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Home My WebLink About13633 (14) � CITY OF DIAMOND BAR ------��' DEPARTMENT OF COTvIMUNTfY&DEVELOPMENT SERVICES 21660 E.Copley I?rive Smte 190 (909)8603195 Fau(909)861-3117 PRE`S$ ,,.�. �::.; .. ��_ BUu.ntri��i�rrAi�piiCarior"r, . ;° ' FIRMLY v o� JOBSITE � �!`'� i,� ��r APPUCATION j Gf.�",�' NUMBER` �� #/C ADDRESS ZJ J N"`�� DATE LP �� c� ISSUE � TYPE OCC APN LOT TRACT DATE CpNST �� GROUP p OWNER '�c' '�t:a o ADDRESS_.(��` �.�-L P+ �• ZONING SETBACKS W CITY 1��Ff1�lt:7� V ZIP TEL. ��,I' FRONT RW ❑-- � APPUCA� '� �.(� V '��'l/ TEL.� J � REAR p �� =�� SIDE/SIDESTREET RW ❑ � CONTRACTOR � �/�s:> SIDE ❑ ApDRESS ' � "° � �- �,.f �� PROPOSED USE � CI7Y ZIP TEL. o ARCWENG! � DESIGNER NO.DWEL. NO. NO. � ADDRESS_ UNITS STORIES BEDROOMS � CITY _ ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREr1NALUATION p� OWNER•BUILDER DECLARAT�ON SFR/Ap�lREM d 1 HEREBY AFFlRM UNUER PENAL7Y OF PERJURv THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- Gdfd(JBJC81pDrt 6L CENSE U1W PoRTHE FOILOWIN�REASON(SEG 7031.5 BUSINESSAN�PFiOFESSIONS CODE:ANY CITVOR (n � COUMYNMICHREWWESAPERMITTOCONSTPUGT,ALTER�MPROVE,DEMOLISH,ORR£PAIRANYSTRUC- W patio/l7eck NRE,VRIOR TO IT9 ISSUANCE,ALSO REa(71RES THE APPLICANT FOR SUCH PERMIT Tp FIIE A SIGNED W STATEMEM THAT HE OR SHE IS LICENSED PURSUANT TO THE PqOVISIONS OF 7HE CQN7RAC7pR5 U- � CENSE LAW(CHAPTER 9(COMMENCINO WITH SECfION 7000)OF DIVISION a OF THE BUSINESS ANO PRO- �' POOBSpe FESSqN5CO0E)ORTHATHEORSHEISEXENPTTHEfiEFROMAN�7HEBA515FORTHEALLEGEDE%EMP- (� TION.ANVV�OI.ATIONOFSECTION7031.66vANYAPPLICANTFORADERIAITSUBJEC'rSiHEAPPLICANTTO � RB-ROOf ,,,� � ACINL PENALTY OF NOT MOflE THAN FNE HUNDREO OOUI.RS(SSOD).): � ❑I,AS0IVNEROFTHEPflOPERTV,ORMYEMPLOYEESWITHWTGESASTHEIRSOLECOMPCN5AT10N, L7 COR11118�Ct81 ' WILL DO THE WOAK,AND THE STRUCTUPE IS NOT INTENDE�OF OFFERED fOF SAI.E(SEC.7044;BU51� J � NESS ANU PROFESSION5 CODE:THE CANTRACTORS LICENSE lAW�DES NOT APPLY TO PN OWNER OF = PqOPERTY N?IO BUIIAS OR IMPROVES THEREON,AND WHO DOE5 SUCH WOR6C HIMSELF OR HERSELF OR � THHIXIOHHISORNEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSAREN6TINTENOEDOR m - � ,OFFEREOFORSALEIF,HOWEVER711EBUILDINGORIMPNOVEMENTISSOLDWRHINONEVEAROFCOMPLE• TION,THE OWNEP-BUIIDER WILL HAVE THE BUR�EN OF PROVING TkAT H[OR SHE�DID NOT 9UIlA OR � IMPqOVE FOR THE PURPOSE bF SALF.). - � w �I,A30WNERC�FTHE PROPERTV,AM EJfCLUSIVELYCANTRACTINO Yl1Tll LICENSED CONTRAC70RS (r TO CONSTRUCTTHE PROJECT(SEC.704a,BUSINE55 ANO PROFE5510N5 COL E:Tr1E CANTRACTORS LI- V2IU811tl11 "i A�J.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERT'WHOBUILDSORIMPROVE$THEPEON,AND � WFIOCOMMCTSGOfiSUCHPRQIECTSWRHACONTMCTOR(S)UCENSEDPURSUAMTbTHECONTFiAG QUANTITY DESC'flIP710N FEE � Y TOfi5 UCEtiSE IAW.�. __ � ❑I AM EXEMPT UNDER SEC. B.&P.C.FOR THIS REASON Q `� 5 ��:k��- �S _— U .:. ., . L�. ¢ DATE _,_ OWNEF ___ �� z W � UCENSED CONTRACTqRS DECL.RRATIOPI � � I HEREBYAFFIfiM UNpER PENALTY OF PEFJURV TNA71 AM lICENSN UNOER PROVISIONS OF CNAPTEP. ��. � 9(COMMENCINO WITH SECTKJN 7000�OF DIVISION 3 OF THE BUSlhESS AND PFlOFESSIONS CO�E,ANO � MY UCENSE IS IN FUII FORGE AN-Df EFFECT. J y y�'� m � LICENSECLASS�_,L�_ IIC.NO. �✓�P��6V��f� � � pATE__^�� COPlTRACTOR f.L._.s'�� i1! � VJORK�RS'COMPENSATION DECLARATION �..F'�,..�1�•� � y t...� � �HEREBV AFFIRM UNDEA PENALTY OF GERJURY ONE OFTHE FOLLONlING DECLARA N5: � � _IHMEANDWILLMAINTA�NACERTIFICATEOFCONSEkT705ELF-INSUREFpAWORKERS' _ CAMPENSATION.AS PfiOVIOED BYSEGTION 3�oa OF THE U87R CODE,POfl THE PERFOftMANCE U �� OF 7NE WORN FOR WHICH THIS PERMIT IS ISSUED. � Q � ��I HAVE AND YNLL MAINYAIN WORKEftS'CQMPENSATION IN^aVqANCE,AS REQUIRED BV SEC710N ' Q 37otl OF 7HE LABOfl CODE,FOR THE PERFORMANCE Oi 71iE WORK FpR WHICH THIS PERMIT IS ��/J ��A 71'� �*�-Y �` �d�n i��i S ISSUED.MYYJORKERS'WMFENSA7FONINSURANCECARFIEflAN�POIICYNUMBENARE: CONSTRUCTION ItiG'1•-nL y�' �I /I � �� yc.�RRIER��r�__GdL��—___—.______________.___ PLAN REVIEW _._—.,_„__.__ / ' �d Z POLICYNUMOER_��d �F�V'�� t p-A e� yy �� '�.� ELECTRIC LI��37+"`T V � �� W� d p (11iS5ECMXJNE�MJTBEOJNF1.EfEDOFTiEPERAMTISFORONEFANJf�EDWl1.AR3(5100) RLE ). PLUMBING _ -- � ICERTIFYTHATINTHEPER�ORMANCEOFTHEWORKF-0RWHICHTHISPERMI7ISISSUED,I MECHANICAL N � �J SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SU6JECTTO THE r � � WORKELIS'COA7PENSATIONL4WSOFCALIFORNIA,ANDAGREETHA7IFISHOl1LDBECOME INSPECTIONFEE _ � � SU&IECTTO THE WORKERS'COMPENSATWN PROVISIONS OF SEC710N 3�Co OF THE LABOR -- GODE,I SHFII FORTHW17H COMPLY WITH THOSE PROVIS ISSUANCE � O a _�� SMIP p DA7E: APPLICANT: �"i� /,�� ~� �� _�� ENEAGY P/C _ WARNING FAILURE TO S CURE WOPKEFiS'COMPENSATIOtd COVERAGE IS UNLAWFUL,ANO SHAI�BE � SU6JECTANEMPIOYERTOCRIMINALPENALTIESAIJDCNI4FINE9UPTOONEHUNDRE�THOUSAND ENERGYPERMIT � DOLLAftS(57 a0,o0o�,IN FD�ITION TO THE COST OF GOMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OFhiE LABOR CODE,INTEPEST,AND ATTORNEY'S FEES. RETENTION FEE: � G -,S d CONSTRUCTION LENDING AGENCY � PRE-ALT FEE: O ¢ IMEREBVAFFlfiMUN�ERPENAIiYQFPERJURYTHATTHEREI5AC9N5TFUC710N_ENDMGAGENCY FOR THE PERFORMANCE OF TNE WORK FOR WHICH 1'HIS PERMIT IS ISSUED�SEC.3087,CIV.CJ. Z W � LENDER'5 NAME I�- LENDEp'S AD�RESS � ICERTIFYTHATIHAVEREA�THISAPPLICATIONANDSTATETHATTHEABOYEINFORMATIONISCAflRECi. TOTTIL FEA.�S r � W I AGREE TO COMPIV WITH ALL CITY AND COUNTY ORDINANCES AND S7ATE LAWS fiELATINd TO BUIL�ING � CONS7RUCTIDN,AN�HEREBYAU7}IORIZEREPRESENTATIVESO:7HISCOUNTYTOENTERUPoNTHE � ABOVE-MENT10NE0 OHOPERTV FOR INSPECTION OURPOSES. COMMENTS_� � _��-r �.��,� �,a��- ¢ PERMIiTEE NAM_� /p qq ��+.-�y � a5�...�...�.-...�..- fi-�..,,� lJ � SIGNANREOFPERMITTEE KI �ATE = RECPT.NO. 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