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Home My WebLink About17453 �'�S�-��--� ._.�—. � CITY OF DIAMOND BAR DEPARTMENT OF COMMUNTI'Y 8c DEVELOPMENT SERVICES 21825 E.Coplay Drive '"" (909)860-3195 Fa�c(909)861-3119 PRESS ""%.q�^' BUILDING PERMIT APPLICATION � FIRMLY o ADDRIESS��Q Q� ��li�(n U V�� DATE CATION 'J O NUMBER `�` `�� #C �`� l ! o� ISSUE TYPE OCC APN LOT�TRACT S DATE ' � "� CONST. GROUP p OWNER �M_�L�i_FJM� " ADDRESS ZONING SETBACKS Z CITY �I�� {�K ZIP TEL FRONT RW ❑ o APPLICANT TEL. SIDE/SIDE STREET RW ❑ z � GONTRACTOR SIDE ❑ oCDDRESS�? Z ZIP TELt PROPOSED USE f� '� � w C ENG/ 't � �� z SIGNER �I �y�� i �" �� , q , NO.DWEL NO. NO. a ADDRES �� a- ._ �� v� � i ti �' -�-�1'alt L �--=;_, �-�r� UNITS STORIES 6EDROOMS � CITY � �� Z�IP� � TF�L.� � cn J " � DESCRIPTION SQ.FT. FACTOR PSF J.AREANA UATION Q OWNER-BUILDER�ECLARATIOI�' SFR/ADD/REM � ' �,' O p I HEflEBY AFFIRM UNDER PENPLN OF PERJURY THAT 1 AM EXEMPT FROM THE CONTiiACTORS LI- G8ffl90/CflfPO1I Z�j 'M W CENSELAWFOfiTHEFOLLOWINGREASON(SEC703156USINESSANDPROFESSIONSCODEANVCITVOR (n U COl1NiYWMICHREDUIHESAPERMIT5000N5TRUCT,AL7ER.IMPROVE.DEMOLISH,ORREPAIRANYSTRUC- W Paho/Deck �7 ,, � , �' �/ W TURE.PFIOR TO ITS ISSURNCE.ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w O✓ STATEMENT THAT HE OR SHE IS LICENSED Pl1RSUANT TO THE PROVISIONS OF THE CANTqACTORS ll- � GENSE LAW(CHAPTER 9(COMMENpNG WITH SECiION��0)OF OIVISION 3 OF THE BUSWESS AND PRO- � POOVSPfl FESS�ONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� � TIONANVVIOLATpNOFSECTION70315BVANYAPPLIGANiFORAPERMIT5U8JECT5THEAPPLICANTTO Z pe-Roof ACNIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(t5o0)) Q ❑I,ASOVJNEROFTHEPROPERN,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COfI1fi10fC12I Z WILL W THE WORN,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044,BU51- J � NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER Of � PROPERTY WHO BUILOS OR IMPflOVES THEREON,AND WMO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGHHISORHEROWNEMPLOYEES,PROVIDEDTNATSUCHIMPROVEMENTSARENOTMTENOEDOR m OOFFERWWflSALEIF.HOWEVER.THEBUILDINGORIMPROVEMENTISSqDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUILOER WILL HAVE THE BUR�EN OF PROVING THAT HE Ofl SHE DID NOT BUILD OH � IMPROVEFORTHEPURPOSEOFSALE) � W ❑I,ASOWNEflOFTHEPROPERTY,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS Q TO CANSTpUCT THE PROJECT(SEC.7044,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- VdIl18I1011 DJ AREA W CENSELAWDOESNOTAPPLY70ANOWNEflOFAPROPEHNWHOBUILDSORIMPflOVESTHEREON,AND � WHOCONTPACTSFORSUCHPROJECTSWITHACONTRACTOq�S)UCENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW) � ❑I AM EXEMPT UNDER SEC B 8 PC FOR THIS REASON Q � U LL � OATE OWNER U � LICENSED CONTRACTORS DECLARATION W ¢ � I HEflEBY AFFIRM UNDER PENALTY OF PERJUflV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � 9(COMMENCINGWITHSECTION7000�OFDIVISION30FTHEBUSINE I�Pj1oFE�SI�O�E,AND � �� MY UCENSE IS IN FULL FORCEAND EFFECT. I �� • m �S� �r � UCENSE CLASS LIC NO J H ~ DATE �L��,CONTRACTOR � d � y VFD ERS'COMPENSATION DECLARATION 1�i�'1�� a � IHEREBYAFFIRMUNOERPENALTYOFPERJURVONEOFTHEFOLLOWINGDECLARATIONS U UJ a 0 I HAVE AND WILL MAINTAIN ACERTIf�CATE OF CONSENT TO SELFINSURE FOfl WORKERS' _ CQMPEN5ATION,ASPROVIDEDBVSEC710N37000FTHELABORCODE,FORTHEPERFORMANCE U ¢ OF THE WORK FOR WHICH THIS PERMIT IS ISSUE� � � � _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASRE�UIREDBYSECTION ��+,�'�d�� Q 37ooOFTHELABORCODE,FORh1EPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS �� ISSl1ED MY WOPKEFS'CAMPE ISATION INSUflANCE CARRIEP AND POLIGY NUMBER ARE CONSTRUCTION j ' I .��fl� �S • PLAN REVIEW n � CARPIER /�7 Z POLICYNLIMBER �G AL�Dy ELECTRIC , �=__4±'`�� 4 (fHISSECTIONNEmNOTBEOJM%FfEDOF7HEPEFiMRISFORdJEHUPDREDDC�LPAS�S�W)aRLESS) PLUMBING " �',� �• �/�{�J Z I CERTIFYTHAT INTHE PERFORMANCE OF THE WORK FOR WHICHTHIS PEFMIT IS ISSUED,I MECHANICAL �� lf�t/ �} SHALL NOT EMPLOY ANY PEfl50N IN ANV MANNER SOAS BECOME SUBJECT TO TH& � WOPKERS'COAAPENSATION LAWS OF CALIFORNIA.AND A EE THAT IF I SHOULD BECOME INSPECTION FEE = SU&IECTTO THE WORKERS'COMPENSATION PROVISION F S[CTION 970o OFTHE LA90R ISSUANCE CODE,I SHALL FORTHWITH COMPLY WITH THOSE P S � � SMIP � p DATE APPLICANT W ENERGY P/C ' � J J WARNING FAILURETO SECURE WORKERS'COMPENSATION CAVEFAGE IS UNLAWFUL,AND SHALL BE - '-t- J �� y SUBJEGTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFlNESUPTOONEHUNOREDTHOUSAND ENERGYPERMIT � \� DOLLARS(5100,00��.IN ADDITION TO THE COSTOF COMPENSATION,DAMAGES AS PftOVI�ED FOR IN �� SECTION37080FTHELABOPCODE.INTEREST.ANDATTOflNEV'SFEES RETENTIONFEE: � CONSTRUCTION LENDINGAGENCY PRE-ALT FEE. '�- � O i � IHERE9VAFFIRMUN�ERPENALTYOFPER�URYTHATTHEREISACONSTRUCTIONLENDINQAGENCV -e FOR THE PERFORMANCE DF THE WORK FOR WHICH TNIS PERMIT IS ISSUEO(SEC.3097,CN C) L`l.////;;; W `�0/ � LENDER'S NAME �s�� F— LENDER'SADDRESS r � ICEflTIFYTMATIHAVENEA�7HISAPPIICATIONANOSTATETHATTHEABOVEINFORMATIONISCORRECT TOTALFEES ,�j�q"� C,��, 1 � IAGREETOCOMPLVWITHALLCITYANDCOUNTVORDINANCESAN�STATELAWSFELATINGTOBUILDING �/L CONSTRl1CTION.AND HEREBY AUTHORIZE FEPRESENTATIVES OF TNIS CDUNTV 70 ENTER UPON THE ZABOVE�MENTIONED ROPE.Q FlTVFOR�NS��URP 5�� COMMENTS — 1 \ o �ur�t� - m PERMITTEEN E(P NT) T �,y� I �� G"/ a ��C � � � � � SIGNFTUR RMI �/�'�! . DATE _ ` RECPT.NO PAID BY VALIDATION ~ WHITE—Department Gopy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy , 7/G 6Z.. �..-` �"'�,, _ A J _" " ` -» _ ��/�� ... _.. , ��j ��Z .� ..� - f✓�� f_,... � - __ - __ � �� _.. _ � - - � �J �� !� m P[�` QfibS ,� �'-��.,�c5 �t� �c-c�°i 4t�'�Ib�"`�a . ��'�Ur.�3or� rwc.ssc-�� d.�,u�-`� Sr�:t�„ .. _�_r _ 3i��.� Cal�.a�$c-M�'t�5 a� �D � 5�{� �-'��(z��Z —_ . . q W��.�L ��,�x.. c��.�y �r p�a� � _._ -- -- �j ,5 a 2— � � ��-n-- � `�P �'1.C_ � .... -- , �� '�" ��`�� r ��ll��j� - - C �„�_ CITY OF DIAMOND BAR DEPARTMENT OF COIvIIviIJNITY 8c DEVELOPMENT SERVICES 1 - 21825 E.Copley Drive PRESS (909)860-3195 Fa�c(909)861-3117 � '"", BUILDIlVG PERMIT APPLICATION FI R M LY � JOBSITE APPLIC O PERMI7 P/C o ADDRESS �`�� E-'�`��r C�.�+�cc� DATE d NUMBER lq��2 # � APN--�LOT��_ TRACT DA E� U3 ONST. GROUP p OWNER hth��YjP !o � ADDRESS �✓� ZONING SETBACKS z CITY �G ZIP TEL. FRONT RW ❑ p APPLICANT TEL. SIDE/SIDE STREET RW � z � CONTRACTOR D SIDE ❑ Q ADDRESS PROPOSEDUSE � Li� �7 �� lN�� CITY�C}�,�— ZIP TEL. / p � , oARC��IENG/ �r , z DESIGNER W NO.DWEL, N . NO. d ADDRESS �O `i�C� UNITS STORIES BEDROOMS � ClTY ,,,�`Y.�i 1C ZIP� TEL. c�i� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFRlADDlREM O I MEREBY AFFIRM UNDER PENAL7Y OF PERIUR7 THAT I AM EXEMPT FROM THE CDNTMCTORS LI- G8f890/C81POR W CENSEUWFOR7HEFOLLOWINGREASON(SEC 7031.58U51NESSAN�PROFES510N5CODE:ANYCI'�YOR (n � COUNTYWHICHREQUIqESAFERMITTOCON5Tqt1CT.ALTER,IMPROVE,DEMOLISFI,ORflEPAIRANY5TRIIG W patio/Dack TUHE,PRIOR TO ITS ISSUANGE,ALSO RE�UIFES THE RPPLICANT FOR SUCH PERMIT TO FILE A SIONEO W � STA7EMENT TNAT HE QR SHE IS UCENSED PURSUAN7 TO iHE PAOVISIONS OF TF7E CONiRACTORS L4 � � CENSE LAW(CHAPTER e(COMMENqNO WITH SECTION 7000)OF DIVISION 3 0F TME BUSINESS AND PR0- POOVSP2 FESSIONSWOE)ORTHATHEONSHEISE%EMPT7HEREFqOMAN�THEBA515FORTHEALLEGEDEXEMR (� UTbN.ANVVIOIATIONOFSECTION7031.59YANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof R CMl P�NALTV OF N07 MOpE THAN flVE HUNDRED DOLURS(SSW)J: Q ❑AASOWNEROF7HEPROPEAlY,ORMYEMPLOYEESW17HlVAGESAS7HEIRSOLECOMPENSATION, � COR1RIBfCIdI Z NALL�O TME WORK.IWD THE STRUCTURE IS NOT INTENDE�Ofl OFFERED FOR SALE(SEC 7044,BUSM J NESS AND PROFESSIONS CODE THE CANTRACTOFS LICENSE LAW OOES NOT APPLV 70 AN OWNER OF � PqOPERNWFIOBUILD50RIMPROVE57HEREON.ANDWHO00ES5l1CHWORKHIMSELFORHERSELFOR m � THROUGHHI90FtHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR QOFFEAEDFORSALEIF.HOWEVER7HEBUILDINRORIAIPROVEA1ENTtSSOIDWiiHINONEYEAFOFCOMPLE- � TION,THE OWNER-BUIIDEH NALL HAYE THE BURDEN OF PROVIN�THAT ME OR SME DID NOT BUILD OR � IMPROVEFORTHEPUqPOSEOFSALE} ❑I,AS OWNER OF THE PHOPERTY.MA EXCLUSIVELY CANIRACT�NQ WITH LICENSED CONTqACTORS � TO CONSTRUCT THE PROJECT(SEC 70l4,BUSINESS ANO PROFESSIONS CODE:THE CONTRACTORS U- V8II19�i0I1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANONTIEROFAPROPEqTYWHO8UILOSOfliMPHOVESTHEflEON,AND F WHOCONTRACTSFORSUGHPROJECTSWITHACONTRACTOfl(S)LICENSEOPURSUANTTOTHECONTMO QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW). � ❑I AM EXEMPT UNDER SEC. B 8 PC FOR THIS REASON U � �� O�S � � � DATE T��__OZ_OWNER U Z W �Q LICENSED CONTRACTORS DECLARATION W lL 1 HEflEBV AFFIFAA UNOER PENALTY OF PERJURYTMAT I AM LICENSED UN�Efl PROVISIONS OF CHAPTER �. � e(COMMENCINO WITH SEGTION 7oaa)OF DIVISION 3 Of TNE BUSINESSAND PROFESSIONS COOE,ANO Z Xt� LIY UCENSE IS M FULL FOflCE PND EFFECT. LL! m � LICENSE CLASS UC NO j V DATE CONTRACTOR a 1J.1 � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBY AFFIRM UNOER PENALT/OF PERJURV ONE OF7HE FOLLOWING DECLARATIONS. � � � `�HAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' � COMPENSATION,AS PROVIDED BY SECTION 370U OF TNE LA60R CODE,FOR THE PERFORMANCE W OF THE WORK FOR WHICH THIS PERMIT IS ISSUED � � W ,IHAYEANDWILLMA�NTAWWORKERS'CAMPENSATIONINSURANCE,ASRE�UIRE08VSECTION Q 37000FTHELABORCODE,FORTMEPERFORMANCEOFTHEWOflKWRWHICHTHISPERMITIS ISSUED.MYWORKERS'COMPENSATIONINSURANCECARRIERANDPOLICyNUMBEflARE� CONSTRUCTION J � PLAN REVIEW CARqIER Z POLIGYNUMBER ELECTRIC �D�� Q o (n�tsSEcnoNNE�rio7eEmMttErmoFn+ErEaMrsraaa�EHuwaEoOa��asR1m)oa�ss} PLUMBING W MECHANICAL Z I CERTIFY THAT INTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSU�D,1 (J SHALLNOT EMPLOV ANY PERSON IN ANV MANNER SOAS TO BECOME SUBJECT TO THE INSPECTION FEE �� WORKERS'COMPENSATIONLPWSOFCALIFOFNIA,ANDAGREETHATIFISHWLDBECOME � SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION3)OOOFTHELABOR � CODE,!SHALL FORTHWliH COMPLY W1TH 7HOSE PROVISIONS. ISSUANCE � SMIP • S� — p DATE. APPLICANT. J ENERGY P/C _ WAFINING FAILURETOSECUREWORKERS'COMPENSAII�NCOVEHAGEISUNLAWFUL.ANDSHALLBE LL SU&IECTqNEMPLOYERTOCRIMINALPENALTIESAN�CIVILFINESUPTOONEHUNORE�THOUSAND ENERGYPERMIT DOLLAflS(y100.000�.IN AODITION TO THE COST OF COtJPENSATION,DAMAGES AS PROVIDED FOq IN J SECTION 3708OFTHE UBOR CO�E INTEREST,ANDATfOpNE1"5 FEES RETENTION FEE: I. b D � a CONS7RUCTION LENDING AGENCY PRE-ALT FEE: O � 1 HERE9V AFFIRM UNDER PENALTY OF PER.IUFiYTHAT THERE IS A CONSTRUCTION LENDINO AGENCY FORTHE PERFOFMANCE DF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC,3097.qV CJ. Z W � LENDER'S NRME � LENDER'SAD�RESS O� wICERTIFYTHATIHAVEflEADTHISAPPLICATIONANDSTATETHAThIEABOVEINFORMATIONISCORflECT. TOTA�FEES G � � 1 A6REE TO COMPLY WITH ALl CI7V AND COUNTY ORDINANCESAND STATE LAWS RELATINO TO BUIL�ING CONSTRUCTION.ANO HEREBV AUTNORIZE REPflESENTATIVES aF TMIS COUNTY TO ENTER UPON THE Z A90VE�MENTIONEDPflOPERNFOR�N3PECTIONPURPOSES COMMENTS � �� f� m 7EAMITTEE NAAAE�PFINn � A-v�.c,.-��/��t}.e� S'8`-�� SIGNA UpEOFPERMITTEE DATE = RECP7.NO. PAID BY VALIDATION ~ WHITE—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOIDENFO�-Fle Copy,OREEN—ApplicanYs Copy �"'e'�'� ;.#5" ��°��"�i��<� ��a�"ff q�';:`'��,=�"�"�F"'c 4° „„�"-'u"= e�.; - a .,g.�,. ,#"ti . -. 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NO. � UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADD/REM p I HEREBY AFFIRM UNDER PENALT'OF PEqJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8t8 B/C8 Ofi 111 CENSELAWFORTHEFOLLOWINOREASON(5EC7o315BU51NES5ANDPROFESSIONSCODEANYCITYOR (n 9 � U COUNTYWHICHqE�UIRESAPERMITTOCONSTRUCT.ALTEfl,IMPROVE,�EMOUSH,ORREPAIRANYSTRUF W patio/Deck Z Tl1RE,PiiIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPUCANT FOfl SUCH PERMIT TO FILE A SIGNED w w STATEMENT THAT HE Ofl SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� 0� CENSE LAW(GHFPTEH 9(COMMENCING WI7H SECTION 7000)OF�IVISION 3 0F THE BUSINESS AND PR0- LL' POOUS(J8 FESSIONSCADE)ORTFIA7HEORSHEISEXEMPTTHEREFROMANDTH[DASISFORTHEALLEGEDE%EMP- � U TIONANVVIDLATIONOF3ECTION7o315BYANYAPPLICANiFORAPEflMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � ACNIL PENALTV oFN07 MORETHAN FIVE HUNDREO�OLLARS(E500)� Q ❑I.ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASiHEIRSOLECOMPENSATIDN, � Commercial Z WILL 00 THE WORK NND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE ISEC 7044,BU51- J N NE55 AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERN NMO BUILOS OR IMPROVES THEREON,AND WHO DOES SUCI i WORK HIMSELF OR HERSELF OR � THqOUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPflOVEMENTSARENOTINTENDEDOR m Q OFFEREDFORSALEIF,HOWEVER,THEBUILDINGORIMPRWEMENTISSOL�WITHINONEYEAROFCOMPLE- Z T10N,THE OVJNER-BUILDER WILL HAVE THE BURDEN OF PROYING THAT HE OR SHE DID NOT BUILD OR � IMPROVEFORTFIEPURPOSEOFSALE) �y,� ❑I,ASOWNEROFTHEPROPERTV,AMEXCLLISNELYCONTRACTINGWITHLICENSEDCONTPAC70RS � TO CANSTRUCT THE PR0.IECT(SEC 7044,BUSINE55 AND PROFESSIONS CODE THE CONTRACTORS LI� VHIlJ8U0f1 ADJ.AREA = CENSELAWDOESNO7APPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTMEFEON,AND F WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW� � ❑IAM EXEMPT UNDER SEC B 8 PC FOR THIS REnSON Q ?� U ti � UATE OWNER E- z U � LICENSED CONTRACTORS�ECLARATION W � I HEflEBV AFFIflM UNOER PENALTY OF PERJURY THAT I AM LICENSED UNDEfl PROVISIONS OF CMAPTER � d 9(COMMENCING WITH SECTION 7000�OF DIVISION 3 OF TNE BUSWE55 AND PROFESSIONS CODE,AND Z �X IAY IICENSE IS IN FULL FORCE AND EFFECT m � UCENSE CLqSS LIC NO j V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION a � I HEREBV AFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLApATIONS z Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' a 2 Q COMPENSAiION,AS PFOVIDED BV SECTION 370o OF THE LA90R CODE,FOR THE PEPFORMANCE U Q oF THE WORK FOR WHICH 7HIS PERMIT IS ISSUEb � w _I HAVE AND WILL MAINTAIN WORKEFS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION j� ✓} ,/ �' Q 370o OFTHE LABOR CO�E,FOR THE PEFFOFMANCE OFTHE WOFK FOR WHICHTHIS PERMIT 15 u I� (� 11 I ISSUEDMYWORKERS'COMVENSATqNINSURANCECARRIERANDPOLICVNUMBERARE CONSTRUCTION _ �1 � �1,'�� J j CARRIER PLANREVIEW� � !i'� Z POLICVNUMBER ELECTRIC 4 � (iHISSEC710NNEmNOTBECOh�LETmOFTHEPERMITISFORONEHUrDRmDOLW1S(5100�ORLESS) PLUMBING Z ICERTIFYTHATINTHEPERFORMANCEOF7HEWORKFORWHICHTHISPERMITISISSUED,1 MECHANICAL (.'} SHAILNOTEMPLOYANYPERSONINANYMANNER50ASTOBECOMESUBJECTTOTHE (n WOFKERS'COMPENSATION LAWS OF CALIFOflNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE .__ ? SU&IECTTOTHEWORKERS'COMPENSATIONPqOVISIONSOFSECTION37000FTHELABOR CODE,1 SHALL FORTHWITH COMPLY WITH TNOSE PROVISIONS ISSUANCE ..,�a � SMIP � p DA7E APPLICANT. 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PAID BY VALIDATION ~ 1(JHITE—De artment Co YELLOW—Rnance Co PINK—Assessor Co GOL�ENflOD—Fle Co GREEN—A IicanPs Co P PY� PY. PY� PY, PP PY ____ - ��fD� �Q - --- _ . � � ��G3 �� ___: . CITY OF DIAMOND BAR — �`` -- DEPARTMENT�F COMMi JNITY&DEVELOPMENT SERVICES , 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ��yK� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE Q APPLICATION PERMIT P/G o ADDRESS Z��7 f,/4�� ourSf �r�_ DATE (Z- Q~Z` NUMBEA !7�7/ # ��`�� cO APN LOT_�_ TRACT ISSUE TYPE OCC p OWNER DATE_. _ . � �-� CONST. GROUP � p ADDRESS � � /„� �/ ZONING SETBACKS FRONT Z CITY �(CL�'1.f+�YI ZIP� TEL. ��I 3 RW ❑ o APPLICANT �— TEL. REAR p -- Z SIDE/SIDE STREET RW ❑ a CONTRACTOR / - e�0 h-C�'1 � _ SIDE � QCDDRES�r`�'�� IP�F'� TEL. PROPOSED USE�D �`h � �( � ��_'�� lV� o ARCH/ENG/ z DESIGNER a ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFFl/ M O p I HEREBY AFFIpM UNDER PENALTY OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G818 0/C8 Off W CENSELAWFORTHEFOLLOWMGREASON�SEC70375BUSINESSANDPROFESSIONSCO�EANYCITVOR (n 9 � ZCOUN7VWHICHREqUIRESAPEFMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC� W P2i10/DBCk W TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STA7EMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PHOVISIONS OF THE WNTRACTORS LI. � CENSE LAW(CHAPTER 9(CAMMENCING WITH SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND PRO- u' PooUSpa O FESSIONSCODE)OFiTH/THEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALIEGEDEXEMP- (� V TION.ANVVIOLATIONOFSECTION7U315BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTD z Re-Roat A CIVIL�ENALTV OF NOT MORE THAN FIVE HUNDRED DOLL4q5(f500)� � ❑I,ASOWNEFOFTHEPROPERN,ORMYEMPLOYEESWITHWAGESA57HEIRSOLECOMPENSATION, 0 COR1R18fC18I Z WILL DO THE WORK,AN�THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 70dd,BUSI� J N NESS ANO PROFESSIONS CODE THE CONTFACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUILDS Ofl IMPROVES THEAEON,AND WHO DOES SUCH WORK MIMSELF OR HERSELF OR � THROUGHHISORHEROWNEMPLOYEES,PflOVIDEDTHATSUCHIMPROVEMENTSARENOiMTEN�E�OR m 0 OFFEREOf-0RSALEIF,HOWEVER,THEBUILDWGORIMPROVEMENTISSOI,�WITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVWG THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR TME F'UHPOSE UF SALE) W ❑I,ASOWNEROFTHEPROPERTV,AME%CLUSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS � TO CONSTRUCT THE PROJEC7(SEC.7044,BUSINESS AND PROFESSIONS CODE THE CONTRNCTORS LI- V81112fI0f1 �" ADJ.AREA W CENSELAWDOESNDTAPPLYTOANOWNEROFAPqOPERNWHOBUILD50RIMPROVESTHEREON,AND F WFiOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPUFSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE UW� 0 ❑1 AM EXEMPT UNDER SEC B 8 PC FOR THIS PEASON Q 7j U LL DATE OWNER F- Z U � LICENSED CONTRACTORS DECLARATION W Q � I MEREBY AFFIFM UNDEfl PENALTY OF PEFJURY THAT I AM LICENSE�UNDER PROVISIONS OF CHAPTER � d 9(COMMENCINGWITHSECTION7000)OFDIVISION30FTHEBUSINESSANDGROFESSIONSCODE,AND Z �X MY UCENSE IS IN FULL FORCE AND EFFECT - �a m � UGENSE CU1SS LIC NO � (...�_�..�/ j V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION a � I HEREBY AFFIRM UNOER PENALTY OF PERJURY ONE OF THE FOLLOWING�ECLAflATIONS. Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' a 2 a CAMPENSATION,AS PROVIOED BV SECTION 37Da OFTHE LABOR CODE,FOR THE PERFORMANCE U OFTHE WORK FOR WHICH 7HI5 PERMIT IS ISSUED w � � OW _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION 37000FTHELABORCADE,FORTHEPERFORMANCEOFTHEWORKFOPWHICHTHISPERMITIS ��' . `A J ISSUEDMYWORKERS'COMPENSATIDNINSURANCECARflIEFANDPOLICYNUMBERARE CONSTRUCTION / �� CARRIER PLANREVIEW ' �, . l� Z POLICYNUMBER ELECTRIC 4 � (fHISSECTIONNE�NOTBEWMPLEfEDOFTHEPERMfTISFORONEHUNDREDDOLLAR3($100)ORLESS) PLUMBING Z ICERTIFYTHATINTHEPERFORMANCEOFTHEWORKFORWHICHTHISf'ERMITISISSl1E0,1 MECHANICAL ('3 SMALLNOTEMPLOYANVPEPSONINANYM/WNERSOFST09EGOMESUBJECTTOTHE N WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE � SUBJECTTOTHEWORKERS'COMPENSATIONPFlOVISIONSOFSECTION3]OOOFTHELABOR �)� � CO�E,ISHALLFO)RTHWIiHCOMPLVWITHTMOSEPROVISIONS ISSUANCE U�_.n��r� p DA7E ��I Z�'p y APPLICANT � SMIP aelC J WARNINGFAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUI,ANDSHALLBE ENERGYP/C � SUBJECTANEMPLOYEflTOCFIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(El ao.000),IN ADOITION TO THE COST OF CAAAPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 37�8 OFTHE LABOR CODE,INTEREST,AND ATTORNEY'S FEES RETENTION FEE. ��r✓[' OCONSTRUCTION LENDING AGENCY PRE-ALT FEE � IHEFEBVAFFIRMUNDERPENALTVOFPERJURYTHATTHEREISACONSTRUCTIONLENDINGAGENCY FOR THE PERFOflMANCE OF THE WORK FOR WHIGM THIS PERMIT IS ISSUED(SEC 309],CIV C) Z W = LENDER'S NAME � F- LENDER'SADORESS � TOTAL FEES C� �4l� � I CERTIFYTHAT I HAVE READ THIS APPLICATION AND STATE THAT THE A60VE MFORMATION IS CORRECT W I AGREE TO COMPLY WITM ALL CITY AND COUNTY ORDINFNCES AND STATE LAWS RELATING TO BUILDING � CANSTRUCTI�N,ANONEREBYAUTHORI2EREPRESENTATIVESOFTHISG�UNTYT�ENTERUPONTHE ZABOVEMENTIONED Pi70PERTV FOF INSPECTION PURPOSES Q � COMMENTS � ��k m PEflMITTEENAME(PflINT) ? ¢ � —/ _ vG —�--�, � � � SI NAT E OF PERMITI'E DA7E = RECPT��O � PAID BY' VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�Fde Copy,GREEN—Applicanfs Copy � , y . , �r;��. . , . ,� ,'4.. e � __ _ R __�. �3` �-.� . - -- _ . �R�. r . , ----� f� - -- , -- . . _ -- � ��. CITY OF DIAMOND BAR � �,�, C,� -��*F{.y�, � DEPARTMEI3T OF COMMUNTTY&DEVELOPMENT SERVICES � �;�;{�•�:: a. 21825 E.Copley Drive ^� �+r' �� (9Q9)860-3195 Fa�c(909)86131 I7 PRESS ` �''� BUILDING PERMIT APPLICATION •.',`�,,,°,. FIRMLY } JOBSITE APPLICATION �� 1� PERMIT i /C o ADDRESS_ ZHOJ Wat@CCOIifS@ DATE � ;1J 13� NUMBER 1� � q9 ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER Anil � Meena Shah p ADDRESS 401 New Selsen ZONING SETBACKS z CITY Placentia ZIP 92�70 TEL.5 FRONT R�n/ ❑ � APPLICANT TEL. REAR ❑ z SIDEJSIDE STREET RW ❑ � CONTRACTOR C ' .✓ � SIDE ❑ � ADDRESS � 6�„� � ciTr _��,n;r ZIP�I LE' TEL. T PROPOSEDUSE Sewer Laterai o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION p� OWNEA-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENFLTY OF PERJURY THqT I AM EXEMPT FpOM THE CONTRACTORS LI- � Garege/Carport LLl CENSELAWFORTHEFOLLOWINGREASON(SEC70315BUStNESSANDPROFESSIONSCODEANVCITVOR U COUNTVWHICHRE�UIRESAPEflM177000NSTflUCT,ALTER,IMPROVE,DEMOLISN,ORREPAIRANVSTRUC- W Patio/Deck W Tl1RE,PAIOq TO 1T5 ISSUANCE,ALSO FEAUIRES TNE APPLICANT FOR SUCli PERMIT TO FILE A SIGNED W � STATEMEM THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTqpCTORS LI� LL � CENSE LAW(CHAPTER 9(CAMMENCING WITH SECTI�N T00o)OF�IVISION 3 OF THE BUSINESS 0.N0 PRO- POOVSpe Q FESSIONSCODE)ORTHATHEORSHEISEX�MPTTHEREfROMANDTHE8A515FORTHEALLEGEDEXEMP- (� V TI�N.ANYVbLATI�N�FSECTION7031.58YANYAPPLICANiFORAPER.411TSlJ8JEC7STHEAPPLICANTTO Z Re-Foof � A CNIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500)) 0 ❑I.ASOWNEROFTHEPROPERN,ORMYEMPLOVEESWITHWAGESFSTHEIRSOLECAMPENSATION, � COR1rt10fC181 Z WILL DO THE WORK,AND THE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044,BUSI- J � NESSAND PROFESSIONS CODE THE GONTqqCTORS LICENSE LAW UOES NOT APPLY TO AN OWNER OF � PROPERTY WHO BUILDS OR IMPROVES THEREON,ANO WHO DOES SUCH WORK HIMSELF OR HERSEIF Ofi � iHROUGHHI50RHEflOWNEMPLOYEES,PqOVIDE�THATSUGHIMPPOVEMENTSARENOTINiENDEDOR m � OFFEREDFORSALEIF,HOWEVER,T}{E8111L�INGOflIAAPROVEMENTISSOIDWITHINONEVEAROiCOA�PLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD Ofl � IMYHOVt FOR THE PUHPOSE OF SALE) w OI,ASOWNEROFiHEPROPERTV,AMEXCLUSIVELVCONTflACTINGWITHUCENSFUCONTRACTORS � i0 CANSTRUCT THE PROJ�CT(SEC 7044,BUSINESS AND PROFESSIONS GODE THE CONTRACTOAS LI- ValUel�lOn ADJ,AREA W CENSEL4WDOESNOTAPPI.YTOANOWNEROFAPROPER'h'WHOBUIL�SOqIMPflOVESTHEREON,AND � WHOCONTRACTSFOASUCHPROJECTSWITHAGONTRACiOR(S)LICENSE�PUflSUANTTOTHECONTRAG- �UANTITY DESCRIPTION FEE Y TORS LICENSE LAW). �� C7 IAM E%E�1PT UNDER SEC B.fl 7 C FOR THIS REASON Q U � � DFTE � __OWNER . � Z w � LICENSED CONTRACTORS DECLARATION W � 1 HEREBY AFFlRM UNOER PENALTY OF PERJURY THAT I AM LICENSED UNDEq PROVISIONS OF CHAPTER � d 9(COMMENCINGWITHSECTION7000)OFDIVISION30FTHEBUSWESSANDPROFESSIONSCODE,AND Z �X MYUCENSE IS W FULL FORCEAND EFFECT � � LICENSE CLASS LIC NO � V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBY PFFIRM UNDER PENALTY OF PERJURY ONE OF TFIE FOLLOWMG DECLARATIONS. Z Z _INAVEAN�WILLMAINTAINACERTIFlCATEOFCONSENTTOSELF-INSUFEFORWORKERS' _ CAMPENSATION,ASPFOVIOEDBVSECTION37000FTHELA00RCODE.FORTHEPERFORMANCE U a OF THE WORN FOR WHICH THIS PERMIT IS ISSUEO � 0 � _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS FEOUIRED BY SECTION Q� 370oOFiHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMI7IS ISSUED MV WORKEFS'CAMPENSATION INSURANCE CARRIER AND pOLICY NUMBEq ARE CONSTRUGTION Q > CARqIER PLAN REVIEW � PO�ICY NUMBER ELECTRIC Q ry Q (IHISSECiIONNEm�TBE�OMPLETE�OFIHEPEPMRISfORIXJEHUf�DRE000L1ARS($100)ORLESS) PLUM6ING _ 'F7�SQ z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERIAIT IS ISSl1FD,I MECHANICAL _ ('} SHAILNOTEMPLOYANVPERSONINANYMANNER50A5T09ECOMESU6JECTT07HE WORKERS'COMPENSATION LAWS OF CALIFORNIA,ANDAGREE THAT IF I SHOULD BECOME INSPECTION FEE � SU&IECT TO TliE WORKEflS'COMPENSATfON PROVIuIONS DF SECTION 37oa�F TFiE 1A80R 25.�� GODE,ISHALLFORTHWITHCOMPIYWITHTHOSEPROVI510N5 �SSUANCE 0 0 DATE �'' V APPLICANT `irf� SMIP W ENERGY P/C J WARNING FAILURETOSECUREWORKERS'COMPENSATIO COVERAGEISUNLAWFl1L,ANOSHALLBE � SUBJECTANEMPLOYEflTOCRIMINALPENALTI£SANDCIVILFNJESUPTOONEHUNDREDiNOUSANO ENERGYPERMIT DOLURS(Stoo,om),IN AODITION TO THE COST OF COMPENSATION,DAMAGES AS PftOVI0E0 FOR IN � SECTION37aeOFTNELA00RCODE,�NTEREST.ANOATTORNEY'SFEES qETENTIONFEE� Q CONSSRUCTION LENDING AGENCY PRE-ALT FEB O � 1 HEFEBV AFFIRM UNDER PENALTV OF PERJUFV THAT THERE IS A CONSTRUCTION LEN�ING AGENCY _ FOR THE PERFORMANCE OF THE WOHK FOR W HICH THIS PERMIT IS ISSUED(SEC 309],Cry C) Z W 2 LENOER'S NAME � F— IENDER'S ADUftESS cC � I CERTIFY TNAT I HAVE READ THIS APPLICATIONAND STATE TItFTTHE ABOVE INFORMATION IS CORflECT TOTAL FE ES V V�S O w I AGREE TO COMPLY WITH ALL CRY AND COUNTV OROINANCESANO S7ATE LAWS REUITING TO BUIL�ING � CqNSTRUCTION,AN�HEREBYAUTNOR2E REPRESENTATNES OF iH15 COUN7V TO ENTER UPON THE � ABOVE-MENTIDNED PROPEFTV FOF INSPECTION PURPOSES COMMENTS _. � ��k � m PERMIttEENAME(PRINT j,q / ¢ �VV � � N S NA REOFP MITTEE OA E 1 = RECPT NO. PAID BY VALIDATION ~ WHITE—De adment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—Ftle Co y.GREEN—A icanYs Co P PY. PY. PY. P PP� PY � � �� r ; � � - - � �\ - -- -_ . fr�� , - ,� , �� r�'�°�- w . ��9�� - - �,��-s�'Il�i-o� �A�� I� � _ -- :._�� . � . �`y� -_ , __-; . . ; ___ �, CI1'Y OF DIAMOND BAR � DEPARTMENT OF COrMdiJNTfY 8t DEVELOPMENT SERVICES , ,,,� 21825 E.Copley Drive (909)860.3195 Fax(909)861-3117 PRESS ,,"°"°' ' BUILDINGPERMITAPPLICATION FIRMLY } JOBSITE • - / �,/� APPLICATION ' ., PERMIT p/� o ADDRESS 1.�� `-��,f�C��f/�� G'V�✓�" DATE rC' �� NUMBER q �� °��-° APN �OT TRACT ISSUE TYPE OCC � DATE CONST. GROUP p OWNER � ��MG"C'''!��.;/y� o ADDRESS �CJr��„� �z'�a�--��/ /�1/ri � ZONING SETBACKS z CITY ��('((?i?�i7 ZIP �EL. - = '� . FRONT RW ❑ � APPLICANT TEL. REAR p 0 SIDE/SIDE STREET RW ❑ � CONTRACTOR_ � � ' ^ �f SIDE p � ADDRESS � � CITY ��'_�/ ZIP �"`��Cr'TEL."�y'" �Y'ti='�3� PROPOSED USE � l.✓�.� �('�'E! " o -t�--- y�1- � , o ARCH/ENG/ z DESIGNER a ADDRESS NO.DWEL. NO. NO. cn UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p R/ADD/REM p I HEREBY AFFIRM UNDER PENALTY OF PERJUHY THAT I AM EXEMPT FROM THE CONTRACTORS LI- G.a�9 W CENSELAWFORTHEFOLLOWINGREASON(SEC7o315BU51NESSANDPROFESSIONSCOOE•ANVCINOR (n � COUNTVWHICHREWIRESAPERMITTOCON9TflUC7,ALTER,IMPROVE,DEMOLISH,OqREPAIHANVSTRUG W PdiiO/DBCk W TURE,PRIOR TO ITS ISSUMICE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � S7ATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CAN7MCTORS LI- � CENSE LAW(CHAPTEfl B(COMMENCINO WITH SECTION 7000�OF DIVISION 3 0F TME BUSINESS AND PR0- LL' POOVSPB � FESSIONSCODE�Oft7HATHEORSHEI6EXEMPTTHEREFROMAN�IHEBA913FORTIiEALLEOEDEXEYP- (� V TION.ANVVIOLATIONOFSECTION70315BVANVAPPLICANTFORAPERMITSU&IECTSTHEMPLICANTTO Z Re-Roof F ACIVILPENALNOFNOTMORETNANFIVEHUNDREDDOLLARS(5500)J• 0 ❑I,ASOWNEROFTMEPROPER7Y.ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � CommefCial Z WILL DO THE WORK,PND THE STRUCTUHE IS NOT INTEN�ED OR OFFERED FOR SALE(6EC 70N,8U51- J � NESS AND PROFE3910N3 CODE.THE CONTRACTORS LIGENSE LPW DOES NOT APPLY TO AN OWNER OF PROPEI7�YVMOBUILDSORIMPROVESTHEREON,ANDNMODOESSUCHWORKHIMSELFORHEHSELFOR � � THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOq m � OFFEREDFORSALEIFHOWEVERTME6UILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,7HE OWNER-BUILDEfl WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE D�NOT Bl11lD OR = IMPROVE F�R 7HE PUR�OSE OF SALE). W ❑I,ASOWNEROFTHEPROPER'iY,AMEXCLLJSIVELVCONTMCTINGWRMLICENSEDCOMMCTOqS � TO CONSTRUCT THE PROJECT(SEC 7060,BUSINE55 AND PROFESSIONS CODE�THE CONTRACTOHS LI- V8IUfl11011 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPRODEFTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTMCTSFORSUCHPROJECTSWITHACONTRACTOR(S)UCENSEDPURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE Y TORSUCENSELAW) � ❑I AM EXEMPT UNDER S�C. B.a P.C.FOR 7HI5 REASON Q ?� U � � Z DATE OWNEH U O � � LICENSED CONTRACTORS DECLARATION W � 1 HEHEBV AFFIRM UNDER PENAL7Y OF PERJURV THAT IAM LICENSED UNDER GROVISIONS OF CHAPTER � p. 9(COMMENCINGWITHSECTION7o00)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCADE,AND Z X MY LICENSE IS IN FULL FORCEAND EFFECT m 0 LICENSE CLASS LIC,NO. j V DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION � � I HER�V AFFIRM UNOER PENALTV OF 7ERJURY ONE OFTNE WLLOWING DECLARATIONS. Z � _IHAVEANDWILLMAMTAINACERTIFICATEOFCANSENTTOSELF-INSUREFORWORKERS' a COMPENSA710N,AS PROVIDED BV SEC710N 37000F7HE IABOR CODE,FOR THE PERFORMANCE U Q OF THE WOflK FOR WHICH THIS PERMIT IS ISSIIED � w _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE.AS REQUIRED BV SEC710N Q 37000FTHE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUED MYWORKERS'COMPENSATIONINSURANCECARRIERANDPOUCYNUMBERARE CONSTRUC110N Q � CARRIEH PLAN REVIEW �,��'� 0 POLICV NUMBER z ELECTFiIC ¢ � (IFIISSEl:11UNNEEllNUftlECUMF�tftUOFIHtF'tHMIISFORONEHUrDRED00LlAR5(5100)ORLE55� PLUMBING Z I CERTIFYTHAT IN TME PERFORMIWCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUEO,I MECHANICAL L} SHALL NOT EMPLOV ANV PERSON IN ANY AIANNER SO AS TO BECOME SU&IECTTO THE N WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE = SU&IECT TO THE VJORKERS'COMPENSATION PROYISIONS OF SECTIIXJ 3700 OF THE LABOP CADE.I SHALL FORTNWITH CAMPLV WITH THOSE PROVISIONS ISSUANCE � SMIP p DATE. APPLICANT. � WARNING.FAILURE TO SECURE WORKERS'COMPENSA7ION CAVERAGE IS UNLAWFUL.AND SHALL BE ENERGY P/C �y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNOREDTHOUSAND ENERGYPERMIT DOLLARS(5700,000),IN AD�ITION TO TNE COST OF COMPENSATION,DAMAGES AS PROYIDED FOR IN � SECT�ON 3]OB OFTHE LABOR COOE,IMEREST,ANO ATTOflNENS FEES RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBY AFFIFM UNDER PENALTY OF PEflJUFYTHATTHERE IS ACONSTRUCTION LENDINQ A�ENCY FOR hIE PERFORMANCE OF THE WORK FOR WHICH THIS PERMR IS ISSUE�(SEC 3097,CIV.CJ. Z W � LENDEH'S NAME F— LENDER'SADDRE55 � TOTAL FEES �� ICEflTIFYTHATIHAVEREADTHISAPPLICATIONAN�STATETHATTHEABOVEPlFORMATIONISCORHECT W I AGREE TO COMPLV WRH ALL CITV M1D CAUNTV ORDINANCES ANO STATE UWS RELATING TO BUILOING � CONSTRUCTION,AND HEREBV FUTHOf1RE REPRESENTATIVES OFTHIS COUNN TO ENTER UPON THE Z ABOVE-MENTIONED PROPERN FOR INSPECTION PURPOSES j / COMMENTS � T�'T6�LJ'��'��%l^i/ '.�.-^ � r �� .�/ ¢ PERFAITTEENAME(PRINn � (!� _ � sio n'r O PERMI E DATE RECPL NO. PAID BV �K 2-`I 9 VALIDATION S ~ WHITE—Department Copy,YELLOW—Finance CoDy�PINK—Assessor Capy,GOLDENROD--File Copy,GREEN—Applicent's Copy �y� �'�' �� .�� s��'�'"`3�� ;_:�`�'��!� , � , ;: �, . �,, �-, � � � � � � . _ � , � _ _ - — -- - - ` — - - - --� ---- ,�;,� � .� � , , ,.. � I � . p.- — W .. . --- {�i �['�(� �, _ __ ____ ,,� .. . g- q ��.[_..FYi"S.ts\ i . . .I... S3i�e.1L.i--��£��F��f7 l�.li.. � � �jj _. """". .._._ --_�".�.-.... .� .. "_._. .......__...�' ` _ .._.____._ . " ""..___._. .,.. ._..' 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GROUP p OWNER Mr�Mrc_ Anil Shah p ADDRESS 40� �EW Jerse Lan ZONING SETBACKS o CITY acent�a Z�p 2870TE�, 57 FRONT RW ❑ p APPLICANT TEL. REAR � z SIDE/SIDE STREET RW ❑ a CONTRACTOR Arcadia ��@CtY1C SIDE � o ADDRESS 0 C�TY ZIP TEL. PROPOSED USE J� o ARCH/ENG/ w DESIGNER NO.DWEL. NO. NO. a ADDRESS � UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION Sa. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFFVADD/REM O Q I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTOqS LI- G8fe98/C2fPOf[ W CENSELAWFORTHEFOLIOWINGREASON(SEC70315BUSWESSANOPROFESSIONSCOOEANVCITYOR (/� U COUNTYNMICHRE�UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUF Z TURE,PRIOR TO ITS ISSUANCE,A�50 REW IFES THE APPLICANT FOR SUCN PERMIT TO FlLE A SIGNED W Patio/Dack w STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTOflS LI- �� CENSE L4W�CHAGTER 9(CAMMENCING WITH SECTION 7oo0J OF DIVISION 30F THE BUSINESS AND PRo- � PooVSpa FESSIONSCODE)OftTHATHEOR5HEI5E%EMPTTHEREFROMAN�TNEBASISFORTHEALLEGEDE%EM7- (� V TION.ANYVIOLATIONOFSECTION70375BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPUCANTTO Z Re-Roof F ACIVILPENALiVOFNOTMORETHANFIVEHUNDREDDOLLARS(SSoo)j ❑I,ASOWNEROFTHEPROPERTV.ORMYEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSA710N, � Commercial Z WILL DO THE WORK,AND THE STRUCTl1RF IS NOT INTENDED OR OFFERED FOR SALE�SEC 7a44,BUSI� J � NESS AND PROFESSIONS CqDE THE CONTRACTORS LIC[NSE LAW DOES NOT APPLY TO AN OWNEfl OF � PHOPERTY YMO BUILOS OR IMPROVES THEREON,AND WHO DOES SI1CH WORK HIMSELF OR HERSELF OR Q THROUGHHISOHHEROWNEMPLOVEES.PROVIOEDTHATSLICHIMPROVEMENTSARENOTINTENDEDOR m � OFFEREDFORSALEIF,HOWEVER,T{EBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPI.E- � TfON,THE OWNER-BUILDER WILL HAYE THE BUflDEN OF PROVWG THAT HE OR SHE DID NOT BU1LD OR � IMPROVE FORTHE PURPOSE OF SALE). W ❑I.ASOWNEFOFTHEPROPERTV,AMEXCIUSNELYCONTRACTINGWITHIICENSEDCONTRACTORS Q TO CONSTFUCT TME PROJECi(SEC 7049,BUSINE55 AND PROFESSIONS CO�E TNE CONTRACTORS LI- V81U8IIOf1 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERNWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPqOJECTSWITHACANTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAP QUANTITY DESCRIPTION FEE Y TORSUCENSELAW�, � �IAMEXEMPTUNDERSEC B&PCFORTHISREASON Q � �OQ A'�. IY6L�IC� ZS�7O � � 1 200 An� 25.90 Z DATE OWNER U � 10� Am ��b �V•Q� � LICENSED CONTRACTORS DECLARATION � a W I I • rec 567.49 Q �HEREBY AFFIRM UNDER PENALTY OF PERJLIRY THAT I AM LICENSED UN�ER PROVISIONS OF CHAPTER � d 9(COMMENCING WITH SECTION 70op)OF DIVISION 3 0F THE BUSWESS AND PROFESSIONS CODE,AND Z W MY LICENSE IS IN FULI FORCE AND EFFECT m � UCENSE CLA55_ . ._.._ LIC NO j r, J V DATE CONTRAC70R a W � WORKERS'COMPENSATION DECLARATION Q � I HEHEBV AFFIFM LINOER PENALTV OF PERJURV ONE OFTHE FOLLOWING DECLARATIONS Z ZI HAVE AND WILL MAINTAIN A CERTIFICATE OF GONSENT TO SELF-INSURE FOR WOfiKERS' _ Q CAMPENSATION,ASPROVIOEDBYSECTION370oOFTHELABORCODE,FORTHEPERFORMANCE U Q OF TME WORK FOF WHICH THIS PERMIT IS ISSUED � W I HAYE AND WILL MAINTAIN WORKERS'COMPtNSATION INSURANCE,AS NE�UIRED BY SECTION Q 37000FTHELABOflCODE,FORTHEPERFORMANCEOFTHEWORKFOHWHICHTHISPERM1T15 ISSUEDMVWORKERS'COMPENSATIONINSURANCECARRIEFANDPOLICYNUMBERARE CONSTRUCTION J � CARRIER PLAN REVIEW 0 POLICV NUMBER ELECTRIC B R7_7 Q Z Q � (IHISSECTICM1NEmNOTBECOPREfFDOFTHEPERMfTISFORONEHUI�DREO�OLWRS(5100)ORLESS) PLUMBING W Z I CERTIFYTHAT IN THE PERFORMANCE OFTHE WORK FOq WHICHTHIS PERMITIS ISSUEO,I MECHANICAL (..j' SHALL NOT EMPLOY ANY PERSON IMANY MANNER SOAS TO BECOME SU9JEGT TO TME N WORNERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHDULO BECOME INSPECTI ON FEE = SUBJECTTOTHEWORKEqS'COMPENSATIDNPROVISIONSOFSECTION37o00FTHELA80R CODE.I SHALL FORTHWITH COMPLV Wlhi THOSE PROVISIONS ISSUANCE Z 5�OO � SMIP p DATE. APPLIGANT J WI1flNINGFAILUHETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDAEDTHOl15AND ENERGYPERMIT DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 37000FTHE LABOR CODE,INTEREST,ANDATTORNEY'S FEES RETENTION FEE. d CONSTRUCTION LENDINGAGENCY PRE-ALT FEE• O � I MEREBY AFFIRM UNDER PENALTY OF PERJURY THAT TNERE IS AGONSTRUGTION IENDING AGENCY _ FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 9097.CIV C] Z W = LENDEN'S NAME � H LENDEH'SADDRESS � TOTAL FEES G�` (� � 1 CEflTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THEABOVE INFORMATION IS CORRECT y[J Z�Z.7 w I AGREE TO COMPLY WITH ALL CITy pND CDUNTY OR�INANCES ANO STATE LAWS RELATING TO BUILDING � CONSTRUCTION,ANDHEREBVAUTHORIZEREPRESENTATNESOFTHISCDUNTYTOENTERUPONTHE ZABOVEMENTIONED PROPEFTV FOR INSPECTION PURPOSES COMMENTS � J � —... m PERMITTEE NHME�PRINT) Q � � SIGNATUREOFPEPMITTEE �A7E = RECPT.NO. PAID BY VALIDATION ~ WHITE—De adment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—FileCo GREEN—A plwanfs Co P PY, PY� PY. PY� P PY — -- � — -- f 's � . �;�-�� r �� . . _ __- - --- -- � _. __w .- � _ . _ _ � �� -. � . . , .. � � - � � _ _ _ CITY OF DIAMOND BAR � t I �f I DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � ° 21825 E.Copley Drive � �� (909)860-3195 Fax(909)861-3117 � PRESS � �'��' BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE APPLICATION PERMIT Q/C ADDRESS 2809 Watercourse DATE � ��'f��NUMBER � q °-° APN LOT �� TRACT �78rJO ISSUE TYPE OCC p OWNER Mr. � Mrs. Sllall DATE CONST. GROUP o ADDRESS 8W erse tl ZONING SETBACKS z CITY Placentia ZIP 9 TEL. � FRONT Ryy � p APPLICANT TEL. REAR � Z SIDE/SIDE STREET RW ❑ a CONTRACTOR • aYt U117 Illg SIDE � , � ADDRESS �i � C�TY �-I�,u�G'' a� ZIP�� TEL.T . � ' t; PROPOSED USE o ARCH/ENG/ z DESIGNER a ADDRESS NO.DWEL. NO. NO. � - UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION O SFR/ADD/REM (�l�. p I HEREBY AFFIRM UNDEF PENALTV OF PERJUqY THAT I AM E%EMPT FqOM 7HE CANTRACTOflS LI- G2I'8 9/C3 O W CENSELAWFORTHEFOLLOWINGREASON(SEC703158USWESSANDPROFESSIONSCODEANYCITYOq (� 9 � rt Z COUNTVN7iICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPqOVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck w TURE,PRIOR TO ITS ISSUANCE,AL50 qEQUIFES THE APPLICANT FOF SUCH PERMIT TO FILE A SIGNED W � STATEMENT TMAT FiE OR SHE IS LICENSE�PL1RSl1ANT TO THE PpOVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF ONISION apF 7HE BUSINE55 AND PRO- �'�" POOUSpe FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMAN�THEBASISFORTHEALLEGEDE%EMP- (� V TION ANYVIOLATIONOFSECTION70315BVANYAPPLICANTFORAPERMITSUBJECTSTHEAPPUCANTTO Z Re-Roof F A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRE�OOLLARS(5500)� � ❑I,ASOWNEFOFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, ❑ COrtIfi78fClel Z WILl00 THE WORK.AND THE STRIICTURE IS NOT INTENDED OR OFFEFED FOR SALE(SEC�044,BUSI- ,.J � NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF PROPERTYWHOBUILDSORIMPfiOVESTMEREON,ANDNMODOESSUCHWORKHIMSELFORHERSELFOR � � 7HROUGHHISORHEROWNEMPLOVEES,PFOVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m � OFFEREDFORSALE.IF,HOVJEVER,THEBUILDINGORIMPFlOVEMENTISSOIDWITHINONEYEAROFCOMPLE- Z TION,THE OWNEF-BUILDER WILL HAVE THE BURDEN OF PROVING THAT NE OF SHE DID NOT BUILD OR � IMYHOVE FOF THE PURPOSE OF SALE) W ❑I,AS OWNER OF THE PROPEHTY,AM EXCLUSNEIY COMRACTINO W ITH LICENSED CONTRACiORS � TO CANSTiiUCT THE PRQIECT(SEC 7040,BUSINE55 AND PFOFESSIONS CODE THE CONTRACTORS LI- VeIl18fi0f1 ADJ.AREA W CEN5ELAWDOESNO7APPLYTDANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � NM1IOCONTFACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICEN3EDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION Y TORS UCENSE LAW) FEE � ❑IAM E%EMPT UNDER SEC B&PC FOR THIS REFSON Q � U � DATE OWNER ¢ Z U � LICENSED CONTRACTORS DECLARATION W � IHEREBYAFFIRMUN�ERPENALTYOFPER.IURYTHATIAMLICENSEDUNDERPROVISIONSOFCHAPTER � '7 WateY' CIOSP..tS � 9(COMMENCMG WITH SECTION 7oao)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COOE,AND Z �� MY LICEN9E IS IN F.U�L.rL FORCE AND EFFECT m 3 K i tc hen S I C�I kS � LIGENSE GLASS-? �� `-I([:.� LIC NO �� U DATE Z -31 CONTRACTOR a �O ��!/I�OCI�S w ' 1 Laundr Tra s � WORKERS'COMPENSATfON DECLARATION J � I s I a n d 5 i n k � IHEREBYAFFlflMUN�ERPENALNOFPERJl1FVONEOFTHEFOLIOWING�ECLARATIONS Z 2 Water heaters 0 I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEM TO SELF-INSURE FOR WORKERS' a a CAMPENSATION,ASPROVIDEDBVSECTION37DaOFTHFLADOPCODE,FOPTiEPERFORMANCE U Q OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED � QW _I HAVE AND WILL MAINTqIN WORKERS'COMPENSATION INSUFANCE,AS RE�UIRE�BV SECTION 3700 OFTHE LABOR CODE,FOR THE GERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUEDMVWORKERS'COMPENSATIONINSURANCEGARflIERANDPOLICYNUMBEFARE CONSTRUCTION J � CARRIER PLAN REVIEW z POUCYNUMBER ELECTRIC Q p � (RiISSECTONNE�NOTBECIXv1PLEfE�OFhiEPERMfTISWRONEHUPAREDDq1AR5(510o)ORLE55) PLUMBING 348.OD Z ICERTIFVTHATINTHEPERFORMANCEOFTHEWORKFOfiWHICHTHISPERMITI51SSllEO,l MECHANICAL ('} SHALL NOi EMPLOY ANY PERSON IN ANY MANNER SO AS 70 BECOME SUBJECT TO THE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE Z 5.O O j SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR CADE,I SHALL FORTHWITH COMPLY WITH THOSE DAOVISIONS ISSUANCE 0 p �ATE. APPLICANT SMIP wWARNINGFpILURETOSECUREWORKEflS'GOMPENSATIONCOVEFAGEISUNLAWFUL,ANDSHALIBE ENERGYP/C �y Sl1BJECTANEMPLOVERTOCFIMINALPENALTIESANDCIVILFWESUPTOONEHUNOREDTHOUSAN� ENERGYPEFiM1T DOLLARS(Stao,000),IN AD�ITION TO THE CAST OF COMPENSATION,DAMAGES AS PflOVIOED FOR IN ¢ SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES RETENTION FEE. ,_ OCONSTRUCTION LENDINGAGENCY PRE-ALT FEE: � IHEREBYAFFIRMUNDERPENALTYOFPERJURYTNATTMEREISACONSTRUCTIONLENDINGAGENCY � FOFTHEPERWRMANCEOFTHEWORKFORWHICHTHISPEFMITISISSUE�(SEC3097.CIVC) � W j LENDER'SNAME ? F— LENDER'SADDR[SS � TOTAL FEES 373.80 � I CEFTIFYTHAT I HAVE flEAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORREGT w I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBV AUiHORIZE REPRESEN7ATIVES OF THIS COUNTV TO ENTER UPON THE � ABOVE�MENTIONEO PROPERTY fORINSPECTION PURPOSES z CDMMENTS � �. V � �) 'h�;J/ �� , ¢ PE MITT NAME(PRINT ` , cn �Cr `—UZ � SIGN 7UREOFPERMITTEE DA7E � = RECPT.NO. PAID BY VALIDATION ~ WHITE—Depahment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy � `s�y��_ _....,., ,_, - -- -- - --� - -_. . b�-a� �� - ------ _ 6�-v� � �� - - - _ , - -- - - - ; �T CITY OF DIAMOND BAR �� DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES ' 21825 E.Copley Drive (909)8603195 Fax(909)861-3117 PRESS ��' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE Zg09 Watercourse APPLICATION ,�I(�,,,� PERMIT `!1 Q(_� p/� a ADDRESS o — DATE �� NUMBER I�S��1�1# °-° APN LOT �F� TRp,C _ 47SSO ISSUE 7YPE OCC °C —�Y'. S Y-IV� S. �1 t111 � 8 DATE CONST. GROUP p OWNER p ADDRESS ��N ersey Yl ZONING SETBACKS o ciTv �acentia ziP 92870rE�. 7145790731 FRONT Rw n p APPLICANT TEL. REAR � Z SIDE/SIDE STREET RW ❑ a CONTRACTOR Seaside Air SIDE � o ADDRESS PROPOSED USE N S F R �" o C�TY ZIP TEL. o ARCH/ENG/ — z DESIGNER � ADDRESS NO.DWEL. NO. NO. � UNITS STORIES BEDROOMS � CITY ZIP TEL._ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION � O SFR/ADD/REM p I HEREBV AFFIRM UNDER PENALTV OF PEFJURY THAT I AM E%EMPT FROM THE CONTFACTORS LI- G8f8 B/Ca Off W CENSELAWFORTHEFOLLOWINGqEASON(SEC7a315BUSWESSANDPROfESS10NSCODEANYCITYOR (n 9 � U COUNTVWHICHREOUIFESAPERMITTOCANSTRUCT,ALTER,IMPftOVE,bEMOLISH,ORflEPAIRANYSTRUC� pat10/DBCI( w TURE,PRIDR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOfl SUCH PERMIT 70 FILE A SIGNED W STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION]000)OF OIVISION 30F THG BUSINESS AND PRO- V' POOUSpB � FESSIONSCODE)ORTHATHEORSHE�SEXEMPTTHEREFAOMANDTHEHASISFOfliHEALLEGEDEXEMP- (� V TION.ANYVIOLATIDNOFSECTION7p315BYANVAPPLICANTFORAPERMITSUBJECfSTHEAPPLICANTTO Z Re-Roof � A qVIL PENALTV OF N07 MORE THAN FIVE HUNDRED�OLLARS(f5oo)� 0 ❑I,ASOWNEROFTHEPROPERTV.OflMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, ❑ COrtIfIlOfClel Z WILL 00 THE WORK ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC�044,BU51- J � NESS AND PROFESSIONS CODE THE CONTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPEflN WHO BUILDS OR IMPROVES THEflEON,AND WHO�OES SUCH WORK HIMSELF OR HERSELF Oq � TNROUGHHISORHERONlNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENDTMTENDEDOR CO Q OFFEREDFORSALEIF,HOWEVERTFiEBUILDWGORIMPRDVEMEN11550LDWITHINONEYEAROFCOMPLE Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVWG THAT HE Ofl SHE DID NOT BUILD Oq � IMPROVE FOR THE PUFPUSt UF SALE). w ❑I,ASOWNEFOFTHEPROP�RTY,AMEICCIUSIVEIYCONTRACTINGWITHI{CENSEDCANTRACTOPS � TO CANSTRUCT THE PflOJECT(S�C.�044,BUSINESS AND PROFESSIONS CODE THE CONTfiACTORS LI- V8IU2110f1 ADJ AREA W CENSELAWDOESNOTAPPLVTOqNOWNEROFAPROPERTYWNOBUILDSORIMPRDVESTHEFiEON,AND = WHOCANTRACTSFORSUCHPROJECTSWITHACONTRACTORSLICENSEDPURSUANTTOTHECONTRAG FEE Y TORS LICENSE LAW) �� UANTITY DESCRIPTION � ❑I AM EXEMPT UNDER SEC B 8 PC FOR THIS REASON Q ?j U LL DATE OWNER F- Z U � LICENSED CONTRACTORS DECLARATION W Q � IHEREBYAFFIRMUN�ERPENALTYDFPERJURYTHATIAMLICENSEDUNDEflPROVISION50FCHAPTER Z 2 Vents � p p_ 9(COMMENCING WITH SECTION 7000�OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND 1X MV LICENSE IS IN FULL FOflCE AND EFFECT m 2 3 �n B t U � LICENSECLASS ._�._. LIC NO ____ � 7 4 Ton Utu o� V DATE CONTRACTOR a � 5-Ton Btu W � WORKERS'COMPENSATIONDECLARATION Q Z R� isters � I HEFiEBY AFFIRM UN�ER PENALN OF PERJURY ONE OFTHE FOLLOWING DECLAHATIONS Z 0 _IHAVEANDWILLMAINTAINqGERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ � CAAAPENSATION,AS PROVIDED BV SECTION 3]0o OF THE IABOR CODE,FOP THE PERFORMANCE U � 1 T n CO I I Il 7� Q OF THE WORK FOR WHICH iH15 PERMIT IS ISSUE� � H/.3 O � _IHAVEANDWILLMAINTAINWORKERSCOMPENSATIONINSURANCE,ASREOUIREOBYSECTION QQ 37000FTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSU W MY WOPKERS'CDMPENSATION INSURANCE CARFIER AND P011CY NUMBER ARE CONSTRUCTION J j CARRIER PLAN REVIEW Z POLICV NUMBER ELECTRIC Q 0 (RiISSECTIONNE�NOTBENMPLEfEDOFTHEPERMfTISFORONEHUNDREDDOLLARS(5100)OFiLESS) PLUMBING Z ICERTIFVTHATINTHEPEpFORMANCEOFTHEWORKFOPWHICHTH15PERMITI5155UE0,1 MECHANICAL � � CJ SHALLNOTEMPLOYANYPERSONINANYMANNtH50A5TO8ECOMESUBJECTTOTHE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECT TO THE WORKEqS'CAMPEt3SAilON PflOV1510N5 OF SECTION 3700 OF lHE LABOfl � CODE,ISHALLFOFiTHWITHCOMPLYWITHTHOSEPROVISIONS ISSUANCE ___ 0 p DA7E APPLICANT SMIP J WARNING FAILURE TO SEGUFIE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFMESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(Eloo.oaOJ,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION970BOFTHELABOflCODE,WTEPEST,ANDATTORNEY'SFEES RETENTIONFEE: OCONSTRUCTION LENDING AGENCY PRE-AlT FEE � IHEREeYAFFIRMUNDERPENALTVOFPERJURVTHATTHEflEISACONSTRUCT10NlENDINGAGENCY FORTHE PERFORMANCE OFTHE WORK FOF WHICHTHIS PERMITIS ISSUED(SEC 3097,CIV C) Z W � LENDER'S NAME 1-- LENDER'SA�ORESS � ICERTIFVTHATIHAVEF�EADTHISAPPLICATIONANDSTATETHA7THEABOVEMFORMATIONISCOfiRECT TOTAL FEES � I AGREE TO COMPLY WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING ��0 � � CONSTRUCTION,ANDHEREBVAUTHORIZEREPRESENTATNESOFTHISCOl1NTVTOENTERUPONTHE Z ABOV[-MENTIONED PROPEflTV FOR INSPECTIDN PURPOSES COMMENTS 0 J � m PEflMITTEE NAME(PRINT) Q U7 � SIGNATUREOFPERMITTEE DAiE /,,� = RECPT NO. lY PAID BY VALIDATION ~ WHITE—De artmen[Co YELLOW—Fnance Co PINK—Assessor Co GOLDENROD--File Co GREEN—A IicanYs Co P PY� PX PY. PX PP PY " ,r, ��4,� ��' - - --_._ .. ��' �� . PRESS FIRMLY CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE 20,0 9 ADDRESS V \I\I 64-Cr"(0 0 v-S c APN LOT aIP 11 TRACT .5k141160-7/70K6 OWNERI4K.4 1.114.4. 1.1,4+1 ADDRESS CITY pit.r4&4 p,r. ZIP at a to TEL. APPLICANT TEL. CONTRACTOR ."."2:4-..:;:.."'olek,'•-z.-• -...,.th ADDRESS . :i /a ...1M1177 MIL-1-- -kligiggli lir/lit i �.":1; '1 CI ZIP .611 TEL 14Mtgratikieg C ENG/ SIGNER ZIP. MM. i'i v— ' • ( N\-- -1 3 4-Ad ,,,__ ADDREST, ', ^ _As. :,.-. . 4..,,.v.___.c 4 a . ; $1. ki'I �� ..�� \ - , -- CITY ' 2IP TEL..,-1 ( �)/ �� G� \ \ I \ 1 J . r-- OWNER-BUILDER DECLARATION' I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIFIESAPERMIT TO CONSTRUCT,ALTER. IMPROVE, DEMOLISH,OR REPAIRANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)) DI,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOW WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) DI.AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) 0 I AM EXEMPT UNDER SEC B 8 PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE- ,t;FE.r.f.nE,AND MY LICENSE IS IN FULL FORCE AND EFFECT, ...,,, . LICENSE CLASS LIC NO -.4w NMI 811.,..' 1 DATE ----m-mt, /1•0 O1 CONTRACTOR =i ERS'COMPENSATION DECLARATION N) I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERS'COMPE SATION INSURANCE CARRIER AND POLICY NUMBER ARE t CARRIER411r-dirK_AY FAL.4.......- ..,: • . POLICY NUMBER •fffratr e 3 in 2-- i (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FC/R ONE HUNDRED COU_ARS(5100)OR LESS) 1 . I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I ) SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS•BECOME SUBJECT TO THE 5 .- WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND A e i EE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISION • 1. F SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE P•_... ...... ) — ,..0'. , . DATE "212.10/ APPLICANT ...,- 1 1 1 WARNING. FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE - SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN 1 SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES ... CONSTRUCTION LENDING AGENCY - I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY L- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC, 3097,CIV C) 3 C LENDER'S NAME LENDER'S ADDRESS F. C I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE NFORMATION IS CORRECT u L I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING , CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE 5.• ABOVE-MENTIONED ROPERTY FOR INSPECTION PURP SES 5 -1 5 Nir-a-v , i.lt,,.) cfmitzt Ci PERMITITE N q (P NT) , < 1 Zi lel z) t SIGNATUR 47.1.7• RMI DATE f P4a;ceixr _ APPLICATION DATE 0 PNEURAMBIETR i .1 4i3 i*P/Co 1 ...._Lci 7 ISSUE DATE E OCC -5 '(-) COPNST GROUP FRONT SEfBACKS ZONING REAR SIDE/SIDE SIDE RW D 0 STREET RW 0 D N0. PROPOSED UNITS t fFk —SVi\k,.-\\xsi- USE D W EL. N0. N0. STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF I.,VJ.AREA/VALUATION SFR/ADD/REM 0 f ol ' i t,(),7 o H .I (I) Garage/Carport 124. ' 1.-4 7' I-U w Lil- CD Z Palm/Deck/Dk 400 f f . C 0 E5 J 5 m PooVSpa I Re-Roof Commercial ) Valuation' 7 (./i I. i i I DJ AREA QUANTITY DESCRIPTION FEE I CI EL F- 0 lil I LU C.D Z Fn D -J 0- -J < 0 2 a x c..) En CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE. 9 91 of 0 IA677 = CC .04-) CC C. 'r--)00 00 ..)---5,L)(75 sSr.. 21 3 15(s,I 40 ii.S- .9 q •:)-S .(:) TOTAL FEES,5 1 q --7 5 H,LI'g')..r)i COMMENTS RECPT. NO 11 0 11 PAID BY 0-1 VALIDATION Re WHITE—Department Copy, —inance uopy,IINIc—Assessor Lopy, py, tvoz lyzoc_c20 'Aez a„h5 Fw-ctAkc) eNctraq efoi-ux5i PiLuK4304.... MASS et) &Poe- eqe_ 5c4ovot0l -Poi--6-I sop-anTircz,,(Ac:4-)00(tw-56 9 5' rs/j/d LALAIA.Ly SPL Xs! . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION APPLItiO/4/0 DATE PERMIT/Cy,r..J P/C ? NUMBER/I C.- # ISSUE DATE 610/0 TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW 0 0 SIDE/SIDE STREET RW 0 0 N0. PROPOSED UNITS USE DWEL. 5.746:2, e-,;(i)1-, /.91/.---(9. 0 t Ccc..-i i N . N0. STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM C/) Garage/Carport I-U Patio/Deck 11.1 U- PooVSpa 0 Re-Roof z 5 I Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE zi 0 EE i- a 1 Ib clec. C z 9 Lai-s zio.so 0 tu -I al 0 Z a-3 m D —I 0- -.I 42 0 2 a I 0 LIJ CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: 960.57, 00 075.1 •S7) /..e)o TOTAL FEES 0. 0 0 COMMENTS RECPT. N0. PAID BY OA 5,L- VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy PRESS FIRMLY BIAMOND BAR Akkiii cri >- •cC CI 9 APN r, LOT e-i f' TRACT cc OWNER kiln,./d--'vie e/7 7' ca ADDRESS 7.5ire?fL.,ei/e-r-co,/(5e-- Li- LU CITY 1)/411."1/1 ZIP TEL. 0 0 APPLICANT TEL. z QCONTRACTOR_A& if J..,_'Zte_ 1,L_,_._ -cc cc ADDRESS 0 CITY s am p-,41/4< ZIP_C+TEL. cl ILI ARC ENG/ n z DESIGNER LIJ a_ADDRESS /7 6—qtru..-4— CITY 4:),,.../J%-( ZIP 94Qtne TEL. CO CO cr) CC OWNER-BUILDER DECLARATION 0 I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LILLI CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.5 BUSINESS AND PROFESSIONS CODE ANY CITY OR C.)OOUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT.ALTER,IMPROVE, DEMOLISH,OR REPAIR ANy STRUC- Z TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED LLI STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- M CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO-FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): 00 LAS OWNER OF THE PROPERTY OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK.AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR CC THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR LLI OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT tS SOLD WITHIN ONE Y EAR OFCOMPLECI TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS CC TO CONSTRUCT THE PROJECT(SEC 7044. BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS ULU CENSE LAW DOES NOTApPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS UCENSE LAW). CC 0 0 I AM EXEMPT UNDER SEC. B PC FOR THIS REASON u DATE 5---0 0> OWNER 0 LICENSED CONTRACTORS DECLARATION ce I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 0- 9 (COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. 0 LICENSE CLASS LIC NO C> DATE CONTRACTOR LU 2 WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS.CI HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS'COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMITS ISSUED LIJ I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3750 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE. •cC CARRIER CI POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERM/T IS FOR ONE HUNDRED COLLARS ($100)OR LESS), M- L1.1 I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY MTH THOSE PROVISIONS. n DATE. APPLICANT. IJJ J WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE LI SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP To ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN—1 SECTION 3709 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES LIJ CONSTRUCTION LENDING AGENCY Cr I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY 0- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC, 3097,CIV C.). LU LENDER'S NAME I—LENDER'S ADDRESS cc I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. LU I AGREE TO COMPLY WITH ALL CITY AND COUNT(ORDINANCES AND STATE LAWS RELATING To BUILDING CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY To ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES JOBSITE ADDRESS Cit (:)g' 1.-""spf. PERMITTEE NAME(PRINT) /D 7 lel SIGNATURE OF PERMITTEEIf 5--er-03 DATE CI -J 03 •cC '7,7TY OF O1 ?t°,PECT(:,7' IMP 5 j kiND,TH 7.1.00!!_; 2!"' UN!DE.R !;;_,N1.)! LI -*P f! 61"'E 1-(_'ii�iii�pe/�!\ I OM:VCR z,!'..1.,-",T!,!;!;_p 'Vi!D t2(..)1\tt", Iin07 ANC! 81-!-T. Harz EAr�,l L ^ 1 FINAL P.0 h;,)r-p,r7V!- 1-1(Y!..1C.,0 i!".! e.E.NCHNCi ROU(7t'Gi,P!!",!!' iivi' POOL, ECIPIC ,POOL t:ENOIN'3 EC_ "IEo°,",g I POOL NiFIL OFF 1-r DEDICA.113N8;-!NAL LNC. I_ANDScArEilf-01(:?!. UN St E ki!Pc.3. ! FINf,ki./(iwil\--. ! 1----!YiE DEPT. !-iF ALTH DFF1 FINAL i_��-�t! 1.7! — !,4-:EFNEP6Y i Ct 3 I 5.:� =1�!�=.:7 SrTil SE-4) ' rEs--FiNAL t-INAL 1--F_AT11,•,!(.5 F!JJAL 1 Rca fci,dr\ 0 PRESS FIRMLY CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE et ADDRESS tXt9q stieler(-6906e 0(' APN LOT lig' TRACT OWNER /4411/ ci-Pf e-ow Ace ii ADDRESS i /1"1-....h. 13x- CITY.fiIiME, ZIP TEL AIM APPLICANT TEL. CONTRACTOR_4.4113,:a_)420(20:f1i ADDRESS_ ICI6-l;iitle/ CITY r r,,,,..e.. ZIP q4,9 TEL ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)) DI,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) 0 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) 0 I AM EXEMPT UNDER SEC B 8 PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LIC NO DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETEDOFTHE PERMIT IS FOR ONE HUNDRED CCLLARS(5100)OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE APPLICANT, WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C) LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES A'711 4/e/ PERMITTEE NAME(PRINT) ,./ ... ... SIGNA UR OF PERMITTE DATE APPLICATION '17 DATE PERMIT 6(9--00 P/C�- ii ' 11-• NUMBER # UL c--) ISSUE TYPE OCC DATE CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE USE RW 0 D SIDE/SIDE STREET RW 0 0 PROPOSED N0. 1 IIIMMI Li Far 16-1, ri UNITS . . t D W EL. 9 . , N0. N0. STORIES BEDROOMS cn 1-1-I w DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION u- 0 Z SFR/ADD/REM Garage/Carport Patio/Deck PooVSpa Re-Roof E —I Commercial 5 co Valuation We ADJ.AREA QUANTITY t DESCRIPTION FEE -4 0 E I- 0 w -J W 0 z Eo" m 1 a I a c..) 2 a z 0 w CONSTRUCTION 419.1 PLAN REVIEW 0 ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE* 3.lkip 1 1 7 _,) G I . �) TOTAL COMMENTS FEES 3gte ic fel- 9 Li 7.,s-0 A&Mb. RECPT. N0. 15Z0 PAID BY VALIDATION MP WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy glid-in d fr-,2,-05,f(/ DIAMOND BAR i PRESS FIRMLY CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBS ITE ,.., .m„ et, ADDRESS G d °7 id.41-e• (OUrSe pre APN LOT 1/ TRACT OWNER /4 it a,L., metnei 6116 A/ ADDRESS 44&( b*/es'a 5-e-4. Auc CITY 4 Cen.14/ ZIP q 7 riSTELf. 5-f4--07-3/ APPLICANT TEL. CONTRACTOR ili 4 14„ 0{IetoPiverv- ADDRESS IQ (y-4 fil OA" crry Xiv,tri.e.- ZIP cil- TEL. P61-IN-60-)-:: ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTYWHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS M00)) DI,AS OWNER OF THE PROPERTY OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) 0 I,AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) 0 I AM EXEMPT UNDER SEC B .5 PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LIC NO 4 qQz../ DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (ThILS SECDON NEED NOT BE COMPLETEDOF THE PERMIT IS FOR ONE HUNDRED COLLARS($100)OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE .../1"'A C APPLICANT . ..--4.----.-- WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY /HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C( LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES Ai q el,cll Pei 10 PERMITTEE NAME(PRINT) 1-k,_epl SIeNT)T E OF PERMITT 5 ' . DATE APPLICATION,/ DATE i 2./4_..).... =Vs I71 71 sp/C c.a._tk, ISSUE DATE / OCC /(2.16-2---CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW 0 0 SIDE/SIDE STREET RW 0 0 PROPOSED N0. UNITS USE DWEL. kW Ci�fp-( Piii----gt-11 fkibilA N0. N0. STORIES BEDROOMS U) LLI w DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION Li- 0 Z SFR/CAM 5.0 Garage/Carport Patio/Deck PooVSpa Re-Roof E ) Commercial 5 co c.t Valuation %,j ci L..) — ADJ.AREA QUANTITY 1 DESCRIPTION FEE -J < 0 E I- 0 w 1 w 0 z E n -) CI. -J < 0 2 a I 0 w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE. PRE-ALT FEE I31.4,0 1 i% 'LS:. no AC .:..k icD TOTAL FEES (4)40 COMMENTS 1/4 RECPT NO . c.: 3 2.-PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy KEILLT.13f CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE ADDRESS 2809 Watercourse APN LOT 49 TRACT OWNER Anil&Meena Shah ADDRESS 401 New Selsen crry Placentia ZIP 92870TEL579.0731 APPLICANT TEL. CONTRACTOR/1,141/ " it- 11.3//men/. ADDRESS I CITY ---71/,At," ZIP ,6'TEL. :fie 41,sr ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7005)OF DIVISIONS OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION,ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PEFtMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($550)) 0 I,AS OWNER OF THE PROPERTY,00 MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY VA-IO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOyEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) 0 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTFIACTOR(S)LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE LAW), 0 I AM EXEMPT UNDER SEC B 8, PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LIC NO DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DEcLARATIONS, I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED My WORKERS'COMPENSATION INSURANCE CARRIER AND poucy NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED Of THE PERMfT IS FOR ONE HUNDRED DOLLARS(WO)OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY pERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE Ck"f. UL/APPLICANT .04.••••••1,^ WARNING FAILURE TO SECURE WORKERS'COMPENSATIO COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER 70 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000). IN ADDITION To THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3759 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C) i . LENDER'S NAME . LENDER'S ADDRESS i i I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT ' I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING , CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ' ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES S lICC ) 4.1 • , 1 PERMITTEE NAME(PRINT r. .../_er., 2 3 SI NA RE OF P MITTEE GAS APPLICATION DATE x ..,PERMIT i 1 4,... (Vs) 1 .. NUMBER 1 ISSUE DATE TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW 0 0 SIDE/SIDE STREET RW 0 CI N0. PROPOSED UNITS USE DWEL Sewer Lateral N0. N0. STORIES BEDROOMS U) I-1-1 LLI DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION 1-1- (.5 Z SFR/ADD/REM - Garage/Carport Patio/Deck PooVSpa Re-Roof F5 -) Commerclal 5 in Valuation ADJ.AREA QUANTITY DESCRIPTION FEE —1 < 0 Ec 1— 0 LU —J LU 0 Z C-73 2 n --1 IL —1 < �••) -2 a x 0 to CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE' PRE-ALT FEE' 41.50 25.00 TOTAL FEES 66.50 COMMENTS RECPT N0. VALIDATIO N WHITE—Department Copy,YELLOW—Finance Copy, PINK—Assessor Copy,GOLDENROD—File Copy, —pp ican s Copy DIAMOND BAD i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE' -, --,-,-4 c ADDRESS(,"' �-'/ LIA-7,7-Cr(0/17-Se C/C AP N LOT ,tq TRACT OWNER (4-11 i )--Mee,/,7 5t,/7 ADDRESS t-i 0/ 41e,e 3-efs.. .y ev-c-, CITY neje eilhii ZIP ' 'TEL.EIL',4,;c),. APPLICANT TEL. CONTRACTOR NC//Lig V d e; ir ie/Orni 61 f ADDRESS iC)C-Ailiel.v.,:e CITY TitY'r. . ZIP j2((0-1-EL. '/h9-a-53-1- ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESSAND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOUSH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7000)OF DIVISIONS OF THE BUSINESS AND PRO- FESSORS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500) ). 0 LAS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUSI- NESS AND PROFESSIONS CODE.THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONEYEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). DI,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC 7044,BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW( 0 I AM EXEMPT UNDER SEC. B.&P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LIC. N0. DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETEDOF THE PERMIT IS FOR ONE HUNDRED DOLLARS(5100)OR LESS). 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE. APPLICANT. WARNING. FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES 'Lag/id/A-el Pa4, ITTEE NAME(PRINT) DATE PRESS FIRMLY APPLICATION DATE • i PERMIT P/C e2._.1...9 1 C - (--- NUMBER # ISSUE DATE TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW 0 0 SIDE/SIDE STREET RW 1:1 0 PROPOSED N0. UNITS USE DWEL. 7 LAJO(Z- /-*:),./.4- /91-1q- ,alrairfavirienemaratemw N0. - N0. STORIES BEDROOMS cn 1.1-1 w DESCRIPTION SQ. FT FACTOR PSF ADJ.AREA/VALUATION I-1- 0 Z R/ADD/REM Garag Patio/Deck Pool/Spa --*"""'• ��........................ Re-Roof E I Commercial 5 co Valuation ADIAREA QUANTITY DESCRIPTION FEE I- L) UJ LU g......N.N......................... CD Z a M -J 0- -1 < �-) a c.) Lil 2 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: I 761 "'—' TOTAL FEES p 7 0 COMMENTS — - . ' At NWEIMINIIM ik LIWOAIPIP.AL1WM111iI- RECPT. N0, PAID BY C I< /7-41 'I VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy C(FV OF DIA10,7)N 3PECT!OT r UNDER OOR-'_.;1")E=I4,-001, EOtINIl'.T.!()N MIO HT 8 r--1 E.C.M1D aEAr-1°FINAL E;(:)Nr) PRE-GfifO ENCHINr. Rot;()1.- POOL EI.I--CTRIC,I POOL FENCING POOL FINAL "(-"SI L I'ATIONS FINAL ENG. L ANDSGAFE/Rflla I ON SITF: IMPS, FINAL ZONAG FIRE DEPT FINAL HEALTH DEPT. NNAL DEV, FELTS HMI-) ENERGY SEWEt'I SEFIIC SEEP FI1/l,,.i„GAS AIR FINAL FINAL HE FINAL FiN PRESS FIRMLY CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 2809 Watercourse APN LOT 44 TRACT 47850 OWNER MrF,Mrs.Anil Shah ADDRESS 401 New Jersey Lan CITY Placentia zip 92870TEL7145790731 APPLICANT TEL. CONTRACTOR Arcadia Electric ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRESAPERMITTO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500)) 0 I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). CI I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW), 0 I AM EXEMPT UNDER SEC B&PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE'S IN FULL FORCE AND EFFECT LICENSE CLASS L(C NO DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OFTHE PERMfT IS FOR ONE HUNDRED DOLLARS$100)OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON INANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE APPLICANT WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C) LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES PERMITTEE NAME(PRINT) i SIGNATURE OF PERMITTEE DATE APPLICATION DATE i...k_;10._.(0,4'ERMIT I 1 g P/C UMBER # ISSUE DATE TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW 0 0 SIDE/SIDE STREET RW P� PROPOSED N0. ..smi. i UNITS LaMIMEIMHIWattnr USE 1 DWEL, N0. N0. STORIES BEDROOMS U) U-I w DESCRIPTION SQ. E3. FACTOR PSF ADJ.AREA/VALUATION I-1- 0 Z SEFt/ADD/REM Garage/Carport Patio/Deck PooVSpa Re-Root EI ) Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE < 0 E I- 1 400 Amp Main 25.90 0 Lu . i LLI 1 200 Amp 25.90 1 100 Amp(sub) 18.00 General 567.49 Electric 0 z Flo 2 1 a I (...) 2 a 2 0 Lii CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE. PRE-ALT FEE- 617.744 25.00 TOTAL FEES 662.29 COMMENTS RECK. N0.1----1i'—..VALIDATION . WHITE—Department Copy,YELLOW—Finance Copy, PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—App icant s Copy 6;1-05 A 1 .,4-, ,-,2--d.5 4„4 PRESS FIRMLY CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 2809 Watercourse APN LOT 44 TRACT 47850 OWNER Mr.&Mrs.Shah ADDRESS 401 New Jersey Ln ci-r( Placentia ZIP 92870 TEL. 714579.0731 APPLICANT TEL. CONTRACTOR A. H. Hart Plumbing ADDRESS i C.:....)izFe_F- CITY<j1-1-1. ,,...1 t C, ....I ZIP',(let TEL//V 76/*-i 3 it ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7505)OF DIVISION SOP THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500Q DI.AS OWNER OF THE PROPERTY.OR My EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER.THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) DI,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) 0 I AM EXEMPT UNDER SEC B&PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND My LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASSI"'3�:,(--16 LIC NO"5"--- DATE 12/3 I/(23 CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED CCLLARS(Elm)OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE APPLICANT WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C) LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES ...\„r,k I kj'1.^6 I a PE INV VANIEIR• -^^- 1-' •.-10 ; .. , SIGN URE OF PERMITTEE DATE APPLICATION DATE 4 1 v--1,(\ -II V N-I'e\PNEUFMMBIETR P/C # ISSUE DATE TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW 0 0 SIDE/SIDE STREET RW 0 PROPOSED N0. UNITS taltiAllailintl i t USE DWEL, N0. N0. STORIES BEDROOMS U) Li w DESCRIPTION SQ. FT FACTOR PSF ADJ.AREANALUATION Li- 0 z SFFt/ADD/REM Garage/Carport Patio/Deck Pool/Spa Re-Roof E —) Commercial 5 CO Valuation ADJ.AREA QUANTITY DESCRIPTION FEE i < C.) E F- �•) ii, ...1 (.5 z E 7 Water Closets m m 0- 3 Kitchen sinks 10 Lavitories 1 Laundry Trays < 0 2 a 1 Island Sink x 0 u.i 2 2 Water heaters CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE. PRE-ALT FEE: 348.80 25.00 TOTAL FEES 373.80 COMMENTS RECPT, N0. PAID BY "1J VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy, N—pp :cant s Copy 6:2-05 AA> DIAMOND BAR i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION 1-A", 410' PRESS JOBSITE ADDRESS 2809 Watercourse APN LOT 44 TEIACI 117850 r &Mrs.Anil Shan OWNER WI• ADDRESS 401 New Jersey Ln cm, Placentia ZIP 92870rEL. 7145790731 APPLICANT TEL. CONTRACTOR Seaside Air ADDRESS CITY ZIP TEL, ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTYWHICH REOUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC. TUBE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)) DI,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY 100-10 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 0 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) 0 I AM EXEMPT UNDER SEC B&PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISIONS OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LIC NO DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY or PERJURY ONE OF THE FOLLOWING DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMFLETEDOF THE PERMfT B FOR ONE HUNDRED DOLLARS($I00(OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE APPLICANT WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100.000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C) LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES PERMITTEE NAME(PRINT) SIGNATURE OF PERMITTEE DATE APPLICATION L,...10 \PERMIT 1 P/C DATE „O.D NUMBER ISSUE TYPE OCC DATE CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW EI 0 SIDE/SIDE STREET RW 0 0 PROPOSED N0. UNITS NSFR—NvAlk.,. USE DWEL, N0. N0, STORIES BEDROOMS CO I-LI w DESCRIPTION SQ. FT. FACTOR PSF LL 0 z ADJ,AREANALUATION SFR/ADD/REM 910v Garage/Carport Patio/Deck PooVSpa Re-Roof E ) Commercial 5 co Valuation ADJ AREA QUANTITY DESCRIPTION FEE -J < 0 E I- C-) w 1 w Vents --7)) 0 z m 1,0 m 2 (Dten D 30 1(1) -J 0 2 3 Ton Btu 1 4 Ton Btu 1 5-Ton Btu 3 •s-a(.5 < c.) -2 a 20 Registers x 0 w M 63.80 2 Returns 87.30 87.30 1 16 Ton Cooling 1 16 Ton Heating CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE -;• ii3.10 2/;5D TOTAL FEES Hig\JA COMMENTS RECPT N0. (.0-50 PAID BY_G1,421_VALIDATION a_d_ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy 4.7,2-6/„