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_ _ _ _ _.�. .__ ....._... _ . _ ,....., - , .-�-- , , : , � � '', — CITY OF DIAMOND BAR � �� COMMUNITY DEVELOPIviENT'DEPARTMSNT : 21660 E.Copley Drive Suite 190 '� (909)&603195 Eax(909)361-3117 � � PRESS "°""^ BUILDING PERMIT APPLICATION j FIRMLY � JOBSITE ,. . :a�c� r�;�f �.,':' .,. y. ^� , ` " �y ' "' APPLICATIQN �� i „�� PERMIT ��� P/ �,r/}'� o ADDRESS d���� MANA�A c� IJ,Q/Qn ��. DATE_ � NUMBER # �° � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER �/�RFC Cf'��9I�Gf`1��CZ ' �` ADDRESS 1.f �I, M/�/�JNj�f�CT' ZONING SET8ACK5 Z CITY .nU�P1t3All� �R ZIP �/7�$ TEL.�d�q—,-�� IC'+� FRONT RW _ O g APPLICANT j�jQj�IUS Cl'�'�Tt✓�A/1�E"7� TEL.�'"' S"fS•�'�� REAR ❑ Z SlDEISIDE STREET RW ❑ ¢ CQNTRACTOR �/�f7/k,J' CP�e'/tfo. - �1� ,�A EG�� SIDE ❑ �'il��a �.�1 ADDRESS.`�S/L N. I�Pr1Y'/�ePR�rf�1 f�l��'R o CITY�'L Ef,�"�- ��. ZIP �+/7L3% TEL.� ` �` Sy36 PROPOSED U$�_���7r ��dyQ(���- o ARCH/ENG/ � z DESIGNER W NO.�WEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CIN ZIP TEL. cr� cn DESCRIPTION S4.FT. FACTOR PSF ApJ.AREANALUATION � OWNER-BCILDER DECLARATION SFRlADC/REM C I HEREDY AFFlRM UNDER PENALTY OF PERJURV TNA'I AM EX[MPT FPOM TF.G CONTRACTORS Li� G8189PJC81P012 � CEN5EL4WFORTHEFOLLOWINGflEA50N(SEC.7o37.5BUSINE55AN�PROFE5510N5CD7E:ANYCITYOF (n __ U CDUNiVWNICNREQUIqESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOUSH,ORREPNRANYSTRUC- w TUqE,PRIOR TO ITg ISSI.'ANCE,AL50 FE�UIFES THE APPLICANT FOfl SUCH PERMIT TO�ILE A SIGNED � PatioiDeck STATEMENT THA7�HE OP SffE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTaACTORS LI. - � CENS[LAW(CHAPTEF9(COMMENCI4GWITHSEbTION7000)OFOIVISION30FTH[BUSWE$SANDPRb- �'�' POOVS(18 � FESSIONSCODE)OFTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFCRTHEALLEGEDEXEMP- � , U 710N.ANYVIOLATIONOFSECTION7097.SBYANVAPPIICAMFORAPERMIT5U8;1EC75THEAPPLICANTTO z Re-Roof ACIVIL PENALTY OF NOT MORETHAN FIVE FIUNGRED pOI.LARS($36b).J: ' - � " Z ❑I,ASOWNF.ROFIHEPROpEqTV,ORMVEMPLOVEESYVITHWAG[SASTHEIR501_EC0�IPENSATION, � COf11f718fCIHI WILL DO 7HE WORK,AN�iHE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEC,7044,BU51- ,J � NcSS AN�pROFE5510N5 COOE:THE CONTRAC'�:ORS LICENSE.CAW GOES NOT APPLY TO AN DWNEF OF ,ry / ( PROPEPTVWFI06UILDSORIMPROVES7NEREON,ANDJJHOOOESSUCHWORKHIMSELKORHERSELFOA � t' /S ' G �J [[ THROUGHHISORHEROWIrEMPLOYEES,PROViJEDTHATSUCHIMPROVEMEN75ARENOTINTENDE00R m . Q OFFEREOFORSALE.IF,HOWEV'cR,T',-IEBUILDINGORIMPROV=MENTISSOLDWITHINON6YEAROFCOMPI.E � � TION,'HE OWNER-BUILDER NALL HAVE THE BURDE�OF PROVING THAT,HE OR SHE Dlb NOT BUILD OR � = IMPROVEFORTHEPURPOSEOFSAIE), ' ' - -' � ❑I,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELYCONTRACTINGWITHLICEN6E�CONTRACTOFlS , /9 Q TO CONSTRUCT THE PqOJECT(SEC.�044,9USINE55 AND PROFESSIONS CADE:THE WMRACTORS LI� 'V2IU8Ii011 .V� ADJ.AREA W CENSELAWDnESNOTPPPLYTOANOWNFROFAPROPERTVWHOBUILDSOqIMPpOVESTFIEREON,AN� — —'— � WHOCON7'RACTSFORSUCHPROJECTSWITVACONTRACTOR(5)LICENSEOPUP.SUANTT0T4�.ECONTRAC (][JqNTITY DESCRIPTION FEE 1'ORS LICENSE LAW.). Y � ❑I AM EXEMPT U'JDER SEC. B.&P.G FOR THIS REASON Q � V I.t_ � pA7E OWNER h- O � ' T W ... . . . � �IGENSEDCONTRACTORSDECLARATION w � . ,Q CC I HEREBYAFFIRM JNQER PENAL7Y OF PEFJURY TMAT IA�^.t UCENStD 11NDER PROVISIONS OF CHAPTER � { '���,,,�. d 9(CON.MENC'�.NG W�TH SECTION 7o0D)OF DIVISION 3 OF THE B1151NES5 AND PROFESSIONS CODE,AND Z J �� `X MY LICENSE IS IN FULL,FORCE AND EFFECT. m o IICENSE CLASS .{,� LIQ NO.�� � U �ATE��Z�"��7 CON7RAGTORA/�IRIUS �lZ���✓�'�/TQ�'? 4. � W . .:;"-: � . ..,;x ,�,.. � WORKERS'COMPENSATION DECIARATION y/��`� �—� � I HEREBYAFfIflM 11NDEF PENALTY OF PERJURY ONEOFTHE FOLLAWING pEC�ARATIONS:` z � I HAVEAND WILL MAINTAIN A CERTIFICATE OF GONSENTTO SEIFdNSURE FOR WORKERS' � _ Q COMPENSATION,ASPROVIDEDBVSECTION37ooOFTNEL480RCODE,FORTHE7ERFORMANCE C.3 _ Q OF THE WOaK FOR WHICH 7F11S PERMIT IS ISSUE�. , � QW __IHAVEANOWILLMAINTAIIv'WORKERS'COMP�NSA�IONINSURANCE,HSREQUIRE�BVSECiION 3]OJ O:THE LAEOR CODE.FOH THE PEPFORMANCE OF THE WORK FOR WHICH THIS PEqM1T IS ��Y �^j"' � ISSUED.MY WORKERS'COMPENSATION�.NSURANCE CAFPIER AN�POUGY NUMBERFR�: ��� CONSTRUCTION � f/ J j CARRIER PLAN REVIEW , ........ ....._ ._,...... . ............:...._. . . , Z POLICY NUMBER_.___.________ ___ ELECTRIC Q —_ o (�Fi165ECTiONNEmN�T6E0?U�I.EfEDOF7HEPERMffISFORONEHUNDREDDJI.LMS(E7oD)ORLESS�. PLUM8ING d/� W Z � I CERTIFY THAT IN THE PERFORMANCEOFTHE WORH FOR WHICH THIS PEPMIT IS ISStIED,I MECHANICAL G�3 SHq�L NOT EMPLOY ANY PERSON IN ANY MANRER SOAS TO BECOME SUBJECTTO THE Uj WORKEFS'COMPE�SATIONLAWSOFCAL�FOpNIA,AN�JAG�iEETHATIFISVi0ULD8ECOME �NSPECTIOiVFEE � = SUBJGCT TO THE WORKERS'COMPEM1'SATION PROVISIONSOFSECTION 37COOFTH'c LABOR p �` G� CODE,I SHALL FORTHVJITH COMPLV WITH THOSE PROVISIONS. ISSUANCE J- Q DATE: I'���1.�' APPLICANT: A/A�Ik°S C�/7����t/a�r� SMIP ___._._... 7 �' 0 J WARNINGFAIWREiOSECUREWOAKEP.S'COMPENSATIONCOVEPAGEISUNLAWFUL,ANDSHA�LBE ENERGYP/C _______ � Z� � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANOCIV�LFINESUPTOON_HUNDRE�THOUSAND ENEFIGYPERMIT ���� DOLLARS(S�OO,aoo),IN AD�ITION TO 7NE COSTOF WMPENSAT�ON.DAMAGES AS PROVIDED FOR IN J SECTIDN37a80FTH[LABORCOOE,INTEREST,ANDAT'OPNEV5FEES. � � - -� � � W RETENTION FEE: Z_+'✓.t�' o CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREB�AFFIFiMUN�ERPENAI.TYOFPERJURVTHA7'�l-IEREIEACONSTRUCTIONLENDINGAG^�NCY FOR THE PERFOR1dANCE OFTHE WORN Wq WNICHTHIS PERMIT IS ISSUED�SEC.�037,qV.G.�. Z ..... .. . . W � __—_ � LENDER'SNAME_ — ' _, ' '- �-- LLNDER'S pD�RESS � � ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATfI1EA80VEINFORMATIONISCORRECT. TOTAL FEES �o� W 'IAGREETOCOMPLVWITHALLCITVANOCOUNTYORDINANCESANDSTATcI�IWSREIATINGT09UILDIIJG ' �" d � CONSTRUCTION,ANDHEREBYAV7HORI2EREPRESENTAT!VESOFTHISCOUNTYTOENTERUPOIJTHE . "�� .- ' Z ABOVE�MENTIONE�PROPERTYFOqINSPECTIONPURPOSES. COMMENTS � � �,I/i!V`J �N/��iV��Y /� Z . . , m PERMITTEENAME(PRINT) . , .:.�. .. . . .� - ' '. .. . . . � .7�r-�.. C��'" l _"jC?-9'�' ' � SIGNATUREOFPERMIT(EE � - DATE -� � ��-� - �r �_p/.�ID BY VALIDATION�� � RECPT.NO. WHITE—Oepartment Copy,YELLOW—Finance Copy,PWK—Assessor Copy,GOLDENROD-File Copy,GREEN—ApplicanCs Copy�� � � � '.".'.�.:" , , . . : .. ..,. , �� „.� . _ � ,� ;,_. .. .,��., ,�. < u , � � F �IA � � �`I . � � . � �� ' . � � � �. � � � a ° � - f3 �.. 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