The URL can be used to link to this page

Home My WebLink About10983 � -- - CITY OF DIAMOND BAR � COMMUNITY DEVELOPMENT DEPARTMENT ,,.....-- _,,.�; 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION � FIRMLY Q ADDR'ESS�6�—�iV D��1�(� D�� DATEICATION/� NUMBER /�� #/C��.� / ISSUE T rvPe occ i $ APN LOT._. TRACT DATE CONST. GROUP � p OWNER ADDRESS S ZONING SETBACKS Z CITY ZIP TEL. REART RW L] o APPLICANT TEL. SIDE/SIDE STREET RW ❑ i � CONTRACTOR " � � p - SIDE Ll I ADDRESS PROPOSED USE I � CITY �--- ZIP TEL��3.�'�3 �ZL' �- I w ARCH/ENG/ , ! z DESIGNER NO.DWEL. NO. NO. � N ADDRESS UNITS _ STORIES BEDROOMS � CITY ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSP ADJ.AREANALUATION O OWNER-BI;ILDER�ECLARATION SFR/ADD/REM � 0, I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT 1 AM E%EMPT FROM THE CONiqACTORS LI� � Garage/Carport W CENSEUWFOflTHEFOLLOWIN6RER50N(SEC.7037.58USIN[SSANDCROFESSION90ODE�.ANYCITYOR j U COUNTYWHICHFE�UIqESAPERMITTOCONSTRUCT.ALTER.IMPROVE.DEMOLI511,ORHEPAIRANYSTRl1C- W Pat10/DBCk jl W TURE,PRIOR TO ITS ISSUANCE,ALSO RLQUIRES THE APPLICANT FOR SUCH PEHMIT TO FILE A SIGNED W ',� � STATEMENT iH�T MC-Ofl SME IS LICENSED PUR9UANT TO THE PROVISIONS OF THE CANTMCTDflS LI- ,� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 1000)OF OIVISION 30F TME BUSINESS AND PRO- � POOVSPB • FESSIONSCqDE)ORTHATHEOFlSHEISEXEMPTTHEREFflOMANDTHEBASISFORTHEALLEGEDE%EMP• �; � TION.IWYYIOIATIONOFSECTION7037.5BYANVAPPLICANTFOflAPERMITSU&IECTSTHEAPPLICANTTO Z Re•Roof �f � ACIVIL PENALN OF NOT MORE THAN FIVE HUNOFED OOLIAFS(SSOD).�: C]I,ASOWNENOFTHEPROPERTV,ORMVEM7LOYEESWITHWAGESASTHEIRSOLECOAIPENSATIUN, 0 COf111710fC10I ,{ Z WILL DO THE WORK,AND 1HE STRUCil1RE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.70<4,dU51- J q NESS AN�PROFESSIONS CODE:7HE wNTRaCTORS IICENSE lAW OOES NOT APPLY TO AN OWNER OF � PROPEN7YNM1i0UU1LOSORIMPROVESTHEFEON.ANOWHODOESSUCHWORKHIMSELFORHEPSELfOR m �j � 7FippUGH HIS OR HEROYIN EMPLOYEES,PROYIDEDTHATSUCH IMPRDVEMENTSARE NOT WTEN�EDOR � 0 OFFEREOFORSALE.IF,HOWEVEfl,TMEBUI�OINGORIMPROVEMENTISSOLDWITHINONEYEAHOFCOMPLE ,# z 710N,THE OWNER-6UILOEFl WILL HAVE THE Bl1R0Eh OF PPOV;hO THA7 4F.OR SHE DI�!!C?BUILD OR � w, IMPROVEFOHTHEPURPOSEOFSALE). ❑I,AS OWNEfi Of THE PROPERT7.AM EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTflACTOF3 � � TO CONS7RUC7 TME PRQIECT(SEC.7014.BUSINESS AN�PROfE5510N5 CODE:THE CONTMC70R5 LI- Va1118�10I1 _, __'-___ADJ.AREA C� A1J CENSEUWDOE6NOTAPPLVTOANOWNEROFAPROPFRTYWHOBUILDSORIMPqOVESTNEHEON,AND _' WMOCANTRACTSFORSUCHPRQIECTSWITMALONTRACTOR�S�UCENSEDPt1R5UM1TTOTHECONTRAP QUANTITY DESCRIPTION r�� ;f"��'�� FEE � ~ TOHSLICENSELAW.). — "'T'�- ' � J N„ ,€ � ❑I AM E%EMPT UNDEN SEC. B.8 P,C.FOA THIS RERSON � j � --- ----- oc Z DATE_ OWNER_—__— W ' � � �S qlytT y � i�aeN r � � LICENSED CONTRACTORS DECLARATION W �5 � IHEREBYAFFIRMUNDERVENALNOFPERJURYTHATIAMLICENSF.DUNDEHPFOVISIONSOFCHAPTEH � � � 9(COMMENCINO WITN SECT�DN 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS COOE,AND Z 3 �X� MYUCENSE5INFULLFORCEANDEFFECT. m � 11J t � g�D� � . � LICENSE CLASS �- LIC.NO. J yy i�.-__ � V' OATE CONTRACTOF _'- a W �—w '_ .j �. WORKERS'COMPENSATION DECLARATION Q � �� I HEREBV AFFIRM UNDEN PENALTY OF PERIURV ONE OF THE FOLIOWING DECURATpNS: U ' "—' a � � _IHAVEAN�WILLMAINTAINACERTIFICATEOFWNSENTTOSELF-INSUREFORWORKEFi3' _ � COMPENSATION,AS PROVIDEO BV SECTION 37000F hIE IABOR CO�E,FOR TNE PERFORMANCE U a OFTNEWORKFOFWHICHTHISPERMITISISSUED. � � � � _I HAVE AND WIIL MAINTAIN WORKERS'COMPENSATION INSURANCE,A6 REQUIRED BV SECTION O� 370oOFTHELABOflCO�E,WRTHEPERFORMANCEOFTHEWOflKWflWHICHTHISPERMITIS � ISSUED.MY WORKE S'CQ/APENSATION INSUR.AN/CE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION � � � ��r� �N�,�--- NREVIE . �rf�� :71).. ��"f/'-%7 CARRIER .-y_�� Z POLICV NUMBEfl t ��_ � �'— �� ___—_. ELECTRIC _ '� � (iHISSECTIONNE�NOTBE00MRETEDOFhiEPEFtAYTISWRONEHUMRED00LLARS(5700)ORLESS� PLUM61NCa _ �, W ICERTIFVTHATINTHEPERFORAIANCEOFTHEWORKFORWH�CHTHISPERMITISISSUEU,I MECHANICAL � (J SHAI.L NOT EMPLOV ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE — � WORKERS'COMPENSATION LAWS DF CALIFORNIA,AND AGREE TMAT IF 1 SHOUL�BECOME INSPECTION FEE � SUBJECT TO THE WORKERS'CAAIPENSATIDN PROVISIONS OF SECTION 37000F THC U180R � O GOUE,I SFWLLFORTHWITM COMPLY WiTHTHOSE PROVISIONS. — ISSUANCE --- — � 'p OATE:"�—rs —�APPLICANT SMIP � � � __'_-- -- � ENERGY P/C J WARNI :FAILURETOSECUREWOFKERS' O ENSATIONCOV AGEISUNLAWNL,AN�SHALLBE 4 LL SUBJECTANEMPLOYERTOCRIMINALPENAL ESANOCIYIIFINESUPTOONEHl1NDREDTNOUSAND ENERGYPERMIT __ DOLLAflS(5100,000).IN A�DITION TO THE COST Of COMPENSATION,OFUAAGES AS PROVI�ED FOR IN '�{ � SECTION37080FTHELABORCODE.IMEFEST,ANDATTORNEY'SFEES. RETENTIONFEE: 3 o CONSTFUCTION LENDING AGENCY PRE-ALT FEE: _ � I HEPEBY AFFIRM UNDER PENALTY OF PE0.1URY7HAT TNERE IS ACONSTHUCTION LENDING A(3ENCV �� d FOR THE PERFOHMANCE OF THE WORK FOR WHICN 7HIS PEPoAIT IS ISSUEO(SEC.3097,CIV.C.�. '� W � LEN�EH'S NPME _ — _ � F-' LEN�ER'SAO�RESS --- � TOTAL FEES y �� 1 CERTIFY 7HAT I HAVE READTHI5 APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS REL471NG TO BUILDING CONSTRUCTION,AND HEREBV/UTHORIZE flEPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE '� Z ABOVE�MENTIONED PROCERTV FOR INSPECTION VURPOSES. COMMENTS _ � �/�iU�1 C��—' � . �m� PEflMI EE NAME�P N7) — � _ - � < r�' � � � 51 F PERMITTEE D E ]] � RECPT.N0.. PAID BV VAIiDATION � WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Flle Copy,GREEN—AppllcanPs Copy d .� _. __.. _��_.__.,�.�.. ' � f tn rn I. . � � �i.-n � rn v: u� v,i a cs � r� en � �� g -i cn:�� r+ r cn : �.I II �� , �j '� zIz z z Sa rr m mE� m a � = C� O O G � � rn r --� m i ,� � ; i� A.�DI A DkC�s 1r 'o .�cl'< r- O C�G C�O b C7''� � �'pl� S�'l -i � � 'S :r r r r y � � mi� �.�� I� G7�� 7 -n �'�i m Z7 m�� i� tn p # �C7� � �- -� • � .Tirnsc> � 'L^ C7�771DCi7i� �1� 2122�ICj��U5�3i 'OL7�� D 'RD -i-1i :•a�".�, I r-" r' mO � '"i : � -I� � I'+ msOIG: 2coO,� o - o n � .�D� : , (il .j C n -pf�v m � D �- Z C = � r= r tTt I<r m n'1 S�D��7 7J .T� ��' C� _- � � � � tn tn 'r-I� � ��t- � c c � D'm � s � m o Ir � � e ,. (13 T�' i' '..� .� W � Z�-1 _{ . . Ta .� C 1� O W a � 'j��I Z Z < �p 17'f C a7 {�! iv cn I �� w' z �lo z�-t �.� z' �=° z m '� p J� m m � i ( ( � _ �� 'z c�� ? �y � D � , � z � m � � .0 i - � -� '`;� � �- � ` � J �:_� �,- _� �i I ° ' ;� � . � � I `� � � ; .�' I fI t. ! � � � �� , � � �, i � � ( � �. ,) �. � ' � �, I � - �I j �� i � � _ � '=;� - — - -� =i �� - — � � t � ! �'' � I ( i I � I ( I ( � � j ,� � 4 ; �-' i � � i � � ( — I, i I , I 4� i • : �' I , ; I � I � !r� � � l € ? � � ! � � � i � � :�. � � � 'j • � � �- ;��. — ; <� : � � ' � I �� j �i � f �� =� � �' I i i � � � � `, � I ;I �� ' � � � � � i I � ` � _ — _ rt_ � � � - � - � r' —�m o�2 � -n r�-n t0 v �� ' . �.. � _3 - , � I O I_ O �. . � m v F n m � ,� -rs c c �'� � I I ' ., i . . Z n�tn � � zID m w O D Q m 77 � r Z, z O I �,� T I� � Z,z i . �I< � m n��la,g � p p'p c � m -1'`� (�� , n , C ' �nl-• --��o rl-=i o� c? n r'Ir',r' i�� Tl�ipr-m�xiv � m�� o � � ; i m = m �`+''mc`niml> � ��-nm x � m I r �i�im�aa , „ I , ! I 0 ��Ir, o -o o� aDiz`-a mlZ;m c� vy zlD�o�° oi1D A -n+';�Ifl �- � � < _lY � � , � G7fr -I2 � '7i �s7lO D�Z�m �I377IprZ�OC � C7r .r:�:,� 0 a. � : � �� . � � _ I � �� R ' ➢ '� -p Z I�6I''`1 � � -I a n C.�� Z F d p�� I'1 i V &� � �.,. y,9 � :f I .. .j � - i 'I ; �_ -i z��'' v�� '�cn �� I .c� m n�� °"' o t� c� -t � � � . i -� � ��a , 3�� j: ��''o ��z p D � �°��i� � � �' � � _ �_i i [i �f � ;I �� ! �— i�� -��.� �;�r � � I � ' 'I � !D �' � `, I �s �a o lc � � � � '� 1.�_ i �� a.: ._ � �_- ''r' _.� � � _ f ( _ �� I� � ,� �`.�� , " j ��: i , � I: I i f , ' I I t I � I (_, �,q�m� � od y � � � I � � ..j - � � i� �� f _ I I l�, ! -"-�-��- .. � � � i ._ 4 �� C ��,�. I.. ' � � I � . 4 � k i _ f �_ I � _ i ' - i � . -J{ *. , —{— E —{� . , �r. :�:,. e i ..:� ,! . -�. I .�, " �,�. �. � .�.�: ! !'' j.�.,. : I ' I ��;. - ��- ! �. . ' �� . � .1 . 5.�:'' �, .. _ .. .. �_ I '� ,� _ : - , � , _ , .► j � i ' i _ ' , .a �, � � � � --��,� i ; � a � � �� fi �� , � � � �� _ . � _ - � � � � �� °�-`. � I � i � — �.— � , , �:�..� ' ? ' i :i i �� a: f i ! ��.� � �, ; � � i� � I - ( I � �, � � ; � � � � � I I i. . � . �1�� - ` _ � G� � -� �i r; f � , - � ! _ .� � ' ' i � � �.<� � ( I ,' � ' , �_ � � ( � � � ... .� _ ::� � . ' . � I � _ . � _ � ; - _ .. , . I (: .. I ,, . _ .. . 4 E � � .__:_: � . ! :- � __�____.��...��..� ._�.� �_�., .�. ._____.. .� �_._..I�.._.�_J._�L;_.�l._I_� _ �!.__ ____ __J.__ _ __ .._�� .