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--- ----- -------_ -- --- --___ .,._-_. _ ------ -- -- ____ _ ____ _ _ -�-------- CITY OF DIAMOND BAR �''� ^ � � COMMUIVITY DEVELOPIVISNT DEPARTIviENT �'°� :;,�„ . 21660 E.Copley Drive Suite 190 � P��P�*r�^ (909)860-3195 Fax(909)861-3117 �"!"" BCJILDINGPERMITAPPLICATION FIF;MLY o D RIESS 3�ONI �� /VO�D OR. _ _DATEICATI N /I (�i1'7 NUMB R f�J 1�� #lC / 7•�'73 ;. � lSSUE �/-��T�TYPE OCC APN LOT TRACT pA?E CONST. GROUP. p OWNER � o ADDRESS 3S� i ��[/,C t�I�O DR. ZaNING SETBACKS oCITY V,�B ZfP �6 TEL FRONT FlW ❑ APPLICANT TEL. REAR ❑ o SIDE/SIDE STREET RW 0 z ' ¢ CONTRACTOR K SIDE O p� ADDRESS' PROPOSED USE � CITY ZIP f TEL. .�j` o ARCH/ENG/ z DESIGNER N0.DWEL. NO. NO. 't�i ADDRE55 UNITS S70RIES BEDROOMS- � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACT�R PSF ADJ;AREA/VALUATION' cn � .�.' � OWNER-BUILDER DECCAAATION � SFR/ADD/REM �- � - � � � ��� O . 0�. I HEREBY AFFIRM UN�ER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- G81'8CJ0/CefPOff � � W CENSELA.WFORTHEFOLLOWINGREASON(SEC,7o3+..5BUSINESSAN�PROFESSIONSCODE:ANYGTYOR (/� � U COUN7YWHICHRcQUIflESAPEHAIITTOCON57RUCi.ALTER,IMPftOVE,DEMOUSH,ORREPpIRANYSTflUG 'W 9[1 IDOCI( -� ' � �, w, '.7URE,PRiOR TO ITS ISSUANCE,ALSO RCQUIflES THE APPLICANi FOR SUCH PERMIT TO FILE A SIGNED , �. STATEfAENT THAT NE Oft SN215 LICENSF.G PURSUANT TO THE PROV{SIONS OF TME CONiRACTORS LI- , , �� ��GENSE LAW(GHNPTEP 9(GDMMENCINQ WITH SEC�ION-]�0�)OF DIVISlON 3 OF iHE 9USINESS AND PRO- ��"' ool/Spa . Q ���FESSIONSCODE)ORTHATHEORSHEISEXFNPTTHEREFROMAN�iHEeA515FOaTHEALLEGEDEXEMP- . (�} . , � ,`y '',TION.ANYVIOLATIONOFSEGTION7o31.56YANYAPPLICANTFORAPERMITSUBJECTSTHEAPPUCANiTO Z Re-Rool � �pCIVIL PENALTY OF NOT MORE THAN FIVE 1UNOREO DOLLARS�'$Soa)_�� � , o , GI,ASOWNEFOFTHEPflOPER7Y,ORMYEMPLOYEESWITHWAGESASTHEIPSOLECOMPENSATION, ' � COfnRIBfCidl � Z �WILL 00 THE WOflK.AND THE STRUCTURE IS NOT INiENOED OR OFFEFE�FOR SALE(SEC 704d,9L'SI- J . NESS AND PROFESSIONS COOE:THE CONTRACTORS LICENSE LAN/DOES NOT APPLY TO AN OWNER OF � � . � �..�PRQPERTYWHOBUILDSORPAPROVESTHEREON,ANDWH00065SUCHWORKHINSELFORHERSELFOR � � ' ' (t .THROUGHHISORHEROWNEMPLOYEES.PROVIDE07HATSUCHIMPROVEMENTSARENOTINTEN'J'eDOfl � ;� � ' " 'Q ���OFFEREDFORSAIE.IF,HOWEVER.THEBUIL�INGORIMPROVEMENTI550LOWITHINONEYEAROFCOMPIE- �' � '�'�TION�,-THE OWNEfl-BUILDER WILL HAVE THE EUR�EN CF PqOVING THAT HE OR SHE a10 NaT BUILD OR � �IPdPROVEFORTHEPUFiPOSEOFSAIE). w �� �❑I,ASOWNEROFiHEPROPERT�AMEXCWSIVELVCONTAACiINGWITHLICEN5E000NTRAC70R5. � , ' W �';:CaEN ENLAWDOESNOTAPPLVTOANOWIv'EAOFAPftOPEFTYWHOBUI DSORDVAPROVESTHEREON,ANL� �IUeFIOfI � ADJ.AREA � �F ,,�WHOCCN7RACTSFORSUCHPHOJECTSWITHACONiRACTOR(5)LICENSEDPlJflSUANTTOTHECONrRAC- QUANTITY DESCRIPTION � FEE Y, ,TORS�ICENSE LAW.). J , Q ❑IAMEXEMPTUNDERSEC, B.&P.C.FORTHISREASON U I� � � - LL.� OATE OWNER ~ . � . ' .. ' Z _' ' ��j„� . . . . . � � � LiCENSED CON7RACTORS_DECLARATION W � � ' ' ¢ 131 F CHA ER � � SED ll ER PROV ONS O PT CL I HEREBV AFFIFu IJNDEfl PENALTY UF PERJURY THAT I AM LICEN N� , I�j � '9(COMMENCINGWITHSECTION7aoo)OFDIVISION30FTHE9USINESSANDPROFESSIONSCO�E,AND Z ' � `XMY LICENSE IS IN FULL FORCE AN�EFFECi. m � �� ��i X i.J ///��� A /��� �/� rC � � � LICENSEGLASS����Q{(�. ` �LIC. O.�(� � , � DATE_�I"�J� /� _CCNTRACTOR �a. L� . O o �'��- �I w II � � WORKERS'COMPENSATION DECLARATION �-� � 1 HEREBVAFFIflM UNOER PENALTV OF PERJURV ONE OFTHE FOLLOWING�ECLAF3ATIONS: v . � — Q II ' C� I HAVE ANO WILL MAINTAIN A GERTIFICATE DF CONSeNTTO SELF�iNSURE FOR WORKERS' = II COMPENSATION,ASPROVIDE�BYSECTION37ooOFTHELABORCODE,FORTHEPERFORMANCE U a OFTHEWOFKFORWHICHTHISPERMITISISSLIE�. � Q � _I HAVEANO WILL MAiNTAIN WORKERS'COMPENSATION INSURANCE,AS FE�UIRE�BV SECTION Q 37oa OF THE LP80R CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERA(IT IS �'�.�9 ��I ISSUED.MYWORKERS'COMPENSATIONINSUflANCECAFRIERANOPOLICYNUMBERARE: CONSTRUCTION ` � ?. CAflR:ER PLAN REVIEW �/"�� ��� � aoucv rvunneea I � a � ELECTRIC ¢ � �. (hiISSECTRJNNEmN0T9ENMPLE7E�OFiHEPERMRISWROfdEHLWDREDDC17AR5(Stao70RLESS)_ PLUMBING �!" w IC'eRTIFYTHATINTHEPEflFORMANC_OFTH�WORKFOAWIIICHTHISPEFMITISISSUED,1 MECHANICAL Z s. (�'� . SHALLNOTEMPLOVANYPERSONINANVMANNERSOASTOBECOMESUBJECTTOTHE Uj. WORKERS'GOMPENSATIONLAWSOFCALIFOflNIA,ANDAGREETHATIFISNOULDBECOME INSPECTIONFEE � � � � � SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION3�ooOFTHEIABOF �p� , �, CO�E,I SHALL FORQTH,/W�ITH COMPLY WiTH THOSE PROVISIONS. �SSUANCE O �'7"/ T. K • �DO . SMIP . � � .�i� � p DATE: �I! APPLICANT: , � � WARNINGFAILURETOSECUREWORKEFS'COMPENSAi1DNCOVEFAGEISUNLAWFUL,ANDSHALLBE ENERGYPIC '�, . -`j,^,,, SUBJECTANEMPLOVERTOCRIMINALPENAL7IESAN�CIVILFINESl1ATOONEHUNOPE�THOl15AN0 ENERGYPERMIT � OOLLARS(5100,o00),INADDITIONTOTHEGOSTOFGOMPENSATION,DMAAGESASPflOY1�EDFORIN -��-------- -- , ', � SC-CTION3]OBOF7HELABORWOE,INTEFEST,AN�ATTOflNEV'SFEES. RETENTIONFEE: - a CONSTRUCTION LENDING AGENCY PRE-ALT FEE CO ' CC 1 HEREBV AFFIRM UN�ER PENALTV OF PERJURV THAT T'r:ERE iS A CONSTRUCTION LENDING AGENCV a' �OF7HEPERFORMANCEOFTHEWORKFORWHICYTFASPERMITISISSUED(SEC.309],CIV.C.). W ' � LENDER'S NAMe ' � ' II ' F- LENDER'SADDRESS . . ' �� ICERTIFYTHATIHAVEREAD7HISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCOqRECT. �OT/"1L i-EGS � /�� ��� �' IAGREETOCOMPLVWIiHALLCIiVANpCOUNTVORDINANCESANDSTATEL4WSRELATiNG700UILDING - - . � ' II �� CONSTRUCTION,ANDHEREBYAUTHOflIZEFEPRESENTA7NE50FTHI5GOUNi'l70ENiERUPONTFE ' � ' �, ABOVE-MENTIONED PROPER7�FOR INSPECTION PURPOSES. . COMMENTS � � T,q� K�y� �oo , � , � � PERMITTEENAMe(PFINTj VJ '�. , �;jJ,�� sicNa7ua�oFVEqMirr'=_E DATE���-7� qECPt NO. a S PAID BY VALIDATION �� Y ~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co .GOLDENROD—File Co GREEN—A licarrt's Co � � � P pY, PY� PY. PY, PP PY _ i..-.�- �wl.'r-. ,v.r Tv-.:; �. ,:,..7 r� ,:...... . _ i - ' r .d:�f`N � �__ � 4. - .. •+, -. � . :> -.� . ._— _ ' __ " .T ,.- ,.., -.._ _. i, .� .- . . '. ::'. ..... .,..,y .,:':" �.�.a t '�:';:1 ...".. , . ... ." . ...� , , � . ���, � �� n �� �� � ����'����� '�.�� � � � ,r,. k g . , y� � `�}_ tl b,� g��,.. � c m , � M.:. a ,'��B , �� �� . �` �x : "% :�„�" �;��. � ' .. - ' > � .. �:.. 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