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CITY OF DIAMOND BAR � '' ' -- — DEPARTMENT OF COMMUNITY dz DEVELOPMENT SERVICES 216b0 E.Copley Ihive S�dte 190 (909)860-3195 Fax(909)86I-3117 PR�$$ ����°? BUD.DING PERMIT APPLICATION FIRMLY oy JOBSITE �2� �� �DG��JD�L �Q/7 APPLICATION �NUMBER_� �/C ADDRESS J � '' DATE+� � APN LO� TRAG'f DA EE N I L �� TMPE OCC CONST. GROUP �j OWNER � �CJ/LS G/�,/�C:.�/�- ADDRESS<<f39 N. _ �9�C� ,�D ,_ ZONING SETBACKS �8 CITY�D//4/yl��ty!/�At� ZIP TEL. REAR Rw ❑ APPiICANT '��• SID�JSIDE STREET RW ❑ CONTRACTOR %' �t! SIDE ❑ g ADDRESS CITY ZIP�jy�G, TE PROPOSED USE � � ARCH/ENG/ `o DESIGNER NO.�WEL. NO. NO. ADDRESS UNITS STORIES ____�___BEDROOMS � CfTY ZIP TEL. � �n DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ApDlREM O I HEAEBY AFFlRM MIDER PENKTY OF PE�WRY THAT I MI EXEMVT FROM iHE OONTRACTORS LF Garege/Caryort C9VSELAWiORTlfEFOLLOIMNGREAAON(SEG.TWI.6BUSINESSAN�PIWFE5SIONSCOUE:ANYCITVOR (n COUNiYVlM1i1CHRE0UIRESAPERNR7000NSTRUCLALTE0.MPROVE,DEMOLISN,OqREPAIRANYMRUC- W pgtIONBCk 711NE,►RqR lb RB IB5UANCE,ILL90 REOUIRE9 hIE APPLICANT FOR BUCH PEFMIT TO FIL@ A Si(iNED 6TATEYEM 1W�T NE Oii BFIE IS LICEN6ED P111i5UMR TO THE PHOVISIONS OF THE CONTRACTORS U- CENSEtAW(CNAPTER Y(C04MENCMO NATH BECTION 70a010F DIVISION 30F lHE BUSINESS AND PR0. � P��PB FESSpNS CODE)Op TINTME OR SHE 18 EXEMPT 7HEREFR]MAND iNE 6A315 FON hIE�1LLEOED @%EMV• TqN.ANYVIOLATqNOFSECTION7Rt1.6BYMIYACPLICANTFOMAPEPYRSU9JECTSTNEAAPLN'.ANTTO Z Re-Roof � ACMLPEWLLTYOFNOTMOREhW7FNEHUNDHFAOOLUNSµbao�.): � ❑I.ASOIMIEAOFTFIEPNOPENII:ORMYEMROYEESWITXWAOESA9THEIRSOLECOMVENSATqN, � COrtfmB�Clel � WILL DO TME WOW(AND TIIE STqUCTUNE IS NOT INTENDE�Oq OFFERED FOq BAIE(SEC.fou,BUSI- J UESS A!m FROFE9310N5 OODE THE CONTRACTOR9lICENSE UW DOES NOTAPPLV TO NI OWNEH OF � PROPERfYNA108U0.DSORIAPROY[9TNEqEp1,ANOWNO00E96UCHWOfiKHIMSELFOHNERSELFOR = � 71tl10UOflWSOHMERONMB�IROYEES,PROVI�EU7NA7lUCHMPqOVEMENTBARENOTIHTENQEDOR m �FERED iDR BALE tF,HOWEYER,7HE BUII,pNa OR IMPpOVBAENT IB 601D WRXIN ONE YFAR OF COMPLE- TION,711E OWNER�UILDER MIILL NAVE 711E BlIROEN OF PROVIN[i TUT HE OR 8HE DID NOT BUIID OR YPROVE FOR THE PURPOSE OF 6ALE�. ❑4 FS OWNER OFTNE PROPEiT'�AN EXGUIBNELYCONiRACTINO W17M IICEN5E0 CONTRACiORS � 70 CONSTAUCTTME PRO.IECT�BEG 7W,BUSINESS Mq VROFESSIONS COOE:7HE CONTRACTORS U- VgWetIM S�X7O ADJ.AREA CENSE LAW COES NOTMPIYTOAN OMMEH OG A PPOPERfY WHO BUMDS OR MPiqVE3 THEAEON,NID WFi000NTRACTBWqSVCMYROJECBWI7Hl100N�RACfOR[5)L10EN9E�PUIISWN�707HEOON7HAG q�qM�7y DESCFIPTION FEE � 7CIRSUCEN6EUW.). ❑IAM EI�YPT LINDER SEC. B.L G.C.FOR TWS REASON � U LL � DATE OWNER V � � IICEN5ED CONTRACTORS DECLARATION W � I HEREBYIIFFIRM UNDER iENALTY OF►ERN/RY T1iAT 1AM LICENSED UN�ER PROVISIONS OFCFI�P7ER �i �(ODAIMENGpKiNATNSECTION7O0o1�DIVISI0N30FTHEBUSINESSANDPROFE5510NSCODE.AN� Z MY 11GEN5E IS IN FULL FORCE AND EFFECT. m 0 UCENSECLAS LIC.NO. / j � pATE CONTRACiOp � 4 WORKERS'COMPENSATION DECLAHATION �/� t � "' Ih V � I NEREBY AFFlRM UNDER PENAL7V OF PERIURY ONE OF TNE iOLLOWINO GECLAM7qN5� I r Z � �_IWIVEANDWILLAUINTNNACEii7�FICAiEOFCON5EN7TOSELFaNSUREFORWORI(EFS' _ OpAPENLATqN,AS PflOVID�8Y6ECT70N�'/o00FTHE LABOfl COOE fOfl TNE PE7iF9RMANCE �U Q THE WORK FON NMICM 1HIS VERMIT L4�59UE�. � HAVE AND N7LL AUIINTAIN WORKERS'COYPENBATION NSURANCE,AS HEOUIqED BY 9ECTIDN ^ ///'''��� 1 � e70D OF iME LA90R CODE,PDR TFIE iEflPDRMANCE P TME WORK FOR WMIpi iMIS PEHM1713 �( `/�) � IS3UED.MYWORIf ENSA SURAN HRIERANDPOLICVNUMBERApE: CONSTRUCTION l=�� / V � CAANER ��.� � �'`� PLAN REYIEW � POLICYlNIMBER7��j�,/��L,/ � EIECTRIC ' / / 7 l r+ (MssEct�oNPFIDNo7eE0p.RE�aFnEPFFMrswaa+EFA�o a�oaLES6y PLUMBING 8 1 CERTIFY7HA71NTHE PERFORMPNCE OFhiE SNORK FOR WNCH THIS PERAAI7161SSUED,1 MECHANICAL '� 6FWJ.NOTEMVLOYANTPEHSONM1iWYMANNERSOASTOBECOMESUBJECTTOTHE y WORKEi1S'COMVENSATpNUW50FCALIFORNIA,ANOA(3REETHA71FIbFKri1LOBECOME INSPECTIONFEE S &16.lECT TO THE WORKERS'OOIAPEN9� N PROVISIDNS OF 6ECTION S7o0 0F THE l/BOR woe,i H comHwmi caMr�r �SE PHOVI51 ISSUANCE p �A APPLICA : SMIP � WAHNINO:FAILUflE TO SECURE YYORKEH9'CAMPENSATION COYERMiE IS UNIAWFUL,M1D 6FULLBE ENERGY P/C � SUBJECTMIEMPLOVERTOCRIMWALPEWILilEBANOCIVILFWESUPTAONEHUNDREDTHIXI3AND ENERGYPERMIT OOLLAR9(i100,OW�,Hi AODITION TO THE C0.9TOf COMPENSATION.DAMAOES AB PROVIDEU FOR W � BECTIDN 97u90FTHE LA60H OOOE.NTEHEST MDAiTORNEY'6 FEES. p�ENTION FEE: OCONSTRUCTION LENDING AGENCV PRE-ALT FEE: � INENEBYAFFIRMUNDEflPENALTYOFPERAIRYTNATTMEREISACONSTRl1CTION6EN�W�AGENCY WRTHE PERFORMANCE OFh1E NfORK FOq WNICNTHIS DERANT IS ISSUED(SEC.90Y7.CIV.F�. . � � LENDEH'S NAME � � LENDER'SAOORE55 � ICEIiTIFVTNA7IHAVERFJ�THISAPPUCATIONANDS7ATETrMTTHEABOVENFOiWAT10fiISODRRECL TOTML FEES �� � � 1 AOREE TO COMPLY N7THALL CT'AND COUN7V OR�INANCE6 ANO BTATE UWS RELATINO TO BULDINO 'R GONSTRUCiION,ANONEHEBYAUTIpRIZEREPRESENT�T1VE50FlN1$COUNTYTOENTEflUPON711E `��. ABOVE-MENTIONE�OIWPERfY FOR INSPECTqN VURPQSES. \ COMMENTS � e� m PE NM�E(PRI ' Q �. v � pN E � D � HECPT.NO. PAID BY VALIDATION WHITE—Deparbnent Capy,YELLOW--FNance Copy,PINK—Asaessor Copy,GOLDENROD--File Copy,GREEN—AppliaanYa Copy : . , � , . �� . , . � < . � , � . , , . . . , , . ...„ . - �.� CITY OF Dl�N9C)NtD BAR �rv�pEc�ior� ��co�� . , ,_._ - � . Y . _ �..�,. t + , t, • � •. E E � • �� __ ,.._..-------------' . ' . ' '. '_ .,;.;,. 5ET BACK � � ` I �LOOF�J015T , --------- - ' ------ -- -- --------._.. -��__- -- _ - FTGSIFORMS/SSE�L ---- -------- I_l FNA i�E(�h47S----4^_�._. ---------------- -----.--------_--------.........._..__.._. ELECTRIC GRUUND - . � UNDER FLOOR DUCT ----_�___._ _—_-�- ---- ----�----._—..__.-•-- ---- ._..� -- —�_.._.......-----......_ GROUND PLUM�I�JG_�_ __ UNGER FLOOR CUt�!qUIT__;_ � _ r_`.. _--- -�------------ --- --- SLAB GRA�3E __ j __ i �� FIREPLACE FOUNDATION �_ _...__.__.._.. -----__ �_�--__----------------�---.-...--.- ---..�_. J..____._..----...... 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