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Home My WebLink About10449 (5) � --/�— CITY OF DIAMOND BAR ' COMMUNITY DEVELOPMENT DEPARTMEHT ��% ..,.;� . 2166U F..Copley Drivc Suitc 190 PRESS (909)860-3195 Fax(909)861-31 l7 """' BUILDING PERMIT APPLICATION FIRMLY y JOBSITE 22�33 I�F�Y APPLICATION PERMIT ��/a,.�-��+ P/C � o ADDRESS DATE NUMBER`� ►t � c� ISSUE� ��TYPE OCC APN LOT TRACT _ DATE � r✓� CONST. GROUP � p OWNER ��nd B1Y' 7.'L'Ill71S Cll:lb H.O.A. � " ADDRESS c o r ensive r 00 ZONING SETBACKS OCITY IP TEL. �r�S�=��H FRONT _ RW ❑__ [ o APPLICANT _ � TEL.�g09�-��-773 REAR ❑ ` z SIDEJSIDE STREET_ RW ❑ � ¢ CONTRACTOR 'I�am L.iahtina. INC. SiDE ❑ � ADDRESS 15189 Sierra Bonita Iane 0 PROPOSED USE CITY �o ziP 91710 TE�. (909) 597-773 � w ARCWENG/ z DESIGNER n/a NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY __ ZIP----- TEL. � cn � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OOWNER•BL'ILDEH DECLARATION SFRlA�D/REM p I HEREBY AFFlRM UNDER PENALTV OF PERJURV THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- � GaragelCarport W CENSELAWFORTNEFOLLOWINGREASON(SEC.7a31.58U51NE55AN�PROFESS10N5CO0E:ANYCI7VOH U COUNTYWHICHRE�UIRESADERMI7TOCONSTRUCT,ALTER,IMPROVE,DEMOLISN,ORREPAIFANYSTHUC� W patio/Deck Z TURE,PRIOR TO ITS ISSUIWCE,AL50 REOUIRES THE APPI.ICANT F�R SUCFI PERMIT'f0 FILE A SIGNED - � STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO Th1E PROVISIONS OF THE CONTRACTORS Lb W . � CENSE LAW(CXRP7ER 9(CAMMENCING WITH SECTION 700a1 OF OIVISION 30F THE BUSINE55 AND PRO- � U"' POOVSpa FES510NS CODE)OR THAT HE OR SHE IS EXEMPT THERFFROM AND THE BASIS�OR THE ALLEGED E%ElAG- " � TION.ANVVIOLATIONOFSECTION7031.SBYANVRPPUCAMFOqAPERMITSU&IECTSTHEAPPLICPNTTO Z Re•Raof �� A CNIL VENALiY OF NOT MORE 7HAN FIVE HUNDRE�DOLLARS(5500).}: � C71,ASOVMEROFTHEPROPERTV,OHMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPf.NSATION, � COtilRl0fGi8I t WILL DO THF WORK,AND THL S'fFUCTUNE IS NOT INTENDED OR OFFERE�FOR 5AlE(SEC.7o4a,BUSI� J C� NE55 AND PROFESSION5 CO�E:THE CONTRAC70P5 LICENSE LAW�OES NOT APPLY 7o AN oWNEF oF S � PROPEHTYWH08UILDSORIMPROVESTHEREON,ANOWHODOESSUCNWORKHIMSELFOPHERSELFUR = � THROUGHNISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPflOVEMENTSARENOTINTENDEDOR m W OFFEREDFORSALE.IFHOWEVEf;iHEBUILDINCORIMPROVEMENT1550lDWITHINONEYEAROFCAMRE- Z� Z TION,THE OWNEH-6UILOER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE��NOT BUILD OR � IMPROVE FOR THE PURPOSEOF SALE). � �7 I,AS OWNEF OF THE PROPERTY,AM EXCLUSIVELY CONTflhCTING WITH LICENSED fANTflACTORS 6 � TO CONSTqUCT THE PROJECT(SEG 7o4a,9lJSINESS ANO PROFESSIONS CADE:THE CONTRACTORS LI- V21U9NOf1 ADJ.AREA �:, W CENSEUWOOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND F WFIOCONTRACTSFORSUCHPpOJECTSWITHACONTRACTOR(5)LN:CNSEDPURSUAN7TOTHECONTRPC- QUANTITY DESCRIPTION FEE �'. Y TORS UCENSF LAW.). [, � J T, f. O ❑I AM EXEMPT UNDEH SEC..___._.._.__ 8.8 P.C.FOfl THIS REASON Q � e r�� P- - E'� � ---- ----- V w � U � - DATE __-' OWNEH_..'__....--_"__...._._..__""'-""' Z W � LICENSED CONTRACTORS OECLARATION w }{;� � I HEREBV A�FIHM UNDER PENAL7V OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAVTER ( � 9(COMMENCWG WITH SECTION 700U)OF DIVISIIXJ 3 0F THE BUSINESS AND PflOFESSIONS CODE,AND � MY UCENSEISINFULLFORCEANDEFFECi Z �� C10 729594 � 3t � LICENSE CLASS __.._ __ LIC.NO. ___.. � �; U DATE___.'._"___'__"_—CONTRACTOR____ '_ a b W � WORKERS'COMPENSATION DECLARATION -� � a N I HEREBV AFFIRM UNDER PENAL7v OF PERRIRV ONE OF THE FOLLOWING DECLARA710N5�� U � N Z � 1 HAVE AND WILLMAINTAIN A CERTIFICA'fE OF CONSENT TO SELF�INSURE FOR WORKEFS' r � COMPENSA710N.ASPROVIDEDBVSEC710Na�ooOFTHELA80RCODE,FORTHEPERFOAMANCE U Q OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED. � � w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION IN9URANCE,AS flE�UIRE�BY SECTION Q 91ooOF7HEI.n90RCODE,FORTHEPERFOHMANCEOFTH[WORKFORWHICHTHISPERMI715 - _ g ISSUED.MYWORKERS'CAMPENSATIONINSUR/NCECARRIERANDPOiICYNUMBF.RARE: CONSTflUCTION � j CAfIRIER ��nt CCiT�Sl�1t1011 � pLAN REVIEW � � POI.I(:YNUMBER WRT9FiFi27.gQ1.-,Q2- ELECTRI ! �'i� ' � Q _._.._. ,___..�:..� ---��'. .:;;.:,-r--� :�- 0 (iH1SSECTIONNE�NOT8E00MPLEfEDOFhIEPEFUMI6FORONEFM1IN)FIEDWLWiS(51�7)IXiLESS). PLUMBING � "'y � ��k'�'' ., _ � �6?.::,;�: Z I C[RTIFY iHAT IN THE PERFORMANCE OF THE WOPK FOR WHICH THIS 7ERA11T IS ISSUED,l MECHANICAL __ (} SHALL NOT EMPLOY ANY PERSON IN ANY MANNEH 50 AS TO BEf:OME SUBJECT TO THE � WORKEflS'COMPENSATION LAWS OF CALIFORNIA. NDAGR THAT IF I SHOIJLO BECAME INSPECTION FEE __ _ ___ _. SUBJECTTOTHEWORKERS'COMPENSATIONPf SIONS SFCTION37 OFTHELABOR ""' F '1 �� ❑E sH�/�ORTHWITHCOMPLYWITH n Rovis �+5. ISSUANC� _.__ `� � �/'�/ �SMIP�� p DATE:�1Q(f_�� APPLICANT: __'_ _—.._. ^ ------------- '- ' J —____""....'____ WARNING ILURE`OSEWREWORKEHS'COMPFNSATION VERAGEISUNLAWNL,ANDSHAI.LBE ENEFGYP/C � SU&IECTANEMPIOVERTOCRIMINALVENALTIESPNDCIVILFINESUPTOONEHUNDREDTHOU9AND ENERGYPERMIT ___— --_— DOLLARS(f100.000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIUED FOR IN ' � SECTION 37oa OF THE LABOR CODE,INTEREST,AND ATTOflNEV'b FEES. RETENTION FEE: ___ ___ _ � CONSTRUCTIONLENDINGAGENCY PRE-ALTFEE: ___._—_ � I HERE6YAFFIqM UNDER PLNALIV OF PERJURV THAT THERE IS ACANSTRUC710N LENQING AGENCY _ _ �- FOFTHEPERFORMIINGEOFTHEWORKFORWHICHTNISPERMITISISSUED�SEC.3097,CIV.CJ. �� Z _--'--'__ � W � LENDER'S NAME__.__ -_ ____ F_- LENDER'SA��HESS -----�----.--- w I CERTIFV THAT I HAVE READ TXIS APPLICATION AND STATE THAT THE A60VE INFORMATION IS CORRECT. TOTAL FEES ��..��' �C� � � 1 AGNEE TO COMPLY WITH ALL CITY PND COUNTV ORDINANCES AND STATE.IAWS RELATING TO BtIILDING CANSTflUCTION.AND HEREBY PUTHORIZE REPFiESENTATIVES Of TMIS COUNTY 70 ENTEH UPON iHE ZpBOVE-IAENTIONEDPROPERTVFORINSPECTIONPURPOSES. COMMENTS _____.__. � 0 J � - __ ___ � � PE NAME(Pfl f) + --- / � __"_'" '� Le � �s K � 31G T REOFP EE OAT � � �'%�� . ' ��'r' = RECPT.�NO.�� -- �+ - � �-_PA�D B��_- . 0 � VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessar Copy,GOLDENROD--FIIe Copy,GREEN—ApplicanPs Copy �, : � f_�.r . _..,� �,,,, .. 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