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Home My WebLink About13433 (17) � ^ _1� CITY OF DIAMOND BAR DEPARTMENT OR COMMUNITY&DEVBLOPMENT SERVICES : � 21660 E.Copley Dsive 3uite 190 �, Bu�inz�fG�i�� 861-31�� PRESS ,....M...., (909)$60-3195 Fae R11�1IT APPLICATIo1�7 - `_� FIRMLY _ .. . , � JOBSITE " APPUCATION PERMIT P!C o ADDRESS� �� " 4 � � DATE NUMBEFi�� # � ISSUE �A� TYPE OCC APN LOT TRACT DATE � ��_ CONST. GROUP p OWNER � �. �` ADD SS �t' � ZONING SETBACKS Z CITY��;�� `__ 4� ZI TE� ' - FRONT RW ❑ � APPLlCANT TEL. REAR ❑ SIDE/SIQE STREET RW O CONTRACTOR � � ��_ ��_� SIDE ❑ pG A�C1R S i.0 � CITY C�1_ ZIP " TE PROPO5ED USE oARCH/ENGI `' � DESIGNER — NO.DWEL. NO. NO. 4 ADDRESS — UNITS ST�RIES BEDROOMS � CITY ZIP TEL. � DESCRlPTtON SQ.FT. FACTOR PSF ADJ.AREANALUATION � OOWNER-BUILOER DECLARATION SFR/ADD/REM Q I HEREBY AFFlRM UNDEF PENALTY OF PERJURY 1HAT I qM EXEMPT FROM THE CONTRACTORS ll- G318ge/C2tPOf� W CENSELAWFORTHEWILOWtNGREA50N(SEC.7031.SBUSINESSANDPROFESSIOM:CODE:ANYCINOR (n 4J COUMYWHICXREDUIRESAPERMITTOCON3TRUCT.ALTER.IMPROVE.DEMOLISH,ORREPAIRANVSTRUG LLI pdfio/DeCk WTURE,PRIOR TO I7S ISSUANCE,ALSD R[-0I11RF.S THE APPIICANT FOR SUCH PERMIT T6 FlLE A SIONE� � STAXEMENT THAT HE OR SNE IS LICENSED PURSUAN7 TO THE PROVISIONS qF THE CANTRACTORS ll- Y CENSE LAW(diAPTER B(CAMMEIdCM(3 WITH SECTION 7000)OF DIVISION 3 OFTFIE BUSME651iND PLiO- LL Poo�Spa I T FESSIONSCODE�ORTHATHEORSHEISEXEMPTTFIEREFROMANDTHEBASISFOflTNE�LLEG[DE%ElAP- V TIOfd.ANYYIOLATIOMOFSEGTION7031.58Y/WYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICAPlT70 z qe.qpp� � � ACIYIL PENALTY OF NOT MOfiE THAN FNE FiUNDflED DOLLARS(55tp)): � �I,ASOWNEROFTHEPROPERTY,ORMV@APLOVEESWITHNlAGESASTHEIRSOLECOMPENSATION, O COfnnlBrCial � WILL 00 THE WORK AND THE S7RUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BUSI- J NESS ANO PqOFESSIONS CODE:THE CONTRACTORS LICENSE 1?,W DDES NOT APPLY TO AN OWNER Of � PFOPERTVWHOBUpASORIMPROVESTHEREON.ANDUhI000E55UCHWORKHIMSFLFORHFPSELFOp m � 7HRWlOHHiSORHEFOWNEMPLAYEES,PROVIDE�THA75UCHfAiVROVEAAENTSAREh'OTINTENOEpOR L�A OFFEFiEDFORSALE1F,FpWEVERTMEBUILDINQORiMPROYEMENTiSSOL�WITNINONEVEAROFCOMPIE Z �TIOtd,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE Ofl SHE DIA NO'f BU�LD OR � IMPROVE WRTNE PURPOSE OF SAI.�. -� � � � ❑I,AS OWNER OF THE PROPEHTl;APA D(CI..USIVELYCONTRACTING WITH Lil'EYSED CON7"FACfOflS � TO WNSTRUCTTNE PRQIECT ISEC.70{4,BUSlNESSANtl PflOFESSiONS CADE:7HE CQNTRAC70RS LI- Valu2tiDn� _ADJ.AREA W CENSEIAWDOESNOTAPPLY70ANOWNEROFAPROPER7VNh109UIlDC�ORlMPROVESTHEREOM,AN� - � WFIOCONTRACTSFORSUCNPROJECTSWITNACONTRACTOR(S}LICENScDPURSUANTTOTHECONTRAG QUANTITY DESCAtPTION FEE TOfi6 LICENSE LAW.�. - � O IAM EXEMPT UNDER S�C. . `9.8 P.G FOR THIS F,'cA30N � ,� .� _ �___�' !� _. DATE _, � OWNER ` _ � � . W -. �q LICENSED CONTRAGTdRS L'�CLARATIOPI i W � CL I NEREBY AFFIRM UNOEH PENALTY OF PERJURY THAT i AM LICENSED UNbEFl PAWISIONS OF CHAPTER ....�.-y�p . � B(COMMENCING WITH SECTION 7000)OF DI'JISION a OFTHE BUS1NE55 AND PROFESSIONS COOE,AND Z ��+ r�^ ( `ii MY tiCENSE IS IN FULI FOflCEAND EFFECT. /� �J�-. � LICENSE CLASS��, LIC.NO. � � `� m _--_ -..�� Y — � � J V DAk'E �_ CONTRACTOR '� n- � [$ WOfiKER9'COMPENSATION DEC FiAT104 a � U � I HEREBV AFFIRAU UNDER PENAIN OF GERJUFiY ONE QF THE FOLLOWING OECLAR0.710NS: Z �� '""e""�* ' � d ----- 0 IHAVEAND'MLLdANNTA7NACERTIFICATEOF�ANSEMTTOSELFiNSUREF�3RWOHKERS' � ' ,��- . + ' "" � � � (X�PIPENSATlGN,AS PftOVIDED BY SECiION 37o00FtHE tABOR COCE.FO(i tHE PEAFORMIANCE W' oF TNE WORi(FOR FVHICN THIS PERMIT IS ISSUEO. � � — W _I NAV@ AND WILL MAIN7AIN WORKERS'CAMPEP'SATION IPISURANCE,AS REQUIRED BY SECTION Q 37COOFTHELAEI+JRIX7DF.,WRTHE?ERFOPMANCEOFT��;EWORKFORWHICHTHISPGPMITIS ISSUED.A1V WOPoKERS'COMPENSATKKJ INSURANCE CARRIER ANO POLICV tJUPABEft AFE: CONSTRUCTIUN �j cpqqiExt � PLAN REVIEW _.� Z PaicYNUMeEA_ . — ELECTRIC ¢ � (iHI55ECiKXdIVE�MDTBECQNPLEI'f3JOFT}{EPEF�H(ISFORONEFiLN�DREDC:MLV'S�§100yORLESS). PLUMBING gy � I CERTIF`/THAT IN 7HE PFPFORMANCE OF THE WORK FOA WHICH THIS PERMIT IS ISS�ED,I MECHANICAL }��,:,�`W , (� SHALLNOTEMPLOYANYOEPS(NdtNANYMANNERSOASTOBECOMESUBJECTT07HE �'�$�g �'- N WORKERS'CONAPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOULO BECOMF INSPECTION FEE � : a'� SU&IECTTO THE WORKEfiS'CAMPENSATION OR041510NS OF SECTION 3�o00FTHE LABOq y b !'3 �j CODE,I SHALL FORTHWITN CCiMPLY WITFI THOSE PFOVISIONS. ISSUAP�lCE r.��" ��' k. a.�V fi�"��=! � o SMSP .. . . . p DATE: _ APPLICAN'6`. ��__._ - . � ' ENERGY P/C WARNING:FAILURE TO SECURE WOF7KERS'COMPENSATION COVERAGE 15 VN V.WFUI.,AND SHAIL BE � SUBJECTANEMPLOYERYOCRIMINALPENAlTIESANDOIV7lFINEEUP700NEHUI�AREOTHOUSAND ENERGYPERMIT DQlLARS(51ao,o00�.1N ADDITION TO TNE COST OF CAMPENSATION,DAMAGES AS PROVIOED FOP IN � SECTION3)089FTHELABORCO�E,INYER[ST,AN�AITORNEY'SFEES. RETENTIONFEE: d CONSTRUGTION LENDING AGENCY PREALT FEE: � I HEREBYAFFIRM UNOER PENALTV OF PERJUR`/THAT THERE IS A CONSTqUGTION LENDING AGENCY __ FOR THE PEF W HMANCE OF THE WORK FOR W HICH TMIS PERMIT IS ISSUED(SEC.3oB'T,qV.C.). z .�J�.��!'1 � ---- � LEN�EWSNAME � _ ` ' 1— LENDER'SAO�RESS . ,. _ . , , .. � I CERTIFY THAT I HAVE READ THIS APPUCAi IDN AN�STATE THATTHE ABOVE INFOftMATION IS CORRECT. TOT�L FC ES - ' W I AGREE TO C�APLY WITH All CITY ANO COUNTY ORDINANCES AND STATE LANS REIA7ING Tq BUILOMG � CONSTRUC7ION,ANDHERE6YAUTHORI2EREPRESEMATIVE50f7HI5COUNIYTOENTERUPON7HE � A80VE-MENTIONEO PROPERTV FORINSPECTION PURPOSES. COMMENTS � � _ C��if1!-�� CAC��-i K>_G�� _ � 'PERMITTEE NAME I Q N y � �SIG URE OF PERMITTEE DAT@ = REC'FT.NO. 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