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Home My WebLink About13598 (16) _ _�,` CITY OF DIAMOND BAR ` � DEPARTMENT OF COMIVIUNITY&DEVELOPMENT SERVICES W � 21660 E.Copley Drive Suite 190 p�;;� (909)860-3195 Fax(909)861-3117 , ` PRESS . BUILb�NG PERMIT APIPI.ICATION `° FIRMLY ,. .,. � JOBSITE � ^ i � � APPLICATION PERMIT 2�'[? (� P/C Q ADDRES�� ;�-° ppTE NUMBER�/✓ �O # � APN T TRAC DAiE� C� =�'S`C�Ci• CONST. GROUP p �WNE " ADDRES -� ZONING SETBACKS � CITY ZIP TEL. RE�ART RW o APPlICANT TEI. SIDEISIQE STREET RW ❑ � CONIRACT SIDE ❑ � ADD 8 � � CI ZIP • TEL.^ PROP05ED USE o ARCHJENG/ A ic�� ( �9!�!�_J��'��C� � DESIGNER �� t`s`4 1" NO.DWEL. NO. Np. Q„ ADDRESS --�- UNI7S STORIES BEDROOMS � CITY ZIP _ TEL. � DESCRIPTION SQ.FC FACTOR PSF ADJ.AREA/VALUATION aOWNER-BWLDER DECL4RATION SFplADD.rHEM p I HEREBY AfFIRM UNDER PENALTY OF PERJUftY THAT i AM EXEMPT fROM 7HE CONTRACTORS LI� �yfagBlCilfPOR W CENSELAWFOfliHEFOILOWINGfiEA50N(SEC.7o31.58U5MESSANDPROFE5510N5CODE:At4YCi'h'bR (J) C� COUNTYWHIQHREQUIRESAPERMRTOCONSTRUCT.ALTER.IMPRDVE,DEMOl!SH,CRREPAIRANVSTRUC- LLI pytiolDBCk Z TUpE,PRIOR TO RS ISSUANCE,ALSD RE�UIRES TFE APPLiCANT FOR SDCH PERMIT TO FILE A SIGNEq � .W�r STATEMENT THAT HE OR SHE 16 LICENSED PURSUANT TO THE PRCVISIONS OF THE COTiTdAC70FS U-' � � CENSE LAW{CMAPTER 8{COMMENGiNO WI7H SECiION 7000)OF pIVISiON 30F THE BUSINE33 hND�PRO- PooU$pa FESSIONS CODE)ORTFIAT HE Oti SHE IS IXEMPTTMEHEFROPA AN�THE BA515 FOq THE ALLEGE�EXEMP- TION.ANVViOLATIONOF5EC710N7031.56YANYAPPLICANTFOtiAPEHMI7SU&IECiSTMEApPIICANT70 z R@-ROof �„� ACiVIL PENALTV OF NOT MOqE THAN FIVE HUNDREO DOLLARS(f5oo)J: - � ' ❑I,ASOWNEROFTHEPROPERN,OFlMYEMPLOYEESWITHWAoF.SASTH"eIRSOLECOMPENSATION, � Commeraial - � WILL OO7HE 1NORK,Nl6 THE STRUCRIRE 1S NOT INTENDEO OR OFFEREO FOR SALE(5EC.7on4,'OUSI� J NESS ANO PROFE5SION5 WDE:THE CONTFACTC7RS LICENSE UW b0E5 NOTAPpLY TO AN OWNER OF � �ROPERTVYJFIOBUILDSORIMPROVES7HEREON,ANDWHOpOESSUCHWORKHIMSELFORHERSELFOq � ' � THROUGHHISORHEROWNEAiPLOVEES,PfiOVIDEDTHATSUCHIMPROVEMENTSAREVOTIN?ENOEOOR � '— p ,OFFEREDFOHSAIEiF,HOWEVERTI'�EBUII.DINGOflIMPFlOVEMENTi55OlDWITHINONEVEAROFCOMPIE� Z TtON.THE OYdNER-BUILDER�WILL HAVE THE BURDEN OF PROVING THAT HE 6R SHE DID NOT BURb OR � IMPFlOVEFORTHEPURPOSEOFSALF�. ' �� ' �� iil ❑1,ASOWNEROFTHE PROPERf1',AM EXCLUSNELY C6NTRAC7ING WITN L�CENSED�NTf3ACTDR5 [r TO CONSTflUCT TNE PROJECT(SEC.7044,BUS!NE55 AND PRO�ESSIONJ CODE:Th;E GONYRACTORS LI� V81U3I�(1� ADJ.AREA LL� CENSEIAWDOE$NOTAPPLYTOANOY�MEROPAPROPERTYWHOBUIL�SOflIMPpMVE5TH8RE:N�}�,ANd = — —"----- � WIIOCONTRACTSFOqSUCHGROJECTSWITHRCONTRACTOR(S)LICENSEOFUHSJANTTOTN9CON7RAG qUAP1TI'TY DESCRIPTION FEE � TORSLICENSELAW.} � ' J Q ❑IAM EXEUIPTUNDER SEC. _ H.S P.0 FOR Tfi15 RFf SOtd � ____ � �_ `—_ — `-- . CL � OATE OWNEA____ ______ _ �' � • W S LICENSEa CONTRACTORS DECLARATIGN w � � I HEREBYAFFIRlA UNUER PENtiTY OF P�AJVP.Y 7HAY I AM UCENSEC UNDER PftOVS:ONS OF CHAPTEft � � � � p.. 0(COAIMENCIMO H7TN SECTION 7000)DyQIV1310N 30F TN,,Ep�USIh'ESS hN PROFESSIONS CUGE,ANQ Z X A1V LICENSE IS IiJ NLL FOPCE AN6 E C +�L . �c^� y�+ 41l � T4 �- T\ . � � UCENSECLASS„ LIQNO.� \..��v � �'' J V DATE �� CON7�tACTOR..,___..^. �~ W i � WORKERS'COMPENSATIQN DECLARATIUN Q. „;r.,,'> ,�,�Y�.�,� `��ri,a��r,e � � I HEREBYAFFIPM UNI�ER PENALTY OF PEFiJURY ONE OF THE FOLLOWING DECIARATIONS ��,��.,�-" � e� . .... . ' d � � _�HAVEANOWILL6IAINTAfWACEpTIFICATEOFCONSENiTOSELF-INSUREEORWORKEFS' _ COMPENSqiION,AS PflOWDEO BY SECTION 37a00F TNE LABOR COOE,FO(7 THE PERFORMA�I�E w � OFTHElVQRK FOR WHICN 7HI5 PcRMIT IS ISSUEO. � � _IHAYEANDWILLMNNTAINWOHKERS'C6MPENSAT!OPlINSURANCE,ASREQUIRED6YS[CTION i � 37000FTHELABOR(X10E.FORTHEPERWFPAA�'C&OFTHCWORKFURWH''�CHTMISPERMITIS ' j"y�/'l�(� ISSUED.A/Y WORKE(75'COMAENSATION INSURANC6 C0.RRIEVi AN�POLICY HUA7BER ARE: CONSTRUCTION Vi �\ l _J j �qqqiEp ____� _�_ PLAN REVIEW � PpucYNUM�ER ELECTRIC � � � '�----- — .... . -:..��'� � (1}RSSEtT}ONNE9JNDTBECk�I.E1'EDCfiHEPEfYNiISFOflb\'EFRINOREDWLlAP5l51oo)ORl:SS). PIURABING '�'�:�:y,.�:�`�� i CERTIFY TIiAT IN TNE PERFORMANCE OF'TFiE WORK FOA WHICH THIS PERMIT IS ISSUFO,I MECHANICAL _ (!S SHAL4NOTEMFLQYANYPEPSQNINANVMANNERSOASTOBECOMESU3JECTTOTHE ��""k-�. (n WORKERS'COMPENSATION IAWS OF CALIFORNIA,AND AGREE THAT IF�SHOL'LO BECOME INSPECTION FEE � � �� a„ SU&IECT TO THE WORKERS°CAMPENSATION PROVISIONS OF SECTION 37Uo OF THE tABDR R,� ;�.Q .7 � 7�' /'� P s CODE.ISHFLLFORTHWIT4iC�MPLYWf'fHTHOSEPROV1510�45. �SSUANCE k tP...�'e^ O �a �_ n.t, ,y �`'�� o �ATE: APPi1CANT: _ SMIp �'�,� ��s y� � `��.4.� � ,+_�'e'�,n��fk- w � J WWARNIN6:FAILUq�TOSECUREWORKEFS'COMPENSATIONCOVERAOEISUNUWFUL,ANDSNAL4BE ENERGYP/G ��a��=' r ' � gi SU&IECTANEMPIOVERTOCflIMlNALPENALTIESANDCIVILFINESUPTOONEHUNDREDTYOl15AND ENERGYPERMIT DOLLAPS(f7oo.o00).IN MDITION TO THE COSTOf COMPENSATfON.DAMAGESAS PROVIDED FOR iN � SECTION WOH OF 7HE LABOR CODE,INTEREST,ANO ATTORNEY'S FEES. RETENTION FEE: oCONSTRUCTION LENDING AGENCY PRE-ALT FEE: , � � IHEREBVAFFIfl6AUNOERPENALTYOFPERJURYTHATTHEREISACONSTRUCTIONI.ENDiNGA4ENCY � FOR THE PER WRMqNCE OF THE WORK FOH WHICH THIS PEIiMIT iS I55UED(5EC.3o87,qV.C.). � ' z r' w � LENDER'S NMIE . . .. . .. F_— IENDER'SAO�RESS_ � ............. . _.. . � ICERTIFYTHATIh1AV AD SAPPLICATIONIWDSTATEiNAT'RiEA00VE1NF0 MA �S�RRF�T. 7�TAL FEES - � � I AGREE TO GOMP ITH AL ITY AND COUNTY OR�INANCES ANO STATE ELA7 G 7o BUil.DING . / ///��''' CDNSTRUCT D H AUTHOFI2E REPRESENTATNES OF INIS O ENTEFl PO HE� �� i �f��/ � AeOV&M P£RTYFORtNSPECTIONPURPOS�S. - � � COMMENT �. t' � � � 9� � o • �� _�_— _ m PEFUu11TTEE NAME(PR Q . . .., .: _. . .. � � SIONATUflE OF PERMITTEE DATE -" = AECPT.NO.__. __ PAID BY � __VAUDATION_ ~ WHITE—DepaRment Copy,Y�LLOW—Finance Copy,PINK-Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy ,.�, ...:�,�� * �:� ��-� ��.��'-� � a � -� .... -„ ,... ,.,, ��"�-�,°� �� :�� _ ;,., . .,<,:;.,<,. ,� . �:._ w�r.�, �� -'� �� ,� � :. � �- v `. �"� �� ''��:�;��"'�� _��''��ffi`� �� a .. ' '��"�� s,� "�,�� . � M ��"� �<_� ��" �,�"�� x � - � ', �"' '��w�� . �.�"r��e.�a :�;,. � ,______�..:_�..�..w�,;..�I�"°.i-�a:�_,.__........ 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