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Home My WebLink About18599 (11) �� i.,ITY OF DIAMOND BAR - � DEPARTME�:T OF C�MMUNI'CY&DEVELOPMENT SERVICES �� .� 2I825 E.Copley Drive ""�W (909)860-3195 Fax(909)861-3117 , PRESS %»� BUILDINGPERMITAPPLICATION '� � � • FIRMLY � JOBSITE �^�� b� APPLICATION D� Z�,�(� PER T r P/C o ADDRESS V r)V �" _ N^ DATE � NUMBER-��j� q � ISSUE � TYPE OCC � APN LOT TRACT DATE � � CONST. GROUP p OWNE�LM/k�L-R6r'IV ��- �iA _ � ADDRESS ZONING SETBACKS Z CITY ZIP TE + FRONT RW ❑ � APPLICANT _ TEL_ REAR ❑ _ � — SIDE/SIDE STREET RW ❑ z ¢ CONTRACTO . ('j- SIDE ❑ � CITY�� ZIP TEL.�� PROPOSED USE `-V C�, U� �"J w ARCH/ENG/ z DESIGNER_ -- — NO.DWEL. NO. NO. a ADDRESS ____ UNITS STORIES I BEDROOMS � CITY ZIP_,_ TEL._ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O OWNER-BUILDER DECLARATION SFR/ADD/FEM p I HEREBv AFFliiM 11N�ER PENALTY OF PERJURV'HAT I AM FxEMPT FROM THE CONTRACTORS LI- G0f0J0/CdfPOR W CENSELAWFORTNEFOLLOWINGREASON(SEC.]09158USMESSANDFAOFESSIONSCO�E:ANYC�TVOR (n U COUNTVWHICHREOUIFESAPERMITTOCONSTflUC',AITER,IMOROVE,�EMOLISH,CRRE7AIRANVSTRUG W PyIIOiDBCI( Z TURE,PRIOR TO ITS ISSUANCE,ALSO REQIJIRES THE APGLICANT FOR SUCH PERMIT TO F'LE A SIGNED w W STATEMENT THAT HE OR SNE IS LICENSED PVfi5UA�1T TO THE PROVISIONS OF THE CONTRACTORS L!- � CENSE LAW(CHNPiER 9(COMMENGING WiTF SEGTION"l000)O�DIVISION 3 C'F THE BUSINESS AND PRO� � POOVSPB OFESSIONSCODE)ORTHATMEORSHEISEXEMPTTMFREFFOMANDTHEBASISFORTNEALLEGEDE%EMP- V TION.ANVVIOLATIONOFSECTION7031.SBYANYAPPLICANiFORAPERMITS�BJEGIS�INFAPPLIGANTTO Z Re-Roof � i � A CIVIL PENALTY OF NOT MORE THAN FNE Ht;NDRED DOLURS(f50o)): � O ❑I,ASOWNEROFTHEPROPER(V.OaMVEMPLOYEESWiTHWAGESASIHEIR50LECDMPENSATiON, ❑ CORIff12fCIdI Z WILL DO THE WORN,AND THE STRUCTURE IS NOT INTEhfJF�OH nFFFRFD fOH SALE!SEC.]Odd.BUSI- J � NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW GO�S NO'AP7'.V TO Atv OWNER OF � PROPERTVNh10BU1LDSORIMPROVESTHEREON,ANDWHO00E55UCHWORKHIMSELFORHERSELFOR � [[ THROUGHHISORHEROWNEMPLOVEES.PFOVIOEDTHATfUCHIMPROVEMENTSARENOTINTENDEDOR m w OFFEREDFORSALE.IF,HOWEYER,h1EBUILDINGORIMPROVEMEN`ISSOLDWITHINONEVEAftOFCOMPLE- � TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING'MA1 HE OR SFE DID NOT BUILD OR Z IMPROVE FORTHE PURPOSEOF SALE). _ ❑I,ASONTJEROFTHEPROPERTVAME%CLUSIVELVCONTRACTINGWI�MLIGENSEDGONiftAGItiHS W [[ TO CONSTRUCT THE PRQIECT(SEC.7oaa,BUSINESS ANO PROFESSIONS CODE:THE CONTPACTORS LI- V21U2fi0f1 ADJ.AREA � W CENSE UW DOES NCTAPPLY TOAN OWNER OF A PROPERTV WHO d'JII DS OF IMPPOVES TMEREON,AND � WHOCANTRACTSFORSl1CHPRQlECTSWITHACONTRACTOF(°�)LICENSCD�URSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE TORSUCENSELAW.�. - Y � � _�I AM E%'cMFT 11NDER SFC. B 8 P C.FOR THIS PEASON Q � U ¢ LL OATE __ OWNcR U Z w � LICENSED CONTRACTORS DECLARATION w Q Q I HEREBVAFFIRM UNDER PENALTV OF PERJl1RV'HAT I AM IICFNSED JNDER PROVISIONS OF CHAPTER � d 9(COMMENCiNG WiTH SECTION]000�OF DIVISION 3 UF THE BUSINESS AND PPOFE55'iJNS CO�JE,AN[l z X MY LICENSE IS IN FULI�ORCE AND EFFECT. m W {y��'}� � � LICENSECLA � �L_��4_ LIC.Nn. �fi�'��.- _ � F 1•` 71�.)d -1 V DATE�_ _ CONTRACTOR___ � 'N1 �I� a w � WORKERS'COMPENSATION DEGLARATION � � a � U � I HEREBY AFFIRM IiNDER PENALTV OF PEFJURY ONEO�THE�OLLOWING�ECLARATIONS: Z Q 0 IHAVEANGWILLMAINTAINACERTIFICATEOFCONSENTiOSELF�INSUREFOFWOHKEHS' _ /COMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR COOE,FOR THE PERFOPMANCE U Q ��OFTHE WORK FOR WHICH THIS VERIAIT IS ISSUED. � � w I HPVE FNC)WILLMFINTAIN WORNEi15'GOMPENSATION INSURANCE,AS REOl11RE0 BY SECTION � �� Q 3]0a OF THE LABOfl CODE.FOR THE PERFORMANCE OF 7HE WORK FOR WHIGH THIS PERMIi IS � �u � ISSUED.MV WORKERS'COMPENSATION I URANCE CAPRIER AM1D POLICV NUMBER ARE' CONSTRUCTION � J � M _ PLAN REVIEW ¢ CAFRIER_ `L ---- - -------- � � aa.icveuMaEa �f �.--_.�-Z _ —__—_ ELECTRIC ¢ � (iHI55EC�lONNEmNJTBEDJMFLETEDOFTHEPERMf�ISFOFONENUPDRED00LlAR5(51W;ORLE55�. PLUMBING w I CERTIFV THA'M THE PERFOflMANGE OF THE WORK FOR WHICH THIS PERMIT IS ISSl1E�.I MECHANICAL Z �} SHALLNOfEMPLOVANVPER50NINANVMANNEflSGASTOBECOMESUBJEf:TiOTHE INS�ECTIONFEE � WORKERS'COMVENSATION LAWS OF CALIFORNIA,AND nf;RFF THAT IF I SHOULD BECOME � SUBJECTTOTHEWORKERS'CDMPE45ATIONPROVISfOhSOFSECTION3�0oOFTHEiA60P � CODE,1 Sh�ALL FORTNWITH COMPLY WIT4 TI105E PROVISIONS. ISSUANCE _ _ � SMIP • Ci7�_ p DATE:_ APPLICAN7 _ w ENERGV P/C J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAG�IS UNLAWFVL.AND SHALL BE — J � � SUBJECT AN EMPI.DYERTO CRIMINAL�ENALTIES AND CIVIL FINES LlP IOONE HLN�RED THOUSAND ENERGY PERMIT DOLURS(f100,000).IN A�DITION TO THE COST OF COMPENSATION,OAMAGES AS PROVIDED FOR IN -- J SEGTION 3t00OF iME LABOR GODE.INTEFEST.AND ATTORNEY'S FEES. RETENTION FEE: �+ � � CONSTRUCTION LENDING AGENCY pRE-ALT FEE � O ..__.. . . . ._ . _ .._._ . __.-_____.. .-�---- .. � I HE0.EBV AFFIRM UNDEF PENALTV OF PERJUFV THAT THFRF li A CONSTR'JCTION LEN�ING AGEN(:V � FOR THE PEPFOFMANCE OF THE WOFK FOF VJhICH THIS PER1.11T IS ISSIIF�j5'rC.309],CIV.C.). Z W ? LENDEN'SNAME_ _ y 1- LENDER'SADC�iiE55 _ _ ./� w I CERTIFYTHAT�1�AVE READ TH6APPLICATInN AND STATE THAT THE ABOVE INFORMATIOM1 IS CORRECT TOTAL FEES G...�{ � I U � I AGaEE TO C01.IGLV WITH ALLCITV AM1�COUNTY ORD'�N4NCE5 ANp STATF LAWS RELATING TO AUILDING � I � C01:STi7UCT�ON,ANDHEREBYAUiHORIZEREPRESENTATIVE50FTNISCWNTVTOEN�ERUGi�NTHE Z ApOVE-M ONF.D PflOP[RTV FOR INSP ION PUR�OSES. ;� COMMENTS_ � � 1 __._...___ � _. ... _- _ — __ m PERMITT AME'�.�PRI ) _ __ ¢ � _��__.a Z --- � SIGNATIiflF.OF PI=R�E ,_- [1nTE ----�'�-�' ---� = RECPT.NO. _ PAID BY VALIDATION _ ~ ITE-Department Gopy,YELLOW-Finance Gopy,PINK-Assessor Gopy.GOLDENRO�File Copy,GREEN-ApplicanYs Copy � � � :�m � �� . ��,��.r: ,_�� - �� , � ..�� a�,� �. � t � �� _ __. �. � �" _ _ _ __ . _. _..__ _ _ _ _ _ _ _ _ _. _ _ . __ _ _ _ . .__ . _ _ . _ � ��,� �� ,�E��,��: � � � _ __ __ _._ _ � ��. � �'� _��. � � . , ry �� __ _ _ �! �; _ _ _ _ 3 " �' 4�:�,. '. � � ... . . .. . ... .. ..... .... ... .. .. ... .. ._.. ...... . ; 4.;.. � ,�'� i R . i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117,PRESS \�W BUILDING PERMIT APPLICATION k(?�Ilt��FIRMLY JOBSITE ',��- ADDRESS in 'Aoeft- APN LOT TRACT OWNER T16Vk'0-(26Mi 0$ RDA ADDRESS CITY ZIP TE 1;2L- APPLICANT TEL. CONTRACTOR M�Ilnkh)� 106V1114 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 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(CHAPTER B (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 I HE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($5M)): ^ 1,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 THAI HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I,AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTlNG 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 BUII DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.) LJ I AM EXEMPT UNDER SEC. B&P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM LINDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLA_LIC NO 11 i.' -CONTRACTOR � 'W DATE- 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 V 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 I URANCE CARRIER AND POLICY NUMBER ARE: W CARRIER - ^'��Y �71--II -z- POLICY NUMBE SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS) THIS 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 10 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. CONSTRUCTlON 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 --- LE NDE R'S ADDRES S CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 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-M ONED PROPERTY FOR INSP ION PURPOSES 1 � 1 PERMITT AME(PRI SIGNATLfI F.OF PI=RI�1T E DATE 00 CC 0 w 0 0 m w 0 0 r n w 0 Q x w 0 I- U w 03 A U cn w t�E 0 w J J S I APPLICATION PER T of P/C DATE NUMBER# ISSUE c TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW REAR^ SIDE/SIDE STREET RW^ SIDE � //�� PROPOSED USE Uf 00 N0. DWEL. N0. N0. UNITS STORIES I BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM W Garage/Carport LU Patio/Deck W LL PooUSpa Z Re-Roof Commercial %u UUL/Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W LU W z m a z Q 2 0 W CONSTRUCTION V PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INS?ECTlON FEE ISSUANCE SMIP 62 C7_ ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 24.�U COMMENTS_ RECPT N0. PAID BY VALIDATION ITE-Department Copy,YELI-OW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy