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Home My WebLink About18531 - 530 Golden SpringsQ W Z Lu W OC W S F ]G [C O W Z O Q ir d >< W 0 H U W 7D rn CID do W Q 0 Q 0 w Z CID CID O M Di _J J Q W CL- cr 0- Du S H MF cr IULJ c� Z m Q I/7 2 DIAMOND BAR' CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & bEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION ADDRIESS—lVz APN LOT TRACT�� _ OWNER ADDRESS _ CITY ZIP TEL. APPLICANT TEL CONTRACTO ADDRESS CITY ZIP TE ARCH/ENG/ DESIGNER ADDRESS 1 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, CR REPAIR ANY S-RUC- TORE, 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 T1500).): ❑ L AS OWNER OF THE PROPER rV OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOH SALE (SEC. 7044, BUFI- NESS AND PROFESSIONS CODE: 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 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 DIO NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ I. AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING W I TH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U CENSE LAW DOES NOTAPPLY TOAN OWNER OF A PROPERTY WHO dU11.DS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). L I 1 AM EXEMPT UNDER SEC. __ B. IT P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY -HAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,ANU MY LICENSE IS IN FULL FORC D EFFE,('.T. �. LICENSE C S _ LIC. Nn. -44 DATE _ CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _IHAV AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' PENSATG AS PROVIDED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE F THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REOUIR90 BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEC. MV WORKER P SATtQ)ANCE AND POLICY NUMBER ARE. J*ER CARRIER _ `,�Nk POLICY NUMBER I MIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS (E100) 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 SUBJECTTO 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 SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (51W 000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTCRNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEC (SEC. 3L)97, CIV. C). LENDER'S NAME_ LENDER'S ADDRESS CEnTIFY 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 TJ ENTER UPON THE ABOVE TIONEL PROPERT R TION PURPOSES. PEHMITTEE NAMEEEIIPRI SI GNAT( IRF OF PFR ITTFF DATE PRESS A', ; A FIRMLY APPLICATIO PERMI I 4` P/C DATE NUMBER `l A ISSUE \ TYPE OCC �fl�s DATE . l3 CONST. GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW ❑ SIDE __1 PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES tIF — BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFRlADD/REM U) Garage/Carport WPatio/Deck LLLL POOUSpa V Z Re -Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U 2 H W LU U Z m 11 Q U_ Z Q U.) 1 CONSTRUCTION 1 I� PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE- SMIP, ENERGY P/C ENERGY PERMIT RETENTION FEE: _ PRE-ALT FEE: TOTAL FEES C. 1 COMMENTS RECPT. NO. _ PAID BY 14 VALIDATION WHITE —Department Copy, YELLOWFinanceCopy, PINKAssessorCopy, GOLDENROD —File Copy, GREEN —Applicant's Copy "WIT —N CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & bEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE — ! — — -- fVs ADDRESS- - N —/' APN LOT TRACT _ p ,— e OWNER .....(,U JV "_"i rl" ADDRESS_ CITY ZIP TEL. APPLICANT TEL CONTRACTO ADDRESS CITY ZIP'"" TE ARCH/ENG/ DESIGNER _1\!IA-Y' ADDRESS T CITY ZIP _ TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LL CENSELAW 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 IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 1000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE) ORTHAT HE ORSHE IS E%EMPT THEREFROM ANO THE BASIS FOR THE ALLEGED E%EMP- TION. ANV VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJEC f S'f HF APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (f500),I: ^ I, AS OWNER OF THE PROPERTY, OR MV EMPLOYEES W iTH WAGES AS 1 HEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT IN i ENDED OR OFFERED FOH SALE (SEC. 70aa, BU"I- NESSAND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NO' APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOEB 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 'HAT HE OR SHE DID NOT BUILD OH IMPROVE FOR 7HE PURPOSE OF SALEI. ^ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING W I rH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 706<, OUSINESS AND PROFESSIUNS CODE: THE CONTRACTORS LI— CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO d'JII.DS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). C I 1 AM EXEMPT UNDER SEC. _, B. 8 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 PPOFESSiONS CODE, AND MY LICENSE IS IN FULL FORC D EFF E,GT. LICENSE C S _ LIC. N9. OATEj- CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _ I HAV AND WILL MAINTAIN ACERi1FICATE OF CONSENT TOSELF-INSURE FOR WORKERS' PENSATION, AS PROVIDED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE F THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKER P SAT(QANCE C$PRIER AND POLICY NUMBER ARE: 1 CARRIER _ NRX POLICY NUMBER"" f +" I'I (fFitS SECnON NEED NOT BE NMPLETED OF THE PERMR IS FOR ONE HUNDRED DOIIARS (f1001 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 SUBJEf,T TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOVED BECOME SUBJECT 70 THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3]00 OF THE LABOR GODE, 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 (f 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 WOF:K FOR WHICH THIS PERMIT IS ISSIJEC (SEC. 309], CI V. 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 IAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE TIONED PROPERT R I TION PURPOSES. PERMITTEE NAME IPRI SIGNATURE OF "R ITTEE T DA E WHITE -Department Copy, YELLOW -Finance Copy, PIN X""y PRESS FIRMLY s,P/C APPLICATIO PERMI GATE NUMBER "g ISSUE TYPE OCC DATE " CONST. GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW ^ SIDE C7 PROPOSED USE NO. DWEL. NO. ! NO. UNITS STORIES I BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck PooUSpa Z Re -Roof Commercial m J Q U 2 F- W W Z fn a Q U Z Q 1 vj Valuation ADJ.AREA I pUANTITY DESCRIPTION FEE CONSTRUCTION 1 I PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INS?ECTION FEE ISSUANCE SMIP _ �I ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES C. 1 COMMENTS RECPT. NO. - — PAID BY Y VALIDATION