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�� CITY OF DIAMOND BAR BLP(d '�i
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)86Q3195 Faz(909)861-3117 PRESS
-�'A�' ` BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE APPLICATION PERMIT �C. �(� P/C
¢ ADDRESS �ni n Si lvar Aawk l�rive 3lliLtS DATE 7/22/99 NUMBER � . ti
c�� ISSUE TYPE OCC _
APN LOT TRACT ��e�� DATE CONST. VN GROUP
°C OWNER Silver Hawk
0
`l ADDRESS 2010 Silver Hawk Drive ZONING SETBACK�iSt See Plan
I � CITY ' ZIP TEL. FRONT RW ❑
APPLICANT No an rE�8.18-22 - 961 REAR ❑
SIDE/SIDE STREET RW ❑
� CONTRACTOR • lm er an SIDE ❑
p� ADDRESS a.tLtrll treet
� CITY Brgg ZIP�,$�]' TEL.�1 G._S7Q—�7,,1 PROPOSED USE S2IT12
w ARCH/ENG/
o J.M. Nolan
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� CITY ZIP TEL.
y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUIIDER DECLARATION SFR/ADD/REM
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� I HEREBV AFFlMI UNDER PENALTY OF PE0.NRV 7HAT I MI EXEMPT FROM THE CONTMCTORS LI- GBfHJB/CefPOh
W CENSEUWFORTMEFOLLOWINGREASON(SEC.7031.58USINESSMIDPHOFESSIONSCODE:ANVCI7YOR (n
C..� COUNT`/WHICHREIXIIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W P8i10/DBCk
W NRE,PHIOH TO ITS ISSUMICE,/�LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMEM THAT HE OR SHE IS IICENSEO PURSUANT TO THE PHOVISIONS OF THE CONTMCTORS LI-
� CENSE UW(CHAPTEH Y(COMMENCIHO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpB
FESSpNS CODE)OR THAT HE OR SHE IS EXEMPT 7HEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
�l TpN.ANV VKK.ATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SU&IECTS THE APPIICANT TO Z Re-Roo1 I,
� A CIVIL VENALTY OF NOT MORE THAN FIVE HUNDRED DOLWRS(5500).): ��
❑I,ASOVMEROFhIEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � Commerciat
MALL DO 7HE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704/,BUSI� J
� NE55 AND VROFESSIONS CODE:TNE CON7RACTORS LICENSE LAW DOES NO7 APPLV 70 AN OWNER OF � Re a ir s r lan avera e + $5 7 S 0/ er un Zt
PROPEHfY WIIO BUILDS OR IMPROVES THEREON,AND NMO DOES SUCH VIORK HIMSELF OR HERSELF OR
� 7HROUGH NIS OR HER ONM EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMEN75 APE NOT IN7ENDED OR m 7
Q ,OFFEREDFORSALEIF,HOWEVER711EBUILDINGORIMPROVEMENTISSOIDWITHINONEVEAROFCOMPLE� ,X3 - �172SO I
Z 'TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVIN�THAT HE OR SHE DID NOT BUILD OH
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w ❑I,AS OWNER OFTHE PROPEHfV,AM EXCLUSNELY COMRALTINO WITH LICENSED CONTMCTOHS
[[ TO CONSTRUCT THE PRQIEC7(SEC.7oa1,BUSINESS AND PROFESSIONS CODE:THE CANTRACTORS LI- Va1118t1Of1 .AREA
W CENSEUWDOESNO7APPlVTOANOWNEROFAPROPERTYWHOBUILD50RIMPROVESTHEREON.AND
� MR7000NTRACTSFORSUCHPROJECTSWIiHACOKTMCTOR(S)LICENSEDPURSUANTTOTMECONTRAC QUANTITY DESCRIPTION FEE
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0 O I AM EXEMPT UNDER SEC. B.L P.C.FOR 7HI5 REASON Q
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DATE OWNER � .
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�Q LICENSED CONTRACTORS DECLARATION W
LZ I HEREBYAFFIRM UNDER PENILTV OF PERIURY THAT I AM LICENSED UNDER PF70VISIONS OF CHAPTER �
� Y(COMMENCINO WITH SECTION 70ao)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS COUE,AND Z
�� MY LICENSE IS IN FULL FORCE AND EFFEC7.
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� UCENSE CLASS LIC.NO. "� J
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� WORKERS'COMPENSATION DECLARATION ��� -�
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� I HEREBY AFFIRM UNOER PENALTY OF VERIURY ONE OF THE FOLLOWING DECLARA710N5: Z
� I IUVE AND WILL MAINTAIN A CERTIfICATE OF CONSENT TO SELF-INSURE FOR M/ORKERS' $ - � ' � '
� COMPENSATION,AS PROVIUED BY SECTION 370o OF THE UBOR CADE,FOR THE PERWRMANCE U
OF THE WORK fOR WHICH 7HIS PERMIT IS ISSUED. � � O
� � ' .
w �(/� I MAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION
Q /' 37oa Of TiE LAHOR CODE,FOR TN��PERf-0HMMICE OP THE WORK FOR WH16H THIS PERMIT IS�, - r , . . , � , .J � .
� ISSUED.MY KER PENSATI NSURANCE�CARHI�RANDPOIICY,NUMBERARE: � .CONSTRUCTION� � �'
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ZP�OLICVNUMBER` .,,��, �: � ELECTRIC+";� , .'�"'.. �..'..�.. �", . - .. .i:�� _ :,�.
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Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS�PERMIT IS ISSUED,1 MECHANICAL
(} SHALL NOYEMPLOY ANY PERSON IN M1Y MANNER SOAS TO BECOME SUBJECT TO THE •, ' � , q , •
� WORKERS'COMPENSA710NUWSOfC�LIFORNIA,ANDAGREETHATIFISHOULDBECOMEi��� ��INSPECTIONFEE � -� ' ��
SUBJEC7 TO THE M/ORKEFS'COMPENSATION PROVISIONS OF SECTION 3700 OF 7HE LABOR ��' �.5 UD
� CODE, SHALLF RTHWITHCOMPLYWIhIdHOSEPROVI510N5. � ISSUANCE . _ , ��"
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p DATE:1�f��� APPLICANT: �SMIP �' �r r.a n 1 ,�, �._ .
w ' ENERGY P/C � � "
J WAfiNING: AILURE SECURE YARKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALI BE - - - �
� SU&lEC7 AN EMPI.OYER TO CRIMINAL PENALTIES AN�CIVIL fINES UP 70 ONE HUNORED THOUSAND ENERGY PERMIT �L��v���a �t��`��
DO�URS(5700.000),IN ADDITION TO THE COST OF COMPENSA710N,DAMAGES AS PPOVI�ED FOR IN
J SECTION 97oe OF THE LABOR CODE,INTEtiEST,M!D ATfORNE1^S FEES. RETENTION FEE:
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d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: . � �
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� I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT 7HERE IS A CONSTRUC710N�EN�ING AGEHCY
n- FOR THE PERFORMANCE OF 7HE WORN FOR WHICH THIS PERMI715 ISSUEO(SEC.3097,CIV.C.). � � �
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� LENDER'S NAME
F— LENDER'SADDRESS
� I CERTIFV THAT I HAVE READ THIS APPLICATION AN�STATE THAT TME ABOVE MFORMATqN IS CORRECT. TOTAL FEES � �
w I AGREE 70 CAMPLV V.7TH ALL CI7Y AND COUNTY ORDINANCES AND STA7E UWS REU7ING 70 BUILDING
� CANSTRUCTION,MID HEREBY AUTHOPIZE REPRESENTATIVES OF THIS COUN7V 70 ENTER UPON THE �
z ABOVE�MENTIONE�PROPER7Y FOR INSPECTION PURPOSES. COMMENTS �
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PER EENAME(PRINT)
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� SIG ATURE OF PERMITTEE D E � P Y (./
= RECPT.NO. PAID BY VALIDATION
~ WHITE—DepaAment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy
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ROOF SNEATHING ; 8 FT. BOND BEAM . �
FRAMINGNENTILIATION FINAL BOND BEAM
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