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--- ,.... __ _ _ - - __.. ,..,. __ ��.. _._ ;,, ,.. . _ ... ... _ _ ,�.:.- , ... _ ___-- T� CITY OF DIAMOND BAR „ �`� COMMUNITY DEVE�OI'i1%I�N'C DEPARTMEI+IT 21660 E.Cop]ey Dnve 5uite 190 ,_% -M.w . .. , PRES� (909)860-3195 Pax(909j 8b1-3117 �'vK" BLJILDING PERMIT APPLICATION FIRMLY � JOBSITE �Q `�G��� APPLICATION -`.- ' PERMIT ( � P7C -- �� o ADDRESS'"" ,:. -��: DATE I ' NUMBER��/ # ISSUE (� j�TYPE OCC `^ APN--�� L�7 TRACT DATE �"�I�" I✓ CONST. GROUP � OWNER ,Jl�+„��C'�„' �.1 o �� FRONT „ " RW ❑ o AD�RESS G'E. I...��L-. ZONING SETBACKS Z CITY �1 �►� ���PEP.yY./�?� I REAR d i--- zAPPLICANT�.�l��� ;_ TEL. � SIDE/SIDE STREE�' RW ❑ ¢ CONTRAGTOR ` C G �'"' _i�_` SIDE ❑ � ADDRESS� ,��p''f e-- PR�POSED USE � �1'H. ��� ^ � CITY" ZtP [/Y� TEL �SS'S=1C3�� I w ARCH/ENG `'r}��I � �--- �?r+�^�yw, C.^ t�c>d �����? S � DESIGNER ► V �/VD� NO.DWEL. " NO. NO. a AbpRESS � � UNITS STORIES BEPROOMS � CI'TY d �� M ZIP �&L. � pESCRIPTION SQ.FT. FqCTOR PSF ADJ.AREANALUATION cn � pWNER-BI;ILDER DECIARATION SFq/A�D/REM � O p I HEREBY AFFIRM UN�ER PENALTY OF PSRJURY THAT I AM E%EMPT FROM 1NE CONTRACYOpS U- � GaragelCarport L7.J .. CENSELIWFOFiHEFOLLOWINGREA50N(SEC.7031.SBUSINESSANDPROFESS76NSCOOE:ANVCITVaFi C.> COUNTYWHICHREQUIRESAPERA11TTOCONSTRUCT,ALTER.IMPROVE.DEMOL15H2ORREPAIPANY�5T�+UC- W PatiolDeck � TURE,PR�OR TO I78 ISSUANCE,k�50 REQUIRES THE APPLICAN7 FOR SUCIi PCRMIT TO FILE A SIGN[0 w � STATEMEM THA7 HE OR SHE IS IICENSED PURSVANT'O THE PROVISIONS OF THE CdNTRAC70p5 LI� � CENSELAW�CHAP7ER9(COMMENCINGlM197H�5EcilON'lOOo)OFtlIVISION90FTHEBUS'MESS'AN�`PRO� �'i' POOVSPB o , FE£SIONSCOOE)ORTHATHEORSHEISEXEMPTTHEFEFROMANDTHE6ASISFORTHEALlEGEOEXEMP- (�J v 7101V.ANVVIOLATIONOFSECilON7o31.5BVANVAPPlJCAMFOfl�1PERM'TSUBJECYS?HEAPPUC.fN�`TO � Re-Foof � ACIVILPE4ALTYOFNOTMORETHANFIVEHUNDREDDOCLARS�$5oa).): ��� - 0 OI,ASOWNEfloFTHEPRoPERTY,OflMYEMPLOVEESWITHWAGE5R5THEIR50LECOMPENSAYION, � Commercial Z WILL 00 7HE WORK,AND TH'c STRUCTURE IS NOT INTENDED OR OFFEFED FOR SA�E(SEC.�044,gUS�, J NESS AND PROFESSIONS CODE:iHE CONTRACTORS LICENSE lqW DOES AOT APPLV TO AN ON/NE4j OF ♦% � PFOPERTYWHOBUILOSORIMPROVESTHEREON,ANDWHOOOESSUCFIWOR12HIMSELFOR'HFb�S-lFpq m � � T�IROUGHHISORHEflOWNEMPLOYEES,?ftOVIOEDTHATS�CH�IMPROVEMENiSARENOTIN�EN�EpOR , W OFFEREDFORSALE.If,HOWEVER,7HE6UILDINGORIMPROVEMENTI550LDWITHINONEVEAROFCbMPLE� � TION,THE OWNER�BUILDER WILL HAVE THE BUR�EN OF PROVING-HAT HE OR SHE DIO NDi BtSILD OR � IMPROVEFORTHEPURPOSEOFSALE), � = OI,ASOWNEapFTHEPROPERTY,AMEXCLl1SIVELYCONTRACTINGWITHLICENSE�CONTRACTOaS W� TO CONSTFUCT THE PROJECT ISEC.]Oa4,BUSINESS ANC PAOFESSIONS CdOE'THE CON`fRACTORS l.i- CENSFLAWOOESN�TAPPLYTOANOWNEROFAPROPERTI'WHOBUILDSORIMPpOVES�'HEREON,AND V81u8lIOPl _ [ ADJ.APEA � WNOGONTRACTSFORSUCHP4iQ/ECTSWITH-ACONTRACTOR(SjUCENSEDPURSUANTTOiHECONTRAC- �UANTITY DESCRIPTION FEE Y TOfiS LIC[NSE LAW.). � J 6 C:I I AM EXEMPT UN�ER SEC.___._ 8.8 P.C.FOF THIS REASON � � � LL' OAiE OWNER V o LICENSED CON7RACTORS DEQLARATION, , � w ¢ CC IHERffBYAFfIRMUNDERPENAL7YOFPERJUFYTHATIAMLICENS[DUNDERPROVIS�ONSOFCHAPTER- � � 0(COMMENCINGWITHSECTION7oDo�OFDIVISION30FTHEBUSIVESSANDPROFE5510N5CODF.,AND Z X MV I.ICENSE IS W fULL FORCE AIJO EFFECT. � � LICF:NSE CLASS (�/'-� C� LIC.I¢O. I'__��� � -. _.. . ~ DATE �'�/d '—�e� CGNTRACTQA •tr�C '�;`C3N � a — W �i����e�F-y� . . . r�' WORKERS'COMPENSATION DECLARATION . Q � I t1EftEBY FFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWINd DECLARATIONS: U C!J � _ . Q � ',HAVEANDWILLMAINTAINACERTIFlCArEOFCONSENTTOSELF-INSU41EfORWORKEPS'� - � COMPE4SATION,AS?qOVIDE�BYSEC'ION37ooOFTHcLABORCOOE,FORTHEPERFORINANCE U , ¢ OFTHE WORK FORVJHICH THIS PEFAAIT IS ISSt1ED. . . � � `�/I_NAVEAN�WILLMAINTAINWORKERS'COMPENSATIONINSURAIJCE,ASREQUIRED�BYSEC'7IpN� Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF TF1E WORK FOP WHICH THIS PERMIT IS� . �1 � ISSUED.MYMlORKE,R.S,g'.C�O�MjP�ENSAi101r�j'SURANCE AFtRI[R ANb POLICV IJUMBCRAPE:� GONSTRUCTION j CARRiER /19T'�., °����`�-�-��� PLAN REVIEW ,� t _ ��Q„' '�"�' ��� Z70LICYNUM6ER��_./ �-__ . ELECTRIC � .;THISSECf10NNEmNOTBEO�MPLEfEDOFTHEP=RMRISFOPdVEHUhDREDDJIJ.ARS(E100)ORLESS} PRUMBING � � I CER?IFY THAT W THE PERFORMANCE OFTHE WORK FOR WHICHTHIS PERlAIT IS ISSU[�,I � ����. MECHANICAL z LJ'' SFIALLNOTE4IPLOVANYPERSONINANVMANNERSOAST08ECOME$UBJECTTOTHE '� � WORKERS'COMPENSATIONLAWSOFCALIFORNI NDAGFE A7 ISHOl11.OBECOME '� INSPECTIONFEE F- SUBJECT TO THE WORKEPS'COMPENSATION O ISIDNS S CTI 37oa OF THE LABOR ��') � CODE.ISHALLFORTHWITHCOMPLYWITHT S '�� ISSUANCE 4 „3V[/ � p DATE�� APPLICAN � SMIP ,r�� a � � � ENERGYP/C J J WAR�JING:FAILURETOSECUREWORKERS'CnMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE�,��� � SUBJECTAN EMPLOYERTO CRIMINAL PENALTIES AN�CIVIL FINES UP 700NE HU���REDTHIXISAND . ENERGY PERMIT OOLL4RS(5100,000),IN hDDIT10N TO THE COSTOF COMPENSATION,DAMAGES AS P{iOVIDED FOR IN /� � SECTION 3708 OF iHE L.160R CODE.INTEREST,AND ATiORNEY'S FEES. RETENTION FEE: I �P(/'P � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEPEBYAFFIi1MUNDERPENALTVOFPERJUflYTHATTNEREISACANSTRUCTIONLENDINGAGENCY d- f-ORTHEPERfORlAANCEOFTHEWORKFORWHICHTNISPERMITISISSUED�SEC.3097,CIVC.). -----�-'��—� . Z W � LEN�Efl'S NAME _�_--_ F- I.ENDER'SADDRE55 � .-. � j ��- W ICERTIFYTHATIHAVEREADTHISAPPUCATIONANOS7ATETHATTHEAF3OVEINFORMATIONISCORRECT. T07AL FEES� . i ��� ' �� d I AGPEE TO COMPLY WITH ALL CIiV AND CAUNT`�ORDINANC'eS AND S7ATE UWS PELATMG Tp RUII b161G � .� � � CONSTRUCTION,ANOHEftEBYAU7HORIZEREPRES�NrATIVE50FTHI5COUN7Y70ENTERVPONTFIE � , ABOVE-MENiIONE�PROPERTYFOR INSPECTION PURPOSES. � � � -�� - COMMENTS___ . � . �� .� � .. . .. QPERMITfEE NAM P _ . . ,�,,yy��� Y � , . . U� `� �g[� �.: i ���.. . .. . t..: (q SIG � eovPERM . . , � °'TE RECPT.NO._ . �� �PAIDBV��` VALIDATION � _ .. . , . .... . . ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy.GREEN—Applican't's Copy � �� �� - � �� � � � � � ������ � . . : . � � a � � `� � � ' , � :� : � A w � � . � � � m ,� ,. ���.�� t a � � ����;�����_ ' � @ �(��°%������P,�'�%F`�'��(.__�_______-� � ���.��i s-�`4��14ai�� i i I.M�� i ___-- �_§ � ��E:.�s�`€'(°'�'-������__�i..._._/_ � _______ ����_�����r°`��,�'42�-�i:�:i.. �1; �,��_ __-� �qQ"�( ���j ;,( ' ____*___�_.__ _.__ }�p yy �q'�*a p�•p{�^�, �5�' ,� �����41 E�f=s�.J�N?.6_3�@*d'�.�.2 ��L�� .... ._.... � �a���L3'�1���&J�f"i'i..�I'�Ya.S�E3� ) � - � -A'�t ' � .. -i ,:.M i, ��� 8 _ __".�'�.�.'�.�_ � -.. � � �...�. �L���'�;���� � �` �3��,;`�'�..�a.��: FL�Bt�h3��a i�?� � _�_ ' "� �__�__—.___._,.�.V *, _.�_ �_ �.._._ � �;����������� __ .��� . i I [ =����L�t �"�3t��C}���i�� ' ___-----_ a�`dr� F'Yq����d��C;� � x . .. �� '�����:�'.�3��E.�.�E��9. . ��.i���=--�.-..-,:_a � � .. � �{ ,.`�;, , , , ; � �C.�C?(����,��1 ; , � a m . _ ��?t���� �:T:�tfl�� a_.��'.,,f�'` ..__. ___�__.. ° � - ._. -----' � ;��ts�:� (:af4�%$?'�€..��TaC��I ?`��c ��l�t�=__����f�_�� � �.—� ��,?�3�°�C���� ' � i � � �R ����1(�`�:,' `; ,.� . �_._ , t�:...,; ,_ __..�__._ _ � ��:'?�I� h��°,�i';�I� � - �,, I Y���=��C,N;�t�� ��_..,.,�� � _ , ,..� �_ ; —� ��t�.�i€ ��.a..(�T.,i��; i i_�.€`�1,7,t',7`tl-��Fi'rl�"i�N� � €���st�l-�i��E,�'tL�1�'1t�:� i ,_ _ �.__ � t=is�ii��-9 C"a�=$11�'1d�I� � � � t,, �. �,a-=,���s�,'3"C,�s3����" // 7� .---''' �� � ���.z9 F��^1"�€.C`i �m � �i, � � 4 9 ��—°�a`T.�.�:�~t Si��i�i �� � �� �`�`��_r=�1i�t�i��"`:c — --- i t �• �� 1`�",l_?�� ; i , �`��.i�ti�`�.}� 1�,:s��` ��,��%�_..__ ��a�'��.F�t��3L _� � � `..`__--_—_ ---� �' .� � � �__� : �..���..�+; €4��.�.�.�:3�s�'� � ., .: ,,,�``/' .; ,# ,�F��:a v 1���. 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