The URL can be used to link to this page

Home My WebLink About15-1244,e Wa,5teJ�4 ernen- l CITY OF DIAMOND BAR DEPARTMENT OF COM NITY & VELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building InVeetum Hotline (909) 839.7027 BUILDING PERMIT APPLICATION JOB 2(z0�-......COL-1) ...SPjZIy4 N OWNERE ADDRESS ...,.M1„_—TRACT AD CITYnT'.5+ ! Zf TEL �2( anti APPLICANT TEL CONTRACTOR ADDRESS CITY ZIP TEL ARCH/ENG/DESIGNER ADDRESS CITY ZIP TEL OWN%OtaDM EMANATION I heady affirm under Mgt, et ury that I am prompt from No Cu manor's State Lasom tae ter the main(s) allocated below by the deckmasNO I Nee bated nest m the roments as rNe1 ISecEod 7031.5, H®Nen Road Ftomnlow Cada Any d” eaarm OW team a pemn Re mtm4tWLaf, mogma6, dem p lah, or maid, req W Wbea, talar to Ila Woaft M mqutrY the epplicart for the pemdtW file agned BNtemad M hasshe be Opened F"sRud oma plcepow"ofEssCambacmrrs Stemupem me (chapter 9) cwmalWtga da Swann at DMnos 3 of the &Wall Pmhmbm fates or met as re Ross is erempt Man lharmure Raw the bards to Me passed eaemlmm Any assistant of Serbon 70313 by my apdigm lora pmbet suajece the applvmm In a care penalty INcoda MmnOm hundred tldiam t85Wj / Y oat a as mme McMly or my, emplcycn won warn n mea sm will do ibae of or U p u of me work ace Me steft's R M analysed m ell per Rate LSertes, 7048 Oaf and pralemgne Code The fn..aaztaa' S1aQ warm Law don nm adow W an macer of property win thrtaah ars"Mr, or Manuel el odor V Improves the Penalty prodded that dw marrommwrts ere net Inmrmod or ans ed for nays d however, the Nuldlare in ImpmeenemN�d wMhmOyearl do Owner-BUMerwai hamaw WNan INprovmg0mtawaenl md6 a ImpmeW Me the pop® atsaB I UI ass ff of are Moot am aallummly o )*% won Roundup I irmare to amabuCt the pmlect i5ecft 7D44 Buenos all FenNsdnas Coda The Co(aG4Mn' SM license law aces not Dopey W an owner of property after bua¢orrmPmaamamn an whowntrurs far The pubtansearn afi ermOaP.aNacfirpumuaa Nada Cmoacmrs' Same, lawn law) U I Fn ammpi beta acenara under the ConUW..a'aStar$ LEAH law for me falkering neasnna7 IH mys%nature below Ute anal Na my peeeplW resianea m wh4h1 owl fade IeaWBd per a 10aa m0 yeambrdmfit ;namuimpmnmsinnemdb)thUPanedi tiMIe9aPywapaeaumaeitaitombulbrtepn owrer buederlfit has � bemdmatNcho In to entlretydyikahaad mnbalae i untlereUndthaaAApymdwaaNkdbU Uw Salm ]049athe ruana588ntl PINatbbne futlaU remwai who meappla:eaarUarbrrltedma dm fdbvnng bane lepton ca awntrM SIGN ..............__ LICENSEE CONWAMR'S OECLAUTM I hoeby, of min under penalty of Polory that f rte warmed under Newsom of Chante 9 U'ommendnq won Sateen 70001 of towboat 3 at Me Sureness and Code, and my family IB In Ml mica wort etlect UCENSECIA55 LIC NO WNTRACTON WOPM-S CDMW* ATWN OE0.ARiIM I NEAEBYAFFIRM UNDER PENNEY OF PERAMYONE OHNE FOLLOWING OOGABATKe45 I have art welt maintain a CeIAME, of Crmem m Sog1rubma for Wean§ Communalism as Rdadd by SecOm 3709 of ace Labor Code for bit pmtolnaxeOR me wsk fa w1,10-99 a rl tswmA hamarawa maeam WRoaere Compwsv" mMbaRe a requial N30,16i$79Gpf the Labor Caste as ma wNarrnarte ofthe waklor'MlmhmUpama U IRouay MyabhaYTatmar®tWn Nnumnw Caller a0 policyti mbsrare CABNER POLICY MEMBER _.... (NILS SECM" NN® NOT BE W hPLE7EO IF TIE VW SFOR ONE HAIRED DOL;AG 41,011 OR LESS) imrMgmahtln polamanmRoOsswaktowaFlsthmDertrJlUtnmd Iaautrot¢ngip/aMpe�NaymanmRo®Rem C*nMe augat m alo Vtarats laws m Ceplaaa, Nq ma Y i lead bewre aa�t W Omxtxwasi CanpsnflDx. Predslons lSeMam 3700IN to taper Caste I ata7�atMihtanpy w17 tlMee DnwUon OM APKtCA7T WARNING Future to eotem W'miata Dong =U anempe U uar M oaf oral baleen an employs m careful poaRles all del Una up mane hardred thousand Detlars 0100 000} In MrM to to cot of to carropmenuffiam deme" Momend for In secem 1706 of ft tabor coda normal Rost aIXa+mYe fees C TRWnaatODINGAGEWY I hereby aftem under penalty as Mury mal tirere U a Cminuctlm LeMnq equity be the pofamanre of -e wont Wr wrvm des cermet is Issued (Sec 3097 Or C) LENDER S NAME UNDER 5ADOREES Iarty the I hamr, roadNe eeprimand and ram Met me abWe Isination Is Wnel I um W Canpty with an cladam =my operacss and unts Uwe mating m In Adma mlabuWw and homby Russel m of the =toy m adprapm me amwe MN�atbn putpce40 iL- PF iTTFE aW.1EORgn ......... �i5 lDATE' APPLICATION DATE d -SJ Zi3b PtC# ' ISSUE DATE O$.1 L6iS PERMIT# Mig'—)244 TYPE CONST OCC GROUP ZONING SETBACKS FRONT RW REAR SIDEISIDE STREET RW SIDE — _ ❑ ❑ ❑ ❑ PROPOSED USE It DWEL UNITS # STORIES # BEDROOMS DESCRIPTION SO FT FACTOR FOR ADJ AREA/VALUATION SRVADEVREM 4 I W W PeRp/DApa �- w Poop z Re Fmgt LOUD rrIXMimmta i i Valuation r Adl Area QUANTITY DESCRIPTION FEE E j, CONSTRUCTION PLAN REVIEW i"'1 •i�3 J ELECTRIC PLUMBING MECHANICAL�-�, fNSPECTION FEE .....-5�:_�-,,, ISSUANCE SMIP 0-6 ENERGY PIC ENERGY PERMIT RETENTION FEE PRE -ALT FEE ^' N❑ BSAF 1 Q TOTAL FEES COMMENTS t'�I RECEIPT PAID BY ._1_0�� VALIDATION WF1RE—Department Copy.YELLOW— FNance Copy, — AssrmorCopy GOLDENROD—Rad COW GREEN —Appllpam's Copy N -• t FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL HOOD Ell UG PLUMBING T -BAR UG ELECTRICAL INTERCEPTER ROOF SHEATHING I /./.,/ /!t Fk _7 /r 11 1 ROOF DRAINS I I FRAMINGIVENTING RDUGH ELECTRICAL ROUGH MECHANICAL RDUGH MECHANICAL C DRYWALL FENCE J DATE/ ALARM LATH PRE FINAL POOL LATH EXTERIOR ......................... WALLS LATH INTERIOR WALL FOOTING/STEEL � GAS TEST WALL STEEL 1-( ) 2ND( ) LIFT SCRATCH COAT WALL BOND BEAM ELECTRIC METER RELEASE WALL GRAIN/ SEAL GAS METER RELEASE WALL FINAL SPECIAL INSPECT10N DO FRAMINGPLANNINGAPPRO01 FINAL BUILDING p / ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING FINAL ENGINEERING/ PW TC Df OCCUPANCY FINAL COMMUNITY SERVICES CERT, of OCCUPANCY FINAL HEALTH DEPT FINAL INDUSTRIAL WASTE COMMENTS Building & Safety Division 21810 Copley Drive Diamond Bar, California 91765 (909) 839-7020 Fax (909) 861-3117 Job Address Z`170S C90 pr',« i" rl ;�,w . Q i�.. QX 0 rlLS Dear Property Owner An application for a budding permit has been submitted in your name stating yourself as the budder of the property improvements specified For your protection, you should be aware that as "owner -budder" you are the responsible party of record on such a permit Building penrnts are not required to be signed by property owners unless they are personally performing their own work If your work is being performed by someone other than yourself, you may protect yourself from possible liability it that person applies for the proper permit in his or her name Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City of County They are also required bylaw to put their license number on all permits for which they apply If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions There may be financial risks for you it you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance For more specific information about your obligations under the federal law, contact the internal Review Service (and if you wish, the U S Small Business Administration) For more specific information about your obligations under State law, contact the Department of Benefit -Payments and the Division of Industrial Accidents If the structure is intended for sale, the property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -budder" building permit, erroneously implying that the property owner is providing his or her own labor and materials personally Budding permits are not required to be signed by the property owners unless they are performing their own work personally Information about licensed contractors may be obtained by contacting the Contractors State License Board at 9821 Business Park Drive, Sacramento, CA 95827, www csib ca oov or at (800) 321-CSIB (2752) Please complete and return the enclosed "Owner -Budder" verificatron form so that we can confirm that you are aware of these matters The budding permit will not be issued until the verification is returned Attention Property Owner An "Owner -Budder" budding permit has been applied for in your name and bearing your signature Please complete and return this Information at your earliest opportunity to avoid unnecessary delay in processing and issuing your budding permit No building permit will be issued until this verification is received by us 1 1 personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) t te-5 2 1 (have/have not) �A."(. signed an application for a budding permit for the proposed work 3 1 have coJ f ted with the following person (firm) to provide the proposed construction Name Address City Phone Contractors License No 4 1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and providerrkator work Name A Address City Phone Contractors License No 5 1 will provide some of the work but I have contracted (hired) the following persons to provide the work Indicated Name Address Phone Type of Work Signed P-il ertyOw Property Owner Date 5i�6 f y 5 NOTICE TO PROPERTY OWNER Dear Property Owner An application for a building permit has begn submitted in your name listing yourself as the builder of the property improvements specified at/11205- Cg(„rt SF�fu'� 1, -k Y{l r�S'Y \YiJ ,�.�, We are providing you with an Owner -Builder AcknowiedgYnent and reformation Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority OWNER'S ACKNOWLEDGEMENT AND VERIFICATION DIRECTIONS Read and initial each statement below to signify you understand or verify this information Cf 1 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property My homeowner's insurance may not provide coverage for those injuries I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property �Y 2 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility Cl7Qp3 1 understand as an "Owner -Budder" I am the responsible party of record on the permit I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own 11 f 4 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts C5 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars {$500}, inctudrnglabor and materials, I may be considered an "employer' under state and federal law f6 1 understand if I am considered an "employer' under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee" I also understand my failure to abide by these laws may subject me to serious financial risk 1�1 7 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general budding Contractor !�L8 I understand as an Owner -Budder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials 9 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www cslb ca oov for more information about licensed contractors Cr 10 I am aware of and consent to an Owner -Budder budding permit applied for in my name, and understand that I amthe party legally and financially responsible for proposed construction activity at the following address (1/! 11 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers d12 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form Licensed contractors are regulated by laws designed to protect the public If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in civil court It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit Note A copy of the property owner's driver's license, form notarization, or other venfication acceptable to the agency is required to be presented when the permit is issued to verify the property owners signature Signature of Property Owner 5 / Date kl