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Home My WebLink About18392 (11) ��`Y. �'c'T �` CITY OF DIAMOND BAR � DFPARTME'�'T OF COMMUNI"fY&DEVELOP[vfENT SERVICES W � 21 S25 E.Copley Drive (909)&60-3195 Fax(9Q9)861-3117 PRESS "-..�' BUILDINGPERMIT_APPLICATION F RMLY } JOBSITE ./��Ii1 �( � ' APPLICATION I,,,j��`g PERMIT ��P/C o ADDRESS� � _ DATE ��NUMBER # W ISSUE � TYPE OCC � LO'f TRACT __ DATE CONST. GROUP p OWNER ��\� � 1� 1,�C� � ADDRESS�"��I V�GZ.1�[^Z��l� T'�t� ZONING SETBACKS O. CITY �iILw�11��'��IP�_�_ 7EL. � " REART RW_ �� — o APPLICANT TEL._ � Z SIDE/SIDE STREET RW ❑ Q CONTFiACTOR_ SIDE ❑ Q ADDRESS — PROPOSED USE ^ ` L < < � CITY ZIP TEL. �, �w ARCH/ENG/ — iZ DESIGNER -- NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP__ TFL._ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER�ECLARATION SFR/ADD/REM O 0 I HERE9Y AFFIRM UNDEF,PENALiV OF PEFJURY THAT i AM E%EMPT FROM TME CONTRACTORS LI� � Garage/Carport W CENSEUWFORTHEFOlLOW11VGREASON�5EC.7o31_56USMESSANDFqOFE55qN5rODE:ANVCI7YOR U COUNTVWHICHREOUIRESAPF:RMITTOCONSTFUCT,ALTER.IMPROVE,DEMOLISH,CRREPA'�,RANVSiRUC� W P0Ii0/DeCk Z TURE.PRIOR TO ITS ISSUANCE,ALSO REQUIflES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED w w STATEMENT THAT HE OR SHE IS IICENSED PUPSl1ANT TO THE PHOVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTER B(COMMENCING W�TN SECTION 1000)OF�IVISI(N13 nF THE BUSINESS AND PRO- LL POOUSpB FESSIONS CODE)OR THAT HE OR SHE IS E%E MPT THEREFROM ANO THE BASIS FOR THE ALLEGED EXEMV� Y, � TION.ANVVIOLATIONOFSECTION'l03�.58YANYAPFLICAN�FORAPERMITSJ9JEC'�SfHFAPPLICANTTO Z e-Root � v A dVIL PENALTV OF NOT MORE THAN FIVE HUNOREO DOLIARS(f500))-. � -- � ❑I,ASOWNEROF7MEPPOPERTY,ORMYEMPLOYEESWITHWAGESASIHEiR50LECOMPENSATON, Q WILL�O THE WORK,AND TME STRUGIUfi[IS NOT INiENDL�OH OFFERED FOH SALE;SEC.]aaa,BU'.I- J C+Ort1fT10fCldl Z NESS AND PROFESSIONS COOE:THE CONTRACTORS IICENSE UW DO'cS NO'APPLY TO AN OWNER OF � PROPERTYWHOBUILDSORIMPROVESTHEREON,ANOWHODOESSUCHWORKHIMSELFORHERSELfOR � � THROUGHHISORHEflOWNEMPLOYEES.PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTEND'c00R m WQ OFFEREDFORSALEIFHOWEVER,THEBl11LDINGOPIMPRWEMENTI550LDWITHIVONEVEAROFCOMPLE- Z TION,�HE OWNEfi-BUILDER WILL HAVE THE BUR�EN OF PqOVIUG'.HAT HE OR SHE DIO NOT&11_D OH � IMPROVE FOR THE PURPOSE OF SAIE). ❑I,AS OWNER OF THE PROPERTV.AM E%CLUSNELY CONTRACTING WI"fN LICENSEO CONTRACTORS � TO fANSTRUGT THE PRQIEC'�(SEC.]066,B1151NE5S AN�PROFESSIUNS CODE�.THE CONTRACTGRS LI- V8llldliOfl V ' ADJ.AREA W GENSELAWDOESNO�'A7PLV(OANOWNEROFAPROPEPTYWNOdJII.D50RIMPROVESTHEREON,AND = WHOCONTRACTSFORSUCHPq0.1ECT5WITHAGONTRACTOR�51lIGEM1SE�PURSUANTI'OTHECONiRAG I QUANTITY OESCRIPTION FEE Y TORS IICENSE UW 1. _ � J � ❑IAM E%EMP7 UNDER S=C.____. ._. . .- _ B.4 P.C.FOP THIS REASON Q � U � � Z. `�ATE �6WNER ___ — U W � LICE:NSED CONTRACTORS DEC RA N w � I MEREBV RFFIRM UNOER PENNI.TY OF PERJURV THAT I AM LICENSED UNDER PRO\'ISIONS OF GMAPTEIl � � 9�COMMENCING WITH SECTION 7000)OF�IVISION 30F iHE BUSINESSAND PPO�ESS:JNS W�E,AND Z X MY LICENSE IS M FULL FORCE AND EFFECT. W m � � LICENSECLASS_ ___ __ LIC.NO. J'I U DATE CONTRACTOR a I W � WOF�KEFS'COMPENSATION DECLARATION -� � ¢ � I HEREBV AFFIRM UNOER PENALTV OF PEFJURV ONE OF THE FOLIOWING DECLARATIONS: U G� Q � IMAVEANDWiLLMAINTAINACERTIFICA'EOFCONSFNTTOSELF�INSUREFORVJOPKERS' _ Z GOMPENSA'ION,AS PHpVIDED BY SECTION 3]0o OF THE LABOR CODE,fOR THE PERFORMANCE U Q OF THE WORK FOR WHICH IHIS PEHMIT IS ISSUEO. � O w IHAVEANDWILLMAINTAINWORKERS'COMPENSAiIONINSURANCE.ASREOUIREDBYSECTION \ Q 3]0o Of THE LABOR G�DE,FORTHE PERFORMANCE OF THC WORN FOR WHICH iH15 PERMR IS �f� I�`� 0 ISSVED.MV WORNER:I'COMGENSATION INSURANCE CA9RIER AND POLICY NUMBEftARE: CONSTRUCTION y��__ J �t� j cnaaieR PLAN REVIEW __ � POLICYNIJMBER_ — ELEGTRIC _______ ._.._.__. Q � (IHISSECTIONNEmNOTBENfAREiECOFT1fPERMfTISFOFIXJEHUWREDDOL.L4fiS(E100)ORLE55). PLUMBING ______ w MECHANICAI Z I CEfiTIFV THAT IN THE.PEftFORMANCE OF TME WORK FOR WHICH THIS PERMIT IS ISSUED,I _ � SHALL NOT EMPLOY ANY PEflSON IN ANY MANNER SOAS TO 6ECOM[SUBJEf:T TO THE � WORKERS'GOMPEN5�4TION LAWS OF GALIFORNIA,AND AGFEE TMAT IF I SHOULD BECOME INS?ECTION FEE � SUBJEGTTO THE WOHKERS'GOMPENSATION PROVISIONS OF ScGTION 3�o00FTHE LABOR �.�— � CODE.ISHAILFORT/+WITHCOMPIYWITNTHOSEPROV�SIONS. ISSUANCE �` � sMiP �J �3 p �ATE: APPLICANT: - — w ENERGY P/G 'J WpRNING FAILUPE TO SEGUFE WORKERS'GOMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE J � SUBJECTANEMPLOVERTOCHIM'�NALPENALTIESAN�GIVILFINESl1PTOONEMUNDREOTMOU5AN0 ENERGVPERMIT �OLLARS(f100.000),IN ADDITION TO7HE COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR IN -�— J SECTION 3]080F THE LABOR CODE,INTEREST ANO ATTORNEV'S FEES. RETENTION FEE: �� — � CONSTRUCTION LENDING AGENCY PRE-ALT FEE _ O � IHEREBYAFFIHMUNpERPENALTVOFPERJURVTHATTHERE15ACON5TF.UC'IOhlEN01NGAGENCV � FOR THE PFRFOFMANCE OF I HE W(JFK FOti WHIGH THIS PERMIT IS ISSUED(SEG.3091,GIV.G.). W S LENDEH'SNAME __ � F= I.ENDEF'SAD�RE55 ///'''\ � IGERTIFVTMATIHAVEREFD"fHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT TOTAL FEES � �J " `-' w I FGFEE TO GOMP�V WITM ALL GITY AND LOUNTV ORDINANGESAND STATE LAWS RELATIN6 T0 9UIlDING ` � CONSTFUGTION,ANO HEHFBf AUTMORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPUN'HE zABOVE�MENTIONED PROPERI'V FOR WSPECTION PUi1PD5E5. COMMENTS � '2'�ar' , '►��-.� — m ERMITTEE NAME(P�IGLS}` ..'�� ._...__. '� . .��L� ti" �� — __ — � qTUq ERlAITTEE � / �ATE ,�} — �� RECPT, NO. yl PAID BY VALIDATION ~ WHI1E—Department Copy,YELLOW �inance C py,GOLDENRO�File Copy,GREEN—ApplicanPs Copy py,PINK—Assessor Co .. . . �r�-S>i ..�. - �� '�s'�:�. ` �^'� :��,o'�rr�' '°' �,� , � 'r � � s� �.. ��, w � .� -.€ .��. a 7r �, .-, , �� '`. � * " � • � � ,.�..� ..., . ... . .. . , �. . . . , ,�".�a. . n: . .. � �.� �, , �- ��.,,�. ,��, y _ _ � ��'�� . . _ _ _ _ _ _ _ _ , _ _ . � . __ _ ; �� . . , -- �� - � sm � , �, � _ _ _ _ �,�, h . , _ . � . . t , � �'� r � , � . � .. � , �a-� i�� . _ � i�a'.i, �i _ .. .. . . .... .. . . . . �. � �;. � � � . .... ... . ...... ... . .. . . . . .. . . . ... ._ . ...... ...... .. ... ... ... . .... .. . .. . r�' CITY OF DIAMOND BAR DEPARTIvIE'VT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT_APPLICATION PRESS FIRMLY a 0 0 0 0 w z- 0 0 z m 0 0 z 0 x w 0 I- U w 0 z 0 w 0 J D W J J LL J W d Z WHITE-Department Copy,VELI.OW-finance Cdpy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy �y�--��