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Home My WebLink About18655 � , �. CITY OF DIAMOND BAR L � � �� DEPARTMENT OF COIvIIviUNTI'Y&DEVELOPMENT SERVICES � � 21825 E.Copley Drive ��% (909)860-3195 Fax(909)861-3117 PRESS '�"'%.+�� BUILDING PERMIT APPLICATION FIRMLY � } JOBSITE �l�� D�� r�Y-�- APPLICATION PERMIT P/C o ADDRESS__r �__� DATE �Z' NUMBER # � � , ISSUE C'� _ T,, TYPE OCC APN--�— LO T C7 DATE � CONST. GROUP p OWNER J � eiC �� ► � p ADDR S i, '-L ZONING ETBA KS z CITY Zlp 7EL. � , FRONT qW ❑ � APPLICANT TEL�^ REAR ❑ z SIDE/SfDE STREET RW ❑ a CONTRACTOR SIDE ❑ ADDRESS l � � CITY � ZIP TEL. � -�_��O PROPOSED USE C oARCH/ENG/ . � I z DESIGNER b�'L 7 1�_____ w NO.DWEL. /1 NO. NO. a ADDRE�yu U{y�Tg rl STORIES �_BEDROOMS � c�Tv /�'C ZIP�� TEL �d cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDEF PENALTV OF PERJUHV THAT I AM E%EMPT FRDM THE CONTRACTOqS L: G8f2Q0/CBfpOR W CENSELAWFOR7HEFOLLOWINGREASON�SEC.7031.5BUSMESSANDPROFESS�ONSrO�E:A4VCI7YOR (f� U COUNTYWHiCHFiEOUIRESAPEFMITTOCON5TRl1CT.ALTER,IMVROVE,OEMOUSH,ORREPAIRANVSTRUG W TURE.PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLiCANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE�S LICENSFD PURSUANT TO THE PqOVISIONS OF ThE CONTRAGTORS U- LL � CENSE LAW(CHAPTER D(COMMENCING WITN SECTION 7ao0)OF DIVI510N 3(�F 7HE 6USINE55 AND PRP POOUS(J8 FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEqEFROMANDTMEBASI5FOR7HEALLEGEDE%EMF- (3 � TION.ANYVIOLATIONOfSECT10N]�31.59YANYAP?IICPN�FDRAVERMI'SU9JECI5'fHEAoPLICANTTO Z R8-R00� � A CIVIL PENALTV OF NOT MOqE TMAN FIVE HUN�pED DOLLARS�5500).): - � OI,ASOWNEROFTHEPROPERTY,ORMYEMPIOYEESWiTHWAGESASiHE?RSOIECOMPENSATiON, � Commercial Z WIIL DO TME WOR%,ANO THE STRUCTURE IS NOT INTENDED OH OFFEqEO FOH SALE(SEC.]044,BU^I� J � NESSANO GflOFESSIONS CODE:THE CONTRACTORS I.I�ENSE LAW DDES NO�APPiY TO AN OWNER OF � FROGEflTY WHO BUILDS OR IMPROVES THEFEON,AN�YMO DOES SUGH WORK HIMSELF OR 4ERSELF OA CC THROUGH MIS OR HER OWN EMPLOYEES,PfiOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDE�OH m QOFFEREDFO{iSALEIF,HOWEVER,THEBUILDINGORIMPROVEMEN71S50LOWITHINONEVEAROFGOMPIE� Z TION,TME OWNER-BIJILDER WILL HAVE THE BURDEN OF PPOVING:HA1 HE OR SHE 019 NOT BUILO OR = IAAPROVE FORTHE�URPOSE OF SALE�. W ❑I,ASOWNEROFTHEPROPERTV,AME%G�USIVELYGONiRACTWGWRMIICEM1'SE�GONTRACTDPS [[ TO CQNSTRUCT TFIE PRQIEGT(SEG.7044,BUSINE55 AN�PROFESSICNJS CODE THF CONTRACTOAS LI. VOIIIdIiOf1 � ADJ-AREA = CENSEUWDOESNOTRP7LYTOANOWNEPOFAPROPERTYWNOdUI1DSORIMPROVESTHERE�J,ANO � -- � WHOCONTRAG7SFOq5UCHPRWECiSWITHACONTRACTOR(5)I.ICENSCDPURSURNTTOTHECOMRAC- QUANTITY DESCRIPTION FEE Y TORS LIGENSE UW.). ¢ CJ I AM E%EMPT UN'JER SFC. B.6 P.C.FOR THIS REASON Q � O � � � U � -- Q DASE OWNER F' � w r � � � UCENSED CONTRACTORS DECLARAT{ON w \, ¢ � I HEREBY AFFIRM UnDER PENALTY OF PENURY THAT IAM UCENSED JNDER PROViSIONS OF CH0.PTER � e(COMMENCING WiTH S£CTION 7000)OF DIVISION 3 UF THE BUSINE55 AND PPOFESSioNS CO�E,AND `X MY LICENSE�5 IN FULI FOR■C E AN�EFFECT. � LICENSE S I"l �_ LIC.NO. ` �(��,/� ,j DATE � ' DI CONTRACTO _ �� W � WORKERS'COMPENSATION DECLARATION '� a � I HEREBY AFFIRM UNDER PENALTV OF PEFJL'RV ONEOF THE FOLLOWING DECLARATIONS. � � INAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSE�F�INSUREFORWORKERS' !dQ � � � � � CqMPENSATqN,NS PAOVIDED BV SECTION 3700nF THE LABOR COOE,FOR THE PERFOAINANCE T Q OFTHE WORK FOR WHICH 7HI5 PERMIT IS ISSUED. �. 1` � � r'd 1 c�,i�� I HAVE AND WIL�MAINTAIN WORNERS'COI.IPENSATION INSURANCE,AS FEOUIRE�BY SEGTION 4 3lao OF THE L480R CODE,FOR jHE PERFORMAfvCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEfl.M/��o RKERS'CAMVE�SFTI I SVRANCE CA 1ER ANO POLICY NUMBEAARE' CONSTRUCTION � cnaAiea_`�'r'��'K-�/�' ..�Y�''�'u�-� PLANREVIEW � ZPOLICYNUMBER � �C '�[C --^. ELECTRIC __ � � �• � " 4 �� Q (iHt55EC'1QVNEEDNOTBEO]MRETEDOFRIEPEPoMISFOnONEFNf�OREDDOl1AR5(EtOD)ORLESS). PLUMBING W 1 CERTtfv tHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT f5 iSSUED.1 MECHANICAL Z — (� SHALL NGi EMPLOY ANY PERSON IN ANY MANNER SOA$TO BECOME SUBJEf,T TO TNE � WOflKERS'COMPENSFTIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDPECOME INS�ECTIONFEE � SUB.fEC�TO THE WORNERS'COMPENSATION PqOVI510NS OF SEC710N 3]oa OF THE LABOR �� CODE,I SHALL FORTHWITH COMGLV WI?H THOSE PROVISIONS. �SSUANCE _ _ � SMIP p DATE � APPLICANT: �- J WARNING�.FAfLUPE TO SEGURE WORKERS'COMPENSATION COVEPAGE 1S UNLAWFUL.AN�SHAI.L BE ENERGY P(C LL SUBJEGTRNEMPIOVER70GftIMINALPENALTIESANDCNILFINESUPTOONEH�NDREDTNOUSAND ENERGYPERMIT DOLLARS(f100.000),IN AO�iTION TO THE COST OF COMPENSATION.DAMA,ES AS PROVIDE�FOR IN J SEC7ION 37080FTHE LABOR CO�E.INTEREST,ANDATT�0.NEv'S FEES. RETENTION FEE: ��-- � - � CONSTRUCTION LENDING AGENCY PRE-AlT FEE � O � I HEFEBY qFFlRM UNOER PENnLt�OF PERJl1RV THAT THERE IS ACONSTRUCTION LENDMG AGFN['V FOR THE PERFOR�IANCE OF T WORI(FOR WH1CH THIS PERAAIT 15155UED�SEC.309�.CIV.C.�. Z �a K.�l.* w - j lCN'JEH'SNAME_ _ ._. _ � F— LENDER'SAD�RESS a I CERTIFV rHqi I HAVE FlEA�THIS APPLICATION AN�SiATE THAT THE ABOVE INFORMATION IS CORRECT TOTAL F E ES w I AGREE TO CONPLY WITH ALL CITY AND GOUNTY ORDINANCES AND STATE UWS RELATING TO AUII nING ��o � CONSTRUGTON,AND HEFE9YAUTHOflIZE REPRESENTA7NE5OF THIS COUNTY TO ENTEii UPON THE � A�Qyjy[.1EN�(IONED PROPEPTY FOR INSPECTION PURPOSES. ? COMMEN?5 0 �%•�_1� �n t � .. —� (.,,��y. 1/—kC�,�C�--- � PE E �ME(P T)__T i/ • � � _Q - f� ' ¢ __� _ � SI,NATURE OF PE 1 EE DATE _ = RECPT.Tb. PAID BV VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Gopy.PINK—Assessor Copy.GOLDENROD—File Copy,GRE N—Applicanfs Copy � ^ '"�.��, ^��`k �i� �.�u�rc."a � �S �r � � � �� .�� ` � � � '� f .. �. �, . , � ,�f � a „, � ; " � ��?. .. � ' �",�'�� ..�-- _ .�� . _ _ - ,� � �, i __.. _ _ __ _ _ ; __ _ _ _ ; ; � . ___ _— �--_.__ . __ _ j � _ __. _ _ _ _ _ _ _ _ � ;�,is� '�i ''�� ,+k�G �"�'�" � _ _._ _. �. �� y �� i fr � �'�a� � , a �,�,r�. ��, _ ��'� ; < ,, �t� ry : � : _ _ � �� ,'�t F � i yy , _ _ _ � ; �� _ � __ _ i �o `� JOBSITE ADDRESS lu5�- OWN LO T CT OWNER ER f ADDR S-e' CITY ZIP TEL. APPLICANT TEL CONTRACTOR ADDRESSI CITY ZIP TEL.-d2.0 ARCH/ENG/71 III rill DESIGNER M"Aw ADDRESS CITY/(L ZIP T d - 3 EL- 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 APERMIT 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 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).): 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 BUB.DS 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). ^ 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 BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). LI I AM EXEMPT UNDER SEC B&P.0 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 FOR E AND EFFECT. LICENSE S_LIC NO „NNw .ss" DATE CONTRACTO�7 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. M KERS"COMPERSATIO I SURANCE C I ER AND POLICY NUMBER ARE # CARRIER Y-'-�IIC-A.>-�. ' �-'-J S�7w"�� / POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT 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 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. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFT WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097,CIV.C.). LENDER'S NAME LENDER'S ADDRESS 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 ABpyyUdENTI NED PROPERTY FOR INSPECTION PURPOSES. J'// � J�&kLlIri PE E �ME D SI NATURE OF PE 1 EE DATE 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 APPLICATION PERMIT FI DATE Z" NUMBER P/C ISSUE C T, TYPE 94 # DATE CONST. OCC GROUP ZONING SETBA KS � FRONT RW � REAR RW ^ SIDE/SIDE STREET � SIDE PROPOSED USE r -tki C N0. N0. DWEL. N0. -_BEDROOMS/I UNITS STORIES DESCRIPTION SQ. FT FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM U) Garage/Carport �W Patio/Deck LL PooVSpa Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE tj 0 Q W {' ' ]I 4 1';A-fj w L ! �� 5v%/ )CJ .c) CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy