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Home My WebLink About10005 CITY OF DIAMOND BAR /� ' � COMMUNITY DEVELOPMENT DEPARTMENT .�, � ,,,,� . 21660 E.Copicy Drive Suite 190 ,� PRESS (909)86b-3195 Pax(909)861-3117 '�'f BUILDING PERA�IT APPLICATION FIRMLY o ADDRtESS ��/ �T L +�f� DATECATION 2,� NUMB R " �a-� #� .d c� ISSUE TYPE OCC � APN LOT TRACT __ _ DATE _ _CONST. GROUP p OWNER �L�X L-lA� " ADDRESS /�--G�r /��V/N�_�_____ ZONING SETBACKS Z CITY �G- MpN7gn ZIP� TEL._ FRONT RW L� APPLICANT TEL. REAR G g SIDElSIDE STREET RW C � CONTRACTOR � S �'�F� C!�'G� /NG SiDE C ADDRESS 7� lii]4aGi�L� A-V�- � C�N fXRI� �F' Z�P q��7� T��.��3 D 7. PROPOSED USE w ARCH/ENG! � W DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNEH-BI:ILDER DECLARP.TION SFRlADDJREM O e � I HEREB�AFFIRM UNDER PENAL7Y OF PEMIRV THAT I AM E%EMPT FROIA THE CONTMCTORS LI- G8f89B/C2I�JOf[ • LLi CENSEUWFOflTHEFO:LOWINGHEA50Y(SEC.7031.5BUSINESSAN�PROFESSIONSCODE:ANYCITYOR (n U COUNTYWHICHREOUIflESAPERMITTOCONSTRUCT,ALTER,IMPROYE,DEMOLISH,ORREPA7flANY5TRUG W patio/Deck •� Z TUflE.PRIOF TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERAIIT TO FILE A SIGNED W STATEMEN'THA7 HE OF SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE C04TRACTOHS LI- g CENSE LAW�CHAPTEH 9(COMMENCING Wlhl SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � Pool/Spa FESSIONS COOE)OR THAT HE OR SHE IS EMEAAP7 THEREFROM AND THE 9ASIS FOR THE ALLEGED ExEMV- QTION.ANYVIOLATIONOFSECTION7031.SBVRNYAPPLiCANTFORA�ERMITSUBJECTSTHEACPLICANTTO Z Rg-Rpp� � AG!VILPENALTYOFNOTMORETHANFIYEHUNORE�DOLLARS�f50o).�: � ❑I.ASOWNEROFTHEPROPER7V,ORMVEMPLAYEESWITHWAGESASTHEIRSOLECAMPENSATION. 0 COR1RIBfC13i Z WILL OO TNE WORK,AND THE STRUCTURE IS NOT INTENDEO OR OFFEFEO FOR SALE(SEC.704s,BU51- J NESS AND PNOFESSIONS fADE.7HE COMRACTORS LICENSE lAW D�ES NOT APPLY TO AN OWNER oF � PROPERTYWHOBUILDSORIMPROVESTHEREON,ANOWHODOESSUCHWORNHIMSELfORHEHSELFOR = _ C[ THROUGHHISOHHEROWNEMPLOVEES,OROVI�E�THA75lJCHIMPROYEMENTSAfiENOTINTENDEDOR m w OFFcREDFORSALE.IF,HOWEVER,THEBUIIDINGORIMPROVEMENT�SSOLDWITHINONEVEqROFCppIPLE- � TION,THE OWNER�BUILDER WILL HAVE'HE 9URDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR Z IMPRWEFORTHEPLIRPOSEOFSALE). � C:I,ASOWNEROFTHEPROPERTV.RME%CLUSIVELVCONTRACTINGWITHIICENSEDCONTRACTORS -- � TO CONS7HUCT THE PRQIEC7(SEC.7odd,BUSINE55 AND PP.�FESSIONS CODE:THE CONTMCTORS LI- VaW3tlOf1 ADJ.AREA LLI CENSELAWDOESNOTAPPLYTOANOWNEFOFAPRO?ERTYWHOBUILDSORIMPqOVE57HEREON,AND � VMOCONTRACTSFORSUCHPROJECTSWITHACONTftACTOR(S�LICENSEOPURSUANTTOTHECONTMC� QUANTITY DESCRIPTION FEE � TORS LICENSE LAW.). +� � C I AM EXEMPT UNOEF SEC._ 0.8 P.C.FOR TNIS FEASON U , %� T� � O yS __—__ __—__...__—_ -- o� 'S r U 12�. LL OATE OWNER________________ f' Z _..- ----- W � � . �`_ _ . � LICENSED CONTRACTORS DECLARATION W ��, �b► �E.L � � I MEREBY AFFIRM UNDER PENAITY OF YERJUAY THAT I AM LICENSf_D UNDER PROVISIONS OF CHAP�ER � d 9(COMMENGING WITH SECTION 7000)OF DINSION 30F THE BJSINE55 AND PROFESSIONS CODE,AND Z � � }C MY LICENSE IS IN FULL FOHCE ANO EFFECT. m / � G� LICENSE CLA55� �'�� LIC.NO. __�a��Q-- J ` �• ~ DATE��_ CONiRAGTOR.��e��iJ/ �- � WORKEFS'COMPENSATION DECLARATION ��d/� Q -- = U � 1 HERE6YAFFIRN UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECLARAi IONS � � • Z Q ` � IHAVEAN�WILLMAINTAINACERTIFICATEOFCONSENTTCSELF-INSUREFORINORKERS' S Z CAMPENSA7ION,AS PHOVIDED BY SECTION�70o OF THE LABOr�CO�JE.FOR THE?ERFORM.4NCE U� Q OFTHE WOFK FOFl WNICH THIS PERMIT IS ISSUED W _ C p � r � �J W _IHAYEANOWILLNIAINTAINWORKEf75'COMPENSATiONINSUftANCE,ASREOUIp.EDBYSECTION O 37ooOFTHELABORCODE,FOR7HEPERFORIAPNCEOF7HEWORKFOflWHICHTHISPERMRIS ISSUED.MY WOHKERS'CAMPENSATION INSURANCE CARRIEP AND POI_ICV NUMB<_R ARE CONSTRUCTIOM __ PLAN REVIEW �/� � CARRIER__��LC ND" �� __ ' �ffi� Z POLICY NUMBER_�s a ELECTRIC _�' f i� Q a €' � (fHISSECiIONNEmNOT8E00MPLEfEDOFTHEPERhYTISFORONEHIA�flFiEDWUARSl5700)ORLE5S1 PLUMBING w � MECHANICAL Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUEO,1 (,'} SHALLNOT EMPLOYANY PEFSON IN ANY MANNEH SOAS TO BECOME SUBJECTTOTHE !.y t�� WOflKERS'COMPENSATIONLAWSOFCALIFORNIA,AN�AGREETHATIFISHOUL08ECOMe INSPEC710NFEE PS !_ �?, .�� = SUBJECTTOTHEWORKERS'CAMP'cNSATIONPROVISIONSOFSECTION370DOFTHELA90R �%�'"•--d;'r�T; CODE.ISHALIFORTHWRHCOMPLVWI'HTHOSEPROVISIONS �SSUANCE ��'��i�� /�'-�/��- y SMIP Ip DATE:N�3�-�97APPLICANT: _�G.�.�_ �__ _� � ENERGY P/C _ � WARNI :FAILURETOSECUREWORKERS'COMPENSATION�OVfFlAGE15L'MAWFUL.ANOSHALLBE �y SU&IECT AN EMPLOVER TO CRIMINAL VENALTIES AND CML FMES UP TO ONE HUNDRED hIDUSAND ENERGY PERMIT DOLLARS(f�00.000).IN ADOITION TOTHE COST OF COMPENSATION,DAMAGES AS CPOVIDEO FOR 14 -- J SECTION 3708 OF TNE UBOR CODE,INTEREST,ANDATTORNE'I'S FEES. RETENTION FEE: � a CONSTRUCTIONLENDINGAGENCY PRE-P.LTFEE: _ � I HEREBV AFFIRM UNDER PENAL7Y OF PERJURV THAT THER'c IS ACONSTRVCTION LENDING AGENCY 0- FORiHEPERFORMANCEOFTHEWORKFOflWHICHTHISPERMITI5ISSUEO(SEC.3�97.CIV.C.), ----" ---- Z W — _— � LENOER'SNAME __ __ _..___.____ F— LENDER'SADDRESS_ _ — —_.____ � TOTAL FEES ¢ ICERTIFYTHATIHAYEREADTHISMPLICATIONANDSTATETHATTHEABOVE�NFORMATIONISCORFECT. V"� I AGREE TO COMPLV WITH ALL CfTV AND COUNTV OROINANCE5 AND S7ATE lAWS RELATING TO BUILOING � CANSTRUCTION,ANDHEREBYAUTHORREREPRESENTATIVESOFTNISCOJN7Y70eNTEFUPONTHE Z AHOVE�MENTIONEDPROPERTYFORINSPECTIONPURPOSES. � COMMENTS � G��> �� m PERMITfEE NAME�PRIM � 4. — � SIGNANREOFPERMITfEE �.�9�'D / "^'� �� V �� _/— � � , • �. 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