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Home My WebLink About10450 C1TY OF DIAMOND BAR ��.' ; COMMUNITY DEVELOPMBNT DEPARTMENT � ,.-.0 21660 E.Copley Drive Suite 190 (909)860-3195 Fux(909)861-3119 PRESS BUILDING PERMITAPPLICATION FIRMLY �� JOBSITE ` a�:. ADDRESS 22�34 � @ 1271 APPLICATION PERMIT ��' ,� p/C o. DATE NUMBER ��`� # �,. ISSUE �. �, TVpE OCC APN LOT TRACT DATE � �'� 't' % CONST. GROUP p OWNER Dl�n�ond Bar Tennis C1Ub H.O.Z1. o ADDRESSc o r ensiVe y 0 ZONING SETBACKS z CITY ZIP TEL. • - � FRONT RW f7 g APPLICANT TEL. (Q09) 597-77 REAR n TC�ri Li h SIDE/SIDE S7REET RW u �'` CONTRACTOR g �g� IriC. � SIDE �• ADDRESS 15'f$33ierra ta �ane � n-- � C�TY � ZIP � � TEL. 5 - 3 PROPOSED USE w ARCH/ENG/ z DESIGNER �a a ADDRESS � NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O OWNER-BL'ILDER DECLARATION SFR/ADD/REM 'Q I HEREBV AFFIRM UNDER PENALTV OF PEqJURV 7HpT 1 AA1 EXEMPT FROM THE CONTRACTORS LI� Gflf9Q9/CflIP01S W�' CENSEUIWFORTHEFOLLOWINCREASON(SEC.7031.SBUSINESSANDPROFESSIONSCA�E:ANYCITVOR �(f) C.�. CDUNiYNMICHREOUIHESAPERMITTOCONSTRUCT,ALTER.IMVROVE,OEIAOLISH,ORREPAiRANVSTRUC• � W Patio/Deck Z�� TURE,PRIOR TO ITS ISSUANCE,ALSO qEW IRES TNE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED W �W STATEMENT THAY HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CONTRACTORS ll- � CENSELAW(CHAPTERe�COMMENCINOWITHSECTION7W0)OFDIVISION30FTHEBUSINESSANDPRO- � POOVSPfl �, FESSDNSCODE)ORTHATHEOflSHEISEXEMPTTHEflEFHOMANDTHEBASISFORTHEAlLEOEDEXEMP- � V: TION.ANVVIOLATIONOFSECTIDN7031.SBVANVAPPLICANTFORAPERMITSU&IECTShIEAPPLICANTTO � RB•ROOf �. A CIVIL PENAITY OF NOT MORE hIAN FIVE HUNORED DOLlARS(5500).�: �� OI.ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEINSOLECOMPENSATION, � Commerciai Z WILI DO THE WORK,ANO THE STqUCTURE IS NOT IN7ENDED OR OFFERED FOR 3ALE(SEC.70da,BU51� J � NESSAN�PRpFE5510N5 CODE:THE CONTRACTURS LICENSE LAW DOES NDT APPLV TO AN OWNER OF j PflOPERTY NhiO BU!LOS OR IMPROVESTHEHEON,AND WH�OOES SUCH WORK HIEISELF OR HEHSELF Oq CT_' THROUCHHISORHEHOWNEMPLOVEES,PROVI�EDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m .Q'� OFFERE�FORSALE.IF,HOWEVER,7HEBUILDINGORIMPROVEMENTISSOIDWITHINONEYFAROFCOM%.E- �Z� TION,iHE OWNEfl�BUILOEfl wILL HAVE THE BUflDEN OF PROVING T41AT NE OR SHE DID NOT BUILD�OR �� IMPPOVE FOR THE 7URPOSE OF SALE). .W f71,A50NMEROFTHEPROPERTY,AME%CLUSIVELVCONTflAC7INGWITMLICENSEDCOMRACTORS � TO CANSTRUCT THE PflQ1ECT(SEC.70A4,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS U� V8Il1811017__ ADJ.AREA = CENSELAWOOESNOTAPPLYTOANOWNE(iOFAVqOPEFTYWHOBUILDSORIMPROVESTHEREON,AND — � NM1IOCANTRACT6FOHSUCHPqOJECTSWITHACONTR4CTOR(S)UCENSEDPURSUANTTOTMECON7RRG QunNnTv DESCRIPTION Y TOR6LICENSELAW.), FEE � ❑IAM EXEMPT UNOER SEC. ____ B.&P.C.FOH THIS RE�SON Q 1 �++u++ye r''�C�.r1CG-Ll rCUPS�l U � DRTE __OWNF.fl � � LICENSED CONTRACTORS DECLARATION W � 1 HEREBYAFFIRM UN�ER PENALTY OF PERJUHY THAT I AM LICENSEO 11NUER PRONSIONS OF CHAPTEH � � — d 9(CAMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINES&AND PROFESSIONS CODE,RND Z w MV LICENSE IS IN FULL FOflCE AND EFFEC7, m — � LICENSE CIASS C�0 uc.rvo. 729594 � � V DATE_ CONTRACTOR___ d W � WORKERS'COMPENSATION DECIARATION a � I HEREBY AFFIqM UNDEH PENALTY OF PEflJUflY UNE OF THE FOLLOWING DEIXARATKKJ&: U ' f/J Z � _IHAVEANDWILLMAINYAINACEflTIFICA7EOFCANS[NTTOSELFINSUflEFORWORKERS' _ , � COMPENSATION.ASPROVIOEDBYSECTION3l0UOFTHELABORCOOE,FORTHEPEHFORMANCE U OF THE WOFK FOR WHICH THIS PLflMIT IS ISSUED. W . � � w __.I HAVEAND WILI MAINTAIN WORKERS'COMPENSATION INSURANCE,A9 HEQUIRED BY SECTION Q 37000F THE I.ABOR COD[,FOR TME PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS J ISSUEO.MV WOR RS'CAMP NS ON INSURANC CARRIER AND POLICV NUMBER ARE: CONSTRUCTION ___ �nont�a�ensaEti.on j cARqiER _ PU1N REVIEW POLICYNUMBER WN�OZIRO�—OZ d .....'..,.j� a Z a.EI�IHIC.' _ _ ��.; ? � (f}GSSECTI(XdNE�NOTeEOLN1Fl.ETmOFh�PEIif.YflSfi�RqJE4RXIMFDDOl1J�ii5(5700�ORLESS� PLUMBING Z I CERTIFY THAT IN THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSLIED,I MECHANICAL ',""'��;�;,� �'� �h C�S SHALL NO7 EMPLOV ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJEC7 TD THE �'.{_,,.�.,�--- (n WORKERS'COMPENSATIONLAWSOFCALIFORN10.AN�AC.REETHATIFISHqULDBECOME INSPECTIONFEE SUBJEC TOTHE ORKERS'COMPENSATbNPROV �150F ECTION37 OFTHEUBOR —'— � DE, SHALLFO THWITHCOMPLYWIT HOSE ISICq , ISSUANC a �� p`�' ".""' O .._..�.... A .y _— 'p DATE: �PPLICANT:___ � SMIP i49�9 J� s� � � WARNING FAILUHE 7 ECURE WORKERS'COMPENSATION VERAGE IS UNUWFUL,AN�SHAIL BE ENERGY P/C _ _ � SUBJECTANEMPLOYERTOCflIMINALPENALTIESANDCIVIL INE9UPTOONEHUNUREUTHWSAND ENERGYPERMIT JDDLLAHS(51a0,000�,INA��ITION TOTME COST OF COMPENS�TION,DAMA6ES AS PROVI�ED FOF IN SECTION37080Fh1ELA60RCODE,INTERE3T,ANDATTORNENSFEES. OG RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ _ � 1 HEREBV AFFIRM UN�ER PENNLTV OF PERIURV THAT THERE IS ACONSiRUCTION LENDING AGENCY _ FOR THE PERFORMANCE OF THE WORK fOR WHICHTHIS PERMIT IS ISSUED(SEC,3097,CIV.C.), — Z W � LENDER'S NNME __ F— LENDER'SADDHESS � "'___'_ � � . ��... w ICER7IFYTHA7IHAVEREAD7HISAPPLICA710NANDSTATE7HATTHEA80VEINFORMATIONISCORRECT. TOTAL FEES � I AOREE TO CAMPLV WITH ALL CITY PND COUNTV ORDINANCES AND STATE lAWS REUTING TO BUILDING ' � CONSTflUCTION,ANDHEREBYAUTHOHREREPRESENTATIVE50FTHISCOUNTYTOENTERIIPONTHE Z ABOYE•MEN710NE0 PROPERTY FOR INSPECTION PURPOSES. 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