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Home My WebLink About13-0068 �____ _ I CITY OF DIAMOND BAR W `�� -��-��` DEPARTMENT OF C01VIl1�IUNITY&DEVELOPMENT SERVICES I 21810 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection I3otline(909)839-70Z7 PRESS ��°^'� BUILDING PERNIIT APPLICATION FlRMLY � JOBSITE Q C'L h h U� P� �1� ' APPLICATION 1 � /� . PERMIT �b� P/C o AODAESS � � � � DATE NUMBER ii � ISSUE TYPE � ��f,.,� � OCC APN LOT TRACT OATE CONST.�,s11lFt� GROUP °C OWNER e OYG v P►'S � O � ADDRESS �2� �� 0� e � � ZONING SEfBACKS oCITY (�lq�� d✓' ZIP TEL. O 'Q FRONT RW O � o APPUCANT �U1�1 Vlq }I � TEL._ L�`�Z�jf� S DEISIDESTREET RW (7 z 4 CONTRACTOR Pars SIDE O ADDRESS ��2 �n u 'P� � � CIIY Lon�°J ZIP_�_ PROPOSED USE �G J� dG'I n ' �p Wl n u� J w� ARCWENG/ 3Z�)� g oo �'1b� . y�(o3 �� -r�6-jr— s ��L� il z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY IP TEL. UNITS STORIES BEDROOMS � �, cn DESCAIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECIARATION SFFUA00/REM O p I MEHEBY AFFlRM UNDER PENALTY OF PEAIURV TUT I AN E%EMPi FROM ME CONTRACT00.5 U- Gdf2g0/CafpOfl � W CE?ISEUWFORTHEFOLLOWWGREASON(SEC.7m1.5BU5WE551NDPROFE55qN5CODEANYQTYOR (n U COUMYWHICTIqEW�qESAVERMI77000N5TqUCf.ALTE0.�MPf40YE.0EMOUSH,ORREPNqANYSTRUG W w 7URE.PFIOR TD RS ISSUANCE,4150 REDUIHES 7HE APPUCANT FOP SUCN PERMIT TO FlLE A SIGNED w Patio/Deck � STA7EAIENT 7N.lT HE OA SHE IS 4CENSED➢URSUAN!TO TH£PqOVI5ION5 OF h1E COMfMCTOHS U- � � CENSE UW(CYUP7ER G(COMMENCWG WITI SECTION 7a00)Of DIVISION]OF THE B1151NE55 AND PFlO- POoVSPB FESSqNS CAOE�OP THAT HE OR SHE IS EXEAIPTTHEHEFROM AND THE B/515 FOR THE ALLEGED E%E1AP- (!� � TION,MIY VIOUTION OF SEC710N 7mtS BY ANY MVUCAHT FOR A PERMIT 5U&lECTS THE APPLICFNT T0 Z qo-Roaf � A CML PENALTY OF NOT MORE TF1AN FNE HUNOHED DOLLMS(S50o).Y � ❑I.1�SOWNEAOFTHEPA07ERTY.OFINVFJIPLOYEESWfTH-WAGESASTHEIHSOLECOM7ENSATON, � Commercial - Z WILL DO THE WORK,AN�THE STRUCTURE IS NOT iNTQlOED OH OFFERED FOR 5lLE�SEC.7ou,8US1- J � NESS I�NO PROFESSIONS COOE:THE COHTRACTOflS UCENSE UW OOES NOT APPLY TO AN OWNER OF j . - VqOVERTY N?i0 BUILOS OH IM�ROVES THEPEON,ANO NMO DOES SUCH WORK HIAISELf Oq HERSELF OR CL THfiO�JGH HIS Oq HER OVM EMPLOYEES,PiiOVIOED THAT SUCH IMPFOVEMENTSARE NOT IMEHDED OR � QOFFEAmPoRSILEIF,HOWEVERNEBUILD�NGORWPROVEMENTIS" 1WfTNINONEYEAROFCONPIE- Z T10N,7HE OWNEHAUIIDER WILL HAVE THE BUHOEN OF PHOVING THAT HE OH SHE DIO NOT BUIID OR � UAPROVE FOF THE Pl1RPOSE Of SILE} w p I,AS OWNER OF THE PkOPEHTY.IUt EXClUSNEIY CAtf�MCTWa w1TH UCENSED COMNACTORS [L TO CONS7RUCT THE Pp0lECT(SEC.7oat,BUSINESS IWO VROFESSIONS CODE:TME COFfTfUCfOHS LI- VeluBtlon ADJ.AREA W CENSEUWDOESHO7APPLYTOMIOWNEAOFAVHOPFA7VWF108UqD50RIMPROVE57HEAEOrLAND � WHOCONfMCT5iOF5Utl1PRQIECTSWRHACAMMCTOfl(SjUCFNSEOPUFSUAN'fTOT}iECONTMG QUANTITY DESCRIPTION FEE Y T00.5 UCENSE UW.} ¢ O I AM E7fENPT 11N0EP SEc. B.i P.C.FOq 7HIS REASON Q � U � ¢ OATE _ OVMER U � Z W � LJCENSED CON'fRACTORS DECLAHATION W � 1 HEREBY AFFlqM UNDER PENALTY OF PERIURY THAT IAM LICENSED UNOFA VROVISIONS Of CNAPTER V. d Y(COMMENCIN(i Wlhi 5ECT10M 7000)OF DMS10N]OF THE BUSIHESS AND PqOFE5510N5 CODE,AND Z I/Y LICENSE LS IN Fi1lL FORCE AND EFFECL ^ p m � UCENSE CUSS � LIC.NO. r�� V OATE � COMHACTOq_�/ d W � WOqKERS'COMPENSATION DECLARA7101Y Q � � 1 HEREBV AFFIRM UNOER PENALTY OF PERIVAY ONE OF THE FOlLOW1NG OECLAMTIONS: Z � _1 HAVE M1D WILL WUNTNN A CFATIFICATE OF CONSENT TO SElF-INSURE FOH WORKERS' = 1 Q �IAPENSATION,AS PROVI�EO 8Y SECTION 37oa OF 7HE LABOR OOOE,FOR THE PERFORMANCE w Q .OF THE wOqK FOR WHICH TNIS PEAMIT IS ISSUED. � / w �� I HAV�AH�WILL MAIMAW WORKERS COMPENSA710N INSUMNCE.AS REOUIPED BY SECTION �^ �� _/ Q 7�0o OF THE I.tBOR CODE.WR T1iE PEAFORM/uJCE OF THE WOH1S FOq WM1CH TNIS PEAMR R —� C3' LSSUED.A1Y WOFKEAS' /A EN�ATION INSUfUNCE CMRIER ANO POIICY NUMBERARE CON$TRUCTION C7� b j CMRIEA �� . • PLAN REVIEW Z 70LIC!Ni1M9Efl Cn11i(�L��I L� J z�— ELECTRIC Q � (niIsSECnwNEIDNo79E�.ErIDOFnEv6aRt5waa+EruPOPmdx1N�5(S�m)oat,E55� PLUMBING W Z I CEPTIFY 7HAT IN h1E PEHFORMMlCE OF 7HE WOHI(FOR WHIQi THIS PERMIT IS L55UED.I MECHANICAL C� �SHALL NOi EA/VIOY 1M'➢ERSON 1N M!Y AIAf7NER 50 AS TO 9ECOME SU C7T0 iHE � WORK RS C ENSATION UWS Oi CALIFOfiNI�ANO AGREE IF I UlD BECOME INSPECTION FEE = SU&lE TO WORICER5COM7ENSATIONPROVIS EC ON I 00 TNELA90R coo, sruu arriwin�coup�r w�ir�niosE vao s. ISSUANCE O y� f� p Oa7E: ��nPPltc.4M: SMIP I. —t '� . J WARNINO:FAIWAE TO SECVRE WORKEFiS COA�PENSATION COVERAGE LS UNUWFU�AND SMALL BE ENERGY P1C �y SUBJECf AN FJAPIOYER TO CRIMINAL VENA�TIES ANO CIVIL FWES UP TO ONE HUNOPED hiW5AN0 ��RGY PERMIT DOLUiiS(itoo,o00�,W ADOI710N TO hiE COST OF COMPENSATION,D��GES AS PFOVIOED FOH IN ¢ SEGTION37oeOFTHELA00RCO0EW7EHE5T.M10AROiiNEY5fEE5. REIEI'ITfONFEE: �O OCONSTRUCTlON LENDlNG AGENCY PRnE-ALT FEE - � � I HEREBY AFG1fiN UHDER PENPL7Y OK PERJURY THAT THERE IS ACONSTAUC710N LENDINO AGENCY �� fOH THE PEAfOFMANCE aF THE WO FOR NM1i1CH THIS PEAMfT IS lSSUEO(SEC.7os/,QV.C} Z w � IENDER'S w1aE � F- IENOEA'SAODRE55 � I CEHi1FY TFIAT I HAVE READ THIS MPUCATtt7N AND STATE THA7hfEABOVE INFOR7AA7KK/19 GO1iAEGT. TOTAL FE ES ��_lJ� w I AGAEE TO COMP�Y WIiH ALL CRV ANO C�IMTY OHDINMI 5 AND STATE UWS RElA7WG TO BNLDING � � � CONSTRUCTIOH,AND HEFFBY AU�HOF712E REPRESENTATI�{5 OF 1H15 CWNT`/TO ENTER UVON 7NE � ABOVE•MEll71ONED�ROP f-0H WSP N VUHPO$�S ? � COMMENTS O —' �) 1 � � FEAAIITTEE NAME(PFI1ln _ � y � � y SIONANRE OF PEAMfTTEE DA7 = RECPT.NO. 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