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Home My WebLink About12303 (14) 1 �� CITY OF DIAMOND BAR �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 � (909)860-3195 Fax(909)861-3117 PRESS "��', BUILDING PERMIT APPLICATION FIRMLY N JOBSITE /� �+ W a ADDRESS ��tiL�L�� ✓7L(�P�GIS�/NI �l� D APPLICATION /a�`_�/PERMIT P/C p -� DATE 7 �l �� NUMBER�Z� # � APN LOT TRACT ISSUE �y, TYPE OCC --�� DATE �"�'�'�C,e CONST. GROUP g OWNER SK�NAG,D Ne �'J��,Til/Y'A/G J U�' q ADD S5�/�JG�J�./aI� �L It'I � �' ZONING SETBACKS W ' FRONT ---- RW CJ z CITY ZIP '/7(o� TEL. /-%��.3 — p APPLICANT D/fI1/N'Ee.d, e,Q�piyi'EL. � �-73I SIDE/SIDESTREET RW u � CONTRACTOR T/U�S •I' SIDE n .__ Q ADDRESS_ ' � �1 Cj` � � CITY�/C`�N/b'�r•� ZIP�f��TEL.)�i� �- � PROPOSED USE �/�T/L C`d Gr£ �_ _ pARCH/ENG/ - �z DESIGNER N0.DWEL. NO. NO. a ADDRESS � CIIY ZIP TEL. UNITS S70RIES BEDROOMS, y v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEHEBY AFFlRM UNDER VENqLTY OF PERIURY TF1AT I AM EXEMPT FROM 7HE CONTRACTORS u� GdfagB/CdfpOR W CB�lSEUWFOR7HEFOLLOWINOREASON(SEC.7o31.58U51NF.55ANDPFiOFE3510N5CADE:ANVCITYOF (J� U ��.RyW�{�CHREQUIRESAPERMIT7ppON5TRUCT,ALT�R,IMPROVE.DEMOLISH,ORREPAIRANVSTRUC- � � TUpE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICPM FOR SUCN PEflMIT TO FRE A SIGNED W PatiolDeck c STIREMENT 7HAT HE OR SHE IS LICENSEO DURSIIANT TO THE PP.OVISIONS OF THE CON7RACTORS ll- � CENSE LAW(CHAPTE%B(COAIMENCING WITH SECTION 7000)OF OIVISION 30F THE 9USINESS ANO Pp0- PODUSp3 a FESSIONSGODE)OR'RUTHEOR5HEISEXEMPTTHEREFROMANI)THEBRSISFOHTHEALLEGEOEXEMP- (� L� TION.MIYVpLqTIONOFSECTION70.97.5BYANYNPPLIGANTFOflAPERMITSU&lECTSTHEAPPLICAMTO Z {3B-RO01 F A CIVIL PENALTV OF NOT MORE hIAN FlVE HUNDREO DOlLAR3(S5o0).): � ❑I.ASOWflEROFTHEPROPERT/,OflMVEMP�OVEfSWI7HWAGF.SASTHEIRSOLECOMP'cNSATION, CommBrCial � WILL 00 hiE WOpK,AND TNE STHUCiURE IS NOT INTEN�EO OR OFFEHED FOR SALE(SEC,�09a,BU51- �J � NESSAND DiiOFE5510NS CODE:hIE COMRACiCAS LICENSE LAW CCGS NOT APPLY 70 AN OKTIER OF � PPOPEH(Y YVFiO 6UIL030R IAIPROVES THEREON,ANO WHO DOES SUCH WORK HIMSELF OR HEP8ElF OR CL THFiOUGHMI50RHEROWNEMPLOYEES,PFiOVIOED7HATSUCHIMPROVEMENTSARENOTINTEN�E00R � � OFFEflEDFORSAIEIFHOWEVER7HEfiUILDMGOqIMPflOVEMENTI550tDW17'HINONEYEAROFWMPLE� ,_. � TION,hiE OWNEH$UILOER WILL HAVE THE BURDEN GF PqOVINO THAT HE OR SHE DID NOT BUll,p OR � IMPROVE FOfl THE PURPOSE OF SRI,E). �yJ O 1.AS OWNER OF THE PROPEATV,A1A EXCLUSIVELY CONTRACTING WITH LICENSED CON7RACTORS (s TO CONSTRUCT hIE PRQIECT(SEC.706d,AUSINFSS AND PROFESSIONS COOE:THE CONTNACTORS LI- Va1118tI0f1 ADJ.AREA_..____....,._.. W CENSELAWDDESNOT�PPLVTOIINOWNENOFAPROPEqTYWHOBIlILD50RIA1PqOYESTHERCON,AND '— � N?1000NTflACiSFOR3UCHPF10.1ECTSWITHACONTRACTOR�S)LICF.NSEDPUPSUANTTOTHECOMqqG QUANTITY DESCRIPTION fEE Y TOR3IlCEN3E4AWJ. � � p ❑IAMEXFN,PTIINDERSEC.,__,__,___ B.flP.GFORTHiSREASON � U � ��y � OATE '.a(.7�SF OWNE �y„fr_ �' '_�—� U Z W . � � LICENSFD CONTRA S DECLARATION W I HEREBY AFFIRM UNDER PENALTY OF PER.�UPV THAT I AA1 LICF.NSF.D UN�ER PROVISIONS OF CHAPTER � a, 9(COMMENCINOWITHSEC7AN7000�OFDNISION30FTHEOUSINF.SSAN�PqOFE55fONSCODE,ANO Z X MY UCENSE IS IN NLL FOqCEAN�EFFEGT. LLI m � � � LICENSECLA55_ _ LIC,NO,___________ � � J V DATE CONTRACTOFI _________ d W � WORKERS'COMPENSATION�ECLARATION � a � ,IHEREBYAFFIRMUNDERPEVALTYOFPEfUURYONEOFTHEFOLLO}yWGOECLAFATIONS: � Z � ___IHAVEMDWILLMAINTAINACERTIFICATEOFCON5ENTTOSELF-INSUpEFORWORKERS' _ � , � . COMiPEN3ATION,ASPR�VIDEDBVSECTiON370DOFTHElA90RCA0E,FORTHEPERFORMANCE � �U OF THE WORIC FOR WHICH THIS PERMIT IS ISSUED. � � � �,__IHAVEPNDWILLMAIMAINWORKERS'COMPENSATIONINSUPAM10E,ASREOUIREDBVSECTION Q 37ooOFTHELA80RCODE,FOR7HEPERFORMANCEOFTHEWORKFORWHICHTHISPF.FiMIT15 � � �y � ISSUED.MVWOFiKEflS'COMPENSAiIONIN5URANCECARRIEtiANDPOLICYNl1MBERARE O ."' _..____.,...._____...._ ��`J '_.._'— ""4" � CAPqIER"" � ^ �_"_' --------------- - ------_._._..---- REVI ' .j Z ._..----------�•�-__�- zaoucvnuMeEa--- ----------- — ELECTRIC __._.__`_....... ---- Q Q (fH6SECfiDNNEWPiOTBEOJtrtllFfEDOFT}iEPEPfMGFORONEkNWf1F.DDOLIMS(510o)ORLESS} PLUMBING W _......_..'-_._"_' . .._.._.. Z I CERYIFY THl1T IN THE PEFiFOftMANCE OF THE WORK FOP WHICH TH!S PF.RAIIT IS ISSUF.D,I MECHANICAL __,.,___..,_. ,. ___ C3 SHALLNOTEMPLOYANVPERSONINANYMANNFqSOAS'(O�ECOMGSUBJ[CTTOTIIE (/) WOfiKERS'CAMFENSATIONLpWSOFCALIFOR�IA,ANDAGREETHATIFISHOLIL�BECOSIF INSPECTIONFEE __.___....,__ F SI/&IECTTO THE WORKERS'�MPENSATION PftOVI510�S OF SECTIOY 3IOOOF THE LPdOq ' � CO�E,ISHALLFOIiTHWITHCOMPLYWIhiTHOSEPROVI5AN5. UANCE , , __ ':-^� __-...'____ � /M9 p OATE'_ _ APPLICANT. SMIP ........_" ._...'_"___ V' _ __—__' J WARNING:FAIWRETOSECUflEWOHKERS'COMPENSfTIONCOVER�GEISUNLAWFUL.AN�SHALLBE ENERGYP/G __.._,...._...___.. __. .._.___...___..-- � SUBJECTpNEMPLOYEflTOCRIMINALPENALTIESANDCIVIIFINESUP'fOONEHUN�RC:DTHOUSAND ENERGYPERMIT DOLLAHS(5100.000).IN ADDITION TO THE COST UF COMGENSATI94,DAMqGES AS PROVIDE�FOR IN ---�------�— ...__'_—__'......... � SECTION37080FTHElA00HCODF,INTERESi,ANDATTOFiNEY'SFEES. RETENTIONFEE; _..____ d CONSTRUCTION LENDING AGENCY PRE-ALT FEE' ...___. p ....... ..----�— � I HERE6YAFfIRM UN�ER PENALTY OF PERJUHY THATTHERE IS A CONSTHUCTION LENOING AOENCY FORTHEPEFFORMANCEOFTHEWOFIKFORWHICH7HISPGRMITISISSUED�SEC.JOB7,CIV.C.). '"---'---� �----'� -�-"---'""-"'"-""--- Z W -- ---------— ----�----- -- � LEN�EF75 NAME....___""""_ _' _'——__'"'— '"_'_' "'.....""""_'___'—"'_ {,= LENDEFf9 ADDRESS ' "'_'_—_'__"'_"'."'"""_ _—'—"_"_ �''�� TOTAL FEES � ICEHTIFYThIqTIHAVEREA�THISAPPLICATIONANDSTATETHATTHEABOVEINFOflMATIONISCORRECT. W IAGPE�TOCAMPLYWITHALLCITYANDGOUNTYOROINANGESANOSTATEUWSFELATINCTOBUILDING � CONSTRUCTION,ANDHEFEBYAU7NORIZEREPRESENT�TIVESOFTHISCOUNTYTOENTERUPONTHE NlOVE-MENTIONE�PFlOPERTY F Fl INSPECT N PURPoSES. —_— � Z �. 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