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Home My WebLink About10724 (5) - CITY OF DIAMOND BAR �� e��D �� COMMUNITY DEVELOPMENT DEPARTMENT _,,,.w . 21660 E.Copley Drive Suite 190 PRESS (909)66o-3195 Fax(909)861-3117 �'""'� BUILDING PERM[T APPLICATION FIRMLY N JOBSITE � �;;. APPLICATION � PERMIT /C o:�. ADDRES � '� DATE NUMBER O� ►� �. ISSUE TYPE OCC -- APN LO TRAC ; DATE CONST. GROUP g OWNER ADDR S ' ZONING SETBACKS � FRONT RW ❑ W CI ZIP TEL. ' z REAR O_ o' APPLICANT TEL. SIDFJSIDE STREET RW ❑ d � CONTRACTOR ' V � SIDE C1 i- Q. ADDRESS a eY ''' r pROPOSED USE � CIN Walrnit�[,PA._�LZ�� TEL s o� ARCH/ENG/ :� z DESIGNER NO.DWEL. NO. NO. a, ADDRESS -- UNITS STORIES BEDROOMS � CITY ZIP_ TEL. _ - � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAIUATION u�. � OWNER•BI:ILDER DECLARATION SFR/ADD/REM O p, I NEREBY AFFIRM UNDER PENAl7V OF PERJURV TNAT I AM EXEMPT FqOM THE fAN�RACTORS LI- GefflQ9(Cdf{10R W CENSELAWFORTHEFOLLOWINOREASON(SEC.7o31.58U51NE55AN�PROFE5510N5CODEANYGITYOi7 ;(n U: CWNTYWHICHflEQUIRESAPERM�TTOCONSTRUCT,ALTER,IMPROVE,DEMOLISM,ORREPAIflFNY57flUC• �� W P8110/DBCk �,, TURE,PRIOR TO ITS ISSUANCE,ALSO REO�IHES hIE APPLICANT FDR SUCH PERMIT TO FILE A SIGNED SiATEMEM THAT NE Ofl SHE IS LICENSED PUHSUANT TO 7HE PROVISIDN5 OF THE CONTMCTORS ll• �.� CENSE LAW(CHAPTER 9(COMMENCING WITM SECTION 7000)OF DIYISION 30F THE BUSINESS AND PRO� ��' POOUSpB 8 FESSIONSCWE�ORTHATHEORSHEISEXEMPTTHEREFROMANDTHE6ASISFORTHEALLEGEDEXEMP- TION.ANYVIOUTIONOF6ECilON7o31.5BVANVAPPIICANTFORAPERMITSUBJ[CTS1H[APPLICANTTO - � Re-Root � ACIVIL PENALT'OF NOT MORE TNAN FIVE HUNORED DOLLARS(SSanJ J: � ❑I,ASOVMEROFTHEPROPERTY,ORMYEMPLOYEESWITMWAGESASTHEIRSOLECOMPENSATION, :� Commercial Z WILL DO THE WORK,ANO THE 57Rt1CTURE IS NOT INTENDED Ofl OFFEREO FOR SALE(SEC.7044,81151� �J NE55 AN�GROFESSIONS COOE:THE CONTRACTOflS LIGENSE lA`N DOES NOTA7PLY i0 AN OWNER OP � PROPER7YYYMOBU�LOSORIMPROVESTHEHEON,ANDNMODOES5UCHWORKHIMSELFORNERSELFOR � m �� THRWGHMISORHEROWNEMGLOYEES,PROVIDEDTHATSUCHIMPPOVEMENTSARENOTINTEN�EDOR w OFFEREOFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMEMISSOlDW1THINONEYEAROFCOMPLE� �� TION,THE OWNEq-BUILDER Wlll HAVE THE BUHOEN OF PROVING THAT HE Oq SME DI�NOT 6UILD OR Z IMPROV[FOR THE PURPOSE OF SALE). _ ❑I,ASOVMEROFTHEPIiOPEN7Y,AMEXCLU5IVELYCONTRACTINGWITMUCENSEDCONTPACTOHS � TO CANSTql1CT THE PROJECT(SEC.7046.BUSINESS AND PflOFESSIONS CODE:TNE CONTMCTORS LI- Velllat1011 ADJ.AREA W CENSEUWI)bESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSOflIMPflOVEST}iEREON,AND � WHOCOMFACTSFORSUCHPROJECTSWITHACONTPACTOR�S)LICEN&EDPIIRSUANTTOTHECONTfiAC p�qNTITY DESCRIPTION FEE TORS LICENSE LANI). � tJ I AM E%E�PT 4N�ER SEC,, ._..,B.B P.C.FOF THI5 REASIXJ Q �x � -- ------- — a LL �ATE OWNEp.'— _'__"_ , F-' V �¢ LICENSED CONTRACTORS DECLARATION � W 2 1 HEREBY AFFINM UNDER PENpITY OF VEHJURY 7HAT I AM LICENSED UNDER PRO�ISIONS DF CHAPTER � � � �. 9(COMMENCINOWITHSECTION7000)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND : Z � ' �X MY LICENSE IS IN FULL FORCEAND EFFECT. m ( � L�CENSE CLAS � IIC.NO.� J U OATE_�=_i�L�CONTRACTOR � � a W. �� WORKERS'GOMPENSATION�ECLARATION Q � I HEREBV AFFIqN UNDEfi PENAL7V OF PERil1RV ONE OFiHE FOLLOWING DECLARATION3: � C�J Z Q � _I HAVEAND WILL MAINTAIN A CENTIFlCATE OF CONSENT TO SELF�INSURE FOR WOflHEFS' S � CAMPENSATION,AS PROVIDED BY SECTION 3�ooOF THE�ABOR GOOE,iOfl 7ME PERFOflMANCE �U OF TNE WORK FOR WHICH TNIS VEHMIT IS ISSUEO. � � w _1 HAVEAND WILL MAINTAIN WOFKERS'COMPENSA710N INSUPANCE.AS flEOUIREO BY SECTION ' O 370o Of'THE LAAOR CODE,FOR THE PERFONMANCE OF THE WORK FOR WHICH THIS PERMIT IS — $ IS&UED.MV WORKERS'COMPENSATION INSURnNCE CARiiIER AND POLICY NUMBEflARE: CONSTRUCTION j cApqiEp _._ PLAN REVIEW _�_ ZPOLICY NUM�ER_,_J._.-- - ELECTRI d - 0 (fHISSEGf10NNE�N�T8E�M14lE�EDOF'fHEPERAMIISL�10l1EHlN�S7REDD011AR5(5/0�)ORL6S} C MBI w MECHANICAL P` Z 1 CERTIFV THAT IN THE PEAFORMANCE OF THE WONK FOR WHICH THIS PEFAIIT IS I55UED,I — (,'J SHALLNOTEMPLOYANYPERSONINANYMANNEFSOAST09ECAMESU&lEC7T07NE � � WORKEFlS'COMPENSATIONLAWSOFCALIFOHNIA,ANDAGREETHATIFISMWLOBECOME INSPECTIONFEE — SUBJECT TO THE WORKEHS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR �, = CODE,I SHALI.FOflTHWITH COMPIY WITH THOSE P��aaayyy ISI 5. ISSUANCE � �!� 9� d�� .�� SMIP `p pATE:�R " _ / APPLICANE_...___' -__ i� ENERGY P!C WAflNING:FAILUflE TO SECUflE WORKEHS'C061PENSATION CAVERqGE IS UNLAWFUL,AN�SHALLBE LL SU&IECTANEMPLOYERTOCRIMINALPENAISIESANDCIVILFINESUPTOONEHl1NOflEDTHW5AN0 ENERGYPERMIT �.�'n ��,�? „"'� . __ �OLLARS(S10D,000�.IN AO�ITION TO THE COST OF COMPENSATION.DAMRGF.S AS PROVIDE�FOR IN _'—"`�n�:'��' � ¢ SECTION]70B OFTHE UBOR COOE,INTEREST.ANDATTORNEYS FEES. RETENTION FEE: j'-"`'"'� d CONS7RUCTION LENDING AGENCY PRE•ALT FEE: ,. � 1 HEREBY AFFIRM UNOER PENALTY oF PEFUURV THATTHERE IS ACONSTRUCTION LENDING AGENCY ` �"'.� "� 'R i.iP-°'*"y � FOF THE 4ERFORMANCEOF THF WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). � � . `,..� z , Z —'_— W � LENOER'SNAME""'_ -----'-.- -' __ J "_ F- LENDER'SAI70RES4 ¢ ICERTIFYTHATIHAVEREADTNISAPPUCATIONANDSTATETHATTHEABOVEINFOqMATIONISCORRECT. TOTAL FEES �� IAOREETOCAMPLYWITHALICITVANpCOUNTVOi701NANCESANOSTATEIAWSRELATINGTOBUILDING GONSTRUCTION,AND HEREBY AUTHOHIZE REPRESENTATNES OF 7HI5 COUNN TO ENTEfl UPON THE ZA60VEMENTIONED PROPERTV FOR INSPECTION PURP0.SE5. COMMENTS_..� � J _ � ��. _-- m PERMITTEENAIA6�PPoNn (��) / - � f �d' � �� . 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