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----�--- CITY OF IDIAMOND BAR �;�� � � DEFARTRTENT�F CO�INITY&DEVELOPMENT SERVICES �i � ' 21825 E.Copley 13rive �,� (909}86Q-3195 F�(909)861-3117 ������ PRESS ''%vtiy'�' BUII.DINGPERMITAPFLICATION FIRMLY. � JOBSITE � f �`�� APPLICATION '"���PERMIT ;�; P/C ¢ ADDRESS��� � � 1`��` �"""`�-• DATE � f ��TIUMBER�� # o� ISSUE TYPE OCC •- APN L T �'RACT DATE CONST. GROUP p OWNER ��^ ADDRESS �� ZONlNG SETBACKS oCITY ' ' ^ ZIP�( .�TEL. p FRONT RW ❑ APPLI ANT TEL REAR ❑ � SIDElSIDE STREET RW ❑ z a CONTRACTOR `7G% '� . �ry SIDE ❑ ADDRESS f t� -'$ ' G � i�'7 !_.+�. °C PROPOSED USE 4� � CITY��'�^�tvFG(���r�ZIP "CEL. �" • %� ��, o ARCfiJENG/ � z DESIGNER NO.DWEL. � . g ND. a ,ADDRESS UNITS STORIES ' ! BEDRODMS�_ � CITY ZIP TEL. c� � DESCRIPTION SQ.FT. FACTOR PSF ApJ.AREAlVALUATION � p� � OWNER-BUILDER DECLARATION SFR/ADD/REM O Q I HERE9Y AFFIFlM UNDER PENALTV OF PERJUqV iHAT I AM EXEMPT FROM 7HE CONTRAC70R5 LI� G2(d98�C:ifPOfl W CENSELAWFORTHEFOLLOWINGFIEASON(SEC.]031.5B1151NESSANDPFOFE55iON5CODE:ANVCIiYOR ((� , U COUNTYWHICHRC-0UIRESpPEflMIi7000NSTRUCT,ALiER,IMPROVE,DEMOUSti3ORREPAiRAM1'YSTRUC- W patiOlDeC1( �, ��.. TUqE.PRIOR TO ITS ISSUANCE,ALSO REdUIRES iHE APPLlCANT FOfl SUCH PERMIi TO FILE A SIGNED W � STATEMENT THAT HE OR SHE IS LICENSE�PURSUANT TO THE PROYISIONS OF THE CONTRACTORS U- � ..CENSE LAW(CHAPTER 9(COMMENqNG W!TH 5[CTION�000)OF ONISION 3 OF THE BUSINESS ANO PRO- LL PoOUSpe FESSIONSCOOE)ORTHA7HEORSHEISEXEMP77Hc'REFROMAN�THEBASISFORTHEALLEGE�EXElAP- (� 'p Q�� TION.ANVVIOLATIONOFSECTION7C31tBVANVAPPLICANTFORAPERMITSUBJECTS7HEAPPUCANTTO z Re-Roof r�(,,,' A CIVIL PENALT'OF NOT MORETHAN FNE F'�I1N�RED DOLLARS(5500).)' .. LJ I,AS OWN EROF THE PROP�CRTY,OR MY EMPLOYEES W ITH LVA�ES AS THEIR SOLE COMPENSATION, z` � Gammercial WILL�O THE WORK,ANO iHE SiIiUCTURE IS NOT INTEN�E�OR OFFERED FOR SALE(SEG 7044,BUSI- .J �:.NESS ANO PflOFE5510N5 CODE:THE CONTRACTOFS LICENSE LAW DOES YOT APPLY TO AN OWNER OF � iROPERTY WHO BUILOS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HEpSELFOR CL�,"THflOUGHHI50RHEROWNEMPLOYEES,PHOVIDE�TNATSUCHIMPROVEIAENTSAflENOTINTENDEDOR 'm Q, OFFEflEDFORSALEIFHOWEVER,THEBUIL01NGOpIMPROVEMEN'ISSOLDWI7:fINONEYEAROFCOMPLE- �.; TION,THE OWNER-BUIL�ER WILL HAVE THE 3URDEN OG PROVING iHAT HE OR SHE DID kOT BUILD OR ���. ��IMPROVE FOR THE PUHPOSE OF SALE). w ❑I,ASOWNEROF7HEPROPERTY,AMEXCLUSNELYCONTRAC7INGW�iHLiCENSE�CANifiAC70qS Q.� .TO CONSiRUCT THE PflOJECT(SEC.'7064,BfJSINESS ANO PROFESSIONS CCDE:THE CONTFiACTORS LI� VHIU2lI0f1 ADJ.AREA � W' CENSELAWOOESNOTAPPLYTOANOWNEROFA?ROPERTYWNOBUILDSORIMPROVESTHEqEON.AND �� � IMHOCONTRACTSFOpSUCHPROJECTSWITHACONTRACTOR(5)LICENSEOPUqSUPNTTOiHECONTRAG QUANTITY DESCRIPTION FEE Y 'TORSLICENSELAW.). � � ❑IAM EXEMPT UNDER SEC. B.8 PC.FOR THIS REASON Q � U LL ¢ DATE OWNER U � W q LICENSED CONTRACTORS DECLARATiON W � 1 HEREBYAFFIRAA UNDER PENALTYOF PERJUFV THAT I AM UCENSE�UNDER PROViSIONS OF CHAPTER � � d 9�COMMENCINGWIT45ECTION7000)OFDIVISION30FTHE6USINESSAN�PROFESSIONSCD�E.AN� z � X MY LICENSE IS IN FULL FORCE AND EFFECT. � UCENSECLA53 ��z�LIC.NO. � d����.. � 1--- � V DAlE_����y`� CONTRAC70R_ a. W . � WORKF_RS'COMPEN5ATION DECLARATION ¢ = U � ' 1 HEftE,Va](FFIRM UNDER PENALTYOF PERJURV ONE OFTH6 FOLLOWINC-DECLARATIONS: Z � �"�IHAVEAN�WILLMAIN7AINACERTIFlCA7EOFCONSEN7TOSELF-INSUREFO4iWORKERS' _ COMPENSA710N,ASPROVIDEDBYSECTIONa'lo00FTHELABOftCOOE,FOR7HEPERFORMANCE `U OF THE WORK FOR WHICH THIS PEFiMiT IS ISSUED. � , O _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION [^q� ib^, ,4� O 3�o00FTHELABORCODE,FORTHEPERWRMANCEOFTHER'OPKFORWHICHTNlSPERMITIS ''�},� � �'R` ISSUED.MYNKIflKERS'COMPENSATIONINSURANCECARRIEfl POLICYNUMBERARE: CONSTRUCTION 'U �J� a CARRIER__,�,�"�� �' `1���'' PLAN REVIEW � g � POLICY NUMBER_�:���a�' � '�—^(,7 p ELECTRIC Q � (MISSEi.710NNEmNOiBEO�APLEfcDOFhIEPEflMfT45FOFONEHIJNDREDDOLIARS(5700)OflLE55). PLUM8ING w ICERTIFYIHATINTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSl/ED,I MECHANICAL Z — — (9 SHALLN07EMPLOYANYPEfl50NINANYMANNER50A570BECAMESUBJECT70THE � WORKEPS'COMPcNSATIONLAWSOFCALIFORNIA,ANDA4REETHATIFISHGULDOECOME �NSPECTIONFEE , � SUBJECT TO THE WOflKERS'"�.OMPENSA710N PROVISIONS OF SECTION 3l0o OF iHE LABOR `� a" � CODE,ISHALLFOR7HWITHCOMPLYWIiHTHOSEPROVISIONS. ISSUANCE � +1 � � p DATE: I��.L�aL.��" APPLICANT.�� SMIP R W � ENERGY P/C 1 WAR :FA R O SECURE WORKERS'COMPEN5ATION GOYERAOE 19 UNLAWFUL,AND SHALL BE . — � SUBJECTANEMPLOYERTOCRIMINAL'�PENALT7ESAN�CIVILFlNESL'Pi00NEHUNDREDTHOU5AN0 ENERGYPERMIT DOLLARS(§1oo,00D),INAD�IiION TO i,HE COS70F COMPENSATION,DAMAGES AS PFOVIDED FOR IN J SECTION3)OBOFTHELABORCODE.INTEREST,AN�ATTORNEV'SFEES. REIENTION FEE: � �� CONSTRUCTION LENDWG AGENCY PRE-ALT FEE� � O � IHEREBYAFFlRMUNDERPENALTYOFPERJURYTHATTHEFEISHCONSTRUCTIONLENOINGAGENCV FOR THE PEitFOPMANCE OF TH�WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30W,CIV.C.J. — Z W � LEN�ER'S NAME I— LENDER'SADDRESS f'� � TOTAL FEES �( �'� � 1 CEPTIFY THAT I HAVE PEAD THIS APPLICA7IONANO STATE THATTHEABOYE MFORMATION IS COPREC7. � � \, ( � IAGREETOCOMPLYWITHALLCITYANDCOUNTVORDI�VANCESAN�STA7ELAWSAELATING706UILDING � kj � � CONSTRUCIION,ANDHEREBVAUTHORiZEREPRESENTATIVE50FTHiSCOUNTViOENTERUPONTHE .z ABOVE-MENiIONEDPROPERTYFORINSPECTIONPURPOSES. COMMENTS - _ , �'��! Q/��l1.., y( �,�.�V'�'... 6lcd /f .1 pa m PERM�TT E NA�Pftl���- { � � '-� �r 2 2"c,?2- � siown�C F aEamirr "` °aTE pECPT.NO. g r PAID BY VALIOATION � � 2 ~ WHITE--0epatlment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GFEEN—ApplicanYs Copy . . . . . ........ . . . .., . ......,,._. .... ,.... .. .._;, ,�':u� Y ,;f�.',t'�, , _' . 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