �� ;�4�� :r 1� CITY OF DIAMOND BAR ��,; DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ,,',�� 21660 E.Copley Drive Suite 190 (909)860-3195 Faz(909)861-3117 PRESS '�M BUILDIlVG PERMIT APPLICATION FIRMLY � JOBSITE >- �,- r APPLICATION PERMIT P/C /� o ADDRESS�j��r-YiI�G.�I�I�f LL�1/TZ`.YL� DATE �� NUMBER /��O # / �j OCC ¢ APN I_OT _ �RA� � DA EE CONST. GROUP p OWNER ` ��V�/1?U/ �/�(3 , " ADDRESS Sk�UI �'�F��ti" !q� ZONING SETBACKS Z CITY��Mifs«l ZIP U'yO TEL FRONT Ryy �_ g APPLICANT _ TEL. REAR � � CONTRACTOR�•�L•w�.7VT2 SIDE SIQE STREET RW ❑_ ❑ � ADDRESS�2! RL.71/�/ �-v4'r o CITY i Vrwi_� ZIP `iL�o TEL.�i Y9-Y76 27��y PROPOSED USE �f� / C�E'�'1 E.�r Cv w ARCWENG! � DESIGNER NO.DWEL. , NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAIUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFlRM UNDER PENALIY OF PERtt1RY THAT I AM EXEMPT FROM THE CANTRACTOpS LI- GarBge/Ca1pOrt liJ CENSEUWFORTHEFOLU�WMGREASON(SEC.70.31.5BUSINESSAN�PROFESSIONSCODE:ANVCINOR (f� G7 COUNTYWHICHREOUIRESAPERMRTOCONSTRUCT,ALTER,IAAPROVE,DEMOLISH,ORREPAIFANVSTRUC- W Patio/Deck W TURE,PRqR TO ITS ISSUIWCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � STAlEMENT THAT HE OR 5HE IS LICENSED PURSUMIT TO TNE PROVISIONS OF THE CONiflACTORS LI� � � CENSE LAW(CHAPTEP Y((%NAMENCINO WITH SECTION]000)OF DIVISION 3 OF THE BUSINE55 ANO PRO- POOUSpe FESSqN500D�ORTHATHEOR3HEISEXEMPTTIEREFROMNN0TME8A515FORTHEALLEGEDEXEMV- (� TION.ANVVKKATIONOFSI:CTIqV7a31.5BYANVAPPUGANTFORAPERMITSUBJEGTSTHEAPPLICANTTO Z Re-Root � A CIVII PENALTV OF NOT MORE THAN FNE HUNOflED DOLURS(55D0).): � .. � ❑I,/SOWNEROFTHI:PROPERTY,ORMYEMPLOVEESWI7HWAGESASTHEIRSOLECAMPENSATION. � Commercial WILL DO THE WORI(AND 7HE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.]Ud4,BuSI- J N NE55 AND PROFESSIONS IX1UE:THE CONTMCTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF j PFiOPERTY WFIO BUILDS ON IYPROVES TMFPFON,AND NRIO OOES SUCH WORK HIMSELF OR HERSELF OR � THNOU(iH MIS OR HER 01MV EMPLOVEES,PqOV10ED THAT SUCH IMPqOVEMEN75 AHE NOT WTENDE�OR m �l� OFFEREDFORSALEIF,H0IVEVF.RTMEBNLDINGORIMPROVEMENTISSOLDWfTHINONEVEAHOFCOMPLE� � TION,THE OWNER-BUILDE.i WILL HAVE THE�UflOEN OF PROVINO THAT HE OR SHE DID NOT BUILD OH Y�/PROVE FORTHE PVRPO'oE OF SALE�. W ❑I,ASOWNEROFTHEPflOPERTY,AME%CLUSIVELYCANTRACTINGWIikUCEN5EDQ7NTRACTORS � TO CONSTRUCT THE PFiOJECT(SEC.:011,BUSINE55 pND PROFESSIONS CO�E:THE CONiRACTORS LI- V21Ue�iOf1 .�L.� ' ADJ.AREA W CENSEIAWDOESNOTAPI'LVTOPNOWNEROFAVROPERTYWHOBUILDSORIMPROVESTHEftEON,AN� = NT�OCONTMCTSFORSUC'.HVR0.IECTSWITHACONTRACTOfl(S)LICENSEDP'JRSUAfJTTO7HECONTMC- QUANTITY DESCRIPTION FEE � TOHS LJCENSE LAW.7. ❑I AM EXEMPT UNDER SEC. 8.L P.C.FOR THIS flEA50N J 3 � LL DATE OWNER � Z U Q w � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDEP FENAISY Of PERIURY THAT 1 AM LICENSED UNDER PaOVI510NS OF CMAPTER � � Y(COMMENCINO WI7H SECTIDN%000)OF DIVISION 3 OF THE BUSINESSAND 4'ROFESSIONS CODE,PND Z i �� 4Y LICENSE IS IN FULL FOIiCEbND EFFECT m � LICENSE CLASS.� L�C.NO.3� �I I � � � V DATE I1-3�-�"Z.UuJ______.__ CONTRACTOR�=�[�.'�JIZ a I W � WORKERS'COMPENSATION DECLARATION Q � INEREBYAFFIRMVNDERPENALTVOFPERJURVONEOFTHEWLLOWINGDECURATIONS: Z � IMAVEANOWILLM�WTAINACEHTIfIGAiEDFCAN5ENT705ELFINSIJREFORWOflKERS' _ � COMPENSATION.ASPHOV�OEDBVSECTION370anFTMEIABOHCO�E,FORiHFPERFORMANCE U Q � OF THE WOFK FOF,WNICH THIS PfRMIT IS ISSUE�. � w I HAVEAN0IVILLMAMRAIN WORKER3'WMPENSATIQN INSURFNCE,AS RE�UIRED BY SECTION � ��o00FTr1ELP,BORCODE,FORTHEFERWRMANCEJFTHEWONKFOFWHICHTHISPERMITIS ��^ ��J � ISSUED.MY WORY,'�_p5'COMPEMSATKKJ INSURANCE fCAR�RIEq AND POLoICY N/UM�-�BER ARE: CONSTRUCTION �� /. (J cARRiER�� — �M/C.:J� a. Citl� pLAN REVIEW � -- q — z, POLICV NUMBFR_ C7 L> U` ELECTRIC — --_._"._'__-- — _ a — �� f�s�c�nrvnE�rareea,nw�_ErEoc�niEPEw.vrsror�aue�Ax�oaEooa.wasgioo�at�EssF PLUMBING ._._ W L Z I CERTIFY THAT M 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL ��L�� L'} StiALLNOT EMPLGYAiJV PERSQN IN ANY MPNNEH 50 AS TO 9ECOME SUBJFCT TO THE (n WORKERS'CCkAPENSATbN LAWS OF CALIFORNIA.AND AGREETHAT IF I SHOULO BECAME INSPECTION FEE SUBJEC'TO THF Vi16RKcP5'C0IAVENSATION PROVISIONS OF SECTION 3]OO OF THE UBOR /� � CWE.I SHALL FOfITHV/iTM COMPLV WITH THOSE PROVISIONS. ISSUANCE �.� '(.� p — � DATE:__._'___ APPLICANT _ _ SMIP ' W /� J WARNINGFAIWRETOSECUREWOHKFRS'COMPF.NSATIONCOVERAGEISUNUWFUL,ANUSHAL�BE ENERGYPIC {� 9�' V'YIY��)� '�R1'�V�,', ��' �'-" �y SIIBIECTANEMPLAYERTOCRIMIN,U.PENALTIESANDCIVILFWE5UV700NEHUNDRE�THOUSAND 6�� -�r— r.;;„`g ??.'+'�-' DOLLARS�floo,a00),IN ADf)ITION TO THE COST OF COMPENSATION,DAMAGES RS PROVIDED FOR IN ENERGY PERH�4TC' J SECTqN 3�980F THE LA&�R CODE,INTEftEST,AND ATTORNEV'9 FEES. i "�';"` -' Q RETENTION FEE: -�� OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBY AFFIRM UNOER PENAL7Y OF PEPJURV THAT THEFE IS A CONSTRUCTION LENDING AGENCV FORTHE PERFORIAMICE CiFTHE WORK FOR WHICH THIS PEAMR IS ISSUED(SEC.9081,CIV.C.). 2 w �,1� (�� _ � LENDER'SNAME y�� p . y,� l �u I— LENDER'S NDORESS�(�� 1 ' /��G L��L p l�J, '1.> � W I CERTIFY THAT 1 HAVE RE4.D THIS APP�ICATION AND STATE THATTHE ABOVE INFORMATqN IS CORHECT. TOTAL FE ES � I AGREE TO COMPLY WITH 4LL CfTY ANO CAUNTY ORDINANCES AND STATE LAWS REUTING TO BVILDING � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTAiNES OF THIS COUNTV TO ENTEP UPON THE Z A60VE-MENTIONED PROPfFTY FOR INSPECTION PURPOSES. COMMENTS � 5[W�- (�� m PERMITTEE NAME RINT) Q � �, _ � SIGNATURE FiMITTEE: OATE �/ = RECPT.NO. PAID BV VALIDATION ~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy � ",� ��s"�� W� ,�a�,, ��e.m.a� �.+�w`l� �@�'a��,a�s��k"� �%'�;».��F�"'T',&.i! #7G' ..�... ,. ., e . .n, � :- �„ � . m :: �5` �,� � �wr.` �." �� a ' "„� ��t" . ; . . . _ . ..... . . . .. P9 v _ .. ��._.;� - '- ` �. _ _. r . , �. �_ . � .; . � P �l} . ; �� .. + • - , _... ..... _...,_ .._. , .._.. , , .. . ._.. , ....... . . ' . .�.r_ .�, , .... ._.. ...... ... . . . ' � �� _ .. . . _ . . '� _ _ ._. .._�. _ __.. _ ._ � r , _ . ..... .. ... t (-•- . , . . _.._ . ..._... ..... . ,._... . .. .. ..._ , , ........ ._._. ... 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GROUP °C OWNER /�??: F `'�d�'� LLO p ADDRESS , d N .'✓ 's�-e� ZONWG SETBACKS w CITY ti IP EL. FRONT qyy ❑ � APPLICANT _ TEL. REAR ❑_ zd SIDE/SIDE STREET RW ❑_T_ � CONTRACTOR� +`a CGi � � SIDE ❑ - Q ADDRES ��' .� ~ 1%`�� CITY a�'� 21p�3TEL. PROPOSED USE � o ARCH/ENG/ p z DESIGNER � ADDR�SS UNITS EL STORIES B DROOMS_ � CITY ZIP TEL. � tq DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � 1 HEREBY AFFlRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CANTRACTORS LI- Gaf0J0/Cefp0lt W CENSEUWf-0RTHEFOLUJWM1GqEA$ON(SEC.)031.5BUSINESSANOPROFESSIONSCODE:ANVCITYOP (n C� WUMTYWHICHqEOl/1RESAPERMITTOCONSTRUCT,ALTER,IMGPOVE.DEMOLISH,ORREPAIRANVSTRUC- W Patio/Deck Z NHE,PRqii TO ITS ISSUIWCE.KSO REOUIRES THE AGPLICANT FOR SUCH PERMIT TO FlLE A SIGNED � ST�TEMENT THAT HE OR;:HE IS LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTOR3 LI� � � CENSE LAW�diAPTER Y((%)AiMENCIN(3 WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- PDOUSP2 FESSIONSCOD�ORTHATHEORSHEISEXEMPTTHEflEFROMMl�THEBASISFORTHEALLEGE�E%EMP- (� TpN.ANYVqLATIONOFSL=CT10N7031.5BYqNYNPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Root � A CIVIL PENALTV OF NOT MOfiE THAN FIVE HUNORED DOLLARS(SSWJ.): � ❑I,ASOWNEROFTHI3PROPERTV,OHMYEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � Commertial WILL 00 THE WORK,M1D i FiE STRUCTURE IS NOT INTENDm Of7�FFEHED FOR SALE(SEC.�oda,BUSI� J N NE55 AND PROFESSIONS IX1[7E'THE CONTRRCTO{75 LICENSE UW DOES NOT APPLY TO AN OWNER OF � PpOPERTV W/i0 BUILDS OR IYPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR S THRWQHHISOHHEROMANEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEOOfi m Q OFFEREDFORSALEIF,Fq1YEVERn7EBUILDINGORIMGROVEMENTIS50LDWITHINONEVEAROFCOMPLE- Z TqN,THE OWNER�BUILDER WILL HAVE THE BUROEN OF PROVING THAT ME OR SHE DID NOT BUIID OR � IMPFqVEFORTHEPURPdSEOFSALE�. W ❑I,ASOMMEROFTHEPROPEflTV,M1E%CLUSIVELYCONTRACTINGWITNLICENSEDOJNTRACTORS � TO CONSTflUCT THE PRPIECT(SEC.7014,BUSINE55 AND PROFESSICN.`+CO�E:THE CONTRACTORS LI- V21U21iOn ADJ.AREA W CENSEUWDOESNOTAPI'LYTOANOWNEROF�PROPEHTYWNOBU�LDSORIMPqOVESTHEREON.AND — � 'MIOCONTMCTSFORSUCHPROJECTSWITHACON7qACTOR(SjLICENSEDPURSUANTTOTHEc:ONTRAG aunr�nlv �E RIPTI Y 70RS UCENSE UW.). FEE O ❑I AM EXEMPT UNDER SEC. B.d P.C.FOIi THIS REASON Q I � �� j I•�d ��D U P 3 �2s• � 0 7� DATE OWNER_ — --- I�— " � d � I � Z ---- W � (�i �,�1.� i � LICENSED CONTAACTORS DECLARATION -� �� J 3�p � � � w I HEREBY AFFIRM UNDER P�ENQtt OF PEFiJl1RY TMA7 I nM uCENSEo uN�ER PROVISioNs oF cMqp7ER �, p � S�' d 0(COMYENCINO WITH SECTION]000)OF DNISION 30F THE BUSINESS AND PROFFSSIONS CObE,AND i X A1Y LICENSE IS IN FULL FO i� D EFFECT LLl � LICENSE CIASS_ � LIC.NO.� ` V DATE____� r ' CONTRACTOR w V C W l rJ i tS �P. �� 3 , D'0, � � WOfi E�ENSATION DECLARATION` �i��' l�N� � I HEREB FFIRM UNOER PENALN OF PERIURY ON[OFTHE FOLLOWING DECLARATI(JNS�. Z � _IMAVEANOWI�LMAMTAINACERTIFICATEOFCONSEN7TOSELFINSUREFORWOFKERS' a S Q COMPENSATION.AS PROVI�ED BY SECTION 3'!0a OF THE UBOR CADE.FOR THE PERFORMANCE U OF THE WORK FOFt WHICH THIS PERMIT IS ISSUED. � � � I MAVEAND WILL MAIMNN WORKERS' ENSATION INSURANGE,AS REOUiRED BY SEG'�ION Q 3�o00F THE LA60H CODE,WR THE PE RM E OF THE WORN FOR WHICH THIS PERMIT IS ISSUED.MYWO$1! ENSA NS NCECARRIERANOPOLIC iunteERnae CONSTRUCTION � / �� — > cItRRIER 6_.� ` f PLAN REVIEW � POI.ICV NUMBEF_ � � [��^� (^ I � ELECTRIC , T,v � � ftwssEcraNNea�rarsE��ooF�aewNrawaoraeHurixiEooaipasryimi E>s�. PLUMBING "� ��' _ _ ul -',•;.. p Z I CERTIFV T IN THE PERFOHMPNCE OF THE WOFK FOR WHICH THIS PEflM1T IS ISSUEO,I MECHANICAL ��"� '' "ci'"1� C,�} SHALLNO PLOYANVPERSONINANYMANNFPSnA5TO8ECAME UBJECTTOTFIE (n WORNE COMPE�TION LAWSOF CALIFORNIA, AGREE I SHWLDBECOME INSPECTION FEE � SUBJ TO THE RI(ERS'COIAPENSATION P IONS EC N 3]0a OF THE LABOFi � ^� � isNnu RTHWITl1COMPLVWITHTH v ISSUANCE �`�. , d--�.�(�'Z O y ' p DA � ( ��APPLICANT "�. � SMIP ____. .. _.____ � C� ENERGY P/C ._ _ � � _ WARNING FAIWRE TO_ :URE WORKERS'COMPENSATION COVEFAGE IS UNLAWFVL,AND SHALL BE �—y SUBJECTANEMPLOVEP�OCRIMINALPENALTIESANDCIVILFlNESUPTOONEHUNDRLDTHOUSAND ENERGYPERMIT � OOlURS(f100.000),IN ADUITION TOTHE COST OF CAMPENSATION,DAMAGES AS PROVIDE�FOR IN J SEG710N 3loB OF THE LABOR CODE,INTEREST,NND FTTORNEY'S FEES. � RETENTION FEE: OCONSTRlJCT10N LENDING AGENCY PREALT FEE � � � I HEREBV AFFIRM UNDER FENA�TV OF PERJURV THATTHERE IS ACONSTRUCTION�ENDINC AGENCV FOR THE PERf-0RMANCE OFTHE WORK FOR WHICH THIS PERMIi IS'SSUED(SEC.309],CN.C.). - Z w __. � �ENDER'S NAME ^�� //� y 1( F-' LENOER'SADDRE55 ¢ ICERTIFVTHATIHAVERE/�DTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATqNISCARRECT. TOTAL FEES w I AGREE TO COMPLV WITH ALL C AND C UNTV ORDINANCES AND STATE UWS FiELATING TO BUILDIN� � CONSTRUCTION,AND HEREBY HORI REPPESENTATIVES OF THIS COUNTV TO ENTER VPON TH � ABOVE-MENT GROP[R FOqI EC7fONPURPOSES. Z j�J / COMMENTS � L R'�! .�•'�.��`-'l�� ------ — ¢ PERMITTEEN (PRI ' • � �' � � ,�. /`.� ___.-'..__'_'"._—"__ ( � 5 F P MITTEI: DATE = RECPT NO. PAID BY VALIDAT70N ~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GFEEN—Applicant's Copy ,„ a � �A»�� „ - � ��'��x.x' {�3.��"s"'� � ��i�ax��a� �'��'�,� � r • , ��" � � ��, � E � � � � �� _ � � _ � , _ ; N , � f ,� �� T � �- . t- � ' `• _. .. __ _ ._._. _ < _ _ _ _ .__ _ ..i .- . . . a._ .._ .__.. _ .. . -;:.. „c. ._�`r<.� . . , ,. . .. . ._.._ . � ____ , _... -- .. __ . . ---._ ._.. - �. . : nW.f s"�77, ��. . . . ..__ .__._. _'— _ _ . . -- }.,; _i"r . :�i . �. ,�ti� �� _ _ . � r < ��k.�� .,. 1 F t°`� . �., s.. — -- _ _ -- __. __ _ _ _ _ � ,. � ..a _ . _ _ . _. � � , ,. � �.1��'�(�.� ; -' . i�.�`�� @�l:fr �. .. �__... ._ ..._.. ._.. __.. .._. . . , � �, _. . . .. , . .. . . . . ..._. ..._ ,._. ._.._ ..._ ._ . . .. 6,t��'.. ..� t. .. , _ ... . . ....... � ... .. .. ..... ...... ..... .._. . ..; . ...._ ..... .__.. , . ,�. �.. . .... .... .. ..... ...... ... .. . . _- ��-- _._.�._ --- ._.. .. ... ._.. ._. . � ... ... .. . �, _ : . a. _ _ � . _ _._.._ :_ u'�� 'i.,a��.� � u� „ _ �G��,�°��'��° � t � �� _ __ _ � _ __ _ _ _ _ __. _ , _ _. _ _ __ _ ______._ _. _ _ _ _ _ _. _ _ _.. _ _ _ _ _ _ _ _ _ r��.:'�:" t�sq� ��a�" � a Y�-�' ' . ...... ..... ..... .. _..._ ...... . .. .... ... . ... .. . i ' � t-i � �' a: - _. _ -- � -� ` � +� �;.�� '� _ � g ; _ �� ,i� �� ' e�w �""��, �� j t aW�E � ''��a#• ,�� _ _ 4 4 A __— _._. __ _.. _ .... .. . ..... —._ .__ ._ . .. . . . , ��. �P�{ "�." , . � 3'. � ;��.�"f. Y�'�.� ... ... .... . . . . ..._. ...... ...... ..... . .... . ..... ... .. . .. i,. . +�.F ' . . ...._ __— � �� a' � � R �� CITY OF DIAMOND BAR -",,�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)86]-3117 PRESS �'°�" BUII.DING PERM APPLICATION FIRMLY � JOBSITE < ADDRESS Z.��Er�C�6 Gq�l'�3�"� C Gl�t,� �L�� APPLICATION "'Z'� �( C'y PERMIT I��j� ; P/C o DATE � NUMBER p $ - ISSUE TYPE OCC APN LOT TRACT DATE_ CONST. GROUP _ p OWNER ��tyf'1� j QC�,.i 'p ADDRESS �..L�1 EAs�ris�..� N`� ZONING SETBACKS Z CITY`Css (1U�.1 c��o Q FRONT g ; ZIP TEL. REAR ___ RW ❑_ APPUCANT _ TEL. SIDE/SIDE STREET RW_ �_�_ � CONTRACTOR=i�.� �_ EL�(,'S¢�L ��(,� SIDE � p� ADDRESS�„�' �b C` �I�S�1 ��p � . � CITY��4..OA �,►aoA Z�p ��2[{�TEL. '71�V-��1�'I�IICa PROPOSED USE , _ 8 ARCWENG/ - . � � l DESIGNER NO.DWEL. NO. � N ,� �_ ADDRESS u� UNITS STORI ROOMS � CI7Y ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILOER�ECLARATION SFR/ADO/REM O t HEREBY AFFIRM UMDER PENRLTY OF PERAIRY TH�T I MI EXEMPT FROM THE CANTRACTORS LI� Ga�e BICe R W CENSEUWFOfi7HEFOLLOWINGREA50N(SEC.7037.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n 9 � �� COUMYWHI(51REWIRESAPERMR7000NSTRUCT,ALTERIMPROVE.DEMOLISH.ORREPAIRANVSTRUC- W NRE,PFlIDR TO ITS ISSU�MlCE,ALSO REWIflES THE APPLICANT FOR SUCH PERMIT TO:ILE A SIGNED W PaIlO/DBCk � STATEMENT THAT HE OR:iHE IS IICENSE�PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI- � CENSE LAW(CHIPTER G(IXJMMENCING WITH SECTION'/WO)OF DIVISION 3 DF THE BUSINESS AND PRD- LL POOUSPB FESSIONS CODE)OR THAT NE OH$HE IS EXEMPT THEREFROM AND THE BASIS FORTHE ALLEGED E%EMP- � TION.ANVVIOLATqNOFSECT10N7031.5BYANYAPPUCANTFORAPERMITSU&IECTSTHEAVPLIGANT'O Z RB-R00� ACML PENALTY OF NOT MIOfiE TNAN FIVE HUNORED DOLLARS(f5o0).): ^ ❑I,ASOWNEROFTMEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, COmmeYC18I 0 � WILL DO THE WORK,AND�lME STRUCiUFE IS NOT MlTENDED OR QFFERED FOR SALE(SEC.70d4,BU51� � � NE55 M!O PROFESSIONS C:ODE,THE CONTMCTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � - PROPERTY WFIO BUILDS OF IMPAOVES 7HEREON,AtJ�NM110 UOES SUCH WORN HIMSELf OR HERSELG OR WTHFIOUGH HIS OR HER OWN EMPLOVEES.GROVIDE�7HAT Sl1CH IMPROVEAIENTS AHE NOT tNTENDED OR � Q OFFEREDFORSALE.IF.Fi01NEVERTME8WL01NGORIMPqOVEMENTISSOlOW17HINONEVFAROFCAMPLE� Z TqN,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVMG THAT HE OR SHE OID NO1 BUIL�Ofl � IMPROVE FOR THE PVRPOSE OF SALE). W ❑I,ASOWNEHOFTHEFROPER'TY,AME%CLUSIVELYCANTRACr�NGWITYI.ICENSE�CONTkqGTOAS — Q TO CONSTRUCT THF.VR0.IECT(SEG]ON,BUSME55 FNC PROFE5510N5 CO[lE�.-HE GONTRAC10R5 LI- '�(dlUallOfi ADJ.AREA W CEN3ElAWWESNOTAPVLYTOANO'NNENOFAPROPEPTYWhIG9UILD50R:MPROYE57HEREON,AND --- �-- - W!p CONTRACTS FOfl uUt:H VRQlECfS WITH A CONTFACTOR(5)L'CENSE�FURSIiANTTO THE SNTRAG FEE ►- QUANT!TY DESCRIPTION � TORS LICENSE LAW.�. - O ❑IAM EJ(EM7T UN�ER SEC.______________._R S P.f.FOR 7415 REP:ON Q �./ � � �,J 3 " Z__ A t 3.s�T a _3.5 /� , �-� —_--_ _- - _.___.__-_ __-__.- 2 � DATE OWNER______ F'� o ------ --------_= w 3 t�n -t. LICENSED CONTRACTGRS nECLARATIPN -� � ` � w '1G U� "(1 I HEREBY AFFlFM UNOEF VENALTY OF PERIURV THA7 I AM LICENSE�UND[R PROViSICNS OF CHAPTEF � � r, �� , �y O�COMMENCINCiW�TFiSE(::TION70oo)�FDNISION30FiH`cBU51N[SSANDPFQFESSIONSCGCEAND Z � �i� C I MY UCENSE IS IN FULL FO�iCE ANG EFFECT. m � �a `, � ` � x � LIGENSE CU55 ` V S �1�C�� '� '3 U � �__ LIC.NO.__ n . U DATE �Z �� rONTRACTOR_.. .• a ��CZ �• QE1` � L. L-_` - `1 _5�_`�_'�c1_-- , 5��—�2.c�C,1 c� , w - � '�S , C ) � WC�RKG'AS'COMPENSkTfQN DEGLARAT�IGN �%�"� Q � O� �a S � N /.. U - - t)� � IHEREBVAFFIRMUNDF.Rl�FMALTYQFPE171UAYONEUF�HEFOLLC�WINGOECLAR0.TICN5. Zr 0Z IHAYEANDWILIMAINT�dNACEP,T!FICATEOFCANsENTTCSELF-INSUfiEfORWORKFHS' a Q - COMFFNSRTICN.ASPHOVI�EDB':'SECTICN3]OOOFTHEIABORCOOE,FGRTHEPFRFORMANCF. U OF TME WORK FOFI WHICH TMIS PEHIAIT IS ISSUED. w O � W _IHAVEAN�WILLM4INTAINWORKEHS'COMPENSATIONINuUqANCE,l3FiEOl�IREP6YSECTION Q3]OOOFTI�IElAF1GaCODE,FORTHEPERFORMANCEOFiHEWOHNfORWHiGHTFI'SG'eHMiTIS SSUED.MY WOIMERS'CFJMPENSATION`IN-SUFANCE CAHRIEUR Ah'U PGL'CV N�UM(E`F�.R AflE' CQN�.iTRUCTION y CARRIEP_.��.>tfi�f��C.F�l'��4_�(.�(.��pI�l�._. �IL'-!—.__ � PLAN FIcVIEW ---_ -_---_ _ ---_--_ �' POL'CYNUMBEH_]8t.��_�1,[-�3.V�--___j _1�f�\ � -_� (.J''1 4 � . � _ I ELECTRIC --------.—,---_ - _LS�_ o massc-cna�:Nc-r�nr.�ra�cauxErr-ooFrr-�Fr.w.rr�s�a�cx��Hunix;eo�xv�ns��oica�Ess�. PLUMDING ____ _ W � --- ... _.— Z I CERTIFY�MAT IN�fHE PtHFOFlMANGE OF�THE WC�K FOR N'HICH THIS PERMIT IS iSSUeD,l MECHANICAL T:^�� ._:,,� (,'J SHA',LNOTEMPLQYqNYPEH50NINANYMANNEFSOA�TOBFCOMESUBJE�'TTOTHE }`�-'�p- . � ---- (n WORKEF5 COMPFN5ATION U1WS OF CALIFOqNIA,AND AGFEF.THAT IF I 5HOl1LG BECOME INSz'ECTION FEE ��-f SUBJECT i0?HE WORKERS'CAMPENSATION FFOVISIONS OF SECTION:nan c)F iHE LABOR rj c�oE,isNnLLco�r�wirHcoMN�rwirvn�os�aaovisions. ISSUANCE __ �•��'"_� O p DATE:___ ._. AP%.ICANT _ _'_ _ SMIP _ - ' ... W _ ___ J WARNING:FA:LURE TO SECURE WORKERS'COMPENSATION COVENAGE;S UNLAWFUL.ANO SHALL BE ENERGY P/C � -��—' • J _. ._. ___-. � SU&IECTAN EMPLOYFRT()CRIMINAL PENALTIES AND CIVIL FWES 11F TOONF HUNDRE�J THOUSAND ENEflGY PERMIT DOLURS�f100 00�),IN AOI)I710N TO THE COST Of COMPENSATION,DAMAGES AS PPOVIDEO FOR IN J SECTION 3]OB OF TNE IABON CODE,INTEREST,AND ATTOqNEV'S FEES. � � OC RETENTION FEF� OCONSTRUCTION LEN�ING AGENCY PRE-ALT FEE: __ _ _ � I HEREBYAFFIRM UNDER PENALTV OF P[PJURV THAT 1HERE IS ACONSTRUCTION I FNDING ACENCY FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERIAR IS ISSUF�(SEC.9091,CIV.G.�. W � LENDER'SNAME__ __ ��-� F- LENDER'SADDRESS � �� w I CERTIFV TMAT I FiAVE REP�D THIS APPLICATION AND STATE TMAT THE ABOVE INFORMATION IS CARRECT TOTAL FE ES l�`��,`�'`� � I AGREE TO COMPLY WITH�4L CITY AND COUNTY ORDINANC[S AN�STATE IAWS REUTING TO BUIL�ING � � DONSTRUCTION,AND HERI=AY AIITHbRIZE REPRESENTATIVES OF THIS COVNTY TO ENTER UPON THE � A60VE-MENTIONF.D PROPf.RTY FOR INSPECTION PURPOSES. COMMENTS � r( ' � _ ��r n �. ` Y�. A �� m PERMITTE AA1 1 �-"� � fc-Z't-�1� ��,z��_� -- � NATUflE OF PENMIT7E: DATC �� , ` �,: � RECPT.NO. PAID BY VALIDATION WHITE-Department Copy.YELLOW--Finance Copy.PINf(-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy '�.��; ,�� ,s�' . k ..�� `��..�'- � r-�.3'a ��;�"��`�� .�� . k �� .�_$.. . �.. . � � . ... .��. � � � d � � _� � � 6�;. .. ._.. . _ , . . . .. . . . 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'� .. .. _. ��.�... Po A...� e .. ^ �"_ CITY OF DTAMOND BAR DEPARTMENT OF COMMUNITY&D�VELOPMENT SERVICES 21660 E.Copley L�ive suite 190 PRESS ��`%fl�°'�`y BUII.DING PERMTI'APPLICATION FIRMLY � JOB5ITE ��-"="'T-- APPLICATIO C � PERMIT f P/C ADDRESS L�4a�f`4 1,�4ii1"W1ih Ci.�'_� �� DATE �� NUMBER �F J _ # ISSUE TYPE OCC � APN �OT TRACT --'�_'-. DATE. CONST. GROUP � QWNER 'C Q.A.�nbh�'l..--�. . G� C�.. a ADDRESS�.Cc;O�_�A_SC�y�w, V�. ZONING SETBACKS Z CITy `+ k�s•?�'1��_ ZIP��,_� TEE._. FftfJNT RW l]� �cc�, APPLICANT __ 7EL. REAR f_7��.� SIDEt81QE STREET RW_..!_ i.J��.� GONTRACTOR�vi.awL•'�� C�-1 �N�- SIdE ❑ t� ADpRESS Z3�.5�3 V iA� 'G3�4. �� E�` —� �~ " Q GITY_�jSLA�S-�.��s4t°y ZIP� TEL.�,�y,-�ttii-�GCZ. PR�P4SED US€ _ _ _ � l w ARCWENG! � DESIGNER NQ.DWEL. Np. �+ --NO. �� ADDRESS � UNITS 9TORlES �-f � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF AdJ.AREANALUATiON cr� � OWNER-BUILDER�ECLAFtATION SFR/RODIREM O � � I HEREBY hFFIFVA UNDER PEN,U:TY OF PERAIRV THAT I AM EXEMPT fHOM THE CONI'HACTQRS LI� G8feS0/CflfPO(I � CENSEtAWFCKiTHEWt.t.U1NMbRERS4N{SEG.7us1.5B4JS�NfS&At�PflGFES510NSCADE:ANYCITYQR (j} COUN'TYNNICHREOUIFESAPERM�TTUCONSTRUCi,ALTER,IMPItOVE,bEMOLiSH,ORfiEPAIRANYSTRUG W P8�I0/DBCk 7URE,PFlIOH TO IT5 ISSUIWCE.ALSO NEOUIRES 7HE APPLICAN7 FOft SUCH PERMIT TO FILE A SIGNEO w wtr 5T�17EMEh7 TtiAT NE OR$HE iS IiCENSED PURSUANT t0 THE PROY1516P3S OF THE C6NiRAC.Tf�RS l4 � POPUS & � CENSE LAW(CMAPTER 9 IC�MENCINQ NATH SEC710Y 70001 oF DIVI5IbN 9 OF THE BUSINESS qN�PRo- � P FESSIONS CC1DE}OR FHA7 HE OR SHE IS FXfMPT THEPEFp�M AND TH�pASIS F�R THE AL�EGED E%EM?- 7pN.hNYYVqLA7K1NOFS[CTit5N7a39.58YANYAPPLICANTFOFiApERMiT5U8.lEC7STHEAPPLiCAhTT9 Z Re-Roof � A CMI.PENALT'Uf'NOT MORE THAN FIVE HUNDRED DOI.I.hRS(&u00J.)', • � �I,AS4R4NEf106TH(-FA4PEfiTY,OflMYEMPLQYEESWITHWAfiESASTHElR54*IECOMPENSATIQN, � G07filiS8tC�3) YALi 00 TNE WORK.M!�aHE STRUCTURE IS NOT IN7ENpED OR OFFEflED FOR SALE(SEC.7DM,BUSI- J � NES9 AND PROFES.SION5 IbOE:THE CONTHACTORS LICENSE IAW�qES NOT APPI.Y'O AN OWNER OF � YP,OPEfittYhtOBUftD50�i�MPFtQYE57HEREON.AND1Wi006ES5UCHWORKHiMSElF6RHERSELFOR m [[ THROU(iHMISORHEFO'MVEMPLOYEES,PRlJVIDEDTHATSUCHIMPROYEMENTSARENOTINTENDEDOR W OFFEREDFfJRSALE.IF,HOVYE4ERTMEBUIID�NGOflIMPflOYEMEI4TIS50lDW17HINGNf-YFAaoFClaMPL6• I � '[tON,THE ONR7ER•BUHDEH YALL.HAVE THE$URDEN OF PROVING THAT HE!k?SHE�FO t�T BUitD DR �� IMPHOVEFOP7MEpURPt>GEOFSAI.Ei. __,___,J � C11,A90WNEROFtNLPftPPEFTY,AMEXCIU$NE�YGONiRACT4N�WttHL"CENuEDCUlifRPCTOflS [� Tq CANSTRUCT THE ARCAJECT{SEr,704f,tll1SiNES-o ANO PIiOF��SS4QN5 COUE.THE CONTRpGTORS i.t� uc11U2II0I1 ____ -____ A��.AREA__- - W CENSELAWCIOESNOTAPFLViOANVWNERCIFAPROPERTYWHOdUfLGSOFIMPflOVFSTNEREON.AND � �� ;1 wxoco'rrancTSFoasuch�rroaecrsmmxc�vrN,vcsn�ts;ucEnsfcN�asuu+rrc ryE�.c�zrv,c- 4UANTITY D�SCRIPTIt7N FEE �-- TOR.4410ENSEUW.1. _ _...__..�. •• f� � t:liM1E%EMPTtRADERSEC._.'__. .��.__...._..B.EP.C.F4RTii�SREu50N .t , C�'��._,_.. F� V'�. • ' � + +� 3 � � _4 S�. s's ) j .'�� E L7 _-- --__...---------. — � OATE ��._-_ CY/NER.__,...-_..'___�-__..__.._-.__._ U � ��G�� ...-.. LLJ �_ '_ _ LICENSEDC6NTRACTtIR6DEClARATidN w � O�` A- QA�NF:I Y'Z"�� IHER£BYAKFItiMUNQfRPfNALT`�OF�EEUVftYTMA'tAAitiGEN5Et3UN�EftPHOViSiO`350fCHAPTFft �y i(COMMENCINO W�TM SECTKNd t000)OF DIVISION 90r-i)SE PUr�MFSSANO PROFESSIONS COUE,A'JO __ � X MY UGENSE IS IN FVLL FOf�(:E NND EFFEC'. �si S 11(0� --- - -- � IICENSEC�lASS�_�_r�"�'_yi�s+� _�_.__ LIC.NO._�( �'}�. ^�� ___ � DATE_.:r2_`_""�-_..�--1..]�..�.._, CON��iRAC70Fi__.3'd'...�+u�iC>j."_�.. ` . '-..... W �nf��s r ' ..'- q� W��RKEAS'C��MPENSATlC}M1 6EClAPATION ` _ �� 1 ��v � I NEREBYAFFIRM UPIDER R=rypy7`f 4F PFRJIiflY ONc O�TNE FGlLC�WikG i,ECIARATK}NS�. � -_' (,� _ IitAVE+WOWRlM+11NTAIN4C6RTlf:�ATEOfGON6EMT09�:1F-0NSVHEf4RWORKFE$' - i --�-` yi4 ^�COMPENSATiOfd,A:i PflOV!DED 8Y 3ECTION 3]a00f iNf.iA.6()N GObE,FOR THE i'ERFOHMANGE OF"ME WORK i�VR WHIC:N THiS PF�iMIT IS IFiSVEC. �Y C� - +�� _....IHAVEANOWILLMAINTAWWfSRKFRS'COMPC_NSATIONiNSUFANCF,ASREOI,nREDAVSECTION '� 3]0(tQFTNELAktOffCXJ'i')E,ff.HTHE?ERFqRMANCEOFTMEWQRKFfjftWH�(;H�Ii15FEe^rvMlTIS � �C--1��.�-ON INSUflNdCE CAHRIF:R httD POUGY Nt1MBEft ARE: I C.�NS`TRUCTION �_� ... _- �-_. .�._�......_ � ascx.icv.,uv Bormc�as�.7.�+a§srr5:__4�_�_��._..--s.-3� � { PI.AN REVfE�N +� J GAftflIfF .f V�' '._.- ��_... �_.... .. � . _ _ ._�-�+.__�_.1C�'N 1 Gs�"']S'__�__.____�- . � FLECTRIC -- '_�.___---- -��SL_� � n -:. � � RHS�ECfFJrvNF.P,'�voTBE7.'Mau=rEuoF�^iErfFani�sriv?,�ME��alrtk�i:�.7allaasfs�co)C�R�Essi. ' PLUMBING ____ � � -. --..�_ ..r--- ___ �� i CE(iTIFY 7Htii iN iHE QfRFpRhAANCE 04'THE ViqRK FUR WNiCH�HIS PERMi�IS ISSUED,� MECNANIGAL .. � SHALL NOT ENPI C ANY PeFSC�N IN ANY MANNEH 50 A9 TO BEGOME SUF1�f:�CT Tq iHE I ' T � INSPECTI4N FEE � FW hKFft5'CCMPEN�FT�OiV l.AM15 4F CAIiPORNIA.ANURGRtE TMAT!F I SHQU'.D B OME --,--r r'--°-�----� --"-- SUBJEGTTOTH�WOFKER�::AMPENSATICINPRC1VI510NSOF TIQN Otl TY �� ISSUANCE �� COfJE.I SHALL F41F1LMWITHCqfEPLY WITHTHO ROVI- �� ~ � _'� _'_�_...__.. • _._-._ o ��.a_c.L sMiP . __.. Cj DATE�"�'�"'�T�c'._, APPLICANT: . ._..�_._._ `"'_"{`�_. ... .. .�_"_ �. W ENERGY PJC � � -. � WARNING.FAI�UflETOSF:CJREWORKERS'CCMPENSATIONCUVtHAU`EISUNIAWFUL,AN75NALLBE --"'T�' . . �-'-"""--" ��- � � SUBJEGTqNEMP40YEFTUCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNCFiEDTHOU$qND ENERGYPERMIF . DOlNRS(it00,b96f,iN ADfliTION T�1NE COST OF fAMPENSATK#�1,OAbiAGES AS PROLqQEO FOR iN - --�� --- v'- J SECTION37DBOFTHELABGRCQDE.MTEflEST.ANGATTbRNEV'SFEE5. flE7EM��lONFEE: ._. - -.--.....- --. ¢ . ..-_�_.u.. W CdNSTRUCT�ON LEND�NG AGENCY PRE-ALS FEE: CL - -�... ,.�----...._ � IHEftEBYAfFiRMt.NOERF'':_NAITYOFPEf1JURYTHATTFIERE7SACAN3TfiUCTION�E#p�NC,.AGENCY __„_ ___ ,. - n- FOR 7ME PEHWHMANCE n'�THF WORK FOR WHICH THIS Vcfl1A1f I515iUE0(5EC.30W,CIV.C.). Z "_ ... . _ .__ W � lENOEF'SNAME_..._._-....__'_".�,..�_......-_"_"�_.�_ h lENOER`SAD�RESS_�. ....- �� /� ��// Jp � tGEA7lFYTHATINAYEREN)TMISAPPUCATICNVANpSTATETtiATTFiEA&OVEKifORMATK7Ffi5CORREG7. TQTf1�FE�S � {��{�� 1 AGREE Td COMPLY W17N ALL CIT'AN�CAUNTV ORDINANCES ANO STATE LAWS REIATMG TO BUILDING '� � CONSTRUC710N,ANO HEPEBY AUTHQRIZE flEPRESENTATiYES OF THI$COUNTY TO ENTEfl UPON TNE � ABQYE-7.1ENTI�ED PRp�E'3TY FOR INSPECT40N PURPOSES. COMMENTS .�.. .-� -- t� �` P'�� T.' �aGY�A{L'h l,• — � m PERMtTTS E[P lNT' -, --�r ."- cn �S"'Z�1'�ic'l _ �, �. .� ( �� )��''� _t�_�� / � 7i7AE:OFPE FTTEE ^- OATE q�'�j�j� �('�''�� } �ECPT.NO, r�/'" '"'� .PAId B�--Y _.,.��-�,V � ` VALIDATION � � ---.._-__. .— - WHtTE-Department Gc;py,YEt14W-Finar�ce Capy.PINK-ASsesSor Copy,G6LDENR6D-File Co¢y.f.�REEN-Apd��nt's Copy � � '�"� .�A �� _'g�,� ��:. ��w .�-°� � �� .:��. � � �� P �� ° � '� a. � � g "' e�ymy�.'� �.� .. . .. . . . . ... . .. . ..: .., , ., : . . _.. ., .s ' '� '.. i �., � : �. . ; . . . .,.... ..._.__.__. _._.. , ,.,.._ , ..._ , ,..,. . . ...__.. .__.. ..... . .... . ..._.. . � F. . .. ...__ �:�'' r ,�. . .... , . ' . . .. , ._. . _ . .._. .__ _ , ___ ... .,„ _ . ..__ '...._... ._. .____. . _._.__ . -� ,� j I ., — _. _ _ . _._ � � _,�� _ _ _ __ , .':�,r. n;;` r^ 'Y."fi vn , S$'-�._ . __. . .._� ___ ._. 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" ` _ . . . . . .,�c..�c�,.4.i � _��,_ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ; ;�� 21660 E.Copley Drive Suite 190 � (909)860-3195 Fax(909)861-3117 PRESS '"""' BUII.DING PERMIT APPLICATION FIRMLY y JOBSITE � APPLICATIO PERMIT ��-7�} P/C o ADDRESS 11k7� �P�TCWfl�1 C�1�7iC� � �t.• DATE � �� NUMBER 6 # � APN LOT. TRACT ISSUE TYPE OCC Q - DATE CONST. GROUP p OWNER ��•LP�s�►,�L/1i �,Q,S a fy p ADDRESS_��'_�)_�(=P1S'l}1'�ti.> (av� ZONING SETBACKS � CITY �S. A1�1�VGS Z�p fi`OQ•t�Q TEL. FRONT pyy �_ APPUCANT � TEL REAR � � SIDE/SIDE STREET RW U_.. � CONTRACTOR_Sv3u�.CS �,�L'�'P�\(, .}�� SIDE � � ADDRESS��rt �1i\ p N.Z. 14 � � PROPOSED USE � CITY ZIP_ TEL. ' � o ARCH/ENG/ , ' DESIGNER__ NO.DWEL. NO.� I ��,i, ADDRESS �� C�1Y _ ZIP TEL. UNITS STO BEDROOMS_ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDEA DECLARATION p SFR/AD�/REM Q I MEREBV AFFIRM Uh'�DEH PENAL7Y OF PERJURY THAT I AiA E%EMPT FROM THE CANTRACTORS�J� G8f0JB/C2f�IOlI W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINES9ANOPROFESSIONSCODE:ANYCIIYOq (n C� COUNTYWHICHREIXIIRE£APEflMiTTOCONSTflUCT,ALTER,IMPROVE,DEMOLISH,ORHEPAIRANVSTRUG W pafi0/DBCk W NRE.PRIOH i0 ITS ISSUiWCE,�L50 REOUIRES THE APVLICqN i FOR SUCH PERMIT TO FILE A SIGNED W .� STATEMENT THAT IiE OR!iHE IS LICENSED PURSUANT 70'HE 7ROVISIONS OF THE CONTRACTORS LI- � CENSE UW(CHA7TER B(tXNAMENCINO WITH SECTpN 7000)OF OIVISION 3 OF THE 9USINESS AND PRO- � POOI/Spa FESSpNSCODE)ORTHATHEORSHEISEXEMPTiHEREFROMANDTHEBASISFORTHEALLEGE�EKEMP- � V TpN.ANYVIOLA7qNOF51�CTIIXJ7031.5BYANYAPPIICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roo( � A CML PENALTV OF NOT NIpqE THAN FNE/AINDRED DOLLIRS�t50C).): � ❑I,ASOWNEROFTHLPqOPERTV,OPMVEA/PLOVEESWITHWAGESASTNEIRSOLEfAMPENSATION, � CORIfTIBICIBI WILL DO THE WORK,AN�TNE STRUC7lIRE IS NOT INTENDED OR OFFERED FOR SALE(SEG.?0<4,6U51� J � NE55 NJD PROFESSIONS�70DE THE CANTRACTORS LICENSE UW OOES NOT APPLV TO AN OWNER OF � PROPER7Y W/p BUYAS d91MPROVE5IMEREON,ANC WHO bOES SUGH WORN HIMSEI F OR HERSELF OR wTHiqUf3HHISORHEROWNEMPLOYEES,PROVIDEDTHAT5UG/1MPq04EMENTSARENOTINTENDE00R m Q OFFEREDFORSAIEIF,HpIMEVERTMEBUILOINGOHIMPtinVEMENTISSOlDW1THINONEVEAROFCOMPIE- � TION,THE OWNEF-BVILDEH WILL HAVF TME BUR�EN OF PqOVING THAT HE CR SHE DID NO}'gUILD OR � IMPROVEFORTHEPUP.PQSEpFSAIE�. I w ❑I,ASOWNeNOFTHEPRO?ER7Y,AMEX(:il1SNELVCnNTRaCTfN�WITH�ICENSED<';UMRACiORS - � TO CONSTRUC'T�riE PHQIECT(SEC.]oa�,BUSINESS RND PRJFESSIONS COCE:THE!:GNTHACTOR$:J- Vfl�UdllOfl ADJ_AFEA � CENSELAWfbESNOTAPI'LVTOMIOWNEROFAPqOPERT/WHUBIIILDSORIMPROVESTHEP.F.ON,AM1D ____- -- -— -- _ NMOCONTMCTSFOqSUCYiPRGJECTSWITHACO4TMClUf1(S�IICEkSE�PURSUM'YTOTHECUNTRAG � OUANTITY DESCRIPTION roas ucENSE uw.7. FEE O ❑1 AM EXEMPT UNDER SEC.__ _ __0.B 7.C.FOR THIS REASON Q � O S rJ� C� L 3 � � r� � o�TE - —�.�ER___- ------- � c .r a s.� r� _ . ��, S UCENSED CONTRACTQRS DECLARATION � W („ ��i� !�� og �-- `�� 3 �� I HENEBV AFFIRM UNOER PENALTV OF PERIURV iHAT IAAi IICENSEJ VN�ER PRUV�.SIONS OF C�'.APiEfl r d 9(COMMENCINO WITIi SF.CTION t00a)OF OIVISION 3 OF TNE BUSIM1LSSANO PRGFi:.5510N5 GG�E,AND � �� U� '.`S��•f_�' LI .��.�G7, � MY LICENSE�S IN R1LL FGFICE ANO EFFFGT. ��L'�_.T_ � LICENSE CLASS�/�,� __ i��,NG._�f J_f�`'11 — wDATE��'—`�\i�__ CUNTFlACrOA_ F,-3�-_��-- - — � W��RKERS'COMPENSATIO�J pECLARATIOP� (�,�(�f,� � '— —'� � �� —'— - � 1HEREBYAFFIRMUNJERFENALTYOfPEWURY'(�NEdfTHEfOiLGWINCDECiARATIONS: — � Ii1AVEANOWILLMiVNTAINACfAiIF�CATEO��ANSEN?TqSLLF�INSUREFORWfiqKERS' � COA/PENSATKIN,A.��HOV!DE�J BV SECTION 3]OOOF THE LAF�fl CD�£,FOR iHE PEFlFnRMANCE _ I OFTYE WORK FUF WHICYTHIS PERMIT IS ISSUW. -- O � W _IHAVcANGWILLMi11NTAINWORKEP5'COMPENSATIONINSURANCEASREUL�.!RE�4YSECTION n37W OF TIIE IAdOR LYN)E.Fnfl THE uERFOPMANGE OF THE WORK FOR WHICH THIS PFqMiT IS ISSUEG.M'Y WOFlKI�PS'COMVENSATION IN5U�RAN+fE CARRIEH AND POL!,CjV NUMeEH ARF: CONSTRUCTION � CARPoER_��sV vL �e�i�___ PLANREVIEW z voc.icvuuMSFa__��L(��__ �'� FLECTRIC � --- �-c�� (IHC',SE(:IKx.�NEFDNO'BF�XWvtEfEDOF�:PFPAATISFGRC7NEh9JbRFt;[lH.uus,`��m)oR�Essl. � PLUMBING w ___' - _ ._.. � ICERTIL;'lHAi IN'HE GFRFORMANCE J�TF,F WC�RN fn9 WHICH THIS PE9MIT 15159�E�.i MECHANICAL C7 SHALLNOIEMPLG`/ANVPEFSONINANY1.41NNEHStJASTOBECONESUGJECiTO'fHF --�-----�-- -�- (/� WORKERS'C;IMPENSATqN LAWS OF GALIFORNIA,NND AGFEE TMAT�F'SHUU�C BECOME INSPECTION FEE � SU9JECTTOTMEWOFiKEqS'i,bMPEId5AT10NPftOVI51�N50F5ECTION37000F7HE�BOR -� �� — ��-- COOE,I SHALL FOHi4WITH COMPLY WITH THOSE PFOVISICNS. ISSUANCE __________� ,.�� --- p DATE:____________. AppucaNi __.___ SMIP W _ -__-_— .—_ -_ -__. J'J WARNINC FMLURE TO SECJRF.WORKERS'GOMPENSFIION GGVERAGE IS UNLAWFUL,FN�SHALLBE [NERGY P/C __-- -._ " _.. _. —. � SU&IECTAN EMPLOVER TO CRIMINAL PENALTIESAND GIVI:FINES UP TO ONE HUNORED THOUSqNO ENERGY PERMIT -^''�� ¢ DOLLARS(floo.oao�,IN AUoI iloN TO iHE COSTOF COMPENSATION,OAMAGES AS PROVIDE�FOR IN � SECTION37oeOFTHELABOqCODE,INTEReST,ANDATTORNEV'SFEES. RETENTIONFEE: . �� O CONSTRUCTIONLENDINGAGENCV " A ..�- � _� PRE-ALT FEE: ti: t � IMEREBYAFFIRMUNDERP'�.:NALTYOFPEFlJUHY7HATTHEPEiSACONSTRUCTIONLEN�INGAGENCY ' t � � FOR iHE P[FWRMANCE O�.=THE WOHN FOH WHICH THIS PEPMIT IS!SSUEO(SEC.309],C�V.C.). ---- Z W � LENOER'SNAME_ __ __ -'- F- LEN�ER'SADDRESS WI CERTIFV THAT I MAVE REAI)THIS APPUGATIUN ANO STA7 E 7HAT THE ABOVE INFORMATION I$CORqECT. TOTA L FE ES ,/C� / �r�c1 � I NGREE TO COMPLY WITM PLL CITV ANU COUNTY OROINANCES AND STATE LAWS REUTING TO BUILDING � CONSTRUCTION,PNO HEREBY AUTHORRE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE�MENTIONE�PqOVE'ATY fOR INSPECTION PURPOSES. � COMIv1ENTS____ _ �Ct �j�� G m PERMITTE �(PRI � (n _-�Ii'�-+�'C�/ ('�.�"��l�i�i� ___ -_ _- �_�.�_1 y SGNATUFEOFGERMI E DATE � � y� -� — � RECPT NO. PAID 8V = . VALIDATION i WHITE—DepaRment Copy,YELLOW—Finance Copy,PINK—Assessor CoDX GpLDENHOD—File Copy,GFEEN—ApplicanPs Copy s�. � � �� .r'��" __ , � .c ,a we'-° ��.�� _��"��°� ��.�M�� , ,��u �,� _ . .M . ��,� � � ,� � � � �, � � � � � .� � , _ � �� '�� "�, �;. ! � � ,� o �� ;, . , ..�.. �, . . � 4�� .. f � .., - ,. . . . ... . _. ._. _.� .� ._ . .__. ...._ .-- . _ —__ -.... ._... �� , ` ,: ... _.. , ___ .__ ...._. _ ..._.. , _ .._ _.._. ...... .. . .... ..__. _....,. . . _. _.._ a .._ _.. , _.— --� ,_, . __ _ . . . _ __' _.. _ __ . . ... . . �„ , ; ��y�. .. . .. �. .-i� ' ,} , �-�rs : : . . _. . .. ._. ._.. ... .._. __ . ... ... .. _�. . . _. __.. ... ,._. ..__ _.... : .. . . __ _.... .._., ..._. __.. ._. ,_ .,_. .. . .. . .� . , ._: " i �;< `Y^- —.__ ._ . .. .__.. ...._. '. . . . . r .. a��.,� . . � f . .' 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' _ " � � _ _ . �� , �, � , ts ��: � s�� .��, � �� ... ��, ._ _ __ _ �. �• � � , 7,� � ; _ __ � , .� � •. �� q ' �� t �� 6 ,;, � . _ � �� _ _ _ _ � . �;� „ > , , � ��,�e ,a� �:,,„ �� Q11110XII Fm CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION t5 j PRESS FIRMLY DATECATI ' 77 ADDRESS ZAW �-�� "L�y�L D12 1 C NUMBER APN LOT TRACT ISSUE TYPE OCC DATE OWNER 7ti-n£14 OQel/C), CONST,GROUP ADDRESS 3 7I01&-mr mv 4U ZONING SETBACKS CITY LOS/+/(„6Lif(iJ ZIP'94)'/0 TEL FRONT RW^ APPLICANT TEL. E REAR^ SIDE/SIDE STREET RW CONTRACTOR L.&-jLwTZ ^ SIDE^ ADDRESS.] LTDA/4(/c_wl'y CITY 1/VU(.(ZIP y2LU6 TEL. 41'I1I76 273Y PROPOSED USE/E ! J Nvr)W/L-m191� ARCF/ENG/_ 24CL�CH��Z PR r I DESIGNER / ADDRESS N0. DWEL. N0. 140. CITY ifV•K ZIP 921-14-TEL. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION OWNER-BUILDER DECLARATION SFR/ADD/REM I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- Garage/Carport CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE: ANY CITYOR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT.ALTER. IMPROVE. DEMOLISH. OR REPAIR ANY STRUC- TURE. W Patio/Deck PRIOR TO ITS ISSUANCE ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED LL.I STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- L CENSE LAW(CHAPTER 9(COMMENCING WITH SECTIO N 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- 0 PooVSpa FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): DI.AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, C1 Commercial WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- J NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPRO E V S THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR CI D THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ 1,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCTTHE PRO,ECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- Valuation ADJ AREA CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH AC%NiTRACTOR(S)LICENSED PURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE TORS LICENSE LAW.). ^ I AM EXEMPT UNDER SEC. B. B P.C. FOR THIS REASON J < U DATE OWNER H 0 LICENSED CONTRACTORS DECLARATION W I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT t AM LICENSED UNDER PROVISIONS OF CHAPTER 0 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 CF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FU Z F LL ORCE AND EFFECT. u 3a I'S" LICENSE CLA LIC. N0. S DATE II' d i�CONTRACTOR L�wl'L WORKERSCOMPENSATION DECLARATION Q U I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECORATIONS: - z HAVE AND WILL MAINTAIN A CERTIFIf.ATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. UJ 1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION �.-� 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ,'•I.2 C'°C� OMPENS CONSTRUCTION ISSUED. MY WORK =RS"C ATION INSURANCE CARRIER AND POLICY NUMBER ARE � J nl PLAN REVIEW CARRIER.lAA-0-4 PL-Sgt//-'t. . POLICY NUMBEII_C_ino,'E-77776 2- ELECTRIC (IRIS SECTION NEED NOT BE COMPLETED OF THE PErNAT IS FOR ONE HUNDRED DOLLARS($I00)OR LESS} PLUMBING �{-•� I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR a a r q CODE,I SHALL FOFITHWITH COMPLr WITH THOSE PROVISIONS. � ISSUANCE SMIP DATE:APPLICANT + �;.•C.� A d �� WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE A ENERGY P/C iBT ri�,_J "S SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND LJ li.i.,ry L�I C s DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN ENERGY PERMIT SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: o('°(• CONSTRUCTION LENDING AGENCY PRE-ALT FEE: I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE CF THE WORK FOR WHICH THIS PERMIT IS I SSUED(SEC. 3097.CIV,C.). R a': LENDER'S NAME 1 b � fiJiA/� +_ E I LL �� R T-k C � �� / } 7Jwu M A/Z LENOER'S ADDRESS ALT 1 4y-/• •v I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FEES i •' I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING � CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS I ��- PERMITTEE NAME(P 1 SIGNATURE OF ITTEE DATE RECPT N0. PAID BY)"'VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy ULI)IIISU CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Faz(909)861-3117 BUILDING PERMIT APPLICATION AODDRIESS�.IF,�<7 d V�'C= �wq 'J'�� !� APN I_OT TRACT OWNER'��L3��/G,d ADDRESS y�t�wX,lf: h+9.tf�" CITY fs N iL�l(U ZIP'1(x� �TEL. APPLICANT_TEL. CONTRACTOR 1••L�WCJtIJ-� ADDRESS 2-!e'-/WLi'?J.V�F/Lit�..A�! CITY UIi1.C:: ZIP I�UYo TEL.�'�1-Y76�L' t,�,'Sr ARCWENG/ DESIGNER SP'��-��N�1Z� iDlei9fi ADDRESS(�17�M/IL'-YLi2.. �,T�T- CITY L i;IM;'ZIP I!LTELq�r°!- 7L�/^ g OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A PERMR70 CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANV STRUC- TURE. PRK)R TO ITS ISSUIWCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE UW(CHAPTER 9(CXMAMENCING WITH SECTION 7000)OF DIVISK)N 3 OF THE BUSINESS AND PRO- FESSK)NS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SL=CTION 7031.5 BY ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(1500).): ^ 1,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND"fl-1E STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.Told,BUSI- NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF,HOIVEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPFIOVE FOR THE PURPOSE OF SALE). ^ 1,AS OWNER OF THE PROPERTY AM EY.CLUSIVELV CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 70.11, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE UW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OH IMPROVES THEREON,AND WHO CONTRACTS FOR SU(:H PROJECTS WITHA CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE UW.). ^ I AM EXEMPT UNDER SEC. B. d P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTKNJ 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND AAY LICENSE IS IN FULL F 0 f?CE AND EFFECT ng �j�t '�j�� LICENSE CUSS 1 1 � �7 p . �,�_LIC. N0.J ��gg J DATE�I' �V'Z�I�-�CONTRACTOR�-EN� �Z WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNUr.R PENAI T'OF PERJURY ONE OF THE FOLLOWING DECURATIONS: I NAVE AND WILL MAINTAIN A CERTIFICATE CF CONSENT TOSELF-INSURE FOR WORKERS' COMPENSATION,Ai PROVIDED BV SECTlON 37W OF THE LIBOR CODE, FOR THE PERFORMANCE OF THE WORK FOE,WHICH THIS PERMIT IS ISSUED. I HAVE AND W LL MARdTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTlON 3700 OF THE LA@OR CODE,FOR THE PERFORMANCE OF THE WORK FUR WHICH THIS PERMIT IS ISSUED. MV WORKERS'COMPENS TKXJ INSURANCE CARRIER AND POLICY NUMBER ARE: u 2 u�-S,q�f�IL��t C3 oA CARRIER� J / POLICV NUMBER C OW��+�Z (TI-pS SECTlON NEED M77 BE NI.IPLEIEOOF7NE FERMff IS FOR ONE HUNDRED DOLLARS(1100)OR LESS I CERTIFY THAT IN'fHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANV PERSON fN ANV MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT iF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LIBOR (:ODE,I SHALL FOFITHWITH COMPLY WITH THOSE PROVISKNS. DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLURS(1100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTON 3708 OF THE U&�R CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFf H E WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV.C.). / LENDERS NAME N / �7��E' Q�'��(� J /^'/^' LENDERS ADDRESS ��1/-'C��V� IJ�A�U,v'-IW I CERTIFY THAT I HAVE REP.D THIS APPLICATION AND STATE THAT THE ABOVE INFORMATK)N IS CORRECT. 1 AGREE TO COMPLY WITH �LLL CITY ANO COUNTY ORDINANCES AND STATE UWS REUTING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTK)NED PROPERTY FOR INSPECTION PURPOSES. �-; �cU,� PERMITTEE NAM (PRINT) SIGNATURE PE ITTEE'. DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN �, 1 PRESS FIRMLY (��,IN, U1,1�IOJI1 CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION I ADDR ESS�L��r 1/.vllq°f L,L�Z�.�Z._ILA APN I_OT_,TRA� OWNER�/Y�I3?L%/(/�(j ADDRESS sk'UI �'�,�m�w"W� CITY_Lu�Mi4� «1 ZIP U'yb TEL. APPLICANT_TEL. CONTRACTOR�•�1=•k/N.71/72 ADDRESS�J.j A(,7!/�t/b'Sq'r CITY c 4't�ZIP°IZ6o TEL.�7 Y9-Y76 Z7S'/ ARCWENG! DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REWIRESA PERMR TO CONSTRUCT ALTER,IMPROVE, DEMOLISH,OR REPAIRANV STRUC- TURE,PRIOR TO ITS ISSUIWCE,ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR E.HE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE IAW(CHAPTER 9((XM/MENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSgNS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VKxATKKV OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): ^ 1,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND-niE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044, BUSI- NESS AND PROFESSIONS IX)OE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PFK)PERTY WHO BUILDS OR IMPROVES THEREON,AND WHO GOES SUCH WORK HIMSELF OR HERSELF OR THRW(iH HIS OR HER OWV EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF,HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WRHIN ONE YEAR OF COMPLE- TKXI,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPO:iE OF SALE). ^ I,AS OWNER OF THE PROPERTY,AM E%CLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT AP{'LV TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUC'.H PRO.IECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.1. ^ I AM EXEMPT UNDER SEC.8. E P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY Of PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTKKJ 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,ANU MY LICENSE IS IN FULL FOfiCE AND EFFECT �7{�� LICENSE CLAS S UC. N0. I/ DATE I1-3(-T"Z-UuJ CONTRACTOR L' LIIG'��Z WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECORATIONS: 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PNOViDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOE.WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'WMPENSATION INSURANCE,AS REQUIRED BY SECTlON 3700 OF THE LA,BOIT CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORY,'�_RS' C OM PEMSATKKJINSUR ANC CAR RIER AN E D POLI C YN U M BER ARE: / w . ) / / c Q y� CARRIER�IU�� '��c�"fL� L.r�C d. (/{it� POLICY NUMBER_V L> � � �(,7 (niC SEL"1)ON NEE'il NOT BE COA1P_ETED OFTHE PERMT IS FOp ONE HUNDRED DOI-CARS(5100)OR LESS} I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I St1ALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO 9ECOME SUBJECT TO THE WORKERS'CCkAPEN5AT10N LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD B'cCOME SU&IECi TO THE NIORKERS'COMPENSATION PROVISIONS OF SECTION 37000E THE LABOR CODE.I SHALL FOFIT}IWITM COMPLY WITH THOSE PROVISK)NS. DATE:APPLICANT WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,ANU SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATON, DAMAGES AS PROVIDED FOR IN SECTK)N 3708 OF THE LA&�R CODE,INTEREST AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMAN C OF T HE WO E RK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV.C.). /Y J LENDER'S NAME r '^'/ �� L y�� u/ ( � p�\ LENDER'S ADDRESS�(,I 1 ''_ '��" � ��+ I CERTIFY THAT I HAVE READ THIS APPLICATK)N AND STATE THAT THE ABOVE INFORMATpN IS CORRECT. I AGREE TO COMPLY WITH �4LL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING C(NVSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTK)N PURPOSES. JCW�- �� PERMITTEE NAME RINT) SIGNATURE RMITTEE: GATE WHITE-Department Copy,YELLOW�inance Copy,PIN PRESS FIRMLY v� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUII,ZSING PERMIT APPLICATION JOBSITE�//�_ S y� ADDRES _ �y� Q APN�Q LOT RADT OWNER/�� ; F '(�d �� ADDRESS�d .�/.'/s'�-e� CITY tI IP EL. APPLICANT_TEL. CONTRACTOR� + 'a CLi �cZ CITY L�ZIp��TEL. ARCH/ENG/ p DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION 1 HEREBY AFFRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLDWING REASON (SEC. 7031.5 BUSINESSAND PROFESSKNS CODE: ANY CITY OR COUNTY WHICH REWIRESA PERMITTO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,OR REPAIR ANV STRUC- TURE,PRgR TO ITS ISSUIWCE.ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS LI� CENSE LAW(CHAPTER 0 ((%)AIMENCINO WITH SECTlON 7W0)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMP- TION.ANV VKXATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSWJ.): ^ I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND'D1E STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 70u,BUSK NESS AND PROFESSIONS Ix1DE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF,HOIVEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER4)UILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I,AS OWNER OF THE PROPERTY,AM E%CLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7014, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND NATO CONTRACTS FOR SUCH PROJECTS WITH ACON7RACTOR(Sj LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW.). ^ I AM EXEMPT UNDER SEC. B. d P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER 0 (COMMENCING WITH SECTKKJ 70W)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COb'e,AND MY LICENSE IS IN FULL FO� D EFFECT��// LICENSE CUSS � LIC. N0. GL DATE F CONTRACTOR ----C;�� OR EENSATION DECLARATION i � � 1 HERE B FFIRM UNOER P ENALN OF PERJURY ONE OF THE FOLLOWING DECLARATK) I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTlON 37W OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUED. -I HAVE AND WILL MAINTAIN WORKER ENSATION INSURANCE.AS REOUiRED BY SECTION 37W OF THE LABOR CODE,FOR THE PE RM E OF THE WORK FOR WHICH THIS PERMI715 J ISSUED. MY WO$I! ENSA NS NCE CARR ANO POLIC UMBER ARE' e CARRIER 6/�M POLICY NUMBER� (1/CB SECTlON NEH7 NOT BE CON1PLEtED OFTFE PEFMTIS FOR CINE HUNOFiED OOI.IAAS(5100)LEAS). I CERTIFY T IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NO PLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME OBJECT TO THE WORKE'COMPE TKNI LAWS OF CALIFORNIA,AGREE I SHOULD BECOME SUBJ TO THE RKERS'COMPENSATION P K)NS EC N 3700 OF THE LABOR I SHALL RTHWITH COMPLY WITH TH V DAT� � ��APPLICANT WARNING: FAILURE TO S :ORE WORKERS'COMPENSATION COVERAGE IS UNLAWFVL,AND SHALL BE SUBJECT AN EMPLOYE TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(fl W,OW),IN ADIJITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER F'ENALN OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE REI,D THIS APPLICATION AND STATE THAT THE ABOVE INFORMATKKJ IS CORRECT. I AGREE TO COMPLY WITH ALL C AND C UNN ORDINANCES AND STATE LAWS RELATING TO BUI! DING CONSTRUCTION,AND HEREBY HORI REPRESENTATIVES OFTHIS COUNTY 70 ENTER UPON TH ABOVE-MENT PROPER PoR I ECTlON PURP OS ES. /j6 / L Imo„_„� � i�,�y i,�„ 1 PERMITTEEN PRI S ^'// S F P MITTEI: DATE WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy PRESS FIRMLY 31�1a 7� U1,1)IIISII 1,1R I Ire:,r CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT'APPLICATION I, ADDRIESS Z.� 16��Gq�IT b3Ah CG1J�ti:(�'2�a? APN LOT TRACT OWNER'TEA dM�"U� I�Q.Cw� ADDRESS��C?1 EAS�riPILa A�� CITY �'Cis('lU�,l ;ZIP�T�Q TEL. APPLICANT_TEL. �(�� CONTRACTOR_5w��_E,�p�(�,'S+C}.� ADDRESS��' �Cb C' �/1F1 ��4,y�,�p c�' CITY��L-aoa ZIP��TEL. '714-��1�'I�IZC3 ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION 1 HEREBY AFFIRM UNIDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOW LNG REASON (SEC. 7037.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR CWNTY WHICH REQUIRES A PERMR 70 CONSTRUCT,ALTER IMPROVE. DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR :iHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER G (IXJAiMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE ALLEGED EXEMP- TION.ANVVIOLATION OFSECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACME PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).): ^ I,AS OWNER OF TH E PROPERTY,OR MV EMPLOYEES W ITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND'THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7014,BU51� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE VFAR OF COMPLE- TK7N,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I,AS OVMER OF THE PROPERTY AM E%CLUSIVELY CONTRACTING WITH I.ICF.NSEU CONTRACTORS TO CONSTRUCTTHE.. PRC1.tECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE: 'HE CONTRACTORS LI- CENSE LAW WES NOT APPLY TO AN OWNER OF A PROPERN Wh10 BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SU<:H PROJECTS WITH A CONTRACTOR(S)L'CENSED FIJRSIiANT TO THE CONTRAG TORS LICENSE LAW.). ^ I AM EXEMPT UNDER SEC. B. 8 P.C. FOR THIS REP�+ON DATE OWNER - LICENSED CONTRACTGRS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERIURV THA71 AM LICENSED UNDER PROVISIONS OF CHAPTER 0 (COMMENCING WITH SECTKNJ 7000)OF DIVISION 3 OF iH�c BUSINESS AND PROFESSIONS CGL�E,AND MY LICENSE IS IN FULL FOH C E ANG EFFECT. �� LICENSE CLASS L�v LIC. N0. ?t 1 �� _ r DATE�?'� �'�� CONTRACTOR °'3�'ZWl W(TRKERS'GOMPENSfiTION DECL;�RATIGN �>'�' I HEREBY AFFIRM UNDER FEMALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. I HAVE AND WILL MAINTPJN A CEP.T!FICATE OF cANSENT TC SELF-INSURE FOR WORKERS' COMPENSATK'.N.AS PROVIDED B':'SECTION 3]00 OF THE LABOR CODE, FOR THE PERFORMANCE. OF THE WORK FOR WHICH THIS PEHIAIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE, r�5 REUL�IREG 6Y SECTION 37000E T}IE UFIUH CODE. FOR THE PERFORMANCE OF THE WOFIK FOR WHICH THLS PERMIT IS :^uSUED. MV WOI7KER5'COMPENSATION INSURANCE CA �R IER ANU PGLICV NUMEF.R ARE { CARRIER_,�],�,��\��t�_�_ 1 p--- POL'CY NUMBEfi_�Q��-��V,�__i_{�f�, (D9S SECTlDty NEED NOT RE CCMPI-ETED OF T}E F'f�F3/!T 6 rINJ ONE HUNDRED DOLLARS;Sio010R LESSj. I CERTIFY-MAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLU V ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJE"T TO THE WORKERS'COMPENSATION LAWS OF CALI'rORNIA,AND AGREE THAT IF I SHOULG BECOME: SUBJECT TU THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR C00 E, 1 SHALL FUH"HWITH COMPLY WITH THOSE PROVISIONS. DATE:_,_.APPLICANT:___ WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVEHAGE;S UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN AUDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV. C.j. LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE REPD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH �4LL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTKNIED PROPERTY FOR INSPECTK)N PURPOSES. PERMITTE AM I .�y7 �� 1 NATURE OF PERMITTE : DATE WHITE-Department Copy,YELLOW--Finance Copy,PIN PRESS FIRMLY CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE L ADDRESSS b I it it� �� APN LOT TRACT OWNER tea-I LL COW C, ADDRESS: 0%CAStPV+ CITY"*jcinv&ZIP AL-64 TEL. APPLICANT TEL. CONTRACTOR_So i.ji tZ fr LPL CL' L� 1J �- ADDRESS .e�5 VA1 EI. IiL%u �rE CITY°r ZIP TEL. -�r4.t+(ACZ ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR OUNTY WHICH REOUIRES A PERMRTO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO. FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): DI,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOWEVER.THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D I,AS OWNER OFTHI_PROPERTY,AM EXCLUSIVELY CON r RACTING WITH UCENSED CONTRACTORS TO CONSTRUCTTHE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). D I AM EXEMPT UNDER SEC. B.A P.C. FOR THIS REASON DATE LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FOFCE AND EFFECT. tt C 0 LICENSE CLASS LIC. N0._ DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER P=NALTY OF PERJURY ONE. OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK I OR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOI.IIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS"COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER I>u17 �� q� L S� JS w � POLICY NUMBER( - ._�y50_116E"11 P- (THIS SECTION NEF.)NOT BE rx:AAFLFOEDOF THE PERM)IS FCIS:I IE I-tNDRE J DOLLARS(SI 00)OR LESS). I CERTIFY THAI IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EHPLO"ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD B OME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF TION 00 TI LAB CODE.I SHALL FORTHWITH COMPLY WITH THO ROVI @w...7V_L1G DAT2!T"�^1�'r '�APPLICANT: WARNING: FAILURE TO SECJRE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100.000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PI'NALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE of THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097, DIV.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. p LHAO..'n c/J%L o t PERMITTE E(P INT SI&WATURF OF PE ITTEE DATE APPLICATIO G PERMIT J P/C 1 DATE NUMBER- 1 # ISSUE TYPE OCC DATE CONST,GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. - N0. c UNITS STORIES rw DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM Garage/Carport w Patio/Deck U- POOI/Spa 0 Re-Roof Z Commercial 5 M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE a3 IL, F4_ -7 L _3,S To i 3, I y W 1 Z.cO-R. CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE-"� SMIP t.,.,..... ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 75 (/�J COMMENTS RECPT. N0. PAID BY VALIDATION 1 WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy U1,1NII�U :sM CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUII.DING PERMITAPPLICATION �� PRESS FIRMLY APPLICATIO --Z i� PERMIT� �� p/C DATE NUMBER� # ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT Ryy^ REAR^ SIDE/SIDE STREET RW^ SIDE ^ PROPOSED USE �r N0. DWEL. N0. � 7 UNITS STORtf{r55 BEDROOMS DESCRIPTION S0. FT FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM � Garage/Carport W Patio/Deck � PooUSpa Z Re-Root � Commercial m i Valuation ADJ.AREA QUANTITY DESCRIPTION FEE a 3o S75c.� c a-i.�� _ ,,, ��, W 1. ��ci � 5 W -_ OU�G� /� -- ��ILU� .�S� °�C� a� �G� � CONSTRUCTlON_ PLAN REVIEW_ ELECTRIC - �� GZ6 PLUMBING MECHANICAL INSPECTION FEE ISSUANCE -� � SMIP ENERGY P/C ENERGY PERMIT�� ' " RETENTION FEE: -, �__ PRE-ALT FEE: �i t�- r,r., ._ °,t:_ TOTAL FEES��,Cdil COMMENTS__ RECPT N0. PAID 8Y �"'J VALIDATION i WHITE-Department Copy,YELLOW-Finance Copy. PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy