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�__�._.__ �1TY OF DIAMOND BAR �'�' DEfl'ARTMENT OF COhiMUNTfY&DEVELOPMENT SERVICES 21825 E.Copley Drive (944)860-3195 FaY(909)861-3117 PRESS ""%yr��'� BUILDING PERMIT APPI,ICATION FIRM LY o� JOBSITE ��� ',� x ����/N �, APPLICAT dt PERMIT / q� P/C ADDRESS �1�'�"'°' DATE ! NUMBER 7�/ ✓ # � I ISSUE TYPE OCC APN LOTi TRACT DATE CONST. GROUP p OWNER �'� . " ADDRESS__�, �i I- g �f ZONING SETBACKS gCITY�� � ZIP TEL. REART RW ❑� APPLICANT '+ TEL. � �;,� ��� SIDElSIDE STREET RW p Z � COIVTRACTOR ! SIDE p ADDRESS �-y � CIN ''�" "�Ii�t�TEL. 2 ��� PROPOSED USE [�� - �� ' �..s�fi.�f �`0�� w ARCHlENG! ' -rr� z DESIGNER 2'� ` "� � � ' w � NO.DWEL. NO. NO. n, ADDRESS � CIN --�I ZIP TEL. UNITS STORIES �' BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� M1lER-BUILDER�ECLARATION 5FR/ADD/REM O p 1 HEREBY AFFIRM UNDER P NALTY OF PERJURY 7HAT I AM E%EMPT FROM THE CONTRACTOflS LI� Gffl'fl9E/C2�(JOfI I:Lt CENSELAWFORTHEFOLLOWIN FiEA50N�5EC.7037.58USINESSAN�PROFESSIONSCODE:ANYCINOR (n ' U COUNTYWHICHREQUIRESAPER ITTOCONSTRUCT,ALTER,IMPROVE,OEMOLiSH,OPflEPAIRANYSTRUP W TURE.PRIOR TO ITS ISSUANCE,�LSO REW IRES THE APPLICANT POR SUCH PEFMI7 70 FlLE A SIGNED W Palio/DeCk �STATEMENT THAT HE OR SHE IS L�C�NSED PURSIJANT TO THE PROVISIONS OF THE CONTRACTOPS LI- � �.CENSE LAW(CHAPTER B(COMM NCING WITH SECTION 7000)OF DIVISION 3 OF iHE BUSINESS AND PRO- � POOI/SP8 � ' FESSIONSCODE)ORTHATHEOF1SHEfSEXEMPTTHEREFROMAN�THEBA5ISFORTHEALLEGEDEXEMP� � U TION,ANYVIOLqTIONOFSECTlO �031.SBYANYAPPLICAN'fFOftAPERMITSUBJECTSTHEAPPLICANT70 Z Re-Roaf r_ ��ACIVILPENALTVOFNOTMORETAM�FIVEHUNDREDDOLLA (ESOUJJ: � .. ❑I,ASOWNEROPTHEPRO ERjYARMYEMPLOYEE ITHWAGESASTHEIRSOLECOMPENSATION. ❑ CommelCial - ,:WILL DO THE WORK,'AN�THE S RUCTURE�IS NOi INT E�OR OFFEREG FOR SALE(SEC.7oa4,BUSL J � ',��NESSAN�PROFESSIONS CO�E: NE�.CONTRACTOpS CENSE LAW DOES NOiAPPLVTO AN DWNEA�F � �,;�PROPERTYWHOBUICDSORIMP VF�STHEREON,AN WHOOOESSUCHWOPKHIMSELFORHERSELFOR � �'�THROUGH HIS OR HER OWN EMP OY�ES,PROVIpED ATSUCH IMPROVEMENTS ARE NOT INTENDED OR m Q ��"�OFFEREDFORSALE.IF,HOWEVE iHEBUILDINGORIM OVEMENTISSOLOWITHINONEYEAROFCOMPLE� Z "�TION,THE OWNFA-BUILDEH WIL HAyE THE BUR�EN O PROVING TIiAT HE Oft SHE OID NOT 9UIL0 OR _ :V IMPqOVE FOR THE PURPOSEOF ALEj. ❑I,AS OWNERpf THE Pfl0 Ef�TY.AM EXCLUSIVE CONTRACTING WITH LICENSED CONTRACTORS � �'i�P TO CONSTFiUCT TNE PROJECT(EC.'i7046,8l7$INES D PROFESSIONS CO�E THE CONTRACTORS L4 VeIIJfltI0i1 �� ADJ.AREA LLJ CENSELAWbOESNOTAPPLYTO NOWNEROFAPROPER7YWHOBUILDSORIMPROVESTHEREON,A4D � '�'��WHOCONTRACTSFdRSUCHPR JECfSWITHACONTRACTOR�S)LICENSEDPL'FiSUANTT6THECONTRAP pUANTITY DESCRIPTION FEE � TORSUCENSELAW.):� � � ❑I AM EXEMPT'UN�ER SEC ' � � B.&P.Q FOR THIS REASON Q - � U � ¢ �A7E� OWNER H' b W � LICEN �.ED�CONTRACTORS DECLARATION W ¢ � I HEfiEBY AFFIRM UNDE(i PENALI���OP PEAJURY THAT I FM LICENSED UNDER PROVISIONS OF CHAPTER � � 9(COMMENCING WITH SECTION 7�q00j OF DNISION 30P iHE BUSINESS AND PROFESSIONS CO�E.AND Z �X 'MY LICENSE IS IN Fl1LL FOpCEANtl EFFECT. m Q LICENSE CLASS� LIC.NO. � j V DATE CONTRACTOR d W � WORK�RS'CAMPENSATION DECLARATION Q � I HEREBYAFFIRM UNDER PENAL Y OF PEFiJURV ONE OF THE FOLLOWMG DECIARATIONS', Z z IHAVEANDWILLMAINiAI �'ACERTIFICATEOFCONSEN7TOSELF-INSl1RE'rORWORKERS' _ COMPENSATION,ASPRO IDEDBYSECTION37aoOFTHELABORCODE,FORTHEPERFORMANCE U �""� � OFTHE WORK FOR WHIC '��THIS PERMIT IS ISSUE�. W �., �,............... � t� I HAVEAND WILL MAINTAI �WDRKERS'COMPENSA710N INSURANCE.AS RE�UIREO BV SECTION � � Q 3�ooOFTHELA90RCOD;,FORTHEPERFORMANCEOFTHEWORKFOftWHICHTHISPERMITIS ":/j/ � ISSUED.MV WORKERS'C h1PEN5ATION IN URANCE C,g-g/g�E,�P,A�N,D POLICY NUMBERARE CONSTRUCTION ((� } CARRIER _ /� PLAN REVIEW ZPOLICY NUMBER I �z a ELECTRIC 0 (fHI55ECilONNEmNOTB�IX7MPLEfEDOFhIEPERMfrISFORONEHUI�DRED�OLIARS(5700)ORLESSJ. PLUMBING � _ ✓ ' , Z ICERTIFYTHHTINTHEP F�FbFMANCEOFTHEWORKFORWHiGHTHISPEFMiTISI55UE�,l MECHANICAL � (r} SFIALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT i0 THE � i �, 1 �/y WORKERS'COMPENSATI NLAWSOFCALIFORNIA.AN�AGREETHA'IFISHOULDBECOME INSPECTIONFEE , i j SUBJECT TD THE WORK RS',COMPENSATION PaOVI510NS OF SECTiON 3]Go OFTHE LA6OR �- ' "' , � CODE,I S LL FORTHWI HCpMPLY WITH THOSE;PROVI ords. ISSUANCE � p-� �j (�^� ' � O � r ��5 � � f IJ G)W � DATE:� Cl I PPIICANT:� _ SMIP � � � WARNING.FAILl1RETO5ECURE ORKERS'COMPENS AONCOVERAGEISUI�B._4WFUL,AND5HAlL8E E N E R G Y P/C i � _ � SUBJECTANEMPLOVERTOCRI INA�,PENALTIESANDCIVIIFINESUPTOONEHUN�REOTHOUSAND � � .J SEC ORN37oeOFOTHELABORCOTO,NECOSTOFCOMPENSATION,DAMAGE5A5PROVIDE�FORIN ENERGYPERMIT �� � W �.TH f�x� / `�_ ) SEREST,ANDATTORNEY'SFEES, RETENTIONFEE: �^-- '"" -- --------"— . ___. ---- �...------ --- O C�NBTbUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMUNDERPENAL OFpERJURYTHATTHEREISACONSTRUCiIONLEN0INGAGENCY � FOR THE PERFOflMANCE OFTH�Wt]PK FOft WHICM TMIS PEFMITIS ISSUEO(SEC.309],CIV.C.). Z I W I � LEN�ER'a^.NAME � F=` LENDER'SAODRESS._.____.. I . ' �j W ICEflTIFYTHATIHAVEREADTHISl1PPLICAiIONAN�STFTETHATTHEABOVEINFOftlAATIONISCORRECT. TOTAL FEES f�I'd • O � I AGREE'TO COM?LY WITH ALL CITY PNfl COUNTY OR�INANCESANO STA7E LAWS RELATING 70 6UILDING � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF hli5 COUNiV TD ENTER UPON THE � ABOVE-MENTIONED PROPERiY !i INSPECTION PURPOSES. COMMENTS � � �������� ¢ PEqMITTEE NAME�Pfll T) . Cn '' J � SIGNATUREOFPER 1 -"� A c . � �, RECPT.NO. 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