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Home My WebLink About14271 (19) _ �.,_ � _�� CITY OF DIAMOND BAR � �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES _ . w 2166D E.Copley Drivc Suite 190 �'�---s (909)860-3195 Fax(909)861-3117 PRESS "°%�'� BLIILDING PERMIT,APPLICATION FIRMLY � ..:... JOBSITE . • ' 'i' APPLICATI� N PERMIT P/C o ADDRESS '��'z�C'S �-1«-uYnitJ� �f'• DATE ��'"'�", e�+� � NUMBER # � APN LOT �� TRACT �� ' (SSUE TYPE OCC p OWNER �� + �►"�Lln9��.s` --e.�Yh�Z DATE CONST. GROUP LL ADDRESS �� - '�i`n i Ri � • ZONING SETBACKS � CITY�"►�fsre �`� ZIP Q`�� TEL. � '"J�'��-1!/ FROIdT RW ❑ APPIICANT TEL. REAR � z SIDE/SIQE STREET RW ❑ � CONTRACTOR SIDE ❑ ApDRESS Q CITY ZIP TEL. PROPOSED USE �� .�� b"�'� .Q� �hi"�� A '��f�� o �1'�r �i a:. 3� •c�ef.f' '"r� �C a".k,'` � ARCH/ENG/ DESIGNER NO.DWEL. NO. NO. ,�y � CDDRESS ��P � TEL. UNITS STORIES � BEDROOMS % cn DESCRIPTION SQ.FT FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFWADD�REM O I HEREBV AFFlRM UNDER FENALN OF 9ERJURV THAT I AM EXEMPT FROM THE CONTRACTORS U- G8f8CJB/C81F10fI W CENSELAWFORTHEFOIIOWINGREASON(SEC.7031.68USINESSANOPpOFESSIONSCWE:ANVCITVOq (� CIXINTVNAiICNREUUIRESAPERMiTTOCONSTRI/Ci.µTER,IMPROVE,DEMOUSH,ORREPAIRANYSTF7UC- W PdtlO/DOCk w TURE,7RIOR TO ITS 198UANCE,AL90 RE�UIRES THE APPLICANT FOR 3UCH PERMIT TO FILE A SIGNEO W � STATEMENT 7HAT HE OR SHE IS UCENSED PURSUANT TO THE 7ROVISIONS OFTHE WNTRACTORS LI- GENSE LAW(CHAVTER 9(CAMMEMCM6 WI7H SECTION 7000)OF a!VISION 30F THE BUSINESS AND PRO- LL" PooVSpa FESSpNS CODE1 OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALIE�ED E%EMP- +� 710N.ANYVIOUTbNOFSECTtON7o31.6BYANVAPPLICANTFORAOEHMITSU&IECTSTHEAPPLICANTTO z RB-Roof a'3��Z � ACM�PENALTV OF NOT MORE THAN FIVE HUNDRE�OQIURS(5500�.): � I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, L] COR1018fC181 - WILL DO THE WOW(;AND THE 9TRUCTURE IS NOT INTENbEO OR bFFEREO FCSR��SACE(SECJoba,BUSI- J � NE55 AND PROFESSIONS CODE:THE CAMMCTOAS LICENSE UV'I DOES NOT APPLY 70 AN OWNER OF = PqOPERTY VIFIO BUILDS OR IMPROVES iNEREON,ANO WliO DOES SUCH WORK HIb1SELF OR HEflSELFOR � THfiOUGHHiSORHEROWNEMPLOYEES,PROV�EDTHATSUCHIM'PROVEMENTSARENOTINTENDFAOR m �1 OFFEREDFORSALEIF,HOWEVER,TiEBUIL0INGORIMPROVEI;IENTISSOLOWITMNONEYEAROFCOMPLE- - n,� z TKNd,TNE OWNERAUILpER WILL HAVE THE Bl1R�EN OF�AOVING-THAT HE OFl SHE OID NOT�BUILD OR = IMPROVEFORTHEPURPOSEOFSALE{. � ❑I,ASOWNEROF7HEPROPER'T1;JIMEACLUSIVELYCANTRACiINOWi7HLICENSE0C6NTRAGTORS � TO CONSTRUCT hiE PRQIECT(SEC.7041,8U91NESS AND PROFESSION5 COOE:7HE CANTFiAf,TORS ll- V8IU8IIOI1 ADJ.AREA W CENSELIWDOESNOTAPPLYTOANO+MdEROFAPROPERTlWH09Utt.DSORlMPROVESTHFREON,AND WHOCOfV TRACTS FOH SUGH PRQIEGTS V4ITMACONTRl\CT4R�5)LICENSEO PUFSUANT707HE CONTRAC- 7oAsucENSEuw.). � qUANTiTY DESCRIPTION FEE � Y�1 MI E%EMPT 11NDER SEC. ��V�� B.A PC.FOR THIS REASON ¢ � �'p�� U LL' DATE 1�"1 l OWNER � � � — W � LICENSED CONTRACTOP�DECLARATION - � 1 HEREBY AFGIR�S UNDER PENALTY OF PcR1URY THAT I AM LICENSED UN�ER PROVISIONS OF CHAPTER � � 9(COMMENCINO WITH SECTION 7000)OF DiVISION 30F THE BUSINESS AND PqOFESSIONS COQE,ANC1 Z MY IiCENSE IS IN FULL FORCE AN�EFFECT. I11 tii � UCENSE CLASS LIQ NQ � U DATE _ CONTRACTOR _ 0- W � WORKERS'C6MPENSATION DECLAAATION ¢ N1MEflE@YAFfIRMUNDERPENRLTYOFPERIURYONEOFTHE WU.GWINGDECLARATIONS: Z � __IHAVEANDWILLMAINTAINACERTIFlCATEOFCf�NSENTTOSELF-INSUREFORWORKERS' a S COMPENSA710N,AS PROVIDED BY SECTION 970o Of THE LA80R CODE,FOR THE PERFORMANCE �U O OFTHIE WORK�OR WHICH THIS PERMIT IS ISSUEO. � � �INAVEANDWI�I,MAIMAINWOPo(ERS'COIAPENSATIONINSURANCE,ASREQUIRE�BYSECTION � 37000KTHElA130RCODE,FORTNEPERFORMANCEOFTHEWORKFOFWHICHTHISPERMITIS ISSUED.MVWORKEAS'COMPEkSATIONINSiIRANCECARRIERANDPOLICYNUMBERARE: CONSTRUCTION 1 � J y cnRRiefl PLAN REVIEW _ � PIX.IC7tdUMBEH ELEC7RIC Q �rt��ssEcttowraEa�rarBEaonRErEooFnreaararr�swaorreHuwa�oa.inras(Sioo�oaiEssF PLUMBING ��3 �� Z I CERi1FY THAT IN THE AEflFORPAANCE OF THE WORK FOR WHICH TNIS PERMIT IS ISSUE�,I MECHANICAL �� T (!S SHAL4ND?EMPLOYANY PERSON IN ANY A9ANNER SO AS TO BECAME SUBJECTTO THE � WORKERS'COA4PENSATION LAWS OF CAIFORNi0.AND AaREE THAT IF I SHOULO BECAME INSPECTION FEE S Sll&IECTTOTHEWtlfiKF.RS'COMPENSATIONPROVISIONSOFSECTION37o00FTHElABOR CODE,I SHALL FORTHWITH CAMPLY WITH THOSE PROVISIONS. �SSUANCE O p OATE: APPUGANT: SMIP � ."� � . '_j WAANING FAILURE TO SECURE WORKERS'COMPENSATION CAVEFAGE IS UNLAWFUL,ANd SHALL BE ENERGY P1C "�r''` ° �� —y SU&lEC7ANEMPIOYERTOCRIMINALPENALT7E5hNDCIVILFINESUP700NEHUN0i7EDTHOUSAN6 ��,��:8 � �-� � ^,}� 1"i.,.�`°.�� DOLURS(f10o,o00),IN A9DITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR W ENERGY PERMIT� � SECTION37080F7HELABORCODE,INTEREST,ANDATTOFNEY'SFEES. RETENTIONFEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBVAFFIRMtINOERPETlALTYOFPERJVflYTHATTHEREISACONSTRUCTIONLENDINGAGENCY FOii THE PERFORMANGE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEG.3oe1,CIV.C.). , Z W � � LEN�ER'SNAME F— LENDEFYSADDRESS `_._.__ � TOTALFEES � � 1 CERTIFY THAT�HAVE REAO THIS APPLICATION AND STATE THAT THE ABOVE INFORMATpN IS CORRECT, W IAGREETOCOMPLVWITHALLCITYANDCOUNTYORDINANCESAN�STATEtAWSREIATINGTO8U1L01NG d � CONS7RUCTION,ANDHEREBYAUTHORIZEREPRESENTATIVESOFTHISCOUN'YTOENTEflUPONTHE � ABOVE•MEN710NEDPROPERTVFORINSPECTIONPURPOSES. o ,.,..,� f� �, COMMENTS_�___ —' f"'{ �i �,lt'_Q"� l�t�4^t1t'i;G-- � m PEPM EE N E( INT) � ' �r �� -,� �"X'' 1�' '" � �/j SIGNA�URE DF PERMITTEE DATE = RECPI:NO. 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