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Home My WebLink About13909 (16) ..,.\\` �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �=/ TM� 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ��rM� � BUII.DING PERMIT APPLICATION FIRMLY o� JOBSITE �/'� L� �� j /LI"� � ��9`/ }�� _ ATION� I f � NUMB R �� #/C ADDRESS l5r',•�s 6�'��'� /'LldeJ�" � ISSUE �'( TYPE OCC APN_ LOT T ACT _ DATE � ��" ' ! CONST. GROUP °C OWNEFI O — " ADDRESS _ ��"_ s� A�a4 - � _,•ZONING SETBACKS Z CITY � �- ZIP��;�TEL. - p i�. � FRONT RW [-!_____ g APPUCANT a�-•"'� TEL.�` ' �y REAR ❑_.__ � � SIDE/SIDE STREET i RW ❑______—___ CONTRACTOR � �.>' � -y SIDE ;_I ADDRE k ' � t-` PROPOSED USE_ � CITY `='� �� ` ZIP��,�'�TEL. , o ARCWENGI _ W DESIGNER -- NO.DWEL. NO. NO. � ADDRESS UNITS __ STORIES __EiEDRO�MS � C17Y ZIP TEL. � u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUAT�ON � OWNER-BUILDER DECLARATION ' SFRIA�D/REM O Q 1 HEfiEBY AFFIRM UNDER PENALN OF PERNflY THqT I M1 EXEMPT FflOM THE CONTHACTOflS LI- G9fBB0/C8/Q011 W CENSEIAWFORTHEFOLLOWINGREA50N(SEC.7037.SBUSMFRAANDPROFESSIONSCADf.:ANVCITVOR (n � U COUNTYWMICMqEQUIPESAPERMRTOCON5TRl1CT,ALTER.IMPROVE.OF.MOIISH.OflREPpIRqNY57RUG W pati0/DBCk W TURE,PRIOR TO IT6 ISSUANCE,ALSO REqUIRES 7HE APPUCPNT FOR SUCH PERMIT TO FILE A S�GNED W STATEMENT TMAT HE OR SME IS I.ICENSEO PURSUANT TO THE PROVISIONS OF THE CANTRACTOHS LI� � CENSE UW(CHAPTEH e�CWAMENCING NATH SECTION 9W0)OF�IVISION 3 OF THE BUSWESSAND Pfl0- � POOUSp2 FE&SIONSCOOE)ORTHATHEOFlSNEISEXEMPT7HEREFROMANOTHEBASISfORTHEAILEGE[lE%EMP- (!j TION.ANYVIOLATIONOFSECTION7W7.SBYPNVAPPLICANTiOF1APFNMIiSU&ILCTSTHEAPPUCANTTO � Z Re-Roof A GVIL PENALTY OF NOT MORE TNAN FIVE HUNORE�UOLLAqS(f So0).�� f11,p90WNEROFTHEPiiOPERN,9NMYEMPLOYEE3WITHYJAGE9A37HEIRSOLECOMPENS.4TIDN. � Commerciai - Z WILL W TNE WORI(ANO THE STRUCTURE IS NOT IN7ENDED OR OFFEREO FOR SALE(5EC.706a.BUSI. � NE53 AND PROFESSIONS GOOE:THE CONTRACTOFS LICENSE LAW DGES NOT APPLY TO AN OWNcR OF ? PROPEHTY N'Fq BUILDS ON IMPqOVESTHEHEON,AND WHO�OES SUC4i WORK HIMSELF OR HEi75ELF OR � 7HRIXIaHHibORHEflOWNEMPLOYEES,PROVIOEDTHATSUGHIMPqOVEMENTSARE�OTINTENDEDOfl m QOFFEREDFORSALE.IF,HOW6VER.T1EBUiL01NGOqIMPROVEMENTISSOLDWITH;NONEVEAROFfAMV�E- z TqN.THE OWNER�BUIIDEF WILL HAYE YHE @URDEN OF PPUVMG THAT!iE OR SHE DIU NOT 6UIlA Ofl � IMPqOVEFORTHEPUPPOSEOFSPIE). - w ❑I,ASONMEROfTHEPFOPERTY,AMEXCLU5IVELYCANTFACTINGWITHLICLNSEDCONiRAGTORS (r TO CONS7RUCT THE PRQIECT(SEC.7044,Bl1SINESS AND PflOFES510N5 COOE:1HE CONTRACTORS LI� VfllllflllOfl ADJ.AREA . W CENSELAWDOESNOTAPPLYTOANONMEROFAPqOPFRiY1YhIODU1LD50RIMPROYESTHEPEON,M'O --- - -�-- WHOCANTMCTSFOflSUCHPRQJECTSWITHACONTRACTOR(S)LICENSEDPUflSUANTTOTNECANTRAG ounNriTv DESCRIPTION FEE �w� � TORSLICENSEUWJ. � J ❑I AM EaEMPT UN�EfiSEC. 0.&P.C,FOFi THIS RFlSIXJ Q [ �i '__"_ _"_"__ � � — � DATE�_ oNMER F' � "___ _.__._._ W � LICENSED GONTRACTONS DECLARATION W . � 1 HEREBV AFFIRM UN�ER PENALTY OF PERJUHY i HA'f I AM LICENSED UNDER PROVISIONS OF CHAPTEH I Q.� 9(COMMENCINQ WITH SECTION 7000�OF DIVISION 9 0F THE BLISINESS ANO PROFE9SIONS c:O�E.AN� Z 'k' �> t �`� 7C MY UCENSE IS IN FULL iORCE AND EFFECT. �' m � t 9' LSJ � VJ p UCENSE CLASS —�� i� LIC.NO. ,� _�____ J V DATE _��_ �` .F / — CONTRACTOR.._._. - - n. _— W � WORKERS'COMPENSATION DECLARATION � � IHEREBVAFFIRMUNDERPFNAITYOFPE0.NJRYONEOFiNEFOLLOWI4Gbf:Cl.AiiATIONS: ¢ [� Q � _IHRVEANDWILLMAIM'AINACERTIFICATEOFCONSENiTOSELFINSUREFORWORKERS' _ � COMPENSATION,AS PHOVIDED BY SECTIDN 370o OF TNE LABOq CADE,FOR TNE PERFORA9ANCF. IU �RSF 7HE WOqK FOR WHICH THIS PFHMIT IS ISSUED. .� 0 W _IHAVEANDWIIIMPINTAINWOFlKERS'COMFENSATIONINSl1HANCE,ASRFQUIREDBVSECTION Q 37000FTHE LA90R COOE.FOR TFIE PERFORMPNCE Of TIIE WORK FOP WHICH THIS P�RMITIS o ��{�� ,7� CONSTRUCTION _ J ISSUED.MY WORKERS' OM N RT INSUflA E C D POLICV N ARE: -..._.__—,..._. .. } PIANREVIFW ._........ .....---- --------...-----'-'- - CARRIER 0 aoucrNuueEa_ 1 L'6`�'1` �.l''.�� ftr��k -,•�- ELECTRIC Z4-cr-r.�---- -...__....-----�- -�--- - � ��, ��''V _.._.� - �- � (�1135EGlpNNE�NOTBECOMR.ETEDOF7HEPERMTI9WRIXJEHUWFEDOq1AR5(510])ORLESSb PLUMBING _..--.--.....__�;'-A''��:#� ---- --- -- w MECHANICAL � ICERTIFYTHATINTHEPERFORMANCEOFTfIEWORKFOHWMICHTHiSPEflMITISI55UED,l ---��-.-..--�-..-..-- ----.---�-- C;S SHAII NOT EMPLOV ANY PCRSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE " Uj WORNERS'COMPENSATION LAWS OF CAUFORNIA.AN�AGFEE THRT IF I SHOUI.O PFCoIAE INSPECTION FEE ___........._.___3....... __.._.. `- SU&1 TTOT EWORKEH9'COMPENSATI� PROVISIONSOFSECiIDN3�000FTF1ELA90fl ' l � sr.� -- j CO� ISH ORTHWITHCOMPLYW�TH ROVISIONS. �„n,...��=+��9' ISSUANCE 1�_,,.� 7�''�l,x`j�� ;r9 I � : .s , o x� r a \�� p DATE:� C APPLICANT: __ �""'�•--= SMIP - � �j — ,_ :.�- =-'". ,y-� �v�rr"'�� '� W ENERGYP/C �� r:�.$ i � t F, . .-. . �,n ....-----'--- J WRflNING:FAILURETO SECUHE NNRKERS'GOMPF.NSATION COVERAGE IS UNLAWFUL,AN�SHnll BE ' • �.. ,y_ , , � -� S�'-- LL SU&IECTANEMPLOVEFTOCRIMI.NALPENALTIESANOCIVIIFINESUPTOONEHI/NDRmTHOUSAND ENERGYPERMIT ��' �:-4��-� 5_;:,e. .� WLLRRS(f100.000�.INMDITIONTO7HF.COSTOFCOMPENSATION,�AMAGESASPflOVIDEDfORIN —�--'---"'-'----- '---"— '-'— J 5[CTION 37oe OF THE LA9oR CODE,INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: __,,.______ � ___ .____..'_— __'_--__.— a CANSTRUCTION LENDING AGENCY PRE-ALT FEE: _ _ O Q 1 HEFEBV AFFIRM UNDER PENALTV OF PEfiJIJRV THAT THERE IS ACONSTRIJCTION L[N�ING AGFNGY __ � FOHTHEPERF'ORMANCEOFTHENOflKFORWHICHTH!SPERMITISISSUED(SEC.?oD7,CIV.C.). Z ...."'—_"_� —' W � LENDER'SNAME ..�—._..._..._....._..._' —" H LF.NOFR'SADDRESS_..____....__ W ICERTIFYTHATIHAVEREADTH�SAPPLIGITIONANDSTATETHAT'fHfA00VEINFORMATIONISCORRECT. TOTAL FEES ��4 � I AGHEE TO CONPI.Y WITH PLL CITY AND CAUNTV ORDINANCES AN�STATE LAWS RELATING TO BUILUING '��- � WNSTRUCf10N,ANDHEREBYAUTHOPIZER[PiIESENTATIV OFTHISCOUNTVTOEMERUPON4liE pf��-y-/�' Lj `�' �' �� Z A90VE-MENTIONEDPROPERTYFORINSPECT�NPUHPOSE COMMENTS � _ """'�-� .y" ��`^� � ��'��._._._ � '�`� �l �� ,. . � ��_/��_ `�.33w�.,�:7. �L�� .�3 � - ------- � PEflMITTEENAME 1 �� y "—__—__._ -----"—'—" ��. � o`.�..R�,_� ��,. � SIGNATUREOFPER, EE � RECPT.NO.�__� PAIO 8Y �� VALIDATION � S ~ WHITE-DepaRment Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GHEEN-Applicant's Copy .._. . . - __ �.. + { I i , i � i ._�_� ..",. � _ _. _..( _. _ i Y... . �� i , �� . .__. , �� ' � � i � � i � � I ! � � I i i � I � � � ' ' ' ; ��'� ; � i f , ' � '' i . i , , � ; , � � � ; i • r�� ' I I �; i � � � i f i � , ! j �I �', � � ��. . � � � �� I � I ' _ � �, � � ` � I i i i � � I I I � � I t i � i , I � � � � �i �� I I ;.. i �� i .i i ...,�-- + �. �._... i . __ i i i - -- -+ I i I i E + I� � � .___ �. ....� . 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