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�--�— CITY OF DIAMOND BAR F' � �I'W COMMUNITY DEVELOPMENT DEPARTMENT � 21660 E.Copley Ddve Suitc 190 PRES•5+ (909)860-3195 Fax(909)861-3117 """" ' BUILDINGPERMITAPPLICATION FIRMLY � JOBSITE ��S H tJt'1K �'CN U�� hU APPLICATION v ,6� � NUMB R 1/ � �#/C �� o ADDRESS DATE _ `� AP Z TRACT � (S SI ISSUE v� TYPE OCC DATE CONST. GROUP p OWNER G ARD p ADDRESS Z.�B C� ' �� LL ,� ZONING SETBACKS Z CITY IP TEL.(�2�4' FRONT RW ❑ p APPL.ICANT SIDE/SIDE STREET RW O Q CONTRACTOR I�b G. t1 L. SIDE ❑ ADDRE55 � L g e��' � CITY C.I-��1�1U ZIP�(7 TEL. PROPOSED USE � Y7Y '�►'7 ' W ARCMIENG/ p z DESIGNER �ON �, �G�F[�i � � � ADDR S .- NO.DWEL. NO. NO. � CIN N k3 I ZI Z TEL. UNITS STORI,ES BEDROOMS cr� cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � �.��� � � � � � OWNER-BIiILDER�DECLARATION� SFR/ADD/REM ...,. �� � � � � � � � � � O p� . I HEREBY AFPIRM IRJDER PENALTY OF PERJUpY THAT I AM EXEMPT FROM THE CONTRAC70HS LI- GO�dJB/CefpOf[ � � � � � W CENSELAWFORTHEFOLIOWIN�REASON(SEC.70915BUSINESSANDPROFESSIONSCODE:ANVqTVOR (n � �.U. COUNTNWHICHREQUIFESAPERMITTOCONSTRUCT,'AITEp,IMPROVE,�EMOLJ5H2ORREPAIRANVSTRUC- ' .� ' . �w��', iUilE;PFIOR TO ITS�ISSUpNCE,bCSO�REqUIRES 7HE'APPLICANT FOfl Sl1CH PEflMl770 FILE A SIGNED '�W Patio/Deck � . . STATEMFNT THAT�HE OR�SHE I$,,LICENSE�PURSUANT TO THE PfiOVI510NS OF THE CONTRACTORS LI- ' - �' GENSEGAW(CHAPTER9�CDMMENqNGWITHSECTION7��OJ�OFDIVISION3OFTHE9USINE55AN�PRO- u' POOUSPB ��� . �� , ��. FESSIONSCO�E)'ORTHATHEOR!SHEISEX6MPTTHEREFflQM11ANDTHEBASISFORTHEALIE�EDEXEMP- (� . . , . � ,�,V� TION.AN�VIOLATIONOFSECTIOR''7037.59YANY'APPLICANTEORAPERMIiSUOJECTSTHEAPPLICAN77o '.Z Re-Roof . � .ACIVILPENALTYOFNOTMORETNAN�FNEHUN�REQOOLLARS(5500)J: � , ❑I,A$'OWMER OFTHE PROPERTV,OR MY EMPLOYEES I�yITH WAGES AS THEIR SOLE COMPENSATIDN, O � Commerciai , ',,,Z� 'WILL00 THE WORK,ANb THE ST;RUCTURE IS'NOTINTENDED'OR OFFEREO FOR SALE(SEC.7044,BUSI- �'�,J �'�� '�NESS AND PROFESSION$CO�E:THE CONTRACTORS UCENSE LAW�OOES NOTAPPLY'TO AN OWNER OF ��'_ , � � . � '� . PftOpERTY'.WHQBUIL�SOfiIMPRDVESTHFAEON,ANDWHOqOE55UCHWORKHIMSH.FORHERSELFOq ' ' ,� THROUGHHISORHEROWNEMPLOYEES,PROVIOE�iHATSU,CHIMPROVEMENTSAHENOTINTENDE�ON ��m ' . � � �';Q', OFFEREbFOR5ALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTI$SOLDWITHINONEVEAROFCOMP�E- ' � ' � TION.Ti1E OWNER-6UILOER WILL;FIAVE THE BURDEN.OF PROVING THAT HE OR SHE DI�NOT BUIID OR = IMPROV�FORTHEPURPOSEOFSALE). ' . .� � ❑I,AS OWNER OF THE PROhERTY,AM EXCWSIVELY CONTRACTING WITH LICENSE�CONTftACTORS ( ' �',, ��� TO FONSTRUCT'THE PROJECT(SEG.7a44,BUSIY,JESS AND;PflOFE5510N5 CODE:iHE.CONTFACTORS LI- V8IU8IIOf1 F � \ �ACIJ.AREA ' � W�'�, ICENSE4AWpOESNOTAPPLYTO NOWNEfiOFAPROPEFTYWH08UILD50RIMPHOVESTHEREON,AND.� � ' �' WHOCONTRACT$FORSUCHPRC�IECiSWITH'ACONTRACTOR(5)IICENSEDPUpSUANTTOTHECONTRAC- � QUANTITY DESCRIPTION ' � ' FEE � � . ,Y; .TORS LICENSE LAWJ. � � Q', ❑I AM EXEMPT UN�ER SEC:,� 8.&P.C.FOR.THIS REASON ��Q �.�, . . � . �C.) . � . � , . LL� ' �.� � . . .�OATE OWNER '�H . � � ' � . ��Z��� .W . ., . �i , . , ����� ., , . LICEN$ED CONTRACTORS DECLARATION ,W � . , , , �, IM�REBYAFFIPMUNDERPENALYHOFPEflJURVTHpTtAMLICENSEDUNDERPROVISIONSOFCHAPTER � _„/,y* ' , "' � � ��'� 9(COMMENCING WRH SEC710N�000)OF DIVISIO,N,3 OFTHE BUSMESS AND PFlOFESSIONS CODE,FND Z r r r-+, X�� MY LIC�NSE IS IN FULL FOFiCE AND EFFECL � �; � � � '��,��. LICENSE�CLAS �.�6����'�� � �UC.NO. �J�Jy�Z�J ...,� � . . .. �j�l DA7E . QONTRACTOR � /T � � a w, � '"�'�� � ��WORKERS'COMPEMSA?ION���,DECLARATJON �� -� � �� �� �� IHEREBVAFFIRMUNDERPENAL.YVOFPERJURVONEOFTHEFOLIOWINGDECLARATIONS: �Z " ' ' ' 0��� �IHAVEANDWILLMAINtAINACERTIFICATEOFCANSENTTOSELF-INSUqEFORWOftf(ERS' _ � � � � . �I; COMPENSATION,ASPROWIDEDBYSECTIbN37aoOFTHELPBORCADE.FORTHEPERFOqMANCE U � , Q�.,; OFTHEWORK,FOFWHICH'(HISPERMITIS�'�.155UED. ��,� ' w�' �I HAVE AND Wll�MAINTAIN WORKERS COM�PENSATION INS�'RANCE,AS REQUIREO BY SECTION /'� � Q,��,� , 370�OF THE LABOfi CODE,FORTHE PERFORMANCE OF THE WORK FOB WHICH iH15 PERMIT IS � �� � 1. L� 1' . ISSIJE�.MVWORKERS'CbMPENSYTIONINSUpANCECARRIERANDPOLICVNUMBERARE: CONSTRUCTION � �—�� �',. +,,�/� }��]���-+ i >� cnRRiEft' VY PG"T_L�I'�°/�`y�' � q PLAN REVIEW r � � POLICYNUMBER ��,'_J, Vf������7[ I� ELECTRIC J Q �� (fHISSECTIONNEmNOTB��O�MPLEfE�OFIIHEPERMfiISFOROt�HU1JDRE000l.1AR5(Slao)ORLESS). PLUMBING . .��" ICERTIFYTHATINTkiEP,CRFORMANCEp���7H�WORKFORWHICHTHISPERMIiI515SUED,I MECHANICAL � ' 'C,'3', � SHALL�NOTEMPLOYANY�PERSONINANYIMANNERSOASTOBECOMESUBJECTTOTHE . , , Uj WORKFAS"�COMPENSATIbNLAWSOFCAl1�ORNIA;ANDAGREETHATIFISHOULOBECOME INSPECTIONFEE ' �. � SUBJECTTOTHE'WORKERS'CAMPENSA'�IONpROYI NSO SECTION3 a0 HELABO CA�E,I �HALL FO THWITH COMPLV WITH7'HqSE P Cj 5 S. ISSUANCE � , , . . � �G,.''. p DATE: �� AaPLICANT � � � � SMIP 6 J'�. WARNING ILURET SECl1REN}ORKERSCOMF�4NSqT10NCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C f �'�, SUBJECTANEN.PLOYERTO,iCRIM�IALPENPLTIE�,ANqCIVILFINE5UP700NEHUNDREDTHOUSAN� ENERC,YPERMIT � � DOUAR$(E1o0,000J,INADpITIONiOTHECOSTOFCd(1PENSATION,DAMAGESASPFOVIDEOFORIN �' J�. SECTION37oeOF�THELABORCO[�E INTERE5T,F�JCSqTTORNEY'SFEES. - ' w � �� RETENTION FEE: �'�Ta �r 'a°.� d CONSTFlUCTIO,IV,tENDINGAGENCY PRE-ALTPEE: � � O, �.; IHEREBYAFFIRMUNDERPENALTYOF'PEf{JURY'�1-,IqTTHEREISACONSiPUCTIONLEkDINGAGENC7 � � . FOfl THE PERFORMANCE OF THE�NOFK FOR WHICH 7HI5 PERMIT IS ISSUE�(SEC.3097,CIV.C.�. _ � . � . Z'� ' , . . . . . . , � � . . ��, LENDER'S NAME . (,,. � ' �' F_—' LEN�ER'S ADURESS A{ p�, � I w�,'', I CERTIFYTHAT I HAVE READ THIS'APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. TOTAL FEES `..d+.1+/� a` ,���� �� � {(J II �;,. IAGREE�TOCOMPLYWITHALLCITYANDCOUNTYOROINANCESANDSTATELAWSREL4TINGTOBUIL�WG �j y �� v \.0 � � G,��I�� . �.'�. CONSTRUCTION,ANOHEREBYAUTHOµRSIZEREPR�SENTATIVESOFTHISCOUNTVTOEMERUPON7HE ' I! �,Ya � y ., . � � � � ' ABOVE-MENTIONEDPROPERTYFO�PECTIONPUFPOSE$. p'<-� � fl�� Q, /7A ��A N�� COMMENTS'a4 .\6� �'b�� , �; ,� .T- ��. f_,�� �'\�, , �'�I P MITT E M (P � ' — . '' � �' 3 9 �/ ���'i SIGNAT qE PERMI EE '' DATE � � � ��';: RECPT.NO. PAIDBY._��, i ' VALIDATION , WHITE--Department Copy,YELLOW—Finance Copy,PINk—Assessor Copy,GOLDENROD—File Copy,GFEEN�'=ApplicanPs Copy ' � ' �� ' , ,. , ,.. ,.. _ .:.- . 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