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Home My WebLink About10492 � I --- CTCY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT .,.W 21660 E.Coplcy Drive Suite 190 PRESS (909)860.3195 Fax(909)861-3117 "��'+ BUILDING PERMITAPPLICAT[ON FIRMLY o DDR'ESS�� • �p� ��Gi�iGC6Ci APPLICATION , PERMIT . � �p,lC DATE NUMBER ��"# c� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP ° g OWNER�`�l-�I� -�L�'i'1 u" ADDR �� ZONING SETBACKS z CI ZIP TEL. FRONT RW ❑_ APPLICANT TEL. REAR ❑ S SIDFJSIDE STREET RW fl � � CONTRACTOR �� J ��(�,. SIDE ❑ � a ADDRESS ' PROPOSED USE - � o A WENG/ 8 f1U, f{ j�]�— TE W DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � O OWNER-6l:ILDER DECLARATION SPR/ADD/REM � Q 1 HEREBV AFFIRIA UNDER PENALTY OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTOqS Lb � Garage/Carport UJ CF.NSEI.AWFORTHEFOLLOWIN�REASON�SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCI7VOR � U COUNTYWHICNREQUIqESAPERMITTOCONSTRUCT,ALTER,IMPROVE.DEMOU5H2OflREPA1FANY5TqUG W P9IIO/DBCI( w7URE,PRIOR TO ITS ISSUANCE,PLSO RE�UIflES THE A7PlICANT FOR SL1CH PERAIIT TO FILE A 516NED w .� STATEMENT TNAi HE OR SHE IS LICENSED PURSUANT TO THE PqOVISIONS OF TNE CONTRACTORS L�- � CENSE LpW(CHAPTER 9(COMMENCING WITM SECTION 7000)OF DIVISION 3 OF TME BUSINESSAND PRO� V' POOUSPB FESSIONSCODE�OR7HA7HEORSHEISEXEMPi7HEREFROMANDTHEBASISFURTHEALLEGEDE%EMP• (� ( g lION.ANYVIOUTIONOFSECTON7031.5BVANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Rooi { � A CNIL PENALTY OF N0T MOFE THAN FIVE HUNDRED DOLLARS(S50o).�: � 0 [7I,ASOWNEROFTHEPROPERTY.ORMVEMPLOYEESWITHWAG[SASTHEIfiSOLE(:OMPENSA710N, � COrt1t110fCifll � Z VlILLDO THE WORK,ANU TNE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,9U51� J � � NESS AN�PROFESSIONS CODE:THE CONTRAGTORS LICENSE LAW DOES NOTAPPLY TO AN OWNEN OF � 7POVERTY WNO BIIILDS OR IMPROVES iHEREON.AND WHO OOES SUCH WOfiK FiIMSELF OR HERSELF OR I (r THROUGH HIS OF HEROWN EAIPLOVEES,PROVIDED THAT SUCH IMPROVEMENTSARE NOTINTENDED OR CD IQ OFFEREDFORSALE.IF,HDWEVERIMEBUILDINGORIMPPOVEMENTISSOLDWRHINONEYEAROFCAMPLE• ( � TION,1HE OWNER�OUI��ER WILL HAVE 7HE BURDEN OF PROVIN�7HAT HE OR SHE UIU NOT BUILO OR = IMPROYE FOR THE PURPQSE OF SALE�. ( LJI.ASOYMEROFTHEPHOPERN,AMEXCLUSIVELYCONTRACTINGWITHI.ICENSEDCANTMCTOqS — — � TO CONSTRUC7 THE PRDJECT(SEC.7094,BUSINESS AND PROFESSIONS CODE:TME CONTflAGTORs LI• V81U8I10(1 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAOROPERiYWHOBUILDSOHIMPflOVESTHEREON,ANO � WII000N7RACTSFORSUCHPRQlECTSWITHRCONTRACTOR�S)UCENSEDPURSUANfTO7HECONTPAG qUANTITY DESCRIPTION FEE ,Y TORSLICENSELAW.1. I O ❑1 AM E%EMPT UNDER SEC.,_,_ _B.8 P.C.FOR THIS REASON �i _ LL DATE_ OWNER_._____—_.___ Z � LICENSED CONTRACTORS DECLARATION W � IHEHEBYAFFINMUN�ENPENALTYOFPERJt1RYhIATIAMLICENSEAUN�ERPPOV1510N50FCHnPTER � ' � � d 9(COMMENCINOWITHSECTION700D)OFDIVISION]OFTHE8U51NESSANOPFOFESSIONSCODE,AN� Z X MY IICENSE IS IN FULL FONCEAND EFFECT. m LLI f � LICENSE CLASS _ LIC.ND. � j 1-- ( V DATE _ _CONTRACTOR d W � u� WORKERS'COMPENSATION DECLARATION –� � � I HEREBYAFFIRM UNDEH PENAITY OF PERJUAY ONE OF THE FOLLOWING DECURATIONS: � � � _IHAVEANDWILLMAINTAINAGERTIFICATEOFCONSENTTOSELFiNSUREFORWOHKERS' � Z COMPEN3AT10N,AS PROVI�E�BY SECTION 37a00F THE IABOR CODE.FOR THE PERFORMANCE Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � � w _I HAVE AND WILI MAINTAIN WOFKEPS'COMPENSATION INSURANCE,AS fiEOUIRED BY SECTION ? Q 37000F THE LABOR CWE,FORTHE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT 15 i O ISSUED.MY WORKERS'CAMPENSFTION INSURANCE CAFRIER AND POLICV NUMBER ARE: CONSTRUCTION � j cpqqiEp _ _ PLAN REVIEW � z rouCVNUMBEa __ ELECTRIC I Q �,�� (IHlSSECTONNE�N0T8E07MPLE�FAOFhEPE0.MITl5fORCMEHINORED00LLAR516100)ORLESS� PC MBIU NG� - .y_..... W / Z I CERTIFY THAT IN THE PERFOFAIANCE OF THE WORK FOR WHICH THIS PEflMIT I515SUED.l ECHANICAL I:`:+�r�� ` 4 (} SFIALLNOTEMPLOYANYPERSONIN�NYMANNERSOASTOBECOIAESUBJECTTOTHE �Y .{. � � WORKERS'COMPENSATIONlAW50FGALIFOflNIA,ANDA6PEETNAiIFISHUULUBECOME INSPECTIONFEE _ = SuBJECTTOTHEWORKEPS'COMPENSATIONPROVISIONSOFSECTION37000FTHELA60R CODE,ISMALLFORTHWITHCOMPLYWITHTHO , RO IONS. ISSUANCE � � SMIP ' r �` � p DATE:�� APPLICANT: . �r�."r. , W ENERGY P/C I J WAHNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE � LL SU&IECTANEMPLOYEHTOCRIMINAIPENALTIESAN�CIVILFlNESUP700NEHl1NDFEDTHOUSAN� ENERGYPERMIT � OOLLARS(5700.000).IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PHOVIDED FOF IN j � SECTION37080FTHElA80RCADE,INTEREST,RNOATTORNEV'SFEES. RETENTIONFEE: � ___ a CONSTRUCTION LENDING AGENCY pRE-ALT FEE: � 1 NEREBV AFFIqM UNDER PENALTY OF PERJl1RY THAT THERE IS A CONSTRUCTION LENDING AGLNCY FORTHE PEflFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSl1ED(SEC.7o97,CIV.C.J. � Z — '_ W � LEN�ERS NAME � � LENDER'5RDDRE55 _.__--- WICENTIFYTMATIHAVEPEAOTHISAPPLICRTIONIWUSTATETMATTHEABOVEINFORMATIONISCORRECT, TOTAL FEES ��/ � IAGFEE TO COMPLV WITHALL CITY AND COUNTV OROINANCESAND STATE UWS RELATING TO BUILDING � � CONSTRUCTION,ANDHEREBYAUTHOR2EREPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE — Z ABOVEd1ENTIONFD VNOPENTY FOR INSPECTION PURPOSES. 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