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. . .. . . . . .. . _.-. �. . . � . ^ . . , . .. .. .. �:-. .. . ...,. .. . . .._ � ....r ��.. . ..:'.-.. � .^'.. -.� §. . .',.' .'- ,'�- _ ... . .. . ---�y'-``'�--- CITY OF DIAMOND BAR / �/ � � COMMUNITY DEVELOPMENT DEPARTMENT ' d�-- � 21660 E.Copley Drive Suite 190 % PRESS (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION � FIRMLY y JOBSITE Z„�.� � � -�� �� S fi APPLIGATION �� , PERMIT "Z � P/C �"')� o ADDRESS DATE NUMBE # d� o ISSUE TYPE OCC `r APN LOT TRACT DATE CONSL_ GROUP p OWNER ��-m���� a ADDRESS `-� ?G�"��(�ti �g-� ZONING SETBACKS Z CITY �i�'7`��_'j��,, ZIP EL �"�p FRONT RW ❑ � APPLICANT �`'� �STEL�� SI�E/SIDE STREET RW � 0 ¢ CONTRACTOR �ei �C7�S I'. SIDE _ ,." �'� �,""�,. � L.-- � CITY E�Ltn.Sc, Z P /? TEL. 2(���z.-d/� POSED�U�S� � �. r — .. i.. ' .. .......,.._. �w ARCH/ENG/ �� z DESIGNER NO.DWEL. NO. NO. a, ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. C° DESCRIPTION SQ.FT. FACTOA PSF ADJ.AREANALUATION cn � OWNER-BGILDER DECLARATION SFR/ADD�REM� � � � � O _ p I HEREBY AFFIRM UN�Eii PENALTY OF PERJJRY 7HAT I AM EXEMPT FROM THE CONTRACTORS LI- G8f2J8/C3fpOn i - ' ' W CENSELAWFOflTHEFOLLOWINGfiEA50N(SG�.�a31.5BU5ME55ANDPROFE5510N5CODE:ANYCITYOR (� C� CDUNTYWHICHPEQUIRESAPERMITTOCONSTRVCT,ALTEP,IMPHOYE,OEMOLISH,ORREPAIftANYSTRUC- W P8ti0/DeCk w TUAE,PRIOR TO ITS ISSUANCE,ALSO RE��IRES THE APPLICANT WR SUCH PERNIT TO FIIE A SIGNED w � STATEMENT THAY HE OR SHE IS LICENSED PUFSUANT TO THE PROVISIONS Of"HE CONTRA6TOR$CI- � CENuE LAW(CHAPTER 9�COMMENCING WITFI SECTION 7aoo)OF DIVISION 3 OF iHE 6USINE55 ANb PRO- � POOUSPd FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMAND7HEBASSFORTHEALLEGEDEJ(EIAP- - ,....� .�,, � TION.ANYVIOLATIONOFSECTION7031.68YANVAPPLICANTFORAPERMITSUBJEC75THEAPPI(CANTTO z RB-RODf �"� - � "" � � ACIVILPENALiYOFNOTMOPETHANFIVEHUNDRED�DOLLARS($5oo).�: --"" " ""' . Q ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLO�EESWITHWAGESASTMEIRSOLECOMPENSATIOH, CI C0171f118fC�21 � ' � � Z WILL DO THE WORK,ANO THE STRl1CTURE IS NOT IN'EN�ED OR OFFEFED FOfl SALE(SEC.7044,BU51- J _ � NES i AND PROFESSIONS CODE:THE CONTFACTORS LICENSE LAW DOES NOi APPGY TO AN OWNEftOF � � PROPERTYW'HOBUILDSORIMPROVESTHEREON,ANOWHODOESSUCHWOAKHIFISELFORHERSELFOR = � � THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENOE�OR m ^ - � QOFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPFOVEMENTISSOLDWITNINO4EVEARtlFCOMPLE- -�-•� � ••:.,�.. '�'.-•.^^-...—.� Z TION,THE OWNER�BUILOER WILL HAVE THE BURDEN OF PROVING THAi HE OR SHE DID N�T BUILD OR . = IMPP.OVEFORTHEPUFPOS[OFSALE). � ❑I,AS OYJNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING W�TH LICENSED CONTqACTORS [[ TO CONSTRUCT THE PROJECT(SEC.7044,6USIVESS ANO PROFESSIONS CODE:THE CONTRACTORS LI� V81112I1Of1 � ADJ.AREA W CENiELAWDOESNOTA?PlY'OANOWNEROFAPROPERiYWHOBU�LD50RIMPROVESTHEfiEON;AND � WHOCONTRACTSFORSl1CHPROJECTSWITHACONTRAC70RIS)LICENSEDPURSUAN7TOTHECON7RAC� pUANTITY ^ DESCRIPTION FEE Y TORS LICENSF LAW). ' '- o O I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS�REASON Q GL � 6 -..S — V P � - ¢ S (, Gj ,i r � �ATE OWNER _ � � /� J^`(� _ ,Y9'}l -, W ( j•" fi s. � LICENSED CONTRACTORS DECtARATION , _, , � � G � � IHEREBVAFFIRNVNDERPENALTVOFPERJURYTHATIAMLICENSEOUNOERPROVISIONSOFCHAPTER /,1 y'� d 9(COMMENCINGWITHSECTION70oo�Of�IVISION30FTHEBUSINESSANDPROFESSIONSCODE,ANO z � W G � !.✓' `X MYLICENSE:SINFULLFORCEANDEFFECT. � / � .p /',q � LICENS/E�,CL/A'SS '(�J�' �` LIC.NO.��/ `p V �lV�� � // � Dw�r,,,s '� "� Ik � onr��-(_�___ CONTRAC798:� —`� d G• ld W / � Cs�_.' In C '�J� i � WORKERS'COMPENSATION DECLARATION ��'`�(�� � � �O� ^� � y � I HEREBY AFFIRM UNDEP PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: U � '2� 4�� 2 � _I HAVEAND WILL MAINTAIN A CERTIF'.CATE OF CONSENTTO SELF-INSUR'c FOR WORKERS' $ O � � COMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE,FOR THE PERFORMANCE U 4 OFTHE WORK FOR WHICH THIS PERMIT IS ISSUEO. � � W I HAVEAND WILLMAINTAIN WOR<ERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION Q � 37o00FTHELABORCODE,FOHTHEPEftFORMANCEOFTHEWORKFORYlHICHTHISPERMITIS � - ISSUEO.MY WOR PS'COMPENSAT�QN I�'SUfl CE CARRIERAND POUCY Nl1M8EPARE: CONSTFIUCTION 1 } CARRIER� 'C G�. PLAN REVIEW ` ro ... .�...:,.,..W.,.._ ` � POIICY NUMBER ' � ELECTRIC. .. .... . .. _. ..�. . ,_ ...�...,....,. ,..,....... : t.,( ¢ Q (�}i13SECTIDNNEmNOTBEWMREfEDOFTHEPERMffISFORONENUIJ�RG�DOLLAAS(y700)ORLESS). PLUMBING M Z I CERTIFYTfiAT IN THE PERFORMANCE OFTdE WORK FOR WHICHTHIS PERMIT�S ISSt1ED,I MECHANICAL i C`J' SHALL NOT EMPIOYANY PERSON IN ANY MANNEP.SOAS TO BECOME SUBJECT TO THE ' � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECl10N FEE � SVBJECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 370o O�THE LABOR � ISSUANCE _ . COO',I SN LL FORTHWITH COMPLV ITH THOS PfiO IONS.`� \ \ ;� p DATE:��_ APPLICA�� v �d SMIP J WARNING:FAILURE 70 SECURE WORICERS'COMPENSATICN COVERAGE IS UNLAWFUL,AN�SNALLBE ENERGY P/C � SUBJEC7ANEMPLOVERTOCRIMINALPENALTIESANOCNI�FMESUPTOONEHUNCREDTHOUSAND i { DOLLARS(5100.000),INAD�ITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROYIDEDFORIN � ENERGYPERMIT ___ _ ¢ SEC710N 3708 OF THE U1BOR CO�E,INTEflEST,AN�AT"rORNEY'S F[ES. RETENTION FEE: d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ' O � IHEREBYAF�IRMUNDcRPENALiYOFPENJURYTHATTNEREISACONSTRUCTIONLENDINGAGENCY f " FOR THE PERFORMANCE OFTHE WORK FOP WHIGHTHIS PERMIT IS ISSUEO(SEC.3�s�,CIV.C.�. Z W S� LENDEF'S NANE " 1= LENDER'SAODRE55 _ w ICERTIFYTFATIHAVEREADTHISAPPUCA710NANDSTATE7HATTHEABOVEINFOFMATIONISCORRE�T. TVTAL FEES t � � w �� � I AGREE TO COMPLY WITH ALL CI7V AND CDUNTY ORDINANCES AND STATE LA'NS RELATING TO BUtL�MG �� ��II�� CONSTRUCTION,AND HEREBV Al1THORIZE REPRESENTAT!VES OF THIS COUNTY TO ENTER UPON THE ; � ��e.0�� - - - ABOVE-M TIONED PqOPERTY FOR INSPECTqN PURPOSES. �f/ � �✓ z ( COMMENTS_i t�% _ '"'-'�es-- ��,S�iM,GQ�„�,ti � m EE NAME(PRI T) �� \ (�'(� /�' � C/) .7R1'�F P��`\�\ _. \ �DATE �✓ _ _ . J�I 1 �; y . , � _ � -. - . �.�;�. � � RECPT.NO.' 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