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- eIT1 JF DIAMO:�ID BAR
► ^----� --� DEPARTMENT OF COMMUNI DEVELO E SERVICES
21660 E.Cooley Drive Suite 190
(909)860-3195 Faz(909)861-3117 PRESS
'�TM' BUILDING PERMTT APPbICATION FIRMLY
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DIAMOND BAR
44i*
JF DIAMOND BAR
DEPARTMENT OF COMMUNI DEVELO E SERVICES 21660 E. Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
PRESS FIRMLY
JOBSITE
ADDRESS leo 5-,64 I)b r; iti_t
APN LOT TRACT -
OWNER R. f II,4176 Sp ugij -
ADDRESS 1 4 n -5 S Le lire
i-it t
CI TY - ZIP '7Ar-TEL 164-plg-ii i 7're
APPLICANT ft,„A, TEL.
CONTRACTOR
ADDRESS
CITY ZIP TEL
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER-BUILDER DECLARATION
-X
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I Am EXEM.T FROM THE CONTRACTORS Li.
CENSE LAW FOR Ti4E FOLLOWING REASON(SEC 7931 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR
ODUNTY WHICH REOUIRES A PERMITTO CONSTRUCT ALTER imFROVE DEMOUSH oR REPAIR ANY STRUC.
TURE. PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FoR SuCH PERmiT To PiLE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PRovISIONS OF THE CONTRACTORS LI-
CENSE LAW(CHAPTER 9(COMMENCING waH SECTION 7000)OF DIVISKTN 3 OF THE BUSINESS AND PRO.
FESSIONS CODE)OR THAT HE OR SHE IS EXEMETTHEREEROLI AND THE BASiS FOR THE ALLEGED EXEMP-
TION ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A.FPM^T SUBJECTS TNF APFLICANT TO
A CIVIL PENALTY OF NOT mORE THAN FIVE HUNDRED DOLLARs(3500))
*LAS OWNER OF THE PROPERTY OR k. EmPLOvEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FoR SALE(SEC 7344 BUSI
NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LA. DOES NOT A Po),_y To AN OWNER OF
PROPEFfTY WHO BuiLDS OR PAPPOVES THEREON AND WHO DOES SIJCH wORK HimSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SL CH mPROVEMENTS APE NOT INTENDED OP
OFFERED FOR SALE IR HOWEVER THE BUILDING OR PAPROVE' (ENT-IS SOL))N/1'1+N ONE YEAR OF COMPLE.
TION.THE OWNER.BUILDER wiu_HAvE THE BURDEN OF IIIPCB/iNG',NAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE 0.SALE)
0 I AS OWNER OF THE PRO.ERTY AM EXCLUSIVELY CONTRAcT)Na WTI-,tICENSED CONTRACToas
TO CONSTRUCT THE PROJECT(SEC 7344 BUSINESS AND PROFFSS)ONS CODE. 1.00 CCATPACTOHS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A OEIOEFRTY W-0 P,.^IP,'OP HAAPPCA. ES T1,4FISON AND
WHO CONTRACTS FOR SUCH PROJECTS WiTH A CONTRACTOP.S,'ICENSED ELEsu A NT 70 THE. CONTRAC-
TORS LICFNSE LAW)
r:,I Am EyPKAPT UNDER SEC L)„ .0 FOP TNIS REASON
DATE OIANEP
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LICENSED CONTRAC,TOPS DECLA,lATON
I HEREBY AFFIRM UNDER PENALTY 0. PERJURY 7A-AAT I 41.4 LICE'AEE UNDE-PROVISIONS CE C.-IA' EF
9(COMMENCING WITH SECTION Tom OF DIVISION 300 THE 105 r.:SS A' r,050FES3t35). COET AN'D
MY LICFNSE IS AN FI ILL FOPCE AND EFFECT
LICENSE CLASS L..T. N.;
DATE r-N-otr,-..•,,,,
WORKERS COMPENSATIO'4"DE 71 40,L"'I-.)'•
I HEREBY AF.IRm UNDER PENAI TY OF PFP.J Ps ONE OE T.- r.-. .--,:,,.^r,qC„A-CAAS
I HAVE AND WILL MAINTAIN A CFRTIMOL-E OF COW-EN "T"AA,A s 7,45 F,WO.PA FRS
COMPENKATiON AS PPOVIDED BY SECTION,,,,,nE",-, .AECP(-ccE PCP"PP P.PP,PPANCE
OF THE W0,'AOR WNI^I.TN, PFP4,11'IA IAA AO
I HAVE Av7,WILL MAINTAN WORVERS.CAOMPFNAAT oN NCI PAN-- E•-• REC. • PE-Pv".J.1N
„,,,,Pic THE LAGOP CCA)P =CP-PE P,PAA":,,)..,07 i., -'-...-: I,�.... .. ....... ^ .- ^,,,,,
1SS,IEG MY WOPKqFS CO'APENEA,cs., NC N.A.:. 2 AAAA-,A- - AT. N Ik/,,,_=t=,
CARRIER
POLICY NA BABER
(THISSEGTON NEE/ NOT PE C.CAMPLETE,T. -,.. PEPM7 E E-P Co,E..',1 ...,-:-.),-,y),E,.;,^),cPLEEs)
I CERTIFY THAT IN THE PERFORMANCE 0= 'rl-ir,W0,-,,'"...•,-,,-n, ”, •,..,'... ,I, '
SHALL NOT EMPLOY AN), FE.KoN (N A)), .,-O,,,OJ3 .---.3 A= "; -.:775,0• . FI-T--
WORKERS COMPFNSATION LAws op,c k. FA'APA,A A'4".. ,-,,,--,,,,e , t;...in,
SUBJEC" PCP"HE WIRI<PP A'OOMPFAAAArAN,0,,,,,,,,,,.." rl,"-, .",,,„r,--c. -Nr. "100
conE i AHA,i coR-H,/,TH cow,Y W,TP,n,C p,C,
DATE APPLICANT
1
1 WARNING FAALURE TO SEcuEE O.1000E05 COMP.,,,A 6-',0,1 '..-.-.1.',, 1 N.AV,„ nr.r,-,A I".E
. SUBJECT AN EMPLOf ER TO(-P4A,NAI pENA,cs ANC)CIVIt p^Ncs 1 P 71',CPN2 HUNDPFD TP..CLEAN-
GOLLAPS :Von Goci IN AOcATIoN TO 7,E C C;-r-^^,5"7• , - _,..., -,50 v. 0.,,-r.., ... r. .
ISECTION -IT,r)E y,-,E1,1cR—37E'tm-E-PFS-A• ^A---;'� r, - I A
CCIVGEP,t1,7,T;0^1 LF NCI',-7: EilE5:0�I
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. I HEREBY AFFIRM UNDER PENALT,OF'ERJUPY 35.4'I.EEE t D :,CO3 BL.D- 1,t_,.,"),.,",AGENC,
• FOR THE PERFORMANCE(0 Tr-E....,cop'NE.,-,-„ -cc,- -- ,cp,,AEP, - ,-„
A-
. LEIB'S NAME
. EEVEI E R S ADDRESS
E
i I CERTIFY THAT I HAVE REAI)THs APOI OA7,Or,ANr'-ATE"cIA""--=A= .7„',..q4","..."--,,,,ts cOPPECT
. I AGREE TO COMPLy wiTH ALL cc',AV/J.O.'i',nP."',14,'ES '5 A-A— , ..3 Pr t�-,I,"'D I-I_".I"
CONSTRUCTION AND HEREBY AUTHOR,ZE REPRESENTATN35 C'Tr. E. CL,,,-.- TO,EN"E-' ((PS�, 771E
3 ABOVE-MENTK)NED PROPERTY EGP NCR= -.-InN F),
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A, 1•74-13
1 PERHiTT. NAME,PRINT) •
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APPLICATION5I49
DATE
C(0 PERMIT ir-4,41C,P/C 60 44-62.
NUMBER
ISSUE
DATE
fI TYPE OCC
10151C CONST GROUP
FRONT SEfBACKS
ZONING REAR
SIDE RW
SIDE/SIDE STREET RW _
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N0. PROPOSED 4IP
UNITS A ,0O111LAull 4 IP.-,41fr 4111
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Garage/Carport 1
Patio/Deck 1
PooVSoa _I
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Valuation q 1 c(ri ADJ AREA
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, ENERGY PiC
ENERGY PERMIT
RETENTION FEE.
PRE-A T Fk, -4-XiTirr-
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TOTAL 3 We-.5,
COMMENTS FEES if 40 A. . ...
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RECPT NO illial PAID BY MAIM WO VAUDATION it;
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