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Home My WebLink About20528LL LU c- c 2 Z F— cc cc 2 C. Z C CE U_ CITY OF DIAMOND BAR I DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES <1� 21825 E. Copley hive (909) 860-3195 Fax (909) 861-3111 BUILDING PERMIT APPLICATION JOBSITE ` { ADDRESS +W L_ _ APN LOT- TRACT OWNER ADDRESS._- _ CITY(— TEL. APPLICANT TEL. CONTRACT � $LinShlne ROOF l ADDRESS 16J laIIlOn ar CITY I1la1tt0�'18r 3 / 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 S LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U- CENSE LAW (CHAPTER 9 (COMMENCING WTH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THERE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERM T SUBJECTS fHE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DO_IARS ("W )'.. ❑ L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS IHEIR SOLE COM-ENSATION, 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'NORK HIMSELF OR HERSE_F 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 OWNERBUILDERWILL HAVE THE BURDEN OF PROVING THAI HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE Cr SALE). C I. AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS 1I- CENSE LAW DOES NOT APPLY 10 AN OWNER OF A PROPERTY WHO B'J II.C5 OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). LJ IAM EXFMPTUNDER SI'C. S. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED IJNDEH PROVISIONS OF CHAP TEH 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 0 F THE BUSINESS AND PPDT ESSiON5 CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENS C3 LJC.110. 755126 DATE_ CONTRACTOR__ uns. lne xt11Z1g W KERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FO'_LOWING DECLARATIONS: I HAVE AND WILL MAIN'-AIN A CERTIFICATE OF CONSENT T O SELF INSURE FOR WORKERS' GO" PENSATION, AS PROVIDED BY SECTION 37DO OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED _ HAVE AND WILL MA'N-'AIN WORKERS' COMPENSAT ION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS SSUED. MY WORKERSCOMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE. CARRIER S�t'at'�ej�'Fund j �I �� POLICY NUMBER ="""7"' _ THIS SECTION NEED NO BE ODMPLETEDOF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1L100) 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 50 AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SU EC�Ai"" OE WOPKERS COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR 1 ORTHNTH COMPLY WITH THOSE PROVISIONS i� APPLICANT Michael Chang DATE. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL F INES UP TO ONE HUNDRED THOUSAND DOLLARS CSIW 000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37DA OF THE LAROVI ;ODF. INTEREST AND ATTORNEY'S FEES, CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UND ERPEN.4LTY OF PERJURY THAT THERE IS A CONS I RUC ] UN LENDNG AGENCY FOR THE PER=ORMAN.{CE OFTHE'NORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CI'J. C.). LENDER'S NAME Michael Chang LENDER'SADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT AGREE TO COMPLY ALL CITY AND COUNTY ORDINANCES ANU STATE LAWS RELATING -0 BUILDING CONSTRUCTION. HE EBI' AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER l.PC1N THE ABOVE MEN PRO ERTY FOR INSPECTION PURPOSES. i I PER EE NA P �1 _ �.----- - - SIGNATI HE OF P RMITTEE�� FPRESS FIRMLY APPLICATION PERMITXS jlb P/C DATE � y # 11. ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT _ RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ _ SIDE ❑ PRQP`O E UIE Tear Off r0 I fa insal PPII � I �+I v 6 NO. DW NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT FACTOR PSF ADJ. AREAIVALUATION SFR/ADDIREM In Garage/Carport WPatio/Deck LL- Pool/Spa ZRe -Roof 0 Commercial m Valuation ADJ.AREA 1 QUANTITY DESCRIPTION FEE J Q — U H- W J W Z_ m CL J Q U_ Z Q 2 W A} - 1 / 4-1I CONSTRUCTION 1_ 1 PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INS?ECTION FEE ~ISSUANCE (SMI RGY P/C _ ENFRGY PERMIT F&TTENTION FEE PRE-ALT FEE: TOTAL FEES U I Y COMMENTS RECPT. NO. 'PAID BY VALIDATION WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy II CITY OF DIAMOND BAR DEPARTME'—:T OF COMMUNTfY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE —r—'_I { ADDRESS —' — L_ _ APN L I" TRACT 0VIVO . ADDRESS --- 1-1'— ZIP TEL. CITY t� -t 4+— APPLICANT °' TEL. CONTRACT Sunshine IZOO-1 6-- 1am012 ar ADDRESS -- 1 CITY I—IamO--'lar ZIP TEL. 3 — ARCH/ENG/ DESIGNER ADDRESS CITY ZIP ,_ TEL. OWNER -BUILDER DECLARATION I HERERV AFFIRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI— CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER. IMPROVE DEMOLISH, CR REPAIR ANY STRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE S LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION' 3 —F THE BUSINESS AND PRO- FESSIONSCODE) OR THAT HE OR SHE IS E%EMPT THERE FROM AND THE BASIS FOR THE ALLEGED E%EMF- TION. ANV VIOLATION OF SECTION 7031.5 BY ANY AP FLICAN' FOR A PERMIT SUBJEC (S fHE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500) ): ' ^ I, AS OWNER OF THE PROPERTY, OR MV EMPLOYEES WITH WAGES AS 1HEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT IMEND[D OR OFFERED FOH SALE !SEC. 70da, BUSI- NESS AND PROFESSIONS CODI=: THE CONTRACTORS LICENSE LAW DOES NO' 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 ENIPLOVEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD W ITHIN ONE V EAR OF COMPLE TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING HAI HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I, AS OWNER OF THE PROPERTY. AM E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7060, BUSINESS AND PROFESSIUNS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY 1'0 AN OWNER OF A PROPERTY WHO d'J II.DS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) iCENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). U I AM E%EMPT UNDER SE: C. e. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENP.LTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTIOW 7000) OF DIVISION 3 OF THE BUSINESS AND PPOFESSiQNS CODE, AND MV LICENSE IS IN FULL FORCE AND EFFECT. C3 75512 uaNO. _ LICENS un$x Ine 1\11iAg DATE — CONTRACTOR W KERS' COMPENSATION DECLARATION I HERERV AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAIN--AIN ACERTIFICATE OF CONSENT TO SELF —INSURE FOR WORKERS' COMPENSATION. AS PROVIDED BV SECTION 37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHIICH THIS PERMIT IS ISSUED I HAVE AND WILL MAIN-"AIN WORKERS' COMP ENSATIOPI INSURANCE, AS REQUIRED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSVED. MV WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: u nd ' a't' F St CARRIER POLICY NUMBER (THIS SECTKXJ NEm NOT BE COMPLETED OF THE PERMIT IS FOF ONE HUNDRED DOLLARS (f100) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SU ECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR C E, I A FORTH'NITN COMPLY WITH THOSE PROVISIONS __,A Michae— Chang DATE: APPLICANT _ WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CiIIM INAL PENALTIES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND DOLLARS (f 100,000), IN ADDITION TO THE COST OF COMPEN SAT!ON, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR --ODE. INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HERERV AFFIRM UNDER PEN.4LTV OF PEfl3URY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOH THE PF.HFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSIIED (SEC. 3097, CIV. C.). MicYLael Chang LENDER'S NAME LENDE H'S ADDRESS - _- -_ - I CE RTIFV THAT I HAVE READ IRIS APPLICATION AND STATE THAT THE ABOV'e INFORMATION IS CORRECT I AGREE TO COMPLY ALL GITV AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, HE EBI' AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIO PRO ERTV FOR INSPECTION PURPOSES. I. - — I PER ' p{E'E NA P t\— I SIGNATURE OF P 'HMITTEE —+'t\ r- 0 0 00 0 0 w m Q 0 0 w 0 W cn 0 W U Z W U F- Z W Z W W F- ]c 2 LL Z 0 d X W 0 W cn Z Q W Q J Z 4 W Z (f� 0 W J IL J W d 0 d Z F-- W 2 WHITE -Department Copy, YELLOW -Finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN -Applicant's Copy