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,.,., -... _.. . .__ ... ._ , �, . �_. .. ,. �.: _. _ ,-� �:;;;,��.. °��,.. �,: . , . .. ,� ---�-- CTTY OF DIAMOND BAR - COMMUNITY DEVELOPMENT DEPARTMENT 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)8b1-3Ii7 PRESS BUILDING PERMITAPPLTCATION FIRMLI( ' Q DDR'ES�/��� � ,r � APPLICATION '� PERMIT , P/C o /.iE1CJ ' • SSUE —�/� �� TYPE ER /� # OCC � � APN LOT_-�-�—. —�q TRA�{T DATE CONST. GROUP p OWNER �'�`N� _F'1 /J/�J"4./���' o ADDRES '��Y�. � ZONING SETBACKS z CITY� ZIP TEL FRONT RW � � APPLICANT TEL. REAR p z � SIDEISIDE STREET R�n/ ❑ , . .:, Q CONTRACTOR � ^-A�- SIDE`' ' ° , p p� ADDRESS I�S � - 'i � CITY �j��� ZI � � L�1' TEL � PROPOSED USE � � � �I�I � � ARCH/ENG/ ' ��Q z DESIGNER_�.J 1 W .,�aM ik� ,q NO.DWEL. NO. NO. � ADDRESS cn UNITS "' STORIES �_ BEDROOMS� � CITY ZIP TEL. , � v� bE RIPTION SQ.Ff FACTOR PSF AD .ARE ATION o � OWNER-BCILDER DECLARATION ��� SF AD /FiEM � � � p I HEREBY AFFIRM UNDER PENALTY OF PERJCRY THAi I AM EXEMPT FROM THE CQNTRACTORS LI- G7f8ge/C3�pOrt��� i � W CENSEL4WFOR7HEFOLLOWINGREASON(SEC.1031.SBUSINESSANDPROFESSIONSCODE�ANYCITYOR ' U COUN7VWHICHREQUIRESAPERMITTOCONSTRUCT,AITER,IMPROVE,DEMOLISHORbEpTIFtAIN'SYRUC� ' w TURE,PFIOR�TO IiS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIi TO FILE A SICaNED W Patio/Deck � �� _; i � � STATEMENT THAY HE OR SHE IS LICEN3ED PURSUANT 70 THE PFiOV15�ON5 0�TI1E CONT(idCTOR$LI� � . . CENSELAW{CHAPTER9(COMMENCINGWITH5EC710N7oa0)'bFbiV1510N30FYF1��6U5YNESSANC�PFiO- POOVS(Jfl � iION.ANYVIOLATI�NOFSECTI0N7031.5BYANYAPPLICA'JTFORAPERMITSU6JECTSTNEAPdLICdNMP � FESSIONS CODE)OR THAT NE OR SHE IS EX'eMPT THEREFROM AND THE BASIS FOR 1'NEALLEGED EX T TO � � ACIVILPENALTVOFNOTMORETHANFIVEHL'NORED[7OLLAF'iS(f5`0(i).)'�� " � ���. :�� R8-ROOf . - - � OI,ASOWNEROF'HEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMp�NSAtION, 0 CORIRIBlC181 Z WILL 00 THE WORK AND THE STRUCTULiE IS NOT INTEl:DEb OR OFFEREb F'OR SAtE($EC.'�044;BUSI- �.1 - � NESS AND PpOFESSIONS CO�E:THE CONTRACTORS LICENSE LAW�OE5NOYAPPLY Td"AN'QVJNER OF � PROPERTY WHO BUILDS OR IMPROVES THEflEON,AND WHO OOES�uUCFI VJOPKfiIMSELF OFi HERSELF�OFt ' � TFIFOUGHHISORHEP.OVlT1E41PLOYEES,PPOVIDEOTHATSIJCHIM�ROVEMENYSAbENOTINT�`NpE00R � . Q OfFERE�fORSALE.IF,HOWEI'ER,THEBUILDINGORIMPROVEMENY9SSOLbWITHINONEYEAROk�CAMPLE- . � TION,iHE OWNER-BUILOER WILL HAVE THE BURDEN OF pROVMG THA'Y NE 07i SHF hlff NaT BUILD'OR . = IMPROVEPoL7THEPURPOSEOFSALE). ' ' ' '.: :""�'�,�'�. w �I,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELVCONTRACTINGWITHLICENS�DCON'('I�AG�"T()fiS � TO CONSTRUCT THE PPOJGCi(SEC.7044,BUSINESS PNO PROFE$SIONS-CObE:�TNE�CON7RA�TdRS LI- V81U8f1a1 ADJ.AREA W CENSELAWOOESNOTAPPLYTOANOWNEROPAPqOPERTYWH09UILD50RIMPFiOJESTHEPEONAN� --- = WHOCONTRACTSFORSUCHPPOJECTSWITHACONTRACTOF(S}CIhEN$EDPURSUANT70THE'CONTRAG � FEE � roas ucENsetAw.). � . QUANTI7V � DESCqiPTION �- � Y �� C7 I AM EXEMPT UN�ER SEC. B.�B P,C FOR THIS REAS'ON J .�... , .. U . � ¢ DATE OWNER �� "�� f— O .. . . �_— . ... U I � - .. � . � LICENSED CONTRACTORS DEGIARATION:.��. .�-.T w 4 ' � I HEREBV AFFIRM 11NDER PENALTV OF PERJ'JRV THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER� � � 9(COMMENCINGWITHSECTION7000)OFDIVISION90FTHEBUSINESSANDPROFESSIOIJ5CObE,AND Z 1X MY UCENSE IS IN FUL�FORCEAND EFFECT. ' ' m , , � UCENSE CLASS LIC.NO. � � U DATE CONTRACTOR a . W . d.�::i� �.�1r ,�,�d-s: � WORKERS'COMPENSATION DECLARATION ' Q .. .. � IHEREBYAFFIRMUNDERPENALTYOFPERJURVONEOFTHEfOLLOWINGDcCLARATIONS: z � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKEflS' ¢ z COMPENSATION,AS PROV�DED BY SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE U Q OFTHE WORK FOR WHICH THIS PERMIT IS ISSUEO. ; � QW _IHAVEAN�WILLMAINTA�NWORKERS'COMPENSATIONINSURANCE,ASREWIR[DOYSECTION /!l 97000FTHELABORCODE,FOR7HEPERF9RMANCEOFTHEWORKFOPWHICHTHISPERMITIS //� ISSUEO.MY WORKEFS'COMPENSATION INSVFANCE CARRIEfl AND POUCV NUMBERARE: CONSTRUCTION ( j cARRiER ._ PLAN REVIEW � � t � .... . _. .., .. � • Z POLICY NUMBER — ELECTRIC Q � (rHISSECTiIXJ�'E�NOTBECOMPLETEDOFiHEPERMRISFORONEHUPDREDOCLfARS(5107)ORLESSI. PLUMBING W Z ICERT:FYTHAT IN THE PEfiFORMANCE OFTHE WOFK FOF WHICH 7HIS PERMI7IS ISSUED,i MECHANICAL . C} SHALLNOTEMPLOYANVPERSONINANYMANNERSOAS'OBECOMESU2JECTiOTHE � WORKERS'COAAPENSATIONLAWSOFCAUfO '.A, AGREETHATIFISHOVL�OECOME INSPECTIONFEE � SUBJ,ECTTOTHEWORKERS'COMPENSATIO P�O SI O ECTION37oCOFTHELA80R �o � �o , s �F wirncoMP�vwirHr eP � ISSUANCE Q p DATE: APPLICANT .� SMIP W ENERGY P/C � J WAPNING:FAII.0 TOSEWREWOflKERS'COM?ENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE � SU&IECTANEMPLOYERTOCRIMINA�PENALTIESANOCNILFINESLIPTOONEHUIJOREOTHOUSAND —�{�rp�� ` '��— T WDOLL0.R5(StDo,000),INAODITION70THEWSTOFCOMPENSATION,DAMAGESASPqOVIDED�FORIN ENERGYPERMIT �{/Y 7 SECTION370B OFTHE LABOR CO�E.INTEREST.ANDATTOFNEV'S FEES. � RETENTION FEE: I� � O , CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBY AFFIRM UNDEfi PENALTV OF PERJUqV THAT THERE IS A CONSTRUC710N LENOWG AGENCY n- FOR THE PEP,FORMANCE OFTHE WOIiK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3es7,CIV CJ. Z w � LENDER'S NAME ' ....:�-..-...',.: F— LENDER'SADDRESS "' ' � � ICEflTIFYTHATINAVEREADTHISAPPIICATIONAN�STATETHATTHEA80VEtNFORMATIONISCORqECT. TOTAL FEES ' � � IAGREETOCOLiPLYWiT'NALLCITVANDCOUNTVORDINANCESAN�STATEUVlS-RELATINGT�OBUILDING � � � '- �-� � CONSTRVCTIDN,ANOHEREBYAUTHOF2EFEPRESENTATNESOFTHISCOUNTYTOENTERUGONTHE- . � -- � .. Z ABOVEMEN170NED PROPERTY FOR INSPECTION PVflPqS�S. � COMMENTS � � � < �'�^`� ��C,.' J � r a —__ m NA �P�� . . , . Q �� ,(j � S TUREOFPERMITI'EE ' � E � � ` RECPT.NO._ � _ AID BY _VALIDATION ` WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—F le Copy,GREEN—Applioani's-Copy ���- ,�, :.,..� , ,;.':�..�.r �. �..�,.r�..,.. ..,...-..:..:,.,. ."...,..:.,. ..,.:.:... �,._;n _E,�tl ..� �':Y•n a�, . ... �, .. . . '.' _' ,.: � .. . . . . . . . , -- . ,. ��.� . ....; . . . . � , . .. . . � . Yk rM.�C..�c.". . ... . ..... �- ,.. ,. . � �II � � ��� �� " ,� . .�� .. .. . . . ........ ,. , . . . 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