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Home My WebLink About12292 (14) , � CITY OF DIAMOND BAR _h j ��- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES. i==� ) I 21660 L.Copley Drive Suite 190 -'"�1. � (909)860-3195 Fax(909)861-3117 PR ESS ��'� BUILDING PERMIT APPLICATION 11 FIRMLY �� JOBSITE ��/f �' �/� j� APPLICATION l PERMIT ! '�jC.-� o ADDRESS T/�'� �!✓U��'� �i-"� �� DATE -r NUMBE �� "' f ISSUE TYPE OCC �- APN_ LOT TRACT�,� DATE CONST. GROUP p OWNER 1 '�P".L�'�J.+9LUs'�T�� ADDRESS ��, " = dLr ZONING SETBACKS �w FRONT RW ❑__. � CITY QfJ ZIP � �TEL.�� APPLICANT TEL. e ' ""TJ' REAR ❑ z SIDElSIDE STREET RW ❑_______ � CONTRAC70F • LsN� 0 ��LV�JOiZ SIDE ❑ _ �- ADDRESS� �� 1� ��- l�,�Ttfy�+ ',p�p/ �� I � CITY r1!!,/Ll OAdlJ /�� ZIP �' TEL�A`r sG/^�� PROPOSED USE__�r1_L/`��'�°'( _�Q 6� �t� oARCH/ENG/ _ _ iz DESIGNER NO.DWEL. NO. NO. a ADDRESS_ UNITS STORIES _ BEDROOMS__ � � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATtON � OWNER-BUILDER DECLARATION 'SFR/ADD/REM � f� O p 1 HEHEBY AFFIRM UNDEft PENALT'OF PERJURY THAT I AM E%[MPT FfiOM THE CANT1iACTOR3 LI- ' G2fdgB/CBIPOIt LLt, CENSEIAWFOHTHEFOLLOWI�GREASON(SEC.7037.SBUSINES5RNDPROFESSIONSCODE:ANYCITYOF (n U CO(1NTVNMICHREOUIRESAVERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRPNYSIAUC- W P8fl0/DBCk Z TURE,PFIOF TO IT9 ISSUANCE,AL50 REQUIRES THE APPLICANT FOFi SUCH PERMIT TO FlLE A SIGNED W � STATEMENT THAT HE OR SHE IS LICENSEO PUR5UANT TO THE PROVISIONS OF TFIE CONTRACTORS LI- C CENSE LAW(CHAPTEA B(COMMENCING WITH Sf.CTION l000�OF OIVISION 30F THE BIISMESS AND PHO- LL PDOUSpB � F FE9810NSCODE)ORiTiATHEORSHEI9E%EMPT7HEREFROMANO7HEBASISFOR1NEAlLEGEUE%EMP- V TION.ANYVIOLATIONOFSECTION7037.SBYANYAPPLICANTFORAPERMITSU&lECTSTHEAPPLIC�NTTO � Re-Rooi � A CML PENRLTY OF NOT MORE THAN FNE HUN�REO OOLLARS(5500�.�� UI,ASOWNEROF7H[PiiOPERN,ORMYEMPLOYEESWITHWAGESAuT11EIRSOLECOMPENSAT;ON, C� COffIRIBfGIeI � YfILL 00 THE WORK,01N0 TFiE 57RUCTURE IS NOT INTENDED OR OFFEFED FOR SALE�SEC.7044,BU51- �1 � � NE33 AND PROFESSIONS CODE:THE CONTPACTORS LICENSE lAW�OES ND7 AVPLV TO AN UWNER OF � } PROPERTYWFIOBUIL�SORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR ' m � TMROUGHHISORHEROIYNEMPLOYEES,PRDVI�EOTHATSUCHIMPHOVEMENTSARENOTiN7ENDEDOR � QOFFEREDFOR3d1EIF,HOWEVERTME9l11LDINGOfiIMPR�VEMENTI550LUWITMINONEYEAROFCOMPLE- Z TqN,THE OWNER-BUILDER WILL HAVE THF DUHD6N OF PROVING THAT HE OF SHE DID NOT BUILD OR � = IMPROVEFORTMEPUflPO5EOF5PlE). � ❑I.ASOWNEflOF7HEPqOPERTV.AMEXCLU5IVELYCANTRAC7INCWITHLICENSEDCANTHACToqS � TO CANSTRUCT THE PRO.IECT(SEC.7oqd,B4SINESS AND PROFESSIONS CODE:THE CONTRACTOflS L6 W �Valuation �-<�6 A0.1.AAEA _ W CENSELAWOOESNOTAPPLYTOANOWNEROFAPROPERTYWHO[3UIlDSORIMPROVESTNEREON,AND " , � WHOCONTMCTSFORSUCHPRQIECTSWITHACONTRAC70Rf5)LICFNSEDPURSUANTiOTHECONTRFG �UANTITY DESCRIPjON FEE Y TORS UCF.NSE LAW.). � � J ❑i AM EXF_MPT UNDER SEC. B.8 P.C.FOR TMIS REn50N Q f, — U — . LL OATE —_—OWNEF --�' � � � --__"'__'__..."'_"'_"_-_'_ w 'r��fj �, y ,. � LICENSED CQN7RACTURS DECLARATION w ! � I NEREBYAFFIRM UNDER PENPLTV OF PEiiJURY THA71 AM LICEN5E0 UNDE11 VNUVISiONS OF CHAPTFfi � � /' . � d, B(COMMENCINGWITHSECTION7ooa)OFOIVISION30FTHEBUSIYESSANDPROFESSIUNSCO�[.AND Z �•'�'`� � !�, X MY LICENSE IS IN Fl1LL FORCE AN�EFFECT. m Y,, Ill � LICENSE CLASS_� __.�LIC.N0. �� li vonreSS� Z� CONTRACTOfi�_4_ S ��5� a w � a� WORKERS'COMPENSATION DECLARATION�j�` '� —� i, � U � � I HERF.BV AFFIRu uNDEF PENALTY OF PER1l1RY ONE OFTHE fOLLOWING DECLA IONS: ' � / Z (' O ✓j a �, INAVEANDWILLMAINTAINACEHI'IFlCaTEOFCANSENTT96ELFINSUREFORWOHKEHS' 2 � CAMPENSATION.AS PROVIDED BV SECTION 3]0o OF THE LA60R CODE,FOR THF.PF.RFORMANCf w �� OFTME WORK FOR WHICH7HI5 PF.qMIT IS ISSUEO. � O ' W ___IHAVEANDWILLMAINTAINWORKEHS'COMPENSATIONINSUMNCE,ASREQUIREUBYSECtiON � / , ( /'y� � O 37ooOFTHELABORCODE.FOR7FiEPF.HV'ORMANCEOFTHLWORKFORWHICHTHISPFFlMITIS . ��-� � �a _.,_ ISSUED.MY WOFlKERS'COMPENSATION INSURANCF:CARRIEF PND POLICV NUMOEH ARE' CONSTRUCTION __ `� �'7��i 1 --�--�-��----. .._. ........'— i; > PLAN REVIEW �_�� ----- ----"- ------ .._. , � POLICVNUMBER__,_ ..--..----- ELECTHIC �^I�'F � � Q 9 V (n-i�ss[cror+NEB�r�o�BECOMWLEIEDOFh1EPFfUNlISFORONEHIN�DREDD0IJ.AAS(5100)ORLESS) PWMBING _��_L.G-� ( w � q � � ICEHTIFYTHATIN7NEPERFORlAA�CEOF7HEWORK�onWHiC11THISPERMITI5ISSUED.I MECHANICAL. ��IJ � (°J SHALLNOTEMPLOYAtiYPERSONIHANYMANYER50A5TOBECOMESUBJ[CTTOTHE � y WORKEFiS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULO�EGOME INSPECTIONFEE ___. . � E - SU&IECTTO THE WORKEFS'C01.1PENSATION PROVISIONS Of SECTION 3 W OF THE LABOR ' U�'_"_' � CODE, SHALIF RTHWITHCOMPLYWITH OSEPFQyI510N�. ISSLIANCE L � _- _ p � L(�'. 'y.y`,df�.^'r SMIP " , � DATE:�� APPLICANT: _�o_.._ ------------....----.._..-----...-------......�°._— ! � WARNINO:FAILURETOSECUREWORKER COMPFNSATIONCAVERAGE UNLAWFUL.ANDSHALLBF. ENEFGYP/C . ___ __ 5 � SUBJECTANEMPLOYERTOCRIMINALPE ALTIESANDCIVILFINESUPTOONEXUNDREDTHOUSAND ENERGYPERMIT � DOLLARS(S1 W.00a).IN ADDITION TO THE GOST OF COi�APENSATION,DAMAGLS AS PHOVIDED FOR IN -- � SECTION3)o90FTHELA90RCODE,INfEHFST.AN�ATTORNEI"SFEES. RETENTIONFEE: __,._._.____-_�___— O CONSTRUCTION LENDING AGENCY p -ALT FEE�y,, � �i7 • - ---- - — ----- - c[[ � ) � t�---- � --- -- ' i HEREBY AFFIRIA 11N0ER PENALTY OF PEHJURY THAT THEflE IS A CONSTRUCTION LFNDING AGENCY � FOR TNE PERFOFMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.309%.CIV C.�. -F� W v �_'_'_"""' _—____' � LENDF.R'SNAME___"' '___"'_-_...__ '— { ._"_'"_ i F- LENOER'SADDF7FS5 ____._ ..-_--------_..____ ,,,� � � ICEHTIFlTHATIHAVEFiEFOTHISAPPLICATIONANDSTATETHATTHEAPOVEINFORMATIONISCORRECT. TVT/`1L FEES I f W I AGHEE TO COMPLY WITH ALL CITY ANU CAUNTY OIiDINANCESAND STATF LAWS RELATING TO BUIL�ING I � CAN9TRUCTION,ANDHEREBVAIfrHOHIZEREPRESENTATIVESOFTHISCOUN�VTOfNTERUPONTHE zA90VE�MEMIONEOPROPERTYFORINSAECTIONPURPOSES, COMMENTS ._..__—.. _ — I -�—�' _��/( TCd ts'A L. 4`.a4 �G1/�. _ _ --- -- m PERMITT E NAM[(PRINI� _._..__ — � ct7`1� �' ' 'e.._°""r/Z' C :� %� ----- N SI A7l1RFOFPERMITTEE �ATE —� � __ ' I = iiECPT.NO._�� PAID BY __.__,_ VALIDATION____ i ~" WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy � I � ��fy. ... � ._�. , '._ _.__. . ,.._... - r i .r.. � _._ _.,.._ r_.,._1 .__. _ , ,� i . � t i � ; � 1 ' � � i �W� j � : � � ` . i ! ' - I ' f ' � � I � � ; ; V� .1i � . I ( i i E � E I � i k � ! I a I i I I I � ; . r�� g� � . � , � � I � �. � . � ' ! . ' . I� � ! - . I . � . i � � � ��, "§ �� i � � � � I . ' � E � , i i � � '� : L , � . � , ; k` � ' � - ; ; �_ ._ 1 _� , i � � j ' � � . � ' . � ; � { . 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