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Home My WebLink About16495 (23) ^ � CITY OF DIAMOND BAR ;''�f � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � _ � Z 1660 E.Copley Drive Suite 190 ,, (9U9)860-3195'Fax(909)661-3117 �/^'/�-� pR�ss '� ��' UII.DING PERMTT AFPLICATiON FIRMLY o� JOBSI7E � /J �. APPLICATION � PERMIT � P/C ADDRESS 2"3 G� . DATE �� _� NUMBER � �� # � ISSUE TYPE OCC APN !OY � TRACT SZ�G>7 DATE CONST. GROUP p OWNER v.,-- -�- �- � ADDRESS ' ZONiNG SETBACKS � W APPUCAN7 zIP ��-TBL. REART RW 0❑ Z CITY �1k�✓s! TEL. I g SIDEJSIQE STREET RW ❑ m SIDE Q AD RESSTOR__�� PROPOSED USE I� .�7� CITY ZIP TEL. , ,,.. w ARCWENGI Z DESIGPJER �" � � ADI�RESS , , NO.DWEL. NO. NO. � CfT,Y Z�P � UNITS STORIES BEDROOMS rn � DESCRIPTION ' --SQ:FL° FACTOR'PSF ADJ.AREA]VALUATION OWNEl�-BUILDER DECL4RATION SFR/ADD/REM O I HEREBY AFFIRM UNDER RENALTV OF PERYURY THR71 AF1 EXEMP7 FROM THE CONTRACTORS LI- GHfege/CdlPOft . ...� '� .�� W �CENSELAWFORTNEFOLLOWiNG RFASON(SEC.7C31.5BUSINESSANOPflOFESSIONSCODE:ANYqTVOfl (n ' U �,CqUNTYriHICHpEqU4RE5APERJ1750CANST9UCT,ALTER,IMPPOVE,DEMOLISH.ORREPFIRANY"aTRUG LIJ ��PdfiO/�eCk � ��„ � � '.TURE.Pfl1OR TO t?S ISSUAIVGE,iLLSD R@QUIRES THE APPLlCANT FOR SUCH PERMIT TO FIL'e A S�GNED � � � � W�' STATEWENT TNAT HE OR SHE iS LICENSED PUR"yUAN"O THE PfiOI'ISIONS OF THE CON'RACTORS L4 � "�' CENSE LAW(C?iAPTER 9(COMM�NCING WITH'SECTlON 70oa}OF ONi51�N 3 OF THE BUSMESS AND Pfl0- ' � POOVSPe . ' . . �'�'FESSIONSCADE�ORTHATHEORSHEISEXEMPTTHEREFHOMANDTHEBASISFORTHEAILEGEDEXEMP- �,� � . � . 'U''' TION'hNVVIOLATIONOFSEC?ION7031.SBMANYRPPLICANTFORAPERMITSU&IECiSTHEAPRLICANTTO � R@-ROOf � ' _� � , . � r' ACIVIL FENALTY OF NOTMORE THAN FIVE HUNDRED DOLLARS(5500}): . i � ❑I,ASOWNERCFTHEPROp'cRT7,ORM�'.,EMPLOYEESWITHWAGESAS7HEIASOLFCDMPENSATION, � COff11118fCIflI � . � , ' �.�WILL 00 THE WORK,AND THE STRUbTURE IS�,NOT INTENOED OR OPFERED FOFt SAIE(SEC.7044.BUSI- ,J ;,. '�;; � � N N6SS AND FftOFESSlONS CODE:�,THF CONTRACTORS LICENSE LFW DOES NOTAPPLY TO�1N'OWNER OF � .. . - .,. . I . . . 1N �.�pFOPERTY WH08lJILOS DP.IMPq6VES TNEREON,AkD NMO DOES SUCH WtlAK HIMSELF OR HEP'sELF OR ' � �. 'THROUGMiFfi50PHEROWt3EMPk.9VEFSPROVlOE'DTHATSUCHIMPROV'cMENTSARENOiINTENDEDOq� � ' '' d i..;,OFGEREDFORSµEiF,HOWEVEF),THEBUILD64GOH�IMPROVEMENTIoSOLpWfTHINONE7EAqOFCOMPLE- �� ' Z �'TION,THE OIHNER-BUiiDER 4MLL NAUE'HE BURDEN OF PRpYING iHAT HE Ofl SHE DID NOT BUIID OR � ., �, IMPhYMIE FOR TNE PURPOSE OF'�SqLE). . � �, . .❑I,AS OYMdER OF THE PRo,RE�Y,AM EXCLUSIVELY CON7RACTING W!TH LfCENSED CONTRACTORS� 6� i0 COMSTRUCT THE AR0.16CY{SEC.70M,BUSIMESS AND PROPESSIONS(:ODE:THE CO,i�TRACTORS LI- Vefuelion ADJ.AREA 18i. CEN96LAW�OESNOTAPPLYTtlANOLiMEROFAPiiOPERTYWH09UtLO50RIMPROVESTHEREbN,RND _'��'�Nh4000NYRACTSF6R5UCFlPRO.iECTSWITHACGNTRACTOR(S)LICEtJSEDPURSUAN7TOTHECQNTRAG � F"''� 'rows iicasE uw.y , QUANTITY DESCRIPTION � FEE � � Q ❑IAM E%EMPTUNOERS�C. . B.&P.G F0.97HI5 P.EASON Q � �.. � LL � DA7E OWNER_ H �. W , Q�; LfCENSEDCONTRACTOAS DECIARATION � . � ,, �. INEAEBYAFFIRPo7UNDERPENAI.TYOfPEPJURYTHATIAMLiCENSEDUNUERPNOVISI�NSOFCHAPTER � .. � �� 9(C4MMENCINCi WITH SECTION 9o0oj OF�MSION 3 OP7HE BUSINE55 AND PRtlfESSIbNS CODE,AND Z � "`V� MY UCENSE IS IN FULL FONCE �EFFECT. �m � � LIGENSE CU155�LIC.NQ. �'� - �� . . . ��, OAFE� l+}� �'°�`��/'��CONTRACTOR � LtJ � - � WORKERS',COMPENSRTIC7N DGCLAAA710M Q � � . �; I HEREB AFFI'AM UNDER PENC,LTY OF PEr°2JURT ONE OF THE FOLLOWIiJG OECLARFTIONS: Z ' G3�� HAVSANOWILLMAINTAINA�CEEtTIFlCATEOPCJNSENTTOSELF�INSURFPORWORKF_PS' ¢ 2 Q�� CA41'$E.NSATIOSJ,ASPN�VIpED6Y5ECTiON3700�FTltEL/1&7RC6DE,FORTHEPER�ORMANCE U "fHE W4FM FOH WhiOH Yii!$PERMIT IS ISSUED. W I � � „ . � �AVE AND WI!1.MAIN7AIN WORSWS'�MFcNSkTION INSUqANCE,AS RE�UIRED BY SECTION �� 3700CFTHELA9ORCOqE,F'JR'HEPERFOSiM,iNCEOFTHEWOWKFOpWHICHTHISPERAAiTIS ��r- I �� 4:SUEa.MY W EFlE'COMP6At5ATION INSURRNCE CAAPoER pND P dICY NUhiB nAe: C4NSTRUCTION �✓6 j GA5R4ER � J.- PLAN flEVIEW �� wot_�cvrcuana a__/�f�. . � ELECTR!C � --- I . y/, ! i �� EEDrq?B,E�oF'ru�vEas�ar�swacr�stwwiamoctittas�S�ao�ca�Ess�. PLUM6ING ,�1� i�': � I CER7IFY THAT IN THE P�RFUfiMA�VCE OFTNE WORK FOR WHICH THIS PERMIT IS ISSLIE�,I MECHANICAL � C,.J' SHA�LIVOT[IMPLOYANYi PE45pPd INANY MANNER SOAS TO 8EC6ME SUBJECTTO THE — I� (�� WORKERS'COMAENSATi3ON,iAWSOFCALIFORNIA.ANDAGREETHATiFISHOU�DB'cCJlAE INSPECTIONFEE I �;,_- SIJBJECTTOTHEWOAKER$'COMCEtdSAT1ONPROVISlONSOFSEC5ID 37000FTHEU180R �^g �� II COb,I SHALLFORT4WtTN COAAPLV WITH SE PROViS10N5. ISSUANCE �.��„ � DATE:�__'��-!�APP�,:icqrv7: ��,(6�� l.�� SM9P - . . I' '� � I � � � ENERGY P/C 'I';, '�, j' WARNING 6AILURE TO SECURE WCIPKERS'.COIAPBJSATION CAVERAGE IS UNLAWFUL,AND SHALL BE -- i . " ' LL SUBJECTANEMPLOYERTOCRIPjINRLPENALTIESAPI�CIVILFiNESUPTOONEHUNDF�DTHOUSANa � II�,�,, ' DOLLARS�=100,000),INADDITIOl�TdTHEC05T'OF(.`OMPENSATION,DAMAOESASPROVIDEDFOAIN ENERGYPERMIT JI. SECTION370BOFTHELABORCOOE'iNTEFEST,AN�ATTOFWEI"SFEES � , . � .,i',�' [L' i �.' � � �- RETENTION FEE: i� � o. CC3NSTRUCTIQN LENDING AGENCY PRE-ALT FEE: � � IHEREBYAFFiRMUNDERPENAL7YOF',PERJURYiHATTHEREiSACONSTRUCTIUNLENDiNGAGENCY � - - - � FOR TME PEAFORMASVCE OFTH2 WORK FQR GH THiS PEflMIT IS ISS D(SEC.3oW,CIV.C.j. � �� .,�� - ' . ' .. � I ', � LENDER'SNAME � . - ,. . I�i � F_,' LENDER'S ALI�RESS �" "� W� ICER7IF/THATIHAVEdtEADTHI$pPPLICATIONANDSTA7ETHATTHEABOVEINFORMFTIONISCORRECT. TOIAL/ ECS ��V, . . �,', IAGREETOCqMPLYWJYHALLC11fY'ANDCOUNTYORDINANCESANDSTATELAWSRELA7lNGTOBUILDING . . ' '�� CANSTRUCTION,ANO HEREBV AUTHOfiiZE AEPR"cSENTA?IVES OP YHIS COUNTY TO ENTEq UFON THE �- - � � F80VE-M NT7C5N . . � Z�. E ED QROPERTY FORINSPE TION PURPOSES. COMMENTS ' � O J �..�� _ . . , . . �', � i ll m�' PEiiMITTEENAME(F�Rf . .. � . . � � . . . . II�',� a � C75'.� . � ' . . . . e/j, F ERtAlTTEE � PATE . . .-- �I �. � � � � RECPT NO. 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