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Home My WebLink About12300 (6) 1�_ CITY OF DIAMOND BAR /- DEPARTMBNT OF COMMUNITY 8z DEVELOPMENT SERVICES � '•- „�w . 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ' ''"' BUILDING PERMIT APPLICATION FIRMLY N JOBSITE �2 r APPLICATION ��J PERMIT Z� P/C _� r� o. ADDRESS �.J I J d I�t p Z G � C`, DATE ��"7''� NUMBER # ! �-•�-� � APN LOT TRACT ISSUE � TYPE O C DAT6 CONST. GROUP p. OWNER �� lH I►.t _ �GS!�. o ADDRESS �3/�s�C9 - /�[G L e3 e�e'1 S ZONING SF,TBACKS W CITY /�i4 /r3A/.'', ZIP 1T6.S"� TEL��'"�l�,!•�i Y!' REART RW u � APPUCANT C`liAlt: �L�"G-n� ?t- TEL�L�i'TZ/�lSC��:�, SIDE/SIDE STREET RW Cl__� � CONTRACTOR_�[r(�,�� GLU�f C'a I SIDE ❑ �• ADDRESS �/' 6 U�', i qJ s:- � CITY � ZIP�r'LT TEL:7/y'77(-�,./�V"�� ROPOSED USE �� A li � C v Ye�=C� I �, ARCH/ENG/ ` z DESIGNER w NO.bWEL. NO. NO. a ADDRESS �- CITY 21P TEL. UNITS__ STORIES BEDROOMS �: i v�- DESCRIPTION SQ.FT. FACTOR PSF A�J.AREANALUATION i � OWNER-BUILDER D�C'u1RATI0N SFRlADD/HEM � � I HEREBY AFFIRM UNDER PENALTV OF PERttJRV THAT I AM EXEMPT FROM TNE CONTRRCTOR6 LI- Gdfa9B/CB�Of[ t/J CENSELAWFORTMEFq10WINOREASON(SEC.7o31.5BUSINESSFNDPROFE5510N5COOE:ANYCITYOR (f, tt( C� COUN7YWHICHflEWIRE6APEHMITTOCONSTHUCT,l�LTERIMPHOVE,UEMOLISH,ORNEPAIRA4VSTAUC� W Patio/OBCk � �� NRE.PRIOR TO ITS ISSUMlCE,AL50 REQ111RE5 THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED � STATEMENi THAT HE OR SHE IS LICENSED PUHSUAN7 TO 1HE PROVISIONS OF THE fANTRACTOR6�I� � W �' CENSE UW(CHAFTER B(COMMENCING WITH SECTIDN 7000�OF OIVISION 3 OF TNE BLISINESS AND PRO- � V' POOVSpB � FESSpNSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDiHEBA313FORTHEALLEOEDEXEMP� (� TION.ANYVIOIATIONOFSECTION70.97.5BYANYAGPLICANTFORAO[RMITSUBJECTSTHEAPPLIChNTTO Re-Roof v' A CMl PENALTY OF NOT MORE THAN FNE HUNDRED DOLLpRB(S50J).): - z j F L]I,ASOVMEROFTHEPROPERTY,ORMYEMPLOYEESwITHWAGESASTHEIRSOLECOMPENSA710N, Q E C� Cammercial - f Z WILL DO THE WOHIC,AND TNF STRUCTUfiE IS NO7 INTENOED OR OFFERFA FOR SAL[(SEC.70ea,SUSI- J _ � � NESS AND PPOFESSIONS CODE:THE CONTMCTORS LICENSE LAW DOES NOT APPL�70 AN OWNEA OF � PROPERTY WFiO BUILDS OH IMPROYES iHEflEON,AND WHO UOES SUCt1 WORK HIMSELP OR HERSELF OR tL THROUGHHISORHENONTlEA/PLOVEES,PROVIDEDTHpTSUCHIMPROVEMENTSAREKOTINTENDEDOR m Q- OFFERmFORSN.EiFFiOWEYEfl,iME9UILDiNGORIMPROYEMINTISSOLDWITHINONEYEpROFCOMPIE Z iION.THE OWNER�UILDER WILL HAVE THE BURDEN OF PROVINO THA'f HE OR SHE DID NOT 6UILD OR = IMPF�VEFORTHEPUpPO5EOF5AlE� . � �y,� C71,ti40WNEROFTHE PROPEHfV,AM EXCLUSIVELYCOMRACTING WRH LICENSED CONTRACTORS r Q TO CONSTflUCT THE PIiOJECT(SEC.7041,BUSINESS ANO PROFESSIONS COOE:TME CONTR0.CTOR5 LI• VeI118�1Of1 L fS �_ ADJ.AREA � W CENSEAAIWDOESNOTAPPLVTOANOWNEflOFAPROPEqTYWNOBU1LpSORIMPROVESTHEREON,AND , - -- ----'— —'- = MM1IOCOMMCTSFORSUCHPRQIECTSWITHACIXJTRACTOfl(5)LICENSEOPUR5�ANTTOTHECOMHAG. � �" toasucEwssuw.�. QUANTITY DESCRIPTION FEE € � g 0 �IAMEXEMPTUNDERSEC. ___,B.BP.C.FORTHISR"eASON � U p LL _ __" ¢ .�___�_' � DATE OWNEH --_,- — U � W r � LICENSED CONTRACTORS DECLARATION W � -I HEflEBYAFFINM UNDER PENALTY OF PERJURY TNl1T 1 AM LICENSED UNDER PqOVI510NS OF CHAPTEH � � �B(COMMENCIN(3WITHSECTIONYo00�OFDIV1610N30FTHEBu51NES5ANDPROFESSIONSC00E,A."1D Z 7C MYUCENSEISINFULIFORCEANDEFFEC7. m � LICENSECLt>A�5S !J "' ,LIC.NO._� t � �T�_.____� j V DATE_`[" � �1 S� conrrrucroA��_�'1C_2�`�" � a w � WORKERS'COMPENSn'fION DECLAr�NTiON ,a � � , U � I HEHEBV AFFIR�I UN�ER GENALTV OF PERJLIRY ONE OFTHE FOLLOWING UECLAfiATIONS: Z Q � �IHAYEANDWILLMNINTAINACERiIFICATEOFCONSENTTOSEIF-INSUREFOPWORKEPS' _ � CAMPENSATION,ASPROVIDEDBYSECTION37000FTMELNSORCOUE,FORTMEPERFOflMANCE W OF7NE WORK FOR WHICH THIS PERMIT IS IS9UED. � � W __IHAYEAN�WILLMAIMAINWORKERS'COMPENSATIONINSURMICE.FSHF�l11REDBYSECTION / Z O 37000FTHE LFBOR CODE,FOR THE PERFOflMANCE OFTHE WORK FOR WHICH THIS PEflMIT IS _ ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AN�VOLICY NUAiBER ARE. CONSTRUCTION /� - �___ , �� >.... A I � Q � ✓' PLAN REVIEW _��`-r � CARflIEfl_"'"'�_"��j�y _ 7 � Z PIX.ICYNUMBER ��9 �`L p ' �� ^,. Y�1�'—y —"_� ELECTRIC �— $ Q r p (iHB3ECt10NNEFDNO'fBECOP.PLEfEDOFhEPERINfISFIXi�NEF0.R.Df1W i at�Ess� PLUMBING _ .._ ._ IN� Z I CERTIFYTHAT IN THE PERFORMPNGE OF TH�WORK FOR WHICH TNIS PERMIT IS ISSUF.D,I MECHANICAL ___. _, �� ('f SH0.LLN0T EMPLOYANY PERSON IN ANY MANN[R SOAS TO BECOME SU9JECT TO THF. (p WOFKERS'COMPENSATIONLAWSOFCALIFORNIA.M1DAGREETMATIFISF10ULOBECOME INSPECTIqNFEE ____________.__._._____ � � SUBJECTTOTHEWONKERS'COMPENSATIONPHOVISIONSOFSECTION3700 THEIAHOR J� � CODE. SHA�.LFrOR/THWI7HCOMPLY WITHT VISIONS. /� / ISSUANCE __'_'_'_"""_'_'____'_ ___'._'�_i 0 DATE: O APPLICANf "� "o�� _1� SMIP _ —__—________._--._ — �� J WARNI(VO:FAIL�GURE WORKERS'CAMPENSATION COVERAGE IS UNLAW WL�AND SHALL BE ENERGY P/C _ _..__. . �y SU&IECTANEMPLOYERTOCRIMINPLPENALTIESANOCIVILFINESUPTOONEHUNURFDiHOUSAND ENERGYPERMIT � DOLLAFlS(L1oo.0aoLINADDITIONTOTHECOSTOFCOMPFNSATION,DAMpGESASPROVI�EDFORIN — �--��-- _ J SECTION37oaOFlHEUBOHCODE,INTEREST,ANUATTORNLV'SFEE3. RETENTIONFE�F/j i�" __�_ O CONSTRUCTION LENDING AGENCY pRE• T FEE: `�'� -� � f' + ----...----"--"------'- �-- � IHEREBVAFFIRMUNDERPENALTVOFP[FIJUHVTHATTHEft[ISACONSTRUCTIONLENOINGPG[NCY _ ✓� j FOFTMEPERFOflMANCEOFTH[WORKFORWHICfiTHISPERMITISISSUED(SEC.30W,CIV.C.). ��-� " W —_"� — � LENDEfl'SNAME_._ — — _ � ---_'�'__" ' "'..._ F— LENDEN'SADONESS ��.c� _ --_ r c � � ICEqTIFYTHATIHAVEHEPDTHISAPPLICAiIDNANDSTATETHRTTHEABOVEMFORMATIONISCARRECL I OTAL FEEJ � , W IAGpEETOCAMFLYYYITHpLLCITYANDCO�NTVOP�INPNCESAN�STpTELAWSRELATINGTOeIIILUING � CONSTRUCTION,PNDHEREBYAUIIWRIZEfiEPRESENTATIVE50F1HI5COUNTYTOENTERUPON7HE Z ABOVE�MINfIONE�PROPER7YWRINSPECTIONPURPO5E5. COMMENTS_ ___ __,. � ('�,�� ,��'�',v��c --- -- QPERMITT (P ,,./—��' Ay� ��j/ _" ' N +y,,.��R—�Q-,P��[.Fc_��,_�.�L� V . � S�GNA7UREOFPERMIT7EE DATE = RECPT.NO..� PAID BY _„_ VAIIDATION ~ WHITE—Dapartment Copy,VELLOW---Finence Capy,PINIhAssessor Copy,ROLDENROD--File Copy,GREEN—Applicanl's Capy � , ' � I_. i. ,�. .a. . .... .,.- i I '� .__ _ _ , ._. _ _ �. c r . (._._ . .�. .. �� , . � � ( I . ! � . .� � , I •�M I i ! , � � � �� ' I � I { I � � I � � : .. �� i . �. ; ' _ I � I � . � , . ' � i I : . ; ; i . + � � i � � ! � � �t - . . ; : � . . . : � ; '. .. ��5 r ' I ' 1 � , I � ,. I . { � � � � , , , � E. i , 5 � ! � � � � � ' ', ( � i I �� 3 , �YC'� I . i � 1 �I , � f i ' � , � � 4 � i � .,5 ..� I , I ' � I , � � 1 ' � ' I , , • , , Y � i� . � : . � � I �. , . . � ; � ' ' ' i ; � � � i , � ' � � � � i ( i � � i � I . �� ' I � � � I � � � � I I � . � �, � ( . , � . ��,�� I f � j � i � � I - , - � � � , . 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