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— _�� __ CI TY OF DIAMOND BAR �� � ��J�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICE w 21660 E.Copley Drive Suite 190 PR�SS ������`' BUII.DING PERMIT APPLICATION FIRMLY �; ADDRESS �� !�� CZ�����f�'f�� �� '. DATE CATIO ;��„��� 3� NUMB R 2� � �/C N� ( l c�+ ISSUE ���Z�_,���TYPE OCC APN ` LOT TRACT DATE CONSL GROUP p; OWNER . C)(�� C�'t3�s�l' ADDRESS M ZONING SETBACKS W' CITY ZIP TEL. `°%'/'� FRONT RW ❑ �� APPLICAN7 , TEL. REAR ❑ a SIDFJSIDE STREET RW ❑ �`� CONTRACTOR ���'U� �''�t�� ��' � � SIDE ❑ �: ADDRESS a �-` `T ►'+1 •— � CITY �'✓°"�►'� ZIP i� TEL 5���'7Z PROPOSED USE ���� � ����f"j� �> ARCH/ENG/ �i�fS�/�Gv C�is % i Z; DESIGNER NO.DWEL. NO. NO. a' ADDRESS UNITS STORIES � BEDROOMS �; CITY ZI TEL. �� DESCRIPTION SQ.Ft FACTOR PSF ADJ.AREANAIUATION - �.�p, _ OWNER-BIJIIDER CLARATION SFRIADD/FiEM O:' Q;. , 1 HEFE9Y AFFlIW UNDER 7ENALTY OF PEFJURY THA AM F.XEMPi fROM THE OOMRACTORS L4� � � Garage/Ce�port � W' .CENSELAWFORTHEFOLLOWINORFASON(SEC.�aa7.5Bt1S1 SSPNDPROFESSIONSCODE:ANVCITYOR� CJ:: COUNTYWHICHREWIRESAPERMITTOCONSTFUCT,ALTER,IM OYE,DEMOLISH,ORREPAIRANYSipUG-. W p81iO/DeCk ' �j5--TURE,PRIOR TO ITS ISSqANCE,ALSO HEOl11RES THE APPLIC POR SUCH PERMIT TO FiCE A SIGNED'� - W �r 3TATEMENT THAT HE OR SHE IS LICENSEO PURSUANT 70 iHE P VISIONS OF THE CONTRACTORS LI-' '-CENSE UlW(CHAPTER e(COMMENCINQ WITH SECTION 7000)OF�I ION 3 OF THE BUSINE33AND PRO - � PooVSpa �� FESSIONSCOD�ORTHATHEORSHEISEXEMPTTHEREFROMANOTH ASISFORTHEALLEGEDEXEMP�- ((} �- 'TION.ANYVIOUTIONOFSECTION7037.68YANYAPPUCANTFORAPERM SU&IECTSTHEFPPLICANTTO- RQ-RDOf :s �`6�� ���' �' ACMLPENALTYOFNOTMORETHANFIVEHUNDREDOOLLARS(5500).): �� ' - ❑I,ASOWNEROFTHEPROPENTY.ORMYEMPLOYEESWIhIWAGESASTHE1fi50LECOMPENSA710N, - OInR7BfClal �.i WILI DO THE WORK AND THE STRUCTURE IS NOT IMEN�6D OR OfFERED FC�i SALE(SEC.7064,BU56'�. _I '. 'NESS AND PAOfES510N5 CODE:TNE CANTRACTOfl3lICEN3E LAW DOES NOT�iG.�PLY TO AN OWNER OF:� y��� . PROPERTYVYFIOBUILOSORIMPROVESTHEREIXJ,ANOWHODOESSUCHWORKHI EIFORHERSELfOR'�� _ ��• THROII(3HHISORHEHOWNEMPLOYEES,PRONDEDTHATSUCHIMPROVEMENTSAR N�TINTENDED�R- - m � W' OFFERmFORSALEiF,HOWEVER,THEBUIlDIN60RIMPROVEMENTI550LOWITHIN� EAROFCOM{'LE-� - Z_-� �'TION.THE OWNEfl$UILDER WILL HAVE THE OURDEN OF PROVING THAT HE OR SHE DI OT BUILD OR - . IMPliOVE FORTHS PURPOSE OF 3ALE). ❑I,ASOWNEHOFTHEPROPERTY,AME%CLUSIVELYCONTRACTINQWITHUCENSEDCO RACTORS �-�� � TO CONSTRIlCT THE PROJECT(SEC.704F,BUSINESS AND PROFE5510NS CODE:THE CON7RA OFS Lb V81UflIlOf1 ADJ.AREA W' CENSEUIWDOESNOTAPPLVTOANOYfNEROFAPROPERTYWHOBUILDSORIMPROVE3THERE AND� �-. Nh1000NTRACTSFORSUCHPROJECTSWI'fHACONTRACTOR(StLICENSEDPUFSUANTTOTHECONT G QUANTITY DESCRIPTION FEE Y� TORS LICENSE LAW.). - J OO i AM IXEMPT UNDER SEC. 8.&P.G FOR THIS REASON� Q � � LL' DA7E ON7VEfl W - i�v �, �_ LICENSED CONTRACTORS DECLARATION � W . �- .I HEREBY AFFIRM UNDER PENAITY Of PERJUflY THAT IAM LiCENSED UNDER PROVISIONS OF CHAPTER � p.- �,8(COMMENCINOWITHSECTION7o00�OPDIV15lON30FTHEBl1SWESSAN�PROFESSIONSCADE.AND Z X ,:MY LICENSE FS IN NLl FORCE AND'EFFECT. m � � :�UCENSE CIASS �!�� LIC.NO.��� � H f �� s � �'���� � � ��ATE �"`�E✓ � � CONTRACTOR W� •1/ f�_� n- � j W � _ WORKERS'COMPENSATION DECLARATION Q �� � V � ; IHEREBYAFFIRMUNDERPENAI.TYOFPEfUURYONEOFTHEFOLLOWINGDECLAPA71INJ5: Z Q � _IHAVEpNDWILLMAINTANdACEiiTIFICATEOFCONSENTTOSELf-INSUREFORWORKERS' � 2 �/ - '� CDlAPENSATION.ASPROVI�EOBYSECTION37000fTHElA80RCODE,FOR7HEPEFFORMANCE W OFhiE WORK FOR WNICH TH�S PERMIT IS ISSUED, c� O W '_IHAVEANDWILLMAIMAINWORKERS'COMPENSATIONINSl/RMCE,ASREQUIRED6YSECTiON �j ` p /� d 37W OFTHE 1A80R CO�E,FOH THE VERFORMANCE OFTHE WORK FOR WHICHTHIS PERMIT I5 �%y / /,„'/E � ISSUED.MY WORKERS'COAIPENSATION INSURANCE CARft1ERANo POLICY NUMBEFARE: CONSTRUCTION _,.,_.. _�/_�asL_ � j: cqnRiER � � PLAN REVIEW �� POLICYNUM6ER ELECTRIC �� (IFf65ECIlONNE�NJTBECOiJ�I.ETIDOF7F�PERA4��SFOR0IJEFRMXMEDD011A�S(S�ao)ORlE55} PLUMBING z- 1 CEHTIFY THAT IN THE PEflFORMANCE OFTHE WOPK FOfl WHICHTHIS PERMIT IS ISSUED,I ' MECHANICAL (}. SHALlNOT EMPIOV ANY PERSON INANY MANNER SOAS TO BECOME SU9JECT TO THE �� WORKEflS'CQMPENSATIONIAWSOFCALIGORNIA,ANDAGREETHATIFiSHOULDBE E INSPECTIONFEE ' -���L � SU&IEGTTOTHEWORKEflS'GOMPENSATIONPROVIS NSOF TION3]o,Q OFTHE BOR ~ CO�E,ISH(A,�LIFORTHWITHCOMPLVWI7HTH05 P �SIO _ f1 . ISSUANCE � . � �/ �,`�y i�{�,�/ p, �ATE: r �� APPLICANT: L d +.��.J .SMIP _____.._ " J' WARNINGFAILURETOSECUREWOflKEflS'COMPENSATIONCOVERAGEISUNtAWFUL,ANOSHALLBE ENERGYPlC LL�� SU&IECTANEMPIOYERTOCRIMINALPENALTIESANDCMIFINESUPTOONEHUNURE�THOUSAND ENERGYPERMIT � WLt,ARS(5100,000),IN ADOIT�ONTOTHE COST OF COMPENSATION,DAMAOES AS PROVIDE�FOR IN J SECTION370BOFiHELAB�RCODE,INTEREST,ANDATfOFNEY'SFEES. RETENTIONFEE: _ _ � �� CONSTRUCTION LENDING AGENCY PflE-ALT FEE: O � IHEREBYAFFIflMUNDEHPENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLENDINGAGENCY - n-- FOR THE PEflFORMANCE oF TNE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,qY.C.). � . ' ' Z __._.. W �� LENDER'S NAME - F- IENDERSADaF1ESS -- wICERTIFYTHATIHAYENEADiHISAPPLICATIONANDSTATETHATTHEABOVF.INFORMATIONISCORRECT. TOTAL FEES � /+ Q �AGflEETOCOMPLYWITHALICIT'ANOCAUNTYOFDINANC[SANOSTATELAWSRELATWGTOBl11LOING ( � .��' � CONSTRUCTION,AND HEflEBY AUTHORIZE flEPFESENTFTIYES OF THIS COUNTY TO ENTER UPON THE f � ZABOVE-MENTIONEO PROPERTV fOR INSPECTION PUFiPOSES. COMMENTS � ��g��� �����'� m PERMfTTEENAME(Pfll � �j^�„s . c"�n _�' ��'��'/� N SIGNAYUREOFPERMITTEE �A7E � RECPT.NO. PAID BY VAIIDATION H WHITE—Department Copy,VELLOW--Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy,GFEEN—Applicant's Copy ; , , k � .�..`�" al�___�_.'_ i T''`�e�--�___�__"_��_"��.;� � i t � I , ; i � I � � I� � � � � ��� � 'rt` � � 3 , � f � S � � i � � ( � j 3 ; 3 � � j � I�, ��" i� � � � . . 3 � � t 1 � � ( � ( �, � , � � ; � , ; , � ; � r: �� � ; ; �� � , ' � � ' � ' k ' ¢ � , ' � � € � i I i I I i � � i ; E j f f � � � � � i �. , ( � � � � � � � I � I i � � E ' ` i i � � � r � i 1 ; j i � � �� I � � � � ; � j -i i � , ; i � ; E ; i � i � � ( i , � � ; � � : ;--;-- ' ' ' � -��---�--�--.--�- ' � ; i ; � j ; I � ' . i ' ' .; ' �,� .i I i i� � ) ' � ( � - � ' � i I �� ( li ..K , � j � i ' i ; . ; � " . p � ! I � � �. � . � i ._ � � � i � � { � ! Y �� � ; f I ( � ! i i - i � i] ! '; .S t— t � � � � { . . a ' � � ! � � � � �� 3 � .�.._�� ' � � ` ---�—�� E � ' � __�__ i j , 4 � � i ( ( ,�� , � � I E E�i�' ; + { , t � ' ( � � � � € � 1 3 � ( E �t� ��y--Iw� I , ; i ! 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