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----�-- CITY OF DIAMOND BAR ���� � � `��� ���f t'�8�� � � � COMMUNIT`.0 DEVELOPMENI'DEPARTMENT ��, 21660 E.Copley Drive Suite 190 ������� (�r�' '� q °O" PRESS (909)860-3195 rax(909)861-3117 ti��� � .L (,.�I,�� "%"", BUILDING PE;RMIT APPLICATION FIRMLY } JOBSITE � j'�C� ,�t/)� �,� APPLICATION � 9l, � PERMIT �,(�� P/C o ADDRESS y' � ��s- " DATE V NUMBER ��' # c� ISSUE TYPE OCC APN LOTI�� T AC;� DATE CONST. GROUP p OWNFR- ,���,L,�l 1�.1 �` ADDF�SS V (`• � ZONING SETBACKS z CITY��f,�-• I��- ZIP � j TEI_ �'4- . 7� FRONT RW 7 � APPLICANT TEI_. REAR ❑ o SIDE/SIDE STREET RW ❑ ¢ CONTRACT fj ' SIDE ❑ ADDR S �` - ~ � ' PROPOSED USE � CITY�-..�'?��Z.tti ZIP 1 TEI_. �/��- �S�. w ARCH/ENG/ — �z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEI_. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BI:ILDER DECLARATION SFR/ADDlREM O p I HEREBY AFFIRM UNDER PE�ALTY OF PERJURY THAT I AM EXEMPI FR01A THE CANTflACTOflS L!- Gel'e9BIC8fPOR W CE45ELAWFORTHEFOLLOWINGREASON�SEC.7037.SBUSI�ESSANDPR9FESSIONSCWE:ANYCITYOR (n U COUN7YWHICHREqUIRESAPERl.7I77000NSTRUCT.ALTER.IMPROVE.�EIAOLISH,ORREPAiRANYSTRUC- W Pafi0lDBCk Z TURE,PRIO'.i TO ITS ISSUANCE.A150 REOUIRES THE A7PLICAN7 FOR SUCH PEFAAIT TO FILE A SIGNE� w w STATEMENT THAT FE OR SHE IS LICENSED PURSUANT TO?HE PROVISI6NS OFTHE CONTRACTORS L!- � CENSE LAW(CHAPTER e(CAMMENCING NATH SECTION�7D00�OF DNISIOIr 3 OF THE 9USINESSAND PFiO- LL' POOUSpB � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMAN�THEBnSISFORTHEALLEOEDEXEMP• (� � TION.ANYVIOLATIIXJOFSECTION7o31.5BYANVAPPLICANTFORAPERMI'fSUaJECTSTHEAPPLICANTTO Z Re-Roof � A CIVI:PENALTY OF NOT M.ORE 7HAN FIVE HUN�R'cD DOLLARS(E5o0).): 0 L71,ASOVJNEFOF7HEPROPEfiTY,ORAIV'eMPLOVEESWI7HWAGESF,STHEIASOLECOMPENSATION, � CommefCiel Z WILL DO THE WORK,AND THE STRUCTURE IS NOT ItJT'eNOED OR OFFERI=D FOR SALE(SEC.7044,BU51- _I NESS AND PROFESSIONS CODE:TI+E O�NTRACTORS LICENSE LAW DOES NOTAPGLY TO AU OWNER OF � PROPERNWHOBUILDSORIMPROVESTHEREON,AN7WHODOESSUCHWORKHIMS'cLFORHERSELFOR � [[ THROUGHHISORHEROWNEMPLOVEES,PFOVIDEDTHATSUCHIMPROVEMENiSARENOTINTENDEDOF m QOFFERE�FORSALE.IF,HOWEVERTHEBUILDINGORIMPROVEMENTISSOLPWITMINONEYEAROFCOMPLE- Z TION,hIE OWNER-BUILDER WILL HAVE TH'c 9UR7EN OF PROVING'HAT HE OFi SHE DID NOT BUILO OR � IMPROVEFORTHEPUFIPOSEOrSALE). W ❑I,ASOWNEROFTHEPROPERTV,AME%C_USIVELYCONTRACTINGIYITHLICENSEDCONTRACTORS � TO CONSTRUCT iHE PROJECT;SEC.7044,BUSINE55 AND PROFESSIONS CODE:THE CONiRACTORS LI- V31U8Ii0� ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNERDFAPROPERiYWHOBUILO50RIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR{S�LICENSE�]PURSUANTiOhIECONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEQ _B.8 P.C.FORTHIS REASON Q n /g /^'` � _ � 9 !+�'� t �.� LL' DATE OWNEft � Z W � LICENSED CONTRACTORS DECLARAiION �j � I HEREBV AFFIRM UNDeR�ENALTY OF PERJURV THAT I AM LIC'cNSE�UNDER PROVISIONS OF CHAPTER � d 9(COMMENCING WTH SECTIO�7ao0)OF DIVISION 3 0f iHE BUSINESS AND PROFESSIONS CODE.AND Z �X MV UCEN5E IS IN FULL CE AND EFFECT. m O �j � � � LICENSE C $ � '✓ LIC.NO. �� �� � V DATE�� CONTRACTO Y � W � WORKERS'COMPENSATION DECLARItTION '1 4 � • � .�� � � IHEREBYAFFIRMUNDERPENAL:YOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS: N Z Q � I HAV'c AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-:NSURE FOR WOFKEFS' S Q COMPENSATION,ASPROVI EDBYSECTION37000FTH€LABORCODE,FORTHEPERFO MA�jCE OF THE WORK FOR W IC T}�PEfiMIT I�5S SU�� / ("�� �� f �r�� wr�'6'>�f') �f� _IHAVE0.NDWILLMA�TAINW6R�2Easb`de�e n(Nd+�u CE,AS ouweosvsecrw Q 37000FTHELAB CO�E,F RTH EFFO CEOFTHEWOFNFORWHICHTHISPERMITI� ISSUeO.A1YNlO RS' O 'S IONIN R� CARRIe .7POLICYNUMBERARE: V CONSTRUCTION ¢ � CARRIER T_ PLAN REVIEW Z POLICYNUMBER ��'�� ELECTRIC ¢ (IH'�SSECT�ONNEmNOTBECOMPETEDOFTiEPERMlfISFORONEHUN�RE'JDOl1.AFiS�y100I�LESS). PLUMBING � Z I CERTIFY THA71N THE PERFORMANCE OFTHE WORK FOR WHICF:THIS PERMIT IS ISSUED,I MECHANICAL _ � � SHAIL NOT EM,PLOY ANV PEFSON:N ANY MA+IAER SO AS TO 7ECOME SUB�ECT TO THE � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANOAGREETF'ATIFISHOU!�BECOME INSPECTIONFEE ____ SUF'ECTTO THE WORKERS'COMPENSAiION PROVISIONS OF SECTION 3700OF?H'c LABOR ,r ~ COOE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE � � --� �, �-�, � SMIP p DATE: APPLICANT. ��-- J WARNINGFA1LUflETOSECUREWORKERS'GOMPQJSATIDNCOVERAGEIt3U1.LAWFUL,AN�SHALLBE ENERGYP/C � SU9JECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIYIL FINES UP TO'JNE HUNDRED THOUSAND � i•� DOLIARS(5100,OOOI.INA'JDITIONTOTHECOS70FCOMPENSATIO�,DAW�GESASPROVIDEDFORIN ENERGYPERMIT ___����_��� � SECTION 370B OF THE LABOR CO�E,INTEREST.AhD ATTORNEV'S FEES. RETENTION FEE: _ � CONSTRUCTION LENDING AGENC�Y PRE-ALT FEE: O � IHEAEBYAFFIRMUNDERPENALTYOFPERJURYTHAiTHcREISACONSTRUCTIONI'cNDINGAGENCV � FOR THE PERFORMANCE O�THE WORK FOR WHICH THIS PERMIT IS ISSU=D�SEC.3097.CIV.C.�. Z W _.__ � LENDER'S NAME _ !— LENDER'S ADDaE55 __ __ � ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIOVISCARRECT. TOTAL FEES i W I AOREE TO COMPLY WITH ALL CITV AND COUN7V ORDINANCES ANO STATE UWS RELATI,�G TO BUIL'JI�G � CANSTRUCTION,ANDH ,EBVAUTHOP2EREPRESEN7ATIVESOFTHISCOUN'VTOENTERi:POYTHE --_ ZA80YE�MENTIONED P ERTY FAR INSPEGTION PURPOS'e5. 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