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Home My WebLink About10018 f �-----� I � f CITY OF DIAMOND BAR ,� � COMMUNITY DEVELOPMENT DEPARTMENT l:% ' � _,,.,� 21660 E.Copley Drive Suite 190 � � PRESS (909)86D-3195 Fax(909)861-3117 '""' BUII.DING PERMIT APPLICATION FIRMLY 4 DDRESS�_J�/✓ ��! l��C/� 6'"'� APPLIGATIOfJ '� ,�r' PERMIT �o P/C p DATE NUMBER # � APN OT TRACT ISSUE TYPE OCC p OWNE��i`��1�� L'�r� r DATE CONST. GROUP o ADDRESS__�'�� ZONING SETBACKS w ,�: FRONT RW ❑ o CITY ZIP TE G' '" — APPLICANT TEL. REAR 17 � SIDEISIDE STREET RW Ll r� CONTRACTOR ' ""`-� SIDE Cl_ � ADDRESS -C "' p ��/�J PROPOSED USE �'✓ r�� o CITY .. ZI�!�7_ TEL.„�P1�,-�� w ARCWENG/ z DESIGNER '� ' W NO.DWEL. NO� NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL._ � u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BI:ILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENPLN OF PERJURY THAT I AM E1(EMPT FqOM THE CONIRACTOR5 U� G2f99B(CBfPOR W CENSEIAWFORTHEFOUAWIN6REASON�SEC.7D31.5BUSINESSANDPHOFES510NSCODE:ANYCIlYOq (n U COUryTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROYE,UEMOLI5H2OflflEPAIflANYSTRUG W Patio/Deck TURE,PRIOR TO ITS ISSUANCE,AL60 REOUIRES 7ME APPLICAM FOR SUCH PERMIT TO FILE A 516NE0 W STA7EMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRAGTORS ll- � � CEN&E LAW(CHAPTEFl 9(COMMENCINO WITH SECTION 7000)OF DIVISION 30F THE BUSMESS AND PR0- LL' POOUSpfl FESSIONS CODE)OR THAT HE OR 5HE IS EXEA/PT THEFEFROM AND THE BASIS FOR THE ALLEOEO EXEAIP• VTION.ANYVIOLATIONOFSECTION7031.68YANYAPPLICANTFOflAPERMITSUBJECT9THEAPPLICANTTO Z Re-Roof � ACIVII PENALTV OF NOT MONE THAN FIVE HUNORED DOLURS(5500).): Z ❑I.ASOWNEHOFTF7EPROPERTYORMYEMPIOVEESWITNWAGESASTME1R50LECOMPENSqTIqN, O COI11RiBfC18I WILL DO THE WORK,AND THE STRUC7URE IS NDT INTEN�ED OR OFFERED FOR SALE(SEC.704s,BUSI� J � NESS AND PROFESSIONS CADE:THf.CONTqACTOHS LICENSE LAW DOES NOT APPLY TO AN OWNER OF j PROPERTY NMO BUIL�S OR IMPROVES THEREON,AND WHO DOE3 SUCH WORKHIMSEIF OR HEfiSELF OR � THROUGHHISORHERONRJEMPIAYEES.PROVIDEOTHATSUCHIMPROVEMENTSAHENOTINTENDEDOii m W OFFEHFAWFSAEIFHOWEVERTMEBUiLDINGOF�MPROVEMENTIS501DWITNINONEYEAROFCOMPLE- �� TION,THE OWNER-BUILDEN WILL HAVE THE BUHDEN OF PROVING TNAT HE OR SHE DID NOT BUILD OR � IMPROVEFORTHEPURPOSEOFSALE). W ❑I,ASOWNEflOFTHEPROPERiV,AMEXCLUSIVEIYCONTPACTINGWITHLICENSEDCONTRACTORS �. TO CONSTRUCT THE DR0.IECT(SEC.706d.BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI• VBIUBIIOfl A�J.AREA W CENSELAWDOESNOTAPPLYTOANONMEROFpPROPEflT'WHOBUILDSORIMPROVESTHEREON.AND ' � WHOCONTRACTSFORSUCHPRQIECTSWITHACONTqqCTOR(S)LICENSF.DDURSUANTTOTHECONTRAG ouANrirv DESCRIPTION FEE Y TORS LIGENSE UW.). � C:1 AA1 EXEAIPTIJNf]ER SEC. 6.8 P.C.FOR THIS REASIXJ �i _ _'_' LL" DATE OWNEq_. ,_ Z � � LICENSED CONTRACTORS DECLARATION W [C 1 HEREBYAFFIRM UNDEfl PENPLTY OF PERJURY TMAT IAM LICENSED UNDEA PflOVI510N50F CHAPTER � � d 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESSAN�PROFESS!ONS CO�E.RN� Z X `X MYLICENSE IS IN FULL FORCE ANO EFFECT. — m fl /,g! . ��9 �+ ] ,/� �//� / a�j L'[� �. q � LICENSE GL,A.�5�5�/� LIG NO.__��` �� j � V DATi/Fe%t ' [� CONTRACTOR��r�?� d W � WORKERS'COMPENSATION DECLARATION -� _ � IXEflEBVAFFIRMUNDERPENALTYOFPERJURYONEOFTHEFOLLOWINGDECIARRT10P1S: N, O I NAVE AND W�LL MAINTAIN A CERTIFICATE OF CONSENT TO SELFINSURE FOR WORKERS' � COMPENSATION,AS PROVIDED BV SECTION 3�00 0F THE 1A80R CODE,FORTHE PERfOHMANCE OF THE WORK FOR WHICH THIS PERMI7IS ISSUEO. � w I HAVE AND WILL MAINTAIN YlOflKEflS'COMPF.NSATION INSURANCE.AS REOIIIRED BV SECTION Q 37000FTHE LABOR CODE,FOH THE PERFORMANCE OF TME WOHK FOH WHICH THIS VEfiMIT IS ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARqIER AND POLICV NU�BERARE: CONSTRUCTION � j CARRIER _ PLAN FlEVIEW __ __ Z caicrNUMeea __ ELECTHIC _ °�v ¢ b � � (iHSSEC110NNE�NDTBECaA6�F7EDOF7IEPERA4ilSFOFtONEM1WRED00LLAR5(tIW)ORLESS} TJMBIN� W Z I CERTIFY THAT IN THE PERFOflMANCE OFTHE WOFlK FOR WHICH THIS PERAIIT IS IS5UE0,1 ECHANICAL _ (�} SHALLNOT[MPLOYANYVENSONINANYIAANNERSOASTOBECAMESUBJECTT07HE �7,�Z � WORKENS'CAMPENSATIONLAW30FCAlIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE _�� a ��G SUBJECT TO THE WORKERS'COMPENSATION PRDVISIONS F SECTION 37000F THE UBOR k; t`i • ' 7..- � � � CADE.ISHALL/F,Q�R�THWITHCAMPLY WITHTHOS O� ISSUANCE '� �r�� __r�f- � M+��s��a�� sE � SMIP p DATE: APPLICANT. _ _�—, — — �� ENERGYP/C : Fa� a+.�F"i J WARNING FAIIURE TO CURE NC7RKEfl5'COMPENSATION COVERAGE IS UNLAWPUL,AND SHALI.BE . LL SU&IECT�NEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEIIUNDREDTHOUSAND � ��-� 8.. �- �"' DOLLARS(5700,000),INPf7DITIONTOTHEWSTOFCOMPENSATION,DAMAGESASPROVIDEOFORIN �ERGYPERMIT � SECTION 9708 OF THE LABOR GODE,INTEflE3T,ANDATTOqNEYS FEES. RETENTION FEE: d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � I MEREBYAFfIRM UNDER PENAITY OF PERJURV 7HAT TNERE 13 A CON3TRUCTION IENUINO pOENCY � FOq THE PEflfORMANCE OF THE WORK FOR WHICH 7HIS PERMIT IS ISSUE�(SEC.3087,CIV.C). -- Z W � LENDEA'SNAME__ i– LENDER'SADDRES3 ._ � C � ICEHTIFY7MR71HAVEREADTHISAPPLICATKKJANDSTATETHA77MEABOYEINFORMATIONISCORREC2 TOTAL rEES � IA6HEE�COMPLYWIT'riALLCITVANDCOIINTVORDINANCESANDSTATELAWSRELATINGTOBULLUING �� CAN5THl1CTION,AND HEREBV AUTHORIZE flEPHE5ENTATIVES OF THIS COUNTY TO ENTERUPON TNE �L z ABOVE•MENTIONE�PflOVERTY FOR INSPECTION PUflPOSES. COMMENTS 0 J � aPERAIITTEE NMIJy(� ��/' � •�; � � f 4a �� Uj SICNANRE OF P q TfE DATE . = RECPT.NO � PAID BY VALIDATION ~' WHITE—Department Copy,YELLOW--Finance Co PINK—Assessa Co GOLDENROD—File Co CaREEN— PY� PY� PY. �1pPllcanCs CoPY _.__ � .R.� _�.,.... .... _ . . y^' i-'- ..� _,.., '�=...._.___ � . .- ___i' - . .._..' _�. ��i�3��r,�-f9-.._.,�.�I� ��Q Cl ��73�i11�jZ1�T :A Im �I{� fr' �CJl . .. .._._ ..... _. � .n G] ,� I C° � �� ` r-I��r7'I . - �,; ' �I mm I Iz't!z � v� v m ��= oio'so�O�� O m ry �t� � �� I ; ,� ; �'3 q,� piy�en m�v � < �'r�'' �O�ele c.ip � � -t � a�� C's � � r. r r 'B '� m � r� G7 C: � �t � �, m "fl C �T� �-,1 S � � 1' v C� 7�,n �I-�a� ml Ix�Iainlz tn � '�I� z � �Ip . � �� , �� .�.m;2�C��77 I ,r � � -i) � � ! 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