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Home My WebLink About12-1132 CITY OF DIAMOND BAR CX Q( TL� , . ^---��' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21810 Copley Drive,Diamond Bar,CA 91765 ' (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS ��`°"'. BULLDING PERMIT APPLICATION FIRMLY o� JOBSITE APPLICATIO � l � NUMBEW��I�` plC ADDRESS DATE � ISSUE ^� 7yPE 'f- �C APN LOT TRACT DATE v CONST. r � GROUP p OWNER o ADDRESS �1��.( Ixn� �� 1.�� I' ZONING SETBACKS FRONT z CITY ��w111P_ZIP Q� TEL. � AW ❑ • � APPUCANT �-- �- - - �� • `- TEL. REAR � ¢ SIDE/SIDE STREET Ryy p � CONTRACTOR SIDE � � ADDRESS � CITY � �,�- ZIP� TE � PROPOSED USE ' o ARCH/ENG/�$ �- z DESIGNER a ADDRESS NO.DWEL. NO. NO. � CITY Z�p �L UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLAAATION � I p SFR/ADD/REM I HEREBV AFFlRAI UNDER PEN�LTV OF PERNRV 7}y�T t AM IXEM7T FROA1 THE CONTqACTD0.S LI� G8fa90/CBIPOfI. I W CENSEUWFORTiEFOILOWIN(3REA.40N(SEC.7031.6BUSMESSANDPROFESSIONSCODEANYG7VOR (n I C� COUNTYMM1i�CHREOUIRESAPERMRTOCONSTRUCT.ALTERIMPHOVE,DEAIOLISH.ORREPNAANVSTRUG W P8110/DBCI( < TURE,VRIOR TO RS ISSUANCE.ALSO REWIRES THE APPLICAN�FOR SUCH PERMIT TO FlLE A SI�NED w STA7EMEHT THAT HE OR SHE IS 110EN5ED PURSUANT 70 THE PROVISIDNS�OF THE�COPlTRACTOR9 U- � CEN9E LAW(GiAP7ER Y(COMMENCINO WI7H SECTION 7000J OF DIVI910N 3 OF THE&13INE59 AND PR6 � PDOI/Sp0 - . Q FESSIONSCOD�OR7HATHEORSHEISEXEMPThiEHEFROMANDTHEBASI5FOR7HEALLEOEDE%EMP- (� V TION.ANYVIOI.ATIONOFSECTION7o31.6BVANYAPFLICANTFORAPERMITSUBJECT3THEAPPLICAN770 Z Rg-R001 � A CML VENALTY OF NOT AqRE TTiAN FIVE HUNDRED DOLLqRS(ibao).�: � ❑I,ASOWNEROFTHEVROPERT',ORMYEIdPLOYEESVA7HWAGESASTHEIq50LECOMPENSATION, � � CpmmBfC121 Z YALL DO THE WORI(AND THE STRUC7URE IS NO7 INTENDED OR OFFEflEU FOR Sl�LE(SEC.7oN,BU51- J ' � NESS AND�qOFESSIONS CODE THE CONtRACTORS LICENSE�LAW DOES NOT APPLV TO AN OYMER OF ? -� PROPEHfY W/10 BUpDS OR IMPROVES 7HEREON,M1D Nh10 DOES SUCH WpRK HIMSELF OR HERSELF OR W 7HROUGH WS OR HER OWN EMPLOYEES,PROVIDED 7HA7 SUpi IMPROVEAIENTS ARE NO7 UlTENDED OR m � � OFFEfimPOR3ALEIF,NOWEVERIMEBUILDWOORPIPROVEMENTISSOLpWfTMNONEYEAROFWMPLE- � Z TION.THE�ONTJER-BUIIDER WILL NAVE THE BURDEN OF PROVWG THAT HE OR SHE DID NOT BUIID OR , � GIPFOVE FOR 7HE PURP0.5E OF SALE} � . ' W ❑4�.4 OWNER OF THE PROPEHTY,/W E%C�U$NELY COMRACT W O WRH LICENSED OONTRACTORS Q TO CONSTRUCT THE PRQIECT(SEC.70N,BUSINESS AHO PROFESSIONS CODE:THE CONTRACTOR9 L{- V81Uatbn r f�OJ.AREA � W CENSELAWOOESNO7APPLYTOANOWNEROFAPROPERTVWHOBUIL0.40RIIAPROVE57HEREON,AND - � F WHOCONTRACTSFORSUCHPROJECfSWfh1ACONTRACTOR(S)LICENSEDPURSUAHfTOTHECONTRAG QUANTI DESCRIPTION FEE � TOt35 LICENSE LAW.). � ❑I A►1 E7(EMPT UNDEA SEC. 8.d P.C.FOR THIS REASON � � � U � �A7E � OWNER �� Q LICENSED CONTRACTORS DECLARATION �w - � � � (L 1 HEi1EBV AFFIRM UNDER PENALTY OF PER.IURY THAT I AM�LICENSm UNDER PROVISION9 OF CFiNPTER � � �� - � D(COMMEJJCPq WfTM SECTION 7000)OF DMSION]OF THE 9USINESS AND PROFESSIONS CODE,AND Z , ' �� 4Y LICENSE�5 W FULL FORCE AND EFFEC7. `�// m � UCENSE CLASS �C�� LIC.NO.. V ,�/O�� . .. ' U DATE �ZA�/�_ CONTRACTOR a . . _. W � WORKERS'COMPENSATION DECLAR �� - � � � I HEREBYAFFIRM UNDER FENALTV OF PERJURV ONE OF THE FOILOWW(3 DECURA710N5: V C� � - .. . Z . . � . . � _IHAVE�ANDWILLMAINTAINACERTIFlCATEOFCONSENTTOSELF-WSUqEFORWORKERS' sy - - COMPENSATIOM,�l4 PRpy�DED BY 6ECTION 37000F THE UBOR CODE,FOR THE PERFORMANCE V OF TiE WOH!(WR W/iMJi THtS PERAIIT IS ISSUED. - W � � ' . W �HAVEANDWM1LMAIMAWWORI(ERS'COMPENSATIONW$URAN 1— CE,�AS HEWIRED BV SECTqN �Z,�� 0 37oD OF THE LABOH CODE,FOR THE PERFORAIANCE OF THE WOPo(FOR WMCM THIS PERA/1713 ISSUED.MV WOPoCERS' MP TION� RANCE CARWERMID POLiCY tJUMBERARE: CONSTRUCTION. � j CARRIER_�� S=�,ffl�._ PLANREVIEW .. . . . Z0 aoucYNUMeER -��T�� —� �� "�� - .. . ELECTRIC . �j Q p f��ID�'�T��mo�n+�a�x*�s�oaa+EM�rnr�n0alu�sKtro)oAtFss). PLUMBING � w Z 1 CERTIFV T1iA7 IN hiE PERFORAIANCE OF THE.WORK FOR WHICli THI$PERMR IS ISSUED.1 MECHANICAL CS SHALL NOT EMPLOV ANY PERSON W ANV MANNER SOAS TO BECOME SU&IECT TO THE (/j WORNER5C0►1PENSATqN UWS Oi CAIIFOiWIA,ANDA(iREE THAT IF I SHOV OME INSPECTION FEE SUB.IECTTO7HEWORI(ERSCOMPEN9A710NPROVISqN50F5ECTqNJ7 ELABOR �� O Ca0E,1 SFWl Fofi(MVlf7H CAMpLY N7TN THOSE PROVIStO ISSUANCE - p DATE:�� APPLICANP.. �SMIP _ W J WARNWO:�FMURE70SECUREWOW(ERSCOMP ASqNC RAGEISUMLAWFUI.,ANpSHAL�BE ENERGYP/C � J �y SU&IECTANEMPLOVEHTOCRIMW�LPEIULTIESANOCI NESUPTOONEHUNDREDTFqUSAND ENEROYPERMIT - DOLUR.4(f100,000),W ADDITION TO THE COST OF CO SA710N,DAMAOES AS PROVIDED�FOR IN J SECTION 37oe OF TiE LABOR CODE,WTEREST.AN RNEYg FEES. � � - w . RETENTIONFEE: � .E� O _ CONSTRUCTION LENDING AGENCY � P///q��E-ALT FEE: � 1 HEREBYAFFIRM UNDER PENALTY OF PERIURY THAT THERE 13 ACOMSTRUCTION LENDINO AOENCY �� O FOR THE PERFORMANCE OF THE WOPoC FOR WHlCJ/7HIS�PERMIT IS ISSUED(SEC.3061,qV.CJ. Z W � LENDERS NnME . . .. . . . • F— LENDERSADDRES3 ' � - - � �ICERTIFYTHATIHAVEREAD7HISAPPLICATIONANDSTATE�iHATT1EABOVEMFORYATION13CORRECT. TOTAL FEES � 1 A6AEE TO COMPLV N7iH A�L CITY AND CIXMTV ORDMAIJCES AND STATE UN5 RELATINO TO BUaDINO � D � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTA7 S OF TNIS CWNiy 7p ENTEH UPON TiE - Z ABOVE-MEMIONED V ERTY FOR WSPECTION PU a COMMENTS " �.j Z�Z 0 � �, m PEAMITTEE W�ME(PR17n � � V . Q � � sw o�TE �O��_ qECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finar�ce Copy,PINK—Assessor Capy,GOLDENROD—File Copy,(iREEN—Appl{canYs Copy CITY OF DiAMOfVD BAR� `� ' ' IiVSPECTION RECORD ...i.: e � S :8 . _�,. �. � i .i p .g ..y ",. � � .� :, .�.. '` ,:'` _.� � t � ''m., � � �. o , � o . . . .. , , ._ .._.. . . ' :d ;. ._; . �. 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